The urban-rural divide: why is a child under 15 dying every five seconds?

Gift is being fed Plumpy'Nut by his father Yosa Augustino after being treated for malnutrition in Juba, South Sudan. (UNICEF/UN0232197/Njiokiktjien VII Photo)

A child under 15 dies every 15 seconds. That’s the stark message from a major new report which lays bare the disparities of the global urban-rural divide affecting children.

The vast majority of the 6.3 million youngsters worldwide who died in 2017 did so in the first five years of life, with newborns accounting for around half of all deaths.

UNICEF, the World Health Organisation, the United Nations Population Division and the World Bank have published the report, Levels and Trends in Child Mortality. It says that children in rural areas are one-and-a-half times more likely to die before their fifth birthday than those in urban/city households. Yet many of the deaths are preventable through basic changes.


Laurence Chandy, UNICEF Director of Data, Research and Policy, said: “Without urgent action, 56 million children under five will die from now until 2030 – half of them newborns. We have made remarkable progress to save children since 1990, but millions are still dying because of who they are and where they are born. With simple solutions like medicines, clean water, electricity and vaccines, we can change that reality for every child.”

Globally, in 2017, half of all deaths under five years of age took place in sub-Saharan Africa, and another 30 per cent in Southern Asia. In sub-Saharan Africa, one in 13 children died before their fifth birthday. In contrast, the number in high-income countries was just one in 185.


Dr. Princess Nono Simelela, Assistant Director-General for Family, Women and Children’s Health at WHO, said: “Millions of babies and children should not still be dying every year from lack of access to water, sanitation, proper nutrition or basic health services. We must prioritise providing universal access to quality health services for every child, particularly around the time of birth and through the early years, to give them the best possible chance to survive and thrive.”

Most children under five die due to preventable or treatable causes such as complications during birth, pneumonia, diarrhea, neonatal sepsis and malaria. By comparison, among children between 5 and 14 years of age, injuries become a more prominent cause of death, especially from drowning and road traffic. Within this age group, regional differences also exist, with the risk of dying for a child from sub-Saharan Africa 15 times higher than in Europe.

Even within countries, huge disparities persist. Under-five mortality rates among children in rural areas are, on average, 50 per cent higher than among children in urban areas. In addition, those born to uneducated mothers are more than twice as likely to die before turning five than those born to mothers with a secondary or higher education.


For children everywhere, the most risky period of life is the first month. In 2017, 2.5 million newborns died in their first month. A baby born in sub-Saharan Africa or in Southern Asia was nine times more likely to die in the first month than a baby born in a high-income country. And progress towards saving newborns has been slower than for other children under five years of age since 1990.

“This new report highlights the remarkable progress since 1990 in reducing mortality among children and young adolescents,” said UN Under-Secretary-General for Economic and Social Affairs Liu Zhenmin. “Reducing inequality by assisting the most vulnerable newborns, children and mothers is essential for achieving the target of the Sustainable Development Goals on ending preventable childhood deaths and for ensuring that no one is left behind.”

The full report and regional/country data is available for download.

Author: Simon Weedy

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