Child Mortality

Since the beginning of the age of the Enlightenment and over the course of modernization, the mortality of children below 5 years of age has declined rapidly. Child mortality in rich countries today is much lower than 1%. This is a very recent development and was only reached after a hundredfold decline in child mortality in these countries. In early-modern times, child mortality was very high; in 18th century Sweden every third child died, and in 19th century Germany every second child died. With declining poverty and increasing knowledge and service in the health sector, child mortality around the world is declining very rapidly. Big countries like Brazil and China reduced their child mortality rates 10-fold over the last 4 decades. Other countries – especially in Africa – still have high child mortality rates, but its not true that these countries are not making progress. In Sub-Saharan Africa, child mortality has been continuously falling for the last 50 years (1 in 4 children died in the early 60s – today it is less than 1 in 10). Over the last decade this improvement has been happening faster than ever before. Rising prosperity, rising education and the spread of health care around the globe are the major drivers of this progress.

# Empirical View

# Country by country – child mortality declined

In the time series plot below I show child mortality over the long run. Today child mortality in industrialized countries is below 5 per 1,000 live births. The time series plot shows that these low mortality rates are a very recent development, and in pre-modern countries child mortality rates were between 300 and 500 per 1,000 live births. In the late 19th century, every second child in Germany died before its fifth birthday. In developing countries the health of children is quickly improving – but child mortality is still much higher than in developed countries.

A second interesting characteristic that is immediately noticeable is that the series are very ‘spikey’ in the 19th century and are then much smoother in the 20th century. This is partly because the data quality is improving over time but it also shows how frequent crises were in pre-modern times. The decline of crises is an important aspect of improving ‘living standards’. In the ‘Our World in Data’ entry on food price volatility you find a long-run series of food price volatility in Pisa by Cormac O Grada that shows how frequent food crises were. In the following plot you can see what these and other crises – epidemics or wars, for example – meant for the health of the population.

# Child mortality in 13 countries around the world, 1751 to 2011  – Max Roser1

Full screen view       Download Data

# A global picture of child mortality from 1800 to today

The chart shows the child mortality rate – the share of children dying before they reach the age of 5 – for the entire world population at 4 different points in time.

How to read the following graph: On the x-axis you find the cumulative share of the world population. The countries are ordered along the x-axis descending by the country’s child mortality rate. This makes it possible to see the child mortality rate for each country. Some countries are labelled, but not all. It is also possible to see which share of the world population had a child mortality rate lower than a given level. For the orange line – referring to data from 1950-60 – we see that close to 70% of the world population have a child mortality rate of higher than 10% back then.

For 1800 (red line), you see that the countries on the very left – Yemen, India, and others that are not labelled – had a child mortality rate higher than 50%. Every second child died before the age of 5. On the very right of the red line you see that in 1800 the best-off countries in the world had a child mortality rate higher than 30%: Every third child died in the countries with the best health.

Looking at the orange line, you see that in the following 150 years some countries substantially reduced their child mortality rate: 30% of the world population has a child mortality under 10%. Other countries were stuck in poor health: More than half of the world (57%) had child mortality that were still higher than 20%. The world was clearly divided into developed and developing countries. The rapid progress of the industrialized countries had the consequence that the distribution of global health was hugely unequal.

The latest data refers to 2013. Global health has improved hugely. Particularly those countries that had the worst health in the 1950s experienced the most dramatic improvements. China for example reduced its child mortality from 28.4% to now 1.3%. The consequence of the faster progress in former developing countries is that global health inequality has fallen since the 1950s.

The global average child mortality rate (weighted population) was 43.3% in 1800 and now fell to 3.4%. Focusing at global inequality we see that in 1800 health was bad around the world, in the 1950s the world became unequal, and today we are back to higher equality but on a much higher level.

Comparing the position of countries on the red, orange, green and blue lines also makes it possible to see the change in a single countries: In 1800 every second child in South Korea died, in the 1950s the rate was halved (26%), and today it is down to 2.7%.

World population by level of fertility over time, 1950-2050 – Max Roser2

World-population-by-level-of-child-mortality

# Child Mortality in Pre-modern Cultures

In ‘Longevity Among Hunter‐Gatherers’ the authors, Gurven and Kaplan, compare mortality patterns of hunter gatherers and modern societies and state that “infant mortality is over 30 times greater among hunter-gatherers, and early child mortality is over 100 times greater than encountered in the United States”.3

# Proportions of subadults (defined as individuals with incomplete skeletal or dental development) in samples of fossil hominids – Chamberlain (2006)4
Site and speciesSubadultsAdultsShare of Subadults
Surface collected sites
Koobi Fora (Homo)
72820%
Koobi Fora (Paranthropus boisei)102926%
Hadar (Australopithecus afarensis)174129%
Excavated sites
Sterkfontein (Australopithecus africanus)
225628%
Swartkrans (Paranthropus robustus)798050%
Zhoukoudian (Homo erectus)152339%
Neanderthals (Homo neanderthalensis)10610052%
Olduvai Gorge (Homo habilis)13668%
Atapuerca (Homo heidelbergensis)19968%

# Child Mortality Globally Post-1950

Though there are still large disparities between child mortality rates between different regions around the world, it is steadily decreasing everywhere.

# Child mortality rate (per 1,000 live births) by world region – Max Roser5

Full screen view

Mortality data around the world (1970-2010) can be studied with an interactive data visualization at HealthIntelligence.org here.

This world map below visualizes this global decrease in child mortality. today, only few countries have over 150 child deaths per 1,000 live births.

# World maps of child mortality, 1950 to 2012 – Max Roser 6

Below we can see that the annual rates of reduction in child mortality is decreasing or leveling off in most regions around the world except for Sub-Saharan Africa, where the rate is decreasing more and more each year.

# Annual rates of reduction (ARR) in the under-five mortality rate, % by region since 1990 – UNICEF (2013)7 Annual rates of reduction in the under-five mortality rate, per cent by region, since 1990 – UNICEF (2013)

# Child Mortality by Cause of Death

Infectious disease during and after the neonatal period is a major cause of child death. Other neonatal issues like birth complications also are major causes. The pie chart below breaks down these different causes.

# Global distribution of deaths among children under age 5, by cause, 2012 – UNICEF (2013)8 Global distribution of deaths among children under age 5, by cause, 2012 – UNICEF (2013)0

Progress is being made to eradicate the most common causes of child death, however, as demonstrated by this bar chart.

# Global under-five deaths from five infectious diseases, 2000 and 2012 – UNICEF (2013)9 Global under-five deaths from five infectious diseases, 2000 and 2012 – UNICEF (2013)0

# Correlates, Determinants & Consequences

# Child Mortality and Income Level

As one would expect, income level of the country is extremely correlated with child mortality rate. The poorest countries have the highest levels of child mortality, and the countries with the highest income have the lowest rates. This relationship has remained the same even as child mortality has decreased around the world, as demonstrated below.

# Child Mortality rate (per 1,000 live births) by country’s income level – Max Roser10

Full screen view
# Under five mortality rate (per 1,000 live births) and total fertility rate (births per woman), 1970 to 2010 – World Development Indicators (2013)11 Under five mortality rate (per 1,000 live births) and Total fertility rate (births per woman), 1970 to 2010 – World Development Indicators (2013)0

# Education and Child Mortality

The effect of education on child mortality for a sample of 175 countries was analyzed in a research paper published in The Lancet. The authors found that around half (51.2%) of the reduction in child mortality between 1970 and 2009 could be attributed to increased educational attainment in women of reproductive age.12 Below we can see that educational attainment by women contributes to the decrease in child mortality rates within countries as well. For instance, Niger has the highest national average of child mortality, but within the country, mothers with a secondary school education or higher experience child mortality rates that are lower than the national averages of the next 16 countries listed.

# Under-5 mortality rate by mother’s education and wealth, selected countries, 2003—2009 – UNESCO (2011)13 Under-5 mortality rate, by mother’s education and wealth, selected countries, 2003—2009 – UNESCO (2011)0

The effect of education on child mortality is huge. Especially in places with relatively little education, the prospects for extending education are promising. In 2008, 4.4 million children younger than 5 years died in sub-Sahran Africa. The UNESCO estimates that an extension of secondary education for all women would save 1.8 million children per year.14

# Health Care and Child Mortality

In a publication in the American Economic Journal the authors report that Thailand’s 2001 healthcare reform led to significant reductions in child mortality, especially among the poor.15 The following graph shows for a large cross-section of countries that high expenditure on health more generally comes along with lower levels of child mortality.

# Under-five mortality rate by per capita total expenditure on health, countries by WHO Region, 2002–2003 – WHO16 Under-five mortality rate by per capita total expenditure on health, countries by WHO Region, 2002–2003 – WHO

# Data Quality & Definition

Child mortality is the probability per 1,000 live births that a newborn baby will die before reaching age five under current age-specific mortality patterns. The uncertainty associated with the estimates of child mortality can be understood if one compares different data sources. The UN Inter-agency Group for Child Mortality Estimation does this for each country of the world. Here is the chart on the child mortality of Brazil as one example. On the same website the differences between various data sources can be studied for a large number of countries.

# Data Sources

# Data on child mortality in early cultures and hunter gatherers

A still often cited early text is Acsádi and J. Nemeskéri (1970) – History of human life span and mortality.17 Other texts on early cultures and hunter gatherers are:

  • Andrew T. Chamberlain (2006) – Demography in Archaeology-Cambridge University Press (Cambridge Manuals in Archaeology)
  • Gurven, H Kaplan (2007) – Longevity Among Hunter‐Gatherers: A Cross‐Cultural Examination. Population and Development Review. Volume 33, Issue 2, pages 321–365, June 2007. Online here.
  • Preston (1995) – Human mortality throughout history and prehistory. In Simon (1995) – The State of Humanity. Wiley.
  • Johnston, F. E., and C. E. Snow (1961) – The Reassessment of the Age and Sex of the Indian Knoll Skeletal Population:  Demographic and Methodological Aspects, American Journal of Physical Anthropology, vol. 19.
  • Brothwell, D. (1975) – Paleodemography, in Biological Aspects of Demography, ed. W. Brass. London: Taylor and Francis.
  • Hopkins, M. K. (1966) – On the Probable Age Structure of the Roman Population, Population Studies, 20, 2.
  • Howell, N. (1979) – The Demography of the Dobe !Kung. New York: Academic Press.

# Long-Run Data

The Human Mortality Database
  • Data: Child mortality estimates and more mortality data
  • Geographical coverage: More than 35 countries. Mostly European but also Taiwan and USA.
  • Time span: For some countries data is available since the 19th century. Few data available for the 18th century.
  • Available at: Online at www.mortality.org.
  •  This very comprehensive source is maintained by the University of California, Berkeley (USA), and the Max Planck Institute for Demographic Research (Germany).

Gapminder.org
  • Data: Child mortality estimates
  • Geographical coverage: Global – by country
  • Time span: From 1800 onwards (data on Sweden go back to 1751)
  • Available at: Online at Gapminder.org
  • The sources of Gapminder are the Human Mortality Database and Child Mortality Estimates Info. Some of the data on child mortality is estimated from data on infant mortality (see the documentation which is online here).

# Post-1950

‘Child Mortality Estimates Info’ (CME Info)
  • Data: The latest estimates based on the research of the UN Inter-agency Group for Child Mortality Estimation
    • List of available data: Under-five mortality estimates, Infant mortality estimates, Neonatal mortality estimates (for all three rates and deaths) Estimates of: Sex-specific under-five mortality rate, Sex-specific infant mortality rate, Annual rate of reduction of under-five mortality.
  • Geographical coverage: Global – by country.
  • Time span: Data availability varies, but for some countries it goes as far back as the 1930s.
  • Available at: Online at www.childmortality.org
  • This very good source is published by UNICEF. It is possible to explore the trends country by country and to visualise the data on a map.

World Development Indicators (WDI) published by the World Bank
  • Data: ‘Mortality rate, under-5 (per 1,000 live births)’
  • Geographical coverage: Global – by country and world region
  • Time span: Annual data since 1960
  • Available at: Online here
  • The World Bank data is based on the estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) at childmortality.org.