An estimated 4.9 million children died before reaching their fifth birthday in 2024, including 2.3 million newborns, according to a sobering new report released by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). This figure represents a profound human tragedy, particularly as the vast majority of these deaths were preventable through proven, low-cost interventions and access to basic, quality healthcare. The report, titled "Levels & Trends in Child Mortality 2025," highlights a critical inflection point in global health: while child mortality has fallen by more than half since the turn of the century, the momentum required to end preventable child deaths is rapidly dissipating.
The data reveals a worrying trend in the pace of progress. Since 2015, the annual rate of reduction in under-five mortality has slowed by more than 60 percent compared to the previous decade. This deceleration suggests that the global community is falling dangerously behind the targets set by the Sustainable Development Goals (SDGs), which aim to end preventable deaths of newborns and children under five by 2030. The report integrates, for the first time, a fully comprehensive analysis of the causes of death, providing a granular look at the specific biological and systemic failures that lead to the loss of young lives.
The Resurgence of Malnutrition as a Leading Killer
One of the most significant additions to this year’s report is the direct estimation of deaths caused by severe acute malnutrition (SAM). The findings indicate that in 2024, more than 100,000 children between the ages of 1 and 59 months died directly from SAM, accounting for approximately 5 percent of deaths in that age bracket. However, experts warn that this figure is merely the tip of the iceberg. Malnutrition acts as a lethal catalyst; it weakens the immune system, making children far more susceptible to common childhood ailments like pneumonia and diarrhea.
Historically, mortality data has frequently failed to list SAM as the underlying cause of death, often attributing the fatality to the secondary infection that finally claimed the child’s life. This systemic underreporting means the actual burden of malnutrition is likely much higher than official statistics suggest. The report identifies Pakistan, Somalia, and Sudan as countries with some of the highest concentrations of direct deaths due to SAM, regions often characterized by food insecurity, climate-induced crop failures, and ongoing civil unrest.
A Chronology of Progress and Stagnation
To understand the current crisis, one must look at the trajectory of global health over the last quarter-century. Between 2000 and 2015, the world witnessed an era of unprecedented success in child survival, driven by the Millennium Development Goals (MDGs). During this period, massive investments in immunization, malaria prevention, and maternal health led to a dramatic decline in child deaths.
However, the transition to the Sustainable Development Goal era in 2015 marked the beginning of a slowdown. The 2015–2024 period has been defined by a "polycrisis"—a convergence of global challenges including the COVID-19 pandemic, an increase in armed conflicts, and the escalating effects of climate change. These factors have disrupted supply chains for life-saving vaccines, destroyed healthcare infrastructure in vulnerable regions, and diverted international funding away from primary pediatric care. The 60 percent drop in the pace of reduction since 2015 is a direct reflection of these systemic shocks.
The Critical First Month: Newborn Mortality Challenges
Newborn deaths—those occurring within the first 28 days of life—now account for nearly half of all under-five deaths. This high proportion reflects a significant lag in progress regarding neonatal care compared to the survival rates of older children. The leading causes of death among newborns in 2024 were complications resulting from preterm birth (36 percent) and complications during labor and delivery, such as birth asphyxia or trauma (21 percent).
Neonatal sepsis, congenital anomalies, and other infections also remain major threats. Unlike the interventions required for older children, such as oral rehydration salts or bed nets, saving newborns requires sophisticated, facility-based care. This includes skilled health personnel at birth, emergency obstetric care, and specialized units for small and sick newborns. The lack of investment in these high-quality clinical services is the primary reason why neonatal mortality remains stubbornly high in low-income settings.
Regional Disparities and the Burden of Infectious Disease
The report underscores a stark and widening gap in child survival based on geography. In 2024, sub-Saharan Africa remained the most dangerous place for a child to be born, accounting for 58 percent of all global under-five deaths. In this region, infectious diseases were responsible for 54 percent of all child fatalities. By contrast, in Australia and New Zealand, infectious diseases accounted for only 6 percent of under-five deaths, and in Europe and Northern America, that figure was 9 percent.
Malaria continues to be a devastating force, remaining the single largest killer of children aged 1–59 months, accounting for 17 percent of deaths in that group. Most of these fatalities occur in sub-Saharan Africa. After years of progress, the fight against malaria has hit a plateau. Countries like Chad, the Democratic Republic of the Congo, Niger, and Nigeria are facing a "perfect storm" of biological and environmental threats, including the spread of drug-resistant parasites, invasive mosquito species, and climate-driven flooding that creates new breeding grounds for disease vectors.
In Southern Asia, which accounted for 25 percent of all under-five deaths, the driver is primarily neonatal. Mortality in this region is largely linked to the lack of access to quality antenatal care and essential newborn services. The report emphasizes that for Southern Asia to meet its survival targets, there must be a massive scale-up in the training of midwives and the modernization of labor wards.
The Adolescent and Youth Mortality Shift
The UN IGME report also expanded its scope to include older children, adolescents, and youth aged 5–24, an age group that saw 2.1 million deaths in 2024. As children age, the nature of the risks they face shifts from biological vulnerabilities to external and behavioral factors.
For younger children in this bracket, infectious diseases and accidental injuries remain the primary threats. However, for those aged 15–19, the causes of death become gender-specific and deeply concerning. Self-harm emerged as the leading cause of death among girls in this age group, highlighting a global mental health crisis that is often overlooked in traditional health financing. For boys aged 15–19, road traffic injuries were the leading cause of death, pointing to the need for better infrastructure and safety regulations in rapidly urbanizing developing nations.
The Economic Imperative for Investment
Beyond the moral obligation to save lives, the report makes a compelling economic case for prioritizing child health. Research indicates that investments in child survival are among the most cost-effective development measures available. Proven, low-cost interventions—such as routine immunizations, treatment for SAM, and skilled care at birth—deliver some of the highest returns in the global economy.
Economic analysis suggests that every dollar invested in child survival can generate up to twenty dollars in social and economic benefits. These returns manifest as improved productivity, stronger national economies, and a reduction in future public health spending. Despite this, the global development financing landscape is shifting. Many donor nations are cutting budgets or pivoting funds toward other geopolitical priorities, placing essential maternal and child health programs under immense pressure.
Official Responses and Calls to Action
The release of the report prompted a series of urgent statements from the heads of major international organizations. UNICEF Executive Director Catherine Russell emphasized the avoidable nature of the crisis. "No child should die from diseases that we know how to prevent," Russell stated. "But we see worrying signs that progress in child survival is slowing—and at a time where we’re seeing further global budget cuts. History has shown what is possible when the world commits to protecting its children."
Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), highlighted the impact of inequality. "Children living amid conflict and crisis are nearly three times more likely to die before their fifth birthday," Dr. Tedros noted. "We must protect essential health and nutrition services and reach the most vulnerable families so every child has the chance not only to survive, but to thrive."
Monique Vledder, Health Director for the World Bank Group, reinforced the commitment to expanding primary care. "These findings are a collective call to speed up implementation of the proven, scalable solutions we know are within reach," she said. The World Bank has set a target of reaching 1.5 billion people with quality health services to help bridge the current gap.
Under-Secretary-General for Economic and Social Affairs, Mr. Li Junhua, pointed to the data deficit. "What is needed now is renewed political commitment, sustained investment in primary health care, and stronger data systems to ensure no child is left behind," he said.
Broader Implications and the Path Forward
The "Levels & Trends in Child Mortality 2025" report serves as a final warning for the SDG 2030 timeline. The integration of data from the Child and Adolescent Causes of Death Estimation (CA CODE) group, led by the Johns Hopkins Bloomberg School of Public Health, has provided the scientific community with the most accurate map to date of where interventions are failing.
To reverse the current stagnation, the UN IGME recommends a three-pronged approach:
First, there must be a revitalization of primary healthcare systems, particularly in fragile and conflict-affected states where the risk of death is highest.
Second, there must be a dedicated focus on the "neonatal window," ensuring that every birth is attended by skilled personnel and that sick newborns have access to oxygen and antibiotics.
Third, the global community must address the underlying drivers of mortality, such as malnutrition and the lack of clean water, which act as "force multipliers" for disease.
As the global development landscape becomes increasingly complex, the survival of the world’s most vulnerable children remains the ultimate litmus test for international cooperation. The science and the solutions exist; the only remaining variable is the political and financial will to deploy them at scale. Without a significant course correction, millions of preventable deaths will continue to occur, stalling human development and leaving the world’s most ambitious health goals unfulfilled.