The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) released its flagship report today, revealing that an estimated 4.9 million children died before reaching their fifth birthday in 2024. This figure includes 2.3 million newborns who perished within their first 28 days of life. While the data underscores a historic decline in child mortality—with under-five deaths falling by more than 50 percent since the turn of the millennium—the report sounds a clarion call regarding a significant deceleration in progress. Since 2015, the pace of reduction in child mortality has slowed by more than 60 percent, threatening the achievement of the Sustainable Development Goals (SDGs) related to child survival.
The 2025 edition of the "Levels & Trends in Child Mortality" report offers the most comprehensive analysis to date, fully integrating cause-of-death estimates for the first time. This integration, facilitated by the Child and Adolescent Causes of Death Estimation (CA-CODE) group led by the Johns Hopkins Bloomberg School of Public Health, allows for a more granular understanding of why children are dying. The findings suggest that the vast majority of these deaths are entirely preventable through known, low-cost interventions and improved access to quality primary health care.
A New Focus on Severe Acute Malnutrition
In a landmark addition to this year’s data, the report provides direct estimates for deaths caused by severe acute malnutrition (SAM). The findings are sobering: more than 100,000 children aged 1 to 59 months died directly from SAM in 2024, accounting for 5 percent of deaths in that age bracket. However, experts warn that this figure represents only the tip of the iceberg. Malnutrition acts as a lethal multiplier, weakening the immune systems of millions of children and making them significantly more susceptible to common childhood ailments like pneumonia and diarrhea.
The report highlights that the true burden of SAM is likely underestimated because mortality data often fail to list malnutrition as the underlying cause. Countries currently grappling with the highest numbers of direct SAM deaths include Pakistan, Somalia, and Sudan—nations frequently beset by the "triple threat" of conflict, climate-induced food insecurity, and fragile health systems.
The Critical First Month: Newborn Survival Challenges
Newborn deaths continue to represent nearly half of all under-five mortality (47 percent), a statistic that has remained stubbornly high despite overall improvements in child health. This reflects a slower rate of progress in addressing the specific medical needs of infants during and immediately after birth. According to the report, the leading causes of death among newborns are complications resulting from preterm birth (36 percent) and complications during labor and delivery, such as birth asphyxia or trauma (21 percent).
Furthermore, neonatal sepsis and congenital anomalies remain significant drivers of infant mortality. Addressing these issues requires a shift in focus toward "the continuum of care," ensuring that mothers have access to high-quality antenatal services and that every birth is attended by skilled health-care personnel. The report emphasizes that the infrastructure for "small and sick newborn care" is a critical missing link in many developing nations.
Regional Disparities and the Concentration of Mortality
The geography of child survival remains starkly unequal. In 2024, sub-Saharan Africa accounted for a staggering 58 percent of all under-five deaths globally. In this region, infectious diseases remain the primary threat, responsible for 54 percent of the mortality rate. In contrast, infectious diseases cause only 9 percent of child deaths in Europe and Northern America, and just 6 percent in Australia and New Zealand.
Southern Asia accounts for another 25 percent of the global total. Unlike sub-Saharan Africa, where infectious diseases dominate, mortality in Southern Asia is driven primarily by complications occurring in the first month of life. This regional distinction suggests that while Africa requires a sustained push against malaria and pneumonia, Southern Asia must prioritize investments in maternal health and essential newborn services to bridge the survival gap.
Infectious Diseases and Biological Threats
For children who survive the neonatal period, malaria, diarrhea, and pneumonia remain the most significant threats. Malaria, in particular, continues to be the single largest killer of children aged 1–59 months, accounting for 17 percent of deaths in this group. The vast majority of these deaths occur in sub-Saharan Africa.
The report notes a worrying trend: after rapid declines in malaria mortality between 2000 and 2015, progress has stalled. This stagnation is attributed to a combination of factors, including conflict, climate shocks that expand mosquito breeding grounds, and the rise of biological threats such as insecticide resistance and the spread of invasive mosquito species like Anopheles stephensi. Countries such as Chad, the Democratic Republic of the Congo, Niger, and Nigeria remain the epicenter of this struggle.
The Burden of Conflict and Fragility
The report highlights a widening gap between stable nations and those affected by crisis. Children born in fragile and conflict-affected settings are nearly three times more likely to die before their fifth birthday than children born in stable environments. Conflict disrupts immunization campaigns, destroys health infrastructure, and forces populations into displacement camps where sanitation is poor and disease spreads rapidly. In 2024, the escalating violence in regions like Sudan and parts of the Middle East has further jeopardized child survival gains that took decades to achieve.
Mortality Beyond Childhood: Adolescents and Youth
The UN IGME report also expanded its scope to include children, adolescents, and youth aged 5 to 24, an age group that saw an estimated 2.1 million deaths in 2024. The causes of death in this demographic shift significantly as children age. While infectious diseases and injuries remain the primary concerns for younger children, adolescence brings new risks.
For girls aged 15 to 19, self-harm has emerged as the leading cause of death, highlighting a global crisis in adolescent mental health and social protection. For boys in the same age group, road traffic injuries remain the most frequent cause of mortality. These findings suggest that public health strategies must evolve to address the behavioral and social determinants of health that affect older youth.
Chronology of Global Child Survival Efforts
The current state of child mortality is best understood through the lens of the last three decades of international policy:
- 1990–2000: The baseline era where under-five deaths exceeded 12 million annually. Initial efforts focused on "GOBI-FFF" (Growth monitoring, Oral rehydration, Breastfeeding, Immunization, Female education, Family spacing, and Food supplementation).
- 2000–2015: The Millennium Development Goals (MDGs) era. This period saw the most rapid decline in child mortality in history, as global funding for HIV, TB, and malaria surged. Under-five deaths were halved during this window.
- 2015–Present: The Sustainable Development Goals (SDGs) era. The goal was set to reduce under-five mortality to at least as low as 25 per 1,000 live births in every country by 2030. However, as of 2024, the 60 percent slowdown in progress indicates that dozens of countries are currently off-track.
The Economic Argument for Investment
While the moral imperative to save children is clear, the report also emphasizes the economic benefits of such investments. Evidence suggests that child health interventions are among the most cost-effective development measures available. Every dollar invested in child survival can generate up to twenty dollars in social and economic benefits.
By preventing child deaths, nations preserve their "human capital," leading to increased productivity, stronger national economies, and a reduction in future public health spending. The World Bank Group has noted that reaching the most vulnerable with primary health services is not just a health goal but a fundamental economic strategy for poverty reduction.
Official Responses and Calls to Action
Leaders of the international agencies involved in the report expressed urgent concern regarding the findings.
UNICEF Executive Director Catherine Russell emphasized the tragedy of preventable loss: “No child should die from diseases that we know how to prevent. 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.”
WHO Director-General Dr. Tedros Adhanom Ghebreyesus focused on the inequality of the burden: “The world has made remarkable progress in saving children’s lives, but many still die from preventable causes. Children living amid conflict and crisis are nearly three times more likely to die before their fifth birthday. We must protect essential health and nutrition services.”
Monique Vledder, World Bank Group Director for Health, highlighted the need for scale: “These findings are a collective call to speed up implementation of the proven, scalable solutions we know are within reach. The World Bank Group health target of reaching 1.5 billion people is our concrete commitment.”
Mr. Li Junhua, UN Under-Secretary-General for Economic and Social Affairs, called for political renewal: “The latest estimates are a stark reminder that many countries are off track to meet the Sustainable Development Goals. What is needed now is renewed political commitment and sustained investment in primary health care.”
Implications and the Path Forward
The 2025 report makes it clear that the "low-hanging fruit" of child survival may have been harvested. To regain the momentum of the early 2000s, the global community must tackle more complex challenges: the integration of nutrition into primary care, the fortification of health systems in conflict zones, and the mitigation of climate change’s impact on disease vectors.
Furthermore, the shift in global development financing—where many donor nations are reducing foreign aid budgets—poses a direct threat to maternal and child health programs. Experts argue that without a reversal of these funding trends and a renewed focus on data-driven interventions, the target of ending preventable child deaths by 2030 will remain out of reach. The science and the solutions exist; the report concludes that the only remaining variables are political will and the equitable distribution of resources.