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A malaria vaccine created at the University of Oxford has proved to be 77 percent effective in early trials and may have a significant effect on the health of children. Over a million people die from malaria each year, mostly children younger than 5. In fact, malaria kills about 3,000 children daily—an average of one child every 30 seconds. Protection against malaria could thus significantly reduce the rate of child mortality in many parts of the world.

For the purposes of this article, child mortality refers to the death of children younger than 5, while infant mortality refers to the death of children younger than a year. While far too many deaths of children occur before they leave the womb (because of abortion or maladies), these statistics refer only to the deaths of children after their birth.

Here are nine things you should know about child and infant mortality.

1. For most of human history, about half of children died before adulthood.

In 2013, two American researchers looked at the estimated mortality rates for children across 43 historical cultures, including ancient Rome, Medieval England, and imperial China. Across the entire historical sample, the authors found that on average more than a quarter of newborns (26.9 percent) died in their first year and almost half of all children (46.2 percent) died before they reached adulthood. The researchers point out, though, that these figures “should be viewed as conservative estimates that generally err toward underestimating actual historic rates.”

2. In the last century the global mortality of children has declined tenfold.

In 1800, the average woman around the world had between five to seven children, and could expect to lose two or three in the first few years of life. By 1950, though, the rate of child mortality had dropped from about one in two to about one in 20 (less than 5 percent). But that was only in the most developed areas, such as Europe, the United States, and Canada. In Mexico, China, and India it stayed above 20 percent, while in Mali and Egypt it remained above 40 percent.

3. Child and infant mortality has been on the decline since the 1950s.

From 1950 to 2015, global rates fell even more—a fivefold decrease from 22.5 percent to 4.5 percent. And the decline occurred in every part of the world: European rates fell from 11 to 0.6 percent; North American rates from 3.8 to 0.6 percent; Latin American rates from 20 to 2.4 percent; Asian rates from one in four children (25 percent) to below one in 20 (3.5 percent); and African rates from one in three children (32 percent) to below one in 12 (8 percent). For example, the rate in Egypt fell from 43 percent in 1950 to 2.2 percent in 2015. The countries where child mortality is highest today have comparable rates to many countries across Europe in 1950.

4. Countries where the most children die are not necessarily those where a child’s chances of dying are highest.

The total number of children dying depends on two factors: the likelihood a newborn will die in the first years of life and the number of children born. Countries with higher birth rates therefore may have a higher total number of children die than countries that have a higher mortality rate but lower birth rate. For example, while Somalia and Chad have the highest child mortality rates in the world (12.72 and 12.32 percent in 2017), they have fewer child deaths than India, which has a child mortality rate of around 4 percent—three times lower than those African countries. In fact, although India has the same rate as the global average, the country has the largest total death toll for children younger than 5.

5. A child’s risk of dying is highest in the first month after birth.

The risk of a child dying is highest in the neonatal period, the first 28 days of life. Almost half (45 percent) of child deaths under the age of 5 take place during the neonatal period. Preterm birth, intrapartum-related complications (birth asphyxia or lack of breathing at birth), and infections cause most neonatal deaths.

6. The leading cause of child death is pneumonia.

For the last 30 years, pneumonia has remained the leading cause of child mortality. Every year it kills an estimated 1.4 million children younger than 5, accounting for about one in seven (18 percent) of all deaths in that age cohort. Although it affects children across the globe, it is most prevalent in South Asia and sub-Saharan Africa. On average, a child dies from pneumonia every 39 seconds.

7. The leading causes of child mortality vary by age.

Children are three times more likely to die in the first year of their lives than in the next four years. Before the age of 1, preterm births and neonatal disorders are the most likely cause. From ages 1 to 4, the leading causes are intestinal infections, respiratory infections, and other infectious diseases (such as measles). Between ages 5 and 9, the most common cause is diarrheal disease (every tenth child in the world who died did so because of such disease, such as cholera and rotavirus infection). The leading cause of death among children between ages 10 and 19 is road injuries, followed by HIV/AIDS, self-harm, drowning, and intestinal infectious diseases.

8. In the United States, child mortality is largely due to accidents.

Child deaths in America are, from a historical perspective, becoming increasingly rare. In 2019, 3,676 children between the ages 1 to 4 died, with the leading causes being accidents (unintentional injuries), especially drowning. A total of 5,497 children who were between the ages of 5 and 14 died in that period, also primarily due to accidents, with the leading cause being an occupant in a motor vehicle traffic crash. Combining all unintentional injury deaths among those between 0 and 19 years, motor vehicle traffic–related deaths were the leading cause.

9. Most child mortality is easily preventable.

Almost all of the leading causes of child mortality are preventable with simple and low-cost interventions. Pneumonia, for instance, can often be controlled with basic health measures, such as handwashing, vaccinations, promoting breastfeeding, and reducing indoor air pollution. The interventions for pneumonia can also help to limit other child-killing diseases, such as diarrhea, meningitis, and tuberculosis. And in the United States, providing swimming training to young children and preventing access to firearms in the home can significantly reduce child mortality.