The child mortality rate measures how many children die before reaching age 5 for every 1,000 born alive. Globally, that rate stands at 37 deaths per 1,000 live births as of 2023, translating to 4.8 million children dying before their fifth birthday each year. While that number is staggeringly high, it represents a 61 percent decline from 1990, when the rate was 94 per 1,000.
How the Rate Is Calculated
The under-5 mortality rate, often called U5MR, counts all deaths among children from birth through age 4 and expresses them per 1,000 live births in a given year. A rate of 37 means that out of every 1,000 babies born, 37 will not survive to their fifth birthday. Public health organizations use this single number as one of the most telling indicators of a country’s overall well-being, because child survival reflects access to nutrition, clean water, sanitation, and basic healthcare all at once.
A related measure, the neonatal mortality rate, tracks deaths in just the first 28 days of life. This period is disproportionately dangerous: more than 40 percent of all under-5 deaths happen in the first month. Babies born prematurely or with complications during delivery account for much of this early vulnerability.
Leading Causes of Death
The top killers of children under 5 worldwide are complications from preterm birth, pneumonia, birth asphyxia (when a baby doesn’t get enough oxygen during delivery), diarrhea, and malaria. What makes these causes so tragic is that effective, low-cost interventions exist for nearly all of them. Oral rehydration salts treat diarrheal dehydration. Antibiotics treat pneumonia. Insecticide-treated bed nets and antimalarial medications prevent and treat malaria. Skilled birth attendants can manage many delivery complications.
Undernutrition is a compounding factor in roughly half of these deaths. A malnourished child who contracts pneumonia or diarrhea is far less able to fight off the infection than a well-nourished one. So while malnutrition rarely appears on a death certificate as the primary cause, it plays a role in a huge share of child deaths globally.
Where Child Mortality Is Highest
The global average of 37 per 1,000 masks enormous regional gaps. Sub-Saharan Africa has the highest under-5 mortality rates of any region in the world. A child born there is, on average, 18 times more likely to die before age 5 than a child born in Australia or New Zealand. In the highest-burden countries, the rate can exceed 100 per 1,000, meaning more than 1 in 10 children die before starting school.
High-income countries, by contrast, typically have rates in the low single digits. Countries like Japan, Finland, and Singapore see fewer than 3 deaths per 1,000 live births. The difference comes down to healthcare infrastructure, access to trained birth attendants, vaccination coverage, clean water systems, and nutrition security. Conflict and political instability further drive up rates in already vulnerable regions by disrupting the health systems families depend on.
How Rates Have Changed Since 1990
In 1990, the global under-5 mortality rate was 94 per 1,000 live births, meaning nearly 1 in 10 children died before turning 5. By 2023 that figure had dropped to 37, a 61 percent reduction. In absolute terms, the world went from roughly 12 million annual child deaths in 1990 to 4.8 million in 2023, even as the global population grew substantially.
Several factors drove this decline. Expanded vaccination programs dramatically reduced deaths from measles, which once killed over a million children a year. Wider distribution of insecticide-treated bed nets cut malaria deaths. Oral rehydration therapy became standard treatment for childhood diarrhea. Improvements in maternal education, sanitation infrastructure, and breastfeeding rates all contributed as well. The progress, however, has been uneven. Many of the countries with the highest rates in 1990 still have the highest rates today, even if their numbers have improved in absolute terms.
The 2030 Global Target
The United Nations Sustainable Development Goals include a specific target for child survival: by 2030, every country should aim to reduce under-5 mortality to at least as low as 25 per 1,000 live births and neonatal mortality to 12 per 1,000. While the global average has already passed the under-5 threshold, dozens of individual countries remain well above it. At current rates of progress, many of the highest-burden nations in sub-Saharan Africa and South Asia are unlikely to meet the target by the deadline.
The challenge is not a lack of known solutions. The interventions that save children’s lives are well established and relatively inexpensive. The gap is in delivering those interventions consistently to the communities that need them most, particularly in rural and conflict-affected areas where health workers, supply chains, and infrastructure remain scarce.