Millennium Development Goal #4

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Main Target

Progress Report: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.

Indicators for Monitoring Progress

4.1 Under-five mortality rate
4.2 Infant mortality rate
4.3 Proportion of 1 year-old children immunized against measles



More closely related to MDG3 (gender equality) than most realize,  is infant mortality. It is a problem with multiple layers. Firstly, malnutrition is a leading cause of morality in children under five years old, with more than half the deaths in children under 5 in South Asia being in the first 28 days after birth. This is a direct consequence of lack of nutrition during pregnancy and after birth. Secondly, the inability to recognize common infant illnesses, like Pneumonia, by caregivers can result in thousands of needless deaths. It is estimated that currently only 20% of caregivers in developing regions recognize the symptoms associated with pneumonia – and if they do, often times they are miles from any doctor or hospital. This leads rural and poor children with double the likelihood of dying before the age of five than their urban and rich counterparts. Lastly, deadly diseases like the measles affect millions of children worldwide, with immunizations as the best and most effective tool to fight them.

Infant mortality is sharply decreasing thanks to immunizations, especially against the measles, which contributed to a decrease by 25% in the children under 5 mortality rate worldwide. Likewise, training mothers to better understand the role of nutrition in their diets while pregnant and the importance (and cost effective) solution of breastfeeding has drastically reduced deaths in South Asia and Sub-Saharan Africa.                                                         

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Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.

Progress Report

Under-five mortality rate

  • Globally, the mortality rate for children under 5 is down by one third, from 89 deaths out of 1,000 live births in 1990 to 60 deaths out of 1,000 live births.
  • North Africa and Eastern Asia have seen the greatest success with lowering their under-five children’s mortality rates, with reductions of 68% and 58%, respectively. Equally as optimistic, in countries that had higher than average under-five mortality rates (40 deaths per 1,000 live births), 10 countries reduced their rates by about half: Bangladesh, Eritrea, Lao People’s Democratic Republic, Madagascar and Nepal.
  • Despite population growth over the last 10 years, the total number of under-five children’s mortality rate declined from 12.4 million in 1990 to 8.1 million in 2009. Overall, that equals about 12,000 fewer children’s deaths each day.
  • All regions except for Sub-Saharan Africa, South Asia and Oceania have seen reductions of at least 50% in this area.
  • Mexico, Bangladesh and Nepal, all countries who had high under-five mortality rates, are expected to reach their goal by 2015.  
  • Overall, Sub-Saharan Africa has the highest under 5 mortality rate, with one out of eight children dying before the age of five (129 out of 1,000 live births), which is twice the average of developing countries on a whole and 18 times the average of developed regions.  This gap is also increasing, due to the progress other regions have made towards this target.

  • South Asia has the second largest rate, sitting at 69 deaths before the age of 5 out of 1,000 live births, about 1/14.

  • Currently, there are 31 countries that have an under-five mortality rate of 100 deaths or more per 1,000 live births, who are all found within Sub-Saharan Africa except for Afghanistan.  At the same time, 4 out of 10 countries that reduced the under-five mortality rate by 50% between 1990 and 2009 are also found in Sub-Saharan Africa and 5 out of 6 countries with a reduction of more than 100 deaths before the age of five out of 1,000 live births are also found within this region.

  • Child Mortality Estimates 2010 - Read more

Disease and Nutrition 

  • Pneumonia is the leading cause of death globally of children under 5 years old, but only 20% of caregivers recognize the symptoms within the developing world on a whole.
  • Diarrhea, malaria and pneumonia are responsible for more than half of all children’s deaths in Sub-Saharan Africa. HIV is also a huge threat to children in this region.
  • In South Asia, over half of the deaths in children under the age of 5 occur within the first 28 days of birth, signaling a large need for greater post-natal care.
  • In both Sub-Saharan Africa and South Asia, under-nutrition is the underlying cause of one third of all children’s deaths.
  • Tackling pneumonia in Liberia - video - Read More

Being Poor and Rural Dueling

  • In all developing regions, rural children are the most at risk. This is especially true in Latin America, the Caribbean, East and South East Asia (excluding China), where the mortality rate for infants is relatively low, but much higher for rural and dispersed children.
  • Often found in the same demographic as rural children, children living in the 20% of the poorest households in any developing region face twice the risk of dying before the age of 5 than the children living in the 20% of the wealthiest households. This risk quadruples in Latin America, the Caribbean and South and South East Asia.  


War and Conflict

  • In 20 of the countries with the highest percentage of deaths within children under five years old, more than half are effected by complex emergencies and/or armed conflict

Mother’s Education

  • A mother’s education is a key factor in determining whether a child will survive their first five years of life or not.
  • A child’s chance of survival increases when the mother is educated at a primary level. The odds of survival increase with secondary or higher education. It has been proven that educated women, no matter the level, will seek medical attention sooner, attend regular doctor appointments during pregnancy and ask more questions while seeing a medical professional.


  • Access to clean water is necessary – and needed – to prevent 1.5 million deaths in children under five years old from diarrhea each year.
  • Empowering women by making critical services to poor and rural areas more accessible and lifting the social barriers to welfare are needed, to allow the mothers to best nurture their children and prevent illness.

Successful Programs

  • Mosquito netting: through the “Nothing But Nets” campaign, more than three million insecticide-treated anti-malaria nets have been distributed to children, pregnant women and refugees in Africa since 2006. In Kenya alone, 44% less deaths from malaria were recorded between 2004 and 2006, versus children who were not sleeping under nets.
  • Multiple governments have taken up breastfeeding campaigns, which helps strengthen the newborns and reduce their vulnerability to disease.

Proportion of 1 year-old children immunized against measles

  • Immunization is an excellent indicator for predicting a child’s survival - 2009 saw 80% of children in the appropriate age bracket get immunized against the measles, which is up from 69% in 2000.
  • The coverage made by the immunizations against the measles in 2008 reached an all-time high of 81% in developing regions, a 70% increase from 2000.
  • Between 2000 and 2008, the large immunization coverage and the opportunity for a second dose led to a 78% drop in measles-related deaths worldwide. Overall, the averted deaths related to immunization made up for a quarter of the decline in deaths for children under five.
  • UN data - Yearly Number of Children Under-1Immunized Against the Measles - Read more


  • Poor and rural dwelling children are still often overlooked and in some cases very hard to reach by medical teams immunizing regions, leaving them at risk.
  • The funding for immunizations is in jeopardy and has been a sharp decrease in the last 6 years. If regular immunizations are not administered, diseases like the measles are at risk at rising and spreading, negating any progress made in the last 10 years. 


“The Millennium Development Goals Report 2011”, the United Nations, June 2011.

“We Can End Poverty 2015 – Fact Sheet”, UN Department of Public Information, September 2010.

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