Neonatal, infant and child mortality

Neonatal mortality – death among children less than 28 days, as well as infant mortality – death among children not yet one year of age, reflect the effect of economic, social and environmental conditions on the health of mothers and new-borns, as well as the effectiveness of health systems. Child mortality – death among children not yet 5 years of age is an indicator of child health as well as the overall development and well-being of a population. As part of the Sustainable Development Goals, the United Nations has set a target of reducing under age 5 mortality to at least as low as 25 per 1 000 live births by 2030 (United Nations, 2021[1]).

The neonatal mortality rates are persistently high in South Asian and South East Asian countries. While rates in Bangladesh, Cambodia, India and Nepal declined by more than half since 2000, neonatal mortality rates remain high in Pakistan at over 40 deaths per 1 000 live births (Figure 5.4). OECD countries in the Asia/Pacific region have neonatal mortality rates of 3 deaths per 1 000 live births or less, but Singapore is the only country where the neonatal mortality rate was below 1 death per 1 000 live births in 2019.

Across the selected countries, the highest incidence of infant mortality is recorded for children with mothers with low educational attainment and little income (Figure 5.5). While all the selected countries show similar trends, the infant mortality differences related to socio-economic status of mothers were widest in Lao PDR (2017): the infant mortality rate was 56 among low-income families and 19 for high-income families; 49 for mothers with low educational attainment and 7 for mothers with high educational attainment.

Child mortality rates have halved over the 2000-19 period. However, one-third of Asia/Pacific countries have not yet achieved the Sustainable Development Goal of a child mortality rate of 25 or less per 1 000 live births (Figure 5.6). Lao PDR, Pakistan, Papua New Guinea, Timor-Leste and Turkmenistan have child mortality rates exceeding 40 deaths per 1 000 live births even though child mortality rates fell significantly over the past 15 years.

Definition and measurement

Neonatal mortality is defined as deaths of children aged less than 28 days old per 1 000 live births (no minimum threshold of gestation period or birthweight). The infant mortality rate is defined as the number of children who die before reaching their first birthday in a given year, expressed per 1 000 live births. The child mortality rate (or under-five mortality rate – U5MR) is the probability – expressed as a rate per 1 000 live births, of a child born in a specified years dying before reaching the age of five when subject to current age-specific mortality rates.

Some countries base their infant mortality rates on estimates derived from censuses, surveys and sample registration systems, and not on accurate and complete registration of births and deaths. Differences among countries in registering practices for premature infants may also add to international variations in rates.

References

[3] OECD/WHO (2020), Health at a Glance: Asia/Pacific 2020: Measuring Progress Towards Universal Health Coverage, OECD Publishing, Paris, https://doi.org/10.1787/26b007cd-en.

[2] UN IGME (2019), Levels and Trends in Child Mortality, https://data.unicef.org/resources/levels-and-trends-in-child-mortality-2019/.

[1] United Nations (2021), SDG Indicators-Goal 3. Ensure healthy lives and promote well-being for all at all ages, https://unstats.un.org/sdgs/metadata/files/Metadata-03-02-01.pdf.

Figure 5.4. The neonatal mortality rate has halved, while huge disparities exist across countries

Figure 5.5. Mothers experienced high incidence of infant mortality when they have low education and wealth

Figure 5.6. The child mortality rate decreased more than half since 2000

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