MDG 4: Reduce child mortality

Target 5: To reduce by two thirds, between 1990 and 2015, the under 5 mortality rate

Three main indicators have been used to monitor child health under MDG 4: the
under 5 mortality rate (U5MR), infant mortality rate (IMR), and the proportion of one
year-old children immunised against measles. The IMR and U5MR are widely recognised
as important indicators of the level of child health and overall development:
“Infant mortality rate (IMR), a measure of child survival, is considered to be one
of the strongest indicators of a country’s wellbeing, as it reflects social, economic and
environmental conditions in which children (and others in society) live, including
their health care.” (Alderman & Behrman, 2004: vii)

In the last few years, the LAC region has made considerable progress with respect to infant
health, and the region as a whole is on track to meet this Target – except for Haiti and
Paraguay. Even though the LAC region is still far behind the industrialised countries’ average
of 6 child deaths per 1,000 live births, it has the lowest under 5 mortality rate of any of the
world’s developing regions (UNICEF, 2005 a). Unlike other regions, LAC has maintained
a steady pace of progress during the 1990s, posting an average annual reduction of 4% over
the course of the decade, which is more than double the world average (UNICEF, 2004
a). Between 1990 and 2003, the region’s under 5 mortality rate fell from about 56 to 33
deaths per 1,000 live births. Brazil and Mexico are countries with large child populations,
which have managed reductions of just fewer than 4.3% and 3.8% p.a., respectively. Several
countries have reached rates close to or lower than 25 per 1,000. Nevertheless, there are
countries which still exceed 40 deaths per 1,000 live births – such as Haiti (123), Guyana
(72), Bolivia (71), Guatemala (49), Honduras (42), and Nicaragua (41) (ECLAC, 2005 a).
The regional (LAC) averages thus mask wide disparities between countries:
“Latin American and Caribbean countries have seen the most substantial improvement
on average, although alarming gaps are opening up within countries there. The
worsening poverty situation in some communities is preventing large groups of children
within these countries from accessing basic health services and care. At the service level,
poor access and utilization of health services, poor quality of care, and the lack of
skilled attendants during delivery and in the immediate postpartum period cause the
largest proportion of preventable deaths.” (Mukelabai, 2004: XVII-1)
The LAC region reached the goals related to measles immunisation coverage, and their
coverage is also better than that of any other region, surpassing that of industrialised countries (UNICEF, 2005 a). Routine measles immunisation coverage has increased from
76% in 1990 to 93% in 2003, and the region had the largest average annual rate of increase
in coverage between 1990 and 2003: 1.3 percentage points. Worldwide, the coverage has
slowly risen to 75% in 2003 and it is estimated that about 4% of the deaths among children
under 5 are due to measles (WHO, 2005 c). ECLAC (2005 a) suggests that the region has
both the ability to make major strides with regard to health care and the need to sustain
successful policies. Ecuador and Peru are high-performing countries, having improved, since
1990, at average annual rates of 3.0 and 2.4 percentage points, respectively (UNICEF, 2005
a). Two thirds of the region’s countries have already achieved 90% coverage against measles,
and another three - Guyana, Trinidad and Tobago, and Venezuela - are likely to achieve it by
2010. Bolivia, the Dominican Republic, Guatemala, Haiti, Jamaica, Panama and Suriname,
on the other hand, still require major investments in the measles immunisation coverage.