The Lottery of Birth: New Report Reveals World’s Most Disadvantaged Children are Being Left Behind in Global Efforts to Improve Child Survival

Lottery of Birth
Lozimary* is 17 months old and weighed just 16 pounds when she arrived at the hospital in central Malawi, and she was severely malnourished. She was refusing to eat and had lost weight. She recovered well after being admitted to the hospital and having first received therapeutic milk and then a nutritional peanut paste. Photo by Oli Cohen/Save the Children. (* after a name indicates that the name has been changed to protect identity.)

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FAIRFIELD, Conn. (Feb. 4, 2015) — Despite historic global progress in reducing under-five child mortality rates over the past 15 years, new research conducted by Save the Children has found that large groups of children are still being left behind, simply because of where they live and the circumstances in which they are born.

Many factors, including whether a child lives in a rural area or belongs to a disadvantaged ethnic group, play a huge role in a child’s chances of survival. Save the Children describes this situation as a “lottery of birth.”

The “Lottery of Birth” report, based on inaugural analysis of disaggregated data from 87 low and middle income countries around the world, reveals that in more than three quarters of these countries, inequalities in child survival rates are actually worsening, resulting in some groups of children making far slower progress than their better-off peers.

In 78 percent of the countries covered in the report, at least one social or economic group has fallen behind and is therefore making slower progress in reducing child mortality, and in 16 percent of these countries, inequalities in child survival rates have increased across all social and economic groups.

Save the Children’s analysis suggests that, without a true step change in action, the lottery of birth will continue into the future, slowing progress towards the ultimate goal of ending preventable child deaths for generations to come.

However, tackling this inequality is possible. Almost a fifth of the countries in the report, including Rwanda, Malawi, Mexico, and Bangladesh, have successfully combined rapid and inclusive reductions in child mortality, achieving faster progress than most countries, while at the same time ensuring that no groups of children are left behind.

The agency calls for the international community to commit to ending preventable child deaths by 2030.

The new development framework, which will replace the MDGs, will be agreed upon at the United Nations General Assembly in September 2015. This framework must set out ambitious child and maternal survival targets and commit to working towards universal health coverage.

It should also include targets to ensure that even the poorest, most marginalized and disadvantaged groups of children are included in global efforts to improve under-five child survival by 2030.

“In this day and age, it is unacceptable that so many children’s chances of survival across the world are purely a matter of whether or not they were lucky enough to be born into an affluent family who can access quality healthcare,” said Carolyn Miles, President and CEO of Save the Children.

“We know that change is possible. We now have a significant window of opportunity to drive this change; world leaders must do everything in their power to ensure that they grasp this opportunity with both hands.”

Some country illustrations:

  • In Niger, a child born in the sub-national region with the highest mortality rate in 2012 was nearly five times more likely to die before their fifth birthday than in the region with the lowest rate. This inequality has doubled since 1998.
  • In Indonesia a child born into the poorest 40 percent of households in 2012 was nearly 2.5 times more likely to die than a child in the richest 10 percent. This inequality has grown double since 2002.
  • In Honduras, in 2012, a child born in Islas de Bahia region was 3.5 times more likely to die than a child born in the most advantaged regions in the country. This inequality has increased considerably since 2006.
  • In Vietnam children born into the Kinh ethnic group in 2010 were 3.5 times less likely to die than their non-Kinh peers.

Other key Lottery of Birth findings include:

  • Disadvantaged ethnic groups and regions are most likely to be left behind; regional disparities in child mortality rates increased in 59 percent of the countries, while disparities between ethnic groups in 76 percent.
  • More positively, 17,000 fewer children now die every day than they did in 1990, and the global under-five child mortality rate nearly halved from 90 to 46 deaths per 1,000 live births between 1990 and 2013.
  • About a fifth of countries have achieved above median reductions in child mortality over the past decade, while at the same time ensuring that no particular groups of children are left behind.

About Save the Children
Save the Children gives children in the United States and around the world a healthy start, the opportunity to learn and protection from harm. We invest in childhood — every day, in times of crisis and for our future. Follow us on Twitter and Facebook.

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