When the Millennium Development Goals were set back in 2000, it wasn’t clear whether they would be achieved. A lot could happen between then and 2015, the target year. And it did: major terrorist attacks, unprecedented natural disasters, political upheavals of all sorts, wars and civil conflicts, and a global economic crisis.
Despite all that, substantial progress actually has been made on MDG 4, which seeks to reduce by two-thirds – between 1990 and 2015 – the under-five child mortality rate. That rate has declined from more than 12 million in 1990 to 7.6 million in 2010. Nearly 21,000 children under five now die every day, about 12,000 fewer than in 1990.
Child health, nutrition, and access to clean water and sanitation are improving. Stunting (damage to children’s physical and cognitive development as a result of chronic under-nutrition) declined in developing countries from 40% to 29% between 1990 and 2008. And there has been progress in preventing HIV among children, with a 24% decline in newly infected children and a 19% decline in children dying from AIDS between 2004 and 2009.
It is commendable that global political leadership has continued to stress the importance of MDG 4. International organizations, governments, non-governmental organizations, the faith community, the private sector, philanthropic organizations, and individuals have stepped forward in various ways to keep up the pressure to get the job done. The glass clearly is half full. “We are making the kind of progress which no one would have dared to predict 20 years ago,” UNICEF Executive Director Tony Lake has said. “The advances of 10 years make it clear that the measurable targets of the Millennium Development Goals have had a galvanizing effect in setting priorities and have been associated with remarkable gains.”
Nevertheless, the highest rates of child mortality still are in Sub-Saharan Africa, where 1 child in 8 dies before age five, and in South Asia, where 1 child in 15 dies before age five. The disparity between these two regions and the rest of the world has grown.
On a worldwide basis, the four major killers of children under five are pneumonia, diarrheal diseases, preterm birth complications, and birth asphyxia. Under-nutrition is an underlying cause of more than a third of under-five deaths. Malaria also remains a major killer in Sub-Saharan Africa.
While progress has been made and there is reason for encouragement, MDG 4 frankly will not be realized without stepped up efforts. As the data show, we are moving ahead and we know what works. UNICEF and Save the Children UK make the case that an additional $60 billion is needed between 2009 and 2015 to implement a full package of maternal, newborn and child health interventions in the 68 countries with the highest child and maternal mortality levels.
UNICEF further advocates that major gains in child and maternal health best can be achieved by focusing programs and resources on the very poorest women and children in the poorest countries. Reaching the poorest of the poor not only is the right thing to do, it is the most effective way to save the lives of millions of vulnerable children and their mothers by 2015.
The conventional wisdom has been that reaching better off, more accessible children is the more cost-effective approach. But the “equity” strategy argues that because needs are greatest among those harder to reach, the benefits of concentrating on them could outweigh the additional costs of reaching them. In effect, the equity-focused approach improves the return on investments, averting many more child and maternal deaths – and hastening the day when no child dies of preventable causes.
Focusing on the poorest of the poor has a familiar ring. It was the message of Blessed Teresa of Calcutta’s work, her call to action, and her inspiration to those who seek a world filled with justice, especially for the least of those among us. To realize MDG 4 really means “taking to scale” (in UN-speak) Mother Teresa’s outreach to the poorest individuals with whom she interacted.
Achieving MDG 4 requires both resources and political will. In the United States, that means an engaged and active constituency must be mobilized to press the decision-makers in Washington to implement a foreign policy that makes child survival and maternal health a top priority. Funding for global child and maternal health largely has survived the massive spending cuts made in recent years and made some gains. But “surviving cuts” is not the way MDG 4 will be realized. Notwithstanding whatever funding reductions are made, the United States Government still will spend billions of dollars on international assistance. Supporters of MDG 4 must call for foreign assistance that reflects their values by providing substantial increases in child survival and maternal health.
Can MDG 4 be achieved? Only if concerned citizens ask their legislators to make it a priority. Children in need know no politics. It is not acceptable that children should die when we have the means to save them. Will we?
 Data cited can be found at the UNICEF site and in Progress in Child Well-Being – Building on What Works (a UNICEF and Save the Children UK report from November 2011). For more information, visit www.unicefusa.org