Substantial global progress has been made in reducing childhood mortality since 1990. The total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to 5.0 million in 2020. Since 1990, the global under-5 mortality rate has dropped by 60%, from 93 deaths per 1,000 live births in 1990 to 37 in 2020. This is equivalent to 1 in 11 children dying before reaching age 5 in 1990, compared to 1 in 27 in 2020.

Children in sub-Saharan continued to have the highest rates of mortality in the world at 74 (68-86) deaths per 1000 live births, 14 times higher than the risk for children in Europe and Northern America. In fact, two regions, Sub-Saharan Africa and Southern Asia, account for more than 80 per cent of the 5.0 million under-five deaths in 2020, while they only account for 53 per cent of the global live births in 2020. Globally, infectious diseases, including pneumonia, diarrhoea and malaria, along with pre-term birth complications, birth asphyxia and trauma and congenital anomalies remain the leading causes of death for children under five.  

COVID-19 disease has a modest direct impact on child mortality, however there are on-going concerns about the indirect impact on child mortality. In 2020, increased under-5 deaths were anticipated from the repercussions of strained and under-resourced health systems, limitations on care-seeking and preventative measures like vaccination and nutrition supplements, or socioeconomic strains on households resulting from job losses, economic contractions or even deaths of parents due to COVID-19. Analysis data from 80 countries, coming from civil registration and vital statistic systems (CRVS), health management information systems (HMIS) as well as specific country-wide monitoring systems (Mozambique and South Africa) indicate no significant deviation from expected mortality for 2020 and in some cases reported fewer deaths than would be expected from historical data. As more data comes in from countries, and further analyses are performed, these results may change for 2021.