How to Cut Child Mortality in Half Again

We already know how to save millions of newborn lives.

In 1997, The New York Times published a piece about deadly drinking water in the world's poorest countries that contained the following fact: “Diarrhea kills some 3.1 million people annually, almost all of them children.” That's a shocking statistic. The death of millions of children—from something easily treatable in much of the world—is a tragedy on an almost unfathomable scale.

But by 2019, something remarkable had happened: In under three decades, child mortality—including deaths from diarrhea—was cut by more than half.

Measles deaths fell 90% thanks to vaccines. Pneumonia deaths fell 70%, also thanks to vaccines. Deaths from diarrhea—which killed 3 million kids a year not too long ago—fell 70%, too, thanks to low-tech interventions like oral rehydration solution, large-scale sanitation programs, and (yes, you guessed it) a new rotavirus vaccine. Malaria deaths fell 36% thanks to effective bed nets and sprays. Even deaths from HIV, which more than tripled as a killer of kids in the 1990s, fell 33% once we figured out how to protect and treat mothers, so they don't pass the virus to their babies.

It wasn't just the child mortality rates from these diseases that went down, though. Year after year, the raw number of overall childhood deaths fell, from 12 million in 1990 to 5 million in 2019—even as the global population rose.

We've made incredible progress, and we keep moving in the right direction. But we aren't moving fast enough. Just under 5 million kids still die each year before reaching their fifth birthday. Another 2 million are stillborn. Virtually all of these deaths occur in low- and middle-income countries—and every single one is a tragedy that devastates families and entire communities.

The question is this: How we can cut child mortality in half again by 2040, to below 3 million deaths a year?

There is reason for hope because we already have most of the tools we need. While continued innovation is necessary, we currently have the know-how to save millions of lives—it's a matter of putting it to use and making sure it reaches the children who need it most.

That begins before children even take their first breaths. It begins with mothers.

When a mother dies during childbirth, her child has more than a 63% chance of dying before their first birthday. To save those kids' lives—and so many others by 2040—we need to focus on keeping women healthy before and throughout pregnancy so they can deliver and raise healthy children.

Stop women from bleeding to death after childbirth

Around the world, postpartum hemorrhage (PPH)—defined by the WHO as losing more than half a liter of blood within 24 hours of childbirth—is the primary cause of maternal mortality. Often, it isn't caught until it's too late, because it's hard to know how much blood loss is too much.

But with a low-cost tool called a calibrated obstetric drape and a trained birth attendant monitoring it, blood loss can be accurately measured in real time. By bundling five interventions that stop the bleeding and by administering them simultaneously rather than sequentially—an approach known as E-MOTIVE—healthcare workers can slash cases of severe bleeding by 60%. Through prenatal screening and treatment of anemia, a common cause of PPH, some PPH cases can be prevented entirely.

Prevent life-threatening infections during labor

Sepsis—a life-threatening condition in which the immune system overreacts to an infection, causing widespread inflammation and organ damage—is another common cause of maternal mortality. In the US, it's responsible for 23% of maternal deaths. But researchers have recently discovered that azithromycin, one of the world's most common antibiotics, can reduce sepsis cases by a third when given preventively. This discovery will be lifesaving for mothers—and therefore babies—especially in places where many women give birth at home, in conditions that aren't sterile.

Speed up the development of babies' lungs

When babies are born preterm (before 37 weeks of pregnancy), their organs are underdeveloped—especially the lungs, one of the last organs to finish growing inside the womb. That leaves these babies vulnerable to a whole host of potentially fatal complications. But now, if doctors learn a mother is at risk of going into preterm labor, they can prescribe her antenatal corticosteroids that help her baby's lungs grow as much as they would over a few weeks—in just a few days.

Fight malnutrition before and after birth

Without a healthy microbiome—the universe of bacteria inside the gut—babies struggle to absorb the nutrients in breast milk no matter how much they're fed. That malabsorption is doubly destructive because it can lead to malnutrition, which can leave babies more susceptible to getting and dying from pneumonia.

While experts used to believe that malnutrition could only be treated at around six months—once a baby starts eating solid foods—we now know that the microbiomes of mothers and babies are connected. That means micronutrient supplements can be given to pregnant women, and when they are, babies gain an additional 5 grams of weight each day during the late stages of pregnancy and are more likely to be born with a healthy gut.

And when a baby is born underweight or preterm, probiotic powders that include bifidobacteria can be added to breast milk to improve their digestive system, help them absorb nutrients, and reduce their risk of getting severe infections and dying.

The focus with each of these interventions is on the beginning of a newborn baby's life (and the lead-up to it). Why? Because half of all deaths of children under five occur in the first 28 days. If a baby is born healthy and survives that first month, the odds increase dramatically that they will live to see their fifth birthday—and will survive into adulthood. Making this happen will require renewed investments by governments and organizations around the world to get these lifesaving interventions to the people and places they're so sorely needed. But it doesn't require much new invention. Again: The solutions to cut child mortality in half again already exist. (And they're all low-cost.)

Of course, there's still much more to do to eliminate preventable deaths of children altogether. We need to continue improving sanitation and increasing access to clean drinking water around the world. We need to develop a vaccine for HIV and next-generation malaria vaccines to really stop those diseases in their tracks. As we saw over the last 30 years, diseases with effective vaccines decline much faster than those we try to control without them.

We also need to ramp up vaccine distribution efforts, with an emphasis on reaching the 60 million “zero-dose” kids in lower-income countries—kids who've never received a single immunization and who now make up half of all childhood deaths from diseases with effective vaccines. These numbers spiked during the pandemic, when routine immunizations were disrupted and vaccine misinformation surged. Fortunately, Gavi: The Vaccine Alliance, which has helped vaccinate over 981 million children in the world's poorest countries since 2000, is working around the clock to reach these kids.

Reaching the goal of halving child mortality by 2040 will not be easy. But with the right commitment, preventable child deaths will one day be as unimaginable to us as life without computers. And in the not-too-distant future, a world where all children have the same chance to survive and thrive—no matter where they're born—will become reality, too.