Ensuring healthy lives and promoting well-being of children is essential to sustainable development. Currently, the world is facing a global health crisis unlike any other — COVID-19 is spreading human suffering, destabilizing the global economy and upending the lives of billions of people around the globe. 

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Before the pandemic, major progress was made in improving the health of millions of people. Significant strides were made in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality. But more efforts are needed to fully eradicate a wide range of diseases and address many different persistent and emerging health issues. By focusing on providing more efficient funding of health systems, improved sanitation and hygiene, and increased access to physicians, significant progress can be made in helping to save the lives of millions.
Health emergencies such as COVID-19 pose a global risk and have shown the critical need for preparedness. The United Nations Development Programme highlighted huge disparities in countries’ abilities to cope with and recover from the COVID-19 crisis. The pandemic provides a watershed moment for health emergency preparedness and for investment in critical 21st century public services. 

Fact Figures
Child health
17,000 fewer children die each day than in 1990, but more than five million children still die before their fifth birthday each year.
Since 2000, measles vaccines have averted nearly 15.6 million deaths.
Despite determined global progress, an increasing proportion of child deaths are in Sub-Saharan Africa and Southern Asia. Four out of every five deaths of children under age five occur in these regions.
Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families.
Children of educated mothers—even mothers with only primary schooling—are more likely to survive than children of mothers with no education.

Maternal health
Maternal mortality has fallen by 37% since 2000.
In Eastern Asia, Northern Africa and Southern Asia, maternal mortality has declined by around two-thirds.
But maternal mortality ratio – the proportion of mothers that do not survive childbirth compared to those who do –   in developing regions is still 14 times higher than in the developed regions.
More women are receiving antenatal care. In developing regions, antenatal care increased from 65 per cent in 1990 to 83 per cent in 2012.
Only half of women in developing regions receive the recommended amount of health care they need.
Fewer teens are having children in most developing regions, but progress has slowed. The large increase in contraceptive use in the 1990s was not matched in the 2000s.
The need for family planning is slowly being met for more women, but demand is increasing at a rapid pace.

HIV/AIDS, Malaria and other diseases

36.9 million -People globally were living with HIV in 2017.
21.7 million -People were accessing antiretroviral therapy in 2017.
1.8 million -People became newly infected with HIV in 2017.
940 000 -People died from AIDS-related illnesses in 2017.
77.3 million -People have become infected with HIV since the start of the epidemic.
35.4 million -People have died from AIDS-related illnesses since the start of the epidemic.
Tuberculosis remains the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths.
Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which put them at increased risk of acquiring HIV.
HIV is the leading cause of death for women of reproductive age worldwide.
AIDS is now the leading cause of death among adolescents (aged 10–19) in Africa and the second most common cause of death among adolescents globally.
Over 6.2 million malaria deaths have been averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global malaria incidence rate has fallen by an estimated 37 per cent and the mortality rates by 58 per cent.

Child Malnutrition

Malnutrition prevalence remains alarming: stunting is declining too slowly while wasting still impacts the lives of far too many young children
Nearly half of all deaths in children under 5 are attributable to under-nutrition; under-nutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery.
The interaction between under nutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which is associated with impaired cognitive ability and reduced school and work performance.
We are still far from a world without malnutrition. While the 2020 edition of the joint malnutrition estimates shows that stunting prevalence has been declining since the year 2000, more than one in five – 144 million children under 5 –were stunted in 2019, and 47 million suffered from wasting.  Meanwhile, the number of overweight children worldwide has remained stagnant for more than a decade.
Measures of child under-nutrition are used to track development progress. In the Post-2015 Development Era, estimates of child malnutrition will help determine whether the world is on track to achieve the Sustainable Development Goals – particularly, goal 2 to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture”.
In 2019, three regions had very high stunting prevalence, with approximately one third of children affected. On the other hand, three regions had low stunting prevalence. However, vast disparities within the low prevalence regions can exist. In Latin America and the Caribbean, for example, despite the low prevalence overall, some individual countries faced medium, high, and in some cases very high stunting rates. Chronic under- nutrition in Latin America and the Caribbean can vary widely between neighbouring countries: In one country less than 1 in 8 are affected, while nearly 1 in 2 of their peers in the country next door are at a disadvantage due to the irreversible physical and cognitive damage that can accompany stunted growth.
In 2019, 21.3 per cent, or more than one in five children under age 5 worldwide had stunted growth. That said, overall trends are positive. Between 2000 and 2019, stunting prevalence globally declined from 32.4 per cent to 21.3 per cent, and the number of children affected fell from 199.5 million to 144.0 million. In 2019, nearly two out of five stunted children lived in South Asia while another two out of five lived in sub-Saharan Africa.
Improving maternal, infant and young child nutrition expands opportunities for every child to reach his or her full potential.
Stunting is the result of chronic or recurrent under nutrition in-utero and early childhood. Children suffering from stunting may never reach their full possible height or their full cognitive potential. Stunted children not only earn less as adults as a result of less schooling and learning difficulties when in school, but they are also more likely to be at risk of overweight and obesity than children of normal height.
Wasting is a life-threatening condition attributable to poor nutrient intake and/or disease. Characterized by a rapid deterioration in nutritional status over a short period of time, children suffering from wasting have weakened immunity, increasing their risk of death due to greater frequency and severity of common infection, particularly when severe.
Nearly half of all deaths in children under 5 are attributable to under nutrition but the face of malnutrition, in all its forms, is rapidly changing, with childhood overweight an escalating epidemic of global proportions. Overweight is the result of a growing number of children living in obesogenic environments with greater availability of processed foods and a more sedentary lifestyle.
Infant and young child feeding
Adopting optimal feeding practices is fundamental to a child’s survival, growth and development, but too few children benefit
Proper feeding of infants and young children can increase their chances of survival. It can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Ideally, infants should be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond. Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.

Infant and Young Child Feeding
What, when and how children are fed, particularly in the first two years of life, is critical to health, development and survival? The early initiation of breastfeeding – putting newborns to the breast within the first hour of life – is critical to newborn survival and to establishing breastfeeding over the long term. Feeding infants nothing but breast milk for the first six months of life, exclusive breastfeeding, is the safest and healthiest option for children everywhere and has great potential to save lives. Starting at 6 months of age, children’s nutrient needs are greater than what breast milk alone can provide. Feeding children solid, semi-solid or soft foods from 6 months of age is key to prevent deficiencies that could result in under nutrition. Diets that meet at least minimum frequency and diversity standards are essential to preventing micronutrient deficiencies, stunting and wasting.
Children Under-five mortality
The world made remarkable progress in child survival in the past few decades, and millions of children have better survival chances than in 1990–5 1 in 26 children died before reaching age five in 2018, compared to 1 in 11 in 1990. Moreover, progress in reducing child mortality has been accelerated in the 2000–2018 period compared with the 1990s, with the annual rate of reduction in the global under-five mortality rate increasing from 2.0 per cent in 1990–2000 to 3.8 per cent in 2000–2018. Despite the global progress in reducing child mortality over the past few decades, an estimated 5.3 million children under age five died in 2018–roughly half of those deaths occurred in sub-Saharan Africa

Child survival and the SDGs

Looking ahead: Child survival and the Sustainable Development Goals
In 2015, the world began working toward a new global development agenda, seeking to achieve, by 2030, new targets set out in the Sustainable Development Goals (SDGs). The proposed SDG target for child mortality aims to end, by 2030, preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-5 mortality to at least as low as 25 deaths per 1,000 live births.
In more than a quarter of all countries urgent action is needed to accelerate reductions in child mortality to reach the SDG targets on ending preventable child deaths by 2030. Of 195 countries analysed, 121 already met the SDG target on under-five mortality, and 21 countries are expected to meet the target by 2030 if current trends continue. Efforts to accelerate progress need to be scaled up in the remaining 53 countries to meet the SDG target on under-five mortality by 2030—two thirds of which are located in the regions of Sub-Saharan Africa.
More countries are at risk of missing the SDG target on neonatal mortality than on under-five mortality. On current trends, more than 60 countries will miss the target for neonatal mortality by 2030, while 53 countries will miss the target for under-five mortality.

Neonatal mortality
The neonatal period is the most vulnerable time for a child
The first 28 days of life – the neonatal period – is the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life at an average global rate of 18 deaths per 1,000 live births in 2018. Comparatively, the probability of dying after the first month but before reaching age 1 was 11 and after age 1 but before turning age 5 was 10. Globally, 2.5 million children died in the first month of life in 2018– approximately 7,000 neonatal deaths every day – most of which close to three quarters dying, with one third dying on the first day.
Harmful practices and intimate partner violence
650 million women and girls alive today were married before their 18th birthday
Child marriage, defined as a formal marriage or informal union before the age of 18, is a fundamental violation of human rights.  It occurs among both boys and girls, though the prevalence is about five times higher among girls – reflecting societal values that hold girls in low esteem and deprive them of the agency to chart their own course in life. It often compromises a girl’s healthy transition to adulthood by resulting in early pregnancy, social isolation, and interruption of education, limited socio-economic opportunities and increased risk of domestic violence. Moreover, adolescent girls are often married to older men, creating a power dynamic that further disempowers girls and exposes them to greater risks of violence, sexually transmitted diseases and a lack of agency.
Around the world, the practice of child marriage has continued to decline. During the past decade, the proportion of women who were married as children decreased by 15 per cent, from one in four to approximately one in five. And progress has been accelerating: of the 25 million child marriages prevented due to progress in the past ten years, 7 million were expected based on prior trends, while 18 million were due to an acceleration of progress. Nonetheless, many girls remain at risk, particularly girls from poor households and those living in rural areas. Ending the practice is critical to achieving Sustainable Development Goal Target 5.3 on the elimination of all harmful practices, but if current trends continue, between now and 2030 150 million more girls will marry before their 18th birthday.
Child marriage is most common in sub-Saharan Africa, where around 4 in 10 young women were married before age 18, followed by South Asia, where 3 in 10 were married before age 18. South Asia has witnessed the largest decline in child marriage worldwide in the last 10 years, as a girl’s risk of marrying before her 18th birthday has dropped by more than a third, from nearly 50 per cent to 30 per cent, in large part due to progress in India.
1 in 3 girls aged 15-19 have undergone female genital mutilation (FGM).
Female genital mutilation (FGM), a grave violation of women’s and girls’ rights and dignity, refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.The international community has codified its commitment to eliminating the practice by 2030 under Target 5.3 of the Sustainable Development Goals.
While the exact number of girls and women worldwide who have undergone FGM remains unknown, at least 200 million girls and women have been cut in 30 countries with representative data on prevalence. The practice of FGM appears highly concentrated in a swath of countries from the Atlantic coast to the Horn of Africa, in areas of the Middle East such as Iraq and Yemen and in some countries in Asia such as Indonesia, with wide variations in prevalence. The practice is almost universal in Somalia, Guinea and Djibouti, with levels around 90 per cent, while it affects only 1 per cent of girls and women in Cameroon and Uganda. However, evidence suggests that FGM exists worldwide as practitioners migrate to other countries. Attitudes towards the practice vary, though the majority of girls and women in countries with data think the practice should end.

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