Definition
The under-five mortality rate is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of five if subject to current age-specific mortality rates.
Goal/target addressed
Goal 4. Reduce child mortality.
Target 5. Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
Rationale
The indicator, which relates directly to the target, measures child survival. It also reflects the social, economic and environmental conditions in which children (and others in society) live, including their health care. Because data on the incidences and prevalence of diseases (morbidity data) frequently are unavailable, mortality rates are often used to identify vulnerable populations. The under-five mortality rate captures more than 90 percent of global mortality among children under the age of 18.
Method of computation
Age-specific mortality rates are calculated from data on births and deaths in vital statistics registries, censuses and household surveys in developing countries. Estimates based on household surveys data are obtained directly (using birth history, as in Demographic and Health Surveys) or indirectly (Brass method, as in Multiple Indicator Cluster Surveys). The data are then summed for children under five, and the results are expressed as a rate per 1,000 live births.
Data collection and source
At the national level, the best source of data is a complete vital statistics registration system—one covering at least 90 percent of vital events in the population. Such systems are uncommon in developing countries, so estimates are also obtained from sample surveys or derived by applying direct and indirect estimation techniques to registration, census or survey data. A wide variety of household surveys, including Multiple Indicator Cluster Surveys and Demographic and Health Surveys, are used in developing countries.
Several international agencies produce country estimates based on available national data for purposes of international comparisons and assessment of global and regional trends (see “International data comparison”).
References
The State of the World’s Children, annual, United Nations Children’s Fund (www.unicef.org/publications).
Monitoring Progress towards the Goals of the World Summit for Children: End-Decade Multiple Indicator Survey Manual, United Nations Children’s Fund (www.unicef.org/reseval/methodr.html).
World Health Organization, www3.who.int/whosis.
World Development Indicators, annual, World Bank (www.worldbank.org/data).
Indicators of Sustainable Development: Guidelines and Methodologies, 2001, United Nations Division for Sustainable Development (www.un.org/esa/sustdev/natlinfo/indicators/isd.htm).
Human Development Report, annual, United Nations Development Programme (www.undp.org).
Periodicity of measurement
Vital statistics are typically available once a year, but they are unreliable in most developing countries. Household surveys that include questions on births and deaths are generally conducted every three to five years.
Gender issues
Under-five mortality rates are higher for boys than for girls in countries without significant parental gender preferences. Under-five mortality better captures the effect of gender discrimination than infant mortality, as nutrition and medical interventions are more important in this age group, while biological differences have a higher impact during the first year of life (see also indicator 14, infant mortality rate). There may be gender-based biases in the reporting of child deaths.
Disaggregation issues
Under-five mortality generally shows large disparities across geographical areas and between rural and urban areas. Under-five mortality may also vary across socioeconomic groups. Children in some ethnic groups might also be at higher risk of malnutrition, poorer health and higher mortality. However, showing and analyzing data on specific ethnic groups may be a sensitive issue in the country. Gender differences may also be more pronounced in some social and ethnic groups.
International data comparisons
Mortality rates are among the most frequently used indicators to compare levels of socioeconomic development across countries. The United Nations Population Division, the United Nations Children’s Fund and the World Health Organization regularly produce estimates of under-five mortality based on available national data. These data series may differ, however, because of differences in methodologies used to estimate data and differences in reporting periods.
The State of the World’s Children, annual, United Nations Children’s Fund (www.unicef.org/publications).
World Health Organization, www3.who.int/whosis.
World Development Indicators, annual, World Bank (www.worldbank.org/data).
Human Development Report, annual, United Nations Development Programme (www.undp.org).
Comments and limitations
Data on under-five mortality is more complete and more timely than data on adult mortality. The under-five mortality rate is considered to be a more robust estimate than infant mortality rate if the information is drawn from household surveys.
In developing countries household surveys are essential to the calculation of this indicator, but there are some limits to their quality. Survey data are subject to recall error, and surveys estimating infant [under-five?] deaths require large samples, because such incidences are uncommon and representative households cannot ordinarily be identified the sampling. Moreover, the frequency of the survey is generally only every three to five years. Therefore, when using household surveys it is important to take sampling errors into account. Also, indirect estimates rely on estimated actuarial (“life”) tables that may be inappropriate for the population concerned.
There are also gender-based biases in the reporting of child deaths.
Agencies
Ministries of health.
National statistical offices.
United Nations Children’s Fund.
World Health Organization.