A lot more babies survive their first few years of life than used to. Since 1990, the global mortality rate for kids under-five fell by half, which marks spectacular progress by any measure. Across the world, there are now 46 deaths for every 1,000 births.
That, though, is still a lot of deaths, and it’s still the same babies in the developing world who are most at risk. What’s changing is that a greater portion of child deaths are happening in cities, particularly in urban slums in Africa and South Asia.
Each year, Save The Children produces a “State Of The World’s Mothers” report, ranking countries by how well they care for their moms. This year, it has a special focus on urban mothers, because the charity sees them as a special and growing concern as the world urbanizes. While many countries are seeing improvements for mothers overall, there are growing disparities in cities. In most developing countries, the poorest urban kids are twice as likely to die before age five than the richest urban children. In some countries, they’re up to five times as likely to die.
“Many countries have made important progress in reducing child death rates overall, including among the poorest urban children. But progress often does not eliminate disparities, and sometimes it exacerbates them,” the report says.
Many of the deaths are caused by a lack of prenatal care, midwife attendance, malnutrition, overcrowding, and poor sanitation. In countries with poor public health systems, you have to pay for care and only the richest can afford it, the report says. The largest coverage gaps are in Delhi (India), Dhaka (Bangladesh), Port au Prince (Haiti) and Dili (Timor Leste).
The report isn’t all bad news. Save The Children also lays out some success stories of cities that have made “good progress in saving poor children’s lives” despite population growth. These include Addis Ababa (Ethiopia), Cairo (Egypt) and Manila (Philippines). In general, they’ve provided better care before, during, and after birth, encouraged use of contraception, and offered free or subsidized health services.
As for the ranking, the countries at the top will not be a surprise. The list is dominated by European countries, with Norway, Finland, Iceland, Denmark, and Sweden in the top five places. The scoring is based on five sets of numbers: risk of maternal death, the well-being of kids, expected years of schooling, and the economic and political status of women.
Shockingly, the U.S. places 33rd. That’s because, while the U.S. ranks relatively well for the economic and educational status of mothers, it does really badly on the other measures. The U.S. has the worst maternal death rate of any (so-called) advanced country. It has an under-five mortality rate on par with Macedonia. And, women are poorly represented politically, with less than one in five seats in Congress held by females.
The report compares mortality rates for 25 capitals of wealthy countries, and Washington, D.C., has by far the worst numbers. At 6.6 deaths per 1,000 births in 2013, its rate is three times higher than Tokyo and Stockholm. The main reason there, as you might have guessed, is inequality, because it’s not like the babies of lobbyists and Congressional staffers are dying early. Infants in Ward 8, one of the poorest parts of Washington, are 10 times as likely to die before the age of five than are Ward 3 infants, for example. As in poor countries, big health disparities exist here, too.