Towards the Sustainable Development Goals : Accounting for Inequalities in Neonatal Mortality in Sub Saharan Africa

Child mortality is undeniably a core indicator for child health and well-being. Recent assessment of the progress in achieving the MDGs has documented accelerated progress in improving child survival in the 2000-2015 period. While the global annual rate of reduction in under-five mortality rate increased from 1.8% (1990–2000) to 3.9% (2000–2015), progress in achieving the MGD 4 target has been insufficient. We track progress in equity of neonatal mortality rates in sub Saharan Africa based on national population-based surveys conducted between 1990 and 2014. Assessing trends in neonatal mortality is inevitable due to the prominent and increased share of under-five deaths occurring during the neonatal period. Further, most interventions aimed at improving survival during the neonatal period are different from those aimed at addressing other under-five deaths. Understanding the trends and contributing factors to the stalled progress is critical when planning effective interventions to reduce neonatal mortality. Extended Abstract Introduction Child mortality is one of the key indicators for measuring social economic development. It is undoubtedly a core indicator for child health and well-being. The onset of the Millennium Development Goals (MDGs) in 2000 set the stage to track progress in reducing by 2015 two thirds of the under-five mortality in the world using 1990 as a reference point (MDG 4). The focus was mostly in less developed countries and Sub Saharan Africa (SSA) in particular since these were regions with the highest under-five mortality since 1990s. Since 2000, the world has witnessed several on-going projects and interventions aimed at reducing under-five mortality. Several initiatives have been taken to ensure that child survival improves globally. For example, the Global Strategy for Women’s and Children’s Health launched by the United Nations Secretary-General, Ba Ki-Moon and the Every Woman Every Child movement boosted global momentum to improve maternal and child health. Recognizing the need for concerted efforts to improve child survival, world leaders renewed their commitment in June 2012 to end preventable child deaths. The agenda towards universal improvement in child survival and maternal health is still on track. With the end of the MDG era, the international community has taken stock of the progress made in attaining MGD 4. The core results of this assessment are both positive and worrisome. For example, the United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) report of 2015 demonstrates through annual updates of child mortality estimates that major progress has been made in reducing child mortality globally. Notably, this progress has accelerated in the years towards the 2015. For example, global under-five mortality rate (U5MR) dropped 53% from 91 deaths per 1,000 live births in 1990 to 43 in 2015. At the regional level, all MDG regions except Oceania have more than halved the U5MR. Eastern Asia, Latin America and the Caribbean, and Northern Africa have at least exceeded the MDG 4 target. Another notable progress is that about a third of countries (62) have reduced their under-five mortality by two-thirds or more and achieved the MDG4 target set in 2000 (UNICEF 2015: 3). In examining these trends, the most appealing results are that SSA, the region with the highest burden of under-five mortality globally, has also witnessed accelerated decline in under-five mortality. SSA annual rate of reduction increased from 1.6% in the 1990s to 4.1% in 2000–2015. Of the 49 SSA countries, all but 5 had a higher annual rate of reduction in the 2000–2015 period compared with the 1990s (UNICEF 2015: 4). While the world celebrates the remarkable achievements in child survival since 2000 in saving the lives of 48 million children under age five (UNICEF 2015: 6), progress has been insufficient to achieve MDG 4 worldwide. Notably, the