save the children

Millions of children die before their fifth birthday because developing countries skew public health spending to the rich rather than the poor, a leading charity says today.

Save the Children says that 4 million child deaths could be averted over a 10-year period if the 42 developing countries which account for 90% of all under-five mortality took an "egalitarian approach". Although UN nations agreed to reduce child mortality by two-thirds from its 1990 level by 2015, progress has been steady and slow – and exacerbated by the rising inequalities within poor nations. In Kenya, where there was an increase of nearly 150,000 under-fives' deaths between 1993 and 2003, an "egalitarian approach", says the charity, would have actually prevented 214,000 deaths.

Save the Children says that in developing nations it is the children of the wealthiest fifth of the population who have disproportionately benefited from the focus on infant mortality to the extent that in some cases the poorest fifth of the population are no better or even worse off. In Burkina Faso, where a reduction in child mortality rates masks an actual increase in child mortality among the poorest 20% of the population.

Sub-Saharan Africa, where close to one child in seven still dies before their fifth birthday, faces the greatest challenge. Although the mortality rate in the region has fallen, high fertility levels mean the absolute number of child deaths has increased since 1990, from 4.2 to 4.6 million.