The development of child mortality can be seen optimistically or pessimistically. In 1990, 12 million children died from preventable causes before they reached the age of five. Last year, the number decreased to 6.6 million,according to estimates of the UN Children's Fund (UNICEF). Compared to births, overall child mortality declined by 40 percent.

Yet the numbers still fall short of the Millennium Development Goals (MDGs). The MDG calls for child mortality to be reduced by two-thirds by 2015. The children's right organization Save the Children has called for additional efforts in reducing child mortality. On Wednesday (23.10.2013) the organization published a country ranking and reports about the successes and the failures.

"We are seeing very positive progress. In the last generation, we have halved the number of children dying of preventable causes around the world," Ben Hewitt, campaign manager of Save the Children, told DW. "But it's opening up some questions on how we take this further and end all preventable child death."

The ranking of 75 emerging and developing countries not only considered the decrease of child deaths, but also examined efforts made to achieve equal chances of survival for boys and girls and for children from rich or poor families. The report went on to evaluate the sustainability of national child mortality reduction polices.

Niger topped the report's list of achievements. Although 114 out of 1,000 children under the age of five still die in Niger, that is considerably less than the 326 out of 1,000 child deaths in 1990. The result is remarkable because the child mortality reduction affected all income brackets. The country's results, however, still trail far behind other parts of the world. In Germany, child mortality rate of 14 out of 1,000.

Majority of child deaths avoidable

Countries like Liberia, Rwanda, Indonesia and Madagascar also score well in the ranking. In fact, some countries met the child mortality MDG. On the bottom end of the list are countries including Haiti, Papua New Guinea and Equatorial Guinea. The main causes that a child dies every five seconds are malnutrition, pneumonia, malaria, diarrhea and premature birth. According to Save the Children, the majority of these deaths could be prevented.

There are several factors explaining why some countries are more successful in the fight against child mortality than others. Political stability and environmental influences like periods of drought have major influences. The most important factor, Hewitt said, is that countries have a specific health care policy. This is the case in Ethiopia where the government trained tens of thousands health professionals. The country is close to reaching the child mortality MDG.

Other countries also show that an increase of the chances of survival can be reached without significant economic growth. "In countries investing in health care and nutrition support for mothers and children, we are seeing dramatic progress."

Martin Dawes, UNICEF communication officer for West and Central Africa, holds the affected government responsible. They must provide sufficient funds for health care. "There is an agreement that governments spend 15 percent of the gross domestic product (GDP) on health," he said. But only Liberia and Togo did so. "In a country like Nigeria, that only spends about 4 percent on health, you are going to have major problems."

The MDGs are interdependent

Notwithstanding the success, there is still a lot to do, Hewitt said. It is not acceptable that the child mortality among newborns increased. The number of deaths among newborn boys and girls amounts to 44 percent of all child deaths before the age of five. The increasing gap between rich and poor and between urban and rural areas endangers the previous progress.

The MDGs are interdependent, Hewitt said, pointing out that the MDGs to reduce child mortality and to reduce maternal mortality are closely connected. The fight against hunger and poverty as well as the call for equality play an important role.

Organizations like UNICEF and Save the Children have already started planning for the period after 2015. According to Hewitt, the set development goals mobilized resources - even though the goals were not reached. "There is the historical opportunity to entirely erase avoidable child deaths until 2030."