The mortality of girl children is a good indicator of gender equality and women's rights. Not only are the causes of child mortality (disease, malnutrition) linked to women's health and education, but if girls do not survive at equivalent or higher rates than boys, this can be a sign of specific gender-based discrimination. Child mortality has decreased globally from 106 per 1,000 live births to 83 in 2005. This is not fast enough. To meet MDG4, the mortality rate must drop to 31 per 1,000 live births by 2015. Figure MDG4.1 shows that all regions are seeing a drop in child mortality, but at the current rate of decrease, MDG4 will not be met until 2045.

Figure MDG4.1: Under-Five Mortality Rates have Decreased, but Gender Inequality Still Exists in Some Regions

The decrease in under-five mortality rates since 1990 has been striking for both boys and girls. Child mortality rates have been roughly halved in East Asia and the Pacific, CEE/CIS and Latin America and the Caribbean.

Notes: Under-five mortality rate is the probability of a child born in a specific year or period dying before reaching the age of five. The under-five mortality rate is not a rate per se. Values shown correspond to weighted averages for 2006. Sources: WHO (2008); and UN Statistics Division database

There are significant regional variations in infant and child mortality rates particularly from a gender perspective. In South Asia and in East Asia and the Pacific, more girls die before their fifth birthday than do boys (see Figure MDG3.5). There has been little deviation from this gender gap since 1990. According to Action Aid, various factors are behind the missing millions of girls and women, including sex-selective pregnancy termination, as well as neglect and discriminatory access to food and medicine.

Women's education levels – especially secondary and higher – significantly affect child survival and well-being. Figure MDG3.5 shows the link between under-five mortality and immunisation coverage for measles and women's education. Changes in child mortality levels are strongly differentiated across socio-economic status according to the Millennium Development Goals Report 2007. The most substantial reductions in child mortality have been observed in the richest 40 per cent of households, where mothers have higher levels of education and better access to basic healthcare.