Understanding Factors Influencing Success in Lowering Child Mortality: Evidence from 1990 to 2010

Y. Natalia Afonso, Johns Hopkins University
David Bishai, Johns Hopkins University
Robert Cohen, Johns Hopkins University
Taghreed Adam, World Health Organization (WHO)
Shyama Kuruvilla, World Health Organization (WHO)

Since 1990, under-5-mortality (U5MR) has declined by 41% worldwide, with Millennium Development Goal (MDG) 4 requiring a 75% reduction overall by 2015. This paper compares two possible sources of progress: improvements in levels of health interventions, social and environmental determinants (health determinants) versus improvements in their efficacy. Using the Oaxaca Blinder method, an econometric method used to compare the effects of different contributing characteristics, this paper decomposes the progress made by 142 low- and middle- income countries. Reductions in U5MR since 1990 were due primarily to changes in levels of health determinants, more than changes in their efficacy or impact. These findings align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.