India, Nigeria, Pakistan, Congo and Angola will account for more than half of global under-five deaths by 2030, according to a UN report which said 69 million children below five will die in the next 14 years unless disadvantaged children are cared for.
'The State of the World's Children', UNICEF's annual flagship report, paints a stark picture of what is in store for the world's poorest children if governments, donors, businesses and international organisations do not accelerate efforts to address their needs.
"Denying hundreds of millions of children a fair chance in life does more than threaten their futures -- by fueling intergenerational cycles of disadvantage, it imperils the future of their societies," said UNICEF Executive Director Anthony Lake.
"We have a choice: Invest in these children now or allow our world to become still more unequal and divided," he said.
The report said that the pace of progress on child and maternal health and survival can increase or decrease as a result of policy choices made by governments and the international community in the coming years.
However, if current trends continue, there will be 3.6 million deaths of children under age 5 in 2030 alone.
A total of 69 million such deaths will have occurred between 2016 and 2030, with sub-Saharan Africa accounting for around half of these and South Asia for another third.
The report said five countries will account for more than half of the global burden of under-five deaths -- India (17 per cent), Nigeria (15 per cent), Pakistan (8 per cent), Congo (7 per cent) and Angola (5 per cent).
The global maternal mortality rate will be around 161 deaths per 100,000 live births -- still five times the level for high-income countries in 1990.
It said pneumonia will remain the second biggest killer of children under the age of five and preterm birth complications will remain the first.
The report noted that significant progress has been made in saving children's lives, getting children into school and lifting people out of poverty.
Global under-five mortality rates have been more than halved since 1990, boys and girls attend primary school in equal numbers in 129 countries and the number of people living in extreme poverty worldwide is almost half of what it was in the 1990s.
But this progress has been neither even nor fair, the report said.
The poorest children are twice as likely to die before their fifth birthday and to be chronically malnourished than the richest.
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Across much of South Asia and sub-Saharan Africa, children born to mothers with no education are almost three times more likely to die before they are five than those born to mothers with a secondary education.
And girls from the poorest households are twice as likely to marry as children than girls from the wealthiest households.
"The geographical distribution of the burden of child mortality is also changing. Globally, child deaths are highly concentrated," it said, noting that in 2015, about 80 per cent of these deaths occurred in South Asia and sub-Saharan Africa, and almost half occurred in just five countries -- Congo, Ethiopia, India, Nigeria and Pakistan.
The report said that while child mortality generally declines as average income increases, many poorer countries are outpacing richer neighbours in reducing their under-five mortality rates.
However, some countries in the fast lane for global economic growth -- including India and Nigeria -- have been in the slower lane for child mortality reduction.
"The policy lesson: economic growth can help but does not guarantee improved child survival and a country's income need not hinder progress," the report said.
The report points to evidence that investing in the most vulnerable children can yield immediate and long-term benefits.
"Inequity is neither inevitable, nor insurmountable," the report said, adding that better data on the most vulnerable children, integrated solutions to the challenges children face, innovative ways to address old problems, more equitable investment and increased involvement by communities can help level the playing field for children.
