Since 1990, significant improvements have been made in child health. The under-five mortality rate has decreased by 49%, from 90 deaths per 1,000 live births in 1990 to 46 per 1,000 in 2013. However, improvements in child survival and health have not been equally distributed and several countries and communities continue facing unacceptably high levels of child mortality. Significant gaps remain between the richest and poorest families, both between countries and within countries. Moreover, the majority of deaths in low-income countries are still from preventable infectious diseases including pneumonia, diarrhea, and malaria. Progress is hindered in many low- and middle-income countries by weak health systems, resulting in global recognition of the importance of investing in health systems strengthening, with particular focus on strengthening the community as an integral component of the broader health system. Lifesaving Solutions The period around birth constitutes a critical window of opportunity for prevention and management of maternal and newborn complications, which can otherwise prove fatal. Availability and accessibility of skilled birth attendants, basic and comprehensive emergency obstetric care, around the time of birth is therefore critical. A large proportion of newborn illnesses and deaths can also be prevented using simple, low-cost interventions during delivery and during the week following birth partum, provided both in the facility and at home (where currently 50 per cent of newborn deaths occur). Regular visits by community health workers at the time of delivery and following birth can be instrumental in preventing complications and post-natal mortality. Essential life-saving interventions include immediately drying the newborn and keeping the baby warm, skin to skin contact, delayed cord clamping, initiating breastfeeding as soon as possible after delivery, supporting the mother to breastfeed exclusively, giving special care to low-birth weight infants, and diagnosing and treating newborn complications such as asphyxia and sepsis. Strengthening referral mechanisms and linkages between different levels of facility-based care, and between health facilities and the community, must be a top priority. Empowering women, families and communities by supporting their involvement and proactive care-seeking for pregnancy care, nutrition, birth preparedness, use of a skilled attendant at birth, recognition of maternal and newborn danger signs, early initiation and exclusive breastfeeding, postnatal care and support for optimal birth spacing is important. In addition, identification of pregnant women by community health workers and continued follow-up and support during antenatal and postnatal period can promote healthy practices and timely care-seeking in case of complications. Facts and Figures

• 17,000 fewer children die each day than in 1990, but more than five million children still die before their fifth birthday each year.
• Since 2000, measles vaccines have averted nearly 15.6 million deaths.
• Despite determined global progress, an increasing proportion of child deaths are in Sub-Saharan Africa and Southern Asia. Four out of every five deaths of children under age five occur in these regions.
• Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families.
• Children of educated mothers—even mothers with only primary schooling—are more likely to survive than children of mothers with no education.