ONE of the happier trends of the first years of this century has been a dramatic fall in infant mortality. In 2013 around 6.3m children under the age of five died around the world, down from 9.7m in 2000. Achieving a two-thirds decline from 1990 mortality rates (when 12.7m children aged five or under died) was one of the UN’s Millennium Development Goals (MDGs), a set of eight development targets for 2015 that were approved at a UN summit in 2000. Working out the extent to which the MDGs were responsible for this decline has become a big part of the debate over whether they were a success and what should replace them when they expire next year.
The main difficulty is to guess what would have happened had the MDGs not been set, points out John McArthur of the Brookings Institution in a new paper, “Seven Million Lives Saved”. During the 1990s the number of child deaths was already falling steeply, and it may be reasonable to assume that this would have continued.
The paper models the counterfactual by extrapolating from the 1990s using data from all 173 countries with populations above 200,000 in 2000, of which 141 were considered “developing” rather than “developed”. Since the decline in infant mortality seemed to accelerate in the second half of the 1990s, it considered two counterfactual trends: one based on the decade and another on 1996-2001, after which the phrase “millennium development goal” began to be used widely by policymakers around the world (see chart). Nearly two-thirds of developing countries included in the study saw the decline in child mortality accelerate compared with 1996-2001.
If the trend for the whole of the 1990s is extrapolated to 2013, 8.2m children under five would have died globally last year; the cumulative total of lives “saved” since 2001 is 13.6m. Using the second extrapolation, the number of child deaths last year would have been around 7.4m—1.1m higher than it actually was—and cumulatively 7.5m more children would have died if that trend had continued.
In Sub-Saharan Africa, where in 2001 only two countries were on track to achieve the MDG child-mortality goal by 2015, more than 90% of countries have seen the decline in child deaths accelerate compared with 1996-2001. (Less happily, the number of countries in Latin America and the Caribbean on track to achieve the goal by 2015 has slipped from 11 in 2001 to six.)
These findings do not prove that setting the MDGs caused child deaths to fall, merely that something improved in the years that followed. Nor does the fact that the biggest improvements came in poorer countries that were the main focus of MDG-inspired policies, lobbying, education and aid. Perhaps all this would have happened anyway. On balance, though, there is good circumstantial evidence that setting the child-mortality MDG helped save millions of young lives.
This article appeared in the International section of the print edition under the headline "The causes of a welcome trend"
