Your coverage of Unicef’s child mortality report (18 March) paints a stark picture. Progress is plateauing and most childhood deaths in 2024 were preventable. This burden is not felt equally; over 80% of under-five deaths occur in sub-Saharan Africa and south Asia.
Neonatal conditions account for over a third of deaths in children under five. Too often, public birth facilities in fragile systems fail when mothers and babies need them most, leaving survival to chance. The barriers are tragically consistent: delays in deciding to seek care, reaching a facility, receiving timely adequate care and recognition of complicated cases with prompt referral.
To stop preventable deaths, we don’t need “miracle” inventions, we need to fix the most dangerous gaps in basic care. A modern delivery room is useless if the doors are locked at night, and a stockroom full of medicine is pointless if there isn’t a professional to administer them. Even the best-equipped clinic can’t function if the lights won’t turn on. When these basics are consistently in place, we can ensure reliable protection for mothers and babies.
Pakistan provides a powerful example of this approach. In 2012, one in 11 children in Punjab died before their fifth birthday. By getting the basics right, with our support, the government increased facility deliveries by over 350,000 annually in just three years – the total volume surpassed even the NHS. This contributed to a 35% reduction in infant mortality rates by 2024. Similar success in Sindh has seen delivery rates at public facilities more than double since 2017. This transformation came from doing the basics well, consistently.
This report must serve as a wake-up call. No woman should depend on luck to survive childbirth – and no baby should die for lack of the basics we already know how to deliver.
Dr Farhana Zareef
Acasus, Toronto, Canada
