A key indicator of children’s health status is the infant mortality rate. The rate in Asia and the Pacific is only half that in Africa but almost twice that in Latin America and the Caribbean. Deaths can be reduced substantially through immunization against common diseases.

The infant mortality rate (IMR) is the number of children, per thousand live births, who die before reaching their first birthday. Countries with higher levels of economic development generally have low IMRs: within Asia and the Pacific, the IMR in high-income economies is only 4 deaths per 1,000 live births, compared with 38 in middle-income economies and 66 in low-income economies. However, some countries have demonstrated that specific interventions can yield good results even at lower levels of development. Geographically, the IMR is the lowest in East and North-East Asia (19) and highest in South and South-West Asia (60).

Between 1990 and 2006, the IMR in Asia and the Pacific fell from 62 to 43, a decline of 32 per cent. Perhaps unexpectedly, the smallest percentage reductions were in those subregions that had the highest infant mortalities in 1990. The reduction in South and South-West Asia, for example, was 30 per cent, and in the Pacific developing economies only 21 per cent – compared with 44 per cent in East and North-East Asia and 48 per cent in South-East Asia.

Subregional averages, however, obscure important differences between countries. Some have achieved good results. In Mongolia, for example, infant mortality increased in 1990 following the transition to a market economy but subsequently declined by 57 per cent. Other countries were also been able to achieve reductions of more than 50 per cent over the 16-year period: Armenia (55 per cent), Indonesia (57 per cent), Thailand (73 per cent) and Viet Nam (60 per cent).

Figure 4.1 – Index of change in infant mortality rates, selected groups of Asia-Pacific countries or areas, 1990-2006

The results in South and South-West Asia are mixed. Bangladesh reduced the IMR by 48 per cent, from a high level. Turkey reduced the IMR by 64 per cent from a relatively high level and Sri Lanka achieved a 58 per cent reduction from a low level. On the other hand, the IMR in India declined by only 30 per cent, from a relatively high level, and that in Pakistan declined by only 22 per cent from a high level.

Figure 4.2 – Infant mortality, Asia and the Pacific, 1990 and 2006

The under-five mortality rate is the number of children who die before reaching their fifth birthday – also expressed as deaths per 1,000 live births in a particular year. It thus includes infant mortality. In 2006, the average under-five mortality rate in Asia and the Pacific was 56, compared with a global average of 72. As with infant mortality, the underfive mortality rate is lower in the more developed countries, In the Asia-Pacific region in 2006, the under-five mortality rate was only 5 in the highincome economies, but 49 in the middle-income economies and 88 in the low-income economies. Again, however, some countries have made good progress even at lower levels of development. By geographical subregion, the under-five mortality rate was the highest in South and South-West Asia, and lower than the regional average in each of the other subregions. As with infant mortality, the highest relative reductions were not among the countries that had the highest rates in 1990.

The United Nations Millennium Declaration aimed to reduce the under-five mortality rate by two-thirds between 1990 and 2015. If the decline in the under-five mortality rate from 1990 had been linear, then countries should by 2006 have reduced the rate by 43 per cent. Globally, however, there has only been a 23 per cent decline. Asia and the Pacific has done better than average, with a 35 per cent decline, but will still need to increase the pace of reduction if it is to meet the target. Within South and South-West Asia, however, several countries are on track to achieve the MDG target. Between 1990 and 2006, Bangladesh reduced the under-five mortality rate by 54 per cent, the Islamic Republic of Iran by 53 per cent, Sri Lanka by 59 per cent and Turkey by 68 per cent.

Some countries in South-East Asia have had similar declines – 63 per cent in Indonesia, 54 per cent in the Lao People’s Democratic Republic, 48 per cent in the Philippines, 74 per cent in Thailand, and 68 per cent in Viet Nam. However
in two countries with high levels of under-five mortality, the declines were modest – only 29 per cent in Cambodia and 20 per cent in Myanmar.

A major contributor to child mortality is malnutrition. A number of countries with high rates of malnutrition also have high rates of under-five mortality – including Afghanistan, Bangladesh, Cambodia, India, the Lao People’s Democratic Republic, Myanmar, Nepal, Pakistan, Tajikistan and Timor-Leste. Although the available data do not permit a thorough analysis of trends, it seems malnutrition is coming down more slowly than infant or under-five mortality. This may be because mortality can be reduced through relatively inexpensive public health measures, such as immunizing children, providing clean water and sanitation, and offering oral rehydration therapy, whereas eliminating child malnutrition may require raising the incomes of poor people through broadly based economic development.

For immunization against common diseases, Asia and the Pacific has performed slightly below the world average. In 2006, in the world as a whole 80 per cent of one-year-old children had received at least one dose of measles vaccine, but in Asia and the Pacific the proportion was 78 per cent. However, there is substantial variation among subregions. The lowest levels are in South and South-West Asia. And those in the Pacific developing economies are also below average. On the other hand, the measles immunization level is above average in South-East Asia and well over 90 per cent in East and North-East Asia and in North and Central Asia.

Figure 4.3 – Under-five mortality, Asia and the Pacific, 1990 and 2006

Figure 4.4 – Prevalence of moderately or severely underweight children, Asia and the Pacific, 1990 and 2006

In South and South-West Asia, India’s low measles immunization rate (59 per cent) reduces the average for the subregion and has a significant impact on the average for Asia and the Pacific as a whole. Indeed, the rate in India is only slightly above the 1990 level, far below the peak of 72 per cent reached in 1995. Other countries in the subregion have done better: Bangladesh has achieved 81 per cent and the rates in Sri Lanka and Turkey are close to 100 per cent.

Immunization with the combination, DPT3 vaccine against diphtheria, pertussis and typhoid follows a similar pattern. India’s low level again pulls down the averages both for the subregion and Asia and the Pacific as a whole. What is alarming is that the latest recorded rate in India is substantially lower than in 1990. Among the smaller countries, immunization rates are lowest in the Lao People’s Democratic Republic – 48 per cent for measles and 57 per cent for DPT3.

Low levels of child immunization are not necessarily the result of low national income. Two low-income economies have performed strongly: Mongolia (99 per cent) and Viet Nam (94 per cent) also have high levels of immunization against
measles.

Figure 4.5 – Index of change in measles immunization of one-year-olds in selected groups of Asian and Pacific countries, 1990-2006

Figure 4.6 – Index of change in DPT3 immunization of one-year-olds in selected groups of Asia-Pacific countries, 1990-2006