mothers and children matter -so does their health 9 saved in 2003 alone. Towards the turn of the millennium however, the overall down ward trend was showing signs of slowing. Between 1970 and 1990, the under-five mortality rate dropped by 20% every decade; between 1990 and 2000 it dropped by only 12%(see Figure 1. 1). The global averages also hide important regional differences. The slowing down of progress started in the 1980s in the WHO African and Western Pacific Regions, and during the 1990s in the Eastern Mediterranean Region. The African Region started out at the highest levels, saw the smallest reductions(around 5% by decade between 1980 and 2000)and the most marked slowing down. In contrast, progress continued or accelerated in the WHO Region of the Americas, and the South-East Asia and European Regions. he result is that the differences between regions are growing. The under-five mor- tality rate is now seven times higher in the African Region than in the European Region; the rate was " only"4.3 times higher in 1980 and 5. 4 times higher in 1990. Child deaths are increasingly concentrated in the African Region (43% of the global total in 2003, up from 30%in 1990). As 28% of child deaths still occur in South-East Asia, two of the six WHO regions-Africa and South-East Asia-account for more than 0% of all child deaths. Looking at it another way, more than 50% of all child deaths are concentrated in just six countries: China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan The fortunes of the world 's children have also been mixed in terms of their nutritional status. Overall, children today are better nourished: between 1990 and 2000 the global prevalence of stunting and underweight declined by 20% and 18%, respec- tively. Nevertheless, children across southern and central Asia continue to suffer very high levels of malnutrition, and throughout sub-Saharan Africa the numbers of children who are stunted and underweight increased in this period (52) THE NEWBORN DEATHS THAT WENT UNNOTICED If further progress is to be made in reducing child mortality, increased efforts are needed to bring about a substantial reduction in deaths among newborns. The first global estimates of neonatal mortality, dating from 1983(53), were derived using historical data and are generally considered to give only a rough indication of the magnitude of the problem More rigorous estimates became available for 1995 and for 2000. These are based on national demographic surveys as well as on statistical models. The new estimates show that the burden of newborn mortality is considerably Each year, about four million newborns die before they are four weeks old 98%of these deaths occur in developing countries. Newborn deaths now contribute to about 0%of all deaths in children under five years of age globally, and more than half of infant mortality (54, 55). Rates are highest in sub-Saharan Africa and Asia. Two thirds of newborn deaths occur in the WHO Regions of Africa(28%)and South-East Asia (36%)(56). The gap between rich and poor countries is widening: neonatal mortal- ity is now 6.5 times lower in the high-income countries than in other countries. The lifetime risk for a woman to lose a newborn baby is now 1 in 5 in Africa, compared with 1 in 125 in more developed countries (57) do not include the 3. 3 million stillbirths per year. Data on stillbirths are even more scarce than those on newborn deaths. This is not surprising, as only 14% of births in the world are registered. Both live births and deaths of newborns go underreported; fetal deaths are even more likely to go unreported, particularly early fetal deathsmothers and children matter – so does their health 9 saved in 2003 alone. Towards the turn of the millennium, however, the overall down￾ward trend was showing signs of slowing. Between 1970 and 1990, the under-five mortality rate dropped by 20% every decade; between 1990 and 2000 it dropped by only 12% (see Figure 1.1). The global averages also hide important regional differences. The slowing down of progress started in the 1980s in the WHO African and Western Pacific Regions, and during the 1990s in the Eastern Mediterranean Region. The African Region started out at the highest levels, saw the smallest reductions (around 5% by decade between 1980 and 2000) and the most marked slowing down. In contrast, progress continued or accelerated in the WHO Region of the Americas, and the South-East Asia and European Regions. The result is that the differences between regions are growing. The under-five mor￾tality rate is now seven times higher in the African Region than in the European Region; the rate was “only” 4.3 times higher in 1980 and 5.4 times higher in 1990. Child deaths are increasingly concentrated in the African Region (43% of the global total in 2003, up from 30% in 1990). As 28% of child deaths still occur in South-East Asia, two of the six WHO regions – Africa and South-East Asia – account for more than 70% of all child deaths. Looking at it another way, more than 50% of all child deaths are concentrated in just six countries: China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan. The fortunes of the world’s children have also been mixed in terms of their nutritional status. Overall, children today are better nourished: between 1990 and 2000 the global prevalence of stunting and underweight declined by 20% and 18%, respec￾tively. Nevertheless, children across southern and central Asia continue to suffer very high levels of malnutrition, and throughout sub-Saharan Africa the numbers of children who are stunted and underweight increased in this period (52). THE NEWBORN DEATHS THAT WENT UNNOTICED If further progress is to be made in reducing child mortality, increased efforts are needed to bring about a substantial reduction in deaths among newborns. The first global estimates of neonatal mortality, dating from 1983 (53), were derived using historical data and are generally considered to give only a rough indication of the magnitude of the problem. More rigorous estimates became available for 1995 and for 2000. These are based on national demographic surveys as well as on statistical models. The new estimates show that the burden of newborn mortality is considerably higher than many people realize. Each year, about four million newborns die before they are four weeks old: 98% of these deaths occur in developing countries. Newborn deaths now contribute to about 40% of all deaths in children under five years of age globally, and more than half of infant mortality (54, 55). Rates are highest in sub-Saharan Africa and Asia. Two thirds of newborn deaths occur in the WHO Regions of Africa (28%) and South-East Asia (36%) (56). The gap between rich and poor countries is widening: neonatal mortal￾ity is now 6.5 times lower in the high-income countries than in other countries. The lifetime risk for a woman to lose a newborn baby is now 1 in 5 in Africa, compared with 1 in 125 in more developed countries (57). The above figures do not include the 3.3 million stillbirths per year. Data on stillbirths are even more scarce than those on newborn deaths. This is not surprising, as only 14% of births in the world are registered. Both live births and deaths of newborns go underreported; fetal deaths are even more likely to go unreported, particularly early fetal deaths