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Every Child Deserves a 5th Birthday. The U.S. Government’s Contribution to A Promise Renewed.

USAID has played a vital role for decades in the development and delivery of low-cost, high-impact interventions to reach the most vulnerable children around the world. These long-term investments have been paying dividends. In the 24 countries where USAID focuses its maternal and child health effort, maternal mortality declined by 40 to 65 percent. Under the President’s Malaria Initiative, 12 of the focus countries have had reductions in childhood mortality rates, which ranged from 16 to 50 percent.

Family planning helps women bear children at the healthiest times so mother and child are both more likely to survive and stay healthy. A USAID-supported analysis found that if all birth-to-pregnancy intervals were increased to 3 years, 1.6 million under-5 deaths could be prevented annually. Children born close together are at increased risk of contracting and dying from infectious diseases and have higher rates of malnutrition. As the largest bilateral donor of family planning, USAID works in more than 45 countries across the globe to increase access to family planning information and services.

Undernutrition is linked to 45 percent of under-5 deaths. Nutrition in the first 1,000 days of life, from when a woman becomes pregnant to her child's second birthday, offers an incredible opportunity to impact a child's ability to grown, learn and climb out of poverty. Undernutrition can weaken a child's immune system and make him or her more susceptible to dying from common illnesses.

The United States continues to be a leader in fighting undernutrition. USAID is pleased to be part of the Scale Up Nutrition (SUN) global movement, which encourages increased political commitment and programmatic alignment to accelerate reductions in global hunger and undernutrition, and promotes a focus on the 1,000-day window of opportunity from pregnancy to a child’s second birthday.

An HIV-positive woman must have access to medication to give birth to an HIV-free baby. USAID and implementing partners have provided PMTCT services to more than 750,000 HIV-positive women, which resulted in 230,000 infants being born free of HIV.

Managing birth asphyxia:

Every year, 1 million babies die in their first minutes of life because they do not receive enough oxygen. Managing birth asphyxia does not take expensive drugs; it requires some very basic medical training. USAID is working to manage birth asphyxia through supporting resuscitation training and equipment in partnership with the private sector in more than 50 countries.

Clean cord care:

A baby’s newly cut umbilical cord can be an entry point for bacteria, which can lead to potentially life-threatening sepsis. Using inexpensive chlorhexidine digluconate to cleanse a cord is a cost-effective strategy to reduce neonatal mortality that can be used by all levels of health workers, regardless of where women deliver.

Kangaroo mother care:

In low-resource settings, preterm infants can be cared for using kangaroo mother care. Keeping a newborn infant warm is one of the most important things that can be done to ensure that newborns, particularly premature newborns, survive. Kangaroo mother care includes exclusive and frequent breastfeeding, extensive skin-to-skin contact and support for the mother-infant relationship.


Vaccines are the best public health investment we can make. USAID continues to strengthen vaccination programs and supports research on new vaccines. Together with other donors, the Obama Administration’s $450 million, multi-year commitment to the Global Alliance for Vaccines and Immunizations (GAVI) will help save 4 million children over the next 5 years.

Sanitation and hygiene:

Pneumonia and diarrhea are the leading killers of children. Handwashing with soap can cut deaths from diarrhea by almost half and from acute respiratory infections by a quarter. USAID is working to provide access to clean drinking water to encourage handwashing with soap and to provide safe excrement disposal methods.

ORS and zinc have been proven to be highly effective in reducing the effects of diarrhea, one of the leading killers of children under 5. In June 2012, USAID signed a public-private partnership in which $20 million was pledged to support diarrhea treatment programs, including the scale-up of the inexpensive and effective ORS plus zinc combination.

Malaria accounts for 30 to 40 percent of hospital visits for children under 5 in most African countries. By combating malaria, we are freeing up hospital beds and resources for other children. Nets and indoor spraying have reduced childhood malaria deaths in sub-Saharan Africa by as much as 50 percent.

The Global Roadmap

The Global Roadmap [PDF, 7.4MB], unveiled at the Call to Action launch event, pulls together the world’s knowledge about how to accelerate child survival, drawing on the latest peer-reviewed statistics and modeling of the global health community. The Global Roadmap includes five strategic shifts in how we "do business."

  1. Increasing efforts in the 25 countries that currently (2013) account for 75 percent of under-5 deaths
  2. Scaling up access to underserved populations
  3. Addressing the priority causes that account for nearly 60 percent of deaths:
    • Neonatal conditions
    • Pneumonia
    • Diarrhea
    • Preterm birth complications
    • Malaria
  4. Investing beyond health programs to include empowering women
  5. Unifying around a shared goal and using common metrics to track progress