The 2014 Committing to Child Survival: A Promise Renewed progress report – the second in a series intended to track progress on child survival and hold Governments accountable – indicates that many of these deaths could be easily prevented with simple, cost-effective interventions before, during and immediately after birth. “The data clearly demonstrate that an infant’s chances of survival increase dramatically when their mother has sustained access to quality health care during pregnancy and delivery,” said Geeta Rao Gupta, UNICEF Deputy Executive Director in a statement to the press. “We need to make sure that these services, where they exist, are fully utilised and that every contact between a mother and her health worker really counts. Special efforts must also be made to ensure that the most vulnerable are reached.”Since 1990, the number of under-five deaths has been slashed in half from 12.7 million to 6.3 million. But more remains to be done. The first 28 days of a newborn’s life are the most vulnerable and as it stands now almost 2.8 million babies die each year during this period.New analysis points to failures in the health system during the critical time around delivery as a significant contributing factor to these unnecessary deaths. It also shows that there is considerable variation – from country to country and between rich and poor –in the quality of health services available to pregnant women and their babies. Around half of all women do not receive the recommended minimum of four antenatal care visits during their pregnancy. Complications during labour are responsible for around one quarter of all neonatal deaths worldwide. In 2012, 1 in 3 babies (approximately 44 million) entered the world without adequate medical support. While evidence shows that breastfeeding the newborn within one hour of birth reduces the risk of neonatal death by 44 per cent, less than half of all newborns worldwide receive the benefits of immediate breastfeeding. Under-five mortality rate by region, 1990 and 2013. Source: UN IGME 2014. Credits: UNICEFAnalysis of 10 high mortality countries found that less than 10 percent of babies delivered by a skilled birth attendant went on to receive the seven required post-natal interventions, including early initiation of breastfeeding. Similarly, less than 10 per cent of mothers who saw a health worker during pregnancy received a core set of eight prenatal interventions. Those countries with some of the highest number of neonatal deaths also have a low coverage of postnatal care for mothers. Additionally, the education level and age of the mother has a significant bearing on the chances of her baby’s survival. Neonatal mortality rates among mothers with no education are nearly twice as high for those with secondary schooling and above. There is some good news, however. The report suggests that in every region, except sub-Saharan Africa, the proportion of under-five mortality among the poorest sections of society is declining faster than in the richest. “It is deeply heartening that the equity gap in child survival is continuing to narrow,” said Ms. Rao Gupta. “We need to harness this momentum and use it to drive forward programmes that focus resources on the poorest and marginalised households; a strategy which has the potential to save the largest number of children’s lives.”A Promise Renewed is a movement launched by UN Secretary-General Ban Ki-moon to intensify global action to improve the health of women and children and reduce preventable maternal, newborn and child deaths. Since June 2012, 178 Governments, members of civil society and the private sector have signed a pledge to redouble their efforts for the cause.