Millennium Development Goal 4: (1)
Reduce child mortality

Target: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

We certainly live in a world of difference. The death of a child is a tragic loss, yet every year there is a 'silent tsunami' with 8.8 million children under five dying in 2008 4 – that is, 24,000 children a day, an annual loss roughly equivalent to the entire population of Bolivia. Some 40% of these deaths occur within the first month of life; 5 nearly three quarters of these neonatal deaths could be prevented if women were adequately nourished and received an appropriate continuum of care during pregnancy, childbirth and the postnatal period. (2)

In poignant contrast to the growing western problems of childhood obesity and diabetes, malnutrition plays a part in half of these deaths, (2) in turn directly related to poverty. Most mothers breastfeed their babies, but then are unable to afford nutritious food when it is time to wean. Tackling child mortality is not just about feeding starving children. To stay healthy, all children need clean water, food, healthcare and a home. Around 400 million children have no access to safe water. Shockingly in an era when we can unravel the human genome, perform amazing surgical procedures and produce ultra-sophisticated designer drugs, some 1.4 million children die every year because they simply lack access to safe drinking water and adequate sanitation. (2) Others succumb to gastroenteritis or pneumonia (6) for a lack of oral rehydration solution or basic antibiotics. HIV/AIDS is a huge and growing problem for children. In 2006, the estimated number of children under 15 years old living with HIV was 2.3 million – 87% of whom are in sub-Saharan Africa. (2) Furthermore, around 15.2 million children have lost one or both parents to AIDS.

Kingdom goals

As Christians we share greater goals than MDG 4 – not only for justice and physical health for the world's children but also the 'life in all its fullness' that Jesus came to bring. (7) He called his followers to walk in his shoes, to be both the 'light' and 'salt' the world needs so much – that perfect mixture of grace, love, compassion and mercy with holiness, justice and righteousness that lies at the heart of the Gospel and mission. How amazing that the God of eternity, who formed the vastness of the cosmos and the intricate mechanism of each ion channel also identifies with the poor:

Whatever you did for one of the least of these brothers of mine, you did for me. (8)

He who oppresses the poor shows contempt for their Maker, but whoever is kind to the needy honours God. (9)

We therefore have a special responsibility to care for the vulnerable, the widows and orphans, the forgotten refugees, and especially the children.

Progress

Substantial progress has been made, with global under-five mortality falling 28% from 1990-2008. Countries such as Bangladesh and Malawi have shown proof of concept that MDG 4 is achievable even in poor environments. (4) However, there are large disparities between different groups and countries, 2 exacerbated in conflict zones. If current trends continue, the MDG will not be achieved until 2045 – thirty years later than planned. (2) (13)

Except for Afghanistan, all of the 34 countries with mortality rates higher than 100 per 1,000 live births are in sub-Saharan Africa. Hopefully, improvement will be seen with interventions such as insecticide-treated bed nets; prevention of vertical transmission of HIV; vitamin A supplementation; and immunisation for Haemophilus influenzae type B, measles and tetanus. However pneumonia, the single leading cause of death in children, 6 has been neglected, and diarrhoeal diseases continue to devastate many lives.

In 2007 the International Health Partnership (IHP) was launched by the UK; 14 and Women and Children First: the Global Business Plan for Maternal, Newborn and Child Health by Norway. 15 These along with the Canadian Catalytic Initiative to Save a Million Lives, 16 have been packaged as part of a broader Global Campaign for the Health Millennium Goals (MDGs). 17 This offers enormous potential to speed progress, though we need to pray for wisdom in the best use of resources to reach those in greatest need.

Making a world of difference

New technological advances have been made in developing vaccines for pneumococcus and rotavirus; low osmolarity oral rehydration therapy; zinc treatment for diarrhoea; long-lasting insecticide-treated bed nets; and artemisinin combination treatments for malaria. All these interventions have the potential to contribute to major gains in child survival if implemented at scale and in an equitable manner. (5) The challenge remains to actually make it happen on the ground.

So what should be our response as Christians? Jesus told his disciples, daunted by a vast hungry crowd: 'you give them something to eat' (18) and he calls us to do the same today. We can all pray and share; supporting CMF's overseas work (19) and that of different missions and agencies such as Tearfund. (20) Sign up to Micah Challenge (21) and mobilise churches to participate actively. Some of us are called to go overseas to serve and encourage and partner in this noble work either with missions or as tentmakers in various secular roles. (22) In preparation, consider attending the annual CMF Developing Health course 19 and a course in working cross-culturally, eg those run at All Nations Christian College; (23) or arrange to visit a church hospital such as Kisiizi Hospital in Uganda (24) to experience modern medical mission.

Go in God's strength for 'unless the Lord builds the house, its builders labour in vain'. (25) As a missionary doctor on his own in a remote area, faced with performing a surgical procedure, wrote: 'it's a tiny needle – but in the mighty hand of God'. (26) Hudson Taylor once said 'God is looking for wicks to burn…the oil and the fire come free'. Let us all press on, not only that MDG 4 is accomplished but also to see the world's children finding for themselves 'life in all its fullness'.