Infant and Neonatal Mortality
About 2.3 million infants died in 2023 — children who didn't reach their first birthday. The global infant mortality rate (IMR) fell from 65 per 1,000 live births (1990) to 27 (2023). Of these infant deaths, ~75% occur in the neonatal period (first 28 days of life). The neonatal-to-infant ratio has risen as later-infancy deaths have been reduced faster.
Key insights
Neonatal share has risen as post-neonatal deaths fell
Globally, deaths under 1 month are now ~75% of all under-5 deaths. The shift has happened because the easiest gains (vaccinations, oral rehydration therapy, antibiotics) saved later-infancy lives faster than they addressed neonatal causes. Preterm birth complications, intrapartum complications, neonatal infections, and birth defects together cause most neonatal deaths — these require functioning maternity health systems.
Country gaps remain wide
Nordic countries: 2-3 deaths per 1,000 live births. Most OECD: 3-6. USA: ~5.4 (higher than peer OECD, often attributed to coverage gaps and prematurity rates). Africa average: ~45. Worst: Sierra Leone, Somalia, CAR, South Sudan, Chad — 60-80 per 1,000. The 30× gap is wider than for most other health indicators.
Sub-Saharan Africa drives the future trajectory
Three-quarters of remaining under-5 deaths occur in sub-Saharan Africa. SDG target 3.2 calls for IMR under 12 per 1,000 globally and NMR under 12 in every country by 2030. At current rates, most sub-Saharan African countries will miss the target. Interventions known to save lives — skilled birth attendance, neonatal resuscitation, kangaroo care, antibiotics, ITNs — exist but coverage gaps persist.
Global infant mortality rate 1960–2023
Deaths under age 1 per 1,000 live births
Key Finding: Steady decline from 122 (1960) to 27 (2023). Half of the total decline has come since 2000.
Infant mortality rate — selected countries (2023)
Deaths under age 1 per 1,000 live births
Key Finding: 20-fold gap between best and worst major economies; US is an outlier among high-income countries.
Methodology & caveats
IMR, NMR, U5MR
IMR = deaths under age 1 per 1,000 live births. NMR (neonatal mortality rate) = deaths in first 28 days per 1,000 live births. U5MR (under-5 mortality) = deaths before age 5 per 1,000 live births. The three nest: U5MR > IMR > NMR. Ratios between them indicate which age band is most vulnerable in each country.
Why the US is high among OECD
US IMR ~5.4 vs OECD average ~3.0. Possible factors: higher rates of preterm birth, gaps in prenatal care for uninsured women, racial disparities (Black IMR ~10.6, white IMR ~4.3), reporting differences (US counts very early extreme-preterm births as live births where some countries record as stillbirths). The reporting-differences explanation accounts for ~25% of the gap; the rest reflects health-system performance.
Measurement issues
Civil registration of births and deaths is incomplete in many low-income countries; survey-based estimates fill the gap. Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) ask mothers about live births and child deaths. Misclassification of stillbirth vs early neonatal death is common. The UN IGME models reconcile multiple sources.