The First Four Weeks: How Many Babies Die Around the World, Why, and What Could Change It

A plain-language guide to two companion 2026 studies in The BMJ—one counting newborn and child deaths worldwide (Sharrow and colleagues), the other identifying their causes (Perin and colleagues)

Two large studies published in 2026 estimate that about 2.3 million babies died in their first four weeks of life in 2024, almost half of all deaths among children under five worldwide. The leading causes were complications of being born too early, problems around the time of birth, and serious infections—conditions that good newborn care can often prevent or treat. Progress has slowed since 2015, and most of these deaths happen in sub-Saharan Africa and South Asia.

For families whose baby is in a neonatal intensive care unit, or who are simply curious about newborn health, figures like these can feel overwhelming. It may help to know that behind them lies a hopeful story: far fewer babies die today than a generation ago, and the reasons most still die are well understood. This article explains what the new research found, how researchers arrived at their numbers, and what it means for babies and families.

A long effort to help more babies survive

Around the year 2000, the world's governments agreed on a set of goals for a healthier future. One of them, known as Millennium Development Goal 4, aimed to cut deaths among children under five by two-thirds between 1990 and 2015. The world made enormous progress—the death rate fell by more than half—but it did not quite reach the goal [1]. Over those years, researchers kept a careful record of what children were dying from. They noticed something important: deaths from illnesses of older babies and toddlers, such as pneumonia, diarrhoea and measles, were falling quickly; fewer deaths from these three illnesses accounted for half of the drop in child deaths between 2000 and 2013 [2]. Deaths in the first month of life were falling more slowly. By 2008, about four in ten deaths of children under five happened in the newborn period, with being born too early, lack of oxygen around birth and infections among the main causes [3]. Later studies confirmed the pattern and urged that more attention go to babies born too early [4][5]. The next set of global goals, the Sustainable Development Goals, which run to 2030, gave newborns a target of their own: by 2030, every country should have no more than 12 newborn deaths for every 1000 babies born alive [6]. By 2023, experts warned that more than 60 countries were not on track to meet it [7].

Two studies that work as a pair

The two new studies were published side by side in The BMJ, a leading medical journal. The first, by Sharrow and colleagues at UNICEF (the United Nations children's agency), estimated how many children died in 200 countries and areas each year from 1990 to 2024, and looked ahead to 2030 [6]. The second, by a team at Johns Hopkins University in the United States working with the World Health Organization and UNICEF, worked out what those children died from in 195 countries between 2000 and 2024 [8]. You can think of the first study as measuring the size of a cake and the second as slicing it by cause.

Neither study enrolled any patients. Instead, the researchers gathered every reliable record they could find: national birth and death registers, large household surveys in which mothers are asked about the births and deaths of their children, and special studies in places where deaths go unrecorded. Because many countries do not record every death, the teams used statistical models—careful mathematical methods—to fill the gaps. That is why each figure comes with a range, called an uncertainty interval, showing how sure the researchers are.

How many babies died in 2024

About 4.9 million children died before their fifth birthday in 2024—more than 13 000 every day [6]. Of these, about 2.3 million were newborns in their first 28 days, which is nearly half. Worldwide, about 17 of every 1000 babies born alive died in their first month, which is still above the 2030 target of 12.

Where a baby is born makes a very large difference. In West and Central Africa, about 30 of every 1000 newborns died in their first month, while in Western Europe the figure was about 2 in 1000. Sub-Saharan Africa accounted for half of all newborn deaths, although only about a third of the world's babies are born there, and South Asia for another third. There is encouraging news too: since 1990 the newborn death rate has fallen by about half, and South Asia has been speeding up its progress. But overall, the decline has slowed considerably since 2015, and newborn deaths have fallen more slowly than deaths among older babies and toddlers.

What newborns are dying from

The most common cause of newborn death was complications of being born too early (prematurity), responsible for about 820 000 deaths in 2024 [8]. Babies born too soon may struggle to breathe, keep warm, feed and fight infection. Next came problems around the time of birth—for example when a baby does not get enough oxygen during a difficult labour—causing about 480 000 deaths. Serious infections of the blood or of the lining of the brain (sepsis and meningitis) caused about 260 000 deaths, lung infections about 250 000, and conditions present from birth, such as heart defects (congenital abnormalities), about 220 000.

To find out what babies die of in places where doctors rarely examine them after death, researchers use "verbal autopsy": a trained interviewer asks the family about the baby's illness, and the answers are used to work out the likely cause [8]. This method is useful but imperfect; it can get individual causes wrong [9]. For the first time, the new study corrected for this using a project called Child Health and Mortality Prevention Surveillance (CHAMPS), which works in parts of sub-Saharan Africa and South Asia. CHAMPS teams use a technique called minimally invasive tissue sampling, in which tiny samples of tissue are taken after a child has died and examined in a laboratory, so that the cause can be established [10][8]. Together with new data, this correction suggested that infections cause more newborn deaths than earlier estimates showed [8][11]. The researchers also caution that some conditions, such as heart defects, are hard to spot through interviews and may be undercounted [8].

The first days are the most dangerous. An earlier study estimated that in 2013 more than a third of newborn deaths happened on the day of birth and nearly three-quarters within the first week [12].

What this means for babies and families

If you live in a country with well-equipped neonatal units, the risk for your baby is very much lower than these global figures suggest. Experts point out that most newborn deaths are preventable with care that already exists [6][7]. They describe how deaths fall as countries provide skilled care at birth, hospital care for small and sick babies, safe oxygen, breathing support, light therapy for jaundice and strong infection prevention [7]. The researchers behind the new study likewise call for more hospital care for small and sick newborns, while noting that this kind of care is costly and needs strong health systems [8]. In[Neo]Sight has also looked at how survival of the very smallest babies differs around the world in an article on the geography of extreme prematurity.

For families everywhere, the message is that the main causes of newborn death—prematurity, problems during birth and infection—are exactly what newborn teams are trained to prevent and treat. Asking questions, attending antenatal care and knowing the warning signs of infection in a young baby are all part of the same effort.

Looking ahead to 2030

The first study looked at several possible futures. These are "what if" scenarios, not predictions. If countries continue at their recent pace, about 12.9 million newborns could die between 2025 and 2030 [6]. If every country reached the 2030 target, that number would fall to about 9.7 million; if every country matched the average of today's wealthy nations, to about 5.1 million. In other words, millions of babies' lives depend on how quickly care improves. About 66 countries are currently at risk of missing the newborn target.

What researchers are working on next

Both teams stress that better records are essential. Only about one in five of the world's young children live where deaths are reliably registered [6], and countries with stronger registration systems tend to have better health [13]. Researchers want to improve the interview method used to work out causes of death and to expand death registration, so that causes are recorded more accurately [8]. Extending CHAMPS-style checks to more places could also help. The new estimates are already being fed into the Lives Saved Tool, a planning program that helps countries choose which services will save the most lives [14][8]. A third paper in the same collection does the same work for older children and teenagers [15].

The bottom line

Far fewer babies die today than in 1990, but about 2.3 million newborns still died in 2024, mostly from prematurity, problems around birth and infections, and mostly in sub-Saharan Africa and South Asia. These two studies show where progress has slowed and why. Their clearest message is a hopeful one: the care that saves these babies is known, and extending it to every newborn could save millions of lives by 2030.

References

  1. You D, Hug L, Ejdemyr S, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275-2286. doi:10.1016/S0140-6736(15)00120-800120-8) ↩
  2. Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015;385(9966):430-440. doi:10.1016/S0140-6736(14)61698-661698-6) ↩
  3. Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969-1987. doi:10.1016/S0140-6736(10)60549-160549-1) ↩
  4. Liu L, Johnson HL, Cousens S, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151-2161. doi:10.1016/S0140-6736(12)60560-160560-1) ↩
  5. Perin J, Mulick A, Yeung D, et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022;6(2):106-115. doi:10.1016/S2352-4642(21)00311-400311-4) ↩
  6. Sharrow D, Hug L, Liu Y, Fell GW, You D. Global, regional, and national levels and trends in under 5, infant, and neonatal mortality during 1990-2024 with scenario based projections to 2030: modelling study. BMJ. 2026;393:e088684. doi:10.1136/bmj-2025-088684 ↩
  7. Lawn JE, Bhutta ZA, Ezeaka C, Saugstad O. Ending Preventable Neonatal Deaths: Multicountry Evidence to Inform Accelerated Progress to the Sustainable Development Goal by 2030. Neonatology. 2023;120(4):491-499. doi:10.1159/000530496 ↩
  8. Perin J, Prieto-Merino D, Wahi A, et al. Systematic estimates of global causes of neonatal and under 5 mortality in 2000-24: secondary data analysis using bayesian multinomial logistic regression. BMJ. 2026;393:e088686. doi:10.1136/bmj-2025-088686 ↩
  9. Kalter HD, Perin J, Black RE. Validating hierarchical verbal autopsy expert algorithms in a large data set with known causes of death. J Glob Health. 2016;6(1):010601. doi:10.7189/jogh.06.010601 ↩
  10. Bassat Q, Blau DM, Ogbuanu IU, et al. Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network. JAMA Netw Open. 2023;6(7):e2322494. doi:10.1001/jamanetworkopen.2023.22494 ↩
  11. Pramanik S, Wilson E, Kalter HD, et al. Country-specific estimates of misclassification rates of computer-coded verbal autopsy algorithms. BMJ Glob Health. 2026;11(3):e021747. doi:10.1136/bmjgh-2025-021747 ↩
  12. Oza S, Cousens SN, Lawn JE. Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study. Lancet Glob Health. 2014;2(11):e635-644. doi:10.1016/S2214-109X(14)70309-270309-2) ↩
  13. Phillips DE, AbouZahr C, Lopez AD, et al. Are well functioning civil registration and vital statistics systems associated with better health outcomes?. Lancet. 2015;386(10001):1386-1394. doi:10.1016/S0140-6736(15)60172-660172-6) ↩
  14. Walker N, Tam Y, Friberg IK. Overview of the Lives Saved Tool (LiST). BMC Public Health. 2013;13 Suppl 3(Suppl 3):S1. doi:10.1186/1471-2458-13-S3-S1 ↩
  15. Eilerts-Spinelli H, Villavicencio F, Perin J, et al. Estimates of global causes of death for children and adolescents aged 5-19 in 2000-24: secondary data analysis using bayesian multinomial logistic regression. BMJ. 2026;393:e088687. doi:10.1136/bmj-2025-088687 ↩