A/HRC/33/23 VI. Issues in focus A. Mortality projections 53. Estimating child mortality is challenging for most developing countries. Only about 60 countries worldwide have fully functioning and complete civil registration systems that can be relied on as a single source to produce reliable mortality estimates. Where there are no well-functioning civil registration systems, modelling exercises are usually required to generate reliable child mortality estimates. The challenges become even greater in the context of conflict and humanitarian crisis. 54. The Inter-Agency Group for Child Mortality Estimation noted a wide variation in how European countries define infant mortality, owing to differences in birth and death registration practices — that is, “differences in the cut-off points for acceptable weight or estimated gestation period to be registered as a birth and subsequent death”.8 This is the case for some of the Eastern European countries. 9 The Committee on the Rights of the Child in its concluding observations on Uzbekistan (CRC/C/OPSC/UZB/CO/1) raised that issue and indicated that the State party’s definition of a live birth was not consistent with the internationally recognized WHO definition, thus hindering an objective assessment of the actual rates of neonatal infant mortality and the effective implementation of approaches for addressing it (CRC/C/UZB/CO/3-4). 55. Scenario-based projections by WHO indicate that, between 2016 and 2030, 94.4 million children are projected to die before the age of 5 years if the 2015 mortality rate remains constant in each country, and 68.8 million would die if each country continues to reduce its mortality rate at the pace estimated from 2000 to 2015. If all countries achieve the relevant target of the Sustainable Development Goals, the projections would stand at 56 million deaths by 2030.10 56. Sub-Saharan Africa will face unique challenges in reducing the number of child deaths. If current trends continue, 37 million children in sub-Saharan Africa will die in the next 15 years.11 Extensive efforts will be required to provide the services and interventions necessary to meet the additional demand generated by a growing number of live births and chid population in the region. There is a 95 per cent probability that the number of children under 5 years will grow by an extra 26 to 57 million, going from 157 million in 2015 to 183-214 million in 2030.12 In South Asia, reducing child mortality must also be urgently accelerated. Two out of the 8 countries in the region, Afghanistan and Pakistan, will need to accelerate progress to achieve the target of the Sustainable Development Goals. Further support is to be given to those countries to ensure that the right of the child to survival is implemented on equal basis with other regions. 57. In order to monitor effectively the number of children dying, the development of civil registrations systems to gather accurate, timely, disaggregated data that can inform decision-making, programming and planning is required. In that respect, well-functioning civil registration systems are essential to bring about accountability for the implementation of the 2030 Agenda for Sustainable Development, as they provide the most reliable basis 8 9 10 11 12 12 Inter-Agency Group for Child Mortality Estimation, “Report 2015”, p. 13. Ibid., p. 14. “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 Inter-Agency Group for Child Mortality Estimation” (WHO, 2015). Ibid. Ibid. GE.16-11320