The Lottery of Birth

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Blanca, six hours old, in Kopsiro Health Facility in Bungoma County, Kenya. Photo: Colin Crowley/Save the Children

The Lottery of Birth shines a spotlight on the children left behind by global and national progress in child mortality reduction.

The report is based on inaugural analysis of disaggregated data from 87 low- and middle-income countries around the world.

Examining inequality in children’s chances of survival – between subnational regions, urban and rural areas, ethnic groups, and economic groups – this report explores a series of fundamental questions:

  • What is the magnitude of the problem? How many countries are leaving children behind?
  • Is inequitable progress in reducing child mortality inevitable?
  • Does focusing on disadvantaged groups mean overall progress will necessarily be slower?
  • What can be done to allow countries to shift onto more equitable pathways, ensuring that disadvantaged groups catch up with those with lower child mortality rates?

The new evidence presented in this report reveals that equitable progress is not only possible, but faster. It contradicts the widespread belief that reaching the poorest and most disadvantaged groups is harder and therefore likely to slow progress. This report makes a powerful case for putting action to tackle inequalities in child survival at the heart of the global fight against poverty – including in the post-2015 framework and in national development strategies.


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