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A new report says too often a child’s survival depends on place of birth, parents’ income and ethnicity. Save the Children calls it an unfair lottery of birth that violates every child’s right to an equal start in life.

Save the Children CEO Carolyn Miles said, in many countries, a child’s survival is a matter of chance.

“We looked at the implications of child survival across 87 countries actually in this report. And what we found was the most deprived kids – those in sometimes rural areas or at the bottom of the socio-economic ladder – those were the children that were dying at the highest rates.”

The report, The Lottery of Birth, saID, “In 78 percent of the countries studied, at least one social or economic group…is being left behind.” In 16 percent of the countries, the report found “inequalities in children’s survival chances increased across all the groups” for which data was collected. But the report said there are countries already trying to close the equality gap.

Miles said, “When they did that – when they actually made parity between, for example, the poorest and the wealthiest kids – they actually dropped [the] mortality rate faster. We need to worry about the most deprived kids. And actually when we do that our progress on something like child survival can actually be faster. So that’s the real nut of this report.”

Much progress has been made over the years in reducing child mortality rates. Save the Children says, currently, 17,000 fewer children die every day compared to 1990. And the under-five child mortality rate has been cut nearly in half.

But Miles said that many children still don’t have an equal chance to survive. The worst child inequality is found in sub-Saharan Africa. She said focusing on the “most deprived kids” levels the playing field.

“Rwanda is a really good example -- Malawi, another good example – where governments have really focused on the poorest, the hardest to reach kids. They’ve made great progress on dropping child mortality. So, saving more kids lives. And they’ve closed that equity gap.”

She said giving all children an equal chance to survive should be part of the Sustainable Development Goals. The SDGs will replace the Millennium Development Goals that expire at the end of this year. She said that the goals should focus on programs known to boost a child’s chances of survival.

“Common diseases are still killing many kids in the developing world. So vaccination campaigns that actually reach some of these hard to reach areas. They might be in the rural areas. They might be in deep urban slums. But making sure that when we do vaccination campaigns we’re looking at reaching every child. So that’s one example. Under nutrition is a big factor in child mortality. And so making sure that those nutrition programs again are getting to all children,” she said.

The Save the Children report encourages governments to spend their own money on child survival programs and not simply rely on donors.

Miles said, “We have seen real progress in places like Ethiopia, for example, where the government has made a huge commitment to child survival. And they have funded tens of thousands of community health workers to be in villages and towns where the health system doesn’t get to. And it’s resulted in much, much better child survival rates in Ethiopia, for example.”

The report recommends Universal Health Coverage to “ensure that poor and marginalized groups have access to quality services.” Save the Children said its “ultimate vision is a world in which no child dies from preventable diseases, no matter where they are born or who their parents are.”