One of the greatest public-health achievements of recent decades has been driving down child mortality around the world. Now, that long-running decline is reversing.
The number of deaths of children under 5 years old is projected to rise this year for the first time in decades, the Gates Foundation, the philanthropy chaired by billionaire Bill Gates that is a major funder of global health and development causes, said in a report Thursday.
About 243,000 more children under 5 years have died or will die this year than in 2024, according to the projections, which were made by the University of Washington’s Institute for Health Metrics and Evaluation, which measures global-health indicators and is funded in part by the Gates Foundation.
The deaths have risen primarily in African countries including the Democratic Republic of Congo, Somalia and Uganda that have been plagued by conflict, mounting debt interest payments, fragile health systems and recent cuts in foreign health aid, according to Gates and health and development officials.
It will take years, Gates said in an interview, to get back on track. “I think we’re going to have five very tough years where at best we’ll be able to plateau the deaths,” he said.
Driving the shift, Gates said, is a 27% decline in global health aid from donors in wealthy countries, including the U.S. and some European governments. Such aid pays for medicine, health clinics and workers, food and other needs for children in poor countries.
The reductions include the Trump administration’s cutting and reorganizing of the U.S. Agency for International Development. “I believe that was a gigantic mistake, and that’s partly why we’ve had the turmoil and increase in deaths this year,” Gates said.
A White House spokeswoman said the U.S. provides more foreign aid than any other country, including this year. “The Trump administration is ensuring all programs funded by American taxpayers align with American interests,” said White House deputy press secretary Anna Kelly. “Partner countries want to be self-reliant in addressing the needs of their people.”
The deaths of children had been declining at least since 1990 thanks to delivery of vaccines, medicines, better nutrition and access to healthcare to mothers, babies and young children.
Child mortality is projected to keep declining in India and most of the rest of the world this year, according to IHME. The number of deaths expected in 2025—about 4.8 million—is less than half of the 11.6 million reported in 1990.
Across swaths of Africa, however, “our teams describe the same pattern: more children arriving at health centers sicker and in greater numbers,” said Melaku Yirga, vice president for Africa of U.S.-based nonprofit Mercy Corps. “In some clinics, every child who walks in is already malnourished.”
Khadra Hussein Ibrahim said she lost her 2-year-old son, Abdi Bari, to malnutrition a few months ago, after Mercy Corps had to cut the nutrition and other services it was providing her family because of an 80% reduction in funding the organization received from USAID for programs in Somalia.
Ibrahim, 40, and her family have been living in a displaced-persons camp outside of Somalia’s capital, Mogadishu, since fleeing severe drought and conflict in their hometown two years ago.
Mercy Corps’s aid had helped Ibrahim “put food on the table for the kids,” she said. Her newborn son was healthy and playful. Yet after the aid was cut, “we returned to worrying about basic needs,” she said.
Ibrahim said she had to travel long distances to find work and food for her family and eventually became weak from hunger. Her son, who was still breast-feeding, fell sick with diarrhea and dehydration.
Unable to get medical help at the camp, she said, she walked roughly 5 miles to a government hospital, but doctors told her it was too late to save him.
Outbreaks of measles, diphtheria and severe diarrhea are afflicting more children and taking place more frequently because of a drop in vaccinations, health officials in Somalia’s southwest state said.
The officials also said they don’t have enough therapeutic food to treat children with severe malnutrition, and that pregnancy complications are on the rise because expectant mothers have difficulties reaching hospitals.
More than 200 health facilities have closed or stopped operating in Somalia, according to the United Nations. Foreign health aid fell 24% this year in the country, according to IHME, which projects more than 34,000 additional childhood deaths there this year.
Write to Betsy McKay at betsy.mckay@wsj.com and Caroline Kimeu at caroline.kimeu@wsj.com