Abstract
BACKGROUND: In 2015, the UN General Assembly set Sustainable Development Goals (SDGs), in which SDG 3.2 called for all countries to reach a neonatal mortality to at least as low as 12 per 1000 live births by 2030. As the SDG era enters its final years, especially after the COVID-19 pandemic, it is time to take stock of worldwide trends in terms of neonatal mortality and progress towards SDG target 3.2. We aimed to evaluate the time trends in neonatal mortality from 1990 to 2023 with projections towards SDG target 3.2 at the global, regional, and national levels. MATERIALS AND METHODS: Annual neonatal deaths and neonatal mortality rate (NMR) between 1990 and 2023 at the global, regional, and national levels were collected from a dataset complied by the UN Inter-agency group for Child Mortality Estimation. The percentage changes in neonatal deaths and the estimated annual percentage changes (EAPCs) in NMRs at the global, regional, and national levels were calculated. The year in which the location with an NMR above 12 deaths per 1000 live births would achieve the SDG 3.2 NMR target was estimated using time-series analyses. RESULTS: Globally, the number of neonatal deaths decreased by 56.42% from 5.24 million in 1990 to 2.28 million in 2023 and the NMR decreased by an average of 2.54% (95% CI: 2.44%, 2.63%) per year from 36.70 deaths per 1000 live births in 1990 to 17.33 deaths per 1000 live births in 2023. The global NMR is expected to achieve SDG target 3.2 by 2036. At the regional level, the NMR decreased significantly in all SDG regions between 1990 and 2023 but remained above SDG target 3.2 in Sub-Saharan Africa, Central and Southern Asia, and Western Asia and Northern Africa, with NMRs of 26.41, 20.74, and 12.80 deaths per 1000 live births in 2023, respectively. Sub-Saharan Africa and Central and Southern Asia are projected to reach the SDG 3.2 target by 2068 and 2041, respectively. At the national level, the NMR increased significantly in Dominica (EAPC = 3.95; 95% CI: 3.74, 4.17), Botswana (EAPC = 1.92; 95% CI: 1.14, 2.70), Grenada (EAPC = 1.06; 95% CI: 0.48, 1.63), and Eswatini (EAPC = 0.32; 95% CI: 0.19, 0.44) between 1990 and 2023. Among the 200 countries and territories worldwide, 125 have already met SDG target 3.2, and 7 are expected to do so by 2030. Of the remaining 68 countries that would not achieve SDG target 3.2 by 2030, 11 would meet it between 2031 and 2040, 12 would meet it between 2041 and 2050, and 37 would meet it after 2050, if the average rate of decline from 1990 to 2023 continues; however, the NMR would be deteriorating in Dominica, Botswana, Grenada, Venezuela (Bolivarian Republic of), Eswatini, Zimbabwe, Dominican Republic, and Fiji. CONCLUSIONS: Despite substantial progress in reducing the NMR worldwide since 1990, more than a quarter of countries and territories would miss SDG target 3.2 by 2030, and nearly half of those countries and territories would meet SDG target 3.2 after 2050. Urgent actions are needed in most regions and countries with high NMRs, particularly those in sub-Saharan Africa.