On April 5, 2013 it will have been 4,594 days since 189 nations made a commitment to deliver the eight Millennium Development Goals, and marks 1,000 days left to make them happen. If the world can deliver on their commitments, this could mean, amongst other bold achievements, meeting Millennium Development Goal 4: reducing the under-five mortality rate by two-thirds between 1990 and 2015, and saving the lives of 4.4 million children in these last 1000 days.
I'm supporting the UN Foundation's Momentum 1,000 initiative, which aims ignite that sense of urgency in the final days of the MDGs. On each of the next 100 days, Save the Children will be marking the day as the deadline approaches. At the UN General Assembly in September this year we'll join world leaders and the heads of agencies in reviewing progress and working with them to identify the challenges ahead. We will be setting out what we think it will take to take MDG 4 even further and achieve the breakthrough of our EVERY ONE Campaign to end the preventable deaths of children before their fifth birthday. We'll be talking about how we can scale up the simple solutions we know can save lives, like immunisations, and how we can take forward the bold aims of achieving universal health coverage.
One of the things I find most exciting about being part of this movement towards achieving the MDGs is the success we've seen already: the number of children dying of preventable causes before their fifth birthday has fallen from 12 million a year in 1990 to 6.9 million today. Stunting -- or damage to a child's physical and cognitive development caused by malnutrition -- declined in developing countries from 45 percent to 28 percent between 1990 and 2008, and the prevalence of underweight children also fell. In other areas too we've seen great progress, in the span of just ten years, 56 million more children were enrolled in primary school.
But not all the numbers are inspiring. The birth day is the riskiest day of their lives for the 48 million women who give birth each year without a skilled health worker present and there's still a shortage of 350,000 trained midwives worldwide. Many countries are also struggling with high rates of child mortality; countries like India which accounts for 20 percent of the total global percentage of child deaths, and Nigeria which sees 2,000 of its children dying every day from preventable causes.
While the MDGs themselves have gained broader support and commitment than perhaps was at first expected, they've drawn criticism too. One of the architects of the MDGs has since said that they "reinforced the money-metric and donor-centric view of development". They were too top down, by using a one size fits all approach they put the highest expectations on those least able to deliver, and accountability has been weak. In the pursuit of quantity, the Goals skipped over quality and equity. There are more children in primary schools, but are they learning anything? For the one third of children not included in MDG4, we didn't even aim to save their lives, and they were already the children the most likely to be born into the poorest families with the fewest chances. In being palatable the Goals forgot the politics, and the context -- Save the Children's Rewrite the Future Campaign focussed on getting the millions of children affected by conflict a basic education, something not referenced in MDG2.
As attention has turned to addressing these shortcomings in what comes next after the MDGs, we shouldn't forget that the strongest platform for any post-2015 goals will be achieving the task we already have in hand. Our focus needs to remain on what we are doing now to make the world a better place for children, in the spirit that the world signed up to the MDG goals.
So while the work to make good on our pledges is immense, with the right focus, partnerships and momentum it's still possible, and the impact of achieving these goals would be staggering. 1.3 million children's lives could be saved every year -- and that's just with one of the MDGs achieved.
In Save the Children's report Ending Poverty in Our Generation we have outlined the necessary steps we need to take in order to build a new MDG framework that will continue the progress towards achieving those targets. The report's recommendations include a need to create a new framework that is transparent, addresses inequalities and develops a global mechanism where citizens can hold their governments to account. In setting out plans, we ask that high burden countries include a focus on reaching the poorest children; incorporate the indirect interventions that are the responsibility of other actors; and include a strong monitoring framework and regular review process, with input from civil society and other stakeholders.
The report also highlights the one goal we've made weakest progress on, MDG 8: "A Global Partnership for Development". Working together across sectors to deliver these goals should be the lynchpin of the Post-2015 framework. A new framework will need to include a leadership role for the private sector to develop alliances with local governments in order build on momentum and continue the targets set out by the MDGs.
For the first time in human history it is conceivable that we could end preventable child deaths, eradicate hunger and rid the world of the scandal of absolute poverty. I don't think that we could have said that in the year 2000, let alone the marker date for the MDGs of 1990. But to get there will require a resolute focus not only on what target we want to reach, but how we can make these aims deliver for the poorest.
Is it still possible to reach our goals? That depends on how we use the next 1,000 days.