The Challenge of Child Survival in Mexico

In 1984, Mexico launched the National Program for the Control of Diarrheal Diseases, which focused primarily on preventing dehydration by using packets with a standardized formulation of salt and sugar that is dissolved in clean water, a method known as oral rehydration therapy. These were previously proven successful at some regional hospitals, so in addition to distributing these packets through the national health system, health professionals trained patients by providing demonstrations on the proper use of the treatment, while mass media campaigns were implemented to further educate the population on how to use it. Mortality from diarrheal diseases, which were once among the leading causes of death among Mexican children under 5, began to fall sharply over the following decade. The response was also strengthened by programs that improved sanitation, vaccination, nutrition, hygiene, and parents’ understanding of basic child health.

Four decades later, the picture looks very different. It is no longer concentrated in infectious diseases, although these still cause deaths among young children. In Chiapas, as an example, a child can be born into circumstances that negatively affect their well-being, making it harder to survive an otherwise treatable disease. In this case, having access to healthcare means that families can actually reach and use effective healthcare resources. Distance, transportation, unreliable access to basic needs, and the cost of medicines are all driving factors that diminish access to healthcare. According to the National Institute of Statistics and Geography (INEGI), 64.6% of children and adolescents in Chiapas lacked access to health services in 2024 and 74.6% lived in poverty. In addition, fewer than half of households had access to water every day, and 27.3% of children and adolescents spoke an Indigenous language, according to the United Nations Children's Fund (UNICEF). 

In this first article in a series exploring some of Mexico’s most critical challenges and how we can intervene to address them, I examine what more can be done to reduce child mortality. Whoever you are, whether an aspiring entrepreneur, an established professional, someone involved in philanthropy, a person who wants to change gears into a high-impact career, or just someone curious to understand high-priority issues, my goal with this series is to help more people identify where they can actually get involved to make a difference.

I chose this topic because, although child mortality in Mexico is lower than it was in the 1980s and a lot has been done to tackle it, today, too many still die from preventable causes, and Mexico continues to lag behind other Latin American peers. The challenge now, as I will assess further in this article, is effective coverage, that is, ensuring that evidence-based interventions reach those who need them and are delivered with sufficient quality. Doing so requires addressing systemic problems, and although this reflects a kind of law of diminishing returns in social progress, with each additional reduction in mortality becoming harder than it was decades ago, it is possible by addressing the broader conditions that shape children’s lives. 

Limited Resources, Attention

That being said, we’ve seen that in recent years the issue has received limited resources compared with previous years, and therefore limited attention. UNICEF, in this sense, reports that Mexico’s public spending on children fell from 26.5% of social spending in 2018 to 15.8% in 2025. Moreover, Mexico spends approximately 5.9% of GDP on health, considerably less than the OECD average of 9.3%. It also has 2.7 practicing physicians and 3 practicing nurses per 1,000 people, compared with OECD averages of 3.9 and 9.2 respectively. At the same time, in 2024, only 78% of the population had access to essential health services. Mexico’s healthcare system is also fragmented across different institutions, with eligibility historically linked in large part to formal employment status, which means that where you work can influence which institution provides your care and the services available to you and your family.

The first thing that stands out is that the main causes of death among children under 5 have changed over the past decades, helping us identify the underlying causes where we should intervene today. According to UNICEF, in Mexico, deaths in this age group fell substantially between 1990 and 2024, from 44.9 to 13.1 deaths per 1,000 live births. The main causes in 1980 were diarrheal diseases, which killed around 41,500 children under 5 in Mexico, while pneumonia killed another 36,600, meaning that the major causes were infectious. However, by 2023, those numbers dropped significantly, to around 1,040 and 3,290, respectively, according to data from the Institute for Health Metrics and Evaluation (IHME). 

A similar shift can be seen in deaths associated with prematurity, birth asphyxia, birth trauma, and neonatal infections, although at a less steep rate. When looking into the most recent causes, many of the leading ones are now tied to what happens during pregnancy, during childbirth, and the first days of life. In 2024, INEGI, for instance, reported that conditions originating around the perinatal period accounted for 53.9% of deaths among children under 1.

Many of the risks to newborn survival begin with maternal health, long before delivery, in part because many people in the country still lack access to adequate sex education. Without access to information and services, they are less prepared to make informed decisions about the timing and spacing of pregnancies or the number of children they have, and may also be less aware of the importance of preconception care. 

When prenatal care starts late or is inadequate, for instance, conditions that could affect the pregnancy may go unnoticed and untreated, while important opportunities to prevent complications can be missed. This may include treating maternal infections and diseases, identifying risks, providing recommended supplements and vaccinations, and addressing harmful environmental exposures. As Mariana Macouzet, director of strategy and innovation at Save the Children Mexico, told me in a recent call, “a large percentage of the population does not have access to or knowledge about the topic, for example, of screening.”

Other causes point to failures in relatively basic forms of prevention and care. Preventing and treating infections, for example, depends on a series of measures that start with basic conditions such as good hygiene and access to clean water, followed by prevention and early diagnosis, appropriate treatment, and reliable systems for tracking and responding to infections. This remains important for pneumonia and diarrheal diseases, which are still among the 10 leading causes of death in this age group. 

Protecting Children From Illness

Vaccination and breastfeeding remain two effective ways to protect children from illness, as does good nutrition, especially when malnutrition or micronutrient deficiencies are identified and addressed early, before they can lead to more serious problems. These interventions are supported by evidence, but the difficulty lies in whether families can actually access them and whether the surrounding conditions allow families to put them into practice.

This leads to a second important trend, where many of these problems come down to whether families can actually access interventions, and whether practices that help protect children, such as exclusive breastfeeding, are supported and followed. The burden of child mortality in Mexico is therefore far from evenly distributed. Where a child is born and the conditions they grow up in can make a difference. “You can go around boasting about the importance of vaccination, but then people go to health centers and there are no vaccines,” says Macouzet. At Save the Children, she says, they have also seen children become seriously ill or die from something as preventable as a gastrointestinal infection caused by unsafe drinking water.

There are major geographic gaps in access to obstetric specialists, fetal medicine, advanced diagnostics, and neonatal intensive care. For women living far from these services, high-risk pregnancies may be identified later or managed with fewer resources. These gaps can become particularly dangerous during labor and delivery, when inadequate monitoring or delays in recognizing fetal distress can turn manageable complications into emergencies, especially when deliveries take place in facilities without the equipment needed to respond or are attended by informally trained personnel.

After birth, weak referral and transport systems may delay access to neonatal care, while some facilities lack trained neonatal personnel, respiratory support, thermal care, or adequately equipped neonatal intensive care units when these are needed. A child can therefore encounter several points of failure across the same continuum of care, from pregnancy through delivery and the first days of life.

In the end, the result is a paradox in which, as Mexico has succeeded in reducing many of the diseases and conditions that once caused widespread child mortality, the deaths that remain have become increasingly concentrated among those in the early days of life who are least reliably reached by health and social systems. The nature of the problem has changed, and the response needs to change with it.

Target Resources Geographically

After looking at all the evidence, it’s hard to point to one intervention that clearly offers the best cost-benefit ratio. From a pragmatic perspective, the recommendation therefore combines two broad areas. On the one hand, increasing access to high-quality and effective health services is essential, although these alone cannot prevent all new cases. On the other hand, education, behavior change, prevention, and communication can shift family and community practices over the long term. Furthermore, efforts to ensure that children grow up in safe environments free from violence are also essential for both areas to work effectively.

Resources, therefore, should be geographically targeted to the most underserved communities, where gaps in effective coverage are greatest. The priority should be to ensure the identification and management of high-risk pregnancies, skilled childbirth, emergency obstetric services, essential newborn care, and functioning referral systems. The same primary-care platform can deliver other high-impact child-survival interventions, including vaccination, infection prevention, nutrition support, supplementation, screening and timely diagnosis and treatment of common childhood illnesses. 

“For three years now,” explains Macouzet, “in a community in Yucatán, we have been working directly with families and the whole community on dengue prevention. This year there hasn't been a single case of dengue in that community because the practices that the community had have completely changed. That right there is entirely a matter of raising awareness and taking action around prevention.” This example illustrates why behavior change belongs alongside healthcare access in a strategy to reduce child mortality. The strongest interventions are those in which these pieces reinforce one another.

Although not every death before age 5 can be prevented, many can. Several nonprofits, public institutions, and other organizations already bring expertise in these different areas. Closer collaboration can help them complement one another and reach more families. The opportunity is to build on what already works, direct resources toward the communities facing the greatest barriers, and ensure that every child has a better chance to survive and thrive.