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Child Mortality and Maternal, Neonatal and Child Health in Iraq in the Last Two Decades: Trends and a Way Toward the SDG Targets for Child Survival

Background: Iraq has experienced decades of devastating wars and conflicts, which profoundly affected health including higher child mortality during 1990s. We examined the recent trends for child mortality and maternal, neonatal, child health and family planning (MNCH-FP) services since early 2000s during which Iraq also experienced war, invasions and conflicts.   
 
Methods:  We conducted in-depth secondary data analyses using Multiple Indicator Cluster Surveys from 2006, 2011, and 2018.  We examined national and subnational rates and trends for neonatal and under-five child mortality and 27 MNCH-FP indicators at national, regional and governorate levels. We used Lives Saved Tool (LiST) to model the impact of expanding coverage for child mortality reduction.  
 
Findings: From 2006 to 2018, under-five child mortality (U5MR) dropped from 40.9 to 27.1 deaths per 1,000 livebirths; neonatal mortality (NMR) declined from 21.6 to 13.3 deaths per 1,000 livebirths, with overall annual rate reductions (ARR) of  3.4% and 4.1%, respectively. ARRs were greater in Kurdistan (U5MR: 8.3%; NMR: 10.6%) compared to South/Central region (U5MR: 2.7%; NMR: 3.2%). Child mortality increased during post-2003 war and ISIS invasion periods. Analysis of governorates shows heterogeneity with limited progress in several governorates. LiST modeling suggests that universal scale up of MNCH interventions by 2030 could reduce 39% of child deaths in Iraq.   
 
Interpretation: Despite wars, conflicts, and invasions, Iraq demonstrated significant resilience and is poised to reach SDG-3.1 goals in upcoming years. However, significant inequity persists by regions, governorates, and socioeconomic variables. Addressing this is critical to strategically accelerate child mortality reduction in Iraq. 
 
Funding: UNICEF Iraq Office through contributions from the Government of Canada and Czech Republic. 
 
Declaration of Interest: All authors declare no competing interests.