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Fifty countries are not making enough progress in cutting the numbers of deaths of children and women in childbirth to meet the Millennium Development Goals in 2015, according to a new analysis.

Among 68 countries considered a priority because of their high death rates, only 16 are on track to reach the MDG 4 on reducing child deaths in spite of increased funding from donor countries and an international effort to help. Fewer still may be significantly reducing women’s deaths in childbirth (MDG 5), but progress is hard to monitor, according to experts writing in a special edition of the Lancet this week.

Some countries have made significant progress – China is now on target for MDG 4. But many more, mostly in sub-Saharan Africa, have made no progress or are doing worse, says the report by Countdown to 2015 for Maternal, Newborn and Child Survival, which includes UN organizations.

“Only three countries have moved from not on-track to on-track since the last Countdown report [in 2005],” said Jennifer Bryce, a senior scientist at Johns Hopkins Bloomberg School of Public Health in Boston, US, and one of the authors.

Peru, Brazil and Indonesia have made the most progress on reducing deaths in children under-five, the new report shows. Bottom of the league are 10 African countries where child mortality has risen: Chad, Cameroon, South Africa, Equatorial Guinea, Congo, Kenya, Lesotho, Zimbabwe, Swaziland and Botswana. HIV and conflict have in many cases been a significant factor in the worsening death rate.

The highest maternal mortality rate is in Sierra Leone, where 2,100 women die in every 100,000 live births. For comparison, the rate in the UK is eight to 100,000.

The Countdown group has identified a range of interventions which can make a difference – including immunization, insecticide-treated bed nets, exclusive breastfeeding, vitamin A supplements, and the employment of more midwives.