Aspiration #4 Every child survives and has a healthy childhood. Although there has been some improvement, far too few of Africa’s children survive birth and the first year of their lives. In Africa as a whole, the infant mortality rate decreased from 90 deaths per 1 000 live births in 1990 to 54 deaths per 1 000 live births in 2014. In 1990, the under-5 mortality rate (per 1 000 live births) in Africa was 146; in 2012 it had decreased to 65. While significant progress has been made since the adoption of the African Children’s Charter, the rate is still unacceptably high. The major causes of infant mortality in Africa are preventable. Asphyxia among infants can be prevented if more skilled birth attendants are available; malaria can be contained if universal distribution of insecticidetreated mosquito nets is achieved; and appropriate antibiotics can prevent pneumonia. Many early child deaths could be prevented with access to simple, affordable vaccinations, in line with the Global Vaccine Action Plan (GVAP) 2011-2020. In 2016, African Ministers of Health, Finance, Education, Social Affairs and Local Governments adopted the Declaration on Universal Access to Immunisation as a Cornerstone for Health and Development in Africa (Immunisation Declaration), committing themselves to continued investment in immunisation programmes. A high maternal mortality rate has a direct bearing on the prospects of neonatal survival. While the average maternal mortality ratio for African countries has decreased from 870 per 100 000 live births in 1990 to 460 in 2013, the African rate is still much higher than anywhere else in the world. Systemic and socially-embedded causes contributing to this situation include low contraceptive prevalence rates; high adolescent birth rates; limited ante-natal care coverage; and a high unmet need for family planning. Sustained improvement to child and maternal survival require improvements to the health care system, including physical access to health facilities (as measured by walking distance). According to the African Children’s Charter (article 14), not only is the enjoyment by every child of the right to the best attainable health a central concern, but it also spells out specific obligations, for example that the State must ensure the reduction of infant mortality rates. Since May 2009, when the AU had launched the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) to accelerate action towards improving maternal and newborn health and survival across the continent, 44 AU member States have launched 14