Though the under-five mortality rate (death per 1000 live births) was reduced by 53% globally between 2000 and 2015, a nagging area of concern remains: children dying during the first 28 days of life.

According to a UNICEF report released on Tuesday, for approximately one million children in 2015, their first day of life was also their last. Though the under-five mortality rate has reduced, the neonatal mortality rate (probability of dying during the first 28 days of life) is on the rise. In 2015, neonatal deaths accounted for 45% of total deaths, 5% more than in 2000.

Neonatal mortality rate varies across regions. “In sub-Saharan Africa, newborn deaths account for about one-third of the deaths of children under five. South Asia, on the other hand, has both high overall child mortality and a high share of neonatal deaths,” the report states.

The United Nations children’s emergency fund says providing all women with antenatal care, skilled care at birth and essential newborn care can dramatically improve prospects for safe pregnancy and child survival. But glaring disparities — not just in access to care but also in the quality of care across regions have hindered survival prospects of a newborn.

For instance, in both Bangladesh and Pakistan, women from the richest households are four and six times more likely to receive antenatal care than those from the poorest. On the other hand, some of the largest gaps in skilled birth attendance are in Eastern and Southern Africa.

Globally, women from the richest 20% of households are still more than twice as likely as those from the poorest 20% to have a skilled attendant at birth.

The report notes that if the trends of the past 15 years continue for the next 15 years, by 2030, an estimated 167 million children, the great majority in sub-Saharan Africa, will still be living in extreme poverty. Approximately 3.6 million children under age five will die that year, still from mostly preventable causes.

Also, countries may have made gains in improving child survival, but children’s lives are increasingly threatened in countries affected by conflict. The Syrian Arab Republic, for instance, had made impressive progress in reducing under-five mortality prior to the current conflict there.