The Millennium Developmental Goal (MDG) 4, initiated in 1990 aiming to reduce mortality of children under 5 years of age (U5M) by two-third in 2015, was achieved in China to an average level lower than 15/1000 in 20121–3 (table 1). Given China's size (1.34 billion population with 16 million deliveries annually), this milestone has worldwide implications. This milestone was achieved through a combination of efforts: social, economic, governmental and medical.4 Over the two and half decades, U5M has undergone three phases of dramatic changes in China. First, the reduction of diarrhoea and pneumonia occurred between 1990 and 1999 as a result of enhanced public health policy in effect and living standard improvement when China was in transition from a low-income country towards a low-to-middle-income developing country, accounted for by improved public healthcare system through vaccination in infancy and childhood, housing and water supply, sanitation and essential healthcare.

Another prominent advance was significant reduction of maternal and infant mortality between 2000 and 2008,3 ,4 achieved by prenatal monitoring of high-risk pregnancy complication and in-hospital delivery, by eradication of neonatal tetanus and alleviation of birth asphyxia and by prevention and treatment of various neonatal diseases, including prenatal diagnosis and neonatal surgery. In general, in this period, there was rapid urbanisation so that maternal and infant healthcare was more efficient than that in rural areas in each province until 2010 when urban residents exceeded 50% of the total population. More very preterm infants survived from …