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The reduction of child mortality is one of the most universally accepted Millennium Goals. However, there is a significant debate on the means of achieving it and on its realism given the situation in most of the least developed countries. The recommendations made for the achievement of this goal are mainly medical ones. However, without underestimating the importance of these measures, in particular vaccinations, it seems increasingly obvious that the rate of reduction of child mortality is mainly determined by the evolution of macroeconomic environment. The influence of the per capita income level on mortality is frequently underlined. But a given level of income growth may not have the same effect on child survival depending on whether it is stable or unstable. Indeed, rises and falls in income probably have asymmetrical effects on mortality. The purpose of this analysis is precisely to show how macroeconomic instability influences the evolution of child mortality. The analysis is based on a panel sample of 97 developing countries over the period 1980–1999. The effect of exogenous shocks is first examined through a variable of income instability. The study of the relation is then deepened with ‘primary instabilities’: instability of world agricultural commodity prices, instability of exports of goods and services and instability of agricultural production.