Maternal and child mortality worsens in Latin America and the Caribbean.

The response to the COVID-19 pandemic in most Latin American and Caribbean countries has led to the suspension or limitation of reproductive, maternal, neonatal, and child health (RMNCH) services that need restoration as soon as possible to avoid premature deaths. The UNDP–UNICEF commissioned report, Challenges posed by the COVID-19 pandemic in the health of women, children, and adolescents in Latin America and the Caribbean, finds that the ongoing reduction in coverage is reversing achievements made in the past two decades on maternal and child mortality.

Before the pandemic, the association between the 2019 RMNCH coverage index and health outcomes was evident in the region: the higher the index, the lower the maternal mortality ratio (MMR) and the under-5 mortality rate (U5MR). The correlation coefficients that measure the linear relationship between the index and the MMR (R2=0·6741) and between the index and the U5MR (R2=0·7023) mean that the RMNCH coverage index explains around 70% of the variance between countries in the MMR and in the U5MR (appendix). In most countries included in the Lives Saved Tool study, the pandemic might reverse years-long achievements towards the 2030 Agenda for the Sustainable Development Goal 3 target of less than 70 maternal deaths per 100 000 livebirths and 25 under-5 deaths per 1000 livebirths (appendix).

We should expect that the countries with better RMNCH coverage and lower mortality are the ones that can best cope with the pandemic's consequences. Of the seven countries with the highest RMNCH index, five dedicate the highest percentage of gross domestic product (GDP) to public spending on health: Cuba (10·9%), Uruguay (6·5%), Costa Rica (5·6%), Argentina (5·6%), and Chile (5·0%); the others spend less than 5·0% of GDP, except for Nicaragua (5·4%). Only the three countries that top the list have maintained access to all health services despite the pandemic and are characterised by a public health system that relies on a strong primary health-care strategy that is equitable, has a high-resolution capacity, and is articulated with the hospital network.

These data more than justify the need to strengthen RMNCH services instead of suspending or limiting them, by: (1) increasing public spending on health and social policies to control the pandemic and to favour social and economic reactivation and reconstruction; (2) restoring and rebuilding essential health services; and (3) strengthening the primary health-care strategy.