Maternal and child mortality worsens in Latin America and the Caribbean
Authors: Arachu Castro
Journal: The Lancet (2020)

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,1Castro A Challenges posed by the COVID-19 pandemic in the health of women, children, and adolescents in Latin America and the Caribbean. UNDP Latin American and the Caribbean, COVID-19 policy documents series number 19, September 2020. United Nations Development Program, New York, NY2020Google Scholar 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 index2WHOPrimary health care on the road to universal health coverage: 2019 monitoring report. World Health Organization, Geneva2019Google Scholar 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).1Castro A Challenges posed by the COVID-19 pandemic in the health of women, children, and adolescents in Latin America and the Caribbean. UNDP Latin American and the Caribbean, COVID-19 policy documents series number 19, September 2020. United Nations Development Program, New York, NY2020Google Scholar In most countries included in the Lives Saved Tool study,3Roberton T Carter ED Chou VB Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study.Lancet Glob Health. 2020; 8: e901-e908Summary Full Text Full Text PDF PubMed Scopus (829) Google Scholar 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).1Castro A Challenges posed by the COVID-19 pandemic in the health of women, children, and adolescents in Latin America and the Caribbean. UNDP Latin American and the Caribbean, COVID-19 policy documents series number 19, September 2020. United Nations Development Program, New York, NY2020Google Scholar 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%).4Pan American Health OrganizationCore Indicators 2019: health trends in the Americas. Pan American Health Organization, Washington, DC2019Google Scholar Only the three countries that top the list have maintained access to all health services despite the pandemic1Castro A Challenges posed by the COVID-19 pandemic in the health of women, children, and adolescents in Latin America and the Caribbean. UNDP Latin American and the Caribbean, COVID-19 policy documents series number 19, September 2020. United Nations Development Program, New York, NY2020Google Scholar 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.1Castro A Challenges posed by the COVID-19 pandemic in the health of women, children, and adolescents in Latin America and the Caribbean. UNDP Latin American and the Caribbean, COVID-19 policy documents series number 19, September 2020. United Nations Development Program, New York, NY2020Google Scholar I declare no competing interests. Download .pdf (.46 MB) Help with pdf files Supplementary appendix