The under age 5 mortality rate is an indicator of child health, as well as of the overall development and well-being of a population. The UN Sustainable Development Goals target reducing under age 5 mortality to below 25 per 1 000 live births by 2030. In 2023, 4.8 million children died worldwide before their fifth birthday (WHO, 2025[1]), with under-five mortality rate estimated at 36.7 per 1 000 live births.
The average under-five mortality rate across LAC33 countries was 16.3 deaths per 1 000 live births (Figure 3.6). Uruguay, Chile, Cuba, Antigua and Barbuda, Argentina and Barbados achieved rates of less than 10 deaths per 1 000 live births. Mortality rates in Guyana, the Dominican Republic and Dominica, were high, between 25 and 36 deaths per 1 000 live births, while rates in Haiti were very high, reaching 52.8 deaths per 1 000 live births. These countries also had the highest infant and neonatal mortality in the region, as seen in the previous section. While under age 5 mortality has declined by an average of 43% in LAC countries between 2010 and 2024, progress varies significantly amongst countries. Countries such as El Salvador, Saint Vincent and the Grenadines, Nicaragua, Bolivia and Haiti, reported a drop of over 80%, while the rate increased by 30% in Dominica, 29% in Venezuela, and 28% in Cuba. Haiti saw a reduction of 159% in the period, over the improvement average in the region.
Causes of under‑5 mortality in the LAC region are very heterogeneous (Figure 3.7). The leading causes are presented using broad ICD‑10 categories grouping multiple diseases. The category “other causes”, which includes conditions such as foetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery and necrotizing enterocolitis of foetus and newborn, accounts for the highest mortality rates overall, with 82 deaths per 10 000 live births in the LAC region. Among specific cause groups, under‑5 mortality deaths rates reach 36.9 deaths per 10 000 live births for perinatal respiratory and cardiovascular disorders, 12.8 for congenital malformations, 10.4 for perinatal infections, 10.5 for disorders related to length of gestation and 6.3 for influenza and pneumonia. Dominica has the highest under‑5 mortality rates for perinatal respiratory and cardiovascular disorders, while Guatemala shows the highest rates for perinatal infections and influenza and pneumonia.
Across LAC countries, under‑5 mortality tends to be inversely related to the current health expenditure per capita (Figure 3.8). Chile and Uruguay have the lowest under‑5 mortality rates, with fewer than 7.5 deaths per 1000 live births, less than half the LAC average, and are among the six countries with the highest health expenditures per capita (Chapter 6). However, Panama reports an under‑5 mortality rate of 13 deaths per 1000 live births with similar expenditure. In contrast, Belize and Nicaragua have achieved the same under‑5 mortality rate with much lower resources. This suggests a non-linear relationship, as health spending is strongly associated with mortality reductions at lower levels of spending, but these reductions diminish as countries approach a mortality floor, given that under‑5 mortality cannot reach zero under real-world conditions. Peru is an example of successful public policies to enhance under‑5 mortality. Interventions including expanding access to antenatal care and facility-based deliveries, ensuring high coverage of vaccines (pneumococcal, rotavirus and Hib), integrating culturally sensitive practices to improve service uptake, vitamin A supplementation and nutrition programmes, and improved safe water and improved sanitation have helped the country moving closer to their SDG goals (García et al., 2024[2]).
