The under-5 mortality rate is a universal indicator for measuring child survival. It reflects both the performance of health systems and the social, economic, and environmental conditions in which populations, particularly children, live. In the Region, a substantial share of under-5 mortality is currently attributable to neonatal disorders (around 40%), congenital anomalies (around 12%), and sepsis, infectious diseases, and lower respiratory infections (around 19%). 

The under-5 mortality rate in the Americas has declined markedly, halving between 2000 and 2022 from 26.09 to 13.11 deaths per 1000 live births. Assuming a linear decline in both live births and mortality rates, this reduction would represent approximately 2.1 million lives saved over the period. Although the Region is projected to have fallen short of its target of 11.75 deaths per 1000 live births by 2025, the indicator remains on the right track, having achieved 81% (12.26 per 1000 live births) of the required reduction from the baseline of 14.4 in 2017. The downward trend continued even during the COVID-19 pandemic and, if the current pace is maintained, the target could be achieved by the end of 2026, one year later than originally planned. 

Considering that neonatal disorders are the main contributor to under-5 mortality and that the neonatal mortality target was achieved, prospects for further progress in reducing under-5 mortality remain favorable. However, the pace of reduction of the post-neonatal mortality was considerably slower than that observed for neonatal mortality between 2017 and 2024, declining by an average of 1.22% per year compared with 2.2%, respectively. Under-5 mortality rates remain disproportionately high in several countries in the Region, with substantial cross-country variation, ranging from 4.65 to 52.75 deaths per 1000 live births in 2024. Social determinants play a significant role in under-5 mortality, underscoring the urgent need to address disparities across socioeconomic groups.