North Korea’s infant mortality rate rose for a second consecutive year in 2023, reversing decades of progress amid the prolonged impact of COVID-19 border closures and disruptions to childhood vaccinations, according to new estimates released Tuesday by a U.N. agency.

The U.N. Inter-agency Group for Child Mortality Estimation (IGME) estimates that in 2023, the under-five mortality rate in North Korea stood at 18 deaths per 1,000 live births, reflecting an increase for the second consecutive year. In 2022, the under-five mortality rate was estimated at 17.72 per 1,000 live births.