The coronavirus pandemic is affecting women more than men in Latin America and pregnant mothers above all, threatening to roll back 20 years of advances in access to family planning, the Pan American Health Organization said on Wednesday.

Women are more likely than men to live in poverty, take on unpaid work and lose their jobs during the pandemic, while pregnant women are at higher risk of getting severe cases of COVID-19, the World Health Organization’s regional branch said.

“Right now, many Latin American women are facing the impossible choice between earning a paycheck and protecting their health. And for too many, healthcare remains out of reach,” PAHO Director Carissa Etienne said in a briefing.

According to United Nations estimates, up to 20 million women in the Americas will have their birth control disrupted during the pandemic, either because services are unavailable or because women will no longer have the means to pay for contraception.

Reproductive services are affected, while pregnancy and newborn care have been disrupted in half of the countries in the Americas, leaving expectant and new mothers at risk.

“If this continues, the pandemic is expected to obliterate more than 20 years of progress in expanding women’s access to family planning and tackling maternal deaths in the region,” Etienne said.

Some women may go through their entire pregnancies without seeing a doctor at time when care could not be more critical, she said.

Because their immune systems change throughout their pregnancies, pregnant women are more vulnerable to respiratory infections, like COVID-19, and if they get sick, they also tend to develop more serious symptoms that require intubation.

Data from 24 countries indicates that more than 200,000 pregnant women have fallen sick with COVID-19 in the Americas, and at least a thousand have died from complications, according to PAHO.