The Brazilian city of Rio de Janeiro has recorded more deaths than births for the sixth consecutive month as the country struggles to contain its coronavirus outbreak.
City authorities reported 36,437 deaths and 32,060 births in March, according to government data.
That same month, at least 10 other Brazilian cities with populations exceeding 500,000 registered more deaths than births, according to CNN.
The proportion of those deaths that were a result of a COVID-19 infection was not immediately clear, but the figures come with Brazil having recorded the world's second-highest coronavirus death toll after the US.
As of Tuesday, more than 358,000 deaths in Brazil were reported as a result of COVID-19, according to a tracker from The New York Times.
President Jair Bolsonaro has largely shrugged off the impact of the virus, and his government has sought to conceal information about the true extent of the disaster.
On April 6, Brazil recorded more than 4,000 COVID-19 deaths within a 24-hour period for the first time.
Intensive-care units are above 90% capacity across most Brazilian states, The Associated Press reported Sunday, citing local data. Seven in 10 hospitals are close to running out of oxygen and anesthetic, the AP said.
Bolsonaro has long refused to enforce a nationwide lockdown and previously said that the virus was a "little flu" about which people should "stop whining."
Bolsonaro has defended his approach, and last week he dismissed being called "genocidal" in his coronavirus response.
"They called me homophobic, racist, fascist, a torturer and now ... what is it now? Now I am ... someone who kills a lot of people? Genocidal. Now, I'm genocidal," he said.
Even with large stocks of vaccines already ordered, Brazil has been slow to roll out shots to its 211 million citizens.
As of Wednesday morning, just 32 million shots had been administered, according to a tracker from the G1 Globo news outlet.
Bolsonaro has also cast doubt on the efficacy of vaccines, saying in December that taking the Pfizer-BioNTech shot could "turn people into crocodiles."
Brazil had planned to vaccinate its population only with doses of the AstraZeneca-Oxford vaccine, but it has ordered backup supplies of China's CoronaVac vaccine, made by Sinovac Biotech, to try to bypass production delays.