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The South American (SA) region is particularly vulnerable to climate change and El Niño Southern Oscillation (ENSO) events which threaten its economy and sustainable development. Therefore, climate adaptation is a regional priority. At least 6% of SA population live at low-elevation coastal zones (LECZ) exposed to sea-level rise, ENSO variability and storminess. This paper reviews some recent and current adaptation experiences in SA coasts focusing on (i) socioeconomic and vulnerability status, (ii) links between adaptation and sustainable development, and (iii) constraints to adaptation. Despite the regional economic growth and poverty reduction over the last decade, an adaptation deficit to current climate variability persists. Overall, SA countries show a poor link between public policies, adaptation, and theoretical-academic scope. Public adaptation efforts in coastal areas are mostly oriented towards risk assessment, vulnerability and reduction of impacts at urban and touristic settlements. Many experiences developed from the academy follow the community-based adaptation (CBA) approach mainstreamed into local plans. Adaptation constraints are linked with poverty, social priorities, allocation of resources and the multifaceted impacts of climate change. Two coastal CBA case studies in Venezuela and Uruguay based on scientific and local knowledge show that non-structural adaptation measures can improve the populations’ perception of risks, provided that stakeholders, mainly the community, are informed and integrated to define adaptation actions. There are lots of plans and less specific actions. We propose that the assessment of adaptation success has to rely on implementation and effectiveness criteria rather than solely on plans. [ABSTRACT FROM PUBLISHER]