Saúde reprodutiva, materna, neonatal e infantil nos 30 anos do Sistema Único de Saúde (SUS)

Abstract

This study presents an overview of public sector interventions and progress made on the women's and child health front in Brazil between 1990 and 2015. We analyzed indicators of antenatal and labor and delivery care and maternal and infant health status using data from the Live Birth Information System and Mortality Information System, national surveys, published articles, and other sources. We also outline the main women's and child health policies and intersectoral poverty reduction programs. There was a sharp fall in fertility rates; the country achieved universal access to antenatal and labor and delivery care services; access to contraception and breastfeeding improved significantly; there was a reduction in hospital admissions due to abortion and in malnutrition. The rates of congenital syphilis, caesarean sections and preterm births remain excessive. Under-five mortality decreased by more than two-thirds, but less pronounced for the neonatal component. The maternal mortality ratio decreased from 143.2 to 59.7 per 100 000 live births. Despite worsening scores or levelling off across certain health indicators, the large majority improved markedly.

Fetal, neonatal, and post-neonatal mortality in the 2015 Pelotas (Brazil) birth cohort and associated factors

“…Inequalities between mortality rates in the first year of life in different regions of the world still persist, and the current risk of death before reaching the age of one in Latin America is twice the risk for children born in North America 1 . In Brazil, in recent decades, there has been a reduction in infant mortality rates (IMR) from 53.4 per 1,000 live births in 1990 to about 13.5 per 1,000 live births in 2016 2 . This decrease can be explained by the implementation of a series of policies, programs, and improvements in social, sanitary, and health conditions, such as poverty and fertility reduction, improvement in female education 3 , urbanization expansion, Brazilian Income Transfer Program (2004), and the increased access to clean water and sanitation that started about 80 years ago 4,5 . Additionally, national programs such as the National Vaccination Program (1973), National Health Assistance for Women and Children (1984), Brazilian Unified National Health System (SUS, 1988), Family Health Strategy (1994), National Humanization Program for Birth Attention (2000), and Healthcare Network for Mothers and Children (2011), among others, contributed to improvements in maternal and infant health services 4 .…”

“…However, despite a 2/3 decrease in infant mortality over the 1990-2015 period, which lead Brazil to meet four of the millennium development goals 4 , continuous monitoring of infant mortality (children under one year) remains a priority in the country. For example, even though the neonatal mortality rate decreased from 23.1 to 9.5 per 1,000 live births , neonatal deaths represented 70% of total deaths during childhood in 2015 4 .…”

“…However, despite a 2/3 decrease in infant mortality over the 1990-2015 period, which lead Brazil to meet four of the millennium development goals 4 , continuous monitoring of infant mortality (children under one year) remains a priority in the country. For example, even though the neonatal mortality rate decreased from 23.1 to 9.5 per 1,000 live births , neonatal deaths represented 70% of total deaths during childhood in 2015 4 . Additionally, infant deaths in 2015 had preventable 6 infectious, nutritional, maternal, and neonatal causes 5 (e.g., a rise in caesarean sections; increased congenital syphilis, premature births, and low birth weight 4 ), all related to poor mother-child health 7 .…”

“…For example, even though the neonatal mortality rate decreased from 23.1 to 9.5 per 1,000 live births , neonatal deaths represented 70% of total deaths during childhood in 2015 4 . Additionally, infant deaths in 2015 had preventable 6 infectious, nutritional, maternal, and neonatal causes 5 (e.g., a rise in caesarean sections; increased congenital syphilis, premature births, and low birth weight 4 ), all related to poor mother-child health 7 . Previous studies have shown that data collection, processing, and analysis of factors associated with infant morbidity and mortality had supported an adequate allocation of resources for planning and restructuring the network of maternal and child care services with the ultimate goal of reducing hospitalizations and infant deaths 7,8,9 .…”

“…These data have been collected through information systems and epidemiologic studies, which are fundamental and of great relevance for the country. Specific limitations of information systems are related to sub-registries, particularly in regions with a historic lack of infant death information 4,10,11,12,13,14 . For example, in 2012 a Brazilian study actively searched for infant deaths in 79 small and medium size municipalities in the North and Northeast of the country, and found that public health monitoring coverage was below 80% in seven states 10 .…”