Maternal and child health in Brazil: progress and challenges

Abstract

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil's progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women's health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.

Anaemia and iron deficiency between 2003 and 2007 in Amazonian children under 2 years of age: trends and associated factors

“…Prematurity is the leading cause of infant deaths in Brazil, predisposing infants to greater nutritional risk, particularly anaemia, due to low Fe status at birth. Despite higher prematurity rates, the prevalence of low birth weight has remained stable at 8 % since 2000 (9) , a level similar to that found in the present study. One explanation for this trend of stable low birth weight concomitant with higher prematurity may lie in the lower frequency of intra-uterine growth restriction (31) .…”

“…In addition to the combined interventions of Fe supplementation and compulsory flour fortification for the prevention of ID (7,8) , in recent years Brazil has seen a major expansion in the Family Health Program (FHP), created to reach individuals from the most impoverished regions of the country (9) . However, few studies assessing the effectiveness of these actions for reducing ID in young infants are available, particularly in the Amazon region.…”

Determinants of child malnutrition in rural and urban Ecuadorian highlands

“…Prematurity is a common cause of infant mortality and its prevention has been suggested as crucial for the application of stunting management strategies (36,37) . Our results also demonstrated the influence of preterm delivery on stunting for the pooled sample.…”

Sexual and reproductive health and rights in public health education

“…All this politicisation and activism did not change the reality that overmedicalisation of women's health is the rule, and that abortion, available only in the private sector, is illegal and remains an important cause of morbidity and mortality. 26 Government support in Brazil is further reflected in access to funding for tertiary institutions for research in sexual and reproductive health and rights issues. 27 There have also been joint initiatives of the National Research Council and the Special Secretariat for Policies for Women.…”