News Release

Maternal and child health in Brazil: Progress and challenges

Peer-Reviewed Publication

The Lancet_DELETED

Improvements in child survival interventions (including vaccinations), nutrition, and health system access are all believed to have contributed to huge reductions in under-5 child mortality in Brazil, that has declined by around 5% a year in the 1980s and 1990s and by 4% per year since 2000, to a rate of 20 child deaths per 1000 population, of which two thirds die before age 28 days. In this second paper, the authors (Professor Cesar G Victora, Universidade Federal de Pelotas, Brazil, and colleagues) say improved education of women and population urbanisation have also contributed to this great progress. Stunting prevalence nationwide has decreased from 37% in 1975 to 7% in 2007, with differences between regions also decreasing. Median breastfeeding time has increased from around 3 months in the 1970s to 14 months in 2007.

Data is not so clear on maternal mortality, with some studies suggesting no change in the past 10 years while others show a 4% annual decline, with a current maternal mortality ratio estimated at between 50 and 60 per 100,000 population: some 5 times or more that of high-income countries. A major challenge is bringing the caesarean section rate down: Brazil has the highest rate of caesarean section in the world, and almost half of all deliveries (47%) are by this method (80% in private sector vs 35% in SUS). This is three times the rate recommended by WHO (15%) and puts mothers and babies and increased risk of complications and death. Half of the caesarean sections that take place are planned in advance. And at 10 stillbirths per 1000 total births, Brazil's stillbirth rate is more than double that of most high-income countries.

Since induced abortions are illegal in Brazil (except in case of rape or medical danger to the mother), many abortions that do take place are illegal. An estimated 1 million induced abortions take place each year, and unsafe/illegal abortion complications cause 215000 admissions to the SUS system, which only carried out 3230 legal abortions.

While appreciating that there is more work to be done to bring the rates of all the above in line with high-income nations, the authors conclude: "The rate of reductions in stunting, infant mortality, and fertility are among the fastest ever recorded worldwide...an overarching challenge is how to reach those that are hardest to reach, such as rural populations in the Amazon Rainforest and northeast regions, including those living in the 10% of Brazilian municipalities that do not have access to a doctor."

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Professor Cesar G Victora, Universidade Federal de Pelotas, Brazil. In USA until May 6 so contact by e-mail only until then, from May 6 can be contacted by phone also. T) +55 53 9982 6676 E) cvictora@gmail.com


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