Infant mortality rate (IMR) measures a nation’s health equity and overall development. In Brazil, this metric reflects national progress alongside deeply entrenched regional and social inequalities. The country has achieved a significant overall reduction in deaths of children under one year old, aligning its health profile closer to developed nations. Despite this improvement, the national average conceals persistent variations in risk that disproportionately affect vulnerable populations. Understanding Brazil’s IMR requires examining both macro-level successes and the specific demographic groups where progress has stagnated.
The Historical Trajectory of Decline
Brazil experienced one of the most substantial drops in IMR globally, accelerating in the late 20th century. In 1990, the national rate was approximately 52.0 deaths per 1,000 live births, reflecting widespread infectious diseases and poor sanitation.
Over the next two decades, the rate fell by roughly 62%, reaching about 19.9 deaths per 1,000 live births by 2010. This reduction was driven by broad societal changes, including rapid urbanization and improvements in basic sanitation infrastructure. Access to clean water and better waste disposal significantly curtailed waterborne diseases, which historically claimed the lives of older infants.
The decline continued, reaching an estimated 12.50 deaths per 1,000 live births in 2023. This shift reflects a change in leading causes of death, moving away from communicable diseases toward conditions related to the perinatal period. However, the slowing of the decline since the 2010s signals the difficulty of addressing the complex, structural determinants of infant mortality that remain.
Geographic and Socioeconomic Inequalities
The national IMR masks disparities that reveal a fragmented health landscape across the country. A geographic divide exists between the affluent South/Southeast and the less developed North/Northeast. For example, in 2006, the southern state of Santa Catarina recorded an IMR of 12.5 deaths per 1,000 live births.
In contrast, the northeastern state of Alagoas recorded a rate of 42.7 deaths per 1,000 live births during the same period, demonstrating a risk three times higher. Recent data continues to show this pattern, with northern states like Amapá exhibiting rates significantly above the national average. This regional difference is rooted in variations in public service provision and economic opportunity.
Socioeconomic status directly correlates with a child’s chance of survival, often measured by the Family Development Index (FDI). Municipalities in the worst socioeconomic stratum had an IMR of 18.8 deaths per 1,000 live births (2006–2008). This is significantly higher than the 13.4 rate observed in municipalities with the best FDI scores.
Lower maternal education and household income are major determinants of increased infant mortality risk. These socioeconomic vulnerabilities disproportionately affect Indigenous and Afro-Brazilian populations, who face systemic barriers to quality healthcare and sanitation. High IMRs in the poorest areas reflect the intersection of racial, social, and geographic marginalization.
Underlying Factors Contributing to Infant Deaths
Infant deaths are categorized into two periods, each associated with distinct causes and interventions. Neonatal mortality, deaths occurring in the first 27 days of life, is highly sensitive to the quality of maternal and perinatal healthcare. Leading causes are often related to conditions originating in the perinatal period, particularly premature birth and low birth weight.
Other common causes of neonatal death include perinatal asphyxia, which is a lack of oxygen during or immediately after birth, and respiratory distress disorders. The high percentage of preventable neonatal deaths points to deficiencies in the provision of adequate care for women during pregnancy and immediate care for newborns. Such deaths indicate a need for improved access to and quality of high-tech hospital-based services, such as neonatal intensive care units.
Post-neonatal mortality covers deaths between 28 days and one year of age and is more closely linked to environmental and socioeconomic factors. Infectious and parasitic diseases, such as diarrheal diseases and pneumonia, are major causes in this age group. These deaths reflect a lack of adequate sanitation, poor hygiene practices, and insufficient access to primary healthcare for timely treatment and immunization.
Key Public Health Strategies and Interventions
Brazil’s success in reducing its IMR is linked to the expansion of its public health infrastructure. The Unified Health System (SUS) provides universal, free access to healthcare, forming the foundation for key interventions. This comprehensive system was designed to overcome financial barriers that previously prevented the poorest families from seeking medical attention.
The Family Health Strategy (FHS) is a cornerstone of this effort, focusing on community-based primary care with multidisciplinary teams. The FHS is credited with reducing infant mortality, particularly in the post-neonatal period, through preventive care, home visits, and health education. Its decentralized nature allows it to reach vulnerable and rural communities that previously lacked medical services.
The Conditional Cash Transfer Program, Bolsa Família, has also played a substantial role in improving child health outcomes. This program provides financial aid to impoverished families, contingent on compliance with health and education requirements. Families must ensure their children receive routine health check-ups, follow up on development, and adhere to the national vaccination schedule.
The combination of cash transfers and mandatory health monitoring has led to an estimated 9.3% reduction in overall IMR in the program’s initial years. This impact was especially notable in areas with high FHS coverage, where the conditional cash transfer created a powerful incentive for families to utilize the available public health services. Furthermore, the National Immunization Program, operating within the SUS framework, has successfully reduced deaths from vaccine-preventable diseases, contributing to the overall decline in post-neonatal mortality.