The infant mortality rate (IMR) tracks the number of deaths of children under one year of age for every 1,000 live births. This measure reflects a population’s overall health and the effectiveness of its healthcare systems. Over the past several decades, Brazil has achieved a significant reduction in its national IMR. However, this national average conceals ongoing challenges and persistent inequalities that affect communities across the nation.
The Evolution of Infant Mortality in Brazil
Brazil has transformed its infant mortality landscape over the last few decades. In the early 1990s, the country’s IMR was recorded at 33.9 deaths per 1,000 live births in 1994. Through public health efforts and socioeconomic changes, this figure saw a steady decline, and by 2011, the rate had fallen to 13.6 per 1,000 live births.
This downward trend, however, began to lose momentum after 2009. Between 2015 and 2019, the neonatal mortality rate, which accounts for deaths in the first 27 days of life, saw only a slight reduction from 8.78 to 8.60 per 1,000 live births. In 2016, the country documented a slight rise in mortality for children under one, interrupting a 25-year period of decline.
Primary Causes of Infant Deaths
Most infant deaths in Brazil are concentrated in the neonatal period, with conditions related to birth and immediate post-natal care being the leading factors. Prematurity and low birth weight are strongly associated with a higher risk of mortality. Complications during labor and delivery, such as birth asphyxia, and infections acquired shortly after birth also contribute to neonatal deaths.
Beyond the neonatal window, other factors contribute. Congenital malformations, which are structural or functional anomalies that occur during intrauterine life, are a cause of infant deaths. Infectious diseases, including diarrhea and pneumonia, have become less prevalent causes due to public health interventions but still represent a threat. The mother’s health and well-being are directly linked to these outcomes, and access to comprehensive prenatal care is foundational in mitigating many of these risks.
Public Health Strategies and Successes
The reduction in Brazil’s infant mortality can be attributed to several public health initiatives. A primary component of this success is the country’s Unified Health System (Sistema Único de Saúde – SUS), established in 1988, which constitutionally guarantees free healthcare access to all citizens. This system laid the groundwork for programs aimed at improving maternal and child health outcomes.
Building on SUS, the Family Health Strategy (Estratégia Saúde da Família – FHS), launched in 1994, was impactful. This program embedded primary care teams within communities, improving access to services like prenatal check-ups, vaccinations, and health education. The strategy was complemented by social programs such as Bolsa Família, a conditional cash transfer program that linked financial assistance for low-income families to health-related requirements, such as attending prenatal appointments and adhering to vaccination schedules.
Regional and Social Disparities
Despite national achievements, health gains have not been distributed equally across Brazil. Stark regional disparities persist, with infant mortality rates remaining highest in the less developed North and Northeast regions. In 2019, the neonatal mortality rate in the North was 10.3 per 1,000 live births, considerably higher than the rates in the more affluent Southeast and South regions.
These disparities are further pronounced among demographic groups. Infant mortality rates are higher for children born to Black and mixed-race mothers compared to those born to white mothers. In one city, the mortality rate for infants of white mothers dropped from 30.4 to 13.9 per 1,000 between 1982 and 2004, while for infants of Black and mixed-race mothers, the decline was from 53.8 to 30.4 per 1,000, widening the gap. These differences are often linked to systemic factors, including poverty and unequal access to quality prenatal and neonatal care.