Maternal and child health in Brazil: progress and challenges

Detalhes bibliográficos
Autor(a) principal: Victora, César Gomes
Data de Publicação: 2011
Outros Autores: Aquino, Estela Maria Motta Lima Leão de, Leal, Maria do Carmo, Monteiro, Carlos Augusto, Barros, Fernando Celso Lopes Fernandes de, Szwarcwald, Célia Landmann
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UFBA
Texto Completo: http://www.repositorio.ufba.br/ri/handle/ri/3066
Resumo: 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 aff ected 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 diff erences 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. Offi cial 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 offi cial 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.
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spelling Victora, César GomesAquino, Estela Maria Motta Lima Leão deLeal, Maria do CarmoMonteiro, Carlos AugustoBarros, Fernando Celso Lopes Fernandes deSzwarcwald, Célia LandmannVictora, César GomesAquino, Estela Maria Motta Lima Leão deLeal, Maria do CarmoMonteiro, Carlos AugustoBarros, Fernando Celso Lopes Fernandes deSzwarcwald, Célia Landmann2011-10-04T13:30:59Z2011-10-04T13:30:59Z20110140-6736http://www.repositorio.ufba.br/ri/handle/ri/3066v.377, n.9780, p.1863-76, 2011.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 aff ected 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 diff erences 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. Offi cial 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 offi cial 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.Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2011-10-04T13:30:59Z No. of bitstreams: 1 Per int 2011.13.pdf: 491979 bytes, checksum: cef00f836566ddd09ce75bfc61d7de9d (MD5)Made available in DSpace on 2011-10-04T13:30:59Z (GMT). No. of bitstreams: 1 Per int 2011.13.pdf: 491979 bytes, checksum: cef00f836566ddd09ce75bfc61d7de9d (MD5) Previous issue date: 2011New YorkSocial ConditionsHealth ServicesMaternal and Child HealthMaternal-Child Health ServicesMaternal and child health in Brazil: progress and challengesThe Lancetinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleengreponame:Repositório Institucional da UFBAinstname:Universidade Federal da Bahia (UFBA)instacron:UFBAinfo:eu-repo/semantics/openAccessORIGINALPer int 2011.13.pdfPer int 2011.13.pdfapplication/pdf491979https://repositorio.ufba.br/bitstream/ri/3066/1/Per%20int%202011.13.pdfcef00f836566ddd09ce75bfc61d7de9dMD51LICENSElicense.txtlicense.txttext/plain1907https://repositorio.ufba.br/bitstream/ri/3066/2/license.txtbf5461cb72473add895113d211307017MD52TEXTPer int 2011.13.pdf.txtPer int 2011.13.pdf.txtExtracted texttext/plain82827https://repositorio.ufba.br/bitstream/ri/3066/3/Per%20int%202011.13.pdf.txt0f2cbd7e2c269aad631725b27b37735aMD53ri/30662022-07-05 14:03:14.636oai:repositorio.ufba.br:ri/3066TGljZW5zZSBncmFudGVkIGJ5IE1hcmlhIENyZXV6YSBTaWx2YSAobWFyaWFrcmV1emFAeWFob28uY29tLmJyKSBvbiAyMDExLTEwLTA0VDEzOjMwOjU5WiAoR01UKToKClRlcm1vIGRlIExpY2Vuw6dhLCBuw6NvIGV4Y2x1c2l2bywgcGFyYSBvIGRlcMOzc2l0byBubyAKcmVwb3NpdMOzcmlvIEluc3RpdHVjaW9uYWwgZGEgVUZCQQoKICAgIFBlbG8gcHJvY2Vzc28gZGUgc3VibWlzc8OjbyBkZSBkb2N1bWVudG9zLCBvIGF1dG9yIG91IHNldQpyZXByZXNlbnRhbnRlIGxlZ2FsLCBhbyBhY2VpdGFyIGVzc2UgdGVybW8gZGUgbGljZW7Dp2EsIGNvbmNlZGUgYW8KUmVwb3NpdMOzcmlvIEluc3RpdHVjaW9uYWwgZGEgVW5pdmVyc2lkYWRlIEZlZGVyYWwgZGEgQmFoaWEgbyBkaXJlaXRvCmRlIG1hbnRlciB1bWEgY8OzcGlhIGVtIHNldSByZXBvc2l0w7NyaW8gY29tIGEgZmluYWxpZGFkZSwgcHJpbWVpcmEsIApkZSBwcmVzZXJ2YcOnw6NvLiBFc3NlIHRlcm1vLCBuw6NvIGV4Y2x1c2l2bywgbWFudMOqbSBvcyBkaXJlaXRvcyBkZSAKYXV0b3IvY29weXJpZ2h0LCBtYXMgZW50ZW5kZSBvIGRvY3VtZW50byBjb21vIHBhcnRlIGRvIGFjZXJ2byBpbnRlbGVjdHVhbAogZGVzc2EgVW5pdmVyc2lkYWRlLiAKCiAgICBQYXJhIG9zIGRvY3VtZW50b3MgcHVibGljYWRvcyBjb20gcmVwYXNzZSBkZSBkaXJlaXRvcyBkZSAKZGlzdHJpYnVpw6fDo28sIGVzc2UgdGVybW8gZGUgbGljZW7Dp2EgZW50ZW5kZSBxdWU6IAoKICAgIE1hbnRlbmRvIG9zwqAgZGlyZWl0b3MgYXV0b3JhaXMsIHJlcGFzc2Fkb3MgYSB0ZXJjZWlyb3MsIGVtIGNhc28gCmRlIHB1YmxpY2HDp8O1ZXMsIG8gcmVwb3NpdMOzcmlvIHBvZGUgcmVzdHJpbmdpciBvIGFjZXNzbyBhbyB0ZXh0byAKaW50ZWdyYWwsIG1hcyBsaWJlcmEgYXMgaW5mb3JtYcOnw7VlcyBzb2JyZSBvIGRvY3VtZW50byAoTWV0YWRhZG9zIGRlc2NyaXRpdm9zKS4KIERlc3RhIGZvcm1hLCBhdGVuZGVuZG8gYW9zIGFuc2Vpb3MgZGVzc2EgdW5pdmVyc2lkYWRlIAplbSBtYW50ZXIgc3VhIHByb2R1w6fDo28gY2llbnTDrcKtZmljYSBjb20gYXMgcmVzdHJpw6fDtWVzIGltcG9zdGFzIHBlbG9zIAplZGl0b3JlcyBkZSBwZXJpw7NkaWNvcy4gCgogICAgUGFyYSBhcyBwdWJsaWNhw6fDtWVzIGVtIGluaWNpYXRpdmFzIHF1ZSBzZWd1ZW0gYSBwb2zDrcKtdGljYSBkZSAKQWNlc3NvIEFiZXJ0bywgb3MgZGVww7NzaXRvcyBjb21wdWxzw7NyaW9zIG5lc3NlIHJlcG9zaXTDs3JpbyBtYW50w6ptIApvcyBkaXJlaXRvcyBhdXRvcmFpcywgbWFzIG1hbnTDqm0gbyBhY2Vzc28gaXJyZXN0cml0byBhbyBtZXRhZGFkb3MgCmUgdGV4dG8gY29tcGxldG8uIEFzc2ltLCBhIGFjZWl0YcOnw6NvIGRlc3NlIHRlcm1vIG7Do28gbmVjZXNzaXRhIGRlIApjb25zZW50aW1lbnRvIHBvciBwYXJ0ZSBkZSBhdXRvcmVzL2RldGVudG9yZXMgZG9zIGRpcmVpdG9zLCBwb3IgCmVzdGFyZW0gZW0gaW5pY2lhdGl2YXMgZGUgYWNlc3NvIGFiZXJ0by4KCiAgICBFbSBhbWJvcyBvIGNhc28sIGVzc2UgdGVybW8gZGUgbGljZW7Dp2EsIHBvZGUgc2VyIGFjZWl0byBwZWxvIAphdXRvciwgZGV0ZW50b3JlcyBkZSBkaXJlaXRvcyBlL291IHRlcmNlaXJvcyBhbXBhcmFkb3MgcGVsYSAKdW5pdmVyc2lkYWRlLiBEZXZpZG8gYW9zIGRpZmVyZW50ZXMgcHJvY2Vzc29zIHBlbG8gcXVhbCBhIHN1Ym1pc3PDo28gCnBvZGUgb2NvcnJlciwgbyByZXBvc2l0w7NyaW8gcGVybWl0ZSBhIGFjZWl0YcOnw6NvIGRhIGxpY2Vuw6dhIHBvciAKdGVyY2Vpcm9zLCBzb21lbnRlIG5vcyBjYXNvcyBkZSBkb2N1bWVudG9zIHByb2R1emlkb3MgcG9yIGludGVncmFudGVzIApkYSBVRkJBIGUgc3VibWV0aWRvcyBwb3IgcGVzc29hcyBhbXBhcmFkYXMgcG9yIGVzdGEgaW5zdGl0dWnDp8Ojbwo=Repositório InstitucionalPUBhttp://192.188.11.11:8080/oai/requestopendoar:19322022-07-05T17:03:14Repositório Institucional da UFBA - Universidade Federal da Bahia (UFBA)false
dc.title.pt_BR.fl_str_mv Maternal and child health in Brazil: progress and challenges
dc.title.alternative.pt_BR.fl_str_mv The Lancet
title Maternal and child health in Brazil: progress and challenges
spellingShingle Maternal and child health in Brazil: progress and challenges
Victora, César Gomes
Social Conditions
Health Services
Maternal and Child Health
Maternal-Child Health Services
title_short Maternal and child health in Brazil: progress and challenges
title_full Maternal and child health in Brazil: progress and challenges
title_fullStr Maternal and child health in Brazil: progress and challenges
title_full_unstemmed Maternal and child health in Brazil: progress and challenges
title_sort Maternal and child health in Brazil: progress and challenges
author Victora, César Gomes
author_facet Victora, César Gomes
Aquino, Estela Maria Motta Lima Leão de
Leal, Maria do Carmo
Monteiro, Carlos Augusto
Barros, Fernando Celso Lopes Fernandes de
Szwarcwald, Célia Landmann
author_role author
author2 Aquino, Estela Maria Motta Lima Leão de
Leal, Maria do Carmo
Monteiro, Carlos Augusto
Barros, Fernando Celso Lopes Fernandes de
Szwarcwald, Célia Landmann
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Victora, César Gomes
Aquino, Estela Maria Motta Lima Leão de
Leal, Maria do Carmo
Monteiro, Carlos Augusto
Barros, Fernando Celso Lopes Fernandes de
Szwarcwald, Célia Landmann
Victora, César Gomes
Aquino, Estela Maria Motta Lima Leão de
Leal, Maria do Carmo
Monteiro, Carlos Augusto
Barros, Fernando Celso Lopes Fernandes de
Szwarcwald, Célia Landmann
dc.subject.por.fl_str_mv Social Conditions
Health Services
Maternal and Child Health
Maternal-Child Health Services
topic Social Conditions
Health Services
Maternal and Child Health
Maternal-Child Health Services
description 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 aff ected 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 diff erences 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. Offi cial 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 offi cial 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.
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dc.identifier.number.pt_BR.fl_str_mv v.377, n.9780, p.1863-76, 2011.
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v.377, n.9780, p.1863-76, 2011.
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