Maternal and child health in Brazil: progress and challenges
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Outros Autores: | , , , , |
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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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: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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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2011 |
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2011 |
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0140-6736 |
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v.377, n.9780, p.1863-76, 2011. |
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0140-6736 v.377, n.9780, p.1863-76, 2011. |
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eng |
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