Child Mortality

Public health cuts leading to more child deaths in Brazil

Number of deaths of children under one year of age increases after dropping for 26 years

In 2016, 14 deaths were recorded for every 1,000 live births, a 5 percent increase over the previous year / Cesar Brustolin/SMCS

Brazil’s infant mortality rate has increased after dropping for 26 consecutive years. In 2016, there were 14 child deaths per 1,000 live births, a 5 percent increase over the previous year. Up until 2015, the country had been recording an average 4.9 percent drop every year since the early 1990s.

Saúde Popular, a website of the National Network of People’s Physicians and a Brasil de Fato partner, spoke with Alexandre Padilha about the reversal of the trend in infant mortality in Brazil. Padilha was the minister of Health in a period when the country recorded one of the most pronounced drops in infant mortality rates in the world.

Read the interview:

Saúde Popular – How do you see today’s situation comparing it to 2013, when Brazil was awarded a certification by the United Nations as one of the countries that had reduced infant mortality the most in the world?

Alexandre Padilha – It’s really sad to see this happening in Brazil after dropping [infant mortality rates] for 26 years. When I was the minister of Health, I remember as if it were yesterday, the United Nations [UN] secretary-general contacted the ministry to congratulate Brazil for achieving, in 2012 – three years earlier than the UN expected – the Millennium Goal of reducing infant mortality.

This rate [increasing infant mortality] is really sad and it is just the tip of a huge iceberg of destruction of the National Health System [SUS], the Family Health Program teams, the Mais Médicos [More Doctors program], and the social protection network that cares for our children.

What could have led the country to experience such a significant change [in this area]? Why is the infant mortality rate an important indicator for some parameters, such as the Human Development Index [HDI], in a State?

That is the point, exactly. It is not a coincidence that reducing infant mortality has been defined as one of the so-called Millennium Development Goals established by the UN. The goal encompassed the years 2000 to 2015, precisely for being such a sensitive indicator to assess how a country is taking care of its children. An extremely sensitive indicator to find improvements or negative changes in the national health system and in the situation of families.

This is why it [infant mortality rate] has increased so rapidly since 2016, clearly showing the direct impacts of the coup. Infant mortality is an indicator that is deeply affected by the basic health care offered at basic heath care units, [including] prenatal care concerns, pregnancy care, child care, vaccination, infant care during the baby’s first week, follow-up meetings.

After such a long time, Brazil’s infant mortality and child mortality [under five years of age] rates increased, especially because of diarrheal diseases, which goes to show the direct link between the destruction of basic health care teams and also the worsening financial circumstances of families.

Could diseases like Zika and chikungunya be responsible for the increasing rate?

That is a false controversy – I would even say it is a lame excuse. They [the government] also said Facebook [rumors] had something to do with the reduced vaccination numbers. That is some nerve, using that as an argument. That would only be an argument if it [vaccination rate] were not directly linked to a huge drop in birth rates, to the number of children born in 2017, and to an interrelation with an increasing mortality rate that was exclusively related to a huge Zika epidemic in 2015.

Their argument is that, in 2016, less children were born in Brazil and that mothers, during the Zika and Zika and chikungunya epidemics, either had abortions – and that’s a risk as abortion attempts and even illegal abortions could have increased in this period – or women would have delayed their plans to get pregnant because of chikungunya, and this is why less children were born in 2016/2017.

But, as infant mortality is a ratio – that is, the number of deaths of children under one year of age divided by the number of children who are born –, in theory, if less children were born, the birth rate would be lower. Every slight variation in the number of deaths would result in a higher rate. So obviously that is not the reason, and other data show that.

First, the infant mortality rate increased in areas where there were no significant reports of Zika [cases]. The infant mortality rate increase where there were no significant decreases in the birth rate, and still the infant mortality rate increased, due to other indicators that show that health care deteriorated.

Evidently there are two main reasons for that. First, health programs were interrupted. They [government] significantly reduced the number of doctors in the Mais Médicos [Program]. When a physician quits [the program], the Ministry of Health is now taking longer to replace them.

There was a very serious decision made by the Ministry of Health, undervaluing community health agents [ACS], as they issued a new Basic Health Care Policy that sets forth that it's no longer mandatory to have ACS staff. So we started to lose this protection of high-risk children as community health agents became unappreciated. And cuts – since 2016, but sharper [cuts] in 2017 – to the Rede Cegonha [“Stork Network”], to programs that aimed to offer quality labor and delivery, prenatal, and newborn care.

[There was] a series of measures in health care, based on other indicators, such as a fall in vaccination coverage – the coverage reduced in Brazil, but not in the rest of the world.

What’s even more serious – and I’d like to draw attention to that – is a Brazilian study published in a major international health care journal. It’s a projection estimating that, if we keep today’s policies, cutting funds, having a public spending cap for the next 20 years, cutting Bolsa Família [Brazil’s major conditional cash transfer program], and cutting Mais Médicos resources, 20,000 children are estimated to die as a result of these current fiscal austerity policies. They estimate 130,000 children will be hospitalized, and that should not happen. This budget freeze for the next 20 years should be revoked.

Padilha, the consolidated data [2018 rate] on infant mortality is not out yet. Is it usually issued in August, September?

Exactly, but there is a very clear trend since 2016 and concerns that the numbers will be even worse for 2017.

Edition: Diego Sartorato | Translated by Aline Scátola