Infant mortality rises alarmingly by 11%, after 15 years of decline.

From the Rede Brasil Atual - A huge effort by the federal government and civil society over 15 years to reduce infant and child mortality rates is now beginning to be undone, at the expense of the fiscal adjustment argument promoted by Michel Temer's government. After more than a decade of consecutive declines, the infant mortality rate (proportion of deaths of children under five years of age for every thousand live births) rose 11% in 2016, compared to the previous year.

The data was tabulated by the Abrinq Foundation, based on information from the Ministry of Health/DataSUS, IBGE, and other official sources. Following the goals of the Sustainable Development Goals (SDGs) defined by the United Nations (UN), infant mortality fell from 30,1 per thousand live births in 2000 to 14,3 in 2015.

"The response was significant, and Brazil became a benchmark. Rates had been decreasing, with the exception of maternal mortality, where rates were still far from the SDGs. From 2015 onwards, there has been a decline in the reduction rates, and in 2016, a growth trend, a concrete indication that we are breaking this pattern of decline with the prospect of increase," says Denise Cesário, executive manager of the Abrinq Foundation.

She explains that Brazil has a series of specific programs to address infant mortality, and that the increase now observed is related to cuts in social programs made by the Temer government, coupled with the discontinuation of other actions related to child well-being. Among the programs that suffered cuts, Denise Cesário highlights the Rede Cegonha (Stork Network), the National School Feeding Program (PNAE) – which guarantees access to healthy food for poor children in preschool –, the Mais Médicos (More Doctors) program, the Bolsa Família (Family Allowance) program, and the near-extinction of the Food Acquisition Program (PAA).

"We realize that the reduction in investment and the withdrawal of specific programs ends up impacting the increase in infant mortality and childhood mortality," says the executive manager of the Abrinq Foundation. "This indicates that the poorest families are the ones most impacted by the lack of investment in social policies. We quickly perceive the impact of these indicators on those who need basic health services, on those who need a range of programs and support for food."

Denise Cesário explains that such deaths are related to prenatal care, care for the pregnant woman and the baby after birth, highlighting that the first thousand days of life (about three years) are considered vital for the child's development. Among the fundamental care aspects are the moment of delivery itself, which should preferably be vaginal, the period of breastfeeding for at least six months, the start of solid foods, and attention to the vaccination schedule.

 

"We need to be vigilant until the age of five to prevent infant mortality. If we pay close attention, we will guarantee development," she states. The executive manager of the Abrinq Foundation points out that the 2016 data shows a slight decline in the death rate up to one month of age. The increase in "preventable deaths" (those that could more easily be avoided) occurs in babies from one month to one year of age (infant mortality), and between one and five years of age (childhood mortality).

Among the preventable deaths, Denise Cesário cites the return of problems that had already been successfully addressed by the federal government, such as deaths caused by gastrointestinal issues like diarrhea, something often linked to basic sanitation and the quality of water used for human consumption.

The executive manager of the Abrinq Foundation also emphasizes the harmful effects of Constitutional Amendment 95, which freezes the federal government's budget for 20 years. "It has a considerable impact; these are very worrying issues. We know that in a crisis, the first cuts are in the social area, and those who suffer the most are the most vulnerable population," she states.

Fiscal austerity

Temer's political choices to address the country's economic crisis are harshly criticized by Tereza Campello, an economist and former Minister of Social Development and the Fight Against Hunger in Dilma Rousseff's government.

Without mincing words, she defines as "stupid" the option of cutting social investment in the short term and not taking into account, in the medium and long term, the increase in spending on the public health system. "It costs less to prevent malnutrition and diarrhea than to treat a child hospitalized in an ICU bed. So it's not a smart, rational fiscal option; it's ineffective from the point of view of fiscal austerity," says Tereza Campello.

While cutting social programs, the former minister recalls that the Temer government prioritized installment plans and discounts of up to 90% for micro and small business owners indebted to the federal government, through the Special Tax Regularization Program for Micro and Small Businesses (Refis). A similar choice was also made regarding the debts of farmers, meeting the demands of the rural caucus at the expense of investment in social programs. "Besides being a great injustice, it's fiscal stupidity," criticizes the former minister.

Tereza says that the country is currently witnessing the return of diseases that were under control, such as measles, syphilis, tuberculosis, and leprosy. "Brazil was a pioneer in reducing diseases like tuberculosis and leprosy, which are now increasing again along with infant mortality." She links the return of diarrhea and malnutrition to the population's income, and also connects the increase in respiratory diseases to the end of the Popular Pharmacy program.

"It's a scandal. They closed the 'Farmácia Popular' (People's Pharmacy), which distributed asthma medication for free! This will have an impact on respiratory diseases, such as pneumonia and respiratory infections. So this poor family, already precarious due to unemployment and the labor reform, will be left without asthma medication. You end the 'Farmácia Popular' and now you're going to increase hospitalizations of children with pneumonia. The medium- and long-term impact is very high. Even from a fiscal point of view, this choice is stupid," criticizes the economist.

 

Knowing the successes

The former Minister of Social Development and the Fight Against Hunger proposes that, at this time of increasing infant mortality, we reflect on the reasons why such deaths had been decreasing steadily and systematically over the past decade. In this regard, she believes that the main reason was not only the expansion of the healthcare network, but also the increase in the population's income, with a direct impact on reducing mortality caused by preventable diseases, such as malnutrition, and others resulting from decreased immunity, such as diarrhea.

"The increase in the crisis and unemployment had to be accompanied by an increase in the safety net, and this did not happen. This is the problem," she analyzes. According to Tereza Campello, it is not enough to justify the social cuts as effects of the crisis. For her, Michel Temer's government abandoned the safety net that would provide support during economic hardship. "It is precisely in times of crisis that the State must provide support, must guarantee better school meals, since they will not eat at home," she assesses, referring to the cuts in the National School Feeding Program (PNAE) and the "end" of the Food Acquisition Program (PAA).

"What remains of the PAA are things that had generated obligations and continued to be paid. The program once had one billion reais and today has only a few million; it was completely dismantled, and it was a program that distributed food to vulnerable populations. There is a set of policies that have ceased to guarantee support, leading to increased unemployment and increased vulnerability among the population," says the former minister, echoing the diagnosis of the executive manager of the Abrinq Foundation.

 "The stagnation of support for the most vulnerable population, coupled with the precariousness of work and the increase in unemployment, directly impacts the most fragile group, which are the children. We already knew that poverty in Brazil was more severe among children, which is why we had a whole set of policies protecting children, and that no longer exists," laments Tereza Campello.

Despite her outrage at the rising infant and childhood mortality rates, the former minister believes that the country now knows how to address the problem, an experience accumulated in public administration, in partnership with civil society, over many years. Optimistically, she believes that when a more favorable political environment arises, Brazil can resume the path of child welfare policies that were being developed until the impeachment of Dilma Rousseff.

Read the article at website of Rede Brasil Atual.