| Hello, *|NOME|* Primary Health Care services for pregnant women and young children are fundamental for the improvement of indicators such as infant and maternal mortality, as seen, for example, by the effects of the expansion of the maternal-child arm of the Family Health Program, documented here. Although the responsibility is shared among the federated entities, the municipalities are the main responsible for the operationalization of these services – being able to equip health centers, optimize care and promote health promotion campaigns. In view of this, it is important to identify where there are problems in maternal and child health and discuss possible solutions - while the government plans of the new municipal administrations are consolidating.
IMDS launched the Technical Note "Maternal and Child Health in Brazil: Challenges and Public Policies" with three objectives. The first is to identify the municipalities with the highest infant mortality, in which improving the health of pregnant women and babies is urgent. The second is to analyze the state of the provision of two essential Primary Care services, the coverage of prenatal care and childhood vaccination. The third is to outline public policy paths to improve the provision of these services and positively impact the health of pregnant women, newborns, and children.
The mortality of children up to one year of age in Brazilian cities is high and with huge discrepancies even between capitals. In 2023, the simple average mortality rate of municipalities in Brazil was 12.9 children up to one year old for every thousand live births. According to data from the World Bank, this rate is more than double the average of OECD countries in that same year, which was 5.2 per thousand live births. Among the capitals, the lowest infant mortality in 2023 occurred in Florianópolis (SC), with 7.7 deaths per thousand live births. The highest was in Macapá (AP), with 18.8 deaths per thousand live births, a rate higher than that observed, for example, in Syria (17.7 deaths per thousand live births). Cities with better prenatal coverage for pregnant women in 2022 also had, on average, lower mortality of children up to one year of age in 2023. More precisely, each additional 1 percentage point of mothers of live births with adequate prenatal care in the municipalities is associated with a reduction in the mortality rate of 0.08 babies per thousand live births. Clear evidence that there is room to improve child health indicators in Brazilian cities. The coverage of adequate prenatal care is very unequal in Brazil. This disparity is manifested even in the comparison between the capitals: while more than 90% of mothers of live births in Curitiba (PR) in 2022 received 7 or more prenatal consultations, in Macapá and Rio Branco (AC) this proportion was below 50%. Regional differences are also quite pronounced. While 84.1% of the mothers in the municipalities of the South received adequate prenatal care, in the North it was only 64.0%. Childhood vaccination, in turn, needs to advance in a generalized way. Let us take the case of polio vaccination coverage, one of the main and oldest immunizers in the Brazilian vaccination calendar. Although the goal to prevent the return of the disease is 95% coverage (explained by the Ministry of Health here), no capital reached 85% in 2022. In Macapá and João Pessoa (PB), coverage was a mere 43% of children aged 0 to 4 years. It is worth remembering that, although there are no recent cases of polio in Brazil, the country has a high risk of resurgence of this serious disease, as can be seen in this Pan American Health Organization (PAHO) dashboard here. Finally, the Technical Note highlights two types of public policy for the improvement of maternal and child health services: complete Primary Care programs and initiatives that solve specific issues, such as low immunization. In Latin America, there are a number of successful examples of programs aimed at the universalization of quality Primary Care, such as the "Chile Crece Contigo" program (details here). In the Brazilian case, the expansion of the maternal and child arm of the Family Health Program (details here) has brought important advances. At the municipal level, the "Mãe Curitibana Vale a Vida" program (details here) is an example of how city halls can act to ensure good follow-up: equipping basic units, making appointment scheduling easy and agile, and integrating the services of the municipal network. An experiment in a context not so different from the Brazilian one and with low vaccination coverage shows that it is possible to significantly increase childhood vaccination with feasible initiatives at the municipal level (read article here). The most effective combination to increase vaccination rates led to a 44% increase and included SMS reminders, small monetary incentives that grew with each visit, and recruitment of people within communities to spread vaccine information. The material discussed here is part of a series of technical notes from IMDS related to the 2024 municipal elections. The data used can be found on the IMDS Elections Panel (access here). See you in the next "IMDS Letter”! Paulo Tafner CEO | 
