Abstract
This study aimed to verify the association of social inequalities with infant mortality rate so as to infer what has changed in Brazil with the implementation of the Pact for Life. This was an epidemiological ecological study of the time series type with spatial correlation carried out through the Mortality Information System, considering the years from 1996 to 2016. For the development and analysis of the data, the 161 Intermediate Regions of Urban Articulation were considered. The infant mortality coefficient in the years studied was the dependent variable, and as independent variables, the ones selected were the Human Development Index, Gini Index, percentage of poor people and the coverage of the Family Grant Program. Descriptive data were analyzed in the Statistical Package for the Social Sciences. Mortality data were spatialized to determine bivariate spatial autocorrelations using the Geoda software. It was identified in the results that there was a decrease in the infant mortality rate in the decades; spatial autocorrelation showed high coefficients in the Northeast in the first decade, and higher coefficients in the North and Midwest in the second decade. In the bivariate analysis of the infant mortality coefficient with the Human Development Index, greater autocorrelation was observed in the Southeast, South and Midwest regions in the two decades; with the Gini index, the first decade showed autocorrelation in the North and Northeast, and in the second decade, there was autocorrelation in the North, Northeast, and Midwest. When assessed with poverty, autocorrelation was observed in the North and Northeast; and with coverage of the Family Grant Program, autocorrelation was concentrated in the Northeast. Even before and after the release of the Pact for Life, social inequalities were directly related to infant mortality. The Pact, which had one of its indicators the reduction in infant mortality, was effective when evaluated in isolation, however, despite the decrease in this problem.
Highlights
Infant mortality is the term used to characterize all deaths that occur in children under the age of one year in a given area in a given period of time
It is the most effective indicator to assess the population’s health situation. This indicator was included in the Millennium Development Goals (MDGs) during the period from 1990 to 2015, with the objective of reducing by two thirds the mortality in children under 5 years of age during that period, and it was later inserted in the Sustainable Development Goals (SDGs) for evaluation by 2030 (United Nations Children’s Fund, 2015)
Confirming the results presented in the spatialization of the Infant Mortality Coefficient (IMC), the Brazilian Institute of Geography and Statistics (IBGE, 2016) reported that the IMC is lower in regions that have greater economic development: Southeast and South, being responsible for 17.7% and 16.1 %, respectively, while the highest coefficients are in the North with 25% and Northeast with 35.6%
Summary
Infant mortality is the term used to characterize all deaths that occur in children under the age of one year in a given area in a given period of time. After technical studies on infant mortality, the Ministry of Health disclosed the Pact for Health in 2006, which appeared as a commitment among managers of the Unified Health System (SUS) to be reviewed annually according to the constitutional principles of SUS. Within this ordinance, three articulated spheres were defined as priority, namely: the Pact for Life, the Pact in Defense of SUS, and Pact of Management of SUS (Ministério da Saúde, 2006). Regarding maternal and child health, the Pact for Life emerge as an important aspect, providing fundamental indicators based on the development of actions that allow an improvement in the health care of this group in Brazil
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