new internationalist
issue 254 - April 1994

The sharp divide
The past 30 years have seen a slow but marked improvement worldwide
in the number of children surviving beyond their fifth birthday. In 1960,
out of every 1,000 children born in Brazil 181 died before the age of
five; by 1992 the number had been reduced to 65. But the differences
between countries are sharp; between regions in the same country they
can be sharper still; in Brazil they are among the sharpest in the world.

Sharper still
Things have not been getting any better for
the people of Brazil, Bom Jesus or the Alto.

Interest payments to service Brazil's foreign debt
increased threefold between 1982 and 1985, while social
expenditure dropped. Food prices rose as minimum wages
fell; the burden of the debt fell on the poor.

Family income in Bom Jesus fell by one-third between 1982
and 1987, from an average $24 per week to just $16. Seventy
five per cent of family income in the Alto is spent on food.

The younger generation of Alto women (aged between 19
and 39) lost almost twice as many of their children before
their first birthday as the older generation.

In 1989, 96 per cent of all child deaths in the
Alto were infants in their first 12 months of life.

Brazil in the world¹
Cuba is the only Latin American country with a low under-five mortality rate - the result of a child survival campaign. About a quarter of all infant deaths in Latin America are in Brazil. In 1992, according to official figures, 236,000 Brazilian children aged under five died - one every two minutes.

The Northeast in Brazil
The Northeast is Brazil's poorest region.
Infant mortality here reaches levels similar to those in many parts of Africa and India.
More than half of all child deaths in Brazil take place in the Northeast.
The under-five mortality rate in the Northeast is officially 116 deaths per 1,000 births, almost double the national average.

Bom Jesus in the Northeast
Bom Jesus (a pseudonym for a town in the Zona da Mata inland from Recife) is in one of the poorest regions of the Northeast. In Bom Jesus in 1987:
722 children were born and 340 died, of whom 322 were under five.
The under-five mortality rate was 211 per 1,000 live births - the same as in Somalia in 1992.
Child deaths account for a large proportion of all deaths - 38 per cent in 1987.

The Alto in Bom Jesus
Nancy Scheper-Hughes interviewed the mothers of 255 children who had died in the Alto, the poorest part of Bom Jesus, to discover what they thought had killed their children.

Most thought it was poverty (often manifesting itself in chronic diarrhea), lack of food, dirty water and worthless medical care. Immunization and oral rehydration therapy can save a child once, but not over and over again if the basic necessities are lacking.

She also surveyed 72 women in the Alto - covering three generations aged between 19 and 76 - about their experience of pregnancy, childbirth and child care. On average, every mother had 4.2 children who survived beyond their fifth birthday - and had lost 3.6 living children.

1 State of the World's Children 1994, UNICEF, this section only.
All other material is taken from Nancy Scheper-Hughes,
Death without Weeping: The Violence of Everyday Life in Brazil,
University of California Press, Berkeley, 1992.