Bolsa Família has reduced child deaths in 20 years in Brazil – 07/14/2023 – Health

Cash transfer programs such as Bolsa Família have prevented an estimated 740,000 deaths of children under five in Brazil, Mexico and Ecuador, according to a global study that assessed the health impacts of these strategies.

According to the survey, infant mortality in the period from 2000 to 2019 fell by 24%, with the greatest variation observed in Brazil, 28%, followed by Ecuador (26%) and Mexico (11%).

There was also a 9% drop in hospitalization for diseases associated with poverty and a 30% drop in the mortality of babies aged 28 days to one year.

Also considering the impacts in the next decade, according to the study, the expansion of income transfer programs in the three countries could prevent even more 153,000 deaths of children under five years of age and reduce infant mortality by 17% by 2030, even with the effects of the global economic and health crises caused by the Covid pandemic.

The work led by ISGlobal (Global Health Institute of Barcelona) published this Friday (14) in the scientific journal Jama Network Open, with researchers from Brazil, Ecuador, Mexico, Colombia, Switzerland and Spain.

To calculate the effects of Bolsa Família and other social programs on infant mortality, the researchers assessed 4,882 municipalities in Brazil, Mexico and Ecuador with similar sociodemographic indicators, such as infant mortality rate, birth incidence and incidence of deaths with ill-defined causes, to avoid noise in the analysis.

Mexico, with the Progresa program, was the first in the world to create a conditional cash transfer program (CCT), in 1997. The Brazilian Bolsa Família, created in 2003 and resumed in 2023 by President Lula (PT) after being replaced by Auxílio Brasil in the Jair Bolsonaro (PL) government, it is the largest income transfer program in the world, with more than 21 million families served. Ecuador has, since 2003, the Bono Human Development program, with 74,000 families assisted.

The analysis then calculated so-called risk ratios (RR) for infant mortality at different ages: neonatal (0-28 days), infants (28 days to 1 year), infants (1 year) and children (from 1 to 4 years). For each age, it was also calculated what the reduction in mortality would be if the program had a low coverage (0% to 29% of the predicted coverage), intermediate (30% to 69.9%), high (70% to 99.9 %) and consolidated (100%).

In total for all ages, infant mortality fell from 7.8% to 6.5%, while infant hospitalization declined by 3%. In the same period, there was an increase of more than 76% in the coverage of the three programs.

Regarding mortality with an associated cause of death, there was a significant reduction in deaths caused by HIV/AIDS infection (68%), malnutrition (67%) and diarrhea (59%), while the drop was smaller for deaths caused by tuberculosis (38%), lower respiratory tract infections (34%) and malaria (24%).

For Daniella Medeiros, researcher at UFBA (Federal University of Bahia) and first author of the study, an important point of the research is that the analyzes for all countries in the studied period were consistent, showing the importance of continuity of income transfer programs. “The high coverage made it possible to prevent these more than 740,000 child deaths, with an even greater effect in Brazil, which is the country with the highest coverage, thus indicating a positive effect of Bolsa Família in reducing mortality,” she said.

According to her, there is an often mistaken interpretation of the benefits of these programs as if they were just a question of income transfer, but in fact they guarantee access to basic rights. “The monetary transfer route provides immediate relief from poverty, which helps to reduce mortality indicators linked, for example, to hunger and malnutrition, but the program’s functionalities go further in guaranteeing for many of these children the first access to the health service they will determine that nutritional status”, he evaluates.

As the conditionalities of the programs are linked to health care, education and children’s nutrition, their presence is a way of guaranteeing these rights, he explains.

Davide Rasella, ISGlobal researcher and study coordinator, also points out that the effects of these conditionalities may, in the future, cost the public coffers even less due to the reduction in health-related expenses. “What we saw was a drastic reduction in infant mortality, a drastic reduction in morbidities [danos à saúde associados] and a drastic reduction in hospitalizations. From an ethical point of view, it is unquestionable to guarantee rights to all, but from an economic point of view, there is a gain in protecting the poorest and most vulnerable”, he says.

The high incidence of problems associated with poverty in Brazil and in other Latin American countries, such as tuberculosis, neglected diseases and hospitalization for diarrhea, put these countries in the crosshairs for the 2030 agenda of reducing child mortality.

In the study, three scenarios were used to assess deaths that could still be avoided by 2030: a poverty alleviation scenario (ideal), a scenario maintaining the current income distribution (intermediate) and a fiscal austerity scenario (restrictive), controlling public spending. With austerity, there would be a peak in child deaths by 2025, followed by a slow decline. In the mitigation scenario, there is a window to avoid 153,601 deaths of children under five years old.

For Rasella, in a post-Covid global crisis scenario, there is no room to implement fiscal austerity measures, and income transfer programs can be an important instrument to protect populations. “Brazil is already an international reference in the reduction of child mortality, but it is true that we had a somewhat obscure period there. However, I believe that the country has the potential to be a world beacon and show that it is necessary to invest in the protection of the poor especially to reduce child deaths to ensure their development in the future”, he adds.

---

Income transfer programs in Brazil, Mexico and Ecuador

From 2000 to 2019

• 24% mortality reduction
• 738,919 deaths of children under 5 prevented

Mortality with associated cause of death

• 67% malnutrition
• 68% HIV/Aids
• 59% diarrhea
• 34% lower respiratory tract infections
• 38% tuberculosis
• 24% malaria

Scenario up to 2030

• 17% reduction in infant mortality
• 153,601 deaths can be prevented