The Impact of Time, Region, and Income Level on Stillbirth and Neonatal Mortality

Background: Neonatal mortality and stillbirth remain prominent global health issues. The majority of these perinatal losses occur in low- and middle-income countries and are related to lack of quality care around delivery. Brazil transitioned from a lower-middle income country to an upper-middle income country in 2006 and has over 95% of its births occurring within the health system. Methods: We conducted a longitudinal, ecological cohort study based on publicly available data from the Brazilian Ministry of health’s data repository on live births and deaths. Data was analyzed at the municipality level from 2000 to 2019. Records from the Atlas of Human Development in Brazil were then used to associate each region with a World Bank income classification. Results: National neonatal mortality rate decreased from 21.2 in 2000 to 12.4 in 2019. Stillbirth rate decreased from 12.0 to 10.2 over this time. Rates were lower when infants born before 28 weeks gestation were excluded. For infants born between 22- and 27-weeks’ gestation, worsening perinatal outcomes were seen after 2012. Municipalities with higher wealth status have lower stillbirth and neonatal mortality rates across all years of the study. Conclusion: Brazil has made significant progress in neonatal mortality and stillbirth rates from 2000 to 2019, yet inequity in perinatal outcomes remains across the country and is correlated with economic status. Nationally, ongoing improvement is needed for infants below 28 weeks gestation and closer exploration is needed into why there are increasing rates of negative perinatal outcomes amongst infants 22-27 weeks gestation.