Multiple perceptions of infant mortality in Ceara State, Brazil

This qualitative study analyzes the perceptions of various social actors towards infant mortality and the program to reduce it in Ceara State, Northeast Brazil. The study compares two municipalities (counties) that showed opposite infant mortality trends from 1993 to 1997, during which time Ceara achieved international visibility for having reduced infant mortality statewide. A total of 48 semi-structured interviews with four groups of key informants - health system managers, community health agents, mothers who had lost a child, and neighbor women with children in the same age bracket - and content analysis revealed "multiple conflicting voices" on the issue. Although the level of political determination to implement the interventions varied between the two municipalities, the differences in perceptions concerning infant death were more striking between the various groups of social actors, regardless of the municipality. The study revealed a kind of authoritarian educational practice that jeopardizes acceptance of the Community Health Agents Program. Public policies are needed that give voice to the people closest to the experience of infant death.