Intended for healthcare professionals

Feature Brazil

Economic success threatens aspirations of Brazil’s public health system

BMJ 2010; 341 doi: (Published 29 November 2010) Cite this as: BMJ 2010;341:c5453
  1. Tom Hennigan, freelance journalist
  1. 1São Paulo
  1. hennigantom{at}

Brazil experienced one of the fastest recorded falls in infant mortality after it established a national health service. But as the country’s emergent middle class bails out of the public system, Tom Hennigan finds services for its poorest citizens are again at risk

During a difficult first pregnancy there was no public healthcare system in Brazil to look after Maria Isabel Laurenço, who was instead forced to rely on an overstretched and underfunded charitable hospital.

“I’d had problems throughout the pregnancy but no prenatal care. At nine months I was suffering real pain, but when I went to the hospital they just gave me a cup of milk with a lot of salt in it because they said I had low blood pressure. Then they sent me home.” Shortly afterwards she fainted. “I woke up five days later to be told my daughter had been born. All this because of the milk they gave me. And to this day I still suffer from high blood pressure.” She believes that a mistake was made and she in fact had high blood pressure.

Mrs Laurenço’s daughter was born 27 years ago, five years before Brazil’s 1988 constitution established health care as the “right of all and the duty of the state.” By the time of her final pregnancy in 1997, the impact of that lofty principle was already being felt in her poor neighbourhood of Cidade Tiradentes on the far edge of São Paulo.

“During my last pregnancy the Family Health Programme already existed and I was looked after very well. It was another world from my first pregnancy. I had a check-up each month, and I could call the surgery and talk to a doctor on the phone. It was a totally different experience.”

Mrs Laurenço is one of the tens …

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