Population Fertility and Mortality of Brazil
As is typical in demographic transitions, declines in mortality
preceded declines in fertility in Brazil, but the process took only
a few decades rather than centuries, as it did in developed countries.
The death rate started to fall in the 1940s because of the expanding
public health system, urbanization, and sanitation. The crude death
rate in 1995 was eight per 1,000 population, a notable decrease
from the 1960-65 rate of 12.3. The 1995 level, which is similar
to that of developed countries, resulted from the age structure
being still relatively younger.
Life expectancy at birth, which is a measure of mortality that
is not affected by different age structures, began to rise in Brazil
in the 1940s. It increased from 42.7 years in 1940 to 52.7 years
in 1970 and 67.1 years in 1995. It is projected to reach 68.5 years
in 2000 and 75.5 years in 2020. Life expectancy for women is about
seven years greater than that for men, but the differential is decreasing.
A decline in mortality has occurred in all regions, but strong
regional variations in life expectancy persist. The lowest levels
are found in the Northeast
(65.4 years in 1995) and the highest in the South (69.4 years in
1995), slightly higher than the Southeast.
The North and Center-West regions have levels of life expectancy
close to the national average. Within the socioeconomic strata,
higher life expectancy is strongly associated with higher family
income. Mortality is generally higher in rural than in urban areas,
except for the lowest income groups.
In the past, the principal causes of death in Brazil were infectious
and contagious diseases, especially diarrhea and intestinal parasites
among infants, as well as tuberculosis, measles, and respiratory
diseases (for a discussion of infant mortality, see Indicators of
Health, this ch.). As these were brought under control in the postwar
period, primarily in the more developed regions, degenerative diseases
such as cardiovascular disorders and cancer became proportionately
more prevalent. Deaths from external causes, including violence
and traffic accidents, also gained importance.
In 1996 the crude birthrate was estimated at 21.16 births per 1,000
population, a significant reduction from 42.1 for the 1960-65 period.
As in the case of mortality, crude birthrates are affected by the
age structure and, therefore, difficult to compare among countries
and regions or over time. It is preferable to use the total fertility
rate, a standardized measure that corresponds to the average number
of children per woman at age forty-nine, the end of her reproductive
life, assuming that she has survived and followed the fertility
patterns characteristic of each age category.
Brazil's total fertility rate dropped from close to six in the
1940s and 1950s to 3.3 in 1986 to 2.44 in 1994, not much higher
than the replacement level of 2.2. Fertility declined in urban and
rural areas, in all regions, and among all socioeconomic strata,
although the rates continued to vary. In large countries, such a
rapid and generalized fertility decline had been observed previously
only in China, where official policy placed intense pressure on
couples to have only one child. Projections indicate a total fertility
rate of 2.0 in the year 2000 and 1.8 in 2020, lower than replacement.
The Brazilian birthrate began to decline noticeably in the 1970s,
by which time socioeconomic changes had made large families less
affordable than in the traditional social and economic structure
in rural areas. In the past, especially in rural areas, children
started work early and supported their parents in old age, and the
children did not cost much to raise. In the 1990s, they attend school
for longer periods and cost more to support.
Meanwhile, new methods of birth control, primarily pills and female
sterilization, became widely available in the 1970s. Oral contraceptives
are sold over the counter without prescription. Surgical sterilization,
which is practiced in Brazil more than any other country, is typically
performed during cesarean deliveries. Such deliveries comprised
nearly a third of all deliveries in the 1980s. Surgical sterilization
is of questionable legality, but is often carried out by doctors
who are paid for the cesarean section by the public health system
and receive private payment for extra services on the side.
The number of Brazilian couples opting for sterilization as a means
of contraception increased by more than 40 percent during the 1986-96
period, based on the Demographic and Health Survey carried out by
Bemfam, an NGO. The survey, conducted between March and July 1996,
interviewed 12,612 women between fifteen and forty-nine years of
age as well as 2,949 men between fifteen and fifty-nine years. The
survey found that 40.1 percent of married women or women living
with partners had been sterilized, as compared with 26.9 percent
in 1986. In 1986 only 0.8 percent of males had had a vasectomy,
as compared with 2.6 percent in 1996. The Bemfam survey showed that
the average age at which women are sterilized was 28.9 years in
1996, as compared with 31.4 years in 1986.
In the early 1990s, the use of birth-control pills and female sterilization
(tubal ligation) continued to contribute to the fertility decline
in Brazil. About 65 percent of Brazilian women used contraceptives,
which is comparable with levels in developed countries. Of the women
who used some method and were in union, 44 percent were sterilized.
About 7 percent used rhythm, while other contraceptives or methods
Abortion in Brazil is significant. In the early 1990s, some 1.4
million abortions were performed each year, almost all of which
were technically illegal. This corresponds to approximately one
abortion for every two live births. The only cases in which abortion
is not subject to legal sanctions in Brazil are rape and danger
to the mother's life, but the law is not enforced effectively. The
practice of unsafe, clandestine abortions helps to explain why Brazil
has the fifth highest maternal mortality rate in Latin America,
estimated at 141 deaths per 1,000 births, in contrast to eight in
the United States.
A fertility decline in Brazil occurred in the absence of any official
policy in favor of controlling birthrates. The government's stance
was one of laissez-faire. Although it did not promote family planning,
largely because of the influence of the Roman
Catholic Church, the government did little to interfere with
the widespread practice of contraception among the population at
large. Nor did the population pay much heed to religious dogma.
In the case of fertility regulation, social change in Brazil occurred
from the bottom up. Women took much of the initiative.
In the 1980s, the Ministry of Health
included family planning services as part of an integrated women's
health program. However, because of a severe lack of funds, the
direct effects of the program were limited. Changing public opinion
and the women's movement in Brazil favored changes in official policy,
which were slow to come about. The 1988 constitution included the
right to plan freely the number of children. A Family Planning Law
took effect in 1997 in order to regulate sterilization, making it
available in the public health network but forbidding it during
deliveries, as well as provide birth-control alternatives through
the same network.
Data as of April 1997