Infant mortality and living conditions: the reproduction of social inequalities in health during the 1990s

An ecological study was conducted to determine the infant mortality trend from 1991 to 1997 and to analyze its relationship to living conditions in Salvador, Bahia State, Brazil. Inequality patterns in infant death were analyzed by spatial distribution and a compound socioeconomic index. The data showed a decline in the infant mortality rate, with neonatal deaths and perinatal causes playing a growing role. Despite this overall trend, the infant mortality rate increased in 1992, and it was only in 1997 that it returned to the 1991 level. This fact was interpreted as related to worsening living conditions during that period. Spatial distribution highlights the persistence of health inequalities; education was the variable with the most significant correlation rate. When distributed according to the living conditions index (LCI), both the infant mortality rate and proportional infant mortality showed a linear increase from the intermediate stratum (20.4 per mil ) to the lowest (29.3 per mil ) and from the highest stratum (5.3%) to the lowest (13.3%), respectively. The authors conclude that despite the reduction in the total infant mortality rate, the persistence of social inequalities and a social process that hinders improvement of living conditions are responsible for the inequalities observed in infant mortality.