Rita de Cássia, 46, chokes on her words and tears stream down her face as she recounts her time working with a new mother who was a frequent drug user.
She remembers when she first walked into the mother’s apartment she shared with her partner – also a drug user – and seeing it covered in mud. There was no toilet, and no sink; they had been sold to buy drugs. The other children in the family were asking for food but there was nothing to give them.
“I bought food and gave it to them. The mother [later] told me she sold a yoghurt I gave her for drugs. I’m poor too and it was difficult for me to give food. It’s the case I remember the most.”
Cássia is a mãe social, or “social mother”, in Sobral, a city in rural north-east Brazil. She is paid a daily minimum wage-level rate by the local health authority to care for new mothers who need extra support. Cássia and her colleagues are given training to look after pregnant women or mothers who have no support from their families, as well as the babies and other children who are at clinical risk or living in difficult conditions. Her work can include any number of tasks: helping mothers breastfeed, looking after other children in the family, helping around the house and more.
The scheme was introduced as part of a 19-year-long movement to reduce infant mortality rates in Sobral. Since 2017, 95 pregnant women, 461 newborn babies and 132 children have been supported by a mãe social.
The help is indispensable for women like Antonia Lucélia Torres, a single mother with four children. “The support has been very, very helpful,” she says. “I don’t know what I would do without it. I would like more.” Cássia supported Torres after the scar from her caesarian section got infected, and today is her last day helping the family.
The future for Torres and others in similar situations is always uncertain, admits Rochelly Rodrigues, a nurse at the local health centre. “[Torres’s] situation is very complicated, financially speaking,” she says. “I fear for the future.” Rodrigues has another single mother she works with, who has a six-year-old and a baby. The mother has already given up one child for adoption and is six months pregnant with another who will also be put up for adoption. “It’s a very sad situation,” continues Rodrigues. “What’s going to be the future of these kids?”
Despite the grim outlook for some families, the help provided by health services in Sobral is having an impact and has drastically cut the infant mortality rate. Since 2012 the number of deaths of infants in the town has more than halved from 46 to 21. Now the municipality of Sobral has the lowest infant mortality rate in the regions of north, north-east and central-west Brazil.
In 2001, when the strategy to reduce maternal and infant mortality was launched, there were 56 infant deaths for every 1,000 births. Efforts were made to provide sex education in schools and community centres. Each infant death was investigated, and pregnant drug users were monitored closely and taught harm reduction strategies. Since 2017, 492 pregnant drug users and 335 new mothers have been supported by the project.
Another area of focus was on premature babies, many of whom were dying because of hospital infections. In a bold move, the health service began discharging newborn premature babies home as soon as possible to avoid infection. A community healthcare worker then visits every day, and a paediatric nurse visits once a week. Rodrigues explains that the mother is shown how to look after a newborn premature baby and given the contact numbers of the health team. “With this follow up-care, the risk of death is minimal. It has had a positive impact,” says Rodrigues.
But work in this domain continues to be difficult; the team operates in challenging areas. Many communities are controlled by gangs and there is a lot of violence and drug use. Rodrigues adds: “What a privilege it is to help but the situation goes beyond what we can do. There are many cases of kids arriving [at the health centre] with nothing to eat. We can’t do everything. We want to, but we can’t.”
