Este estudo investiga o impacto do Programa Bolsa Família (PBF) sobre a defasagem escolar de mães adolescentes (até 19 anos), utilizando dados longitudinais da Coorte de 100 Milhões de Brasileiros (C100), no período de 2004 a 2015. A análise concentra-se na região do Semiárido Setentrional (SemiSet), com comparações em nível regional (Nordeste) e nacional (Brasil). Adota-se uma estratégia quase-experimental por meio do pareamento por escore de propensão (propensity score matching - PSM) com algoritmo Kernel, visando estimar o efeito médio do tratamento sobre os tratados (ATT). Os resultados indicam que mães adolescentes pertencentes a famílias beneficiárias do PBF apresentam menor incidência de defasagem escolar em comparação àquelas de famílias não beneficiárias com características observáveis semelhantes, sendo o efeito protetivo mais pronunciado no SemiSet e crescente conforme o tempo de exposição ao programa. O estudo também analisa variações no impacto em função da elegibilidade ao Benefício Variável Jovem (BVJ) e da qualidade da gestão municipal das condicionalidades do programa, medida pelo IGD-M, evidenciando que ambos os fatores contribuem para a intensificação dos efeitos positivos do PBF na trajetória escolar dessas jovens.

Bard, Keller, and Leavens' call for a WILD psychology is timely. This commentary argues that moving beyond WEIRD bias requires accountability and structural transformation, not just awareness or inclusivity. We must challenge the aspiration to universality, embrace multiplicity, and engage in anticolonial praxis to dismantle systemic inequities in knowledge production and achieve genuine epistemic justice in the developmental sciences.

Resumo O objetivo deste artigo é identificar a relação entre privação material e mortalidade por neoplasias de mama, colo do útero e próstata, na população adulta brasileira, e a relação existente entre raça/cor e privação material. Estudo ecológico transversal, calculou-se a taxa média de mortalidade/100.000 habitantes, com óbitos padronizados por idade e sexo e redistribuídos por causas mal definidas, estratificados por grupo etário e raça/cor. Aplicou-se o modelo Binomial Negativo, contendo a interação entre raça/cor e Índice Brasileiro de Privação (IBP). Foram analisados 85.903 óbitos, sendo mais prevalente os por neoplasias de mama. O risco de morte por neoplasia de colo do útero foi 8,5% maior para negras do que para brancas, nos demais sítios a mortalidade foi maior entre brancos. Para todas as causas com aumento da idade ocorreu aumento da mortalidade. Houve interação significativa entre raça/cor e IBP para todas as causas, apenas os óbitos por neoplasia de colo do útero aumentou com o aumento do IBP, nas demais houve redução. O IBP oferece uma visão multidimensional das condições socioeconômicas da população brasileira, permitindo melhor compreensão de como os determinantes sociais operam sobre as neoplasias selecionadas.

Resumen El objetivo es Identificar la relación entre privación material y mortalidad por neoplasias de mama, cuello uterino y próstata en la población adulta brasileña, y la relación entre raza/color y privación material. Este estudio ecológico transversal calculó la tasa media de mortalidad/100.000 habitantes, con defunciones estandarizadas por edad y sexo y redistribuidas según causas mal definidas, estratificadas por grupo de edad y raza/color. Se aplicó el modelo Binomial Negativo conteniendo la interacción entre raza/color y el Índice Brasileño de Privación (IBP). Se analizaron 85.903 defunciones, siendo las más prevalentes las debidas a neoplasias de mama. El riesgo de defunción por cáncer de cuello uterino fue 8,5% mayor para mujeres negras que para blancas. En otros lugares, la mortalidad fue mayor entre las personas blancas. Para todas las causas, hubo un aumento de la mortalidad con el aumento de la edad. Se observó una interacción significativa entre raza/color e IBP para todas las causas. Solo las defunciones por neoplasia cervical aumentaron con el aumento del IBP, en las demás hubo una reducción, pero menos significativa entre las personas negras. El IBP ofrece una visión multidimensional de las condiciones socioeconómicas de la población brasileña, permitiendo una mejor comprensión de cómo los determinantes sociales operan sobre neoplasias seleccionadas.

This article aims to identify the relationship between material deprivation and mortality from breast, cervical, and prostate neoplasms in the Brazilian adult population and the relationship between ethnicity/skin color and material deprivation. This cross-sectional ecological study calculated the mean mortality rate per 100,000 inhabitants, and deaths were standardized by age and gender and redistributed per to ill-defined causes, stratified by age group and ethnicity/skin color. We applied the Negative Binomial model, containing the interaction between ethnicity/skin color and the Brazilian Deprivation Index (IBP). We analyzed 85,903 deaths, and the most prevalent were those due to female breast neoplasms. The risk of death from cervical cancer was 8.5% higher for Black women than white women. In other places, mortality was higher among white people. For all causes, mortality increased with age. There was a significant interaction between ethnicity/skin color and IBP for all causes. Only deaths due to cervical neoplasms increased with higher IBP, while a decline was observed in other causes but was less significant among Black people. The IBP offers a multidimensional view of the socioeconomic conditions of the Brazilian population, allowing a better understanding of how social determinants operate on selected neoplasms.

Resumo O objetivo deste estudo foi identificar indicadores de desigualdades sociais associados à mortalidade por neoplasias na população adulta brasileira. Utilizou-se como método a revisão de escopo, estabelecendo-se a pergunta norteadora: qual o efeito das desigualdades sociais na mortalidade por neoplasias na população adulta brasileira? Foram identificados 567 trabalhos, sendo 22 considerados elegíveis. Identificou-se uma diversidade de indicadores, como o Índice de Desenvolvimento Humano e o Índice de Gini, entre outros, que avaliaram primordialmente diferenças de renda, escolarização, desenvolvimento humano e vulnerabilidade. Não foi estabelecido um único padrão de associação entre os indicadores e as diferentes neoplasias, assim como não se identificou um indicador único capaz de explicar o efeito da desigualdade social em todos os níveis de área e por óbitos por todos os tipos de neoplasias, mas identificou-se que a mortalidade é influenciada pelas desigualdades sociais e que o estudo dos indicadores proporciona definir qual melhor explica os óbitos. Essa revisão destaca importantes lacunas referentes ao uso de indicadores sociais não modificáveis, à análise de pequenas áreas e ao uso limitado de indicadores multidimensionais.

Background Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. Methods A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32–36), (iii) severe (28–31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. Results 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63–0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59–0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43–0.74). Conclusions An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.

Violence of all types is a global public health problem. Cash-based incentives can potentially reduce violence outcomes by reducing economic hardership. We aim to deliver a comprehensive systematic review of the relationship between cash-based incentives with a variety of violence outcomes. We searched studies assessing the relationship between cash-based incentives with violence outcomes at PubMed, EMBASE, Global Health and LILACS from the database's creation until July 12th, 2023. We evaluated the relationship of cash-based incentives on five types of violence outcome: intimate partner violence (IPV), child maltreatment, suicide, youth violence, and general violence. Cash-based incentives were grouped into Conditional Cash Transfer (CCT), Unconditional Cash Transfer (CCT), cash in combination with interventions other than cash(cash+), tax credits, cash for work and start-up grants. We classified the strength of evidence according to the study design and quality. An evidence map was developed to indicate gaps in the literature and impact (reduction, null and mixed). This systematic review is registered on PROSPERO, number CRD42020167049. The strength of evidence was mainly classified as moderate, or limited. The evidence map indicated research gaps on the effect of cash+ and cash for work on suicide and general violence, tax credit on general violence and start-up grants on child maltreatment, suicide, and general violence. Despite the important number of mixed evidence, we found strong and very strong evidence that cash-based interventions reduced transactional and age-disparate sex among girls, suicide, IPV victimisation, physical, emotional and sexual IPV, and physical child maltreatment. Future studies should focus on the gaps found in this review.

Purpose:This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System primary care health units in the northeast region.Patients and Methods:A total of 1058 pregnant women in the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA pregnancy risk categories. Prevalence ratios (crude and adjusted) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust error variance. All analyses were stratified by race (Asian, black, brown/mixed, Brazilian indigenous, and white).Results:Approximately 84% of the pregnant women used at least one medication, with a lower proportion among white women. The most reported medications were antianemic preparations (71.08%; 95% CI 68.27-73.72%), analgesics (21.74%; 95% CI 19.36-24.32%), and drugs for functional gastrointestinal disorders (18.81%; 95% CI 16.57-21.28%). Approximately 29% of women took potentially risky medications during pregnancy, with a higher prevalence among Asian and white women. Factors associated with medication use during pregnancy include a greater number of prenatal consultations, higher education levels, health problems, and smoking. In addition, maternal age above 25 years, smoking status, and two or more previous pregnancies were associated with potentially risky medication use during pregnancy.Conclusion:A high prevalence of medication use during pregnancy was found; however, this prevalence was lower among white women. Nonetheless, black and brown women used antianemic preparations less frequently. This finding suggests that race is a factor of inequity in prenatal care, demanding public policies to mitigate it.

Background Ethno-racial inequalities are critical determinants of health outcomes. We quantified ethnic-racial inequalities on adverse birth outcomes and early neonatal mortality in Brazil. Methods We conducted a cohort study in Brazil using administrative linked data between 2012 and 2019. Estimated the attributable fractions for the entire population (PAF) and specific groups (AF), as the proportion of each adverse outcome that would have been avoided if all women had the same baseline conditions as White women, both unadjusted and adjusted for socioeconomics and maternal risk factors. AF was also calculated by comparing women from each maternal race/skin colour group in different groups of mothers’ schooling, with White women with 8 or more years of education as the reference group and by year. Findings 21,261,936 newborns were studied. If all women experienced the same rate as White women, 1.7% of preterm births, 7.2% of low birth weight (LBW), 10.8% of small for gestational age (SGA) and 11.8% of early neonatal deaths would have been prevented. Percentages preventable were higher among Indigenous (22.2% of preterm births, 17.9% of LBW, 20.5% of SGA and 19.6% of early neonatal deaths) and Black women (6% of preterm births, 21.4% of LBW, 22.8% of SGA births and 20.1% of early neonatal deaths). AF was higher in groups with fewer years of education among Indigenous, Black and Parda for all outcomes. AF increased over time, especially among Indigenous populations. Interpretation A considerable portion of adverse birth outcomes and neonatal deaths could be avoided if ethnic-racial inequalities were non-existent in Brazil. Acting on the causes of these inequalities must be central in maternal and child health policies. Funding Bill & Melinda Gates Foundation and Wellcome Trust.

Background: Racial and ethnic health inequities are a public health concern from a range of structural societal conditions rooted in Racism. The collection of disaggregated race and ethnicity-based data is crucial to understand and appropriately address health inequities. Current data collection efforts remain incomplete and insufficiently widespread. In the Americas, the proportions of Afro-descendants are overrepresented in cardiovascular, maternal mortality and vector-borne diseases. There is limited evidence data on race, ethnicity, and health inequities regarding Latin American and the Caribbean region. Methods: To evaluate the use and scope of population-based race and ethnicity data in health literature. We present a protocol for a series of distinct but interconnected scoping reviews, in the context of racial health inequities across three major health outcomes including i) cardiovascular diseases, ii) maternal, infant, and neonatal mortality, and iii) vector-borne diseases in Latin American and the Caribbean countries between January 1, 2000, to June 30, 2023. Datasets include PubMed/Medline, Embase, CINAHL (EBSCOhost), Global Health, Scopus, LILACS (Virtual Health Library), Web of Science databases and grey literature. We will include cross-sectional, cohort, case-control, surveillance-based, and ecological study designs that analyzed the relationship between race and ethnicity and the selected health outcomes, written in English, French, Spanish, or Portuguese. This protocol is available on the Open Science Framework (Doi: 10.17605/OSF.IO/PE35D). The scoping reviews follow the Joanna Briggs Institute methodology and the Arksey and O’Malley framework. Will be reported in accordance with the Preferred Reporting Items for Systematic Reviews Extension guidelines. Discussion: The series of scoping reviews will systematize and make available the current evidence regarding race and ethnicity inequities in the American and Caribbean region within the context of major health outcomes for a better recognition of knowledge gaps.Results will have critical implications for the documentation of the effect of Racism on health outcomes and shaping racial health inequities observed among these health outcomes, the designed and development of policy action to mitigate and eliminate racial health inequities in the Americas, promoting health equity by making of the invisible, visible.

Resumo O racismo antinegro atravessa a vida das mulheres pretas e pardas comprometendo a saúde sexual e reprodutiva. O racismo obstétrico que ocorre durante a gravidez, pré-natal, parto, aborto e puerpério atinge estas mulheres expondo-as à desfechos maternos negativos e muitas vezes letais. Este estudo objetiva apresentar o racismo e suas manifestações na morte materna por COVID-19. Estudo transversal, com dados das notificações de COVID-19 entre gestantes e puérperas registradas na base de dados da Síndrome Respiratória Aguda Grave (2021 e 2022). Foram coletadas informações sobre raça/cor, idade, região, sinais e sintomas clínicos, UTI e óbitos. Os resultados apontam como o racismo afeta as gestantes e puérperas pretas e pardas, que apresentam maior letalidade por COVID-19 comparada às brancas (diferença que alcança os 14,02%), em particular no puerpério. Gestantes pretas e pardas são as que menos acessaram UTI. Após ajustes, a chance de óbito materno no puerpério para as mulheres pretas foi 62% maior em comparação as brancas (RC=1,62; 95%IC: 1,01-2,63). O racismo e suas manifestações (des)organizam as trajetórias reprodutivas das mulheres pretas e pardas que na sua interação com o sexismo contribuem para desfechos maternos negativos e letais por COVID-19.

Background The world is currently experiencing multiple economic crises due to the COVID-19 pandemic, war in Ukraine, and inflation surge, which disproportionately affect children, especially in low-and middle-income countries (LMICs). We evaluated if the expansion of Social Assistance, represented by Social Pensions (SP) and Conditional Cash Transfers (CCT), could reduce infant and child mortality, and mitigate excess deaths among children in Brazil, one of the LMICs most affected by these economic crises.Methods We conducted a retrospective impact evaluation in a cohort of Brazilian municipalities from 2004 to 2019 using multivariable fixed-effects negative binomial models, adjusted for relevant demographic, social, and economic factors, to estimate the effects of the SP and CCT on infant and child mortality. To verify the robustness of the results, we conducted several sensitivity and triangulation analyses, including difference-in-difference with propensity-score matching. These results were incorporated into dynamic microsimulation models to generate projections to 2030 of various economic crises and Social Assistance scenarios.Findings Consolidated coverage of SP was associated with significant reductions in infant and child mortality rates, with a rate ratio (RR) of 0.843 (95% CI: 0.826-0.861) and 0.840 (95% CI: 0.824-0.856), respectively. Similarly, CCT consolidated coverages showed RRs of 0.868 (95% CI: 0.842-0.849) and 0.874 (95% CI: 0.850-0.899) for infant and child mortality, respectively. The higher the degree of poverty in the municipalities, the stronger the impact of CCT on reducing child mortality. Given the current economic crisis, a mitigation strategy that will increase the coverage of SP and CCT could avert 148,736 (95% CI: 127,148-170,706) child deaths up to 2030, compared with fiscal austerity measures.Interpretation SP and CCT programs could strongly reduce child mortality in LMICs, and their expansion should be considered as an effective strategy to mitigate the impact of the current multiple global economic crises. Health 2023;27: Published https://doi.org/10. 1016/j.lana.2023. 100618

Importance Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. Objective To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. Design, Setting, and Participants This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. Main Outcome(s) and Measures Maternal death. Results A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. Conclusions and Relevance This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.

A gravidez e a maternidade na adolescência são questões relacionadas aos direitos humanos, aos direitos sexuais e reprodutivos e à saúde pública. Identificar iniquidades raciais nas tendências temporais da maternidade na adolescência e acesso ao pré-natal no Brasil. Foi realizada uma análise descritiva da proporção de mães adolescentes de nascidos vivos, características sociodemográficas e número de consultas pré-natais segundo raça/cor e faixa etária (10-14 e 15-19 anos) com dados do Sistema de Informação de Nascidos Vivos. As tendências ao longo do tempo foram avaliadas usando modelos de regressão binomial negativa. No período da análise, foram identificadas 6.118.205 mães adolescentes, sendo a maior proporção de mães entre 15-19 anos de idade (95,14%). A análise de tendência mostrou um padrão geral decrescente de maternidade entre as adolescentes de 10 a 14 anos (RR=0,97; p<0,0001) e uma tendência estacionária entre as que tem idade entre 15 e 19 anos (RR=0,99; p=0,611). Iniquidades raciais foram encontradas, com tendência decrescente observada apenas entre adolescentes Brancas (faixas 10-14 e 15-19) e Pardas (10-14 anos). Iniquidades raciais também foram encontradas no número de consultas pré-natais e nas características sociodemográficas. Indígenas (20,8%), Pardas (40,4%) e Pretas (41,9%) são as que menos referem a realização de 7 ou mais consultas de pré-natal em relação às Brancas (56,6%). As iniquidades raciais atravessam as trajetórias sexuais e reprodutivas de meninas e adolescentes levando a maternidades não pretendidas. As políticas de saúde devem considerar o racismo e suas manifestações.