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Maternal characteristics and neonatal mortality in Brazil

4. Discussion
In this study, we examined the risk of neonatal mortality according to the maternal characteristics in Brazil between
2006 and 2016. Using the decision trees, we measured the effect of different characteristics on the NMR. Combining
two different determinants makes disparities in NMR more evident. This classification enables us to offer specific
solutions according to the characteristics of each group in addition to contributing to better monitoring of the effect
of each determinant. The lowest NMR were found when mothers were 20-34 years of age and had 12 or more of
schooling. In contrast, high rates were found when mothers had no education, were unmarried, and were older than
34 years of age. When combined, these factors compose the highest risk groups.
The previous studies have assessed the importance of maternal characteristics in the distribution of neonatal
mortality using local samples. The present study is an effort to provide new information in this direction. According to
Flenady (2015), most neonatal deaths in developing countries could be prevented with better care during pregnancy,
since many are due to inadequate health care for the mother before birth, as shown by Gaiva, Fujimori and Sato (2015)
in Brazil. The features selected in the present investigation are available at the onset of a pregnancy and can help
detect such cases more quickly.
The results concerning mother’s age confirm the findings of the previous investigations. Some studies report
strong evidence for both socioeconomic and biological issues concerning the risk of infant death among adolescent
mothers (Fonseca, Flores, Camargo Jr. et al., 2017; Oliveira, Gonçalves, Costa et al., 2016; Teixeira et al., 2016). In
Brazil, the pregnancy rate among adolescents has generally declined in recent decades, although levels remain high
(UNFPA, 2018). Adolescent pregnancies are more likely to occur in marginalized communities, which are commonly
characterized by poverty as well as lack of education and employment opportunities (UNICEF, 2013), leading to an
increased risk of infant mortality (Oliveira, Gama and Silva, 2010). According to César, Ribeiro and Abreu (2000),
the difference found in the mortality of children of adolescent mothers may reflect the poverty effect more than the
age effect and is also an indicator of the precariousness or even lack of adequate prenatal care.
While the average age of mothers at childbirth has decreased in Latin America to around 20-24 years old in the
past decade, the average age in developed countries had increased significantly to above 28 years. Mothers older than
35 years of age tend to have a better education, a planned pregnancy and better care in terms of both medical and
emotional aspects. However, they face challenges due to their older age. Age is related to an increase in the incidence
of diseases such as diabetes and hypertension, both of which are associated with higher infant mortality risk (Jahromi
and Husseini, 2008; Dietl, Cupisti, Beckmann et al., 2015; Oliveira, Gonçalves, Costa et al., 2016; Vidal et al., 2018).
Education provides several health advantages because it exerts a positive influence on psychosocial and behavioral
factors. The results of the present investigation are in agreement with data described in the previous studies (Fonseca,
Flores, Camargo Jr. et al., 2017; Oliveira, Gonçalves, Costa et al., 2016), which report that mothers with 10 or more
years of schooling have half the risk of losing their babies in the 1 month than mothers with 1-4 years of schooling,
st
whereas women with no schooling have a higher risk of NMR compared to women with schooling. Teixeira el al.
(2016) found that more than 8 years of mother’s schooling were a protective factor, exerting positive effect on the
reduction in infant mortality. In the present investigation, the risk of neonatal mortality was significantly higher
among mothers with no schooling. Fonseca, Flores, Camargo Jr. et al. (2017) found that children of mothers with less
than 4 years of schooling had a greater chance of neonatal death compared to the children of mothers with at least 4
years of education. The authors report that the ability to acquire knowledge on health issues and the optimal use of
health services are attributed to a higher educational level. The ability to assess the onset of symptoms properly is
also correlated with education.
Many changes have occurred in recent decades. Access to information and the standardization of health-care
protocols has diminished the impact of mother’s schooling on the life outcome. However, this variable has an
explanatory power that needs to be better distinguished from its correlation to wealth and the availability of health-
care services. The present study confirms a trend found in recent research. Fonseca, Flores, Camargo Jr. et al. (2017)
investigated data from the state of Rio de Janeiro between 2004 and 2010 and found that NMR was reduced at a lower
rate among mothers with fewer years of schooling and that there was no reduction in the NMR among mothers with
no schooling.
Marital status is the least studied factor in terms of infant mortality. Most studies often distinguish this variable
into two major groups (married and unmarried). According to DeRose, Salazar-Arango, García et al. (2017),
unmarried mothers in the Global South are younger, have less schooling and a lower socioeconomic status compared
to the married mothers. A systematic review and meta-analysis of neonatal mortality risk factors in Brazil were

30 International Journal of Population Studies | 2019, Volume 5, Issue 2