**Abstract**

This chapter introduces and discusses to what extent policies focused on promoting maternal and infant health through public health services are or are not effective in the coverage area. The discussion is based on accounts of adolescents mothers or still pregnant—and the assistance provided to them and their children through these services. The accounts, which are derived from an independent program of home visits to accompany these adolescents, are complemented by observations made by the visitation team about whether assistance provided by health services promote maternal and infant health and the rights of children and adolescents. To provide context, we present a panorama of current public-health policies and services aimed at mothers and infants in Brazil, as well as some health indicators for this population. Finally, we discuss the possibilities and challenges of promoting the healthy development of mothers and their children in these contexts.

**Keywords:** public policies, promotion of maternal-infant health, adolescent pregnancy, prenatal, maternal-infant mortality

#### **1. Introduction**

Brazil is a country of continental dimensions, with enormous geographic and cultural diversity and with major problems of social inequality. To get an idea of the regional differences, while the north region is covered by the Amazon rainforest, has the largest population that self-identifies as indigenous, and accounts for 42.25% of Brazil's territory with the lowest population density, the southeast region is the most populous, has the largest urban center, greatest industrial output, and accounts for more than 50% of everything the country produces (in GDP terms) [1].

Furthermore, in the past decade, the country has undergone both advances and setbacks, in terms of politics and economics, that have directly influenced the development of its public policies, including those in regard to maternal-infant health, the focus of this chapter. In this sense, although currently there are important investments in programs focused on reducing maternal-infant mortality rates, humanizing services, and promoting the healthy development of the population, the country still has a long way to go.

In historic terms, the passage of the 1988 Constitution was an important step in the process of changing the paradigm of Brazilian health policies, in that it began to address the concept of health as a right of all citizens and the obligation of the state. This prioritization led to the creation of the Unified Health System (Sistema Único de Saúde or SUS), which is geared toward providing free services to all individuals, ranging from the simplest outpatient consultations to more complex surgeries, and which represents one of the largest public health systems in the world, offering integrated, universal, and egalitarian access to all Brazilian citizens [2, 3].

SUS promotes the regionalization of services; hierarchization into increasingly complex levels, depending on the needs of the population being served; the decentralization of command, giving autonomy to each sphere of power to make its decisions; and the participation of the population in the system's day-to-day operations. All these principles seek not only to prevent illnesses but also work toward promoting health, quality of life, economic and social development, and the reduction of inequalities [4].

Also worth mentioning is the Child and Adolescent Statute (Estatuto da Criança e do Adolescente or ECA) of 1990, which includes eight articles dedicated to rights to life and health. This statute has been praised for the advances it provides in the form that children and adolescents are viewed in the country. As a result, it seeks to ensure dignified conditions of life, starting even before birth, considering that articles 7 and 8 guarantee that pregnant mothers and newborns have access to pre- and perinatal services by way of public policies that promote healthy development [5].

Also included in the social advances relevant to the promotion of health and improved quality of life of the population—especially mothers and children—we should note the role of the Bolsa Familia Program. Created in 2003, this is a wealthtransfer program at the federal level that helps families living in poverty and extreme poverty to break the intergenerational cycle of poverty. Furthermore, it seeks to contribute to the expansion of access to public services that represent basic rights in the areas of health, education, and social assistance, representing one of the main factors that have led to the reduction in infant mortality [6].
