Panel 7.5 Brazil’s achievements in improving stunting prevalence and breastfeeding practices: Ingredients of

In the past three decades, Brazil has experienced rapid changes in key social determinants of health and nutrition and undergone major healthcare system reforms (Victora et al, 2011). These changes are reflected in Brazil’s impressive improvements in stunting levels and breastfeeding practices since the mid-1970s. Stunting prevalence, for example, dropped from 37 percent in 1974–1975 to 7 percent in 2006– 2007. During the same period, the median duration of breastfeeding increased from around 2.5 months to 14 months. Exclusive breastfeeding rates in children younger than four months of age similarly rose steeply from a low of around 4 percent in 1986 to 48 percent by 2006–2007 (Victora et al, 2011). These achievements were made through a vast expansion in access to maternal and child health and nutrition services coupled with broad social, economic, and political changes. The most notable changes included steady reductions in poverty and fertility, a transition from a military dictatorship to a stable democracy that introduced many social reforms, huge investments in primary and secondary schooling that led to substantial improvements in women’s education, food supplementation programs targeted at mothers and children, extensive water and sanitation programs, and cash transfer programs targeted at the poorest population groups (Pérez-Escamilla et al, 2012). In an effort to reduce Brazil’s high child mortality and stunting rates, particularly in comparison with othe