From rhetoric to reality in improving maternal health outcomes: an analysis of women’s rights activism in Brazil

This thesis presents the results of an empirically-grounded exploration of the ascendance of maternal mortality as an issue and its neglect by Brazilian public policy. Its purpose is to contribute to the existing scholarly debate on social policy and participation in order to advance knowledge on the dynamics of agenda setting and activism. More specifically, it relies on a case study of political and policy strategies aimed at maternal mortality reduction, to determine whether or not decentralisation has led to processes and environments that are more adequate to the advancement of women’s rights. Policy and discourse analyses are used to discuss the continuous appropriation, transformation and re-appropriation of decentralisation by the different policy networks and its influence in the depoliticisation of the wider human rights movement. In-depth interviews with key-actors participating in the 1980s and 1990s health sector reforms in Brazil demonstrate that decentralisation does not live up to its social justice premise and that, as it is not inserted into a wider culture of political measures for positive change, it reinforces existing power hierarchies and elitism. This historical analysis serves as a statement of the voracious power neoliberalism has over all types of policy making as well as its opportunistic advancement of certain political strategies created by different individuals and networks involved in the institutionalisation of human rights-based approaches. This control exerted by neoliberalism over policy and policy discourse is particularly acute in the case of maternal mortality. In its most progressive format, maternal mortality touches upon politically contentious issues that are often resisted by conservative networks supporting neoliberal control over public health sector reforms, principles and practices. Furthermore, in the face of new and multiplying policy spaces created by decentralisation, women’s rights networks lose their political leverage as sophistication, capacity and resources become indispensable