The baby's eyes were bright as a bird's, but in the arms of her mother she lay limp and silent. Her mother looked worried. So did Luzide da Silva Oliveira.
Oliveira, who works with a group called Pastoral da Crianca, or Shepherd of the Children, here in Brazil, had just weighed 11-month-old Geslaine. The baby had gained only one pound in a month.
"She's underweight, and I think she's suffering from malnutrition," said Oliveira, as she stood close to the baby's mother, Clodineia Alvez, 24. "She was about seven pounds when she was born, but since then she's barely doubled her weight. She's starting to fall off the chart."
Alvez and Dona Luz, as the fiery 60-year-old Oliveira is known, worry that Geslaine may not see her first birthday. And with good reason.
After nearly a decade of steadily increasing per capita income that has now surpassed $4,700, the infant mortality rate remains alarmingly high here--41 out of every 1,000 babies die before they turn 1 year old--compared to countries of comparable wealth.
Malaysia and Poland have rates one-fourth as high. Much poorer countries, such as Cuba and Costa Rica, boast rates half as high. China, with one-quarter the per capita income of Brazil, has a rate that is 25 percent lower. In South America, only Peru and Bolivia have higher rates than Brazil.
Behind the high incidence of infant deaths are a host of problems that have bedeviled Brazil for much of its modern history. Income distribution here remains among the least equitable in the world. Poor women are handcuffed by low levels of education. Rural residents lack access to decent health care. Some regions, once neglected by the government, remain woefully underdeveloped.
Like most developing countries, Brazil has cut its infant mortality rate by more than 50 percent over the past two decades. But its continuing struggle illustrates the stark challenges the country faces as it tries to improve life for the most vulnerable of its 167 million people.
Brazilian babies die because women, especially in rural areas, often cannot get competent prenatal care. Sometimes pregnant women walk miles to a hospital, only to wait 12 hours to be seen.
The infants who die usually do not make it past the first month. And a majority of those who die in the first few weeks succumb to easily treatable ailments, such as malnutrition, diarrhea and respiratory infections. Living in poorly ventilated shacks without basic sanitation makes them especially vulnerable.
Medicine to treat such afflictions may cost a middle-class Brazilian family a day's wages. It may cost people such as Alvez a month's pay.
"Every week I have a crowd of 250 people here at these gates begging for medicine," said Roman Catholic Bishop Francisco Austregesilo, a prominent activist in the northeast. "And 80 percent of them want it for their children."
In Brazil, "you'll find serious regional disparities, disparities within in each state, within each city, even from neighborhood to neighborhood," said Jacques Schwarzstein, a Brazilian who directs UNICEF's office in the northeastern city of Recife, Brazil's fourth-largest.
The northeast, Brazil's least-developed region, has an infant mortality rate that is double the national figure. In the small town of Sao Jose da Tapera, in the state of Alagoas, last year's rate stood at 148 deaths per 1,000 live births.
The government says the problem is not just health care. Ana Gorette, who oversees children's health for the Ministry of Health, says it's also "a problem of lack of sanitation and education, and a lack of access to information."
But the disparities in Brazil reveal themselves even in such prosperous states as Parana, and its capital, Curitiba, a city with gorgeous, gleaming malls and blocky, modern mansions. Its per capita income last year reached $7,977.
It is also a city in which people live at river's edge in cramped wooden shacks without plumbing. Residents such as Alvez and her husband support their four children--ages 5, 3, 2 and 11 months--by ripping through trash to collect paper for recycling, a job that pays about $21 a week.
Parana has one of the country's lowest infant mortality rates, thanks largely to a combination of municipal and state government efforts. Parana and Curitiba have created dozens of programs aimed directly and indirectly at reducing infant mortality.
Yet "our income distribution is very irregular," said Mayor Cassio Taniguchi. "We have a great gap between our rich and our poor. It's a big challenge for the whole country, but we can't sit around waiting for miracles."
Income disparities contribute greatly to disparities in access to health care throughout Latin America, said David Brandling-Bennett, deputy director of the U.N.'s Pan American Health Organization. Countries such as Costa Rica and Chile, which have focused on preventive care and regional health services, generally have had the most success reducing infant mortality rates, he said.
Brazil's government has addressed lack of access to health care by creating a system of community health care teams around the country. By all accounts, the advent of these teams has helped the poor, but the program is spotty. Some residents in and near Curitiba say community health workers visit them only once or twice a year.
And so such groups as Shepherd of the Children, which receives public and private funds, scurry to fill the gaps. They venture into Curitiba's slums to weigh children, to offer advice, to urge women to breastfeed and to make their prenatal visits. They also provide milk and a nutritious supplement called "multimix"--a powder that includes rice and wheat fiber and leaves from cassava, pumpkin and sweet potato plants.
Alvez's daughter, Geslaine, fell behind from the start. She couldn't breastfeed after Geslaine turned 3 months. Then pneumonia struck Geslaine--twice. And even as they battle to keep Geslaine alive, Alvez's husband wants another child.
"Does she eat well?" asked Dona Luz.
Yes, the mother said softly.
"More than cookies? Do you give her the multimix?" Dona Luz asked.
"I put it in the beans," Alvez said.
Alvez said she gives the baby multimix twice a day. Dona Luz suggested four times a day.
"Do it like a prayer," the volunteer says. "Do it with faith."
The sun was near setting, and the mothers who had brought their children to be weighed were returning home. Finally, Dona Luz asked if Alvez thought her suggestions would help.
The mother, shoulders hunched and eyes dark with worry, said yes, but not very convincingly.
Lives Cut Short
Brazil's infant mortality rate is as high as that in many poorer countries. But the rates in many countries on the same economic level as Brazil, including Chile and Malaysia, are much lower.
(gross national product per person);
Infant mortality rate, selected countries
Infants who die before age one, per 1,000 live births
$160; Sierra Leone 136
$200; Niger 123
$970; Bolivia 67
$2,610; Peru 43
$4,790; Brazil 41
$410; Nicaragua 40
$3,700; Mexico 32
$2,680; Costa Rica 14
$4,820; Chile 12
$3,590; Poland 10
$4,530; Malaysia 8
$1,300; Cuba 7.2
$29,080; U.S. 7.0
$26,210; Sweden 3.6
SOURCE: Population Reference Bureau