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FUJIWARA-DISSERTATION-2015.Pdf Copyright by Luis Mario Fujiwara 2015 The Dissertation Committee for Luis Mario Fujiwara Certifies that this is the approved version of the following dissertation: THE ROLE OF THE PASTORAL DA CRIANÇA PROGRAM IN THE INFANT MORTALITY TRANSITION IN BRAZIL, 1980-2000 Committee: Chandler Stolp, Supervisor Joseph Potter, Co-Supervisor Bryan Roberts Robert Wilson Patrick Wong THE ROLE OF THE PASTORAL DA CRIANÇA PROGRAM IN THE INFANT MORTALITY TRANSITION IN BRAZIL, 1980-2000 by Luis Mario Fujiwara, BA, MA Dissertation Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY The University of Texas at Austin August 2015 Dedication I dedicate this dissertation to my son Francisco, In Memoriam, who despite his very young age was an absolutely inspiring example of courage and determination in his fighting for survival. I also would like to dedicate this work to my love Vanessa, my Rock of Gibraltar, which companion makes me, every day, a much better person. This dissertation is also dedicated to my father Roberto, In Memoriam, and my mother Marilene, who inspire on me the will to fight for a better, fair, and egalitarian world. I would also like to dedicate this dissertation to my grandmother Maria Magdalena, In Memorian, who taught me the meaning of unconditional love, thank you for always had believe on me, and stimulated me to pursuit all my childhood dreams. Finally, I would like to dedicate this work to all Pastoral’s volunteers and personnel, whose devotion to saving lives and promoting human rights is absolutely inspiring, and a concrete example that another world is possible. Acknowledgements Finish this degree would not have been possible without the financial support from the LBJ School of Public Affairs. The J. J. “Jake” Pickle Fellowship supported me in my initial years in this academic program. I am deeply thankful for Representative Pickle, to whom I had the chance to personally express my gratitude right before his dead in 2005. I am also very grateful for the financial support from the Inter-American Foundation (IAF), the resources provided by the IAF Grassroots Development Fellowship allowed me to conduct my field research in Brazil. This dissertation would not have been possible without the engagement of the Pastoral National Coordination that was always absolutely supportive, patient, and impartial in the conduction of this evaluative exercise. It would be impossible to thank all people that supported me during my Texan adventure. Even in this way I would like to express my gratitude to my family, including my cousins Alhetea Fujiwara, Daniel Fujiwara, Flora Fujiwara, and Leticia Fujiwara, and my aunts Biru Fujiwara, Lehita Tapajós Guimarães, and Teresinha Tapajós Guimarães, for always believing on me and supporting my dreams. I also want to express my gratitude to my uncles Antonio Fujiwara, Célio Fujiwara, Delfim Fujiwara, and Milton Fujiwara, who helped me to pay my initial registration at the Masters Program in the Fundação Getulio Vargas from São Paulo in 1997. I would like to thank my Masters Advisor Marta Ferreira Santos Farah, and my colleagues of the Fundação Getulio Vargas de São Paulo, Peter Spink, Fernanda Martinez de Oliveira, Ilka Camarotti, Hélio Batista Barboza, and Marco Antonio Carvalho Teixeira, whose hard work and commitment inspired me to pursuit an academic career in v field of public policy, and to focus on themes linked with human rights, gender, and ethnic-racial equality. I would also like to thank my colleagues Ana Rosa Monteiro Soares, Andreia Arrais, Andreia Melo, Antonio Mello, Eunice Borges, Fernanda Carvalho, Larissa Lamera, Larissa Leite, Luiz Machado, Margarita Nechaeva, Miren Saiz, and Wanderley Andrade from the United Nations in Brazil for their continuous support and inspiring energy in the pursuit of a better world. I would like to specially thank my colleagues Andrea Azevedo, Anita Campos, and Caio Csermak, from UN Women, you are my own Wild Bunch – thank you so much for teaching me a lot, specially that working can be a lot of fun. I would like to acknowledge the support of my friends Alvaro Quezada- Hofflinger, Amber Stolp, Ana Maria Blanco, Ana Paula Ramone, Andre Davini, Andres Manosalva, Angela Reese, Anny Raquel Piccino, Athayde Motta, Carlos Potiara Castro, Carlos Rocha, Case Watkins, Cassie Smith, Daniel Bisetto, Danilo Butkus, Demetrius de Paula, Drew Nelson, Edgard Dias, Edgard Piccino, Ernesto Amaral, Fábio Pacano, Fernando Rodriguez, Flávia Leite, Flávio Bersi, Dr. Foo Swasdee, Gustavo Simplis, Jaime Marroquin, Jeff Holle (and Flute), Jennifer Potter-Andreau, John Cuttino, Jospeh Vavrus, Juan Carlos Obando, Juliana Leite, Kara Anderson, Kevin Schroeder, Kristin Wylie, Laura Spagnolo, Leandro Alves de Souza, Lori Schroeder, Louise Tedford, Luis de La Mora y Mora, Lula Marcondes, Manu Balan, Márcia Onyszkiewicz Lee, Marcelo Azambuja, Márcio Siwi, Maria Garcia, Michael Coffman, Michael Gale, Miguel Alvear, Nenem Melo, Nestor Castaneda-Angarita, Mauro Spagnolo, Pedro Leal, Pinguim, Rene Brito, Ricardo Bernardes, Ricardo Meirelles, Robert “Doc” Green, Sam Gorman, Sebastian Barriga, Sonia Frias, Thiago Mendes, and Walter Castro. Thank you so much for your friendship and patience, in the good and in the bad times. vi I would like to thanks Dr. Victoria Rodriguez for the support provided during my initial period of studies at the LBJ School of Public Affairs, when I was a Visiting Scholar from Brazil in 1999. I would like to thank the members of my Dissertation Committee Dr. Bryan Roberts, Dr. Robert Wilson, and Dr. Pat Wong for providing useful and instrumental inputs in the development of this work. I would like to thank Dr. Joseph Potter, my co-advisor, who inspired on me the necessary curiosity that stimulated me to acquire a complete new set of knowledge in the fields of quantitative methods and demographics. Finally, I would like to especially acknowledge the role that my great friend and advisor Dr. Chandler Stolp had during all the time I studied in Austin. Dr. Stolp support was crucial in personal, professional and academic ways, and I am deeply thankful for that. I would probably not be here it was not for you. Thank you so much for believing on me, and teaching me so much about life, statistics, and econometrics. vii The Role of the Pastoral da Criança Program in the Infant Mortality Transition in Brazil, 1980-2000 Luis Mario Fujiwara, PhD The University of Texas at Austin, 2015 Supervisor: Chandler Stolp Co-Supervisor: Joseph Potter This dissertation focuses on the role Brazil’s innovative Pastoral da Criança program had on the transition in infant and child mortality observed in that country from 1980 to 2000. Using a variety of approaches to program evaluation, this study provides insights into the novel implementation of the Pastoral program and its overall effectiveness in contributing to the infant and child mortality transition in Brazil. This dissertation also tries to understand how it was that the Pastoral managed to succeed in promoting development when so many other efforts have failed in the past. Given the environment of complexity in which this evaluative exercise was carried out, triangulation, complementarity, development, initiation, and expansion analysis were used, at the micro level of evidence, to the macro level of methods, to generate robust estimations of the Pastoral overall impact in terms of reducing infant and child mortality, as well as of the Pastoral’s effects in terms of promoting community and women’s empowerment. viii Table of Contents List of Tables ....................................................................................................... xiii List of Figures ...................................................................................................... xvi List of Illustrations .................................................................................................xx Chapter 1: Introduction ............................................................................................1 1.1 Motivation of this Dissertation ..............................................................3 The Pastoral da Criança Program ..........................................................7 1.2 Research Questions ..............................................................................12 1.3 Policy Implications ..............................................................................13 1.4 Outline of the Dissertation ......................................................................16 Chapter 2: Background and Prior Research ...........................................................18 2.1 Poverty, Health, Development, and Aid .................................................18 2.2 The Evolution and Relevant Covariates of Infant and Child Mortality ..............................................................................................28 Evolution of Infant and Child Mortality ..............................................28 Relevant Covariates of Infant and Child Mortality in Brazil ...............35 Socioeconomic Covariates of Infant and Child Mortality ..........36 Regional Covariates of Infant and Child Mortality ....................38 Identity Based Covariates of Infant and Child Mortality............40 Rival Programs Covariates of Infant and Child Mortality ..........46 2.3 Prior Research on the Effects of the Pastoral da Criança .......................54 Chapter 3: Evaluative Theoretical
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