Brazil slashed its infant mortality rates by 50% between 1990 and 2006 thanks to rising incomes and better healthcare

The woman at the door furrows her brow and breaks into a giggle. "What's broccoli?"

It's early afternoon in Ipuca, a rural shantytown in one of the most deprived corners of Rio de Janeiro state, and Lucileide Alves Costa, a 25-year-old mother of two, is receiving a visit from members of the Pastoral da Crianca, an outreach group devoted to fighting infant mortality.

Pointing to 1-year-old Francisco, the visitors rattle off a list questions from their notebook: "Is he eating ok?" "Does he eat vegetables?" "Has he been vaccinated?" Costa responds in the affirmative - until broccoli is mentioned. "I use onions and pepper – and stock cubes," Costa confesses. "But I've never cooked broccoli. What is that?"

Welcome to the frontline of a three-decade battle against infant mortality in Brazil, a country that has managed to drastically reduce death rates over the last 30 years, saving tens of thousands of young lives.

A 2008 study by Unicef found that Brazil had slashed infant mortality rates, those among children between 0 and 1 year of age, by over 50% between 1990 and 2006. According to the report the national death rate had dropped from 48 deaths per thousand live births to around 19.

Even in Brazil's indigenous communities, some of the worst-affected areas, the government says things are improving. According to Brazil's health agency Funasa, there was a 10% drop in infant deaths in indigenous areas between 2007-2009.

In 2000, Funasa claimed that the death rate in such areas was nearly 75 for every 1,000 children under the age of one. In 2009 that figure dropped to around 42 per 1,000.

All of which means that Brazil is on course to meet the fourth millennium development goal, which calls for a two-thirds reduction in the infant mortality rate by 2015. Other countries performing strongly include Bangladesh, Egypt, Indonesia, Mexico, Nepal and the Philippines. But elsewhere results are not so uplifting. In Somalia, Unicef figures show that the mortality rate among under-fives remained stable between 1990-2004, with around 225 deaths per 1,000. While Haiti managed to reduce its rate from 150 per 1,000 to around 117 deaths, it still remains on Unicef's "off-track" list.

Globally the under-five mortality rate has fallen from 90 deaths per 1,000 live births in 1990 to 65 in 2008, according to a Unicef report published this month (Sept 2010). But the rate of decline means that overall MDG4 will not be attained, with sub-Saharan Africa and South Asia still lagging.

Lucileide, an immigrant from Brazil's impoverished north-eastern state of Ceara, ranks among Rio's poorest residents. Her house lacks running water – she uses a neighbour's well - and the front door of her cramped home opens out onto a black river of raw sewage.

Yet even here a combination of government action and the work of community support groups such as the Pastoral da Crianca has drastically reduced child and infant mortality. Thirty years ago it was common for mothers in slums like these to lose their children during or soon after childbirth. No longer.

"It's very rare nowadays," says Leila Maria Rangel Soares Santana, 55, the Pastoral's local organiser. "We had one death some time ago but it was because of something that happened at the hospital, not bad pre-natal care. Dehydration and diarrhoea – these are very common here and in the rest of Brazil. But here, infant mortality hardly exists any more."

The plummeting number of child and infant deaths in the Rio favela tells a wider story of a improving living standards in Brazil. According to the Ministry of Health 43.601 Brazilian babies died in 2008 compared to 95,476 in 1990.

"The fall in infant mortality is the result of families having greater access to information, health services and income," Brazil's social development and hunger minister, Marcia Carvalho Lopes, says.

Lopes also attributes the continuing fall to recent government projects such as Fome Zero, or Zero Hunger, and Bolsa Familia, an income transfer project which conditions cash transfers to low-income families on the vaccination of children and their presence at school.

"Bolsa Familia mothers are breast-feeding more. Pregnant women are doing more pre-natal," she says.

While government action has played a major role, the Pastoral da Crianca is widely credited with spearheading the drive to reduce infant mortality rates in Brazil.

The group, which aims to train mothers in basic healthcare and healthy eating, was founded in 1983 by Zilda Arns, a legendary Brazilian medic and aid worker, and now boasts a network of 260,000 volunteers across the country from the Rio favelas to the remote riverside communities of the Amazon jungle and the arid backlands of north-east Brazil, where Costa was born.

Arns was killed in Port-au-Prince earlier this year when the Haitian church she was speaking at was hit by January's earthquake. Her group's work, however, goes on – not just in Brazil but in countries such as Angola, Haiti and East Timor. Today the Pastoral says its volunteers care for nearly 2 million Brazilian children, while mortality rates among children within their reach is significantly lower than children who are not.

"Today rates [of infant mortality] among the children we support are under 10 [deaths per 1,000]," says Antonio Chaves, the group's state coordinator in Rio. "Before in some areas the rate was over 70."

"The healthcare system is still not of a first-world standard, but it has improved a lot," he adds.

In Jardim Catarina the Pastoral helps around 550 children, using community "leaders", usually local mothers themselves, to reach out to expectant mothers through monthly visits and weighing sessions. Each leader is responsible for around 15 children between the ages of 0 and 5 and around five expectant mothers.

Much remains to be done. While infant mortality rates in south-eastern states such as Rio and São Paulo have massively receded, the rate of infant deaths remains high in the poor north and north-east of the country.

Jorge Abrahao de Castro, the director of social policies at Brazil's Institute for Applied Economic Research, a state-funded think-tank, says Brazil is still characterised by "very high regional differences" in social indicators, including infant mortality.

"This rate has been falling in Brazil… [but] we still have a very high [overall] rate of around 22.8 deaths per 1,000 [among 0-5 year-olds]."

"The worst areas are improving more quickly," he says, adding that he is confident Brazil would achieve its millennium goal - which is to reduce its overall under-five death rate to 20 per 1,000 - one year ahead of schedule, in 2014.