The Azores continue to record one of Portugal’s higher neonatal mortality rates, although pediatrician Joana Rosa cautions that the archipelago’s small population can make annual rates fluctuate sharply with only a few additional cases. Improvements recorded in 2025, including a significant decline in perinatal mortality, are encouraging, but health authorities say continued attention to prevention, early detection, equitable access and communication among the nine islands remains essential.
Behind every mortality rate is a number that statistics can never adequately contain: a pregnancy interrupted, a newborn lost, a family confronted with an absence that no percentage can describe. That human reality accompanied the opening at Hospital do Divino Espírito Santo of the second training module of the Regional Program for Monitoring and Improving Infant Mortality, known as PRAMMI. Under the theme “From the Newborn to the Adolescent: Intervening to Improve,” healthcare professionals from hospitals and Island Health Units throughout the Azores gathered to examine how the Region can continue reducing infant and pediatric mortality and improving care.
Joana Rosa, a pediatrician at Hospital do Divino Espírito Santo and manager of the program under the Regional Health Plan 2030, urged particular caution when interpreting Azorean statistics. In a population as small as that of the archipelago, she explained, only two or three additional premature births or deaths can substantially alter a mortality rate. Infant mortality, which placed the Azores third among areas with higher rates in 2023, subsequently declined. There was an increase in 2024, part of a pattern Rosa said was also observed elsewhere in Portugal and Europe, followed by another decline in 2025. The Azores now stand fifth in the comparison she presented, an evolution she described as positive.
Perinatal mortality provides an especially important example of how rapidly the figures can change. Rosa said the Region experienced a high value in 2024, associated particularly with fetal deaths, extreme prematurity and structural disruptions affecting healthcare services. In 2025, however, the rate fell to approximately 3.5 per 1,000 live births, which she described as below the mainland Portuguese average and a very positive result. Neonatal mortality remains comparatively high within Portugal, but Rosa resisted interpreting the figure as cause for alarm. Instead, she called it a reason for vigilance: the objective should be to understand the trend over several years and preserve the improvement seen in 2025.
Modern medicine itself introduces new complexity into these statistics. Advances in neonatal care now allow extremely premature babies and children born with serious congenital conditions to survive circumstances that would once have offered little or no possibility of survival. Likewise, technological and pharmaceutical progress means pediatric services increasingly care for children with chronic and complex illnesses into later childhood. Rosa therefore expects annual fluctuations to continue. The ambition, she said, is that the long-term direction should nevertheless remain downward and increasingly close to national averages.
Geography cannot be removed from the equation. Nine islands mean distance, dispersed populations and unavoidable limitations in access to highly specialized care. Rosa acknowledged that insularity and geographic dispersion are determinants that healthcare policy cannot eliminate. What can be reduced are their consequences. Greater equity in access between islands, stronger coordination among institutions, earlier detection of complications during pregnancy and common clinical protocols can help ensure that geography does not become an unnecessary additional risk.
Prevention is equally important. Rosa pointed specifically to smoking as one of the behaviors associated with fetal mortality on which public health can intervene. Better pregnancy surveillance and faster identification of complications can improve neonatal outcomes, while protocols for fetal death can help establish causes more accurately and generate knowledge for future prevention. The Regional program is also seeking greater standardization among institutions so that healthcare professionals throughout the archipelago are, as Rosa repeatedly emphasized, “speaking the same language.”
That phrase reaches the heart of another problem she considers unresolved: interoperability. Healthcare professionals need timely and equal access to patient information regardless of where care was previously provided. Rosa said this remains a significant weakness not only in the Regional Health Service but nationally, and one that was not resolved through investments under the Recovery and Resilience Plan. For an archipelago, where a pregnant woman or sick child may need to move between islands and institutions, the ability of information to travel seamlessly can become almost as important as the ability of the patient to travel.
Training sessions such as PRAMMI are consequently part of a larger strategy. They bring professionals together around shared protocols, prevention and knowledge, while similar educational efforts must also reach the wider community. Reducing mortality, Rosa stressed, cannot be the responsibility of one program or one group of specialists; it requires coordinated work throughout maternal, neonatal and pediatric healthcare.
The higher neonatal mortality rate in the Azores should therefore be read with both seriousness and statistical caution. Small populations magnify individual events, making one year an unreliable verdict on an entire healthcare system. But caution must never become complacency. Each number remains a reason to ask whether something could have been detected earlier, communicated faster, prevented, or treated differently.
Across nine islands, medicine must continually overcome the distances that geography created. Some of those distances are measured in nautical miles; others exist between hospitals, computer systems, clinical information and access to specialized care. The first cannot be abolished. The others can—and perhaps the most meaningful progress will come when, for every child born in the Azores, the quality and continuity of care become less dependent on the island where that first breath is taken.
Based on a story by journalist Frederico Figueiredo in Correio dos Açores-Natalino Viveiros, director. Phots from Novidades and CA.