The extension of basic health services to the poor in Costa Rica from 1960 to 2005 made a decisive contribution to the rapid decline of mortality. When governments in the 1970s introduced community-based health care and nutrition programs in impoverished rural and urban areas, mortality rates plummeted. After governments in the mid-1990s made primary care by Comprehensive Basic Health Care Teams (EBAIS) the gateway to the entire health system, mortality decline accelerated after 15 years of slow progress. The public provision of basic health services was not the only reason for the rapid decline of mortality in Costa Rica; other government social policies, particularly family planning programs and the provision of safe water and adequate sanitation, also contributed. In few other nations, however, has the contribution of basic health service provision to the rapid decline of mortality been as conspicuous as in Costa Rica.

This chapter reviews the politics and policies that led to rapid infant mortality decline in late twentieth-century Costa Rica. It reconstructs the tempo of infant mortality decline within Costa Rica over time and compares infant mortality levels and changes in Costa Rica to those in other countries. It finds that these infant mortality levels and changes were associated less closely with GDP per capita, income inequality, and income poverty than with education, family planning, safe water, sanitation, nutrition, and primary health care policies. It also finds that democracy encouraged these mortality-reducing social policies.