[The small epidemiologic transition: further decrease in infant mortality due to medical intervention during pregnancy and childbirth, yet no decrease in childhood disabilities]

Abstract

The small epidemiologic transition, which started to occur during the 1960s, was a continuation of the large epidemiologic transition. The large epidemiologic transition concerned a strong increase in the life expectancy as a result of the virtual disappearance of mortality during the early life years. During the most recent stage of this epidemiologic transition, two types of medical intervention in pregnancy and childbirth were introduced: antenatal screening and diagnosis followed by selective abortion, and neonatal intensive care for preterm babies. These two types of intervention have opposite epidemiologic effects. On the one hand these have led to a further decrease in the mortality. Yet, on the other hand the prevalence of childhood disabilities has scarcely decreased or has not decreased at all, because intensive interventions after childbirth can lead to more disabilities occurring in the population than those removed due to selective abortion. The small epidemiologic transition has arisen from an expansion in knowledge and possibilities to observe and intervene. These have indeed led to an increase in options before, during and after pregnancy, but not to a reduced morbidity at the start of life.