Abstract

PIP: Historical analysis of trends in infant and maternal mortality rates reveal different patterns and factors that influence them. Recent international and urban-rural differences in trends, associations with population density and the influence of parental social class and income has led to questioning the long accepted interpretation of the sharp decline of infant mortality in Britain (at the turn of the century) as due to such measures as pure water supplies, sewage disposal and pasteurization of milk. Several authors now believe that direct control of fertility influenced parity and birth spacing, with all other factors contributing to the decline in infant mortality. While the drop in infant mortality rates can be attributable to social and environmental influence, trends in maternal mortality differ considerably. Even though high maternal mortality has often been associated with areas of poverty, such a link has been indirect; the determining factor is the place of delivery, and the skill and care of the birth attendant. The decline in maternal mortality rates began by the mid-1930's and have been halved every 10 years since. National concerns due to high rates of maternal mortality led to different organizational solutions. The US adopted a specialist obstetrician/hospital-based delivery system; the Netherlands combined midwives with home delivery; New Zealand trained midwives but with delivery in hospitals, and Britain included specialized obstetricians with better training of midwives and general practitioners. All of these variations had no effect on mortality rates. The decline is attributed to the use of sulphonamids followed by penicillin and improvements in medical management. In a recent publication entitled "Working for Patients", mortality rates continue to remain the outcome measures to be used universally while infant mortality rates are considered crude and not amenable to health interventions.