International Journal of Epidemiology 2000;29:542-548
© International Epidemiological Association 2000
Community-based prevention of perinatal deaths: lessons from nineteenth-century Sweden
a Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden.
b Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
c Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Reprint requests to: Tobias Andersson, Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, 901 85 Umeå, Sweden. E-mail: tobias.andersson{at}epiph.umu.se
Background Perinatal deaths have been more difficult to prevent than infant deaths in low- income countries due to its close relation to poor maternal outcome. The aim of the study was to perform a comprehensive population-based analysis of perinatal mortality in a high mortality setting and to determine the impact of midwifery-assisted home deliveries.
Method The study design was a community-based cohort study. In all, 4876 perinatal deaths were recorded among 116 211 newborns in the districts of Sundsvall and Skellefteå in northern Sweden during the years 1831–1899. Relative risks, 95% CI, population attributable proportions and prevented fractions were calculated.
Results The overall perinatal mortality rate was 42.0 per 1000 births. A previous stillbirth represented one of the most important risk factors (RR = 3.25, 95% CI : 2.97–3.56), with a population attributable proportion of 7%. Two or more previous stillbirths gave an RR of 8.50 (95% CI : 7.58–9.53) and a population attributable proportion of 4%. There was an increased risk of perinatal mortality for mothers over 35 years old, the primiparous and the unmarried, while grandparous women had a higher perinatal mortality that was accounted for completely by a poor history of previous stillbirths and infant deaths among these women. The children of crofters, farmers and workers had higher perinatal mortality, but area had no significant impact. During the years 1881–1890 and 1891–1899, the prevented fractions of midwifery were 15% and 32%, respectively.
Conclusion Poor reproductive history, particularly previously high perinatal mortality, is associated with high perinatal mortality. Midwifery-assisted at home deliveries successfully reduced perinatal mortality.
Keywords Nineteenth century, developing countries, epidemiology, history of medicine, perinatal mortality, preventive health services, reproductive medicine
Accepted 8 November 1999