Trends and risk factors of maternal mortality in late-nineteenth-century Netherlands

Abstract

Using family reconstitution data from the Dutch provinces of Groningen, Drenthe, and Zeeland, trends and risk factors of maternal death from 1846 to 1902 are studied. Findings confirm other studies of maternal mortality trends for the Netherlands in the last quarter of the nineteenth century and show that rates were already steadily decreasing in the mid-nineteenth century. The role of biological and social risk factors including age, parity, birth interval, social class, season, and year of giving birth were also explored. Among biological factors we find an increased risk of maternal death for short birth intervals, late maternal age, high and low parity, multiple gestations, and stillbirths. Social factors associated with increased risk are belonging to the skilled working class, being a farmer, giving birth in winter or spring, and giving birth in earlier years. We also explore trends in the data which reveal directions for future research.

Keywords::

• childbirth
• family reconstitution
• maternal mortality
• nineteenth century

Notes

^1. The Groningen data does not include records from the city of Groningen, but it is complete for the rest of the province.

^2. There is mixed evidence that the marital status of the mother affects her risk of maternal mortality. One Swedish study found single mothers to have a significantly higher risk of death (Andersson et al., 2000) while another found no relation (Högberg & Brostro¨m, 1985). On one hand, unmarried women were more likely to deliver in hospitals where the risk of contracting puerperal sepsis, a major cause of maternal mortality, was higher (Van der Waals, 1987). On the other hand, the fertility rate of unmarried women was quite low. Only 1.21% of unmarried women between ages 15–49 gave birth at the beginning of our study in 1846. By 1902 this number had halved to .63%, or approximately 2.5% of all births (Centraal Bureau voor de Statistiek, 1975).

^3. Except for Groningen city.