Perinatal mortality surveys.

JOURNAL Perinatal mortality surveys "No phenomenon or stage in a sequence has only one cause; all antecedent stages are successive causes and as science has no reason to infer a first cause, the sequence of causes can be carried back to the limit of knowledge." These words from Karl Pearson's The Grammar of Science' are quoted in the report of what may well have been the first survey of individual fetal deaths.2 This was done in 1914 at the end of an era when public concern about infant mortality had given rise to a series of government reports and trips to France, where things were said to be better. The survey by Eardley Holland and Ridge of 300 fetal deaths in London hospitals and poor law institutions took the form of pathological examinations of the fetuses and interviews with the parents. In the past seven or eight years infant and perinatal mortality has once again been in the public eye. Comparisons have been made with other countries, controversies have raged, and oversimple explanations and remedies have been proposed. There have also been positive outcomes. One of these has been rising enthusiasm among midwives, obstetricians, paediatricians, and people working in the community health services for collecting data to help them assess their own work.3 An unfortunate side effect of this welcome trend has been some duplication of effort, because the people concerned have been unaware of the extent to which data are already being collected by others. In particular, many people are unaware of the vast body of data collected routinely by the National Health Service and government departments.4 One symptom of this is the time it took for people to realise that in the late 1970s, as in the early 1900s, infant mortality rates were actually falling rapidly. Most routine statistics are collected as byproducts of legal or administrative processes, which range from the registration of births, marriages, and deaths to the administration of the health services. This naturally affects their nature, strengths,-and limitations. Because the civil registration of births and deaths is required by law, coverage should theoretically be complete, though it is possible for anomalous cases to fall through the net.' A study in Flanders and the Netherlands found that the explanation was commonly that doctors did not have sufficiently detailed knowledge of their countries' registration laws.6 Birth and death registration data may be used to make BRITISH …