The measurement of maternal mortality.

r ^ HERE are, of course, problems in the interpretation of all historical mortalities, but those surrounding maternal mortality show some unusual and rather complicated features, and they illustrate some interesting points concerning what one might call the "mechanics" of death registration in the past. For the most part, I deal here with the Registrar General's statistics for England and Wales. The easiest way to show a trend in mortality is to display the total number of deaths. Figure i shows total maternal deaths (and also total births) in each decade from 1850 to 1980, indexed to 100 in 1850. In round figures there were between 8 and 9 maternal deaths per day in 1850, rising to a peak of 13 per day in the 1890s and falling to less than 1 per week in the 1980s. The shape of this graph— the initial rise followed by the steep fall from the end of the nineteenth century—resembles the trend in infant mortality, which perhaps is not surprising. We think of mothers and infants as closely linked and expect their deaths rates to be shaped by the same sort of determinants of mortality. Showing total deaths, however, is acceptable for comparing something like road deaths over two or three years, but it is a misleading way of showing maternal deaths over a period of 140 years, for it takes no account of changes in the population at risk, which, in the case of maternal deaths, is women of childbearing age (15-44). Figure 2 (also indexed to 100 in 1850) corrects for this factor. The figure shows a huge change in the population of women aged 15—44 a d also shows the maternal death rate expressed as the number of maternal deaths per 1,000 women aged 15—44. The French, incidentally, were fond of showing maternal mortality in this way. Once again we have