Wednesday 18 March 2020
08.30 - 10.30
Mortality in the Past: what do we know, what do we need to know?
Emiko Higami :
Abortion for Maternal Protection and the Eugenics Protection Law: Changes in the Maternal Mortality Rate
Japan's maternal mortality rate was 427 per 100,000 birth in 1906. In 1941, it declined and remained at 188 for 35 years. At the time, the main causes of maternal mortality were puerperal fever, hemorrhaging and preeclampsia (hypertension in pregnancy). Puerperal fever was reduced by the spread of the ... (Show more)
Japan's maternal mortality rate was 427 per 100,000 birth in 1906. In 1941, it declined and remained at 188 for 35 years. At the time, the main causes of maternal mortality were puerperal fever, hemorrhaging and preeclampsia (hypertension in pregnancy). Puerperal fever was reduced by the spread of the use of midwives and disinfection. Urban maternal mortality was higher than in rural areas, because there were a lot of patients with preeclampsia and some pregnant women died with eclampsia during parturition and puerperium. Obstetricians did not explicate the mechanism of preeclampsia.?Young people had a high incidence of tuberculosis, so pregnant patients with tuberculosis might die during their labours. A patient with preeclampsia and tuberculosis was permitted to have an abortion in order to protect her life without it being a feticide crime. Tatsuo Honda described that Japan had 500 thousand abortions in 1935. In the 1930s, many women wanted to avoid preeclampsia, and some of them urged the spread of contraception by the Ogino method.
Japan began to take measures for maternal protection to ensure human resources due to the continuing War. Japan enacted the National Eugenic Law for preventing genetic defects in 1940. However, many psychiatrists thought there was inadequate genetic proof of mental disease in this Law. As a result, there were only 238 abortions in the following 9 years. After the War, Japan enacted the Eugenic Protection Law in 1948, which permitted not only abortion for genetic defects but also abortion for mothers with a high risk of disease and abortion for rape. If a woman tried to have an abortion, a judgment by the Eugenics protection commission was required. In the following year, there were only 246 thousand abortions. The most common reason for these abortions was maternal protection. Moreover, a woman who tried to have an abortion for any reason except maternal protection, had to get permission from a commissioned welfare volunteer for this procedure. Because many women were reluctant to do this, they had an illegal abortion instead. However, in 1952, Yasaburo Taniguchi proposed to amend this Law, which was consequently amended to abolish the Eugenics protection Commission and other complicated procedures, and required a eugenic specific obstetrician to decide whether abortion was necessary. After 2 years, the maternal mortality rate had increased from 170 to 184. Since a fair number of women repeated pregnancies and childbirths or abortions, a few of them suffered from preeclampsia and died. For this reason the annual number of abortions increased to more than 1 million from 1953 to 1961. This high maternal mortality rate was remarkable in spite of the fact that the deaths of young people from tuberculosis etc. had been reduced by using antibiotics. Thus, Taniguchi and the eugenic specific obstetricians were responsible for taking mothers’ lives, as well as fetal lives by the large number of abortions. (Show less)
Mayra Murkens :
New Opportunities for Research into Infant Mortality in Maastricht, 1864-1955
The long lasting, high incidence of infant deaths in Maastricht has puzzled scholars for many years. Whereas the majority of the Netherlands witnessed a vast decrease in infant mortality during the last decades of the nineteenth century, Limburg, and Maastricht in particular, had to endure continuing high rates or even ... (Show more)
The long lasting, high incidence of infant deaths in Maastricht has puzzled scholars for many years. Whereas the majority of the Netherlands witnessed a vast decrease in infant mortality during the last decades of the nineteenth century, Limburg, and Maastricht in particular, had to endure continuing high rates or even a nominal increase during those decades. The common assumption by doctors and scholars in the past, was that the lack of breastfeeding was to blame. This made infants much more susceptible to gastro-intestinal infectious diseases, especially during hot summers. More recent theories relate the Roman Catholic denomination of the southern provinces to their mothers not breastfeeding their children.
Eventually infant mortality rates of the southern provinces did decrease, although this happened a few decades later than in the north-western part of the Netherlands. What caused the infant mortality to drop after all these years? In this paper, individual level cause of death data will be analysed in order to gain a deeper understanding of this process and its causes. This is a rather unique opportunity, since these type of data are truly scarce. The major advantages of the data are: 1) the causes of death are not yet classified into incomprehensible old disease categories, and 2) the available information on the individual is much richer. In addition to information on the cause of death, we know the age and gender of the deceased, but also the place of death, the exact death date, religion, and the occupation (if applicable, and otherwise the occupation of the parents). This creates the possibility to perform a wide range of analyses such as on the timing in the year (seasonal influences), on the influence of social economic status, or on spatial effects, which could be combined with other data on certain hygienic or public health measures.
In this paper the emphasis will be on explaining the eventual decrease in infant mortality in Maastricht by looking into smaller groups (divided by age in terms of weeks and months, gender, and social economic status) and how different trends for those groups contributed to the overall decline. Investigating how and why infant mortality in Maastricht eventually did decrease, may also shed new light on the issue of why this decline came so late. (Show less)
Guéter Port-Louis :
Sexual Rik Behaviors for HIV in Haiti
At the beginning of the 21st century, Haiti had a notable decrease in the prevalence of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) due to progress in the global health system. However, in the Caribbean region, Haiti continues to have the highest prevalence because of the sexual behavior of ... (Show more)
At the beginning of the 21st century, Haiti had a notable decrease in the prevalence of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) due to progress in the global health system. However, in the Caribbean region, Haiti continues to have the highest prevalence because of the sexual behavior of the population. Given the above, this study seeks to analyze the factors associated with sexual risk behaviors for HIV in Haiti separately by sex. For this reason, the Mortality, Morbidity and Utilization of Services Survey (EMMUS) of 2012 is used, with a sample of 17,646 observations: 9,959 women aged 15-49 years and 7,687 men aged 15-59 years.
Based on logistic regression models, it was found that age, marital status, educational level, level of knowledge of HIV and the department are the most relevant predictors for sexual risk behavior for HIV in Haiti. In addition, differences in the factors associated with the risky sexual behavior of men and women are highlighted. In addition, the results allow to see that the cognitive and social psychological perspective, and the interactional perspective are important in the analysis of risky sexual behavior in Haiti.
This research highlights the relevance of education and knowledge of HIV prevention tools in having safer sexual behaviors. It also shows the need to raise awareness across individuals in formal union and adults so that they are not considered exempt from the sexual risk for HIV.
Keywords: Haiti, prevalence, HIV/AIDS, risky sexual behavior, logistic regression, cognitive and social psychological perspective, interactional perspective, DHS. (Show less)
Michail Raftakis :
Urban Penalty in Hermoupolis, Greece (1859–1940)
This paper examines mortality patterns in the city of Hermoupolis, on the Greek island of Syros from 1859 to 1940. It outlines the main reasons that contributed to mortality decline and removal of ‘urban penalty’ in Hermoupolis in the first decades of the twentieth century. This study draws on a ... (Show more)
This paper examines mortality patterns in the city of Hermoupolis, on the Greek island of Syros from 1859 to 1940. It outlines the main reasons that contributed to mortality decline and removal of ‘urban penalty’ in Hermoupolis in the first decades of the twentieth century. This study draws on a unique database, containing individual-level death records (ca 45,000 individuals) for the entire population of the city.
In the mid-nineteenth century Hermoupolis was the most important Greek industrial centre and one of the biggest ports in the East Mediterranean. By the late-nineteenth century and due to the rise of other ports and industrial centres in the Greek mainland, the city experienced a serious decline in its economy and gradually transformed into a provincial and rather insignificant city.
Levels of mortality in Hermoupolis in the second half of the nineteenth century were high, with life expectancy at birth (e0) ranging from 28 years in 1870 to 35 years in 1907. Hermoupolis’ CDR of 32 per thousand in 1896 was higher than the national average (around 25 at the time) and the highest yet calculated rate in Greece in almost every census year from the mid-nineteenth century until 1940. Comparisons of Hermoupolis with other semi-urban and rural Greek populations suggest that an ‘urban penalty’ was clearly operating in the city even during the first decades of the twentieth century, most likely as a result of insufficient sanitary infrastructures, low living standards, unhealthy working conditions and in-migration.The high prevalence of infectious diseases in combination with the relatively low e0 (43 for both sexes in 1928) suggests that the second stage of Omran’s epidemiologic transition ‘age of receding pandemics’ was still ongoing, although in its final phase. A combination of factors was found to be responsible for the mortality decline in Hermoupolis, including mass immunisations, decline in fertility and wider access to water, which may have enabled improvements in personal hygiene among the residents of the city.
Finally, this paper produces important new insights into Mediterranean urban historical demography and is the first comprehensive study of urban mortality in Greece utilizing the largest and one of the longest time-series yet calculated from civil registration and census data. (Show less)