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Obstetric service and perinatal mortality in Norway.

Information on personnel, equipment and care facilities at all maternity institutions has been related to the perinatal mortality among all single births in Norway, 1967--1973. There was a total of 454,358 single births during this seven year period which comprised the study data set. An obstetric score based on personnel and equipment as defined in a previous study has been used to divide the country into three groups of counties, with low, medium and high obstetric scores. Perinatal, fetal and early neonatal (less than seven days) mortality rates specific to birth weight categories in 500 gram intervals have been compared between the county groups. Significant differences were found in the mortality rates between the group of counties with low obstetric score and the two other groups. There is both a relative and absolute increased difference in mortality for births weighing 3000 grams or more compared to births less than 3000 grams. The major component in the perinatal mortality difference is due to a difference between the low and higher obstetric score county groups in the early neonatal mortality rates. Time trends indicate that the relative differences in perinatal mortality are not decreasing over the seven year period, but rather, have increased slightly. Potential differences in the populations at risk in the three county groups are discusses. An adjustment was made to eliminate the effects of some potential confounding variables, namely high parity and maternal age and illegitimacy, without basically changing the results.

Adult↗

[Healthy, legitimate children: on marriage and social assistance in Argentina (1935-1948)].

This analysis of the forms of social protection available in Argentina during 1935-48 pays special attention to the distinguishing aspects of infant mortality and birth rates in urbanized areas along the country's coastline. Different government public health institutions -- such as pediatric and maternity institutes -- undertook assistance work among single mothers, where moral teachings played an important role and where marriage was encouraged for its regulatory role in avoiding high rates of illegitimacy. In this task, physicians, visiting nurses, and social assistants from government institutions agreed with the church hierarchy and Catholic intellectuals, since both sectors considered matrimonial legitimacy vital to limiting a decline in the national birthrate.

Argentina↗

[Early introduction of dairy formulas in infant feeding].

Frequency, main features and factors associated to introduction of supplemental artificial milk formula at the first month of life were studied in 365 infants born from June 1st, through October 31, 1980, who were under control at a well baby clinic of Santiago, Chile, along years 1986 throughout 1987. By means of life-table analysis, time length of breast feeding was measured and compared in children with and without early formula introduction. In 22.5% of infants an artificial milk formula was given (82/365). In 80% of the cases (66/82) this was done upon instructions of health personnel on grounds of poor weight increase. Early introduction of formula negatively influenced duration of breast feeding which attained a median length of three months in artificially fed infant against ten months in those exclusively breast fed. Main features of infants and mothers prone to early formula introduction were maternal age 35 years or over, previous breast feeding shorter than six months, illegitimacy or first child, fourth or over in birth order, low birth weight and, or, hospital admission in the first four weeks of life. No influence was identified from educational level, of maternal work, desired or unwanted pregnancy, maternal nutritional status in the last three months of pregnancy, child spacing, type of delivery, sex and gestational age of the infants.

Age Factors↗

The right to be born: surrogacy and the legal control of human fertility.

South African law, in common with many other legal systems, has exercised a strong measure of control over the fertility of its citizens via the sanction of illegitimacy and the prohibition of marriage (and hence legitimate children) between certain persons, e.g. those who fall within the so-called prohibited degrees of relationship. Until last year, when the Mixed Marriages Act was abolished, marriage across the colour line was prohibited in South Africa. The requirement of a valid consent by both prospective spouses in order to enter into marriage further excludes certain categories of persons from procreating legitimate children, e.g. the insane and mentally feeble, while the requirement of consummation will exclude certain categories of paraplegics from solemnizing a valid marriage. Age restrictions on marriages and the requirement of parental consent for minors are further factors limiting the individual's freedom to procreate. These restrictions have a well-established historical basis extending over many hundreds of years. They can be broadly categorised as having as their objective the preservation of the family unit. The above provisions were formulated at a time when the law never contemplated the spectacular advances in human biology that have produced the numerous artificial forms of conception, such as AID, IVF and surrogacy. The legislature, both in South Africa and elsewhere, at first adopted a neutral approach to this new fertility revolution and watched the courts struggle to adapt outmoded principles to the new technology. Legislation relating to AID and IVF eventually appeared in many jurisdictions; as a result of its delayed introduction public opinion had been educated to accept the new techniques and the legislation is by and large favourable to these new techniques. Not so, however, as far as surrogacy is concerned. South Africa, England and Australia have produced essentially negative legislation on this subject. Certain American states, however, have adopted progressive legislation accepting surrogacy. The merits of surrogacy are discussed and it is submitted that it should be condoned by the South African legislature under certain circumstances, as it can fall in the scope of furthering the interests of the family unit.

Contracts↗

Determinants of temporal and areal variation in infant mortality in Germany, 1871-1933.

This article investigates how sociodemographic, economic, medical, and public health factors influence infant mortality by using data about German administrative areas from 1871 to 1933. Marital fertility has the largest impact on infant mortality, followed by illegitimacy, medical care, urbanization, and infant welfare centers. The variables considered here account for most of the variation in infant mortality. Some of the unexplained variance is due to factors associated with regions, such as breastfeeding patterns, and with time periods, such as national health insurance. The analyses found no evidence that advances in medical technology affected infant mortality or that the influence of economic development changed over time.

Child Health Services↗

[Studies of obstetric and socioeconomic factors in the origins of prematurity].

Data of 400 term deliveries and 100 preterm deliveries were analyzed to determine the effect of the socio-economic situation, prior abortion, premature birth and other complications on current pregnancy outcome. Of special interest was the question if pregnancy complications in an antecedent pregnancy would lead to intensified care in a following pregnancy. A prior premature birth increases the risk for prematurity significantly. In contrast to earlier studies illegitimacy has no influence on rate and outcome of preterm birth. It is the most striking result of this study that a high risk factor as previous abortion, stillbirth or prematurity gives no cause for improved or intensified prenatal care.

Body Weight↗

The effect of marital status at first birth on marital dissolution among adolescent mothers.

The sequencing of marriage and first birth was expected to play an important role in the stability of marriage among adolescent mothers. We hypothesized that adolescent women who married prior to conception would have the lowest rates of marital disruption, followed by those who married between conception and birth. Adolescent women who gave birth prior to marriage were expected to suffer the highest rates of marital dissolution. The results provide partial support for our hypotheses. There is little difference in the probability of separation between adolescent mothers who had a postmarital conception and those who had a premarital conception but married before the birth. Having a premarital birth, however, significantly increases the probability of marital dissolution. We also hypothesized that marital status at first birth would have less effect on the probability of marital dissolution for blacks than for whites. This, too, is generally supported by our findings. Among black females, those with a premarital birth are the first to suffer a marital disruption, but by the end of ten years there is little difference in the probability of separation among the three marital status groups. In contrast, among white females, those with a premarital birth are the first to experience a disruption, and this differential persists over all subsequent marriage duration intervals. Thus, the sequencing of marriage relative to birth has similar short term effects for whites and blacks, but the effect for blacks is evident only in the short term. Ten years after the marriage, black adolescent mothers have similar rates of marital stability regardless of the sequencing of marriage. This is consistent with the findings of previous research and with our hypothesis; with the black family pattern of lower rates of marriage, higher rates of illegitimacy and higher divorce rates, the sequencing of marriage has no long lasting consequences on marital stability. Finally, our predicted decline in the effect of marital status at first birth over historical time also finds partial support. For white females there has been a change in the effect of marriage-first birth sequencing on separation over time. In the period encompassed by the women in our study, white adolescent mothers who married subsequent to the birth have been the most likely to experience a separation at all marriage duration intervals, but this differential narrows as age at interview declines. Among black females there has been no change in the effect of a premarital birth over time.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Thoracic adolescent idiopathic scoliosis: perinatal and environmental aspects in a Swedish population and their relationship to curve severity.

A perinatal and environmental survey was done on 551 adolescent patients with idiopathic thoracic scoliosis to determine if maternal age, paternal age, patient's sex, birth order, season of birth, birth weight, weight at 10 years, socioeconomic group, or population density influenced the severity of the curve. No difference between mild and severe scoliotic patients emerged in any of the factors. A significant difference between the study group and the general population was found in maternal age. Scoliosis was commoner in higher socioeconomic groups. The rate of illegitimacy among scoliotic patients was half that expected. None of the factors examined was of value in predicting curve severity.

Adolescent↗

Landmark article Dec 23, 1922. Medicolegal application of human blood grouping. Third communication. By R. Ottenberg.

The best technic for the tests is the open slide method. The sources of error are: (1) deteriorated serums; (2) weak serums; (3) hemolysis; (4) incubation at 37 C.; (5) drying; (6) settling of cells; (7) microscope observation; (8) dense cell emulsions; (9) undeveloped group characters, and (10) autoagglutination. On account of these, the following precautions must be observed: (a) Every test must be done in duplicate, using different sets of test serums. (b) Test serums must be shown to be active at the time of the tests. (c) Wherever there is the possibility of doubt, both serum and cells of the individual must be tested. (d) The cell emulsion without addition of test serum must also be examined. In studies of human heredity, the accidental inclusion of cases of illegitimacy can best be avoided if the mother of each family fully understands the object of the examinations and consents to them. Buchanan's failure to confirm the hereditary nature of the blood groups is apparently the result of errors of observation. He disagrees with all other authors, who are unanimous in their findings and have recorded almost a thousand cases.

Blood Group Antigens↗

A note on racial differences in the effect of female economic opportunity on marriage rates.

The previously observed aggregate relationship between marriage rates and female work opportunities is not found among black Americans. Alternative definitions of family formation which take illegitimacy into consideration are explored and also found to be unrelated to black females' economic opportunities. Although some of the difference may be attributed to measurement error, the significant disparity between the two populations probably reflects substantive differences.

Adolescent↗

A decomposition of trends in the nonmarital fertility ratios of blacks and whites in the United States, 1960-1992.

We use a method of standardization and decomposition developed by Das Gupta to update Smith and Cutright's analysis of demographic factors responsible for increases in the nonmarital fertility ratio (illegitimacy ratio) among blacks and whites in the United States. We create standardized rates for each year between 1960 and 1992, and consistent, exhaustive decompositions of the nonmarital fertility ratio for any interval during this period in terms of four components: (1) the age distribution of women of reproductive age, (2) the proportion of women unmarried at each age, (3) the age-specific birth rates of married women, and (4) the age-specific birth rates of unmarried women. Nonmarital fertility ratios are much higher among blacks than among whites, but both increased monotonically from 1960 to 1992. During the last 10 years, each increased by nearly 10 percentage points. Increases in the proportion of women not married, at all ages, account for the preponderance of the increase in black nonmarital fertility ratios. Increasing rates of unmarried childbearing, however, have played a role during the most recent decade (1983-1992). For whites, from 1960 until 1975, declines in marital fertility were most important in producing increases in the proportion of children born out of wedlock. Since then, these proportions have increased primarily because of increases in unmarried women's birth rates, and secondarily because of declines in the proportion of women who are married. These trends are consistent with arguments that emphasize declining economic incentives to marry and reduced access to, and acceptability of, abortion.

Adolescent↗