The Comparative Study of Maternal Mortality over Time: The Role of the Professionalisation of Childbirth

Midwifery in western countries emerged during the seventeenth century in France with the training of midwives under supervision of male obstetricians. A wave of new schools of midwifery reached all European countries in the eighteenth century to reduce maternal and infant mortality. During the nineteenth century most European countries adopted a strategy for the promotion of skilled attendance at delivery based on professional midwives who progressively replaced traditional midwives. However, the effectiveness of the strategy reflected by the coverage of deliveries by these midwives varied widely among European countries. This was partly due to a conflict of interest with medical doctors. The reduction in maternal mortality was parallel to the intensity of the coverage by professional midwives with a clear contrast between the USA—with a staggering maternal mortality around 600–800 per 100,000 live births—and Sweden, Denmark, Norway or the Netherlands with a ratio around 250–300 per 100,000 live births. The more recent history of maternal mortality reduction in Sri Lanka and Malaysia showed that technical and political conditions similar to what will be shown to have prevailed in Sweden also permitted the dramatic fall.