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When reading this article on BBC News I was surprised by the following claim:

Just compare now to what happened 100 years ago or so. Then, many women died in their 40s because of having to give birth many times. Lots of people died young.

This seems to imply that giving birth takes a toll on the body that is cumulative, eventually causing death in a significant number of women. This seems unlikely to me.

It is possible that the wording is poor, and it actually means that each birth carried a significant risk of death for the mother, and that multiplying this risk-per-birth by a large number of births per woman meant that many women died in childbirth. Even then, I find it unlikely that giving birth accounted for a significant proportion of female deaths; significant enough that it apparently is worth being the only mention in the article as to why people used to die younger.

So:

  1. Was giving birth a significant factor in causing death a century (or more) ago?
  2. Was the risk of dying from childbirth cumulative (i.e. increasing with each birth)?
Oddthinking
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AndyT
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    A strict reading of the claim doesn't even say that these women died during childbirth, only that they died during their 40s due to having given birth so often; in other words, the pregnancies and births caused long-time damage that caused them to die earlier. I have never heard such a claim before though. – Sebastian Redl Oct 08 '15 at 12:45
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    I do not think the wording was poor, I think it is clear they meant the risk of the delivery and post-delivery complications (like postpartum infections). Still I find the claim this has caused a significant proportion of deaths interesting and notable. – Suma Oct 08 '15 at 12:47
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    The BBC News claim is probably due to a misunderstanding of life expectancy. I would suspect life expectancy was in the 40s, because many women died in their 20s and 30s giving birth. Averaging with women dying in their 60s, 70s, 80s, without giving birth, leads to a life expectancy in the 40s. – gerrit Oct 08 '15 at 12:57
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    @Suma: I'm speculating, but I read the intended statement as "Women had a life expectancy in their 40s, because they attempted to have more children than modern women, and each child-birth was riskier than today, so more of them died younger." i.e. poorly worded or poorly quoted. – Oddthinking Oct 08 '15 at 13:41
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    @Oddthinking - could you include that speculation in your answer? I think you've worded it better here than where your answer states *"I don't think this section is relevant in any case, because I don't think that was what was intended by the claim"* – AndyT Oct 08 '15 at 14:15
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    Why is everyone talking about long-term damage/cumulative toll? The professor never said anything about that in the article. Below someone stated the chance of death during childbirth was ~4%. If you (planned on) having 10 children, that means your chances of dying during childbirth were `1-0.96^10` ≈ 1 in 3. That's what she meant. – BlueRaja - Danny Pflughoeft Oct 08 '15 at 15:45
  • @BlueRaja-DannyPflughoeft - because of the quote in the article "many women died in their 40s because of having to give birth many times". That states that they died in their 40s, and they died because they gave birth many times. If the chance of death during childbirth is consistent (i.e. always 4%) then 4% of women would die with their first child, 3.84% would die with their second child, 3.686% with their third child, etc. So that would justify "many women died in their 20s due to childbirth", but *not* many died in their 40s. – AndyT Oct 08 '15 at 15:55
  • @BlueRaja-DannyPflughoeft - Given that childbirth in your 40s is unusual anyway, how could women be dying in their 40s, due to lots of childbirth, if it isn't due to some long-term / cumulative damage? – AndyT Oct 08 '15 at 15:56
  • Why do you find it unlikely that carrying and giving birth, resulting in major changes to the body, has negative consequences? And that doing this multiple times could cause cumulative damage when factored particulalry with a lack of knoweldge about recovering from the experince? – jmoreno Oct 09 '15 at 04:17
  • @jmoreno - I found the concept that childbirth might kill you some 10 years after you last gave birth incongruous. This is because I assumed it was a binary situation, i.e. either you died or you didn't, rather than it causing damage to internal systems. I supposed that death in childbirth is due to "things that would heal over time", e.g. blood loss. My feeling is (to some extent) backed up by the research that the risk of death is lower in the second and third birth than it is in the first. Although the research then does state that it increases thereafter. – AndyT Oct 09 '15 at 07:42
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    It's still a major cause of death... In developing countries and countries with bad health-care, complications due to pregnancies and births, remain the number one cause of death for women of child-baring age. In addition, comes all the non-lethal - but perhaps life-shortening - complications caused by pregnancies/birth - like some forms of diabetes, incontinence, hypertension, and so forth. – Baard Kopperud Oct 09 '15 at 10:38
  • @BaardKopperud I think childbirth might even be a major cause of death for women in developed countries, especially for younger women. That is partly because young women, say ages 18 to 25, don't die very often in developed countries. – Ellie Kesselman Jan 27 '17 at 02:36

1 Answers1

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Has maternal mortality due to child birth dropped in England over the past 100 years?

Yes. Tremendously.

The 2006 paper, British maternal mortality in the 19th and early 20th centuries examines this.

Figure 1 illustrates the incredible improvement, just up to 1970 alone.

Annual death rate per 1000 total births from maternal mortality in England and Wales (1850-1970)

Annual death rate per 1000 total births from maternal mortality in England and Wales (1850-1970)

We can see from the chart that, around 100 years ago, the death rate was 40 per 1000, or a 4% chance. That is, one in 25 women giving birth would die.

Does maternal mortality have a significant effect on life expectancy of women?

Yes.

The 2008 paper Life Expectancy and Human Capital Investments: Evidence From Maternal Mortality Declines looked at Sri Lanka (admittedly not England), and the improvement in maternal mortality just between 1946 and 1953. They concluded it

increased female life expectancy at age 15 by 4.1%

That is a very impressive improvement. By aged 15, girls have already passed the dangerous first years of their lives. To improve their expected lifespan by an additional 4%, from only the reduced risk of dying during child-birth gained in seven years in the mid-1900s, is almost staggering.

Are women more likely to die during later pregnancies than earlier ones?

It's not quite that simple.

The first birth is the most dangerous, and then the next few are safer. As the woman has more children, the risk grows again.

I draw this conclusion from the review paper The Relationship Between Fertility and Maternal Mortality from the book Contraceptive Use and Controlled Fertility: Health Issues for Women and Children Background Papers.

All the population-based studies indicate and results from hospital studies generally confirm that the first birth and births of high order are strong risk factors for maternal mortality (Table 2). These studies indicate a J-or U-shaped risk with parity: high during the first pregnancy, lowest during the second or third, and high again by the fifth pregnancy. A similar pattern is found for gravidity, with an even stronger relative risk for first pregnancies relative to later-order pregnancies than is observed for first births.

Notes:

  • Definitions:

    In the UK, gravidity is defined as the number of times that a woman has been pregnant and parity is defined as the number of times that she has given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn.

    In the notes, the original author finds that these details of these definitions unfortunately differ between studies.

  • The data discussed above isn't from 100 years ago. It is largely from the 1970s and 1980s, so it might not represent the exact situation in 1915 nor 2015. This is a weakness in this part of the answer.

  • I don't think this section is relevant in any case, because I don't think that was what was intended by the claim, but I include it for completeness. I believe (without anyway of proving it) that the quote was probably intended to mean "Women had a life expectancy in their 40s, because they attempted to have more children than modern women, and each child-birth was riskier than today, so more of them died younger", but it was unfortunately poorly worded or poorly quoted.

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Oddthinking
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  • Comments are not for extended discussion; this conversation has been [moved to chat](http://chat.stackexchange.com/rooms/30039/discussion-on-answer-by-oddthinking-a-century-ago-was-giving-birth-a-major-caus). – Oddthinking Oct 09 '15 at 00:38
  • That graph is striking. It suggests that there were NO medical improvements at all before 1930 and then continual improvements. What changed? – Raedwald Oct 28 '15 at 07:48
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    @Raedwald: This is mentioned [in the chat room](http://chat.stackexchange.com/transcript/message/24598440#24598440). – Oddthinking Oct 28 '15 at 08:12