VITAL and HEALTH STATISTICS ANALWICALSTUDIES Infantloss inthe Netherlands Trends in infant and perinatal mortality in the Nether- lands prior to and after World War Il. Analysis by age, sex, causes of death, age and parity of motherl place of delivery, season, urban and rural areas, and social factors; maternal mortality; description of ma­ ternal and child health services; general demographic and socioeconomic trends. Washington, D. C. Augusf 1968 (lJ. ~EpARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Wilbur J. Cohen William H. Stewart Secretary Surgeon Gen.=ral Public Health Service Publication No. 1000-Ekries3-No. II ‘Forsale by the Superintendent of Documents, U.S. Government Printing OffIce Washington, D. C., 20402- Price 50cents NATIONAL CENTER FOR HEALTH STATISTICS THEODORE D.WOOLSEY, Director PHILIP S.LAWR E“NcE; SC.D., Associate Director OSWALD K. SAGEN, PH.D.,,Assistant Director for Health Statistics Development WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development ALICE M. WATERHOUSE, M.D.,Medical Consultant JAMES E. KELLY, D. D. S., Dental Advisor LOUIS R. STOLCIS, M. A., Executive O//icer MA RGERY R. CUNNINGHAM, ~n/orrnatzon O//icer OFFICE OF HEALTH STATISTICS ANALYSIS IVJAOM.MO RIYAMA,Ph.D.,Director DEAN E.KRUEGER, Deputy Director Public Health Service Publication No. 1000-Series 3.)40. 11 Library of congress Catalog Card Number 68-60073 FOREWORD This report is one of a group of analytical studies designed to de­ lineate the perinatal and infant mortality problem inthe United States. While the primary concern is with the problem of perinatal and infant mortality in this country, it was felt that much could be learned from the experience of other developed countries with advanced medical sys­ tems. During the period 1950-65, infant m,ortalit y was no lcnger declining at its former pace in the United States and in several other countries (England and Wales, and Scotland, for example) but in the Netherlands and Sweden, the rates appear to have declined to a level which is about half of that in the United States. Despite declines in infant mortality for the United States in 1966 and 1967, the differential between this country and the Scandinavian countries remains evident. The National Center for Health Statistics arranged with a number of investigators to prepare comprehensive reports on perinatal and in­ fant mortality in their own countries. Contracts were negotiated with investigators in Denmark, England and Wales, the Netherlands, Norway, Scotland, and the United States. Earlier reports evolving from these contracts appear in Series 3 of Vital and Health Statistics: No. 4 Infant and Perinatal Mortality in the United States No. 5 Infant and Perinatal Mortality in Scotland No. 6 International Comparison of Perinatal and Infant Mortality: the United States and Six West European Countries No. $ Infant Mortality Problems in Norway No. 9 Infant and Perinatal Mortality in Denmark The present report for the Netherlands is the sixth in this group of studies on perinatal and infant mortality. The methodology, findings, and conclusions are those of the investigators. Iwao M. Moriyama, Ph.D. Director Office of Health Statistics Analysis ... 111 CONTENTS Page .. Foreword ------------------------------------------------------------ 111 1 1, Nature and Processing of Data -------------------------------------- Notification and Registration ----------------------------- ---------- 1 Live Birtis ---------------------------------------------------- 2 StiUbirths ------------------------------------------------------ 2 Deaths --------------------------------------------------------- 3 Calculation of Rates ----------------------------------------------- 3 Classification of Causes of Death ----------------------------------- 4 11, Historical Trends in Infant Loss ------------------------------------ 5 General Trend ---------------------------------------------------- 5 Age Components -------------------------------------------------- 6 Sex Differences --------------------------------------------------- 8 Urban and Rural -------------------------------------------------- 9 hternational Comparisons -------------------------------- --------- 9 III. Postwar Trends in Infant Loss ------------------------------------- 10 Age Components -------------------------------------------------- 10 Perinatal Mortality --------------------------------------------- 12 Postnatal Mortality --------------------------------------------- 22 Social Factors-------------&----- --------------------------------- 24 Urban and Rural ----------------- --------------------------------- 25 International Comparisons ----------------------------------------- 25 w. Maternal Mortality ------------------------------------------------ 26 General Trend ---------------------------------------------------- 26 Causes of Death --------------------------------------------------- 26 Age of Mother ---------------------------------------------------- 27 v. Outlook for Infant Loss ------------------------------------------- 27 VI. Summary --------------------------------------------------------- 28 Nature and Processing of Data ------------------------------------ 28 Mortality Trends -------------------------------------------------- 28 Maternal and Child Health Services -------------------------------- 30 Future Trends ---------------------------------------------------- 30 AcWowledgments ------------------------------------------------------ 30 v CONTENTS—Con. Page Bibliography ---------------------------------------------------------- 31 Detailed Tables ------------------------------------------------------- 34 Appendix I. General Demographic, Socioeconomic, and Sociohygienic Trends ------------------------------------------------------------- 48 Population -------------------------------------------------------- 48 MortaliW --------------------------------------------------------- 50 Socioeconomic Development ---------------------------------------- 52 General MeticalCare ---------------------------------------------- 55 Preventive Care -------------------------------------------------- 55 Appendix II. Maternal and Child Health Services ------------------------ 59 Organization of Services ------------------------------------------- 59 Obstetrical Care --------------------------------------------------- 60 Maternity Home Help ---------------------------------------------- 60 Welfare Centers ------- ------- ------- ---.--- ------- ------- ------- - 61 Curative Care ---------------------------------------------------- 62 Appendix 111. Deftiitions of Terms ------------------------------------- 63 vi SYMBOLS Data notavailable ----------------------- --- Category nonapplicable ------------------ . Quantity zero -------------------------- - Quantity more than Obut less than 0.05---- 0.0 Figure doesnot meet standards of reliability orprecision ----------------- * IN THIS REPORT are summan’zed studies which have been carvied on for move than a decade on infant loss in the Netherlands. The trends in infant and pevinatal mortality are analyzed in the light of changing pat­ tevns of medical demography, the organization and development ofhealth and medical services, and the general standard of living. Infant mortality was ~educed by hulf in each of three periods: between 1900 and 1922, between 1923 and 1939, and between 1948 and 1964. All age components of infant loss (fetal and infant mortality) have decreased more rapidly in the postwar thun in the prewar years. Perinatal mor­ tality has fallen much move slowly thunpostnatal mortality (1-51 weeks), drastically chan~”ng the vatio of these two components j?om 1 to 1 in 1927 to 3 to 1 in 1950-54 and to 5 to 1 in 1960-64. Currently, perinatal mortality accounts for more than 80 percent of infant loss. Obstetrical care in the Netherlands has three distinctive chmacteristics. Fi%st, domiciliary confinement with the sevvices of a family doctor OY midwife is far moye usual than institutional confinement, with only 30 pevcent of the bivths occuming in a hospital. Second, midwives give pvenatul and natal cave as independent practitioners. Third, a special voluntwy organization pvovides caye in the home foy mothev and the newbovn. A veview of infant and perinatal mon?ulity by sex, age, cause of death, social class, and other facton indicates that jiwther reductions I in infant loss in the Netherlands may be expected. ... Vlll INFANT LOSS IN THE NETHERLANDS J. H. de Haas-Posthuma, M.D., and J. H. de Haas, M.D.l In this monograph are summarized the studies the light of the changing patterns of medical de­ we have carried on for more than 15 years on mography, the organization and development of infant loss in the Netherlands. Such investigations health and medical services, and the general are indispensable in evaluating child health and standard of living. Social, biological, and medical maternal care programs and sociohygienic con­ factors are closely interrelated in nearly all ditions. problems of public health. Infant loss is a classic Hollandts2 position with regard to infant loss example of this interrelationship. is distinctive in three respects: its rates are low Although the rates of infant loss in the Neth­ compared with those of other countries, the fre­ erlands are relatively low, the irreducible mini- quency of hospitalized births is low, and infant mum is far from having been reached. Analyses care has a relatively long tradition. Moreover, by sex and other biological factors, social class,