Infant Mortality in the Lapp Areas of Finnish Lapland
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169 INFANT MORTALITY IN THE LAPP AREAS OF FINNISH LAPLAND Leena Soininen and Hans K. Akerblom Inari-Utsjoki Health Centre, Ivalo and Children's Hospital, University of Hel~inki, Finland Infant mortality is generally regarded to be high her infant mortality of Finnish Lapps differed in ethnic minorities in arctic regions. Therefore from that of the majority population living in it appeared worthwhile to analyze infant mor· the same area. Referring to the definition diffi tality in the three northernmost communes culties of Lapps, mentioned above, we decided {I nari, Utsjoki, Enontekio) of Finnish Lapland, to look on infant mortality in those municipali having a considerable Lappish population. The ties in northern Lapland, which have a consider· location of those three communes is shown in able Lappish population. Fig. 1. In the year 1970 the proportion of Lapps in lnari was 30%, in Utsjoki 75% and in Enontekio -------~-----------~ 17%. However, the total number of Lapps in fllL ARC Tl( ()(I ,\N Finland is rather small. More than half are living in the municipality of lnari (Table I). TABLE I. The distribution of Lapps in the Lapp municipalities of Finland. Year Total num· per cent ber of lnari Utsjoki Enontekio Lapps 1948 2,260 56 33 f 1 1970 3,540 59 29 11 Fig. 1. The municipalities in Finnish Lapland with The numbers of live births in the Lapp muni· Lappish population. 1. lnari, 2. Utsjoki, 3. Enon· cipalities and in the rest of the province of Lap tekio. land are given in Table II. MATERIALS AND METHODS Source of data Demographic aspects The data for the years 1950-79 was collected The definition of a Lapp in the scientific sense from the vital statistics of the Central Statisti· is difficult. To find out the number of Lapps in cal Office of Finland, and was grouped by decade. Finland one started in 1926 to determine the act ual Lapp population, chiefly on linguistic grounds, Statistical analysis but taking also into account the opinion of the The difference between infant mortality in the people interviewed on whether they considered various areas was analysed by the chi-square test themselves Lapps by extraction. This information using Yates' correction. was considered for the first time in the Finnish official census of 1970. Bonsdorff et al. (1) RESULTS compared the census of lnari in 1970 with the Infant mortality rates in the Lapp municipali results obtained by counting the Lapps in lnari ties, and for comparison in the province of Lap by genealogical criteria. The conclusion was land and in all Finland are presented in Table that the census will give the general trend even Ill. During the three periods studied, infant mor· of the genealogical development of the Finnish tality never differed significantly in the Lapp Lapps. municipalities from that in the rest of the pro· In the present study we liked to know whet· vince of Lapland. The main cause of death was in- 170 TABLE II. Live births in the Lapp municipali· DISCUSSION ties and in the rest of the province of Lapland Infant mortality is usually regarded as a good cri· in 1950-1979. terion of the standard of maternal and child health care (MCH) and of socio-€conomic standards. In Deeade Lapp municipalities Rest of Lapland arctic regions, infant mortality has been high in 1950-59 2,722 18,939 ethnic minorities in North America as compared 1960-69 2,524 44,212 to the remaining population in the same country 1970-79 1,579 26,315 or area (e.g. 3, 4). In 1960 the Alaska native infant mortality was 75 per 1,000 live births, whereas TABLE Ill. Infant mortality (per 1,000) in Lapp the all U.S. rate was 26. By 1969 the Alaska na· municipalities, the province of Lapland and all tive rate had declined to 31 per 1,000, still notice Finland in 1950-79. ably above the U.S. all races figure of 20 (3). The primary contribution to the decline has been Decade 3 Lapp Province of All Finland attributed to the marked reduction in deaths municipa- Lapland during the post-natal period, the downward lities of trend correlating most clearly with the reduction Lapland in respiratory infections and diarrhea (3). 1950-59 36.0 41.93 31.0 In the 1971 census of Canada's Northwest 1960-69 21.4 21.9b 17.5 Territories (N.W.T.) 33% of the population were 1970-79 13.7 1 l.5c 10.3 of Inuit origin, 21% were Indian and 46% of non native origin (7). In the N.W.T. infant death a vs. the rest of Finland, P<0.001 rates (per 1,000) were in 1972 73 for Inuits, 47 b vs. the rest of Finland, P<0.001 for Indians and 26 per others (7). Hobarth (4) c vs. the rest of Finland, P<0.05 analysed socio-economic correlates of mortality and morbidity among Inuit infants. The study fectious diseases. On the other hand, infant indicated that high employment of males, good mortality in the whole province of Lapland uncrowded housing with facilities such as tanked was significantly higher per decade than in the water, vented toilets, and modern heating were rest of Finland. The difference, however, has associated with good infant health. An impove been decreasing during the two latest decades. rished and thus usually traditional life-style was Infant mortality rates for the individual years associated with bad health, as is employment of 1950, 1955, 1960, 1965, 1970, 1975 and 1979 the mother, early bottle-feeding, overcrowded for the province of Lapland and all Finland are housing, and the drinking of intoxicants by given in Table IV. It appears that infant mor both parents. Brett et al. (2) analysed the N.W.T. tality in Lapland caught up with that of all Fin infant mortality in 1973: the rates were 46 for land by the mid-70's. Indians, 45 for Eskimos, 9 for Whites, the total being 29. Thus, although there had been a signi TABLE IV. Infant mortality (per 1,000) in the ficant decrease over the previous 15 years, infant province of Lapland and ·all Finland at 5-year mortality rates in the N.W.T. were still appreci intervals between 1950 and 1979. ably higher than in the rest of Canada. Among the various contributing causes to death in this Year Province of Lapland All Finland age group, transportation problems were consider ed important (2). 1950 62.3 43.5 In Greenland infant mortality was in 1980 1955 42.3 29.7 54 (per 1,000) in Eastern Greenland and 37 in 1960 27.5 21.0 Western Greenland (5). In the north of Sweden 1965 21.6 17.6 in the province of Norrbotten, which has a majori 1970 14.1 13.2 ty Swedish population and a Lapp minority, 1975 8.6 9.6 infant mortality reached the level of all Sweden 1979 5.6 7.7 in the early 1960's, as an indication of a similar MCH in Norrbotten as elsewhere in Sweden (6). 171 In Finland the improvement in general living mortality study: Infant mortality in the Northwest conditions between 1950 and 1979 has been spec Territories, 1973. in R.J. Shephard and S.ltoh tacular, as in industrialized countries in general. (Eds.): Circumpolar Health, Proceedings of the 3rd Our northernmost province, Lapland, has also International Symposium, Yellowknife 1974. benefited from the development. Particularly the University Toronto Press, Toronto 19/6, p. 435. improvement of the road communication system 3. Fleshman, J.K.: Disease prevalence in the in the province has been important. A crucial Alaskan Arctic and Subarctic . Acta Soc.-Med. factor of infant mortality is MCH. It became Scand. Suppl. 6:217, 1972_ statutory for the whole country in 1945. In Lap 4. Hobarth, C.W.: Socio-economic correlates of land, in the course of the development of commu· rnortality and morbidity among Inuit infants. nication systems, including telephones, the MCH In A.I. Shephard and S. ltoh (Eds.): Circumpolar services became during these decades more and Health, Proceedings of the 3rd International more accessible for every mother and family. One Symposium, Yellowknife 1974, University of important milestone was the Sickness Insurance Toronto Press, Toronto 1976, p. 452. Act of 1964. It provided almost free transpor· 5. J~rgensen, P., M~ller, J. and Zachau-Christi tation to medical services, and mothers could ansen, B.: Live born in Greenland, maternal age, simultaneously start to bring their infants to the birth-weigh, neonatal and infant mortality during MCH centres. For the province of Lapland an 1975 to 1979. This volume. P. 166. other milestone with regard to improved general 6. Petterson, F.: Prevalence of disease in the health care occurred in the early 1970's. The north of Sweden. Acta Soc.-Med. Scand. Suppl. Primary Health Care Act of 1972 provided more 6: 206, 1972. positions of Public Health Nurses. As can be seen 7. Smith, M.D.: Changing health hazards in from Table IV, infant mortality in the province infancy and childhood in northern Canada. of Lapland reached the level of whole Finland R.J. Shephard and S. ltoh (Eds.): Circumpolar by the mid-70's. For the northermost provinces Health, Proceedings of the 3rd International of Finland (Lapland and the province of Oulu) Symposium, Yellowknife 1974, University of also the foundation of the University of Oulu, Toronto Press. Toronto 1976, p. 448. and the start of its Department of Pediatrics in 1964 has affected the level of MCH in northern Finland. In fact, the decline in infant mortality Leena Soininen, M.D., Chief Physician.