Eilidh Garrett

Medical provision and urban-rural differences in maternal mortality in late nineteenth century Scotland.

This paper examines the effect of variable reporting and coding practices on the measurement of maternal mortality in urban and rural Scotland, 1861–1901, using recorded causes of death and women who died within six weeks of childbirth. This setting provides data (nu202f=u202f604 maternal deaths) to compare maternal mortality identified by cause of death with maternal mortality identified by record linkage and to contrast urban and rural settings with different certification practices. We find that underreporting was most significant for indirect causes, and that indirect causes accounted for a high proportion of maternal mortality where the infectious disease load was high. However, distinguishing between indirect and direct maternal mortality can be problematic even where cause of death reporting appears accurate. Paradoxically, underreporting of maternal deaths was higher in urban areas where deaths were routinely certified by doctors, and we argue that where there are significant differences in medical provision and reported deaths, differences in maternal mortality may reflect certification practices as much as true differences. Better health services might therefore give the impression that maternal mortality was lower than it actually was. We end with reflections on the interpretation of maternal mortality statistics and implications for the concept of the obstetric transition.

Mortality, work and migration: a consideration of age-specific mortality from tuberculosis in Scotland, 1861-1901

This paper provides an examination into some of the most enduring debates regarding tuberculosis mortality during the nineteenth century: those related to gender, geographic and temporal variations. We use populations reconstructed from individual census and civil register data for the period 1861 to 1901, comparing a growing urban area with a declining rural area, both with around 20,000 inhabitants in 1861. Our analysis shows that among young adults tuberculosis was linked to excess female mortality in the urban area and excess male mortality in the rural area. We demonstrate that in the town textile workers of both genders had particularly high mortality from tuberculosis, and that the only reason for higher overall female mortality was the predominance of young women in the textile labour force. We show that the age and gender-specific pattern of mortality in the rural area is consistent with higher male than female out-migration together with return migration of those who had contracted the disease elsewhere and needed care during their lengthy illness. We argue that the observed patterns are difficult to reconcile with the bargaining-nutrition account of gendered patterns in tuberculosis mortality, and that they provide little support for nutrition as a key influence on the disease. However, our findings do reinforce Andrew Hindes recent argument that geographical patterns in sex-specific tuberculosis mortality rates were largely determined by migration patterns, and we discuss the implications of this for our understanding of the decline of the disease over the late nineteenth century.