Kapronczay Károly szerk.: Orvostörténeti Közlemények 202-205. (Budapest, 2008)

TANULMÁNYOK — ARTICLES - VARGA, Gabriella: A comparative study of the social-political determinants of infant and child mortality in Sweden and Hungary 1850-1945. - Összehasonlító tanulmány a svéd és a magyar csecsemőhalandóság szociálpolitikai tényezőiről 1850 és 1945 között

Although we have less data about the widespread of breastfeeding the information about its protective factors was known and studied in both countries already in the 19

th century. Midwives The role of midwives beyond the presence at the delivery can have a great effect on the pregnancy and on the early period of the infants' life. Sweden started education of midwives in 1708 and after 1711 only educated midwives were allowed to practice. Moreover, the first lecture-book for midwives about delivery was published in 1697 (Sundin et al. 2005). From 1819 on all the midwives had to be educated in Stockholm. In 1881 knowledge of asepsis was also included in midwife education, when a law was passed which instituted the use of antiseptic techniques. In the middle of the 19

th century, the midwives duty was extended to infant care. Education about neonatal care at their schools was completed with emphasis on warmth, neonatal resuscitation, daily care of the umbilicus and early breastfeeding (Andersson et al. 2000). By 1860 30% of the deliveries in Swedish rural areas were attended by a midwife (Högberg, 1983). This percentage increased quite rapidly later on, midwife assisted deliveries in 18 parishes of northern Sundsvall increased from 43,7% in 1871-80 to 73,4% in 1890-99. In the period between 1871-99 77% of the deliveries in white-collar workers families were assisted by a midwife, while in fanners families this percentage was 60,4%. The percentage of deliveries attended by midwives was higher in towns than in farming areas: 73,6% to 50,8%. A number of midwives were explicitly recruited from farmers families to make sure they will return to work in those areas. (Andersson et al. 2000) According to Oberg (1996) the percentage of deliveries assisted by midwives increased in Sweden from 50% in 1870 to 80% in 1994. In Sweden increase of influence of a midwife present at birth could be seen after the reform of midwife-education. Thus the impact of the organisation of licensed midwives with knowledge of asepsis could reduce perinatal and maternal mortality after 1881. This was explicitly seen among those with specific risk factors. Births out of wedlock and those in the lowest socio-economic group with the father as a crofter or a worker had the same elevated risk factor. In Hungary institutionalization of midwives in form of guilds in 1738, ensured a higher quality of their practice due the fact that they took an exam from a physician (Deáky, 2005). However, the first book of guidelines for midwives written in Hungarian was published in 1766, followed by a study book in 1772, and the first courses for midwives started at universities during the 1770s, with widely spread form after 1881. During most of the 19

th century a part of practicing midwifes were midwives with exam but no formal education. We found also that to take care of both mothers and childrens health became the duty of midwives after 1908. (Kapronczay, 2001) After public health management (both policy making and enforcement) had become duty of the state in 1876, Hungarian parliament legislated a territorial regulation of the health care workers. Every settlement with more than 6000 inhabitants (with more than 5000 after 1908) had to employ one doctor, and one midwife had to work for every 1500 inhabitants. (Kapronczay, 2001) According to Bezerédyné (1967) every settlement with more than 800 inhabitants had to engage an educated midwife after 1908. However there were still 9117