Midwives and their Role in the Reduction of Direct Obstetric Deaths during the late Nineteenth Century: The Sundsvall Region of Sweden (1860–1890)

Maternal mortality remains a cause of legitimate concern in developing parts of the world where rates often exceed 650 per 100,000 live births—at least twenty times higher than in the developed world, and appears impervious to all efforts to reduce it. Overwhelming poverty, insufficient health care, and the paucity of well-developed and thoroughly integrated programmes to reduce maternal mortality help ensure that these rates are comparable to, if not actually higher than, those found in some of the most unhealthy European cities and regions of the nineteenth century. Contemporary studies of maternal mortality in the developing world often ignore the power of traditional cultures and their influence on birth practices. This lack of attention is surprising because of the very real impact that such learned behaviour can have on the willingness to accept new and alien methods. Many researchers instead choose to perceive the problem of high mortality among pregnant women and new mothers as one that a more efficient delivery of modern medical techniques should easily solve. In the rare instances when the role of culture enters the discussion it is perceived as a minor obstacle that diligent medical practitioners and committed politicians could easily overcome if only they had the initiative to do so. In the same way it is frequently alleged that the simple solution to high maternal mortality requires only an infusion of money to pay the salaries of more doctors and midwives who can introduce the latest techniques and medicines to an increasingly ‘‘enlightened’’ population. The recent work of Gijs Walraven and Andrew Weeks responds to these arguments and emphasizes the need for medical practitioners to overcome cultural and social distances in developing nations of today. In their judgment: