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Epidemiologic Notes and Reports Perinatal and Maternal Mortality in a Religious Group -- Indiana

In May 1983, the Indiana State Board of Health received reports of apparently excessive perinatal and maternal mortality among members of a religious group in the northeastern part of the state. Approximately 40 deaths among Indiana residents were reported to have occurred over the past 8 years in this group--a fundamentalist church that avoids all medical attention in favor of spiritual healing. Pregnant members receive no prenatal care; they labor and deliver at home without medical assistance. To assess the effect of this group's practices on reproductive outcomes, the Indiana State Board of Health, in cooperation with CDC, investigated perinatal and maternal mortality rates for church members from 1975 to 1982 (1).* Because most members in Indiana reside in Elkhart or Kosciusko Counties, the investigation focused in these counties.

Each of the 40 deaths among Indiana members that occurred from 1975 through 1982 was confirmed, including 21 perinatal deaths, seven infant and child deaths, six maternal deaths, and six nonmaternal adult deaths. Of these, 17 perinatal and three maternal deaths occurred among residents of Elkhart or Kosciusko Counties. Reported fetal deaths accounted for 11 of these 17 perinatal deaths.

To estimate 1979-1982 live births in Elkhart and Kosciusko Counties, the Board of Health screened 1975-1982 birth records in these counties for births that were not attended by physicians and that occurred outside hospitals to women who had not received prenatal care. Using these criteria, 344 live births were identified for calculating the perinatal and maternal mortality rates among church members.

The estimated 1975-1982 perinatal mortality rate for members residing in Elkhart or Kosciusko Counties was 48/1,000 live births and fetal deaths, compared with 18/1,000 for all other Indiana residents. The estimated 1975-1982 maternal mortality rate for members residing in Elkhart or Kosciusko Counties was 872/100,000 live births, compared with 9/100,000 for other Indiana residents. Reported by C Spence, MD, TS Danielson, MD, Div of Maternal and Child Health, Indiana State Board of Health; Pregnancy Epidemiology Br, Div of Reproductive Health, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: This report highlights the increased risk of perinatal and maternal mortality for women receiving no obstetric care. Because the denominators may have included nonmember births, the rates may underestimate perinatal and maternal mortality among religious-group members. Ongoing surveillance and investigation of maternal deaths by the Indiana Maternal Mortality Committee (2) improved the likelihood that all Indiana pregnancy-associated deaths during the years examined in this investigation were identified.

Other religious groups may also encourage members to avoid medical care. By advising lay people of the risks associated with lack of obstetric care, public health officials and health-care providers may increase the safety of childbirth in their communities.


  1. Spence C, Danielson TS, Kaunitz AM. The Faith Assembly: a study of perinatal and maternal mortality. Indiana Medicine 1984 (March);180-3.

  2. Ragan WD. Maternal mortality in Indiana: a report of maternal deaths in 1979. J Indiana State Med Assoc 1981;74:565. *The perinatal mortality rate is defined as the number of fetal deaths (greater than or equal to 20 weeks' gestation) plus the number of neonatal deaths (infants who die less than or equal to 28 days after birth) per 1,000 live births plus fetal deaths. The maternal mortality rate is defined as the number of maternal deaths (pregnancy-related deaths that occur during or up to 1 year after termination of pregnancy) per 100,000 live births.

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