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