Too long a sacrifice? : maternal mortality in Northern Ireland during the first half of the 20th century

The pioneering medical statistician, William Farr, commented in 1875 on the lack of improvement in maternal mortality in England and wondered: How long is this sacrifice of lives to go on? The same question might have been posed, perhaps even more sharply, in relation to the neighbouring island of Ireland. According to some authorities the burden of maternal mortality was particularly severe in Northern Ireland. The purpose of this article is to trace the evolution of maternal mortality in Northern Ireland during the first half of the twentieth century, to relate this to comparable changes in Britain and Ireland, and to comment on the forces making for change. The course of change within Ireland, as exemplified by the northern capital of Belfast and the southern capital of Dublin, provides a regional focus. The main quantitative measure used to observe change in maternal mortality is the Maternal Mortality Ratio (MMR). Both the numerator and the denominator of this ratio are subject to distorting influences. Thus, a further aim of the article is to highlight methodological issues relating to the study of maternal mortality as viewed through the prism of published official statistics. In the course of doing so, other aspects of the institutional, social and medical history of the period are brought into the light.