BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

254 Patternsof Mortality in Childhood
need for research to gain an understanding
of patterns of reproduction and conditions of
survival of products of pregnancy in this
high-altitude area. The patterns appear to
be unusual, judging from the evidence on
age and parity of mothers of deceased children
and from the smnall number of previous
products.
In addition to these differences between
projects, there are distinct differences within
the two projects that have rural areas. In
San Juan Province the average number of
previous products in the rural departments
(3.2) was much higher than that in the city
of San Juan (1.9). Likewise, in the El Salvador
project the averages were 3.9 products
in the rural municipios and 3.0 in the city
of San Salvador.
In Table 154 the vital losses in previous
pregnancies are divided into fetal deaths
and deaths of those born alive. In two
projects with high death rates, Recife and
El Salvador, more than 30 per cent of the
products of previous pregnancies resulted
in death (38.2 and 33.2 per cent, respectively)
(Figure 127). This represents great
reproductive wastage in terms of the prod-
Fmo. 127. Mortality of Products of Previous
Pregnancies of Mothers of Deccased Children in
15 Projects.
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ucts, a great biological expenditure for the
mother, and also a serious psychological and
financial impact on the family. In these two
projects more than 20 per cent of the total
previous products were lost by deaths of
children born alive.
In the next five projects with over 27.0
per cent of the products resulting in death
(Ribeirio Pr~to, Sdo Paulo, Sherbrooke,
Medellin, and California), more than half
were fetal deaths in all except one project
(Medellin). In Sho Paulo, Sherbrooke, and
California, which had low birth rates, the
percentages for loss as fetal deaths were
15.1, 18.9, and 17.1, respectively. Many of
these were early fetal deaths or abortions.
In S~o Paulo 82 per cent of the fetal deaths
were classed as early fetal deaths (abortions).
In San Juan Province, the city of
San Juan had 16.3 per cent loss as fetal
deaths. The two Northern American projects
had the highest percentages for losses as
fetal deaths, followed by Ribeir~o Pr~to
and Sio Paulo.
In the Bolivia project 21.0 per cent of the
products of previous pregnancies died after
birth, but the percentage of reported fetal
deaths was low, 3.0. Probably some losses
were forgotten or were not stated because of
reticence on the part of parents. Actually
in this project, in half the families in which
home interviews were conducted someone
than the mother provided the history
-usually the father. A deficit of fetal
deaths among the products of previous
pregnancies is also suspected in Chaco Province,
where losses of only 3.2 per cent were
remembered.
In San Juan Province, losses as fetal
were recorded less frequently in the
rural departments than in the city of San
Juan. In that city 16.3 per cent of the products
were fetal deaths, while the figure was
only 7.4 per cent in the rural departments.