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Birth Counts Statistics of Pregnancy and Childbirth
European Journal of Obstetrics & Gynecology and Reproductive Biology 97 (2001) 263±264
Book reviews Birth Counts Statistics of Pregnancy and Childbirth Vol. 1. The text; Vol. 2. The tables. The Stationary Office, London, 2nd Edition, 2000, £ 29.95 each (available from The Stationary Office, P.O. Box 29, Norwich, NR3 1GN, UK, Tel.: 44-870-600-5522; fax: 44-870-600-5533; URL: www.the-stationary-office.co.uk) It is often dif®cult for generalists to ®nd reliable health statistics. Many are published in the hard-to-®nd ``grey'' literature, and those relating to reproduction, are spread among many sources. In 1984, things became much easier, at least in the UK, with the publication of the ®rst edition of Birth Counts from the National Perinatal Epidemiology Unit in Oxford. Researchers all over the world, myself included, refer to it constantly. At last here is the updated and expanded second edition. Like the ®rst it consists of two volumes. The main data are in the second, over 350 tables covering maternal and fetal mortality statistics, geographical and social class differences, as well as statistics on place of birth, staf®ng levels and the costs of having a baby. However, the general reader will get most from Vol. 1. This begins with descriptions of data de®nitions and sources, and an account of how the data were collected. The remaining chapters provide a commentary on the main results. Highlights include chapters on the history of fertility control and fetal loss, and on social inequality and perinatal mortality and morbidity. The former makes it clear that the dramatic 18th century fertility decline in the UK must have been caused by recourse to the ancient methods of withdrawal, abstinence, abortion and infanticide, rather than to effective contraceptives. The latter is relative restrained in its use of anti-capitalist rhetoric, a staple of most other public health writing on health inequality these days, perhaps re¯ecting the failure of reproductive data to demonstrate a widening of social class differences in stillbirth and infant mortality in the 1980s. Nevertheless, the authors still get in two gratuitous references to Mrs. Thatcher. Firstly, her telling parliament that a small rise in infant mortality in 1986 might be a statistical error; it was probably genuine, and was later attributed to a rise is sudden infant death associated with an exceptionally cold winter. Secondly, the obligatory reference to her alleged interference in state funding for what eventually became the National Survey of Sexual Attitudes and Lifestyles 1990±1991 is also trotted out. Whether true or not, the Wellcome Trust, a large charity, rapidly took it up, so ultimately government funding was unnecessary. I also wonder why Fig. 5.18 (p. 153) showing how poverty, de®ned as below half average income (i.e.
relative poverty), increased during the 1980s, is not accompanied by a similar graph of absolute poverty. The inclusion of Fig. 5.18 is especially odd as the authors admit that there are no data directly relating either relative or absolute poverty to the outcome of pregnancy. However, these are political quibbles. Readers from outside the UK will be particularly interested in the ®nal chapter on international comparisons. Unfortunately this is the only chapter in Vol. 1 not illustrated by selected tables and graphs from Vol. 2. This is justi®ed by the dif®culty in avoiding misleading international comparisons, but is a weakness for those readers who cannot afford both volumes. Nevertheless, these are wonderful books. Let us hope we do not have to wait 16 years for the 3rd edition, and that someone somewhere is working on ``Birth Counts; The European Edition.'' In the meantime, buy Vol. 1 for yourself, and harry your library to get both. Jim Thornton Centre for Reproduction Growth and Development University of Leeds, 34 Hyde Terrace Leeds LS2 9LN, UK Tel.: 44-113-392-6370; fax: 44-113-392-6452 E-mail address: [email protected] (J. Thornton) PII: S 0 3 0 1 - 2 1 1 5 ( 0 0 ) 0 0 5 4 9 - 2
Healthcare in The UK: The Need for Reform Ruth Lea, Institute of Directors, 116 Pall Mall, London SW1Y 5ED, UK, £ 10.00 Observers rightly praise the British National Health Service for its universal coverage and relatively low cost delivery of healthcare, and it remains enormously popular with the British public. However, it is increasingly also criticised for providing worse care than other comparable country's systems, and of being unresponsive to patients. The present government plans to inject extra money into the system and to set targets in the hope that it is spent wisely, but they do not promise any fundamental change. In this paper from the Institute of Directors, an association of senior business executives, Ruth Lea vividly describes the present system as one of ``triple nationalisation''; the government funds the health service, decides what it will do, and provides the healthcare. She argues for reform to reduce the proportion of health care paid for by the state, to let the market decide priorities, and to encourage independent providers. Her central suggestion is based on an old idea,
0301-2115/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved.
Book reviews Birth Counts Statistics of Pregnancy and Childbirth Vol. 1. The text; Vol. 2. The tables. The Stationary Office, London, 2nd Edition, 2000, £ 29.95 each (available from The Stationary Office, P.O. Box 29, Norwich, NR3 1GN, UK, Tel.: 44-870-600-5522; fax: 44-870-600-5533; URL: www.the-stationary-office.co.uk) It is often dif®cult for generalists to ®nd reliable health statistics. Many are published in the hard-to-®nd ``grey'' literature, and those relating to reproduction, are spread among many sources. In 1984, things became much easier, at least in the UK, with the publication of the ®rst edition of Birth Counts from the National Perinatal Epidemiology Unit in Oxford. Researchers all over the world, myself included, refer to it constantly. At last here is the updated and expanded second edition. Like the ®rst it consists of two volumes. The main data are in the second, over 350 tables covering maternal and fetal mortality statistics, geographical and social class differences, as well as statistics on place of birth, staf®ng levels and the costs of having a baby. However, the general reader will get most from Vol. 1. This begins with descriptions of data de®nitions and sources, and an account of how the data were collected. The remaining chapters provide a commentary on the main results. Highlights include chapters on the history of fertility control and fetal loss, and on social inequality and perinatal mortality and morbidity. The former makes it clear that the dramatic 18th century fertility decline in the UK must have been caused by recourse to the ancient methods of withdrawal, abstinence, abortion and infanticide, rather than to effective contraceptives. The latter is relative restrained in its use of anti-capitalist rhetoric, a staple of most other public health writing on health inequality these days, perhaps re¯ecting the failure of reproductive data to demonstrate a widening of social class differences in stillbirth and infant mortality in the 1980s. Nevertheless, the authors still get in two gratuitous references to Mrs. Thatcher. Firstly, her telling parliament that a small rise in infant mortality in 1986 might be a statistical error; it was probably genuine, and was later attributed to a rise is sudden infant death associated with an exceptionally cold winter. Secondly, the obligatory reference to her alleged interference in state funding for what eventually became the National Survey of Sexual Attitudes and Lifestyles 1990±1991 is also trotted out. Whether true or not, the Wellcome Trust, a large charity, rapidly took it up, so ultimately government funding was unnecessary. I also wonder why Fig. 5.18 (p. 153) showing how poverty, de®ned as below half average income (i.e.
relative poverty), increased during the 1980s, is not accompanied by a similar graph of absolute poverty. The inclusion of Fig. 5.18 is especially odd as the authors admit that there are no data directly relating either relative or absolute poverty to the outcome of pregnancy. However, these are political quibbles. Readers from outside the UK will be particularly interested in the ®nal chapter on international comparisons. Unfortunately this is the only chapter in Vol. 1 not illustrated by selected tables and graphs from Vol. 2. This is justi®ed by the dif®culty in avoiding misleading international comparisons, but is a weakness for those readers who cannot afford both volumes. Nevertheless, these are wonderful books. Let us hope we do not have to wait 16 years for the 3rd edition, and that someone somewhere is working on ``Birth Counts; The European Edition.'' In the meantime, buy Vol. 1 for yourself, and harry your library to get both. Jim Thornton Centre for Reproduction Growth and Development University of Leeds, 34 Hyde Terrace Leeds LS2 9LN, UK Tel.: 44-113-392-6370; fax: 44-113-392-6452 E-mail address: [email protected] (J. Thornton) PII: S 0 3 0 1 - 2 1 1 5 ( 0 0 ) 0 0 5 4 9 - 2
Healthcare in The UK: The Need for Reform Ruth Lea, Institute of Directors, 116 Pall Mall, London SW1Y 5ED, UK, £ 10.00 Observers rightly praise the British National Health Service for its universal coverage and relatively low cost delivery of healthcare, and it remains enormously popular with the British public. However, it is increasingly also criticised for providing worse care than other comparable country's systems, and of being unresponsive to patients. The present government plans to inject extra money into the system and to set targets in the hope that it is spent wisely, but they do not promise any fundamental change. In this paper from the Institute of Directors, an association of senior business executives, Ruth Lea vividly describes the present system as one of ``triple nationalisation''; the government funds the health service, decides what it will do, and provides the healthcare. She argues for reform to reduce the proportion of health care paid for by the state, to let the market decide priorities, and to encourage independent providers. Her central suggestion is based on an old idea,
0301-2115/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved.