On the subject of infant mortality in Malta
The Malta Independent has interviewed Paul Soler, consultant paediatrician at the state general hospital, on the subject of a report published by The Lancet which shows that Malta has one of the highest infant mortality rates in western Europe.
I knew that one of the main reasons for the high rate is that women in Malta tend not to abort pregnancies even when the foetus is detected at a fairly early stage to have serious problems. But I had no idea that the other major contributing factor is obesity in pregnancy.
Please note that I do not wish the comments board beneath this post to be hijacked by people with the usual hackneyed arguments for and against divorce. The topic here is not abortion. Most of these infants are born not because abortion is illegal in Malta but because their parents choose not to abort them.
Maltese people have free, easy and open access to abortion at the end of a ferry ride or flight to Catania, a much shorter and easier distance to travel than many women do who live rurally in large countries. And Maltese women fly out regularly for abortions in London and have done so for many years. It’s even easier and cheaper now with EU membership and the collapse in price of airline fares.
I don’t wish this to turn into a debate on the injustice to women who can’t afford to do that, either, because again, that’s a whole other issue.
The point is that there is a strong element of choice at work here, and the pundits ignore it because – simplistically – they argue that the absence of abortion in Malta equates to the denial of access to abortion for Maltese women. In fact, it does not and hasn’t for as long as abortion has been legal in other parts of Europe.
The parents of these infants are choosing to have them be born. All but the poorest have the option of abortion next door in Catania or at the end of a RyanAir flight to London and they don’t take it. I read in another newspaper report – I can’t find the reference right now – that this indicates a “high level of early bonding between the mother and the foetus” and I believe this to be correct.
Here’s an excerpt from the interview in The Malta Independent.
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Comparing Malta’s death rate for children aged one to four years to other countries in the EU, Dr Soler said that Malta’s rate compared very favourably with other EU countries while pointing out that the rate is lower than in the Netherlands, Switzerland and the UK.
Dr Soler said that Malta’s figures tally closely with those of the US which are higher than those of central Europe, reportedly due to a higher proportion of preterm deliveries and a higher incidence of maternal obesity in the US.
In 2010 Malta, for instance, congenital malformations and chromosomal abnormalities accounted for 46% of deaths in the first year of life (12/26 months).
Dr Soler exlained that countries with legalised termination of pregnancy would obviously alter this figure.
On Malta’s Infant Mortality Rate (deaths in the first year of life per 1,000 live births) which accounts for the relatively elevated child death rate from 0-4 years, he said that possible explanations for this are that in other European countries, figures for babies with congenital malformations and chromosomal abnormalities do not feature because many of these babies are terminated during pregnancy.
In Malta, termination is not practised.
But there may be other factors which have an impact on the wellbeing of the baby before birth and in the first year of life, such as “maternal obesity and an unhealthy lifestyle”.
“It is known that Malta has a relatively high prevalence of obesity when compared to the rest of the world, and maternal obesity is associated with increased risk of complications for both mother and baby,” Dr Soler said.
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http://www.independent.com.mt/articles/2014-05-08/news/obesity-may-account-for-relatively-elevated-child-death-rate-4897374208/
Nice weather for the time of year, isn’t it ?
How about smoking and drinking during and after pregnancy? And I’m referring to the father too in this case.
Can’t stand parents smoking and driving with the poor babies at the back.
While I have not read the report or article, what caught my eye is the high rate of congenital defects.
This may also be associated with the possibility or otherwise of abortion. However, while working in a reputable children’s hospital in London in the 80s, I was often asked all kinds of questions which could help explain why at times half the infants/children in the cardiac ICU were Maltese.
After discounting other factors at the time which may still be prevalent now, one factor that became evident is that Malta’s rate of congenital heart defects was double that of the UK’s.
There are too many reasons that may contribute to infant mortality and congenital defects are less easily understood as they may vary from one environment to the other.
Is it allowed to turn this into a debate on obesity? Because it seems to me that this taboo should long have been tackled. What good is economic growth if it is accompanied by an explosion in obesity?
Maltese parents are not likely to resort to a termination of pregnancy even when there is irrefutable evidence that the foetus has malformations that are incompatible with life. Their wishes should be respected.
Another point that one should take in consideration is the not inconsiderable number of multiple pregnancies that result from the treatment of infertility, most of which end up with unhealthy babies that are unlikely to survive more than a few weeks after birth.
Common misconception but not true. Foetuses with anomalies will never even implant, let alone be born.
I see a disproportionately large number of older mothers, 35-somethings, with twins or, you guessed it, even triplets.
If only I had a penny for every time a 35-something woman who has delayed pregnancy beyond the natural told me that she is planning on having twins.
I too arrived at that conclusion when I saw the results. It is an obvious factor. Abortion is less than a decade away from hitting Malta like a train.
‘All of humanity is diminished by the very existence of a law that implicitly tells us that some people’s lives are less worthy of life than others’.
It is time to revisit this news item:
“Joseph – Malta li rrid nghid fiha” – by Cyrus Engerer
http://www.youtube.com/watch?v=S9dib02T2Z0
There are at least another two factors to be considered. Firstly, the state does not offer the Nuchal translucency test and most obstetricians do not inform pregnant women that the test is available privately.
This is the test which checks for foetal abnormalities at 12 weeks of pregnancy.
So many women won’t know about the abnormalities before they discover later by ultrasound or after delivery.
Also, the streptococcus B test has only started to be routinely carried out, less than a year ago, so until then, most mothers with the bacterial infection were at high risk of passing the infection to the baby during delivery.
The infected babies would suffer from serious illnesses and even risk death.
We are so far down the PC road that I will be hounded to hell for this but, what the heck – one of us has to say it: the “strong element of choice” you refer to is actually the choice to be (or not to be) obese.
Why should people who choose to be obese pay the same as people half their weight for flights?
Why should people who choose to be obese expect me to foot the bill when they’re boarded out?
Why should people who choose to be obese expect me to pay their medical fees?
Why should people who choose to be obese expect plain sailing when it comes to having children?
We are all great at claiming “rights” but few of us want the responsibilities that go with them.
What use are tub-o-lard parents who’ll be dead by 50 to children?
That kind of statement is hardly proof that obesity is a major factor affecting our statistics though it may well explain some early deaths and is in itself an undesirable feature.
How about the standard of care for premature and other debilitated neonates. Is this up to scratch?
[Daphne – Very much so. It’s excellent, though the Special Care Baby Unit can at times be over-burdened with the effects of fertility treatment that sometimes results in ‘batches’ of premature twins and triplets occurring far more frequently than they do in nature.]
I confirm that some obs/gynae do not inform women of the nuchal translucency test precisely to push their own pro-life agendas.
This happened to me recently. I got to know by pure chance during my 11th week of pregnancy about this test.
When I confronted my (private clinic) gynae that I should have been informed about this test – that it is my right and her duty as my doctor to keep me informed – the doctor simply couldn’t understand my point.
She kept insisting that this test is only done for termination purposes and Maltese do not terminate pregnancies. It was obvious that she is against abortions in all cases, and so she will not inform her patients about this test precisely to avoid any abortions.
Though I agree that most Maltese would deliver their baby to full term regardless of any conditions in the foetus, the blanket ban on abortions is limiting some Maltese from taking the abortion option (besides the financial aspect).
[Daphne – There is a far more important reason why parents should know of problems like these up ahead of the birth. They have time to get used to the situation, plan for it, and are spared the terrible shock of discovery at the moment of birth, which adds to the emotional trauma.]