Epidemiological appraisal of the active role of women in the decline of infant mortality in Spain during the twentieth century.

This paper is concerned with the question of the role which the psycho-cultural development experienced by women in developed countries throughout this century may have played in the decline of infant mortality, taking in Spain between 1900 and 1979 as a basis for observation. We think that, by studying the psycho-cultural development of women, included under the general concept of standard of living, we can take a step forward in explaining such a frequently investigated but nonetheless incompletely understood subject as is that of the marked decline of infant mortality which has taken place in this century in developed countries in general, and in Spain in particular. To this effect, we have attempted to demonstrate the need to consider socio-cultural factors, in addition to the already repeatedly studied economic and biomedical ones; the more so when we take into account the marked decline in infant mortality which occurred in Spain in the 1940s, in which period there was a pronounced stagnation in the economy. To this purpose, we have studied fertility, not only as a gauge of the biological risks which generate a certain reproductive pattern for infant mortality, but also as an indicator of the socio-cultural development of women. Similarly, and through a review of historical documents, we have analysed the role of women in birth control, their incorporation into more qualified jobs, their level of education, their growing awareness of their own situation in society, as well as pertinent legislative changes. All these processes affect the health of children through factors which, although they are very difficult to evaluate and quantify, have previously been described and examined in other studies. Our study has shown the probable relationship between the decline of fertility and the decrease of infant mortality, in view of the fact that there has been a pronounced decrease of parity and fertility in women belonging to the oldest fertile age groups. Similarly, the indications pointed out with respect to the processes mentioned above lead us to infer that in Spain the woman has played a significant role in the decline of infant mortality produced in this century, and especially in the first half of the century. We have embarked on a scantily developed line of investigation, and suggest the need for new studies on the subject.