Maternal mortality in Greece: The evolution from traditional mammis to overmedicalized obstetric care during the 20th century

Abstract

Greece has been absent from the literature on maternal mortality in historical Europe, as very little evidence is yet available regarding maternal mortality patterns before the 1950s. The discontinuity in the collection and publication of demographic data in Greece, as well as the nonavailability of continuous national published statistics are the most important reasons for the lack of studies on maternal mortality. Therefore, this study aims to address this gap by utilising annual published statistics at the aggregate level, focusing primarily on the first half of the 20th century, while also making a significant contribution to the postwar period. The results of the study indicate a high incidence of maternal deaths in Greece, particularly in the northern—mostly rural and later annexed—regions of the country until the late 1930s. An important reason may be the lack of obstetric care in these areas. Although major urban centres were primarily served by qualified midwives by the mid‐1920s, rural Greece had access only to untrained midwives due to the insufficient number of trained midwives that could cater the needs of the entire country. Other contributing factors may include the high prevalence of infectious diseases, such as tuberculosis and malaria in certain areas of the country, poor nutritional status throughout the country before the 1950s, low literacy rates, low living standards, and lack of public health infrastructures. Greece's case study is intriguing as it has transitioned from an almost absolute lack of obstetric care, with the exception of the mostly untrained rural midwives known as mammis before the 1950s, to becoming one of the most highly medicalised countries in Europe by the end of the 20th century, succeeding very low levels of maternal mortality.