Association of marital status and years of schooling with perinatal outcome: the influence of pre-natal care as an intermediate variable

The association between mother's education and perinatal mortality, and between marital status and proportion of preterm deliveries was analyzed using data from 20,000 women and newborns delivered at the Hospital Barros Luco-Trudeau in Santiago, Chile. A highly significant correlation was found, but after being controlled by pre-natal care, that association disappeared for those mothers with good pre-natal care, remaining only as a part of the association for women who did not attend the pre-natal clinics or did not follow minimal standards of care. The definition used for "good pre-natal care" was much less demanding than WHO recommendation. We required a minimum of only 5 visits, starting before the 5th month of the pregnancy and with blood pressure and body weight registered at each visit. Pre-natal assistance was provided mostly by registered midwives, with occasional consultation by physicians. The efficiency of a low cost health activity, such as pre-natal care, in improving infant health is held in contrast with the inefficiency of high cost technology when applied to developing countries' health problems.