May 9th, 2013

Ghirlandaio’s 1488 portrait of a young Florentine noblewoman has become the signature piece of the Thyssen-Bornemisza museum in Madrid:

Her name was Giovanna degli Albizzi Tornabuoni. Both parts of her surname mattered at the time. The Albizzi were rivals of the Medici, the Tornabuoni the Medicis’ right-hand men. Her marriage two years earlier to Giovanni Tornabuoni was a political one, a burying of the hatchet between powerful clans. The Tornabuonis were clearly proud of the catch and celebrated her beauty and status in this lovely portrait.

The melancholy Grecian-Urn atmosphere created by the rigid pose and sombre background with pious knick-knacks is no accident. Giovanna died in childbirth, aged only eighteen, the year of the portrait. (Was it begun in life? I’ve suggested to the museum an X-ray to see if Ghirlandaio began with a more cheerful background of Tuscan hills or a rich interior. I’ll let you know if they take me up.)

The beautiful Giovanna can therefore represent all the young women who have paid the ultimate price for our dangerously large brain cases.
Giovanna was as high-status as you could get in the most advanced city in Europe in 1488, but that didn’t help her. Typical pre-industrial maternal mortality rates were from 1% (the rate in Chad and Somalia today) to 3%. They are two orders of magnitude lower today; rates are counted in deaths per 100,000 deliveries, and range from 2 to 50 in OECD countries.

How are some countries of interest to us doing on this metric? Here’s a table for the OECD drawn from the CIA World Factbook. I’ve added the much higher and less noisy rate for infant mortality. The rankings correlate roughly, but not in detail; they capture different aspects of health care, since infant mortality is more a matter of antenatal care, maternal death of emergency obstetrics.
Maternal mortality table
Spreadsheet here, including the full world rankings. {Well, there will be once I’ve fixed the download problem.)

No surprises really. Health care in the USA maintains its resolute mediocrity on maternal mortality as on other metrics. Maternal mortality is two to three times that achieved by a substantial group of high-performing countries, infant mortality 1.5 to twice. Some of the high-performing countries on both, like Spain and the Czech Republic, are quite a lot poorer than the USA.

Could there be a genetic component to maternal mortality? A study in New York found rates much higher among African-American women, controlling for poverty and lifestyle. Cuba does better than the USA on infant mortality, but much worse on maternal. Genes or hospitals? If it were genes, you’d expect to see higher rates in West than in East Africa, which doesn’t seem to be the case. We should keep an open mind on this one.

19 Responses to “Portrait of a dead lady”

  1. NCG says:

    How terribly sad. Did the baby die too?

    • James Wimberley says:

      I fear not, judging from Giovanni’s letter to Lorenzo de Medici after the tragedy, quoted here: “e la creatura sperata da lei, gli cavammo di corpo morta, che m’è stato ancora doppio dolore.” My Italian is not good though, and Google Translate won’t deal with cavammo.

  2. Ebenezer Scrooge says:

    Add bipedalism to the brain case. Bipedalism constricts the birth canal; the brain case expands the fetal circumference. Collectively, a good example of unintelligent design. Mother Nature is a kludge.

    And James, why would you expect genes to show higher rates in West than in East Africa? I’m not disputing this assertion, just wanting to know what it is based on.

    • James Wimberley says:

      If it’s an African-American gene, then you’d expect to find it differentially in West Africa, and among the descendants of West Africans through the slave trade in Brazil, Cuba, Jamaica, and the USA. East Africa is the origin of humanity, so everybody radiates out from there genetically. An East African mutation for risk of maternal death would either be ancient and universal, or recent and local to the region and so irrelevant to the USA.
      On a similar basis, I proposed here that Barack Obama (half-white, half-Luo) was closer genetically to Hillary Clinton than to his wife Michelle.

  3. Anonymous says:

    Tell me about it. During the birth of our eldest daughter, after 12 hours of labour, and my wife passed out from exhaustion, I was thrown out the theatre, and the gynaecologist set to work with a forceps. Born with a black eye, the now-grown woman still carries a tiny scar on her eyelid (it was supposed to be “gone in a few days”, but in a way I am glad it wasn’t).

    “Big baby, small mother” was his comment afterwards “You can send her to shcool tomorrow.” – she weighed just short of 10lbs. Actually, he alluded to genes as well – my wife is South Asian, I am Irish. His opinion was the baby was bigger than a South Asian woman would usually carry.

    Our second child weighed almost the same, but was a problem-free delivery.

    Who pioneered the forceps birth? A benefactor of humanity. Would it have saved this young lady?

    • James Wimberley says:

      Do you have diabetes in the family? It’s correlated with high birth weight. I weighed 11 pounds.

      • Ebenezer Scrooge says:

        Diabetes is not so much correlated with high birthweight, as diabetes pretty much directly causes high birthweight. (Sugar, y’know.) Maternal diabetes is fairly common and resembles a temporary Type II diabetes.

        On the other hand, the causation does not mean perfect correlation–my li’l monster was a bit on the light side, even though my wife had mild maternal diabetes.

    • Russell L. Carter says:

      ” … I was thrown out the theatre…”

      Hah! The doc started the strong pull with the forceps with just me and a nurse (y la madre, claro) in the room, and when the bed came rolling he not gently directed me, “LOCK DOWN THOSE LEGS”. Which I was happy to do. I am not easily perturbed by uncertain situations but I admit for a minute or two I was beginning to wonder. About a lot of things, that we take for granted.

      There were several very distinct impressions from the forceps on her skull, which I found quite disturbing. They did indeed go away soon after, thankfully.

      Fascinating history on forceps here:

      James, I wish I had time traveled to read this post back a year ago when I strolled through that museum, after several glorious hours in The Prado. I could have focused! But I also didn’t discover Hughes’ Barcelona until afterward as well. Sigh.

  4. Toby says:

    Fascinating history of the use of the forceps in Wikipedia – it was pioneered in 17th century England (so too late for Giovanni Tornabuoni, if it could have saved her), but was kept as a family secret for 150 years. It came into general use in the 19th century, but is now largely replaced by vacuum suction or sectioning.

    • Russell L. Carter says:

      Whoops, didn’t read your comment before posting, sorry! That really is some interesting stuff, including the bit about keeping forceps secret.

  5. Betsy says:

    Too bad Intelligent Design couldn’t have intelligently designed an exit for the baby through the mother’s big, open, bone-free area just between the top of the pelvis and the bottom of the ribcage — otherwise known as the belly.

  6. Katja says:

    I’m somewhat surprised that the UK is doing comparatively poorly; no matter what else one says about the NHS, prenatal care and maternal care is supposed to be pretty good, and my personal experience has been very, very good. I can to some extent understand a slightly higher maternal mortality; maternal care is very midwife-centric in the UK (and a comparatively high number of women give birth at home in the UK, though still less than 3%, as I recall), so it may be more likely that there isn’t a doctor on hand if something goes wrong during delivery, but I honestly wouldn’t know how one could improve much on the prenatal care I’ve received for either of my daughters.

    • James Wimberley says:

      A speculation. The NHS is closing small maternity units (against local opposition) and concentrating services in larger specialist units. The policy is probably driven by perinatal mortality and morbidity. Problems for the mothers are much rarer. But maybe what’s good for babies here is not so good for mothers.
      Is it immigration? Spain and France also have lots of immigrants with traditionalist ideas on the status of women, and nuch better numbers.

  7. Freeman says:

    What’s up with Estonia?

    • James Wimberley says:

      Estonia (pop. 1.3m) has only 15,000 births a year so the maternal mortality rate of 2 per 100,000 must mean roughly “we had a death four years ago”. A very noisy number. Latvia and Lithuania have the higher rates you’d expect, so it’s unlikely to be economic, genetic or cultural factors. (When I worked in the Baltics a little in the 1990s, I noticed how little they smoked; something Russians did.) Estonia’s infant mortality is also ordinary. Maybe they just have one very good obstetric unit in Tallinn.

  8. davidh says:

    While preparing to teach an art history survey course for which I, a graphic designer and photographer, was completely unprepared, I had a classicist friend translate the Latin text posted on the wall behind the lovely woman: “O Art, if only you were able to depict the character and the soul, there would be no picture more beautiful in all the world.”

  9. Ed Whitney says:

    Too bad about the forceps; Anonymous’ daughter can never grow up to be President of the United States. The Constitution says that no one except a natural born citizen can hold that office.

    Time for the next generation of birthers to start looking into the birth records of future candidates. We cannot have anyone who was delivered by forceps or c-section holding the highest office in the land.

Post a Comment