Deaths of infants and of their mothers may be the most dramatic consequence of ill health, but there are other serious consequences which affect the child and, indeed, may follow it throughout adult life. The damage done by infections and associated malnutrition to a young child in its formative years is manifested in retarded physical growth and mental development, which it may never be able to catch up on, thus impairing the potential for a full and active adult life. Poverty, ignorance, and ill health thus create a vicious cycle spanning from one generation to the next, and from which the individual has little chance of escape.
A striking expression of this generation link is the frequency of "low birth weight" (LBW) babies, ie, babies weighing less than 2500 gm at birth. It is now known that this frequency is closely determined by the same adverse maternal and environmental factors which determine the nutritional status of the mother. It has also been observed in developed countries that the frequency is higher among mothers who smoke during pregnancy. About 21 million LBW (small for date) babies are born each year, the greatest majority of them in developing countries. The observed incidence rate ranges from about 4% in the most developed countries to over 30% in some poor rural populations. It is also known that LBW is the single most important factor determining the survival chances of the child. The infant mortality rate is about 20 times greater for all LBW babies than for other babies, and the lower the birth weight the lower is the survival chance.
Rupture of a caesarean scar during a trial of vaginal birth: a dramatic consequence as old as the modern caesarean section
