Maternal mortality, tuberculosis and social deprivation in Madrid during the second and third decades of the 20th century

In this paper we jointly study maternal mortality and tuberculosis during the second and third decades of the 20th century in Madrid. Nicknamed the “city of death”, the Spanish capital was marked by a high mortality where tuberculosis accounted for approximately 26/28% of all deaths of women of reproductive age. Using a large longitudinal individual-level database including causes of death, we discuss the definitions of maternal mortality, then highlight its high level in the Spanish capital. However, the risk of dying was significantly lower for migrant women than for native. In the context studied, an evident example of the “healthy migrant” paradox with selection at origin is outlined. At the same time, there are clear links between tuberculosis as a cause of death during the 60 days following a delivery and the socio-spatial inequalities characteristic of a city that saw wealthy areas side by side with disadvantaged areas, characterized by low standards of living conditions and insufficient hygiene. The results of the statistical models analyzed are controlled for geographic, social and biological variables in addition to individual demographic characteristics. The robustness of the results is ensured by the size of the sample used, which allowed us to study an event - a death following delivery - that, even at the time of this study, was rare. • We study the association between maternal mortality and tuberculosis • We use longitudinal individual data with detailed causes of death • Our database size authorizes the study of a rare phenomenon as maternal mortality • And its relationships with tuberculosis, which is still an issue in poor countries • We provide an illustration of the "healthy migrant paradox”