The Small Epidemiologic Transition has transformed pregnancy with an unknown outcome to gestation as a developmental process with a carefully monitored beginning and end. It moreover shortened gestation as an essential component of the life cycle, as the first days of a new living being can be spent in a Petri dish and its last moments of maturation in a neonatal intensive care unit.
This book has a focus on two types of medical intervention surrounding pregnancy and childbirth: antenatal screening and diagnosis followed by induced abortion, and neonatal intensive care for preterm babies. These two types of intervention have opposite demographic effects. It is explored whether the Small Epidemiologic Transition involved an increase of the prevalence of handicap in childhood. Such a contribution to an expansion of morbidity could arise from a situation whereby more handicap is generated by life-saving efforts shortly after birth than is taken away from the population by selective abortion.
The Small Epidemiologic Transition is about small infants and their short lives. This is encapsulated in one figure in this book which shows the chances that a pregnancy ends in a spontaneous abortion, and induced abortion, or livebirth. The focus is on the outcomes of pregnancy that are regarded as problematic, unwelcome, and not anticipated. There is a formal side to this theme, where the demographic or epidemiologic events of interest are captured in graphs and frequency tables. This systematic aspect is symbolized by the shape of the illustration on the front cover, which reflects the chances of pregnancy termination by week of gestation. There is also a more intimate side of the story concerning the experience of parents with problematic pregnancies, their shattered hopes and difficult decisions. This side of the story is reflected in the skipping-rope with its solid beginning that eventually disintegrates into a broken end. The tattered end of the rope that has fallen into the grass symbolizes the forfeited playfulness of children and the dreams of their parents.
Willem Jan van der Veen received his Master Degrees in Demography and Geography and his PhD in Demography from the University of Groningen, the Netherlands. He worked on this book while at the Population Research Centre, Groningen. Currently he works at the Faculty of Medicine, Department of General Practice, at the University of Groningen.
