Lessons from Semmelweis:A Social Epidemiologic Update On Safe Motherhood

Julie Cwikel


In this historical review, Ignaz Semmelweis's study of handwashing to prevent puerperal fever is described and used as a benchmark from which to identify salient issues that are informative to today's women’s health activists working for Safe Motherhood. The epidemiology of contemporary excess maternal mortality is reviewed. Using the conceptual framework of social epidemiology, the paper addresses four issues that were problematic in Semmelweis’ era. New tools in public health are presented that can help to solve critical, still challenging problems to reduce excess maternal mortality, nosocomial infections, and puerperal fever at childbirth: 1) progress in behavioral methods to promote health behavior change, 2) the introduction of participatory action research, 3) the diffusion of evidence-based public health practice and 4) understanding how politics and health interact and present challenges when trying to meet public health goals. Social exclusion and marginality are still key issues in determining who has access to safe motherhood and who risks her life in maternity. Applied social epidemiology allows practitioners to make effective use of the already accumulated evidence and translate it into effective public health practice to promote safe motherhood around the world.


Semmelweis, Maternal Mortality, Evidence-based medicine, Community-based participatory research

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Department of Family and Social Medicine
Albert Einstein College of Medicine/Montefiore Medical Center
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