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.
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.