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A Reappraisal of Grand Multiparity

IN MANY COUNTRIES of the world, socioeconomic trends and increasing medical facilities have markedly decreased the incidence of grand multiparity. In other areas, due to religious or cultural factors, to underdevelopment, or to relative affluence, this change has not occurred. Kuwait is an example of particular interest. The population is about 700,000 and just under half of these are indigenous Kuwaites who feel the need for natural increase to populate their country. The other half are mainly healthy, fertile young men and women, imported labor from the surrounding Arab countries. Both groups live under conditions of relative affluence; Kuwait enjoys one of the highest per capita incomes in the world. Although the progress of education is leading to responsible parenthood, there are few of the socioeconomic pressures which have urged other countries to adopt national birth control policies. Solomons drew attention in 1934 to the special hazards which exact a heavy toll of the life and health of mother and baby after five or more confinements. Advances in surgery and obstetrics and the advent of antibiotics, blood transfusion, and safe anesthesia have much ameliorated this situation, especially when due care and alertness are exercised in the management of the grand multipara. There has been a