The birth rate fell dramatically from the late 19th century with families having fewer children and more women choosing to delay childbearing, or not to have children at all
McKeown (1972) argued that the main factor was improved nutrition, and therefore it was social and economic improvements that brought down the death rate, rather than health innovations
Tranter (1996) disputed this, arguing that about three quarters of the fall in the death rate between 1850 and 1970 could be caused by the elimination of lots of preventable diseases