LIFE After the child has begun its ante-natal life, of healthy parents, united under the sanction of so ciety, the next stage is comparatively simple. The normal outcome is the birth of a living child; and so powerfully does nature work toward this end that a very moderate amount of attention is usually sufficient to insure it. The problem is further simplified by the fact that the welfare of the child at this stage depends on the welfare and intelli gence of one individual—its mother—who, if our preliminary conditions have been met, is normal in mind and body and has the good of the child at heart.
At present, it is true, this ante-natal period ap pears to be the most dangerous period of life. English and French authorities have estimated that one out of five or six pregnancies end in abor tion or miscarriage.* The proportion may not be * The latest available English estimates, in the Forty third Annual Report (1913-14) of the Medical Officer of the so large in this country, but there can be no doubt that the waste of life in this way is enormous. In addition, there are the children born dead, though at full term, which probably occurs in at least one case out of twenty.* We should consider in this connection also the large number of deaths in the first month of infancy which are attributable to congenital debility, prematurity, convulsions, mal formations, and injuries at birth. The infant death-rate from congenital causes has been prac tically unaffected by the measures which have been so extraordinarily successful in cutting down the infant death-rate as a whole in many cities in the last few years, and sanitarians are agreed in urging extensive and thorough provision for ante-natal in struction as the most important measure to be taken if it is hoped to effect any considerable further reduction in infant mortality.
A large part of this loss of life before birth, or im mediately after, is sheer flagrant waste, which would be avoided if the most elementary social policies were in force. Statistical statements on these points must be made guardedly, but the Local Government Board (page xxviii), are somewhat lower: a total ante-natal mortality, including still-births, of one hundred and fifty per one thousand births, one-half of which may be ascribed to syphilis. This estimate still makes
the ante-natal mortality much higher than the total mor tality in the first year after birth.
* This is about the proportion of still-births in New York City at the present time, but it is probable that many still births are not yet reported.
elimination of intemperance, of the physical dis ease of syphilis, and the social fact of illegitimacy would certainly eliminate over half the miscarriages, still-births, and abortions, natural and criminal, that occur. For the rest, and for the early deaths after birth, what is mainly needed is such a family budget and such conditions in the home as will give the mother a moderate degree of comfort and rea sonable freedom from anxiety and overwork; such provision of advice and instruction for her, adapted to her understanding, as will save the embryonic human being from actual violence through her ignorance or carelessness, and bring it to birth in the best possible condition; and such competent attendance at birth as will do away absolutely with all avoidable injuries to mother or child.
It is astounding how very moderate are the needs of the mother at this time, and how great the re turn for a slight investment in her comfort. Five hundred French babies whose mothers spent ten days or more in a pre-maternity home before con finement were found to weigh twelve per cent more, which means that in other ways also they were con siderably better equipped for life, than five hundred whose mothers, otherwise in much the same cir cumstances, worked up to the day of confinement. The study recently published by the Children's Bureau shows that in Johnstown, Pennsylvania, the infant mortality rate in the poorest families was three times as great as in the families in com fortable circumstances where the father's annual earnings amounted to $I2oo or more. It is exceed ingly important that there should not be overwork of any kind (or over-fatigue through social func tions or pleasures) at any time during this critical period, and that toward its end there should be a considerable lightening of tasks and responsibility; but, on the other hand, it is not necessary, or even desirable, that the mother should spend the nine months in idleness. Occupations suited to her strength are an advantage.