The definite instruction of prospective mothers is a social service and a social duty of the first order of importance. There is perhaps no other form of social work which yields larger returns on the modest investment required. It is a service needed by the comfortably well-to-do as by the poor. It can be rendered by a qualified private physician or an experienced mother as well as by a nurse from the Department of Health, but when instruc tion from natural private sources is lacking, then it should be provided at public expense. Encourag ing beginnings have been made by governmental agencies and private organizations in various places, and the results which are everywhere apparent after only a brief trial leave no doubt as to the desirability of greatly extending such service.
The Federal Children's Bureau made the prepara tion of an authoritative pamphlet on Pre-natal Care* one of the first claims on the very moderate resources of its first year's appropriation, and this has proved to be one of the popular publications of the government. It is deservedly so, for it is written by a competent mother, simply, clearly, and scientifically, explaining everything in such a way as to inspire confidence in the advice given and to dissipate unnecessary alarms and fears. For the normal American woman who can read and understand simple English and follow simple in structions nothing could be better.
There are many mothers, however, who, un fortunately, can not profit by such instruction as this. For them an organized clinic service, of physicians and of nurses with special aptitude and qualifications, is needed in the cities and towns. In rural districts this work can probably best be done through a district-nursing system. The
Budin Foundation in Paris is a classic example of this kind of service, but the New Zealand Society for the Health of Women and Children bids fair to become the best known in America, through the publication, recently, by the Children's Bureau of an account of its methods. The instruction and supervision given by such organizations are not confined to the ante-natal period; their ante-natal work, in fact, is usually an extension backward from milk-stations and visitation of new-born * By Mrs. Max West.
babies, as the necessity of beginning earlier becomes apparent.
The New Zealand Society is a private organiza tion, supervised and subsidized by the government. In the five years after it was organized the infant mortality of the city of Dunedin, where it has its headquarters, a residential city of about sixty thousand inhabitants, was exactly cut in two, and brought to a point considerably lower than that of New Zealand in general, though at the beginning of the period it was already lower than in any American city for which we have credible data. In New York City, among the three thousand moth ers supervised by the Milk Committee and by the Department of Health in the first year after it took over the pre-natal work of the Committee, the percentage of still-births and of premature births was considerably less than the average for the city, only about half as many babies died during their first month and only four mothers in all, and over ninety per cent of the babies were still being fed entirely from the breast at the end of their first month.