MATERNITY AND INFANT WELFARE. After the World War all civilized countries realized the importance of decreasing the high death-rate among women at childbirth and among infants under one year of age. In Great Britain there is a considerable body of new legislation intended to supplement welfare agencies and to provide State aid. The Maternity and Child Welfare Act 1918 gives comprehensive powers to local authorities. It consolidates the work commenced in 1906 by the St. Marylebone Health Society. Like nearly every other move ment to fight disease, modest experiments by groups of social workers pointed the way to larger State and municipal action.
In 1910 there were 90 infant welfare centres in Great Britain, and by 1914 the number had risen to 40o. Owing to the impetus of the War and the Child Welfare Act of 1918, there were in May 1928 no fewer than 1,561 infant welfare centres under the local authorities and 87o voluntary centres, as well as 153 maternity institutions recognized by the Ministry of Health.
The various enactments bearing on the subject are the Fac tory and Workshops Act of 1901, which endeavours directly to protect the woman who has recently given birth to a child; the Midwives Act of 1902, which laid the foundation of a safe and efficient system of practice by midwives ; the Notification of Births Act of 1907 and the extension of the act in 1915, which Miss Margaret Llewelyn Davies described as "nothing less than a welcome by society to each of its newly-born citizens, and a signal of help and a message of hope to every mother in the land." Under this act the father or doctor or midwife must notify the public health authority within 36 hours of the birth of a child. Advice and help, free of charge, are then given by a woman health visitor. The National Health Insurance Act provides a maternity benefit of 4os. for an insured woman or the wife of an insured man.
The Ministry of Health, formerly the Local Government Board, encouraged local authorities to extend and develop their maternity and child welfare services. In a circular letter to local authorities issued in 1914 the board stated that an estimate had been laid before parliament for a grant to be distributed to local authorities and voluntary agencies in respect of institutions or other provision for maternity and child welfare, that more extended and system atic measures than had hitherto been generally adopted were necessary. Sir Arthur Newsholme, in a report on maternal mortal ity in connection with childbearing, published in 1915, stated that "the present report is intended to draw attention to this unneces sary mortality from childbearing, to stimulate further local inquiry on the subject and to encourage measures which will make the occurrence of illness and disability due to childbearing a much rarer event than at present." His successor, Sir George Newman,
10 years later (1924), in his preface to Dr. Janet Campbell's Maternal Mortality, referring to the fact that approximately 3,000 mothers had died each year at childbirth for the previous io years, stated: "That is a serious and largely an avoidable loss of life at the time of its highest capacity and in its most fruitful effort." Administration.—The local authorities carrying out matern ity and child welfare schemes are the county councils, county borough councils and the councils of certain of the larger county districts--as a general rule those having a population of more than 20,000. These are in the main the authorities which adopted the Notification of Births Act referred to above, under which some work for mothers and babies was already being done before the passing of the act of 1918. The regulations, under which a grant is payable by the Exchequer of so% of the approved net expenditure of local authorities, set out the services which may and should be comprised in a maternity and child welfare scheme, and from them the scope and content of the services may readily be understood. I. The salaries and expenses of inspectors of mid wives and of health visitors and nurses engaged in maternity and child welfare work ; 2. The provision of a midwife for necessitous women and for areas insufficiently supplied with this service; 3. The provision, for necessitous women, of a doctor for illness con nected with pregnancy and for aid during the period of confine ment ; 4. The expenses of a centre, i.e., an institution for providing medical supervision and advice for expectant and nursing mothers and for children under five years of age, and medical treatment at the centre for cases needing it ; 5. Arrangements for instruction in the general hygiene of maternity and childhood; 6. Hospital treat ment for complicated cases of confinement and for children under five years of age found to need in-patient treatment ; 7. The cost of food certified as being necessary to expectant and nursing mothers and for children where the case is necessitous ; 8. Ex penses of crèches and day nurseries and of other arrangements for attending to the health of children under five years of age whose mothers go out to work; 9. Accommodation in convalescent homes for nursing mothers and for children ; 1o. The provision of homes and other arrangements for attending to the health of children under five years of age of widowed, deserted and un married mothers ; I 1. Experimental work in relation to maternity and child welfare work; 12. Contribution by a local authority to voluntary institutions. Exchequer grants on the same scale are also paid to voluntary agencies which carry out certain services to the satisfaction of the Minister of Health.