Maternity and Infant Welfare

The expenditure on maternity and child welfare services pro vided by local authorities for the year 1927-28 was upwards of ii,5oo,000, in addition to which Exchequer grants amounting to over £217,000 were made to voluntary agencies. If to these figures is added nearly £2,000,000 paid in maternity benefit under the national health insurance scheme, a total of nearly £4,000,000 is spent each year on these services, without taking account of the expenditure out of local rates, or of the voluntary agencies, or of other benefits paid to women during pregnancy from health in surance funds or of the voluntary hospital services.

Infant and Maternal Mortality.

The services given at the centres by both lay and professional workers helped to secure the reduction of the infant mortality rate from 154 per I ,000 births in 190o to about 7o per I,000 births in 1927. This grati fying result means that (calculated on the average infant mortality of 1901-10) there was in 1927 a further saving of some 40,000 infant lives. "It also implies a better physical condition in chil dren from one to five years of age, and a more enlightened under standing of personal and public hygiene" (Sir George Newman). While this saving of infant lives is all to the good, it is disturbing to find on an analysis of the statistics that the reduction in the infant mortality rate has occurred almost entirely subsequent to the first few weeks of life and that the death-rate of infants up to the age of four weeks has remained almost stationary, being 32 per i,000 births in 1927 as against 4o births for 1906-1o.

So, too, in the case of maternal mortality, notwithstanding that Sir Arthur Newsholme reported in 1915 that "800 mothers die each year in England and Wales as the result of childbearing whose lives would be saved if the experience of the rest of England and Wales were as favourable as London," and that there would be a further saving of i,ioo lives of mothers secured annually in Eng land and Wales if puerperal fever were to be eliminated "as it has been substantially from the experience of many lying-in hos pitals." Dr. Janet Campbell, Io years later, writes that "avoid able maternal deaths are a matter of everyday occurrence," and that "puerperal infection leads to more deaths and more injury than any other complication of childbearing." It has been shown that the mortality rate of very young babies is nearly as high as it was early in the century. On examining the statistical returns of maternal mortality as published by the regis trar general it is seen that while the death-rate of mothers at childbirth was 5 per i,000 births for the period 1906-10, it was 4-I 1 per i,000 births in 1927.

Here then is the problem. Improvements in general sanitation and public health services, a better education in public and per sonal hygiene, the maternity and child welfare services, the ser vices provided under the national health insurance scheme, have had no visible effect upon the vital statistics relating to child bearing. Comparing the period 1906-10 with the year 1927—i.e., the period prior to the establishment and development of matern ity and child welfare services by the local authorities with the latest complete figures available—it is seen that taking the 1906-10 period as the relative mortality rates provisionally ascer Maternal mortality 82.2 % Infants under four weeks 80.0 Infants from four weeks to one year According to Dr. Janet Campbell, the death of the mother is often followed by the death of the baby and "by the impaired health and nutrition of the remaining children." Disability Among Married has been pointed out that the mortality returns "reveal only a part of the total damage and disability, and that an incalculable amount of un reported and often untreated injury and ill-health results from pregnancy and labour." Statistics relating to the comparatively heavy incidence of sickness amongst married women were pre sented to the royal commission on national health insurance which reported in March 1926. The Government actuary reported that an urgent matter is the excess of the claims of married over unmarried women. At the important ages, 20-25, 25-30 and 30-35, the married woman's rates of sickness represent the following percentages of those of the unmarried class: 1921 1922 1923 Ages 20-25 ..... . . 242 284 299 25-30 . . . 198 242 30-35 ..... . . 158 171 198 The majority report of the royal commission recommended the provision of improved maternity services "as and when funds are available to meet the cost." The minority report, however, de clared that "the high maternal death-rate and the great amount of sickness amongst mothers clearly prove the need of reorganiza tion and extension of maternity work," and recommended that medical benefit under the health insurance scheme should in clude medical attention at confinement and should be extended to include the wives and dependants of insured men. The pro vision of more adequate services for women at childbirth is a matter of urgent necessity. "If a woman can rely upon securing the services of a careful up-to-date practitioner, or upon the at tendance of a well-trained midwife who is able to obtain prompt and competent medical assistance in case of need, nearly all other conditions become of minor importance" (Dr. Janet Campbell).