THE New Zealand Herald AND DAILY SOUTHERN CROSS TUESDAY, AUGUST 14, 1928. MATERNAL MORTALITY.

New Zealand Herald, Volume LXV, Issue 20024, 14 August 1928, Page 8

THE New Zealand Herald AND DAILY SOUTHERN CROSS TUESDAY, AUGUST 14, 1928. MATERNAL MORTALITY.

An increase in maternal mortality in the Dominion, noted in the annual reports for 1927 by the officers of the Department of Health, calls for public attention. The -leading facts of this increase, together with suggestive comments by these officers, were given in articles published yesterday. Sir Truby King, returning from abroad, refers to-day to the subject in relating impressions of his travel. The increase is sudden and disquieting. There is recorded a higher death-rate in this connection from all causes than obtained in either 1925 or 1926, the rise being from '1.25 per thousand births in 1926 to 4.91 last year. The mortality from puerperal septicaemia, 2.51 per thousand, was the highest since 1885, when it was 3 per thousand. A little serious consideration of these figures is enough to stab concern broad awake. When it is remembered that conditions in New Zealand favour a relatively low general death-rate^-the Dominion has the lowest in the world —this increase in maternal mortality gets added emphasis. This is obvious justification for the view that, while this country has reason to be proud of its exceptionally low rate of infant mortality, its losses of mothers are discreditably heavy. Credit must be given to the officers of the Department of Health for their alertness in calling attention to the serious position and their earnest counsels as to ways of effecting improvement ; but an aroused public concern is essential to the adoption of practical means to remove what is both a disaster and a disgrace. There is cold comfort in the knowledge that throughout the Empire this cause of self-reproach exists. In Britain, as Lady Cynthia Colville has recently shown, the rate of mortality has been high and unchecked during the last twenty years—years in which national self-esteem has been considerable because of steady progress in general matters of hygiene and public health. There the death-rate of infants has encouragingly fallen. During the war it was strikingly said that it was safer to be a soldier in France than a baby in England. Since then the infant death-rate has fallen from about 130 per thousand to less than half that figure. But with motherhood it is otherwise. "It is safer to be a miner, a seafarer, or a worker in any trade scheduled as dangerous," says Lady Colville, "than to be an expectant mother.

Nor is it alone the fact that Britain loses annually three thousand mothers that has awakened consternation : behind the ranks of the fallen are uncounted companies of wounded —women rtfaimed for life, incapacitated, in many instances doomed to perpetual invalidism. There are countries without the reproach. Denmark and Holland lead them; Sweden, Norway and Italy are in their wake. The facts have been taken as a challenge to the British Ministry of Health. Its chief medical adviser, Sir George Newman, has besought the nation "to bank on motherhood." Last October there was issued by Dame Janet Campbell, senior officer of the Ministry for Maternity and ChildWelfare, an illuminating report on "The Protection of Motherhood." Conferences attended by this gifted doctor and Sir George Newman were held to discuss the question. It has been deemed pressinglv urgent, and means to stem the appalling ebb have been formulated. For the guidance of this country it may be noted that, while lines for research into the admittedly obscure causes and incidence of puerperal ailments have been laid down, some practical steps have been taken to deal with the evil in ways known to be essential to a better state of things. These accord closely with those commended by our own officers of the Department of Health. A higher standard of obstetrical training for medical practitioners is one of these. This improved education, as Dr. Jellett urges, demands increased resources. That is a matter of financial policy—to be dealt with as an imperative necessity. Because of lack of means —a want of clinical material as well as funds — present methods of training are inadequate. A doctor's aid at childbirth is especially desirable in abnormal cases, and there is insufficient instruction, however good, and insufficient experience to implement the instruction, to ensure that highly expert aid whenever and wherever required. This calls for remedy. It may be furnished in part by the increased clinical requirements of the general medical course, in part by the training of expert obstetricians and their employment by the Department of Health in allotted districts. From the new regulations for the training of midwives good deal is to be expected, but this will not remove the need for the highlyskilled practitioner. In a wellorganised system of ante-natal clinics there would be something of promise At present they are very limited in operation. In their extension there is scope for an expanded service from the Plunket Society It is to a widespread voluntary institution such as this that the Dominion must look for aid in combating the evil to which the death-rate of mothers compels attention. If it be pleaded by the heads of this voluntary institution that already it finds its work hampered for lack of funds, they should consider plans to give its finances a less haphazard basis than now is the rule—an application of the society's own principles of rational and regular feeding. The fact is that part of the administrative approach to the question must be taken by the public, and in this the Plunket Society may reasonably be expected to give a lead. There is a pressing necessity for much practical thinking about' every phase of | the question. \