11

H—3l

Other Causes of Maternal Deaths in 1929, 80. 1928. 1929. 1. Puerperal albuminuria and convulsions .. .. .. 38 34 2. Puerperal haemorrhage .. .. .. .. 15 10 3. Other accidents of labour .. .. .. .. 4 8 4. Accidents of pregnancy .. . . . . . . 11 12 5. Puerperal white-leg, embolus, and sudden death . . 9 14 6. Following childbirth (not otherwise defined) . . 1 2 78 80 International List. The following table gives the death-rate from puerperal causes in various countries (a quinquennial average —such an average discounts annual extremes) : —

It will be seen from this that New Zealand's puerperal death-rate, unlike her general death-rate, is relatively high, due less to puerperal-septicEemia deaths than to deaths from other puerperal causes, such as puerperal albuminuria and convulsions, puerperal hasmorrhage, and other accidents of labour. It will be seen also that several other countries believed to possess skilled midwifery service, which show a relatively high puerperal death-rate, also owe their relatively high rate more to these other puerperal causes than to puerperal septicemia. I instance Northern Ireland, Australia, Canada, Scotland, and the United States of America. In previous reports, by graphs and tables, I have demonstrated that in New Zealand these other puerperal causes are less fatal to women residing in the fourteen principal urban areas than to women in the rural areas and the smaller towns. It is probable that not only in New Zealand, but also in the several other countries to which 1 have referred, this higher death-rate is in some measure attributable to the scattered distribution of population rendering ante-natal care and the procurement of skilled midwifery service more difficult of attainment. Another factor which should be taken into account is that we have reason to believe that the collection of statistics is more accurately performed in New Zealand than in many European countries. The notification of puerperal septicemia in New Zealand is so thorough as to have occasioned comment overseas, and the questionnaire of medical practitioners by the New Zealand Government Statistician regarding female deaths is searching.

Death-rate per 1,000 Births from Country. Period. Puerperal | Other Puerperal All Puerperal Septictemia. j Cauaes. Causes. Sweden .. .. .. .. 1920-24 1-15 1-36 2-51 Italy .. . . . . . . 1922-26 1-02 ! 1-52 2-54 Netherlands . . .. . . 1923-27 0-59 ! 2-03 2-62 Norway .. .. .. .. 1921-25 0-74 | 1-91 2-65 Uruguay . . . . . . . . 1922-26 1-67 | 1-01 2-68 Denmark .. . . .. .. 1922-26 0-95 1-81 2-76 Hungary .. .. .. .. 1922-26 1-43 1-57 3-00 Japan .. .. .. . . 1921-25 1-21 2-07 3-28 England and Wales .. .. 1923-27 1-48 2-52 4-00 Germany .. .. .. .. 1921-25 2-80 1-47 4-27 Spain .. .. .. .. 1922-26 2-25 2-09 j 4-34 Switzerland .. .. .. 1922-26 2-07 ! 2-57 | 4-64 New Zealand 1925 29 1-85 2-86 4-71 Irish Free State . . .. .. 1923-27 1-67 i 3-05 j 4-72 Northern Ireland .. .. .. 1921-25 1-55 3-21 4-76 Union of South Africa .. .. 1923-27 2-03 j 2-96 i 4-99 Australia .. .. .. . . 1923-27 1-84 3-65 ' 5-49 Belgium .. .. .. .. 1921-25 2-68 2-85 5-53 Canada .. .. .. .. 1923-27 1-80 I 3-98 5-78 Scotland .. .. .. .. 1923-27 1-78 4-47 6-25 Chile .. .. .. .. 1922-26 1-69 4-98 6-67 United States .. .. .. 1920-24 2-54 4-36 6-90 Trinidad .. .. .. .. 1923-25 3-58 5-68 9-26 British Guiana .. .. .. 1922-25 2-68 11-55 14-23 Ceylon 1923-27 7-40 11-75 19-15