H.—3l,

PART VI.—MATERNAL WELFARE AND MATERNITY SERVICES. I have the honour to present my report for the year 1940. During the year all the private hospitals and public maternity hospitals have been periodically inspected and reported upon by the Nurse Inspectors acting under the instructions and supervision of the Medical Officers of Health. These reports were all reviewed by me, and any additional action considered necessary was advised or taken. Most of the districts were visited and any special problems discussed with Medical Officers of Health and their officers. Thirteen new maternity hospitals, two new medical and surgical hospitals, and ten new medical and convalescent hospitals were licensed, fourteen licenses were surrendered, and the license of one maternity hospital was revoked. In addition to the above routine work, the following pamphlets were revised and reprinted : H.-Mt. 18, " Technique of Isolation, Medical Asepsis and Disinfection of Maternity Hospitals," and H.-Mt. 20, " The General Principles of Maternity Nursing, including the Management and Aseptic Technique of Labour." The Department also published a pamphlet, H.-Mt. 14, entitled " Maternity Exercises," which was the joint work of Professor Dawson, of the Otago Medical School and University, and Dr. Sylvia Chapman, Medical Superintendent of St. Helens Hospital, Wellington, to whom the thanks of the Department are tendered. The year was marked by a material increase in the birth-rate, a fall in the maternal death-rate, and by an increasing demand on maternity-hospital accommodation. Sections I, 11, and 111 deal in detail with maternal welfare, maternity services, and private medical and surgical hospitals respectively. SECTION I.—MATERNAL WELFARE. Table I shows, for the period 1927 to 1940— (1) The number of births for both Europeans and Maoris : (2) The birth-rates per 1,000 of the population for both Europeans and Maoris : (3) The European still-birth rates per 1,000 total births : (4) The European neo-natal death-rates per 1,000 total births : (5) The European still-birth and neo-natal death-rates combined : (6) The percentage of first births to total births for the European population only : (7) Maternal-mortality rates, including septic abortion, for both Europeans and Maoris : (8) Maternal-mortality rates, excluding septic abortion, European and Maori: (9) Death-rates from septic abortion, European and Maori. The European death-rate from all puerperal causes for the whole period under review is set out in a graph on page 32, which also shows the variations from year to year in the various causes of death. Further details are given in Tables II and 111. The outstanding facts to be noted are a marked increase in the European birth-rate, which, from the lowest rate of 16-17 per 1,000 of the population in 1935, has risen to 21-19 in 1940 ; the increased birth-rate in 1940 accounted for 3,938 more births than occurred in 1939. Coincident with the rise in the birth-rate and an increase in the proportion of first births to total births, the death-rate from diseases and accidents of childbirth, pregnancy, and the puerperium has fallen to 2-93, and if septic abortion, which is not an obstetric problem, is excluded, the death-rate is 2-50, the lowest rates ever recorded in New Zealand. The death-rate from septic abortion has also fallen slightly. The fall in the maternal death-rate from 2-95 in 1939 to 2-50 in 1940 is due to the reduction in the number of deaths from accidents of labour which include deaths from haemorrhage, embolism, shock, and other accidents of childbirth, and in a reduction in the deaths from puerperal sepsis following childbirth. Table 111 gives in further detail the causes of deaths occurring in 1940, grouped according to the new International Standard of Classification. This method of classification has not been adopted for Table II and the graph, as in the new classification deaths from embolism, thrombosis, puerperal pyelitis, and pyelonephritis not accompanied by puerperal sepsis, previously classified as accidents of labour or toxaemia, are now classified as puerperal infections. To adopt this classification and to include these in puerperal sepsis following childbirth for the graph and Table II would give an incorrect picture of the variations in these causes of death from year to year. Table IV gives the numbers and rates of the maternal deaths of Maoris from 1930 to 1940 grouped as they are for Europeans in Table 11. European and Maori death-rate is 2-67. Owing to the widely-different obstetric standards of the two races, the combined maternal death-rate is of little value except for comparison with other countries having similar conditions.

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