Preventible Infant Mortality

Kai Tiaki : the journal of the nurses of New Zealand, Volume IX, Issue 3, 1 July 1916, Page 132

Preventible Infant Mortality

Particularly at this time, when the ravages of war are depleting the populations of so many countries, our own included, it is surely of the highest importance that all possible care should be taken to safeguard the lives of all infants and growing children. There is no doubt that this matter is engaging the attention of many far-seeing minds everywhere. We especially, as nurses and midwives, should realise the necessity of saving every possible child, and preserving its health m the best available environment. We have heard protests against the preservation of the " unfit," but m most cases the child who survives -m adverse surroundings prove its "fitness" — the exception always proving the rule. At any rate, the prevalent medical and nursing conscience makes it encumbent to preserve all lives at the risk of possible occasional "unfitness." It is the object of this article to survey, as briefly as possible, what we arc doing m New Zealand to ensure that every baby born under whatever circumstances, will have the best chances of life and health and even to go further, and endeavour to ensure that every child that should be, is born. One is almost aghast at the magnitude of the subject and at one's own temerity m approaching it, yet it must be grappled with, and nurses and midwives should certainly show more than a passing interest m it. Our Editor might be disposed to invite expressions of opinion on the various points raised from readers of the journal who have given these matters thought. Consideration should first be given to the care of expectant mothers, and antinatal hygiene.. The Plunkett nurses do much to guide and assist expectant mothers. Their as T sistance could be much more availed of, to the great advantage of both mothers and infants. We must also note what is being done, and what should be done (a difficult problem about which there is great diversity of opinions) for the unfortunate mothers of illegitimate children. For the sake of these children, if not for their erring mothers, whom some would

push further into the abyss of despair and degradation as a punishment (are these themselves so holy?) they cannot be allowed to drift. With this arises the quesof venereal disease ( unfortunately too common, even among married people), and their effect on abortions which are all too prevalent, and criminals are so difficult to deal with. Better facilities should be offered to induce women, as well as men to seek treatment for these terrible diseases. Workers among unfortunate women lament the difficulties often experienced of getting sufferers into hospital. In days gone by certain of our New Zealand hospitals had lock wards for these cases. A few years ago our Government seemed to be waking to the appallingly wide dissemination of venereal diseases, and the importance of taking active steps to arrest them. Nurses m England and America were also awaking to their serious consideration and endeavouring to devise some practical means of improving the state of affairs. We nurses m New Zealand, on the whole, seem to have shown but slight interest, probably because m our hospital training schools the subject was igiven but slight attention, further than that specific cases were treated as being infectious. However, m the winter of 1910, the Wellington Branch of the T.N.A- were roused to great interest by an absorbing lecture, which few who heard it could ever forget, by Dr Agnes Bennett. We were urged to intelligently use our privilege of the womens' vote when the time comes, and legislation on this question that so greatly affects women and children is brought forward " Hygiene and Mortality," was the title of Dr. Bennett's lecture. She said: "The syphilitic traint is a common cause of abortions and miscarriages, and those that are born alive are liable to be mentally and physically weaklings, or to develop blindness, deafness and mental aberrations at the time of puberty as they are growing up." We have many splendid institutions devoted to the sympathetic care and reformation of erring girls and women, and their infants are m these Homes, and

given the best attention. Such work is most valuable, especially when the girls are admitted some little time before confinement, and made to remain to "mother" their infants for some months afterwards. In most cases the results are good. They are taught to realise their responsibilities as mothers and generally maintain their children themselves, when necessary through the fathers absconding. The good work of some of these institutions is often restricted through lack of funds. St. Mary's Home, Otahuhu. and the Door of Hope, Auckland, are doing invaluable work m this connectionGood midwifery nursing is another large factor m the prevention of infant mortaly, especially when the midwife appreciates her duty m the matter of teaching the mother the right way to feed and manage her child when she takes up the burden herself. Our Midwives' Act was passed m 1904, and began to operate m 1907. Since then the facilities for securing good miclwif ry attention have steadily improved. Private Maternity Hospitals arc licensed only to registered midwives, or where such are resident managers. Country midwives and district nurses are being' more freely provided m country districts, but many more are needed. Until the Infant Life Protection Act was passed, very little was done except: by philanthropic organisations to guard the lives of unfortunate and illegitimate infants. There are many flagrant cases of baby-farming, amounting to child murder, on record. The Act is now rigidly enforced, being administered by the Education Department, and prohibiting any child being boarded out for gain, except m a licensed Home. The Infant Life Inspector visits and enquires into all the circumstances and must be satisfied that any person applying for a license is suitable, and her home clean and fit to ensure the necessary care of the child or children. A record is kept of every boarded-out baby; they are frequently inspected, and each child's health and progress is noted. This is really splendid work, and offers a good field of usefulness for a. trained nurse or midwife, who, if possessed of the apti*tude for social service also, should surely make the best Infant Life Inspec-

tors. Much judgment is needed, and inside knowledge of humanity and social conditions. It is to be hoped that m all future appointments to these positions preference will be given to trained nurses ( ither, or both, general and maternity. The Plunkett Society again takes up its great work m the care of the child. Everyone is familiar with its methods, which aim at teaching and helping the mothers and guardians to carry out the very best methods of child-rearing. Breast feeding and proper " mothering" are first aimed at ; failing these the best substitutes. Many lives have been saved, and puny malnutrition babies developed into robust children under the Plunkett Nurses' treatment. The appalling ignorance of infant feeding is marvellous, and because of this illegitimate children born at Rescue Homes, where they are properly cared for, often have a much better chance of life and health than many born under happier circumstances. The causes of preventible infant mortality might then be briefly summarised thus : — 1. Syphilis. 2. Maternr.l ignorance during pregnancy. 3. Illegitimacy. 4. Inferior midwifery. 5. Malnutrition and insanitation due to unsuitable feeding and defective child management. Against these causes might be placed the remedial measures which have so far been used m New Zealand to counteract them : — 1. Syphilis — The CD. Act amendment which has been to date the subject of serious consideration on the part of our Public Health authorities. (Note the Press report of statement by the Hon. the Minister m to-day's paper — April 29th.) "Very important information on the subject of venereal diseases is contained m a report of a Royal Commission which recently made investigations m Britain, The report has come under the notice of the Minister for Public Health, the Hon. 0. W. Russell, who has sent it to Dr. Valintine, head of the Public Health Department, and asked him to furnish a report as to how far it will be possible m

New Zealand to make use of the results of the investigations m England." "I think this is a matter that should be at once dealt with by the Public Health Department," said Mr Russell, referring to the subject to-day. "The recommendations of the Commission appeal to me m many respects. I note that the Commission has declared that notification is impracticable, and m that opinion I agree. Two methods of dealing with this scourge appear to me to be possible — • that the Government should establish curative stations m the four large centres, or that the work should be done by the hospital boards. Any attempt to resurrect the Contagious Diseases Act would be strongly opposed. I propose to brin-g before Cabinet the question of providing funds necessary to enable a campaign against the plague to be undertaken throughout the country." 2. Maternal ignorance during pregnancy. — (a) The teaching and advice to intending patients by the matrons of the State and other Maternity Hospitals on pre-natal hygiene. (b) The teaching of the Plunkett nurses and properly trained midwives who undertake maternity cases, of prenatal hygiene. 3. Illegitimacy. — The efforts of kindred philanthropic organisations for : — (a) Better guarding of young girls thrown on their own resources and adrift from their homes, or who have never possessed the semblan ce of a home. The Door of Hope, Auckland; the Young Women's Christian Association; the Girls' Friendly Society, all do most excellent work of this kind. The Door of Hope deals chiefly with incorrigible and neglected girls, who are brought before the Courts, but have not actually fallen. Its work is splendidly preventive and the results are good. (b) The "rescue" (?) of fallen women. — In this connection the Salvation Army Homes, St. Mary's (Otahuhu), the Alexandra Home (Wellington), the Linwood Refuge (Christchurch), and others, all do good work.

4. Inferior midwifery. — (a) The Midwives' Act. (b) The Private Hospitals Act. (c) The State maternity and other midwifery training' schools, where poor people and working people can secure the best maternity nursing and care, and the supply of trained midwives is kept igoing for all classes. (d) District nurses and country midwives, who cater for the country and backblock people. 5. Malnutrition and insanitation due to unsuitable feeding and defective child management. — (a) The Infant Life Protection Act. (b) The teaching and example by trained midwives of mothers after confinements m their own homes. (c) The instruction at the State Maternity Hospitals to mothers during convalescence. (d) The teaching given to unfortunate mothers at Rescue Homes, etc. (c) The work and teaching of the Plunkett Nurses. Endeavours have certainly been more or less energetically made to cope with this great national loss, but much remains to be done. Our duty is plainly to assist, m every possible way, any effort to check the great waste of human life- Nay, more, nurses and midwives with the superior knowledge they possess should be m the front ranks to devise ways and means. Let us look round with seeing eyes, and a desire to help. We are all potential mothers — more or less. With regard to the CD. trouble, it may seem an indirect, but it is a very real, cause of infant mortality. We should associate ourselves with organisations which aim at the betterment and upraising of women, and the safe-guarding of children, particularly those of us who cannot take positions where we can intimately teach and do the great work ourselves. Patriotic work appeals to all just now. We all want to serve m a special sense. We cannot all go on active service. We are not required ; but there is much national work to do nevertheless, and close at hand. Lifesaving and health-giving can still be our forte; if they are only tiny lives they

igrow into the men and women who will do our nations work when we have passed on. Some weeks after writing the above, I was interested m seeing m our New Zealand papers several articles which go to prove that other thinking people of this country have also had this large subject m mind, and have more ably portrayed the dangers ; it is for us to find the remedies. Adjutant Holmes, of the Salvation Army, m the course of a striking address on May 21st, to a crowded congregation m the Albert street barracks, Auckland, said: "About 1,000,000 children have been born m Great Britain since the outbreak of war, and of that number 100,000 have already died. These figures are ever more terrible than our casualty lists, for the men who have died on our battle fronts have died for the cause of righteousness and liberty, while these children's lives have igone for nothing. It is humanly certain that for every soldier's grave dug m France we have dug a baby's grave m England. "It is the child's life," said the Adjutant ' ' which is our greatest asset, and if the streets are to be filled with boys and girls we must give serious attention to the problem of infant mortality." He went on to say* — "Infant mortality is reckoned on children who die before reaching the age of one year, but there is also the serious problem of the prenatal death — the death before birth. In England it is estimated that there are about 150,000 pre-natal deaths each year, and m 1915 it was found that the total number of deaths of children under one year was 250,000." He went on to say that although m New Zealand infantile mortality was compar-

atively low as compared with the United Kingdom, we were frequently faced with the fact that more care ought to be taken of the young lives here m the Dominion. Drink, ignorance and bad motherhood were the greatest causes of the loss of so many child lives. Marriage of the physically and mentally unfit was responsible for a vast amount of infantile mortality. It should be recognised that men and women below a certain state of fitness were not justified m introducing feeble and diseased children to the world. The " Auckland Star/ which reported Adjutant Holmes' splendid address, had also a leading article m the issue of May 23rd, headed, "The Essential Child." It begins: — "Amid the clash and clamour of destruction comparatively little attention has been given to the saving of civilian life, yet there never was a time when the subject was so important Out of the baby crop of 1905 we are pretty certain that 280,000 are lost (m Great Britain) and probably at least 30,000 more are deteriorated. One may go ba«k to the babies of 1895 and reflect how many more young recruits the British Army would have to-day if the mortality among children had not been so high. . . . That the wastage is preventable or reducible, has been clearly proved. "There are places where no babies die. There are places m our own country where few babies die. They will to live — these helpless ones — and it is a matter of making the conditions fit for them to live. Where the conditions are right they do live. . . The fact that the New Zealand death rate is the lowest m the world is no reason why it should not be made smaller still." A fact which is seldom realised is that there is as much need for the checking of infantile mortality m some country districts as m the cities.