Report of the International Conference on the Perinatal and Infant Mortality Problem of the United States / under the sponsorship of the National Center for Health Statistics, Public Health Service, U.S. Department of Health, Education, and Welfare.

  • United States. Public Health Service.
Date:
1966
Catalogue details

Licence: Public Domain Mark

Credit: Report of the International Conference on the Perinatal and Infant Mortality Problem of the United States / under the sponsorship of the National Center for Health Statistics, Public Health Service, U.S. Department of Health, Education, and Welfare. Source: Wellcome Collection.

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    MAJOR FINDINGS OF THE FOREIGN STUDIES Scotland Dr. Charlotte A. Douglas In Scotland there had been impressive de- clines in maternal, fetal, and infant mortality from 1935 until the early 1950's when the decline in the mortality rates became more gradual. Since then there have been only slight improvements. Dr. Douglas attributed the decline to the compara- tively low birth rate plus the increased avail- ability and utilization of maternity hospitals and maternal and child care. Today, 80 percent of the live births, 90 percent of the fetal deaths, and 90 percent of the premature births are delivered in maternity institutions. The average stay in the hospital is 9 days. Fetal death registration was instituted in 1939, and since then the fetal death rate has de- creased 55 percent. Improvement has been great- est for deaths due to difficult labor, ill-defined conditions, and toxemias, In general, neonatal mortality is the result of intra-uterine conditions and birth hazards. These causes are responsible for 98 percent of first-day deaths, 95 percent of first-week deaths, and 90 percent of first-month deaths. Postneonatal mortality, however, is chiefly caused by respira- tory diseases and congenital abnormalities. Illegitimacy in Scotland is more a social problem than a medical one. Now, the illegitimacy ratio is 5.2 percent of live births. Although these children are a social problem which may persist in following generations, the effect on the overall infant mortality rate is comparatively low. Dr. Douglas placed great emphasis on the re- lationship between social class and fetal and infant mortality. For statistical purposes, the social class of the infant is determined by the father's occupation. There are five defined classes, ranging from professional and man- agerial occupations (class I) to unskilled workers (class V). Although the infant mortality rates in all five classes have declined over the past 30 years, the distinction between classes I and Vhas widened. In 1939, the fetal death rate of class V was 11/4 times ashigh as that of class I; in 1963, itwas about 21/3 times as high as that of class I, Neonatal mortality shows a similar trendinclass distinction. In 1939, class I had a neonatal mortality rate of 25.9 and class V of 39.9, whereas in 1963, class I had a neonatal mortality rate of 9.5 and class V of 22.3. The gap between these two social classes is greatest in the post- neonatal period; and instead of closing, this gap has widened throughout the years, for in 1939, the deaths in class V were 6 times that of class I, whereas in 1963 they were 13 times as great. The Scottish Registrar General's Report for 1943 included an appendix analyzing infant mor- tality and fetal deaths by social class for the year 1939. Another tabulation was published in the report for 1944, and these statistics have been published every year since then. In 1943 Professor Richard Titmuss drew attention to the inequalities in infant mortality rates in the different social classes. His findings were confirmed by Morris and Heady in 1956. In France, similar mortality differentials were found by Croze, andin Hungary by Gzabady. For some time in Aberdeen, Baird, Kincaid, and others have been working on the problem of reproductive efficiency and have established the fact that there is an association between maternal stature and pregnancy outcome. The measure of maternal stature was used as an index of the biological fitness of the mother. They have shown that for each social class, as a general rule, the taller the woman the less likely is she to produce a fetal death or an early neonatal death, This tendency to show a widening difference between the social classes is difficult to under- stand in a country where medical care is available to all and where there is ample maternity hospital accommodation for any woman requiring expert care. It is true that the more intelligent women tend to seek prenatal care earlier in pregnancy than do women who may be careless about their health, and who are also overburdened with heavy household duties and the care of other children. This situation, might be expected to explain to some_- extent the differing mortalities between the classes, since antenatal care, however good, cannot be the whole explana- tion. Itis true that family size with the concomitant extra burdens on the mother can be exhausting,