Child-Birth and Mother-Death
THE article in the Spectator of August 31st on " The Health of the People" comes to hand simultaneously with various publications in America bearing upon what is perhaps the most vital feature of the whole general sub- ject. That is, the relationship among the three factors of the birth-rate, the infantile death-rate, and the maternal death-rate. From these it is apparent that Great Britain and America are each confronted by two similar if not identical problems of grave import—to wit, an ominous decline in the birth-rate and a concurrent increase in the number of deaths of mothers in child-birth: Of these the former is so marked in England and Wales, according to Sir George Newman's annual report, as to bring those countries " almost within sight of a stationary popula- tion." It might seem extravagant to say the same of America. Yet statistics are suggestive of a strong ten- dency in that direction. The increase of American popu- lation in the first half of the last century was more than three per cent. a year ; from 1860 to 1890 it was about two and a half per cent. ; from 1890 to 1910 it was about two and one tenth per cent. ; in the next decade it fell to one and one half per cent. ; and it is expected that the census which is to be taken next year will show not more than the latter figures. These statistics include, of course, increase of population through immigration as well as through excess of births over deaths. Unfortunately, the imperfection of the American registration system makes impossible an accurate computation of the birth-rate. But such records as do exist and are accessible indicate unmistakably a serious decline, particularly among the native white stock, and most particularly among the Anglo-Saxon element. The birth-rate for all classes, so far as it is ascertainable, was for each thousand of popula- tion 25.1 in 1915 and only 21.4 in 1925.
The advance of medical, surgical, and sanitary Science has in America, as in Great Britain, materially lessened the rate of infant mortality. But it is also true in America, as in Great Britain, that, as the Spectator reminds us from Sir George Newman's report, this favourable procesS is " accompanied by an increase in the maternal death- rate." And this latter circumstance is causing in America much concern, with far-reaching effects. Of course, the scientific progress which has decreased the infantile death-rate should also have decreased the maternal death-rate, since it largely applies to the conditions and circumstances of child-bearing. Also it is to be observed that in America there has been in recent years an enor- mous increase in the proportion of births which occur in lying-in hospitals and in lying-in wards of general hos- pitals, in circumstances as favourable as possible to the mothers as well as to the infants. Yet it is reported that there has been no decrease in the maternal death-rate, but rather an increase, in the last thirty years. At the present time it is estimated that in the whole United States at least 15,000 women die every year in child- birth, and that 30,000 more are rendered incurable invalids with ailments which prevent further child- bearing and which, in a considerable proportion of cases, soon prove fatal. In fact, for women in America between the ages of fifteen and forty-four years, the danger to life from child-bearing is greater than that from any disease or group of diseases excepting only tuberculosis. Such mortality is greater in America than in any other civilized country, the number of deaths to the thousand being 6.5, while in Great Britain last year it was 4.42 (exceptionally high figures), in Italy 2.7, in the Scandina- vian countries 2.6, and in the Netherlands 2.3.
Now these unfavourable conditions of motherhood have two major results of a most disastrous character. One is, obviously, to incapacitate tens of thousands of women yearly for further child-bearing, an evil the mag- nitude of which may be pretty accurately computed. The other, Which in America at least is widely recognized and is presumptively of great extent, but is not susceptible of statistic al ascertainment, is to deter thousands of women, through fear, from child-bearing or even from marriage, and in many cases to impel them to contraceptive methods of " birth control " which are as mischievous as the com- plications they are designed to prevent. All this ob- viously has a potent influence for the decrease of the birth-rate, and may be reckoned one of the important factors therein.
The general question of the causes of such great maternal mortality, both in Great Britain and in America, must be left for the technical consideration of gynaecologists. But there are two phases of it, in America at least, which are within the ken of every intelligent and reflective layman, and which pertain to sociology and education as well as to physiology and obstetrics. One is the Craze among young women for what they call " boyish figures." This has led to even the most extreme measures of dieting and drug-taking to reduce and limit the weight, and to some extraordinary physical exercises and mechanical appliances to prevent the normal development of hips and bust. The corsets of the early Victorian era, for the contraction of waists to wasp-like slenderness, are more than rivalled by appliances. for contraction of the hipS. The result is that a large proportion of young women, especially in the fashionable ;world, have a pelvic capacity considerably less than normal ; a condition the effects of which upon their ability for safe child-bearing must be apparent.
The other phase of the subject is the too general lack of instruction and physical culture of girls for the pro- spective needs and duties of motherhood. We may not hold to the old rule that women's activities should be con- fined to " kitchen, church, and children." But the very existence and perpetuity of the human race denotes child- bearing to be the most essential and supreme function of the female sex. And seeing that it is so, common sense and humanity dictate an adequate mental and physical preparation for the discharge of that function, in order that it may be achieved with as little pain and with as little peril as possible to health and life. Such preparation, frankly and understandingly imparted, should be an essential and important part of every young woman's education, either at home or at school, or both. Unfortunately, such education has been and is grossly neglected, both at home and at school. A dozen or more years ago a popular Pacifist song in America was, " I Didn't Raise My Boy to Be a Soldier ! " With equal—though perhaps unintentional—truth uncounted American women might to-day declare, " I Didn't Raise My Girl to Be a Mother ! "
There can be no question, then, that one of the very direct and essential means of maintaining the birth-rate at a reasonable and normal figure must be to lessen the perils to health and life which are now increasingly involved in child-bearing, and that this latter achieve- ment is to be in large part effected through the abatement of pernicious fashions and social customs, and through a rational and efficient preparation of young womanhood for those functions which, of all human activities, approximate most closely to the powers of the Divine
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