View report page

75
calling attention to the high mortality rate of maternal
deaths.
The maternal mortality rate for the country as a whole is
equivalent to about 4 maternal deaths for every 1,000 live
births, and this figure has been fairly constant for more than
20 years. Although there has been some reduction in the
deaths from puerperal septic infection since the passing of
the Midwives Act, 1902, the deaths from other causes and
accidents of childbirth have remained sufficiently numerous
to prevent any lowering of the average total death rate.
The maternal deaths directly due to childbearing, though
greatly to be deplored, represent only one aspect of the
sacrifice of life and health which mothers may be called upon
to make. The numbers, some 3,000 per annum, are relatively
small compared with the total deaths at all ages and from all
causes, but these numbers do not adequately portray the
magnitude of the issue. In the first place these women are
for the most part young and healthy and their loss involves
exceptional domestic distress. Secondly, these deaths are
indicative of an immense burden of suffering and ill-health
among those women who are fortunate enough not to succumb
to causes which prove fatal to others. Such deaths are necessarily
associated with a large number of infant deaths before,
during or shortly after birth, some at least of which might be
prevented.
Since 1900, while the maternal mortality rate has remained
almost stationary the infant mortality rate has fallen with
astonishing rapidity from 154 to 69 (provisional figure for
1923) per 1,000 births. But the fall has occurred almost
entirely subsequent to the first few weeks of life, while the
still-birth rate and the death rate during the first month have
been scarcely affected at all. This neo-natal death rate,
which is intimately bound up with maternal death and injury,
can be substantially reduced only by measures which are also
likely to secure the most efficient practice of midwifery in the
widest sense.
The reduction of this maternal and infant death rate is no
insoluble problem. The number of deaths remains high
mainly because, until recent years, little direct attention has
been paid to this question and because even now no sufficiently
systematic and vigorous measures are taken to prevent
and treat puerperal disease. There must always be certain
risks connected with childbearing, but under favourable
conditions they should be relatively negligible. The mother
should return to normal health and strength after her lyingin
with a healthy baby which she is able to nurse herself.
Unfortunately at the present time many women are left with
some more or less disabling physical injury which causes
ill-health and may lead to difficulty in, or be deterrent to.