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Leaving aside, then, the biological point of view, we may reasonably suppose that the fall
in the birth rate is due, in part at least, to the changed economic conditions. The improved general
standard of living has led to what we must regard as a permanent diminishing of the size of families.
It is undesirable, even for the future of the "race," that that standard should be lowered ; and the
object must be to maintain and improve it, so that fluctuations within the new limits of the general
birth rate are avoided, and so that the new maximum number of children may be enlarged. Attainment
of this aim will be greatly helped by any measure which will lessen the expenses of confinement
and childhood. A point which is frequently overlooked is that a confinement involves a capital outlay.
There are many, especially among young married people, who can well afford to support a child, but
who lack the necessary ready money for the actual confinement. The Council can be, and is, of great
assistance in providing inexpensive treatment and arranging facilities for payment by instalments;
and any enlargement of these services is to be welcomed from the point of view of population.
Nor must the psychological effect of measures to make motherhood safe be underrated, and
this safety must be the aim, not only of the maternity services, but also of the medical profession as
a whole. (It should not be forgotten, in this connection, that among the causes of maternal mortality
must be considered the later age of marriage.) Great advances have already been made, both in
pure medical treatment, and in the investigation of the effects of malnutrition and housing conditions.
There is still a wide field for further progress, the general boundaries of which have after many investigations
now been laid down as coming within the sphere of social rather than individual medicine.
As instances may be mentioned the establishment of municipal midwives and the rapid increase in
institutional confinements (in London now two-thirds of all confinements).
It seems, therefore, that we must resign ourselves to a permanent change in the structure of
the population, and a permanently lowered birth rate. Much can be done, however, to maintain the
rate at the highest point possible within the new low general standard. The local authority can
help in that maintenance by the continuance and, if possible, the extension of the facilities for inexpensive
maternity treatment and by a continued investigation of and attack upon the causes of maternal
mortality. Public Health work proper, therefore, links up here with the larger national—indeed,
international—problem of population, without any extension of its legitimate scope; and it is
probably in this local and domestic fashion that the problem will best be solved.