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30
provide a reasonably accurate indication of the social circumstances
of any particular area. However, because approximately
one third of all infants dying in one year will be found to have
been born in the previous year, great care must be exercised when
drawing conclusions from any rise or fall in infant mortality rates,
for such rates are not comparable year by year unless the birth
rates remain more or less constant. Further, it must be borne
in mind that as infant mortality has now reached relatively
small proportions, any slight deviation in the number of deaths
tends to misleading fluctuations in the rate and only a long term
appraisal is likely to reflect the true position.
As reported on numerous occasions in previous Annual
Reports, the refractory core of infant mortality is the perinatal
death, for there are as many deaths in this brief period of life
as will occur during the next 40 years among the survivors.
A recent survey of perinatal mortality instituted by the
National Baby Trust Fund, covered 98 per cent of all births in
England, Scotland and Wales (17,500) which occurred during one
week in March, 1958, and 94 per cent of the 8,000 perinatal deaths
during three months of the same year.
This valuable survey showed that the risk of perinatal deaths
varied geographically from North and West to South and East, as
much as 40 per cent and confirmed that poor physique and standards
of health, increasing maternal age, multiparity and social
class, all exert influences on perinatal mortality; but, having
listed these, it is a far cry from providing suitable remedies.
For instance, there is the equivalent of a 30 year gap between
the infant mortality rates of unskilled workers and the professional
group. This is most unexpected when one considers
that identical social and welfare services are available to all
Social Groups (Groups as defined by the Registrar-General).
Paradoxically, the survey revealed that improvements in living
standards of the lower social groups would appear not to have
had as great an effect as anticipated on the factors concerned
with infant mortality. The latest available figures for England and
Wales showed that the infant mortality rate of Social Group I
was about 19 per thousand compared with 40 for Social Group V.
Investigations have indicated that it is likely that "housing" and
"education" have a greater effect on infant mortality, but that
these are essentially "long term" remedies. In addition, it seems
that surprising differences in attitudes towards the use of available
welfare and medical services exist among the social groups.
(A recent family survey in Newcastle showed that attendances
at welfare centres of families of Class II and III were twice as