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47
Infantile Mortality
Infant Mortality of any given locality is measured by relating the
number of deaths of children under one year of age recorded
during the year to the number of live births registered for that
particular area during the same period.
Bad housing, overcrowding, poor sanitation, low standards of
education, illegitimacy, all tend to produce higher infant mortality
rates. It follows therefore that the infant mortality rate should
provide a reasonably accurate indication of the social circumstances
of any particular area. However, 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.
Since the beginning of the century substantial improvements
have been achieved. In 1901 the infant mortality rate for the area
now known as the London Borough of Greenwich was 130 per
1,000 live births, the actual number of children dying before
reaching the age of 1 year being 818. Comparable figures for 1968
are 17.33 and 59 respectively.
However, despite the fact that since 1948 actual infant deaths
have declined from 118 to 59 (a reduction of 50%), neonatal
deaths have not shown a pro rata decrease. Indeed, the reverse is
true. Twenty years ago neonatal deaths formed 67% of all infant
deaths whereas today the figure is 69.5%. When one considers
early neonatal deaths, i.e. those taking place during the first week
of birth, there is a disturbing increase from 54.2% to 67.8%.
Such analyses indicate that even with vastly improved ante
natal services, advances in chemotherapeutics and diagnostic
techniques the refractory core of perinatal deaths remains
essentially unaltered. A glance at the accompanying table of deaths
of infants under 1 year of age will reveal that the majority of the
early neonatal deaths arise from prematurity and congenital
anomalies, an observation which is as relevant today as it was in
1948.
My previous Reports have indicated the relationship existing
between perinatal mortality and age, social class, parity, bad
obstetric history, previous abortions, premature and still births,
postmaturity, etc., and the effects which institutional and domiciliary
maternity and midwifery services have had on its reduction.
However, it is becoming increasingly obvious that methods which