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23
Maternal Mortality.
The maternal mortality rate cannot be expressed in a manner
comparable with mortality rates from other causes. The rate
should be expressed as the number of maternal deaths for each
1,000 of the female population exposed to risk, that is to say, per
1,000 pregnancies. Since, however, pregnancy is not notifiable,
and in numerous cases would not be notified even if there were
legal obligation to do so, the maternal mortality rate is expressed
as the number of maternal deaths for each 1,000 live births. The
rate as so expressed is purely arbitrary and is not strictly comparable
with the rate in any other district, as no account is taken of such
material factors as the social conditions. Reference to the
statistics of the Metropolitan Boroughs will show that higher rates
are found where a high proportion of the female population is
residing away from home, at work as domestic servants, shop
assistants, clerks, and the like, and low in the working-class
boroughs.
As in previous years, the Lambeth rate this year depends
largely upon the number of unwanted pregnancies terminating in
abortion. In classifying abortions among the various causes of
death, the Registrar General has three choices. Where the woman
herself brings about the abortion from which she dies the cause
is, classed as suicide. Where the abortion is due to interference by
others the cause is manslaughter. Where there is no evidence
available pointing to active interference either by the woman
herself or by others, then the death is deemed to be due to
maternity. It will be realised from such a classification that much
of the fear of death from ordinary maternity has been misplaced,
and that the phobia fostered in recent years may do as much
harm as good.
There were 15 deaths following pregnancy in 1935, of which 6 were
abortions. Two only of these are classed as maternal deaths, there
being no evidence of criminal interference, while the other four
were held to be due to causes other than maternity. For the
purposes of the maternal mortality rate there were 10 deaths,
giving a rate of 2.61 per 1,000 live births. The average rate for the
past six years is 2.71, compared with an average for England and
Wales of 4.26, which comparison is among others an indication of