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An adjustment had been made in order to minimise the disturbing effect of
illegitimate births. In view, however, of the lower fertility and higher age of marriage
among the well-to-do the higher mortality of first confinements makes the figures
at ages 15-25 of doubtful value for purposes of comparison, the Group A figure being
relatively over-stated; the rates for ages 25-45 are more fairly comparable, and
show that the dominating factor in maternal mortality per 1,000 births is not social
condition per se, but the fertility of the women compared.
Some observations on the subject of fertility in relation to social condition will
be found on page 6.
The influence
of economic
factors.
In a supplement to the 44th annual report of the Local Government Board on
Maternal Mortality, the death rates per 1,000 births during 1911-14 in the county
boroughs of England and Wales are tabulated in order of puerperal fever mortality ;
and in " Maternal Mortality " (Reports on Public Health and Medical Subjects,
No. 25, Ministry of Health) similar figures are given by Dr. Janet M. Campbell for
the years 1919-1922. In both periods the county boroughs of Oldham, Bury, Rochdale,
Dewsbury, Blackburn, Barnsley, Blackpool, Bradford, Huddersfield and
Halifax appear in the first thirteen boroughs with highest maternal mortality, while
West Ham, Worcester, Reading, Eastbourne, Bath, Bootle, Portsmouth, Southampton
and Coventry are placed in both periods among the 22 boroughs of lowest mortality.
Forming of these two groups, one, Group A, containing the nine boroughs of consistently
low maternal mortality, and B, the ten boroughs of consistently high
mortality the following contrasts are obtained:—
Death-rate all Fertility Illegitimate births Maternal Mortality
causes. rate. per cent, of total. per 1,000 births.
1912—13 1920—21 1911—14 1919—22 1911—14 1919—22 1911—14 1919—22
Group A 13.1 11.8 20.5 17.1 3.66 4.29 2.94 2.94
Group B 15.2 13.8 16.2 14.7 5.25 6.20 6.41 6.71
In these two groups the maternal mortality rates are shown to follow the general
death-rate and to vary inversely with the fertility. In the following table Group A
comprises metropolitan boroughs with low maternal mortality both in 1911-14
and 1919-22 (Stepney, Shoreditch, Bethnal Green, Greenwich and Bermondsey),
while Group B contains boroughs of high maternal mortality in both periods (Chelsea,
Stoke Newington, Fulham, Kensington, Westminster and Hammersmith):—
Death rate all Fertility Illegitimate births Maternal mortality
causes. rate. per cent, of total. per 1,000 births.
1912 1922 1911—13 1921—23 1911—14 1919—22 1911—14 1919—22
Group A 15.7 15.1 24.2 20.5 2.34 2.67 2.54 2.66
Group B 13.0 13.1 17.4 14.6 5.63 6.71 3.92 4.57
In these two groups the maternal mortality varies inversely with the fertility,
and also inversely with the general death rate.
It is, therefore, concluded that the general environmental conditions which
determine the mortality from all causes are not the specific factor in the maternal
mortality rate per 1,000 births, but that this is dependent upon the relative fertility
of the groups of mothers compared. This conclusion is consistent with that reached
by consideration of the movement of the maternal mortality rate in London in recent
years, see page 13, and with the variation of fertility with age of mother, see
page 16.
With regard to the groups of county boroughs, it will, of course, be apparent