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Infant Deaths
The birth rate in Willesden has shown a further decline to 14 24 per 1,000 population as compared
with the highest post-war rate of 21.94 in 1947, and with the pre-war rate of 16.13 in 1938. The illegitimate
birth rate shows a slight increase (see table 1) to 69.94,per 1,000 registered live births; it has now reached
the high war-time levels, but it is still well below the peak of 1945, when it was almost 1 per cent. of the total
births.
The infant mortality shows an unwelcome rise to 28.53 (see table 2), but for the second time (see
1949 annual report) the illegitimate infant mortality is less than the general infant death rate.
Three-quarters of the infant deaths occur in the first four weeks of life (neo-natal period); the large
reduction in the infant mortality during and since the war has been largely in the age period 1-12 months,
particularly for infections (e.g. the mortality from gastro-enteritis to-day is only one-fifth of the pre-war
rate (see table 3)). The death rate from birth injuries is now greater than before the war, but this is probably
due to more accurate diagnosis rather than to an actual increase in the number of deaths. It is significant
that as a result of improvements in methods of diagnosis, mortality attributed to ' other causes' has been
halved. Apart from birth injuries there have been remarkable falls in the rates for all causes of death,
including the neo-natal period.
With the general reduction in the rates for all causes, the mortality for prematurity, although much
less than before the war, is now responsible for one in four of infant deaths. It thus becomes the most
important single cause of infant deaths to-day. The same conditions which are responsible for premature
deaths probably account for stillbirths as well. Stillbirths also produce a great wastage of life and the rate
has always been higher than 20 per 1,000 in Willesden (see table 2). Emphasis on the saving of infant
lives is therefore shifting to the prevention of stillbirths and prematurity. It is unlikely that the place of
treatment of prematurity, whether in the home or the hospital, has had any appreciable effect on the prognosis
; for although table 5 shows that more deaths generally take place in hospital they are largely due to the
greater severity of the condition of the child. Arrangements have been made for the more severe home
premature births to be admitted to the special premature unit at the Hammersmith Post Graduate Hospital,
and a specially equipped ambulance with trained staff are sent for the baby.
The best way of dealing with prematurity is to prevent it. It is known that there is a very definite
social gradient in respect of prematurity; the death rate from prematurity is twice as great in Social Class V,
the lowest economic group, as in Social Class I.
The fall in prematurity and stillbirths during and since the war is probably due to improvements in
social conditions, particularly in better nutrition following full employment and well-planned rationing. The
different incidence of prematurity in the wards of Willesden can also be accounted for by these factors (see
table 4). It is hoped that the increase in the mortality rate for prematurity (table 5) is not due to a
deterioration in nutrition caused by the higher costs of living and the growth in redundancy.
The comparison of the infant mortality in the wards shows similar differences as in the annual reports
of 1949 and 1950. Three wards show a mortality of over 35 per 1,000, while three show a rate of under 20
per 1,000—the lowest was under 15 per 1,000. If the standards of living in the borough as a whole had
been raised to those of the best ward, it would probably have resulted in a saving of 232 infants and 163
stillbirths during the post-war period 1946-51.