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56
The maternal mortality rate is commonly accepted as an index
of the general efficiency of the maternity services. Quite apart
from its utility for this purpose being nullified to an appreciable
extent by the inclusion of such deaths as those from abortion, the
figure is too small as an index. Rates in any one year of anything
from 2 to nearly 7 are possible and normal when the average rate
is 4. Considered another way, three additional deaths in a district
with 3,000 confinements annually will transfer the rate above
instead of below the average. A larger figure which would be
subject to relatively much smaller fluctuations would be a more
accurate index. Although many stillbirths are, in our present state
of knowledge, causeless, or, at least, inexplicable, a large number
are closely related to ante-natal conditions and conditions appertaining
at the confinement. Similarly, although not by any means
all of the neonatal deaths are related to these conditions, such as,
for instance, those dying from gross congenital abnormalities, the
bulk of them are. Analysis of stillbirths and of neonatal deaths
could give for each group those which are subject to the influence
of ante-natal care and attention, and of skilled attention at labour.
Such a figure would then be a more accurate index of the efficiency
of maternity services than that at present used.
INFANT MORTALITY.
The infant mortality rate, by which is expressed the number
of deaths among infants under one year of age per 1,000 born was
44.9 compared with the figure of 59 for the country as a whole
63 for the Great Towns, 66 for London, and local rates of 47.5 and
42.1 for the vears 1934 and 1935.