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74
INFANT MORTALITY.
The infant mortality rate is the death rate per thousand births of
infants under one year of age. It has been accepted as being a delicate
index of the social or sanitary state of the community. It is customary
to differentiate the rate of mortality of those under one month of age,
the neo-natal mortality rate, from that occurring amongst those up to
the age of twelve months. The former is related more to pre-natal or
natal conditions. On the other hand the latter is dependent more on
environmental conditions, and the very marked fall which has occurred
in the infant mortality rate in this century in this country has mostly
been the result of a decline in the number of deaths in this group.
The fall in the infant mortality rate in the early part of this century
is, for those interested in public health, one of the most dramatic occurrences.
Whereas from 1880 to 1900 there was little improvement in the
rate, from 1900 to 1925 it fell from 154 to 75. Progress since then has
been less rapid, but has been progressive except for set-backs in some of
the war years, and the national figure is now under 50. The fall was
largely co-incident with the growth of the child welfare services, and it is
frequently, though largely erroneously, claimed as the result of the growth
of that service. At one time 40 was accepted as being a probable irreducible
minimum. The rates of 30 and under already attained in some
places have shown there is a much higher standard to be aimed at.
Discounting the years 1940 and 1941, which were those in which the
war conditions exerted their worst influence on the health of the district,
as judged by the vital statistics, the neo-natal rate here for the years
1938-44, has ranged from 20.2 to 22.7. The real reason for these deaths
is very doubtful in many of these cases which are grouped under a variety
of headings, such as injury during birth, prematurity, malformation,
debility, convulsions, etc. Even though the true cause were ascertainable,
so frequently nothing can be done to prevent a similar occurrence in
others. Many infants are born prematurely, in most cases no cause for
the early onset of labour being ascertainable. Amongst those prematurely
born a very high percentage fail to survive. Again, while in some,
fatality following a birth injury points to the need for a higher standard
of obstetrics, in others the infant is sacrificed either to the health or life
of the mother or possibly as a result of a trial of labour. Practically
nothing is known of the reason for developmental abnormalities though
if it should be found there is an undue incidence of children born to mothers
who while pregnant suffered from rubella, it might lead to the discovery
of other causative conditions.
Deaths of infants after the one but under twelve months of age are
much more related to environmental factors, the rate tending to be high
in places where bad housing, overcrowding and defective sanitation
prevail, coupled with maternal ignorance or neglect. Severe climatic
conditions, even spells of harsh weather, can influence the infant mortality
rate by causing deaths of infants in these age groups. The ascribed
cause of death in the majority of these cases is either gastro-enteritis or
some respiratory disease. It is in this group that those deaths are saved
which result in a low infant mortality rate in any district. The following