H.—3l.

The above table, which is compiled from figures supplied by the Government Statistician, sets out the puerperal-mortality rate for New Zealand classified according to the international classification. For the sake of comparison it is shown from the year 1927-30. Considered as a whole, the table shows an increase of the puerperal-mortality rate which, unless carefully analysed, is apt to be misleading. Analysis shows that a decrease in the death-rate for the four-year period under review occurs in deaths from haemorrhage and accidents of labour, which are down by about 30 per cent. Also in those due to puerperal sepsis following confinement, which have dropped 50 per cent, during that time. The death-rate from septic abortion, on the other hand, has increased by over 100 per cent. Variation in the other deaths from puerperal causes is insignificant. Reference to the table will show that, excluding deaths from septic abortion, the puerperal-mortality rate has fallen from 4-41 to 3-96 per 1,000 live births from 1927-30. The marked fall in the deathrate from puerperal septicaemia following labour and the considerable fall in the from haemorrhage and the accidents of labour may be regarded as satisfactory, though the period is not long enough yet to entitle me to regard the improvement as permanent. I hope it will be. I think, at any rate, it is an indication that we are proceeding along the right lines, and is certainly an encouragement to further combined effort on the part of the medical and nursing professions in co-operation with the Department. The efforts should be directed to further improve and extend the advantages of a sound aseptic technique as applied to obstetrics. Septic Abortion. The marked increase in the death-rate from septic abortion is a cause of great anxiety, for while the deaths from puerperal sepsis following confinements show a satisfactory decline, the deaths from puerperal sepsis following abortion in the same period have doubled. The problem of dealing with this is not a medical one. It is universally conceded that the great majority of deaths from this cause are due to induced abortion. The underlying causes of the increase in this practice are undoubtedly social and economic, as opposed to medical, and in consequence cannot be dealt with by the medical profession or the Health Department alone. However, both may be of assistance in co-operating with societies concerned with women's welfare, and with educational and religious bodies in considering what remedial measures are necessary. That something must be done in this direction is obvious. Action will surely follow when it is known that in 1930 thirty women lost their lives through this cause, and of these thirty, twenty-six were married women. The nature of these cases makes it impossible to get any reliable information of the number of non-fatal cases. There is therefore no means of statistically calculating the risk of this procedure ; that the risk is very serious is practically certain. If we suppose that there was such a large number as even 700 induced abortions causing the deaths of twenty-six married women it means that the risk of this procedure is more than ten times as great as the risks of child-bearing. It is probable that the risk is much greater than that. I hope the knowledge of the great risk attached to induced abortion will restrain many of those who, foi economic or social reasons, or from dread of child-bearing, contemplate resorting to this practice.

Table V. Death-rates per 1,000 Live Births, from Puerperal Toxæmia, Albuminuria, and Eclampsia, in certain Countries, during the Ten Years, 1920-29.

Forceps Eate. The forceps rate for all maternity hospitals for the year 1930 is 8-12 per cent, and for St. Helens Hospitals 3-84 per cent., as compared with 9-29 per cent, and 4-24 per cent, respectively. There can be no doubt that the generally reduced forceps rate is largely due to Dr. Jellett's vigorous campaign against the abuse by a few practitioners of these useful and necessary aids to delivery in abnormal cases. There is no doubt that the reduced forceps rate has been one of the influences in reducing the mortality rate due to puerperal septicemia, and has probably favourably influenced the death-rate from post-partum haemorrhage. Eclampsia. In 1930 the international classification of cases of toxaemia was changed, to include cases of hyperemesis gravidarium. In Tables IV and V these have been excluded from the 1900 figures and the previous classification retained for the sake of uniformity. The puerperal-mortality rates for toxaemia, albuminuria, and eclampsia for the four years shows that the increased work done in the public ante-natal clinics, as shown in Table 111, has not materially affected this cause of maternal deaths, unless it is to prevent increase. It is unsatisfactory and disappointing, and indicates the necessity of very careful inquiry into the reasons for New Zealand, s very high rate under this heading, and into the causes of our failure to reduce it by means of the work of the free ante-natal clinics, co-operating with the medical attendants of the patients, of which a considerable number have been established, 0 as shown in Table 111. In these clinics approximately one-fifth of the women confined in 1930 received some ante-natal care.

34

Country. 1920. 1921. ! 1922. 1923. 1924. 1925. j 1926. 1927. 1928. | 1929. I . '. ! Ho ll an d 046 043 0-39 0-34 England and Wales . . 0-78 0-71 0-71 0-68 0-72 0-70 0-75 0-82 0-84 0-81 Australia .. 0-86 1-04 0-69 140 1-13 1-30 1-22 1-27 | 148 0-84 New Zealand .. :. 1-24 144 1-21 1-22 1-29 1-14 1-12 0-93 140 1-27 Canada .. .. 1-08 1-22 1-27 1-39 1-21 1-32 1-33 1-39