MATERNAL MORTALITY AND BIRTH CONTROL

Ladies' Mirror, Volume 3, Issue 5, 1 November 1924, Page 27

MATERNAL MORTALITY AND BIRTH CONTROL

By E. W. FLINT

From Our Readers (continued)

A NOTE ON THE ARTICLE WHICH APPEARED IN OUR SEPTEMBER ISSUE

I have just read the article on Maternal Mortality which appears in your issue of August. The article is headed “What is Wrong with the Truth?” and the closing paragraphs. emphasise the need for thorough investigation into the causes of this maternal mortality and the necessity for strong measures being taken to improve matters. But does your article tell the truth? It seems to me that one very important aspect of the question was entirely ignored. One factor wnich, perhaps, contributes more to both maternal mortality and child mortality than any other is not mentioned. That factor so prolific in the causation of a high maternal and infantile deathrate is excessive child-bearing, especially among the poorer classes. Nowhere in the article in the Mirror is any mention made of too large families as even a contributing cause in maternal mortality. Is the Mirror, which demands the truth and nothing but the truth in regard to this matter, afraid of the well-known opposition of some Church bodies to any mention of necessity for limiting families to a reasonable number consistent with the wage received by the bread-winner and the opportunities of “outdoor exercise” by the wife ? Dr. Truby King, in his introduction to the article, stressed the necessity for “plenty of outing and exercise during pregnancy and suckling.” In another part he emphasises the necessity for the prospective mother to keep up “her own health and fitness.” What is the use of Dr. King or the Plunket Society giving advice of this sort to women who cannot follow it because of the call upon their time by a fairly large family? Is it not hollow mockery for anyone to offer such advice to a class of women who we know need it most, but who cannot in the very nature of things take that advice? Fancy anyone advising a mother of the working class to have “plenty of outing and exercise” when that woman is tied down with, say, four or five of a family! Your article says “all sections of the community should agree to face essential facts,” and yet the article makes no mention whatever of one of the most essential factors in the problem! Every day, as one travels around, one sees the drudgery, poverty and hopeless struggle of many women to clothe, educate and feed decently large families, while every year or so they are called upon to give birth to another child. If the Plunket Society really wish to see a drop in the maternal mortality, and also the infantile mortality, they must abandon this atti-

tude of silence in regard to limitation of families and advocate the use of preventative measures for women who nave already brought into the world as many mouths as they can do justice to, and which comprise as large a family as they can attend, to and keep their own health. As regards the results of a high birthrate causing a high infantile death-rate, I think the study made by Dr. Alice Hamilton of sixteen hundred (1,600) working-class families is illuminating. Although the table

showing the results of her investigation may be familiar to you (a reading of the article in the August issue of the Mirror would incline one to the belief that ■ it is not familiar to some welfare workers in New Zealand), I will give it below. Deaths per 1,000 births in— Families of 4 children and less . . 118 Families of 6 children . . . . 267 Families of 7 children . . . . 280 Families of 8 children . . . . 291 Families of 9 children . . . . 303 This table shows that the child mortality is two and a half times as great in families of eight as in families of four and under. This is, of course, slightly away from the present discussion, but it serves to show the relation between a high birth-rate and a high infantile death-rate, and who can doubt that the same relation obtains also in regard to the maternal death-rate and large families, though perhaps in lesser degree. An investigation by Arthur Geiseler, and cited by Dr. Alfred Plaetz at the First International Eugenic Congress (London, 1913),

of 26,000 births from unselected marriages, and omitting families having one or two children, shows the following death-rate: — Deaths During First Year. Ist born children . . 23% 2nd Dorn children . . 20% 3rd born children . . 21% 4th born children . . 23% sth born children . . 26% 6th born children . . 29% 7th born children . . 31% Sth born children . . 33% 9th born children . . 36% , 10th born children . . 41% 11th born children .. 51% 12th born children . . 60% ‘ ‘ Thus we see that the second and third children have a very good chance to live through the first year. Children arriving later have less and less chance, until the twelfth has hardly any chance at all to live twelve mouths.” This, of course, does not take into consideration those who die up to the age of five years. One could dilate on this subject at great length, but I have no intention of going as thoroughly into the question here as the problem deserves; rather only to show how closely related is the high birth-rate and the high maternal mortality and infantile death-rate. I am no writer, as can be seen, but one cannot forbear to comment on the article as it appeared in the Mirror. Until those interested in welfare work consent to tackle this problem without evasion, no appreciable improvement will result from their efforts. Whether you care to publish the whole or part of this letter, or to receive it privately, I do not care a great deal. I should certainly like to sec my views placed before your readers, but in all likelihood this will not measure up to the literary standard required for the Mirror. If I have helped to put the other side of the question before you and impressed upon you the necessity for taking a broader view of the whole problem, I will be thankful. I do not underestimate the good work done by the Plunket Society in New Zealand nor doubt that the advice given by both Miss Patrick and Dr. Truby King is good, but I repeat, what is the use of giving advice which it is utterly impossible for those who need it most to follow? The mother of two or three children with a reasonable interval of three or four years between them will be more able to follow the excellent advice given in the Mirror last month than the all-too-common household drudge and childhearing machine so many women are.