Besides the forms of work already mentioned, this association lays stress upon the importance of better teaching of obstetrics in our medical schools, upon the extension of maternity hospitals, out-patient obstetrical services, visiting obstetrical nurses, and either the thorough education or gradual abolition of midwives, also pre-natal instruction of expectant mothers. Many mothers lose their health or their lives, and more babies perish or become permanently crippled or blind, as a result of improper management during child-birth.
Why Poverty is Fundamental
The first field study of the Children's Bureau has just been published (1915), and inaugurates a proposed series of studies in infant mortality, to be made in typical American communities. It was undertaken by means of personal interviews with the mothers of all the babies born in the city of Johnstown, Pa., during one calendar year, 1,551 in all, of whom 196 died, or 134 per 1,000 births. The estimated rate throughout the United States is 124 per 1,000 (U. S. Census Report, 1911), which may be compared with a rate of about 261 in Russia, 105 in England, 75 in Australia, and 51 in New Zealand.
Owing to the method of enquiry, and to the absence of a physician upon the staff of the bureau, only family, social, industrial and civic factors were considered in Johnstown, omitting all reference to two important causes of infant mortality—alcoholism and venereal disease. Emphasis is placed upon the economic factor, and it plainly appears from a study of the tables presented, that, whatever the immediate cause of death, the underlying cause in a large majority of cases was that mother of all evils, poverty.
A study of environment shows that the death rate was 271 per 1,000 babies in the poorest sections of the city, or more than five times that in the best residential sections. It was 171 for foreign mothers as against 104 for native mothers. It was 214 for illiterate foreign mothers, or 66 per 1,000 greater than for foreign mothers who could read. The duration of the mother's rest period before and after confinement was found to affect the result, as was also the employment of a midwife instead of a physician. But most of these points depend directly upon the fundamental question of income. The father's earnings were discovered to be the one factor of greatest importance. Babies whose fathers earned ten dollars a week or less died at the rate of 256 per 1,000, while those whose fathers earned $25 or more a week died at the rate of 86 per 1,000. The foreigners, especially the recent arrivals, were generally those who lived in the poorest and most unsanitary quarters, whose women were ignorant and overworked, forced to carry water, to keep lodgers, or to work for wages, and all these misfortunes were commonly due to the lack of a proper living wage for the men.
