Report of the International Conference on the Perinatal and Infant Mortality Problem of the United States / under the sponsorship of the National Center for Health Statistics, Public Health Service, U.S. Department of Health, Education, and Welfare.

  • United States. Public Health Service.
Date:
1966
Catalogue details

Licence: Public Domain Mark

Credit: Report of the International Conference on the Perinatal and Infant Mortality Problem of the United States / under the sponsorship of the National Center for Health Statistics, Public Health Service, U.S. Department of Health, Education, and Welfare. Source: Wellcome Collection.

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    Should the pregnancies be too rapid, depletion of the mother's reserves of iron may lead to about 11 percent of the women inthis country now have more than four children, and the average family size is only 2.5 children. So, some further explanation must be sought. It would appear that the woman's growth is influenced not only by heredity but also by nutrition, housing, economic conditions, and the way of life of her parents. It has been found that there is a relationship between the number of siblings in the mother's parental house and her future reproductive capacity. In nonmanual workers there is an increase in perinatal mortality only when the mother was one of five or more children; while in the unskilled classes there is an increase when the mother had only one sibling. These facts appear to lead to the generaliza- tion that the smaller the family the better will be the education and upbringing of the future mother. There is also a continual process of social selec- tion and the usual tendency is for the average woman to rise out of her social class or remain within it. In this way, as the women with better reproductive potentialities move upwards, those remaining in classes IV and V are biologically and physically less able to produce and rear children successfully. Probably as these lower classes lose more and more women who are reproductively efficient, the perinatal and infant mortality rates will remain above the average. England and Wales Dr. Katherine M. Hirst In England and Wales the total infant mortality has declined through the years, but it began to level off during the 1950's as did that of the United States. Perinatal mortality began to level off at the end of the 1940's; but in the midfifties fetal mortality began to fall again, while first- day mortality remained stationary. Postneonatal mortality appeared to start rising in the midfifties. Three main causes of death were discussed— infections, diseases of early infancy, and congen- ital malformations. Infant mortality from infec- tions has decreased steadily since 1935. While, in general, deaths from infective conditions continued to lessen during the 1950's, deaths from pneumonia and bronchitis and from gastro- enteritis stopped declining and began to level off around 1957. Diseases of early infancy, which include immaturity, birth injuries, and asphyxia and atelectasis, are responsible for 75 percent of first-day mortality. In this cause group, im- maturity appears to be a strong factor in neonatal deaths, as half of the deaths ascribed to birth injuries and two-thirds of those ascribed to asphyxia are associated with immaturity. There has been no decline in first-day deaths (mainly caused by diseases of early infancy) since 1950. There has been virtually no change in the mortality rate for congenital malformations dur- ing the fifties. Low-birth-weight babies constitute one of the important high-risk components of infant mor- tality. In England and Wales the proportion of babies weighing 2,500 grams or less at birth is about 6.6 percent ofall live births. This percentage has remained unaltered for the past 10 years. Also, the proportion of babies weighing 1,500 grams or less at birth has remained at 11 percent of the total of low-birth-weight babies for the past 10 years. Neonatal mortality of low-birth-weight babies has decreased from 155 neonatal deaths per 1,000 ‘live births of 2,500 grams or less in 1953 to 128 in 1963; however, mortality of infants under 24 hours old has remained almost at a standstill. There are geographical factors in infant and perinatal mortality in England and Wales, in that there is a southeast to northwest gradient with the lower fetal and infant mortality rates in the southeast. However, the gap is gradually closing. The urban and rural areas both show this south- east to northwest gradient. As in Scotland, there isa fairly steep gradient from socioeconomic class I to socioeconomic class V which does not seem to be narrowing. Despite the fact that the gap between the incomes within these classes has been decreasing, the differences in the infant mortality rates between classes I and V have increased slightly. Dr. Hirst pointed out that one reason for the widening disparity is that cultural customs of a group do not necessarily change as rapidly as do economic Situations. One of the most important steps in lowering infant mortality is the acceptance of new ideas, such as receiving antenatal care early in pregnancy or being hospitalized for birth;