The Case for Birth Control: A Supplementary Brief and Statement of Facts

by Margaret Sanger

ECONOMIC FACTORS

EARNINGS OF FATHER

A grouping of babies according to the income of the father shows the greatest incidence of infant deaths where wages are lowest, and the smallest incidence where they are highest, indicating clearly the relation between low wages and ill health and infant deaths.

For all live babies born in wedlock the infant mortality rate is 130.7. It rises to 255.7 when the father earns less than $521 a year or less than $10 a week, and falls to 84 when he earns $1,200 or more or if his earnings are “ample.”[^[30]] The variation in the infant mortality rate from one earnings group to another is not perfectly regular and consistent, but if any two or more consecutive groups are combined an invariable lowering of the infant mortality rate from one such combined group to that next higher results.

[30]. “Ample” as used in this report has a somewhat arbitrary meaning. When information concerning the father’s earnings was not available and the family showed no evidences of actual poverty, the word “ample” was used. If no information concerning earnings was available when, on the other hand, the family was clearly in a state of abject poverty, then the income was tabulated as “Under $521.”

Table 30.—Distribution of Live Births and of Deaths During First Year, and Infant Mortality Rate, According to Annual Earnings of Father and Nativity of Mother, for Legitimate Live-Born Babies.
ANNUAL EARNINGS OF FATHER ACCORDING TO NATIVITY OF WIFE.	Total live births.	Deaths during first year.	Infant mortality rate.
Total	1,431	187	130.7
Under $625	384	82	213.5
Under $521	219	56	255.7
$521 to $624	165	26	157.6
$625 to $899	385	47	122.1
$625 to $779	224	24	107.1
$780 to $899	161	23	142.9
$900 or more	186	18	96.8
$900 to $1,199	138	14	101.4
$1,200 or more	48	4	83.3
Ample[[1]]	476	40	84.0
Husbands with native wives	785	76	96.8
Under $625	80	16	200.0
Under $521	32	9	([[31]])
$521 to $624	48	7	145.8
$625 to $899	193	20	103.6
$625 to $779	86	6	69.8
$780 to $899	107	14	130.8
$900 or more	129	10	77.5
$900 to $1,199	92	7	76.1
$1,200 of more	37	3	([[31]])
Ample[[1]]	383	30	78.3
Husbands with foreign wives	646	111	171.8
Under $625	304	66	217.1
Under $521	187	47	251.3
$521 to $624	117	19	162.4
$625 to $899	192	27	140.6
$625 to $779	138	18	130.4
$780 to $899	54	9	166.7
$900 or more	57	8	140.6
$900 to $1,199	46	7	152.2
$1,200 or more	11	1	([[31]])
Ample[[32]]	93	10	107.5

[31]. Total live births less than 50; base therefore considered too small to use in computing an infant mortality rate.

[32]. See note on page [45].

In considering the babies of native and of foreign mothers separately in the foregoing table, similar variations in mortality rates according to earnings of father are found, although the foreign infant death rate is higher in each group. The foreign are less numerous both actually and relatively in the higher wage groups.

The foreigners of a given wage group almost always live in a poorer neighborhood than the natives earning the same amount. The foreigners go where they find their own countrymen, most of whom are poor, and hence even those who earn a fair wage find themselves, until they become Americanized, surrounded by poor conditions and an ignorant class of people.

It is of interest to note what per cent. of the native and what per cent. of the foreign are in the several earnings groups. The next table shows this for all married mothers and not simply for those of live-born babies as in the foregoing table.

Table 31.—Number and Per Cent of Mothers by Nativity, According to the Annual Earnings of Husband.
ANNUAL EARNING OF HUSBAND.	ALL MOTHERS.		NATIVE MOTHERS.		FOREIGN MOTHERS.
	Number.	Per cent.	Number.	Per cent.	Number.	Per cent.
Total	1,491	100.0	816	100.0	675	100.0
Under $521	233	15.6	36	4.4	197	29.2
$521 to $624	174	11.7	50	6.1	124	18.4
$625 to $779	229	15.4	86	10.5	143	21.2
$780 to $899	166	11.1	108	13.2	58	8.6
$900 to $1,199	146	9.8	98	12.0	48	7.1
$1,200 and over	50	3.4	39	4.8	11	1.6
Ample[[33]]	493	33.1	399	48.9	94	13.9

[33]. See note on page [45].

The 1,491 married mothers included in the foregoing table bore 1,517 babies in 1911, the excess being due to plural births. The 33 unmarried mothers and their 34 babies (one mother had twins), although included in some of the general tables, are not included in those relative to the earnings of the husband.

GAINFUL WORK OF MOTHER

In localities where large numbers of women are engaged in industrial work, comparisons are frequently made of the death rates among their babies with those of the babies of mothers not so engaged. In Johnstown, however, industrial occupations are not open to women, and but 3.1 per cent. of the mothers visited went outside their homes to earn money. All mothers who gained money by keeping lodgers or in any other way are, for convenience, designated “wage-earning” mothers, even though their earnings were not in the form of a definite wage at stated periods.

Although not industrially engaged, nearly one-fifth of the mothers did resort to some means of supplementing the earnings of their husbands. Usually they kept lodgers. This was done by the foreign mothers principally, exactly one-third of whom had lodgers, as compared with less than 1 per cent. of the native women. Usually work done outside the home consisted either of char work or of assisting husbands in their stores. Generally these stores were in the same building with the home.

When a mother of a young baby does not give her full time to her duties within the home but resorts to means of earning money, it generally indicates poverty. This is true to a greater degree in Johnstown than in places which have many inducements for women to work. In Johnstown, with its excess of males, especially in the foreign population, the woman’s services are particularly needed to make the home.

In the group where the husband earns $10 a week or less—that is, under $521 a year—many of the women are wage earners. In each group showing better earnings for the husband the number and percentage of wage-earning wives decline. Such a tabulation as the following almost automatically fixes the minimum wage on which a man, wife, and a child or two can live with any degree of comfort in Johnstown at about $780 a year. When the husband’s wage is less than $780 a year, it is shown that the wives, in considerable number, must be wage earners. As shown in the next table, in nearly half of the families where the husband earns $10 a week or less (less than $521 a year), the wife resorted to some means of earning money; when he earned as much as $900 a year, only 8.9 per cent. of the wives worked, and in the small group where the man earns as much as $1,200 a year, only 1 in 50.

Table 32.—Number and Per Cent of Husbands with Wage-Earning Wives, by Nativity of Wife and Annual Earnings of Husband.
ANNUAL EARNINGS OF HUSBAND.	TOTAL HUSBANDS.			HUSBANDS HAVING NATIVE WIVES.			HUSBANDS HAVING FOREIGN WIVES.
	Number.	Husbands with wage-earning wives.		Number.	Husbands with wage-earning wives.		Number.	Husbands with wage-earning wives.
		Number.	Per cent.		Number.	Per cent.		Number.	Per cent.
Total	1,491	278	18.6	816	26	3.2	675	252	37.3
Under $521	233	111	47.6	36	9	25.0	197	102	51.8
$521 to $624	174	57	32.8	50	3	6.0	124	54	43.5
$625 to $779	229	51	22.3	86	4	4.7	143	47	32.9
$780 to $899	166	25	15.1	108	6	5.6	58	19	32.8
$900 to $1,199	146	13	8.9	98	1	1.0	48	12	25.0
$1,200 and over	50	1	2.0	39			11	1	9.1
“Ample”[[34]]	493	20	4.1	399	3	.8	94	17	18.1

[34]. See note on page [45].

It is impossible to judge from statistics alone whether or not the work done by an individual woman, either her own housework or work for money, is so excessive as to affect her during pregnancy or while nursing to the extent of reacting on the health of the baby; but the fact is that the infant mortality rate is higher among the babies of wage-earning mothers than among others, being 188 as compared with a rate of 117.6 among the babies of nonwage-earning mothers. Wage-earning mothers and low-wage fathers are in practically the same groups, and it is difficult to secure an exact measurement of the comparative weight of the two factors in the production of a high infant mortality rate.

Table 33.—Distribution of Live Births and of Deaths During First Year, and Infant Mortality Rate for Babies of Wage-earning and Nonwage-earning Mothers, According to Annual Earnings of Father.
ANNUAL EARNINGS OF FATHER.	MOTHER A WAGE EARNER.		MOTHER NOT A WAGE EARNER.		INFANT MORTALITY RATE.
	Live births.	Number of deaths in first year.	Live births.	Number of deaths in first year.	Mother a wage earner.	Mother not a wage earner.
Total	266	50	1,165	137	188.0	117.6
Under $521	105	26	114	30	247.6	263.2
$521 to $624	53	8	112	18	150.9	160.7
$625 to $779	48	6	176	18	127.1	102.3
$780 or over, or “ample”[[35]]	60	10	763	71	166.7	93.1

[35]. See note on page [45].

ILLEGITIMACY

Of the 1,551 birth included in this investigation 34, or 2.2 per cent., occurred out of wedlock. Nine of the 32 illegitimate babies who were born alive died during their first year. It is recognized that these figures are a very small base from which to draw conclusions concerning the effect of illegitimacy on the infant mortality rate. It is of interest, nevertheless, to note that the findings for this small group are similar to those of countries which compute an infant mortality rate for legitimate and illegitimate children separately, that is, a rate for illegitimates more than twice as high as for children born in wedlock.

Table 34.—Distribution of Births and of Deaths During First Year, and Infant Mortality Rate, According to Legitimacy.
LEGITIMACY.	Total births.	Live births.	DEATHS DURING FIRST YEAR.
			Number.	Infant mortality rates.
Illegitimate	34	32	9	281.3
Legitimate	1,517	1,431	187	130.7

Thirty-two, or 3.7 per cent., of the 860 native mothers, as compared with 2, or 0.3 per cent., of the 691 foreign mothers visited, had illegitimate children in 1911.

REPRODUCTIVE HISTORIES

In addition to the data relating exclusively to babies born in 1911, a statement was secured from each mother as to the number and duration of each of her pregnancies and the result thereof; that is, the number of children she had borne, alive or dead, the number of miscarriages she had had, and the age at death of each live-born child who had died. Although this information was secured for all mothers, tabulations are presented of the data furnished by married mothers only. Comparatively few single mothers reported more than one child, and information from them on this point is not believed to be as reliable as that from married mothers.

The 1,491 married mothers of babies born in 1911 had had an aggregate of 5,554 pregnancies, resulting in 5,617 births, the excess of 63 births over pregnancies being due to plural births. Eight hundred and four of these children died under 1 year of age, making an infant mortality rate of 149.9 for all their babies, as compared with the rate of 134 for those born in 1911. The stillbirths of these women numbered 194, or 4.5 per cent. of the total number of births; miscarriages reported numbered 191, but these were not added to the total reportable[^[36]] pregnancies.

[36]. “Reportable” pregnancies are those terminating either in the birth of a live child or of a dead child when the period of gestation exceeds 28 weeks; that is, when its registration or report is required by law.

Details as to the infant mortality rates for all babies born to native and foreign mothers included in this study, not only in the year 1911 but at any other time, are presented in the next table, which classifies the babies according to the total number of reportable pregnancies that their mothers had had, to and including the pregnancy resulting in the 1911 birth.

Table 35.—Distribution of Mothers, of Live Births, and of Deaths During First Year, and Infant Mortality Rate for Babies of Native and Foreign Married Mothers, According to the Number of Reportable Pregnancies.
REPORTABLE PREGNANCIES FOR MARRIED MOTHERS.	Number of married mothers.	NUMBER OF BABIES.		INFANT MORTALITY RATE AMONG BABIES OF—
		Born alive.	Died in first year.	All mothers.	Native mothers.	Foreign mothers.
Total	1,491	5,363	804	149.9	113.1	184.6
1	339	322	35	108.7	75.9	183.7
2	283	544	59	108.5	76.5	156.7
3	214	626	92	147.0	118.0	177.6
4	186	723	78	107.9	99.4	116.3
5	147	704	103	146.3	86.1	191.5
6	94	546	88	161.2	157.4	163.6
7	83	555	78	140.5	100.0	173.8
8	54	426	95	223.0	157.6	272.7
9	33	283	41	144.9	128.4	155.2
10 or more	58	634	135	212.9	164.5	257.6

The statistics, based upon the results of all her reportable pregnancies, show a generally higher infant mortality rate where the mother has had many pregnancies, but there is not always an increase from one pregnancy to the next. This is more clearly shown when the pregnancies are grouped as in the next table.

Table 36.—Infant Mortality Rate for all Children Borne by Married Mothers, According to Specified Number of Reportable Pregnancies.
REPORTABLE PREGNANCIES FOR MARRIED MOTHERS.	Infant mortality rate.
Total	149.9
1 and 2	108.5
3 and 4	126.0
5 and 6	152.8
7 and 8	176.4
9 or more	191.9

This tendency is shown in still another form of summary: Combinations of four or less pregnancies are, for convenience, considered as group 1, while the combinations of over four are designated group 2. The differences in rates in the two groups are notable. The infant mortality rate is much lower for the first than for the second group.

Table 37.—Infant Mortality Rate for All Children Borne by Married Mothers, According to Specified Number of Reportable Pregnancies, by Groups
REPORTABLE PREGNANCIES FOR MARRIED MOTHERS.	Infant mortality rate.
GROUP 1.
2 or less	108.5
3 or less	124.7
4 or less	119.2
GROUP 2.
Over 4	171.5
Over 5	178.8
Over 6	183.9

This influence of the size of the family upon the infant mortality rate is shown in the computations giving the relative infant mortality rate for the different children borne by married mothers. The rate is most favorable for the second-born child, being 131.2. Among first born it is 143.6; for tenth or later born children 252.3.

Table 38.—Infant Mortality Rate for All Children Borne by Married Mothers, According to the Order in which the Child was Born
ORDER OF BIRTH.	Infant mortality rate.
First-born child	143.6
Second-born child	131.2
First and second born children	138.3
Third-born child	144.2
Fourth-born child	142.0
Third and fourth born children	143.2
Fifth-born child	178.1
Sixth-born child	175.5
Fifth and sixth born children	177.0
Seventh-born child	192.1
Eighth-born child	165.4
Seventh and eighth born children.	181.5
Ninth-born child	128.2
Tenth or later born child	252.3
Ninth and later born children	201.1

The next table gives a further elaboration of the same data; that is, it shows the infant mortality rate where such rates are lowest and highest, respectively, according to the age of the mother at the child’s birth and the order in which the child was born. Attention is again directed to the fact that the statistics presented in this section on “Reproductive histories” are based upon the total number of reportable pregnancies; that is, in addition to the pregnancies resulting in births in 1911, all prior pregnancies of the women considered in the investigation have been included.

Table 39.—Lowest and Highest Infant Mortality Rates, According to Age of Mother at Birth of Child and the Order in which Child was Born.
ORDER OF BIRTH.	INFANT MORTALITY RATES, ACCORDING TO MOTHER’S AGE.
	Lowest mortality.		Highest mortality.
	Mother’s age.	Mortality rate.	Mother’s age.	Mortality rate.
All children	20–24	140.0	Under 17	367.3
First child	25–29	92.1	17–19	190.4
Second child	25–29	100.3	17–19	178.6
Third child	30–39	106.4	25–29	160.8
Fourth child	30–39	122.4	20–24	155.0
Fifth child	30–39	105.8	25–29	236.6
Sixth child	30–39	164.8	25–29	171.4

The difference in size of family for native and foreign mothers of different ages are indicated in the next table. The total and average number of live-born children, not reportable pregnancies, are given.

Table 40.—Total and Average Number of Live-Born Children Borne by Married Mothers Having Either a Live Birth or a Stillbirth in 1911, Classified by Nativity and Age of Mother.
AGE OF MOTHER AT BIRTH OF CHILD IN 1911.	ALL MARRIED MOTHERS.			NATIVE MARRIED MOTHERS.			FOREIGN MARRIED MOTHERS.
	Total.	Live-born children.		Total.	Live-born children.		Total.	Live-born children.
		Number.	Average.		Number.	Average.		Number.	Average.
All ages	1,465	5,363	3.7	801	2,600	3.2	664	2,763	4.2
Under 20 years	81	96	1.2	62	70	1.1	19	26	1.4
20 to 24 years	456	908	2.0	258	483	1.9	198	425	2.1
25 to 29 years	389	1,261	3.2	196	536	2.7	193	725	3.8
30 to 39 years	459	2,480	5.4	240	1,188	5.0	219	1,292	5.9
40 years and over.	80	618	7.7	45	323	7.2	35	295	8.4

The next table shows all losses of pregnancy sustained by 628 mothers and the rate of loss per 1,000 births for mothers having different numbers of births or reportable pregnancies. For all mothers it was 188.4. “Loss,” as here used, means the sum of infant deaths (or deaths in first year) and stillbirths.

Table 41.—Aggregate Number of Births, Losses, and Rate of Loss Per 1,000 Births, According to Number of Births per Mother.
NUMBER OF BIRTHS PER MOTHER.	Aggregate number of births.	Aggregate number of losses.	Rate of loss per 1,000 births.
Total	5,617	1,058	188.4
1	335	53	158.6
2	554	87	157.0
3	648	113	174.4
4	748	109	145.7
5	740	133	179.7
6	576	119	206.6
7	574	104	181.2
8	432	102	236.1
9	324	65	200.6
10 or more	686	173	252.2

The influence of the economic factor on infant mortality among the babies born prior to 1911 can not be determined with exactness, as no inquiry was made concerning earnings of the father when the other children were born. But it is believed that his earnings during the year following the birth of the 1911 baby can be regarded as an index of the economic standing of the family for some time past. In individual cases, of course, revolutionary changes in the family’s income may have occurred, but for the great mass of people in the group considered it is not likely that within such a short space of time as that covered by the child-bearing period of the women considered—most of whom had not had numerous pregnancies—marked changes had taken place. If these known earnings are accepted as an index, the following variations are found to occur in the infant mortality rate for all the babies of whom a record was secured:

Table 42.—Infant Mortality Rate for all Children of Married Mothers Included in this Investigation, Distributed According to the Father’s Earnings.
FATHER’S ANNUAL EARNINGS.	Infant mortality rate.
Under $521	197.3
$521 to $624	193.1
$625 to $779	163.1
$780 to $899	168.4
$900 to $1,199	142.2
$1,200 and over	102.2

The infant mortality rate for the babies whose fathers earn under $521 is almost twice as great as for those born into families in the most prosperous group. These figures strengthen the conclusion reached in the study of the babies born in 1911, namely that the economic factor is of far-reaching importance in determining the baby’s chance of life.

Table V.—Distribution of Live Births and of Deaths During First Year, According to Number of Persons and Number of Rooms per Family.
PERSONS PER FAMILY (NOT INCLUDING BABY).		All live born babies.	NUMBER OF BABIES WHO WERE BORN ALIVE AND NUMBER OF SUCH BABIES WHO DIED DURING FIRST YEAR IN HOMES HAVING—
			1 room	2 rooms	3 rooms	4 rooms	5 rooms	6 rooms	7 rooms	8 rooms	9 rooms	10 rooms and over.	Unknown number of rooms.
	{Births	1,463	33	165	147	526	222	233	38	43	22	12	22
Total	{Deaths	196	3	29	24	79	20	20	6	6	4	2	3
	{Births	24	3	7	4	6	2						2
2	{Deaths	19	1	5	4	6	1						2
	{Births	275	14	46	35	96	29	37	4	6	1		7
3	{Deaths	31		5	4	12	2	3	3	2
	{Births	234	7	44	20	83	40	23	4	5	2	2	4
4	{Deaths	30	1	12	5	9	2					1
	{Births	229		27	24	88	31	43	4	5	1	1	5
5	{Deaths	22		1	6	9	1	4		1
	{Births	182	2	21	17	56	37	34	5	7	2		1
6	{Deaths	18		4		8	2	3		1
	{Births	164	2	10	20	50	32	30	9	6	3	1	1
7	{Deaths	15		1	2	6	1	3	1		1
	{Births	107	2	5	14	37	16	18	4	6	2	3
8	{Deaths	17			2	6	3	1	2	1	1	1
	{Births	79	2	2	6	27	13	13	6	2	4	4
9	{Deaths	8	1			2	2	1			2
	{Births	58	1	1	2	26	7	15	1	1	3		1
10	{Deaths	15			1	11	2	1
	{Births	36		1	1	16	3	10		3	2
11	{Deaths	4		1		1	1	1
	{Births	21		1	1	10	2	6		1
12	{Deaths	5				2	1	1		1
	{Births	20			1	13	4			1	1
13	{Deaths	4				3	1
	{Births	8			1	5	2
14	{Deaths	2				1	1
	{Births	6				3	2						1
15	{Deaths	1											1
	{Births	4				4
16	{Deaths	2				2
	{Births	3				1		1		1
17	{Deaths
	{Births	5			1	1		1	1		1
18	{Deaths	1				1
	{Births	2				2
19	{Deaths
	{Births	3				1	1	1
20	{Deaths	1						1
	{Births	1						1
22	{Deaths	1						1
	{Births	1				1
23	{Deaths
Not	{Births	1					1
reported.	{Deaths

Table VIII.—Distribution of Deaths of Infants at Specified Age, According to Cause of Death of Infant and Nativity of Mother.
CAUSE OF DEATH OF INFANT AND NATIVITY OF MOTHER.	Total deaths under 1 year of age.	AGE AT DEATH.
		Less than 1 week.				1 week but less than 1 month.				1 month but less than 1 year.
		Total.	1 day or less.	2 days.	3 to 6 days.	Total.	1 week but less than 2.	2 weeks but less than 3.	3 weeks but less than 1 month.	Total.	1 month but less than 2.	2 months but less than 3.	3 months but less than 6.	6 months but less than 9.	9 months and over.
All causes	196	45	30	4	11	29	14	7	8	122	18	16	42	31	15
Native mothers	85	25	18	3	4	9	2	1	6	51	9	7	18	12	5
Foreign mothers	111	20	12	1	7	20	12	6	2	71	9	9	24	19	10
Diarrhea and enteritis	52	1			1	5		3	2	46	5	4	17	15	5
Native mothers	17	1			1					16	3	1	5	5	2
Foreign mothers	35					5		3	2	30	2	3	12	10	3
Respiratory diseases	50					3	3			47	7	4	15	13	8
Native mothers	19									19	2	2	8	5	2
Foreign mothers	31					3	3			28	5	2	7	8	6
Premature births	24	21	19		2	3	3
Native mothers	11	11	11
Foreign mothers	13	10	8		2	3	3
Congenital debility or malformation	19	10	7	1	2	6	2	3	1	3	1	2
Native mothers	5	4	3		1	1			1
Foreign mothers	14	6	4	1	1	5	2	3		3	1	2
Injuries at birth	7	7	3	2	2
Native mothers	6	6	3	2	1
Foreign mothers	1	1			1
Other or not reported	44	6	1	1	4	12	6	1	5	26	5	6	10	3	2
Native mothers	27	3	1	1	1	8	2	1	5	16	4	4	5	2	1
Foreign mothers	17	3			3	4	4			10	1	2	5	1	1

Table X.—Distribution of Births to Married Wage-earning Mothers, According to Husband’s Annual Earnings and Nativity and Earnings of Mother.
NATIVITY AND ANNUAL EARNINGS OF MARRIED MOTHER.	Total births.	BIRTHS TO MARRIED WAGE-EARNING MOTHER WITH HUSBAND EARNING ANNUALLY—
		Under $521.	$521 to $624.	$625 to $779.	$780 to $899.	$900 to $1,199.	$1,200 and over.	Ample.[[37]]
All wage-earning mothers	281	112	57	51	25	14	1	21
Under $53	20	6	5	1	4	1	—	3
$53 to $103	57	23	12	11	7	3	—	1
$104 to $207	89	46	16	19	3	3	—	2
$208 to $311	60	23	16	12	4	3	1	1
$312 and over	46	14	8	8	7	2	—	7
Not reported	9	—	—	—	—	—	2	7
Native wage-earning mothers	26	9	3	4	6	1	—	3
Under $53	6	2	1	—	2	1	—	—
$53 to $103	5	2	1	2	—	—	—	—
$104 to $207	5	1	1	2	1	—	—	—
$208 to $311	4	3	—	—	1	—	—	—
$312 and over	3	1	—	—	2	—	—	—
Not reported	3	—	—	—	—	—	—	3
Foreign wage-earning mothers	255	103	54	47	19	13	1	18
Under $53	14	4	4	1	2	—	—	3
$53 to $103	52	21	11	9	7	3	—	1
$104 to $207	84	45	15	17	2	3	—	2
$208 to $311	56	20	16	12	3	3	1	1
$312 and over	43	13	8	8	5	2	—	7
Not reported	6	—	—	—	—	2	—	4

[37]. See note on page [45].

Table XI.—Distribution of Results of Reportable Pregnancies (Live Births and Stillbirths) and Miscarriages, According to Number per Mother and Nativity of Mother.
NUMBER OF REPORTABLE PREGNANCIES PER MOTHER AND NATIVITY OF MOTHER.	REPORTABLE PREGNANCIES AND RESULTS THEREOF.												MISCARRIAGES IN ADDITION TO REPORTABLE PREGNANCIES.
	Total pregnancies.	Total births.	Excess due to plural births.	Number of mothers.	Live births.					Stillbirths.			Number of miscarriages reported.	Number of mothers reporting miscarriages.
					Number.	Number of mothers having live births.	Deaths in first year.			Number of still-births.	Number of mothers having still-births.	Per cent. of all births.		Total mothers.	Per cent. of all mothers.
							Number.	Number of mothers having babies die.	Infant mortality rate.
All married mothers	5,554	5,617	63	1,491	5,363	1,465	804	509	149.9	254	194	4.5	191	130	8.7
1	339	343	4	339	322	318	35	34	108.7	21	21	6.1	8	8	2.4
2	566	576	10	283	544	279	59	54	108.5	32	28	5.6	23	16	5.7
3	642	650	8	214	626	214	92	75	147.0	24	23	3.7	26	18	8.4
4	744	752	8	186	723	180	78	64	107.9	29	21	3.9	22	18	9.7
5	735	740	5	147	704	147	103	67	146.3	36	31	4.9	20	14	9.5
6	564	568	4	94	546	93	88	60	161.2	22	13	3.9	23	14	14.9
7	581	586	5	83	555	83	78	48	140.5	31	22	5.3	27	15	18.1
8	432	437	5	54	426	54	95	42	223.0	11	7	2.5	15	9	16.7
9	297	299	2	33	283	33	41	20	144.9	16	11	5.4	13	8	([[38]])
10 or more	654	666	12	58	634	58	135	45	212.9	32	17	4.8	14	10	17.2
Native	2,717	2,744	27	816	2,600	801	294	206	113.1	144	115	5.2	136	92	11.3
1	234	236	2	234	224	222	17	17	75.9	12	12	5.1	7	7	3.0
2	346	351	5	173	327	170	25	23	76.5	24	21	6.8	18	13	7.5
3	333	338	5	111	322	111	38	31	118.0	16	16	4.7	21	15	13.5
4	376	377	1	94	362	94	36	31	99.4	15	13	4.0	13	10	10.6
5	325	326	1	65	302	65	26	21	86.1	24	19	7.4	13	10	15.4
6	222	222		37	216	37	34	22	157.4	6	5	2.7	17	9	([[38]])
7	266	267	1	38	250	38	25	18	100.0	17	11	6.4	25	13	([[38]])
8	184	187	3	23	184	23	29	17	157.6	3	2	1.6	8	5	([[38]])
9	117	118	1	13	109	13	14	7	128.4	9	6	7.6	4	3	([[38]])
10 or more	314	322	8	28	304	28	50	19	164.5	18	10	5.6	10	7	([[38]])
Foreign	2,837	2,873	36	675	2,763	664	510	303	184.6	110	79	3.8	55	38	5.6
1	105	107	2	105	98	96	18	17	183.7	9	9	8.4	1	1	1.0
2	220	225	5	110	217	109	34	31	156.7	8	7	3.6	5	3	2.7
3	309	312	3	103	304	103	54	44	177.6	8	7	2.6	5	3	2.9
4	368	375	7	92	361	92	42	33	116.3	14	8	3.7	9	8	8.7
5	410	414	4	82	402	82	77	46	191.5	12	12	2.9	7	4	4.9
6	342	346	4	57	330	56	54	38	163.6	16	8	4.6	6	5	8.3
7	315	319	4	45	305	45	53	30	173.8	14	11	4.4	2	2	([[38]])
8	248	250	2	31	242	31	66	25	272.7	8	5	3.2	7	4	([[38]])
9	180	181	1	20	174	20	27	13	155.2	7	5	3.9	9	5	([[38]])
10 or more	340	344	4	30	330	30	85	26	257.6	14	7	4.1	4	3	([[38]])

[38]. Not shown when base is less than 50.

Table XII.—Distribution of Results of Reportable Pregnancies (Live Births and Stillbirths) and Miscarriages, According to Number per Mother and Age of Mother at Each Pregnancy.
NUMBER OF REPORTABLE PREGNANCIES AND AGE OF MOTHER AT BIRTH OF BABY BORN IN 1911.	REPORTABLE PREGNANCIES.				LIVE BIRTHS.		BABIES DYING IN FIRST YEAR.			STILLBIRTHS.			MISCARRIAGES.
	Total.	Resulting births.		Number of mothers.	Number.	Number of mothers.	Number.	Number of mothers.	Infant mortality rate.	Number.	Number of mothers.	Per cent. of all births	Number reported.	Mothers reporting.
		Number.	Excess over pregnancies.[[39]]											Number.	Per cent. of all mothers.
All married mothers	5,554	5,617	63	1,491	5,363	1,465	804	509	149.9	254	194	4.5	191	130	8.7
Under 20 years	107	108	1	89	96	81	12	11	125.0	12	12	11.1
20 to 24 years	933	946	13	461	908	456	140	115	154.2	38	29	4.0	19	18	3.9
25 to 29 years	1,316	1,329	13	395	1,261	389	185	132	146.7	68	55	5.1	46	27	6.8
30 to 39 years	2,570	2,595	25	466	2,480	459	382	207	154.0	115	84	4.4	95	66	14.2
40 years and over	628	639	11	80	618	80	85	44	137.5	21	14	3.3	31	19	23.8
Average age: 28 years.
1 reportable pregnancy	339	343	4	339	322	318	35	34	108.7	21	21	6.1	8	8	2.4
Under 20 years	74	75	1	74	67	66	8	7	119.4	8	8	10.7
20 to 24 years	178	179	1	178	176	175	18	18	102.3	3	3	1.7	3	3	1.7
25 to 29 years	57	58	1	57	54	53	4	4	74.1	4	4	6.9	3	3	5.3
30 to 39 years	30	31	1	30	25	24	5	5	([[40]])	6	6	([[40]])	2	2	([[40]])
Average age: 23 years.
2 reportable pregnancies	566	576	10	283	544	279	59	54	108.5	3	28	5.6	23	16	5.7
Under 20 years	24	24		12	21	12	3	3	([[40]])	3	3	([[40]])
20 to 24 years	312	317	5	156	302	154	42	37	139.1	15	13	4.7	6	6	3.8
25 to 29 years	148	151	3	74	141	73	9	9	63.8	10	9	6.6	5	3	4.1
30 to 39 years	78	80	2	39	76	38	5	5	65.8	4	3	5.0	12	7	([[40]])
40 years and over	4	4		2	4	2
Average age: 25 years.
3 reportable pregnancies	642	650	8	214	626	214	92	75	147.0	24	23	3.7	26	18	8.4
Under 20 years	9	9		3	8	3	1	1	([[40]])	1	1	([[40]])
20 to 24 years	231	234	3	77	227	77	40	31	176.2	7	6	3.0	7	6	7.8
25 to 29 years	285	288	3	95	277	95	41	33	148.0	11	11	3.8	14	7	7.4
30 to 39 years	108	110	2	36	105	36	8	8	76.2	5	5	4.5	4	4	([[40]])
40 years and over	9	9		3	9	3	2	2	([[40]])				1	1	([[40]])
Average age: 26 years.
4 reportable pregnancies	744	752	8	186	723	186	78	64	107.9	29	21	3.9	22	18	9.7
20 to 24 years	156	160	4	39	148	39	28	21	189.2	12	6	7.5	3	3	([[40]])
25 to 29 years	300	301	1	75	290	75	26	23	89.7	11	10	3.7	10	6	8.0
30 to 39 years	252	255	3	63	249	63	21	17	84.3	6	5	2.4	6	6	9.5
40 years and over	36	36		9	36	9	3	3	([[40]])				3	3	([[40]])
Average age: 29 years.
5 reportable pregnancies	735	740	5	147	704	147	103	67	146.3	36	31	4.9	20	14	9.5
20 to 24 years	50	50		10	49	10	9	7	183.7	1	1	2.0
25 to 29 years	280	283	3	56	266	56	51	31	191.7	17	15	6.0	6	4	7.1
30 to 39 years	375	377	2	75	361	75	40	27	110.8	16	14	4.2	12	8	10.7
40 years and over	30	30		6	28	6	3	2	([[40]])	2	1	([[40]])	2	2	([[40]])
Average age: 30 years.
6 reportable pregnancies	564	568	4	94	546	93	88	60	161.2	22	13	3.9	23	14	14.9
20 to 24 years	6	6		1	6	1	3	1	([[40]])
25 to 29 years	132	133	1	22	127	21	23	17	181.1	6	1	4.5	6	3	([[40]])
30 to 39 years	360	362	2	60	347	60	54	36	155.6	15	11	4.1	13	9	15.0
40 years and over	66	67	1	11	66	11	8	6	121.2	1	1	1.5	4	2	([[40]])
Average age: 33 years.
7 reportable pregnancies	581	586	5	83	555	83	78	48	140.5	31	22	5.3	27	15	18.1
25 to 29 years	98	99	1	14	90	14	23	13	255.6	9	5	10.0	2	1	([[40]])
30 to 39 years	392	395	3	56	377	56	45	28	119.4	18	15	4.6	19	11	19.6
40 years and over	91	92	1	13	88	13	10	7	113.6	4	2	4.3	6	3	([[40]])
Average age: 34 years.
8 reportable pregnancies	432	437	5	54	426	54	95	42	223.0	11	7	2.5	15	9	16.7
25 to 29 years	16	16		2	16	2	8	2	([[40]])
30 to 39 years	408	413	5	51	403	51	87	40	215.9	10	6	2.4	15	9	17.6
40 years and over	8	8		1	7	1				1	1	([[40]])
Average age: 35 years.
9 reportable pregnancies	297	299	2	33	283	33	41	20	144.9	16	11	5.4	13	8	24.2
30 to 39 years	207	208	1	23	195	23	32	15	164.1	13	8	6.3	5	4	([[40]])
40 years and over	90	91	1	10	88	10	9	5	102.3	3	3	3.3	8	4	([[40]])
Average age: 37 years.
10 or more reportable pregnancies	654	666	12	([[41]])58	634	58	135	45	212.9	32	17	4.8	14	10	17.2
30 to 39 years	360	364	4	33	342	33	85	26	248.5	22	11	6.0	7	6	([[40]])
40 years and over	294	302	8	25	292	25	50	19	171.2	10	6	3.3	7	4	([[40]])
Average age: 39 years.

[39]. Excess of births over pregnancies due to plural births.

[40]. Rate not computed because of small base.

[41]. Includes 21 having 10 pregnancies; 16 having 11; 11 having 12; 6 having 13; 3 having 14; 1 having 16.

Table XIII.—Distribution of Results of Reportable Pregnancies (Live Births and Stillbirths) and Miscarriages, According to Number per Mother and Husband’s Earnings.
SPECIFIED NUMBER OF PREGNANCIES FOR ALL MARRIED MOTHERS AND ANNUAL EARNINGS OF HUSBAND.	REPORTABLE PREGNANCIES.				LIVE BIRTHS.		BABIES DYING IN FIRST YEAR.			STILLBIRTHS.			MISCARRIAGES.
	Total.	Resulting births.		Number of mothers.	Number.	Number of mothers.	Number.	Number of mothers.	Infant mortality rate.	Number.	Number of mothers.	Per cent. of all births	Number reported.	Mothers reporting.
		Number.	Excess over pregnancies.[[42]]											Number.	Per cent. of all mothers.
All reportable pregnancies	5,554	5,617	63	1,491	5,363	1,465	804	149.9	509	254	194	4.5	191	130	8.7
Husband earns:
Under $521	938	946	8	233	902	227	178	197.3	110	44	31	4.7	27	17	7.31
$521 to $624	691	700	9	174	668	173	129	193.1	75	32	25	4.6	22	14	8.0
$625 to $779	816	826	10	229	797	227	130	163.1	88	29	21	3.5	21	15	6.6
$780 to $899	611	616	5	166	588	163	99	168.4	61	28	23	4.5	30	19	11.4
$900 to $1,199	574	581	7	146	548	143	78	142.3	48	33	24	5.7	25	18	12.3
$1,200 and over	196	199	3	50	186	49	30	161.3	18	13	9	6.5	8	6	12.0
Ample[[43]]	1,728	1,749	21	493	1,674	483	160	95.6	109	75	61	4.3	58	41	8.3
1 reportable pregnancy	339	343	4	339	322	318	35	108.7	34	21	21	6.1	8	8	2.4
Husband earns:
Under $521	48	48		48	43	43	11		11	5	5
$521 to $624	23	23		23	22	22	2		2	1	1		1	1
$625 to $779	46	48	2	46	46	44	6		5	2	2		2	2
$780 to $899	35	35		35	32	32	3		3	3	3
$900 to $1,199	38	39	1	38	36	35	4		4	3	3
$1,200 and over	13	13		13	13	13	1		1
Ample[[43]]	136	137	1	136	130	129	8	61.5	8	7	7	5.1	5	5
2 reportable pregnancies	566	576	10	283	544	279	59	108.5	54	32	28	5.6	23	16	5.7
Husband earns:
Under $521	62	64	2	31	62	31	11	176.4	11	2	2	3.1
$521 to $624	72	74	2	36	68	36	8	177.6	6	6	6	8.1	3	1
$625 to $779	110	111	1	55	108	55	17	157.4	16	3	3	2.7	2	2	4.4
$780 to $899	56	56		28	53	28	9	169.8	7	3	3	5.4	4	2
$900 to $1,199	46	46		23	41	23	2		2	5	5		4	4
$1,200 and over	16	16		8	14	7	1		1	2	1		1	1
Ample[[43]]	204	209	5	102	198	99	11	55.6	11	11	8	5.3	9	6	5.9
3 reportable pregnancies	642	650	8	214	626	214	92	147.0	75	24	23	3.7	26	18	8.4
Husband earns:
Under $521	114	115	1	38	110	38	27	245.5	23	5	4	4.3	5	3
$521 to $624	102	104	2	34	101	34	16	158.4	13	3	3	1.9	1	1
$625 to $779	84	84		28	82	28	13	158.5	11	2	2	2.4	3	2
$780 to $899	87	87		29	83	29	6	72.3	6	4	4	4.6	5	4
$900 to $1,199	57	58	1	19	55	19	11	200.0	8	3	3	5.2	7	3
$1,200 and over	6	7	1	2	7	2	1		1
Ample[[43]]	192	195	3	64	188	64	18	95.7	13	7	7	3.6	5	5	7.8
4 reportable pregnancies	744	752	8	186	723	186	78	107.9	64	29	21	3.9	22	18	9.7
Husband earns:
Under $521	104	104		26	101	26	13	128.7	9	3	2	1.9	4	2
$521 to $624	88	89	1	22	86	22	10	116.3	9	3	1	3.4	2	2
$625 to $779	136	137	1	34	129	34	19	147.3	15	8	6	5.8	3	2
$780 to $899	96	97	1	24	95	24	13	136.8	12	2	1	2.1	3	3
$900 to $1,199	56	58	2	14	55	14	4	72.7	2	3	1	5.2	2	2
$1,200 and over	40	41	1	10	39	10	5		4	2	2		2	2
Ample[[43]]	224	226	2	56	218	56	14	64.2	13	8	8	3.5	6	5	8.9
5 reportable pregnancies	735	740	5	147	704	147	103	146.3	67	36	31	4.9	20	14	9.5
Husband earns:
Under $521	130	131	1	26	125	26	21	168.0	12	6	6	4.6	3	3
$521 to $624	90	91	1	18	85	18	20	235.3	12	6	5	6.6	3	1
$625 to $779	100	100		20	99	20	18	181.8	13	1	1	1.0	3	2
$780 to $899	110	110		22	106	22	13	122.6	8	4	4	3.6	3	2
$900 to $1,199	65	66	1	13	60	13	6	100.0	5	6	4	10.0
$1,200 and over	30	30		6	26	6	10		6	4	3		2	1
Ample[[43]]	210	212	2	42	203	42	15	73.9	11	9	8	4.2	6	5
6 reportable pregnancies	564	568	4	94	546	93	88	161.2	60	22	13	3.9	23	14	14.9
Husband earns:
Under $521	132	132		22	124	21	26	209.7	14	8	3	6.1	2	2
$521 to $624	60	60		10	59	10	9	152.5	8	1	1	1.7	6	2
$625 to $779	114	115	1	19	110	19	14	127.3	11	5	2	4.3	3	2
$780 to $899	48	48		8	48	8	7		6				4	2
$900 to $1,199	72	74	2	12	70	12	12	171.4	9	4	3	5.4	4	3
$1,200 and over	12	12		2	11	2	3		1	1	1
Ample[[43]]	126	127	1	21	124	21	17	137.1	11	3	3	2.4	4	3
7 reportable pregnancies	581	586	5	83	555	83	78	140.5	48	31	22	5.3	27	15	78.1
Husband earns:
Under $521	91	92	1	13	88	13	13	147.7	8	4	4	4.3	4	2
$521 to $624	56	56		8	51	8	15	294.1	6	5	4	8.9	1	1
$625 to $779	98	101	3	14	97	14	16	164.9	9	4	3	4.0
$780 to $899	35	35		5	32	5	6		5	3	2		3	1
$900 to $1,199	84	84		12	79	12	7	88.6	5	5	2	6.0	5	3
$1,200 and over	21	22	1	3	22	3	1		1				2	1
Ample[[43]]	196	196		8	186	28	20	107.5	14	10	7	5.1	12	7
8 reportable pregnancies	432	437	5	54	426	54	95	223.0	42	11	7	2.5	15	9	16.7
Husband earns:
Under $521	120	120		15	117	15	31	265.0	12	3	2	2.5	5	2
$521 to $624	96	98	2	12	94	12	22	234.0	10	4	2	4.1	1	1
$625 to $779	40	41	1	5	41	5	11		4				2	1
$780 to $899	48	49	1	6	46	6	11		5	3	2		5	3
$900 to $1,199	24	24		3	24	3	6		3				1	1
$1,200 and over	16	16		2	16	2	3		2				1	1
Ample[[43]]	88	89	1	11	88	11	11	125.0	6	1	1	1.1
9 reportable pregnancies	297	299	2	33	283	33	41	144.9	20	16	11	5.4	13	8
Husband earns:
Under $521	81	82	1	9	80	9	15	187.5	6	2	2	2.4	3	2
$521 to $624	72	72		8	70	8	10	142.9	6	2	1	2.8	3	3
$625 to $779	18	18		2	15	2				3	1		1	1
$780 to $899	18	19	1	2	17	2	5		2	2	2
$900 to $1,199	18	18		2	18	2	2		2
$1,200 and over	18	18		2	16	2				2	1
Ample[[43]]	72	72		8	67	8	9	134.3	4	5	4	6.9	6	2
10 or more reportable pregnancies	654	666	12	58	634	58	135	212.9	45	32	17	4.8	14	10	17.2
Husband earns:
Under $521	56	58	2	5	52	5	10	192.3	4	6	1	10.3	1	1
$521 to $624	32	33	1	3	32	3	17		3	1	1		1	1
$625 to $779	70	71	1	6	70	6	16	228.6	4	1	1	1.4	2	1
$780 to $899	78	80	2	7	76	7	26	342.1	7	4	2	5.0	3	2
$900 to $1,199	114	114		10	110	10	24	218.2	8	4	3	3.5	2	2
$1,200 and over	24	24		2	22	2	5		1	2	1	8.3
Ample[[43]]	280	286	6	25	272	25	37	136.0	18	14	8	4.9	5	3

[42]. Excess of births over pregnancies due to plural births.

[43]. See note on page [45].

Table XIV.—Distribution According to Number of Pregnancies and Age Groups of Married Mothers Classified by Nativity.
MOTHER’S AGE AND NUMBER OF REPORTABLE PREGNANCIES.	ALL MOTHERS.		NATIVE MOTHERS.		FOREIGN MOTHERS.
	Number.	Per cent.	Number.	Per cent.	Number.	Per cent.
Total pregnancies	1,491	100.0	816	100.0	675	100.0
1	339	22.7	234	28.7	105	15.6
2	283	19.0	173	21.2	110	16.3
3	214	14.4	111	13.6	103	15.3
4	186	12.5	94	11.5	92	13.6
5	147	9.8	65	8.0	82	12.1
6	94	6.3	37	4.5	57	8.4
7	83	5.6	38	4.7	45	6.7
8	54	3.6	23	2.8	31	4.6
9	33	2.2	13	1.6	20	3.0
10 and over	58	3.9	28	3.4	30	4.4
Under 20 years, total pregnancies	89	100.0	66	100.0	23	100.0
1	74	83.1	55	83.3	19	82.6
2	12	13.5	10	15.2	2	8.7
3	3	3.4	1	1.5	2	8.7
20 to 24 years, total pregnancies	461	100.0	261	100.0	200	100.0
1	178	38.6	114	43.7	64	32.0
2	156	33.8	86	33.0	70	35.0
3	77	16.7	42	16.1	35	17.5
4	39	8.5	14	5.4	25	12.5
5	10	2.2	4	1.5	6	3.0
6	1	.2	1	0.4
25 to 29 years, total pregnancies	395	100.0	199	100.0	196	100.0
1	57	14.5	45	22.6	12	6.1
2	74	18.7	46	23.1	28	14.3
3	95	24.1	40	20.1	55	28.1
4	75	19.0	40	20.1	35	17.9
5	56	14.2	17	8.5	39	19.9
6	22	5.6	7	3.6	15	7.7
7	14	3.5	4	2.0	10	5.1
8	2	.4			2	1.0
30 to 39 years, total pregnancies	466	100.0	245	100.0	221	100.0
1	30	6.4	20	8.2	10	4.5
2	39	8.4	29	11.8	10	4.5
3	36	7.7	25	10.2	11	5.0
4	63	13.5	33	13.5	30	13.6
5	75	16.1	40	16.3	35	15.8
6	60	12.9	24	9.8	36	16.3
7	56	12.0	28	11.4	28	12.7
8	51	10.9	23	9.4	28	12.7
9	23	4.9	8	3.3	15	6.8
10 and over	33	7.1	15	6.1	18	8.1
40 years and over, total pregnancies	80	100.0	45	100.0	35	100.0
2	2	2.5	2	4.4
3	3	3.8	3	6.7
4	9	11.3	7	15.6	2	5.7
5	6	7.5	4	8.9	2	5.7
6	11	13.8	5	11.1	6	17.1
7	13	16.3	6	13.3	7	20.0
8	1	1.3			1	2.9
9	10	12.5	5	11.1	5	14.3
10 and over	25	31.3	13	28.9	12	34.3

Table XV.—Distribution of Married Mothers by Losses Sustained, According to Nativity of Mother and Number of Possible Losses.
NUMBER OF BIRTHS OR POSSIBLE LOSSES AND NATIVITY OF MOTHER.		DISTRIBUTION OF MOTHERS ACCORDING TO NUMBER OF LOSSES.
	Number of mothers.	1 loss.	2 losses.	3 losses.	4 losses.	5 losses.	6 losses.	8 losses.	10 or more losses.
All mothers	1,491	399	121	60	24	13	8	1	2
1 birth	335	53
2 births	277	67	10
3 births	216	73	14	4
4 births	187	55	13	8	1
5 births	148	48	19	11	1	2
6 births	96	44	13	8	2	1	2
7 births	82	22	19	10	2		1
8 births	54	18	8	10	4	2	2
9 births	36	9	10	5	1	1	2
10 or more births	60	10	15	4	13	7	1	1	2
Native mothers	816	199	59	19	5	6	1	1
1 birth	232	29
2 births	170	36	5
3 births	111	35	7	1
4 births	98	33	6	3
5 births	65	19	10	4
6 births	38	19	7	1		1
7 births	37	10	8	3			1
8 births	21	8	5	3
9 births	15	4	4	3	1
10 or more births	29	6	7	1	4	5		1
Foreign mothers	675	200	62	41	19	7	7		2
1 birth	103	24
2 births	107	31	5
3 births	105	38	7	3
4 births	89	22	7	5	1
5 births	83	29	9	7	1	2
6 births	58	25	6	7	2		2
7 births	45	12	11	7	2
8 births	33	10	3	7	4	2	2
9 births	21	5	6	2		1	2
10 or more births	31	4	8	3	9	2	1		2

Population, Registered Births, Deaths of Infants under 1 Year of Age, and Infant Mortality Rates for Registration States and Registration Cities having a Population of at Least 50,000 in 1910.
AREA.			DEATHS[[44]] OF INFANTS UNDER 1 YEAR OF AGE.
	Population in 1910.	Births.[[45]]	Number.	Per 1000 births.[[46]]
REGISTRATION STATES.
Connecticut	1,114,756	27,291	3,476	127
Maine	742,371	15,578	2,108	135
Massachusetts	3,366,416	86,765	11,377	131
Michigan	2,810,173	63,566	7,912	124
New Hampshire	430,572	9,385	1,373	146
Pennsylvania	7,665,111	202,631	28,377	140
Rhode Island	542,610	([[47]])6,595	([[47]])1,111	([[47]])168
Vermont	355,956	7,343	791	168
REGISTRATION CITIES OF 50,000 POPULATION OR OVER IN 1910.
Connecticut:
Bridgeport	102,054	2,976	367	123
Hartford	98,915	2,411	286	119
New Haven	133,605	3,772	406	108
Waterbury	73,141	2,150	320	149
Washington, D. C.	331,069	7,016	1,068	152
Portland, Me.	58,571	1,163	167	144
Massachusetts:
Boston	670,585	17,760	2,246	126
Brockton	56,878	1,359	134	99
Cambridge	104,839	2,462	293	119
Fall River	119,295	4,591	854	186
Holyoke	57,730	1,702	362	213
Lawrence	85,892	3,165	529	167
Lowell	106,294	2,630	607	231
Lynn	89,336	2,218	216	97
New Bedford	96,652	3,873	685	177
Somerville	77,236	1,728	174	101
Springfield	88,926	2,438	302	124
Worcester	145,986	3,918	536	137
Michigan:
Detroit	465,766	11,960	2,138	179
Grand Rapids	112,571	2,693	329	122
Saginaw	50,510	897	130	145
Manchester, N. H.	70,063	1,939	375	193
New York, N. Y.	4,766,883	129,316	6,159	125
Bronx Borough	430,980	10,926	11,047	96
Brooklyn Borough	1,634,351	43,128	5,063	117
Manhattan Borough	2,331,542	66,112	8,900	135
Queens Borough	284,041	7,095	865	122
Richmond Borough	85,969	2,055	284	138
Pennsylvania:
Allentown	51,913	1,406	202	144
Altoona	52,127	1,392	166	119
Erie	66,525	1,713	197	116
Harrisburg	64,186	1,308	169	129
Johnstown	55,482	1,628	268	165
Philadelphia	1,549,008	38,666	5,334	138
Pittsburgh	533,905	15,059	2,259	150
Reading	96,071	2,370	336	142
Scranton	129,867	3,512	520	148
Wilkes-Barre	67,105	1,840	269	146
Rhode Island:
Pawtucket	51,622	([[48]])	191	([[48]])
Providence	224,326	([[48]])	827	([[48]])

[44]. Exclusive of stillbirths.

[45]. Provisional figures; exclusive of stillbirths.

[46]. Based on provisional figures for births.

[47]. The figures for Rhode Island are exclusive of Providence and Pawtucket.

[48]. Returns of births not received from State board in time for inclusion.

It will be seen by this table that Johnstown is among the 10 cities of more than 50,000 population which had an infant mortality rate of 1910 in excess of 150 per 1,000 births. These 10 cities and their respective rates are as follows: Lowell, Mass., 231; Holyoke, Mass., 213; Manchester, N. H., 193; Fall River, Mass., 186; Detroit, Mich., 179; New Bedford, Mass., 177; Lawrence, Mass., 167; Johnstown, Pa., 165; Washington, D. C., 152; and Pittsburgh, Pa., 150.

It should be borne in mind that the absolute infant mortality rate of 134, computed for the group of babies included in this investigation, that is, for those born in Johnstown in 1911, can not be compared with any of the approximate rates in the foregoing table, since the basis of computation is entirely different. But the method used in this report seemed to be the only practicable one for our purpose, namely, to measure the infant mortality rate in different districts of the city where the babies are subjected to varying conditions.

Conditions similar to those existing in Johnstown were found in Chicago by Dr. Alice Hamilton, Bacteriologist in the Memorial Institute for Infectious Diseases, Hull House. The results of a study made of 1,600 families in the neighborhood was published in 1910. The investigation was undertaken to find out the truth or falsity of a general feeling among the district nurses that a high birth rate was accompanied by a high death rate. It was found that a high birth rate was not so much accompanied as outrun by a high death rate. The number of children live-born was compared with the number of children who reached the age of three, so it is a study of child mortality, rather than of infant mortality. The child mortality rate rises and falls very much as does the infant mortality rate in Johnstown. A table calculated from the data of all the families shows an ascending mortality rate:

No. in Family	Child Mortality Rate
4 children and less	118
6 children and more	267
7 children and more	280
8 children and more	291
9 children and more	303

Expressed in words this table says that child mortality increases as the number of children per family increases, until we have a death rate in families of eight and more, which is two and a half times as great as that in families of four children and under.

FOURTH ANNUAL REPORT OF THE CHIEF, CHILDREN’S BUREAU, U. S. DEPARTMENT OF LABOR, Washington,
October 7, 1916

INFANT MORTALITY—MANCHESTER

The findings of the bureau’s earlier study in Johnstown, Pa., are confirmed in many respects by the findings in Manchester—the coincidence of a high infant mortality rate with low earnings, poor housing, mother’s work, and large families.

The mortality rate among the 1,564 live-born babies studied in Manchester was 165 per 1,000 births, which is considerably higher than the estimated rate for the whole country.

Manchester is primarily a textile town, and the textile mills employed 36.3 per cent. of all the fathers of babies born in Manchester during the 12 months covered by the study. Of the fathers, 13.7 per cent. were earning less than $450 per year; 48.5 per cent. less than $650; 22.9 per cent. $850 or more; 6.4 per cent. $1,250 or more.

Of the babies with fathers earning less than $450, about 1 in 4 died before it was 12 months old. The great majority of the babies had fathers in the wage group from $450 to $849, and of these about 1 in 6 died. Of the babies whose fathers earned $850 but less than $1,050, 1 in 8 failed to survive. Where the fathers earned $1,050 or more, 1 baby in 16 died in the first year.

Where families lived two or more persons per room, the infant death rate was twice as high as where they lived less than one person per room. The babies living in houses occupied by a single family died at the rate of 86.1 per 1,000, but those in tenements occupied by more than six families died at the rate of 236.6 per 1,000.

When the mother was a wage earner the baby’s chances of living were less than when she was not. Babies of mothers who had worked at some time during the year before the baby’s birth died at the rate of 199.2 per 1,000, while babies of nonworking mothers died at the rate of 133.9. Babies of mothers employed away from home some time during the year after childbirth while the baby was still alive and under four months old had a rate of 277.3, while babies of mothers not employed during that time had a rate of 122.

Babies of foreign-born mothers did not fare so well as babies of native mothers. The differences of rates, however, are only partly accounted for by their lower earnings. The largest foreign element in Manchester is Canadian French, and among them the infant mortality rate, 224 per 1,000 live births, is greater than that among any other group of the population, although their earnings are in general higher than those of other foreigners.

Sheer size of family appears to be one factor in this high Canadian-French rate, one-third of their babies being sixth or later in order of birth, while over one-sixth of these mothers had had from 9 to 18 children. These Canadian-French babies in families of 6 or more children died at the rate of 246.2 per 1,000 and the rate rises to 277.2 per 1,000 when only babies ninth or later in order of birth are considered.

CHAPTER V
MATERNAL MORTALITY AND DISEASES AFFECTED BY PREGNANCY

This chapter shows that the female death-rate is much greater during the child-hearing age than at other periods and notably greater than the male death-rate at any period. The outstanding fact is that this abnormal female death-rate, between the ages of 15 and 45, must be ascribed to too frequent pregnancies and to those diseases of the lungs, heart and kidneys which are hastened by pregnancy. Ninety-five per cent. of such deaths could be averted by the dissemination of knowledge to prevent conception.

THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL BIOLOGICAL AND HYGIENIC ASPECTS. E. HEINRICH KISCH, M.D., Professor of the German Medical Faculty of the University of Prague, Physician to the Hospital and Spa of Marienbad, Member of the Board of Health, etc. Translated by M. Eden Paul, M.D. Rebman Co., New York.

It is astonishing to observe the number of full term deliveries and miscarriages that a woman will experience within a comparatively short period of time, as is seen too frequently among the laboring classes, and more especially, among the factory workers. If we assume the original mortality of childbirth to be 6 per mille, a woman who in the course of 15 years undergoes labor (at full term or prematurely) 16 times, runs a risk of death to be expressed by the ratio of 6 × 16 = 96 per mille; that is to say, on the average of 1,000 women who became pregnant as often as this, nearly one in ten will die in childbed. P. 278.

In certain serious general disorders, in diseases of the heart, or of the lungs, in pelvic deformity, and in pathological changes of the female reproductive organs, it may be right to employ means for the prevention of pregnancy—not merely sexual abstinence, but actual measures to prevent fertilization. P. 395.

Based upon the observations of Schauta and Fellner, the latter author advances the rule that in the case of a woman suffering from disease, marriage should be forbidden only when the mortality from the disease in question is not less than 10%. In this category we must include severe cases only of pulmonary tuberculosis, whilst cases of laryngeal tuberculosis will, according to this rule, be absolutely unfit for marriage. Among heart affections contra-indicating marriage, he includes mitral stenosis, other valvular affections in which there is serious disturbance of compensation, and myocarditis; he considers marriage inadmissible also in cases of chronic nephritis, and among surgical affections, in case of malignant tumor. No case in which during a previous pregnancy the patient has been affected by one of the following diseases; viz. severe chorea, mental disorders, severe epilepsy, pulmonary tuberculosis which progressed much during pregnancy, morbus cordis, with considerable disturbance of compensation, severe heart trouble due to Graves disease—in all such cases a repetition of pregnancy should be avoided. P. 261.

FOURTH ANNUAL REPORT OF THE CHIEF OF CHILDREN’S BUREAU OF THE U. S. DEPARTMENT OF LABOR,
JUNE 30, 1916

MATERNAL MORTALITY

A study of maternal mortality, by Dr. Grace L. Meigs, head of the hygiene division of this bureau, has been undertaken as a direct corollary to the infant mortality inquiry. The sickness or death of the mother inevitably lessens the chances of the baby for life and health. A large proportion of the deaths of babies occur in the first days and weeks of life, and these early deaths can be prevented only through proper care of the mother before and at the birth of her baby.

In the introduction to the report on “Maternal mortality in connection with childbearing,” issued as a supplement to his report as medical officer of the local government board of Great Britain for 1914–15, Sir Arthur Newsholme says:

The present report is intended to draw attention to this unnecessary mortality from childbearing, to stimulate further local inquiry on the subject, and to encourage measures which will make the occurrence of illness and disability due to childbearing a much rarer event than at present.

The attainment of these ends is important as much in the interest of the child as of its mother. That the welfare of the child is wrapped up in that of the mother was fully recognized in the board’s circular letter of 31st July, 1914, and the schedule appended to that letter; and each year it is becoming more fully realized that, in order to insure healthy infancy and childhood, it is necessary that, both during pregnancy and at and after the birth of the infant, increased maternal care and guidance and medical assistance should be provided.

The Children’s Bureau studies of infant mortality in town and country reveal clearly the connection between maternal and infant welfare and make plain that infancy can not be protected without the protection of maternity.

In her report Dr. Meigs undertakes to do no more than to assemble and interpret figures already published by the United States Bureau of the Census and in the mortality reports of various foreign countries and to state accepted scientific views as to the proper care of maternity. She shows that maternal mortality, although in great measure preventable, is not decreasing in the United States. Her report reveals an unconscious public neglect due to age-long ignorance and fatalism. As soon as the public realizes the facts to which Dr. Meigs calls attention it doubtless will awake to action, and suitable provision for maternal and infant welfare will become an integral part of all plans for local protection of public health.

The report is summarized as follows:

“In 1913 in this country at least 15,000 women, it is estimated, died from conditions caused by childbirth; about 7,000 of these died from childbed fever, a disease proved to be almost entirely preventable, and the remaining 8,000 from diseases now known to be to a great extent preventable or curable. Physicians and statisticians agree that these figures are a great underestimate.

“In 1913 the death rate per 100,000 population from all conditions caused by childbirth was but little lower than that from typhoid fever; this rate would be almost quadrupled if only the group of the population which can be affected, women of childbearing age, were considered.

“In 1913 childbirth caused more deaths among women 15 to 44 years old than any disease except tuberculosis.

“The death rate due to this cause is almost twice as high in the colored as in the white population.

“Only 2 of a group of 15 important foreign countries show higher rates from this cause than the rate in the registration area of the United States. The rates of three countries, Sweden, Norway, and Italy, which are notably low, show that low rates for these conditions are attainable.

“The death rates from childbirth and from childbed fever for the registration area of this country are not falling; during the 13 years from 1900 to 1913 they have shown no demonstrable decrease. These years have been marked by a revolution in the control of certain other preventable diseases, such as typhoid, diphtheria, and tuberculosis. During that time the typhoid rate has been cut in half, the rate of tuberculosis markedly reduced, and the rate for diphtheria reduced to less than one-half. During this period the death rate from childbirth has decreased in England and Wales, Ireland, Australia, and Japan. The other foreign countries studied show stationary or slightly increasing rates. The death rate from childbed fever has decreased only in England and Wales, Ireland, and Scotland.

“These facts point to the need in this country and in foreign countries of higher standards of care for women at the time of childbirth.

“The low standards at present existing in this country result chiefly from two causes: (1) General ignorance of the dangers connected with childbirth and of the need for proper hygiene and skilled care in order to prevent them; (2) difficulty in the provision of adequate care due to special problems characteristic of this country. Such problems vary greatly in city and in country. In the country inaccessibility of any skilled care, due to pioneer conditions, is a chief factor.

“Improvement will come about only through a general realization of the necessity for better care at childbirth. If women demand better care, physicians will provide it, medical colleges will furnish better training in obstetrics, and communities will realize the vital importance of community measures to insure good care for all classes of women.”

While the figures given by Dr. Meigs are a startling indication of the great number of maternal fatalities occurring in various parts of the country, no estimates can be made of the number of mothers who survive only to suffer from a degree of preventable ill health which limits or defeats the well-being and happiness of their households.

MATERNAL MORTALITY FROM ALL CONDITIONS CONNECTED WITH CHILD BIRTH IN THE UNITED STATES AND CERTAIN OTHER COUNTRIES. By Grace L. Meigs, M.D. U. S. Department of Labor, Children’s Bureau, 1917.