9. I have left myself but scant time to speak of what is at once a chief lesson of the war and the most pressing problem in the preventive medicine of the immediate future. I refer to the need for more complete protection of motherhood and childhood against the dangers besetting them.
It would be a mistake to assume that only since war began have efforts both by sanitary authorities and by voluntary agencies been made on a large scale to diminish infantile and maternal mortality. But during the war, and since it terminated, these efforts have been redoubled and are becoming universal; and there is opening out a prospect of safe maternity for mothers and of protected infancy for all newcomers on the stage of life. If only we are prepared to do what is almost immediately practicable for this end, death or injury associated with child-bearing will become rare, the loss of infant and child life will be halved, and what is still more important, mothers and infants will cease to be damaged by neglect or ignorance at critical periods of their life, and will not become burdens to themselves and to the community.
This is no visionary dream. Past experience shows that it is within reach. What other interpretations can be placed on the facts revealed in official reports?
I am unable to quote Canadian figures; but I am justified in assuming that differences similar to these I am about to quote from my own reports exist also here. The average number of deaths of mothers from complications arising during pregnancy, and at or after confinement, are one maternal death for every 250 infants born alive. In some parts of England instead of four mothers, six or even eight or nine mothers die for every thousand infants born. There are marked differences in maternal mortality in neighbouring towns and districts; and the only conclusion which fits in with the facts is that, in many parts of the country, the arrangements for medical attendance on mothers at and before their confinement are inadequate or deficient in quality or both.
The Maternity Benefit under the National Insurance Act, though a valuable evidence of the interest of the State in maternity, has not provided a sufficient remedy. It was an unconditional benefit limited to insured women or the wives of insured men, and there was no guarantee that the money allotted would be utilized in supplying the medical, midwifery, or nursing assistance needed by the patient, or in relieving her from domestic duties which she is unfit to perform. It was furthermore, inadequate for these purposes. We should not think of handing over to each individual householder an annual sum of money, advising him to expend it on a supply of books or in the education of his children. It is more economical and more effective to provide free libraries and public elementary schools without payment of fees. Is not similar action important in connection with child-bearing, on which the continuity of family life and civilization depends? That this is so is recognized in the steps towards the desired end taken in recent years by the Local Government Board jointly with local authorities. Let me enumerate some of these. The Central Authority have undertaken to pay one-half of approved expenditure incurred locally on the following agencies:
(a) The salaries and expenses of inspectors of midwives;
(b) The salaries and expenses of health visitors and nurses engaged in maternity and child welfare work;
(c) The provision of a midwife for necessitous women in confinement and for areas which are insufficiently supplied with this service;
(d) The provision, for necessitous women, of a doctor for illness connected with pregnancy and for aid during the period of confinement for mother and child;
(e) The expenses of a Centre, i.e., an institution providing any or all of the following activities: Medical supervision and service for expectant and nursing mothers, and for children under five years of age, and medical treatment at the Centre for cases needing it;