Dr. HOWARD. There is nothing I could say that would be more impressive on the decline of maternal mortality in this coutry than as shown on the graph on the first page of my statement. There is no country in the world that has had such a rapid decline in maternal deaths as the United States.

The comparison is often drawn that the United States has a high maternal mortality rate as compared with other countries. There are so many factors that enter into this, and when we consider the northern half of our country, the maternal mortality rate there compares very favorably with other countries.

As a matter of fact, perhaps to emphasize that more clearly, recently published in the past 2 weeks, the maternal mortality rate for Connecticut, for 1945, was 1.0, which is the lowest maternal mortality rate ever published anywhere in the world.

Senator DONNELL. 1.0 per what?

Dr. HOWARD. Per thousand live births, or 10 per 10,000.

The latest records of the United States so far as I know have not been published, but I am very certain that many of the Northern States will have a reduction comparable to that of Connecticut.

The big problem, therefore, is in certain sections of this country, and we realize the high maternal mortality rate that exists in the South. This rate among the colored folks is over twice as high as among the white people.

The problem, therefore, seems rather definite. We have the problem among the colored folks in the South. The northern section is doing exceedingly well.

Senator PEPPER. Doctor, to save time, you do not mean to say that the problem is exclusively among the colored people in the South?

Dr. HOWARD. The decline in the maternal mortality rate in this country is going on in both the North and the South, but the reaching of this minimum rate that we are trying to establish, of course, is much closer in the North than in the South. It is still rather high in the South.

That is all I have to say at the moment.

Senator PEPPER. Senator Donnell?

Senator DONNELL. Have you examined S. 1318, Doctor?
Dr. HOWARD. Yes, I have.

Senator DONNELL. Would you care to give us your opinion as to that bill?

Dr. HOWARD. My reaction is very much like that of Dr. Wall. The feeling that the Government should sponsor, and should appropriate funds for the care of these women in pregnancy, does not seem to us to be the American way of doing things. It does not seem necessary except in those States where conditions are such that the State cannot carry on a suitable maternal and infant care progrm.

In those States where it is needed, then some means must be taken to guarantee that the mothers in those States will have good maternity

care.

Senator DONNELL. Doctor, I understood your testimony as to the decline in maternal mortality rate applies with varying degrees throughout both the North and South in this country.

Dr. HOWARD. That is right.

Senator DONNELL. That there is a general decline.

Dr. HOWARD. Yes, sir.

Senator DONNELL. Though that decline has not been as marked in the southern part of the country, generally speaking, as it has in the north. Is that right?

Dr. HOWARD. Yes, sir.

Senator DONNELL. I take it that the applicability of that testimony was as to whether or not there exists as great a need as might be argued in the first instance for legislation of this kind. Is that your point?

Dr. HOWARD. Yes, sir.

Senator DONNELL. You are inclined to think, as I understand it, that some of the statements made as to the appalling conditions in this country are fallacious because of the fact that they reflect the extremes, and a very high degree of mortality in some sections of the country, and therefore do not give a proper picture of the conditions in our country, generally speaking. Is that your point? Dr. HOWARD. That is correct.

Senator DONNELL. I notice on the list of witnesses here today that you are marked as representing the American Medical Association. Is that correct?

Dr. HOWARD. I am, sir.

Senator DONNELL. Would you tell us please the authority under which you act in speaking for the American Medical Association? Dr. HOWARD. Well, I was appointed by the American Medical Association to appear here.

Senator DONNELL. Who appointed you, please?

Dr. HOWARD. The board of trustees.

Senator DONNELL. The reason for my inquiry primarily was the point that Senator Aiken made, indicating that there has been no official action taken, as I understand it, by the house of delegates with respect to S. 1318.

Dr. HOWARD. I was not a member of the house of delegates at the December meeting.

Senator DONNELL. Last year?

Dr. HOWARD. Yes, sir. It seems to me that some action had been taken, but I cannot be sure of that because I was not a member of the house. But, I thought there was some action taken at that time.

Senator DONNELL. The board of trustees acts in the interim between meetings of the house of delegates, does it, in expressing the opinion of the American Medical Association?

Dr. HOWARD. Yes, sir.

Senator DONNELL. And you have been directed by the board of trustees, this interim body, to appear here and express the view of the American Medical Association?

Dr. HOWARD. That is right.

Senator DONNELL. Do you deem yourself to be expressing the views of the trustees of the board of that organization when you do not advocate S. 1318?

Dr. HOWARD. I am advocating-I am following the instructions from the board of trustees to appear against this bill.

Senator DONNELL. And you, accordingly, are appearing against

S. 1318.

Dr. HOWARD. I am; yes, sir.

Senator DONNELL. And opposing it, and expressing your view that it would be an unwise piece of legislation.

Dr. HOWARD. That is true.

Senator PEPPER. Dr. Howard, has the American Medical Association adopted any affirmative proposal and recommendation for a plan to provide all needed medical care and care for crippled children and welfare care for the mothers and children of the country?

Dr. HOWARD. No. The American Medical Association has not any definite plan except the belief that the voluntary type of insurance should be sponsored in the various States and improved to the point where it will do a pretty comprehensive job.

Senator PEPPER. When you say "a pretty comprehensive job" that means that there would still be segments that would not be covered. Dr. HOWARD. I do not believe that anything can be done to cover every person in the United States.

Senator PEFFER. This bill, if it were passed, its declared purpose is to make medical, hospital nursing, and other care available to the mothers and children of the country. We can at least provide money if we chose to do so, could we not?

Dr. HOWARD. Yes, sir; but what the outcome would be, I do not know.

Senator PEPPER. We could provide more personnel and offer more incentive and offer them an education.

Dr. HOWARD. Yes, sir.

Senator PEPPER. We could provide more hospitals if we appropriate the money.

Dr. HOWARD. I think the Hill-Burton bill has done that already. Senator PE R. I know, but we could provide the facilities if we appropriated the money for it.

Dr. HOWARD. Yes, sir.

Senator PEPPER. And we could employ diagnostic facilities and clinics and all of those things if we passed this bill and provide enough money, could we not?

Dr. HOWARD. Yes; but that is just in the bill. We have no way of determining whether the bill will work out or not except possibly to think of some of the other countries where similar programs are in progress.

Senator PEPPER. You do not mean that you have any doubt, do you, that if we pass this bill that it would actually save lives of mothers and children in this country and provide more healthy and wholesome child population in this country? Do you deny that?

Dr. HOWARD. In maternal mortality the decline might be a little more rapid, but not much more rapid than at the present time.

Senator PEPPER. When you speak of "a little more rapid" do you realize you are speaking of the mothers of children, and the wives, and the future children that will give a great deal to this country? If it were your child, it would be a little more than statistics, would it not?

Dr. HOWARD. It would. I am not attempting to simply use statistics, and I certainly have as much sentimental feeling toward the children and the mothers in this country as anyone else. That is why I am a physician.

Senator PEPPER. You are not advocating a program that will certainly provide more hospitals for them, and provide more nurses for

them, and provide more doctors for them, and provide more diagnostic facilities for them.

How can you say you want to save more children and more mothers and yet oppose legislation that would provide that care for them? That is, care which they are not getting?

Dr. HOWARD. I think that in the areas which are in need of this, very badly in the South, that something should be done in the way of establishing prenatal clinics, and in establishing, perhaps, obstetrical wards and hospitals for the case of these women.

But there are certainly some areas that do not need it, and Connecticut, does not need it.

Senator PEPPER. The State is not required to take it under this bill, is it?

Dr. HOWARD. No; but I do not think any State would pass it up. Senator PEPPER. They would be putting up their own money, matching a large part of the funds, if they did avail themselves of it. But you say the American Medical Association has not gotten up a plan of its own except through the voluntary part.

Dr. HOWARD. Yes, sir.

Senator PEPPER. I believe that is all, Doctor.

Thank you very much.

Senator PEPPER. Dr. M. Edward David, University of Chicago School of Medicine.

STATEMENT OF DR. M. EDWARD DAVIS, UNIVERSITY OF CHICAGO, SCHOOL OF MEDICINE

Dr. DAVIS. I am professor of obstetrics and gynecology at the University of Chicago. I am the obstetrician at the Chicago Lying-In Hospital. I am a member of the various national special medical societies. I will not enumerate them. I am a diplomat of the American Board of Obstetrics and Gynecologists. I have been interested in maternal and child welfare for many years, and I have taken an active part in the postgraduate education of doctors in at least 17 States during the past 12 or 15 years.

I come here today at the invitation of Senator Pepper, and I paid. my own expenses.

In the limited time at my disposal I should like to summarize briefly my attitude toward bill S. 1318, a bill to provide for the general welfare by enabling the several States to make more adequate provision for the health and welfare of mothers and children.

It is with the welfare of mothers that I am concerned primarily, but mother and child are so closely linked that what concerns one necessarily concerns the other.

To simplify this discussion I have asked myself several questions, and in their answers I think that you will learn what I think about the bill.

In the first place, is there need for Federal funds for maternal welfare in the United States?

Senator PEPPER. Excuse me, Doctor, I think it will add to the understanding of your testimony if you would give us a little bit about your own background, what education and experience you have had.

Dr. DAVIS. I have been with the Lying-In Hospital in Chicago, which is the leading maternity hospital.

Senator PEPPER. What about yourself? What has been your own personal education?

Dr. Davis. I am a graduate of Rusk Medical College. I was born in the West, in the wide open spaces of Wyoming. I am a graduate of Rusk Medical College of 1922. I was trained in obstetrics in the Chicago Lying-In Hospital. At that time it was affiliated with Northwestern University.

Subsequently I went to Europe and spent a year in European clinics. On my return to this country, I worked at the Carnegie Institute of Embryology in Baltimore, then I spent more time in postgraduate studies, and came back to the Chicago Lying-In Hospital, where I have been ever since.

At the present time, as you have heard, I am professor of obstetrics and gynecology at the University of Chicago.

Senator PEPPER. Do you do any private practice as well?

Dr. DAVIS. No, the faculty of the University of Chicago Medical School is what is known as a faculty on a full-time basis. We have the same standing in school as the professor of physiology, professor of chemistry and professor of anatomy. We receive a full-time salary and devote all of our time to our position.

Senator PEPPER. I see. Thank you very much.

Now, go right ahead.

Dr. DAVIS. The first question I raised is the need for Federal funds for maternal welfare in the United States.

You have heard Dr. Howard tell you that there has been a tremendous decline in maternal mortality in the United States particularly during the last decade. It is gratifying to all of us that this decline has taken place, and we are proud of the effort of everyone that has been identified with the work.

But there are still some 7,000 women that die every year in the United States, and most of us who have studied the statistics concerning these deaths are convinced that at least half of these women can be saved, and it is about these women that we are concerned.

The deaths alone are important. However, they are not the most important consideration. Vital statistics are cold; they are a brutal analysis of what is taking place.

What concerns us, too, are the various damages that are the result of child bearing. Women are permanently invalided as a result of poor obstetrics, and a permanent invalided mother is a much more serious problem than one who has gone to heaven.

Then we are concerned with the many babies who lose their lives unnecessarily. Many of these deaths are preventable.

And then there is the larger group of babies that do not die; they are the crippled, hopelessly crippled; they fill your State institutions; they are the idiots and the imbeciles; and they are a constant source of worry and grief to their families; and you have to support them out of taxes because we support our institutions for the insane and the feeble-minded.

And so they, too, are very important when you consider the entire problem.

Another thing that concerns us is the tremendous discrepancy between the type of care that is available in the various parts of the country, and in the various parts of the individual States.