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LETTER OF TRANSMITTAL.

U. S. DEPARTMENT OF LABOR,

CHILDREN'S BUREAU, Washington, September 25, 1916.

SIR: I transmit herewith a report entitled "Maternal Mortality from all Conditions Connected with Childbirth in the United States and Certain Other Countries," by Dr. Grace L. Meigs, in charge of the hygiene division of this bureau. This report has been prepared because the bureau's studies of infant mortality in towns and rural districts reveal a connection between maternal and infant welfare so close that it becomes plain that infancy can not be protected without the protection of maternity.

In this study Dr. Meigs undertakes to do no more than to assemble and interpret figures already published by the United States Bureau of the Census and by the statistical authorities of various foreign countries, and to state accepted scientific views as to the proper care of maternity. She points out clearly that maternal mortality is in great measure preventable, that no available figures show a decrease in the United States in recent years, and that certain other countries now exhibit more favorable rates. This report reveals an unconscious neglect due to age-long ignorance and fatalism. It is earnestly believed that whenever the public realizes the facts it will awake to action and that adequate provision for maternal and infant welfare will become an integral part of all plans for public health protection. The generous assistance of the United States Bureau of the Census in the preparation of this report is gratefully acknowledged.

Dr. Meigs desires that special mention be made of the assistance of Miss Emma Duke, head of the statistical division of the Children's Bureau, and of Miss Viola Paradise, research assistant in the division of hygiene.

Respectfully submitted.

JULIA C. LATHROP,

Chief of Bureau.

Secretary of Labor.

Hon. WILLIAM B. WILSON,

MATERNAL MORTALITY FROM ALL CONDITIONS CONNECTED
WITH CHILDBIRTH.

SUMMARY.

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 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 3 countries, Sweden, Norway, and Italy, which are notably low, show that low rates for these diseases are attainable.

The death rates from childbirth and from childbed fever for the registration area of this country apparently are not falling to any great extent; 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 from tuberculosis markedly reduced, and the rate from diphtheria reduced to less than one-half. During this period there has been a decrease in the death rate from childbirth per 1,000 live births in England and Wales, Ireland, Japan, New Zealand, and Switzerland.

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