Page images
PDF
EPUB

State health departments in administering the program have responsibility for determining eligibility and for authorizing needed care. Care is provided without cost of the enlisted men and without financial investigation. When authorizing medical or hospital care, the State agency assumes full responsibility for payment for all the care, thereby relieving the servicemen of any anxiety concerning medical care for their wives and infants.

Established in 13 States in April 1943, the program has been in operation since March 1944 in all the 48 States, the District of Columbia, Alaska, Hawaii, and Puerto Rico.

SERIES OF MONTHLY TABLES

The series of monthly tables presents a report on the volume of maternity and infant cases provided care under the program during the current month and since the beginning of the program in the individual States. Definitions of terms used in the tables are as follows:

New cases authorized.-This group includes servicemen's wives and infants for whom the initial application for care has been approved and for whom services have been authorized. A subsequent pregnancy of a woman previously cared for is counted as a new case; subsequent illnesses of an infant are not counted as new cases, as an infant is counted as one case until he is 1 year of age. The report includes reopened cases of women and infants who have moved from and have returned to the State, and cases transferred from other States. Cases completed. This group includes servicemen's wives for whom all service that has been authorized and that is to be provided has been paid for, and servicemen's infants who are at least 1 year of age and for whom all care that has been authorized and that is to be provided has been paid for.

Cases closed without payment.-This group includes those servicemen's wives and infants whose applications have been approved but for whom no care is to be provided and no expenditures made because the individuals have moved, died, withdrawn their applications, or for some other reason have failed to receive the care authorized.

Cases incomplete.-This group includes servicemen's wives and infants for whom care has been authorized but whose cases have not been completed or closed without payment.

TABLE 1.—Maternity and infant cases authorized in April 1946, and from time of approval of State plan through Apr. 30, 1946

[blocks in formation]
[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][subsumed][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][subsumed][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

1 Number of cases incomplete as of Apr. 1, 1946, in 37 States differs from number of cases incomplete as of Mar. 31, 1946 because of corrections submitted by State agencies.

[merged small][graphic][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][ocr errors][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][ocr errors][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed]

1 Number of cases incomplete as of Apr. 1, 1946, in 20 States differs from number of cases incomplete as of Mar. 31, 1946, because of corrections submitted by State agencies.

TABLE 3.-Cumulative case count through Apr. 30, 1946, by State 12

[graphic][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed]

1 Data in this table are subject to revision on the basis of corrections submitted by State agencies on reports for months prior to April 1946.

Time period covered is from the beginning of the EMIC program in the individual States through April 1946. The beginning of the time period varies among the States from April 1943 to March 1944. The separation of the cumulative case count into maternity and infant cases is estimated for some months prior to April 1946.

EXHIBIT 77

TEN YEARS OF PROGRESS IN REDUCING MATERNAL AND INFANT MORTALITY WITH FIGURES SHOWING CHANGES IN THE RATES BETWEEN THE 2 YEARS 1942-43

(By Marjorie Gooch, Sc. D., Division of Statistical Research, U. S. Children's Bureau)

With publication by the Bureau of the Census of data on births and deaths for 1943, it is possible for the first time to compare infant and maternal mortality rates over a 10-year period. Although much information on these subjects has been available for a number of years, the first year in which reasonably satisfactory data were available for every State in the Union was 1933.

Between 1933 and 1943 the maternal mortality rate declined 60 percent from 61.9 deaths directly due to pregnancy and childbirth in 1933, per 10,000 live births, to 24.5 such deaths in 1943. The infant mortality rate during the same years dropped from 58.1 deaths of infants under 1 year of age, per 1,000 live births, to 40.4 in 1943-a decrease of 31 percent.

The reporting of these comparable figures for the entire United States is a milestone in the history of vital statistics.

Development of birth and death registration in this country has been a long, slow process.

The first vital statistics published by the Federal Government were for the year 1850; these were based on data collected during the decennial population census of that year. Although the information covered the entire United States, the method of obtaining the data made it inevitable that they would be incomplete and inaccurate.

In some of the earlier-settled States, official registration of certain facts about births and deaths at the time the birth or death occurred had been in force since early colonial times. This principle-registration rather than enumeration-was used in the establishment in 1900 of the death-registration area. Only 10 States, the District of Columbia, and a small number of cities were included in this first registration area. But even this small beginning required that some central agency be given responsibility for the annual collection, compilation, and publication of the information. The Bureau of the Census was given this responsibility, and from this small beginning the structure of the present-day vital statistics has grown up. Similarly a birth-registration area was begun in 1915, with only 10 States and the District of Columbia included. Gradually States were added to each of these registration areas until in 1933 all the States were included in both the birth- and the death-registration areas.

Admission of a State to either registration area required proof that certain standards of completeness of registration had been met.

The registration procedure—that is, the filing of an official document giving specified information about the birth or death soon after it occurred-involves many persons and procedures. The certificate is filed with a local registrar, forwarded by him after he has made a record of certain facts, to the State registrar. In the office of the State registrar copies are made of the statistical information and sent on to the Federal Bureau of the Census which makes the Nation-wide tabulations and analyses of the data.

It is obvious that with the millions of records involved each year, definite classifications of many items must be agreed upon. Sometimes it becomes necessary or advisable to change some of the definitions and when this is done direct comparisons of current data with those published earlier are sometimes difficult or even impossible to make.

The classifications of causes of death are made according to the International List of the Causes of Death. This list is revised every 10 years to keep pace with advancement in medical knowledge. The latest revision was made in 1938, and deaths that occurred from 1939 through 1943 were classified according to this latest edition. Deaths that occurred from 1933 through 1938 were classified according to the 1929 edition. There were more extensive changes in the classification of causes of maternal deaths than of infant deaths, but the major discrepancies brought about by the revision have been overcome by the use of broad groups of causes. There are hidden variations, however, that cannot be corrected by this practice.1

Another change which was made in the tabulations of the Bureau of the Census during the 10-year period from 1933 to 1943 was the change from a place-of

1 For a discussion of the problem of classification of causes of death, see Vital Statistics Rates in the United States, 1900-1940, by Forest E. Linder and Robert D. Grove (U. S. Bureau of the Census, Washington, 1943).

« PreviousContinue »