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State health departments in administering the program have responsibility for determining eligibility and for åuthorizing 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 seryice 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been approved but for whom no care is to be provided and no expenditures made because the individuals have moved, died, withdrawn their applications, or for some other reason have failed to receive the care authorized.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

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18, 393) June 1943.

592 July 1943.
8, 250 May 1943.
18, 929

Do.
90, 272 June 1943.
14, 338) November

1943.
14,396 May 1943.

2,914 April 1943. 10, 676 June 1943.

3, 741

454

66 235

743

79
1, 221

488
316

Connecticut.
Delaware.
District of Co-

lumbia.
Florida.
Georgia.
Hawaii.
Idaho
Illinois.
Indiana..
Iowa
Kansas
Kentucky.
Louisiana.

374 434 101

151 1, 597

721 621 375 609 521

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23, 288

Do.
20, 498) August 1943.
2, 126 May 1943.
6, 655 Do.
62, 532

Do,
36, 689 Do.
22, 617) June 1943.
25, 770 May 1943.
23, 877 Do.
20, 033

December

1943.
7, 568 May 1943.
16, 544 April 1943.
35, 444 August 1943.
43, 541 May 1943.
25, 184 June 1943.
20, 367) April 1943.

34, 614 May 1943.

6, 135 June 1943. 15, 731 2,429 April 1943. 4, 2321 June 1943. 30, 992 April 1943. 8, 875

Do. 112, 440 June 1943. 36, 655 April 1943.

3,997 March 1944. 53, 753) August 1943. 26, 961 April 1943. 12,074 september

1943. 71,681

Do. 5,327 February 1944. 6,583 April 1943. 19, 546

Do. 6, 629 May 1943. 16, 646 July 1943. 63, 364 December

1943. 10, 441 May 1943.

4,604 April 1943. 24, 692 July 1943. 24, 437 May 1943. 17, 109 April 1943. 23,957 May 1943. 2,645 April 1943

Maine.
Maryland.
Massachusetts..
Michigan.
Minnesota
Mississippi.

208

483 1, 122 1, 239 632 375

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239

Alabama. Alaska. Arizona. Arkansas. California.. Colorado. Connecticut. Delaware District of Columbia. Florida. Georgia Hawaii. Idaho Illinois. Indiana Iowa.. Kansas. Kentucky Louisiana Maine. Maryland. Massachusetts. Michigan. Minnesota. Mississippi. Missouri. Montana. Nebraska. Nevada. New Hampshire. New Jersey. New Mexico. New York, North Carolina. North Dakota. Ohio Oklahoma. Oregon Pennsylvania. Puerto Rico Rhode Island. South Carolina. South Dakota. Tennessee. Texas. Utah Vermont. Virginia. Washington West Virginia. Wisconsin. Wyoming..

3, 074

151 1,519 2, 258 19,693 1, 965 3, 443

349 1,982 4, 865 3,871

489.

816
9, 231
6, 599
3, 541
2,831
3, 190
2,812
1, 720
2,547
6, 738
8, 115
3,895
2,607
3, 778

861
2, 801

272

943 5, 926

949 20, 175 11, 021

635 13, 162 3, 044 2, 285 13, 743 1, 859 1, 137 3,085

670 3, 153 15, 085 2, 135

503 3, 628 4, 184 1, 908 3, 677

239

370

21 113

300
2, 448

253
294

52
197
336
402

86 100 1, 277

594 459 394 553 355 177 399

863 1,010

423 313 774

69 202

28 131 599

125 2, 492 694

51 1,016

451

256 1, 415

408

14 120

376
1,884.

320
380

38
335
522
476

35 129 1, 560 .849 434 398 781 545 218 307 751 982 373 436 884 100 292 36 64 870

140 2,374 794

33 1, 298

574

351 1, 665

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3,000

158 1, 510 2,164 20, 225 1,893 3, 338

361 1, 842 4, 440 3, 766

539

777
8,915
6, 317
3,564
2,714
2,915
2, 608
1, 673
2, 634
6, 838
8, 133
3, 935
2, 404
3, 606

829
2, 701

264 1,010 5, 591

922 20, 260 10, 901

653 12, 851 2, 823 2, 189 13, 037 1, 764 1,081 2, 928

613 3,164 15, 050 2, 019

512 3, 483 4, 132 1, 859 3,671

242

400

14 120

350 2,000

250 300

55 200 350 400 80

90 1, 152

592 500 280 450 350 220 439

950 1,111

400. 350 800

80 250

30 150 600 140

2, 450

456

700

55 1,400

500

282 1,500

126 110 327

83 338 1, 174 117

58 443 509 318 583 42

196 162 376 135

321 1, 206 233

48 574 558 355 570 39

150 120 360 100

400 1, 200 200

60 400 550 350 550 40

I 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.

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5 25 50 300

30 175 13 50 50 50 10 40 336 153 175

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18 271 106 104

60

2
4

65 150 45 92 300 252 200

Alabama
Alaska
Arizona
Arkansas.
California
Colorado.
Connecticut.
Delaware.
District of Columbia.
Florida
Georgia
Hawaii.
Idaho.
Illinois.
Indiana
Iowa.
Kansas
Kentucky
Louisiana
Maine
Maryland.
Massachusetts.
Michigan.
Minnesota
Mississippi.
Missouri
Montana
Nebraska.
Nevada
New Hampshire.
New Jersey.
New Mexico.
New York.
North Carolina
North Dakota.
Ohio.
Oklahoma
Oregon.
Pennsylvania
Puerto Rico.
Rhode Island.
South Carolina.
South Dakota.
Tennessee
Texas.
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin.
Wyoming-

75

310

32 508

311 3,076

368 1, 177

122 353 570 645

88 469 2, 344 2,890 1, 150 1,019

506 1, 119

304

973 2, 444 2, 377 1, 953

965 1,347

607 1, 731

109

153 1, 203

323 8, 443 1,490

497 3, 026

663

296 3, 877

322 172 537 266

725 1, 618

730

937 2, 258 1, 284

584 807 79

34

6 25 36 312

31 160 14 38 38 32 15 51 320 127 162 71 56 166 31 84 259 229 209

62 236 59 99

4 17 92

24 1, 249

49 28 205 37 60 267 12 20 52 26 46 167 27 79 114 131 62 99 14

292

33 504

311 3, 199

346 1, 297

121 339 580 671

96 502 2,389 2,910 1, 208

991

501 1, 137

333 1, 018 2, 469 2, 413 1, 949

785 1, 422

619 1,660

96 156 1, 235

306 9,032 1, 397

491 3, 124

626

2 13 2 4 16 13

2 11 1 0 1

59 144

2 37 221 191 209 226 148

45 159 16 14 59 40 636 138

34 107 62

9 404 39 22 46 44 69 25

6 10 637

78 131 101

6

250

75 150

4 35 100

40 870 60 30 250

24

0 12

2 173

345

300

1

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3, 567

294 169 541 247

702 1, 760

751 1,005 1, 716 1, 337

503 802 87

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200

125 150 100 100

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":

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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.

1

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 classi. fied 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."

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. 8. Bureau of the Census, Washington, 1943).

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