LETTER OF TRANSMITTAL.

U. S. DEPARTMENT OF LABOR,

CHILDREN'S BUREAU,

Washington, D. C., March 30, 1914.

SIR: I have the honor to transmit herewith a report concerning the work of the New Zealand Society for the Health of Women and Children.

Through the courtesy of the State Department the work of the society was brought to the attention of this bureau by a report of the American consul general at Auckland, Mr. William A. Prickitt. The infant mortality rate of New Zealand has been for some time recognized as the lowest of any country in the world and it is stated that recent further reductions are due in large measure to the activity of this society. As an example of its value, the consul general states that the work of the society has reduced infant mortality in Dunedin, a residential city of about 60,000 inhabitants, 50 per cent during five years, from 1907 to 1912. Because of the absence of adequate birth and death registration in the United States, the infant death rate of this country, as a whole, is unknown, but estimates tend to show that it is at least twice the rate in New Zealand, which the registrar general of that country reported in 1912 to be 51 per 1,000. New Zealand, like certain of our States, is a young and vigorous country with a scattered population and with no large cities, and there is every reason to believe that similar volunteer effort in this country would produce similar results. In view of the marked and growing interest in the preservation of infant health in the smaller cities and rural communities of the United States, I believe that the following account of the methods of the New Zealand society is especially timely. It will be seen that public interest is strongly enlisted in its efforts. Seventy volunteer committees in as many districts maintain the educational and nursing work in conjunction with the central office, and the Government itself assists in various ways. The detailed statement which follows is not offered for the purpose of urging exact reproduction of the New Zealand organization, but rather to stimulate interest in working out whatever methods are practicable locally for securing the same results which New Zealand secures.

This report has been prepared by Mrs. Etta R. Goodwin, of the Children's Bureau.

Very respectfully,

Hon. WILLIAM B. WILSON,

Secretary of Labor.

JULIA C. LATHROP, Chief.

NEW ZEALAND SOCIETY FOR THE HEALTH OF WOMEN AND

CHILDREN.

WHAT THE SOCIETY HAS ACCOMPLISHED.

The Society for the Health of Women and Children was founded in New Zealand in 1907 to continue and extend a health mission among mothers which had been started by Dr. F. Truby King, medical superintendent of the Government "Seacliff" Mental Hospital at Dunedin. Although the infant death rate in New Zealand was one of the most favorable in the world, it was felt that it was too high, and with this conviction Dr. Truby King made a plea for educational work in his statement that a "generally diffused knowledge and recognition of infant requirements and maternal duties would save the community one life per diem, and would correspondingly increase the strength and vitality of the rising generation."

For several years the society made no attempt to call attention to the possible relation between its work and the steady decrease which was taking place in the infant death rate in New Zealand. But after five years of effort it seemed safe to take some share of the credit for the reduction, and, accordingly, the report of the Dunedin branch of the society for 1913 points out the lowering of the rate which has taken place since the society began its work and gives as an illustration the figures for Dunedin, a city which in 1911 had a population of 41,529 (with suburbs, 64,237).

Taking the seven years from 1900 to 1907, the average death rate among children under 1 year in Dunedin and suburbs was 8 per cent. For the last five years the average has been 6.5 per cent; for the last three years, 6 per cent; for the last two years, 5 per cent; and for the last year (1911), 4 per cent.

More recent figures, as shown in the Official Yearbook for New Zealand for 1913, give Dunedin an infantile death rate of only 3.8 for every 100 births in 1912.

The diagram on the following page, which is also taken from the report of the society, shows the figures for Dunedin in striking contrast with rates for several of the large cities of Europe.

The report explains that the reason for contrasting groups of years instead of giving individual years for Dunedin is to show the stable and sustained decline in the infantile death rate from 1907 onward. The fall would have appeared more striking had the four later periods been compared, not with the average for the preceding seven years. but only with the year 1907, when the rate was 9.5 per 100 births. This contrast, however, would have been misleading.

8% DUNEDIN = Average infantile mortality for 7 years (1900-1907)

= Average infantile mortality for last 5 years (1907-1912)

- Average infantile mortality for last 3 years (1909-1912)

= Average infantile mortality for last 2 years (1910-1912)
= Average infantile mortality for last year (1911-1912)

The decrease has been a general one in New Zealand and not confined to a single city as is shown by a table from the Report of the Inspector General of Hospitals and Charitable Institutions and Chief Health Officer for 1911-12:

NUMBER OF DEATHS PER 100 BIRTHS IN NEW ZEALAND AS A WHOLE AND IN THE FOUR PRINCIPAL CITIES, YEARS 1902–1912.

2

1 Original table shows deaths per 1,000 births. Figures from Official Yearbook of New Zealand, 1913.

In order fully to realize what a remarkable work has been accomplished it will be significant to compare the figures with the rates of some of the States and cities in the United States. The registration of births in the United States is so incomplete that no figures for our country as a whole can be quoted in discussions of birth and death rates. In a few States and individual cities, however, the registration, although not complete, is good enough to furnish figures which may be compared with those for New Zealand in order to study the relative success of the two areas in preserving the lives of their babies. The following rates are quoted from the report of the Bureau of the Census, Mortality Statistics, 1911, from the New Zealand reports, and from the Sixty-ninth Report of Births, Marriages, and Deaths in Massachusetts

2 Sixty-ninth Report of Births, Marriages, and Deaths in Massachusetts. These cities were chosen in order that an opportunity might be given to compare the New Zealand rates with cities in the United States in approximately the same population class as the New Zealand cities.

The report of the New York State Department of Health shows a reduction to 10.5 per 100 births in 1912.

TERRITORY IN WHICH SOCIETY WORKS.

In estimating the problem with which the health agencies in New Zealand have to deal, and in judging the practicability of methods with reference to their application to the problems of the United States, it is interesting to remember that in its youth as a country (actual settlement was not begun until 1839), in its size, and in the number of its people, New Zealand is not dissimilar to some of the States in the United States. The length of the whole group of islands is 1,000 miles and the extreme width is 180 miles. The area in square miles is 104,751 and the population was 1,071,428 in 1911.