NATIONAL CENTER Series 3 

For HEALTH STATISTICS INumber 5 

VITAL and HEALTH STATISTICS 

ANALWICAL STUDIES 

pR@ER~OF ~ : 

PUBLICATIONS BRANCH 

EDITORIAL LIBRARY 

Infant and Perinatal 

Mortality in Scotland 

Analysis of infant mortality trends in Scotland by age at 

death, sex of child, cause of death, social class, and 

geographic region; maternal mortality trends; stillbirth 

and perinatal mortality trends; effect of illegitimacy on 

infant mortality; historical and geographical background 

of Scotland; and discussion of Scotland’s maternal and 

child welfare policies. 

Washington, D.C. November 1966 

[J S . DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Health Service 

wit liam H. Stewart John W. Gardner 

Secretary Surgeon General 
Public Health Service Publication No. 1000-Series 3-No. 5 

For sale by the Superintmdent of Dcmments, U.S. Government Printing Offica 

Washington, D.C., 20402- Price .35 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

FORREST E. LINDER, PH.D, Director 

THEODORE D. WOOLSEY, Deputylli~ecto? 

OSWALD K. SAGEN, PH.12,Assistant Director 

WALT R. SIMMONS,M.A.,Statistical Advisor 

ALICE M. WATERHOUSE, M.D.,Medical Advisor 

JAMES E. KELLY, D.D.S., Dental Advisor 

LOUIS R. STOLCIS,M.A.,Executive O//icer 

DONALD GREEN, bz/om-zatio~ Officer


OFFICE OF HEALTH STATISTICS ANALYSIS 

I WAO M. MORIYAMA,PH.D., Chic/ 

D1V1S1ONOF VITAL STATISTICS 

ROBERT D. GROVE, PH.11, Chic/ 

DIV1S1ONOF HEALTH INTERVIEWSTATISTICS 

PHILIPS.LAWRENCE, SC.D., Cbie/


DIV1S1ONOF HEALTH RECORDS STATISTICS 

MONROE G. SIRKEN, PH.D, Cbie/


DIVIS1ONOF HEALTH EXAM1NATION STATISTICS 

ARTHUR J.MCDOWELL, Cbie/


D1V1S1ONOF DATA PROCESSING 

LEONARD D. MCGANN, Chief


Public Health Service Publication No. 1000-Series 3-No. 5 

Library of Congress Catalog Card Number 66-60072 
FOREWORD


This is one of a group of analytical studies 

the perinatal and infant mortality problem in 

particular interest is the fact that the United 

designed to delineate 

the United States. Of 

States is not alone in 

experiencing an important change in the infant mortality trend. For a 

number of countries, infant mortality is no longer declining at its former pace. 

Although the primary concern is perinatal andinfant mortality in 

the United States, it was felt that much could be learned from the experience of other developed countries with advanced medicals ystems. The 

National Center for Health Statistics arranged with a number of investigators to prepare comprehensive reports of perinatal and infant mortality in their own countries. Contracts were negotiated with investigators in Denmark, England and Wales, the Netherlands, Norway, Scotland, 

and the United States. The report “Infant and Perinatal Mortality in the 

United States” was published as Series 3, Number 4 of the Vital and 

HeaUh Statistics of the United States. The present report for Scotland 

is the second in this group of studies on perinatal and infant mortality. 

The methodology, findings, and conclusions are those of the investigator. 

All tables of population, birth, and death data included in this report are taken. or adapted from tables published in the Annual Reports 

of the Registrar-General for Scotland. Health data from the National 

Health Services were taken from the Scottish Health Statistics of the 

Scottish Home and Health Department. 
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CONTENTS


Foreword


Introduction


Maternal Mortali~Trends


MortaliW byCause


Mortality by Geographic Region


L40rtaliW byAge


Mortality by Social Class


Stillbirths


StillbirthRates by Geographic Region ---------------------------------


Cause of Death -----------------------------------------------------


Sex ofFetus


Stillbirth Rates by Age of Mother and Parity


Stillbirths by Gestational Age and BirthWeight---


Seasonal Incidence


Social Class


Perinatal and Neonatal Mortality


First Year of Life --------------------------------------------------


First Week and FirstMonth


Postneonatal Mortality


Effect of Illegitimacy on Infant Mortality


Summary


Acknowledgment


Detailed Tables


Page 

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1 

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2 

3 

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4 

4 

4 

5 

5 

6 

9 

10 

10 

12 

12 

12 

14 

15 

16 

18 

19 
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CONTENTS—Continued 

Appendix I. Historical and Geographical Background ofScotland


Census Population ,-------------


Population Migration


AppendixII. Maternal and ChildWelfare


Beginning of Health Services


Sanitation andInfectious Disease


Infant Mortality


Legislation for Care of Mothers andInfants


National Insurance


National HealthService


Education


Other Services


Welfare Foods


Financial Aid------------------------------------------------------


Family Planning


Appendix III. Explanation of Terms U,sdh This Report


References


Page 

33 

33 

34


38


38


38


39


39


40


40


41


41


42


42


42


43


44

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IN THIS REPORT, detailed statistics are pvovided on mortality associated with birth in Scotland. The focus of attention is on decreases 

in maternal and infant mortality since 1930 and in stillbirth mortality 

since 1939. Improvement in infant mortality was chiefly in the postneonatal pem”od; little change has been observed in the fivst day of life. 

The greatest prog~ess has been in the reduction in movtality due to 

communicable diseases. Like stillbirths, movtality due to congenital 

malformations has shown no improvement since the quinquennium 1931-

35, nor has birth injuvy OY asphyxia at birth. The vate of pvematuvity is 

now one- eighth of that in 1931-35. 

Theve has been improvement in each social class gvoup, but the decline 

has been gveater fov the highev social classes. Mortality from respiratory and digestive diseases is Relatively va?’e in childven of more prosperous families, but ~espiratovy diseases still cause losses among 

those ji%ancially and intellectually less privileged. 

SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more than O but less than 0.05---- 0.0 

Figure does not meet standards of * reliability or precision 
INFANT AND PERINATAlm MORTALITY 

IN SCOTLAND 

Charlotte A. Douglas, O.B.E., M.D., D. P. H., F. R.C. O.G.’ 

INTRODUCTION more evident in the neonatal death rate than in the 

stillbirth rate for deaths from birth injury. 

In this study some of the main trends and Postneonatal deaths show a still greater class 

present levels of maternal, perinatal, and infant distinction. This is especially true of deaths due 

mortality in Scotland are discussed. to gastroenteritis, respiratory conditions, and 

All rates show substantial improvement and accidents. 

compare favorably in any international study. 

Maternal mortality at present (1963) stands at a MATERNAL MORTALITY TRENDS 

rate rather over 0.37 per 1,000 live births. All The maternal mortality, stillbirth, and early 

causes of maternal death have shown great im- infant death rates are the only accurate measures 

provement and some, e.g., puerperal sepsis and 

we have of the success of childbearing for mother 

hyperemesis gravidarum, have almost disap- and child. There is, however, no accurate measure 

peared. So far as maternal mortality is concerned of the numbers of women who may be damaged in 

social class differences have been eliminated. the birth process, though some measure may be 

The stillbirth rate is now 45 percent of the gleaned from gynecological wards and clinics. 

1939 rate and improvement has been greatest for In Scotland the maternal death rate during deaths attributable to difficult labor, ill-defined 

any given year is calculated on the basis of reg- conditions, and toxemias. The rate of stillbirth istered live births during that year. Prior to 1931 

from fetal abnormality is unchanged. Though certain causes of death in pregnant, parturient, 

women of all classes have benefited from modern and puerperal women had been classified as maobstetrical procedures and therapy, stillbirth ternal deaths, though their connection with repro- rates show definite social class distinctions. duction was one of time only. In subsequent years In neonatal mortality of infants under 7 days these deaths were relegated elsewhere and an acold in contrast to stillbirths, no improvement has 

cessory table of such deaths during pregnancy and 

been shown in death from birth injury. In other 

up to 28 days after delivery has been published words, the grosser forms of birth injury have separately. The only other significant recent 

improved but much has still to be done if early change is that in 1939 the registration of stillneonatal death is to be avoided. Fetal defects births was begun in Scotland. This allows a more 

show no improvement. Social class distinction is accurate measurement of the maternal death rate 

on the basis of a more comprehensive denominator. For long-term comparison the more recent 

IiDr. DougI as was formerly of the Departmentof Health rates have of necessity been calculated on the 

for Scotland. basis of live births alone. 

1

Mortality by Cause 

In Scotland priority is given to maternity as a 

cause of death and therefore deaths from abortion 

and ectopic pregnancy are included in the maternal mortality rate. In England and Wales deaths 

from these causes are not included in the official 

rate. 

From the beginning of registration the general 

trend of maternal mortality rate was upward. This 

was entirely attributable to the rise in the rate 

for puerperal sepsis which increased from 1.6 to 

2.5 per 1,000 live births in 1881-85 and remained 

with minor fluctuations at that level for the next 

15 years. During this period the rate for all other 

causes remained approximately 3 per 1,000 live 

births. In retrospect it is difficult to say exactly 

why the rate for puerperal sepsis rose when 

general environmental hygiene was improving, 

but the birth rate then prevailing resulted in 

overcrowding both within and without the family 

circle, in cities and towns, and overcrowding was 

undoubtedly responsible for increasing the spread 

and virulence of septic conditions within the household. For the woman giving birth to a child at 

home in such conditions the risk of infection was 

extremely high. 

Following the turn of the century deaths from 

puerperal sepsis fell but rose again in the post 

World War I period, probably again the result of 

overcrowding. After a slight decline it rose in the 

decennium 1926-35 but again began to fall in 1937. 

This 1937 fall was associated with the gradual disappearance of rachitic pelvis, which meant less 

gross instrumental and other interference during 

parturition. At this time too, there was increasing 

maternity hospital provision, making for better 

facilities for the abnormal case. From then the 

fall in the sepsis rate became more rapid, first 

with the advent of the sulfonamide drugs followed 

by the antibiotics, until at present the rate is very 

low indeed. 

In Glasgow and the surrounding urban areas 

rickets was unfortunately common in lower working class children. The severely contracted pelvis 

necessitated cesarean section and beyond the 

necessary surgical intervention caused no problem. The lesser but still considerable degrees of 

contraction necessitated difficult forceps delivery 

or if delivery was impossible then craniotomy, 

often with disastrous results to mother and child. 

“Failed forceps ,” a convenient term of obstetrical 

jargon, frequently resulted, apart from the damage 

to the child, in death from shock or puerperal 

sepsis and was in itself a not inconsiderable component of the maternal mortality rate. After World 

War I intensive educational and medical efforts 

were made to prevent the occurrence of rickets, 

so that young women grew up with better physique, 

which resulted in improved reproductive efficiency comparable with that of the rest of the . 

country where rickets in children was uncommon. 

The high mortality rate prevailing in the 

early 1920’s was a subject much discussed between the central and local authorities and the 

medical profession. The conclusion was reached 

that despite previous lack of success further 

effort was required for betterment. To find out 

the causes leading to this high death rate the 

Government proposed and made a nationwide investigation. Local authorities were asked to provide comprehensive returns with respect to every 

woman dying during pregnancy or within 4 weeks 

thereafter. The information so obtained was analyzed and commented upon in the Report on Maternal Morbidity and Mortality. 1 Apart from much 

relevant information on the factors contributing 

to a fatal issue it was found that only 42 percent 

of the infants from pregnancies ending in death of 

the mother were alive 4 weeks later, i.e., at the 

time of reporting. The main recommendations of 

the report became the basis of the Maternity Services (Scotland) Act of 1937, which differed from 

the corresponding Midwives Act, 1936 for England 

and Wales, in that local authorities were required 

to provide not only the services of midwives, but 

also the services of general practitioners and 

obstetricians with anesthetist help where necessary. 

This domiciliary midwifery service was very 

popular and in most areas covered almost all 

domiciliary births, the aim being to provide a 

unified service. Indeed, at that time, for the first 

time in history, the maternity services over the 

greater part of the country were under a unified 

control. Local authorities were responsible for the ‘ 

majority of the maternity hospitals, the work of 

the obstetricians, and the nursing staffs in them; 
in addition the general practitioner was paid by 

the local authority during the period in which he 

was in charge at a domiciliary confinement. Midwives and nurses were local authority employees, 

and prenatal clinics whether housed in local 

authority or hospital premises were part of the 

same service. The unity of control had a greatly 

beneficial effect on the efficiency of the service; 

it developed a habit of coordination between doctor, nurse, and obstetrician which still prevails 

even though under the National Health Service 

(Scotland) Act the maternity services are now 

organized in three parts. 

Not all areas had adopted these measures 

before 1939 when at the start of the Second World 

War the necessity to remove expectant women 

from areas likely to be targets for enemy action 

made the creation of emergent y maternity hospitals necessary. These hospitals were placed 

where the need for them was greatest, and, as 

the y had the services of skilled obstetricians, 

they were so greatly appreciated locally that most 

have continued since. 

The decline in maternal mortality began in 

1935 and with the exception of a small rise during 

1941 the rate has fallen steadily, admittedly more 

slowly in the last few years, until 1960 when it 

reached a record low level of 0.35 per 1,000 

births, The rate rose fractionally to 0.39 per 

1,000 births in 1962 but fell again slightly in 1963, 

and indications are that a further fall will be 

experienced in 1964. 

In Scotland there is now good provision for 

maternity care, including skilled care for all abnormalities, which, combined with the widespread 

practice of antenatal care, ensures that emergencies in this field are few, that surgical and 

other interference during parturition is a matter 

of election and not of urgency. This is borne out 

in table 1. 

It will be realized that in a small country 

like Scotland the actual number of deaths in each 

cause group is so small in anyone year that rates 

calculated on such figures would lead to considerable fluctuation. Accordingly triennial periods 

have been used on which to base rates and table 1 

shows these rates from 1931-63. The cause list in 

table 1 is that in use for the years 1931-33 and 

the detailed list of the subsequent triennia has 

been compressed to it for purposes of comparison. 

For each of these groups of causes there has been 

great improvement, but favorable experience 

varies in degree and in time of onset. In the 

toxemias, hyperemesis gravidarum began to improve in the early 1940’s and has now almost 

disappeared, as have other toxemias. But though 

eclampsia and both antepartum and postpartum 

toxemias have shown a gradual reduction they 

still remain as a definite entity in the maternal 

mortality rate. The same is true of death from 

embolism. Every method known to medical science 

has been used to prevent deaths from embolism 

but so far without complete success. In recent 

years, with the increase of maternity hospital 

provision and availability of obstetric specialists, 

there is plenty of room for early admission to 

hospital of cases known to have low set placentas 

and of women likely to exhibit abruption of the 

placenta; indeed, there have been only two deaths 

from placenta previa as a complication of pregnant y in the last 10 years and none from antepartum hemorrhage since 1960. Abortion, whether 

natural, therapeutic, or deliberate still exacts 

its toll and further education in prevention of 

pregnancy is necessary because, in the main, such 

deaths occur in women with families. Further reduction in maternal deaths now depends almost as 

much on the woman herself as on the services 

provided. 

Mortality by Geographic Region 

For many years the Northern Region of the 

country, despite at times difficult climatic conditions and distances from specialist institutional 

care, returned on the average favorable rates. 

However, in the last 20 years there has been improvement throughout the land and all areas have 

benefited equally the overall rate now varies 

from 0.3 to 0.4 per 1,000 total births and the 

number of deaths in any one area is so small that 

even a single death noticeably influences the rate. 

Mortality by Age 

There has been a great reduction in the 

general death rate of women as well as in the 

maternal death rate. Table A shows the general 

3 2Mi-KLi O - M -2 
Table A. Death rates (all causes) of 

women in the reproductive age period: 

Scotland, 1911-63 

Year 

Rate per 1,000 women in 

specified age group 

1963-------- 0.4 

1962-------- 0.4 ;:: ::: 1961-------- 0.4 0.8 5.5 

1956-60----- 1.0 

1951-55----- EN 1.5 M 

1946-50----- 3.0 6.5 

1941-45----- M 3.3 

1936-40----- 2.6 ;:; 

1931-35----- 2.8 ::; 

1926-30----- 4.1 1::: 

1921-25----- ::; 4.5 10.1 

1916-20----- 4.4 6.2 11.6 

1911-15----- 3.9 5.6 12.7 

mortality rates forwomenbydecennialagegroups 

in the reproductive period. In each age group 

there has been a downward trend since World 

War LTheimprovement in the age groups 15-24 

and 25-34 years, in which the majority ofparturients are included, is such that the death rate 

in 1963 was about one-eighth of that recorded 

in 1916-20. Itis obvious, therefore, tbat present 

dayparturients are on the average ofmuchbetter 

physiologic condition than those during World 

War Ianditmay be assumed that part of thedecline in maternal mortality mustbe ascribedto 

the improved general health ofwomen as wellas 

to the better all-round maternity services. 

Mortality by Social Class 

In a paper on social C1$SS differences of 

maternal mortality in Scotland” McKinlayshowed 

that the maternal mortality rate in 1939-40, 

age-standardized by social class, was lowest 

in classes I and II and highest among unmarried 

women as a group. In 1944-50thetotal age-standardized rate had fallen by 53percent. This reduction pertained almost equally at all age periods 

throughout the reproductive span. The smial 

classes each participatedin the improvement but 

the greatest relative and absolute change was for 

unmarried mothers (a decrease of 69 percent). 

This general decrease was naturally least in 

classes I and II, the classes with the lowest maternal mortality rates. In the years 1960-62 the 

rate for all classes fell further and is now so low 

that all class distinctions have disappeared. 

STILLBIRTHS 

The Registration of Stillbirths (Scotland) 

Act was passed in 1938 and registration of stillbirths began in 1939. 

In Scottish Law the definition of a “Stillbirth” 

is as follows: 

A child which has issued forth from its mother 

after the 28th week of pregnant y which did not 

breathe or show any other sign of life. 

Before the beginning of stillbirth registration 

knowledge of the number of stillbirths occurring 

had to be gleaned from the annual and other reports made by Medical Officers of Health. Though 

these reports were reasonably accurate it was 

difficult to get a clear picture of the exact fetal 

loss . 

The present registration form is comprehensive and gives particulars of marital status, sex 

of child, age of parents, parity, weight of fetus, 

period of gestation, social class, cause of death, 

and place of occurrence. 

Stillbirth Rates by Geographic Region 

Table 2 shows the Scottish stillbirth rate 

year by year since registration was begun in 1939. 

In the past 25 years the national rate has fallen 

to less than half. Though generally there has been 

improvement in all geographical areas, the Northern Region has maintained the best experience. 

This region includes the islands of the northwest 

and many very sparsely populated landward areas, 

some with long distances from hospitals and 

clinics. Despite geographical and climatic difficulties in this area, the rural medical and nursing 

services for pregnant and parturient women are 

good, but it may be that the excellent biological 

condition of the people is in part accountable for 

these very favorable rates. 

Urban existence in itself, however, cannot 

be blamed for the higher rate in cities and large 

burghs, for when the rates for the four largest 

4 
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cities in Scotland for the 3 years 1960-62 are calculated, the position is as follows: 

Stillbirth 

rate per 

1,000 total 

Live biyths Stillbirths births 

Aberdeen-- 9,788 178 17.9 

Dundee---- 11,170 216 19.0 

Edinburgh - 25,569 465 17.9 

Glasgow--- 71,081 1,655 23.3 

It will be seen that the stillbirth rate for 

Glasgow is less favorable than the rates for the 

other three cities. The individual rates per 

1,000 total births for 1961, 1962, and 1963 for 

each city make this point even more clear: 

1961 1962 1963 

Aberdeen 15 18 15 

Dundee --------- 16 18 19 

Edinburgh 19 16 18 

Glasgow 23 22 21 

Since there is readily available skilled care 

and ample hospital accommodation in all four 

cities, lack of skillor accommodation cannotbe 

blamed for the difference in rates. Some other 

factor must be influencing the rate for Glasgow 

and this, in all probability, is due to the higher 

proportion of high parity families in the poorer 

classes. 

Cause of Death 

In table 3 the stillbirth rates per 1,000 total 

births by cause of death from 1939 through 1963 

are given, During these years, while the total 

rate has been more than halved, the rates for 

some causes have progressed more favorably 

than others. There has been little change in the 

rate for acute and chronic diseases in the mother. 

Syphilis, formerly a prominent cause of stillbirth, 

cm now be dealt with effectively. The decline in 

plticental and cord conditions has been slow, and 

the rate is still 90 percent of the rate at the beginning of registration. There is obviously room 

for research into the causes of placental insufficiencyy, infarcts, and antepartum hemorrhage; 

also, more thought probably could be devoted to 

methods of avoiding pressure on the cord during 

parturition. The rate due to difficult labor and 

birth injuries is 25 percent of its former level and 

some of this improvement can be ascribed to the 

disappearance of rickets and the deformed pelvis. 

Modern care of the hypertensive and the 

toxemic patient and also the absence of chronic 

nephritis arising from complications of scarlet 

fever and other hemolytic streptococcal infections 

in youth have reduced the rate for toxemias to 

40 percent of its former level. Despite considerable research and increase in knowledge of the 

causes of fetal defects there appears to be little 

that can be done to prevent them because the 

origin of these defects lies very early in existence, and at times before the woman herself is 

aware of pregnancy. 

The rate for ill-defined and unknown causes 

has dropped chiefly because in the latter years 

there has been an increasing interest throughout 

the country in stillbirth and neonatal pathology. 

Autopsy is performed when the exact diagnosis is 

in doubt. 

Sex of Fetus 

The sex of the fetus and its effect on stillbirth arouses some interest, as the ratio of male 

to female stillbirths has changed in recent years. 

In the earlier years of registration the excess of 

the male rate over the female gradually decreased 

until in 1956 the female rate became greater than 

the male rate and has remained so until now. The 

increase in the female rate is entirely due to conditions affecting the central nervous system. In 

all other causes the rate for the male exceeds that 

of the female. 

In table B the stillbirth rates by sex and 

cause are shown for the periods 1941-43 and 

1961-63. There has been improvement in the total 

rate between the triennium 1941-43 and that of 

1961-63. In the earlier period for all cause of 

death groups except fetal defects, the male fetus 

had a worse experience than the female. In the 

period 1961-63 the male fetus in most cause 

groups had a slightly worse experience than the 

female except for fetal defects and only in those 

affecting the central nervouss ystem. In ill-defined 

or unknown causes and toxemias the differences 

5 
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Table B. Stillbirth rates by sex and cause of death: Scotland, 1941-43 and 1961-63 

Cause of deathl 

Male


All causes (Y30-Y39)


Acute and chronic diseases in mother---------(Y3O, Y31) 

Toxemias (Y32.1, Y32.3-Y32.5, Y33) 

Antepartum and other hemorrhages---(Y32.2,Y36.1-Y36.4) 

Other placental and cord 

conditions (Y36.0, Y36.5, YM&;j 

Fetal defects 

Difficult labor and birth injuries-----------(y34,Y37) 

Other defined causes (Y32.O, Y35, Y39.O-Y39.3) 

Ill-defined and unknown causes (Y39.4-Y39.6) 

Female


All causes (Y30-Y39) 

Acute and chronic diseases in mother---------(Y3O, Y31)


Toxemias (Y32.1, Y32.3-Y32.5, Y33)


Antepartum and other hemorrhages---(y32,2,Y36.1-Y36.4) 

Other placental and cord 

conditions (Y36.0, Y36.5, Y36.6) 

Fetal defects -----(Y38) 

Difficult labor and birth injuries-----------(y34,Y37’) 

Other defined causes (Y32.O, Y35, Y39.O-Y39.3) 

Ill-defined and unknown causes (Y39.4-Y39 .6) 

Year


1961-63 1941-43 

Rate per 1,000 total births


19.4 39.9 

0.7 

M 

3.6 

3.1 2: 

2.0 9.5 

20.6 35.4 

0.5 

1.6 

2.7 

3.6 4.1 

6.7 7.9 

1.6 

M 

M 6.7 

~See Appendix 111 for explanation of comparability of cause-of-death classifications,


between the rates are slight despite amale preponderance, but in other defined causes the male 

rate is greaterthanthatofthefemale.The improvement of bothmale and femaleratesisrelativelyand absolutely greatest
fortoxemiasand

difficult
 labor.


In table4 rates for each trienniumsince


1950 show again in detail that itis in conditions 

of thecentral nervous system thatthefemale fetus, 

when compared withthe male, issogreatlyaffected,especially inanencephalus and spinabifida.In hydrocephalus, though on the whole the 

female rate is higher than that of themale, the 

female preponderance is not so great. In these 

types ofmalformation which wouldappear tostem 

from the same cause an explanationis noteasyto 

find. 

Stillbirth Rates by Age of Mother 

and Parity 

Table 5showsthe stillbirth
 ratesfrom 1939


through1963 for the various quinquennia of the 

reproductive age periods. The presentrateisnow 

45 percent of the rate of1939. At all age periods 

the rate has fallenandthroughout the years womenofthe 20-24 age group have had the best experience. Women of both this agegroup and the 

25-29-Year group are less likely to produces 

stillbirth than are young women under 20yearsof 

age. The liability forastillbirthincreases rapidly 

in the later age groups. The rate for illegitimate 

stillbirths is always higher than that for the legitimate, but thesedifferences are notreliablesince 

the actual number of illegitimate stillbirths born 

6 
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Table C. Stillbirth rates by age of mother and cause of death: Scotland, 1963 

Age of mother 

Cause of death 

All Under 20-24 25-29 30-34 35-39 40 years 20 

ages years years years years years and over 

All causes (Y3O-Y39) 19 

Acute and chronic diseases 

in mother-------------(Y3O. .———,Y31) 0.5 

Toxemias-(Y32.l,Y32.3-Y32.5, Y33j 1.4 

Antepartum and other hemorrhages---- (Y32.2, Y36.1-Y36.4) 3.1 

Other placental and cord conditions (Y36.0, Y36.5, Y36.6) 

Fetal defects (Y38) N 

Difficult labor and birth 

injuries--------------(Y34, Y37’) 1.8 

Other defined 

causea-(Y32.0, Y35, Y39.O-Y39.3) 1.0 

Ill-defined and unknown 

causes (Y39.4-Y39.6) 2.6 

to women of all age periods issmaH (131, 150, 

and 146 in 1961, 1962, and 1963, respectively). 

There is also the fact that many of these stiUbirths are products of a first pregnancy which 

carries a higher risk of fatali~. The number of 

illegitimate stillbirths, however, is so small that 

it has little effect on the national rate. 

As has been shown in respect to stillbirths 

in general, age of mother has an influence on the 

individual causes. Table C shows this for 1963. 

In this year for mostcauses womeninthe younger 

age groups had the best experience. Stillbirths 

occurring as a result of toxemias, antepartum 

hemorrhage, and placental andcord conditionsincreased with themother’s advancing age. On the 

whole the lowest rates were obtained for women 

of the 20-24 and 25-29 age groups. Surprisingly, 

the younger women, the under 20agegroup, had 

a higher rate for acute and chronic diseases in 

the mother and for fetal defects. Itmaybe thatas 

a group they are more careless about general 

health and live in circumstances where thereis 

Rate per 1,000 total births 

17 16 16 22 31 42 

M 0.2 0.4 0.7 0.9 

1.3 1.2 1.2 3.0 ::? 

2.8 2.2 2.8 3.6 5.6 5.8 

11.7 

::: ::: N ::: u 7.6 

1.5 1.3 1.5 2.3 2.6 4.5 

0.7 0.8 1.7 2.5 1.0 

2.5 2.5 2.2 2.6 3.9 5*5 

more liability to current infections. The pattern 

was the same in previous years. 

Table 6 shows the stillbirth rates oflegitimate births by parity from 1946 through 1963. 

Throughout the period the risk has been above 

average for the first birth, has fallen to a minimum for the second birth, and after that the rate 

has risen with parity. In the higherparitiessmall 

numbers make theratesunstable. Paritynaturally 

increases with age and the data forageand parity 

show that after the first birth, as a rule, the 

younger the mother, thelower the parity, and the 

less the likelihood of astil.lbirth. Itis difficult to 

assess whether age or parity has thegreaterimportance. 

Table D shows the combined effects of age 

and parity for the 3 years 1961-63 andagain even 

with increasing parity the age group 20-24 years 

has the best experience. Adequate spacing of births 

must also be of importance, as within each age 

group increasing parity shows an increase in 

mortality. But, even though increasing age of 

7

---------------

------------------

------------------

------------------

------------------

------------

----

-----

---------------

------------

------------

----------

Table D. Stillbirth rates of legitimst;9~~;i&sby age of mother and parity: Scotland,


Age of mother


I Rate per 1,000 total legitimate stillbirths


All ages---------------w= — 20.3 -

19.2 14.1 17.5 22.7 —31.6 

Under 20 years 17.3 17.5 16.0 13.3 

25-29 years 17.0 20.6 15.7 12.6 16.3 19.3 23.i 

30-34 years 22.1 26.6 20.8 16.8 18.4 21.9 28.7 

35-39 years 29.1 31.8 28.6 22.1 22.9 27.8 36.2 

40 years and over 42.9 22.0 44.7 39.3 37.3 45.8 48.5 

I II I II I I I 

20-24 years 16.1 18.0 13.4 11.9 1::; 17.; 

mother coupledwithincreasing paritycan exert 90 percentof stillbirths
 takeplaceinmaternity


some influence on theratesitwould seem that institutions
presumably these occur despite


age and parityhave lesscombinedeffect on the skilled care,afactpreviously
notedby McKinlay


nationalratethanmight be expected. As almost who statedthat“whiletheinfluence
of age and


Table E. Stillbirth rates of legitimate birth: by cause of death and parity: Scotland, 

lYbl-63 

All parities Primiparae I Multiparae


Cause of death


1963 1962 1961


Rate per 1,000 total legitimate births


All causes (Y3O-Y39) 18.7 19.5 20.4 19.3 20.0 20.9 18.3 19.2 20.2


Acute and chronic diseases


in mother----------(Y3O, Y31) 0.5 0.6 0.7 0.6 0.7 0.5 0.5 0.5 0.7


ToxemiaS (Y32.1,


Y32.3-Y32.5, Y33) 1.4 1.7 1.8 2.1 2.3 2.8 1.0 1.3 1.3


Antepartum and other


hemorrhages-----------(y32.2,


Y36.1-Y36.4) 3.1 3.4 3.3 2.6 2.8 3.2 3.3 3.7 3.4


Other placental and cord


conditions


Y36.5,(%:;j 3.3 3.7 3.7


Fetal defects (Y38) M ::: 5.4 5.2 ;:! 5.7 ::: ::$ H


Difficult labor and birth


injuries-----------(Y34,Y37) 1.7 1.7 1.9 1.9 1.7 1.8 1.7 1.7 1.9


Other defined causes---(Y32.0,


Y35, Y3900-Y39.3) 1.0 1.0 1.1 0.3 0.2 0.2 1.4 1.4 1.5


Ill-defined and unknown
 causes (Y39.4-Y39.6) 2.5 3.2 3.0 3.0 3.8 3.0 2.2 2.9 3.0


8

--------- --------------

-----------

-----------

---------

Table F. Stillbirth rates by cause of death and period of gestation: Scotland, 1961-63 

Period of gestation 

Cause of death 

28 weeks 28-31 32-35 36-39 40-43 44 weeks Not 

and over weeks weeks weeks weeks and over stated 

Rate per 1,000 total births 

All causes---- (Y3O-Y39) 19.9 2.7 4.6 6.3 5.5 0.1 0.7 

Acute and chronic diseases 

in mother (Y3O, Y31)

Toxemi.as 

0.6 0.l 0.1 0.2 0.1 0.O 0.0 

Y32.3-Y32.~3$ij 1.6 0.3 0.5 0.5 0.3 0.O 

Antepartum and other 

hemorrhages----------(y32.2, 

Y36.1-Y36.4) 3.1 0.6 0.9 1.2 0.4 0.0 0.1 

Other placental and cord 

Y36.5, Y36.6) 

Fetal defects (Y38)

Di,ffi,cult labor and birth 

H 

0.4 

0.6 

0.5 

1.5 M 

1.6 

1.0 

0.0 

0.0 M 

injuries----------(Y34, Y37) 1.8 0.1 0.2 0.5 1.0 0.0 0.1 

Other defined causes-- (y32.O, Y35, Y39.O-Y39.3) 1.0 0.2 0.3 0.4 0.1 0.O 0.0 

Ill-defined and unknown 

causes (Y39.4-Y39.6) 3.0 0.5 0.6 0.9 1.0 0.O 0.2 

conditions (Y36 .0, 

parity of the mother are of some importancein 

determining the outcome of a specific pregnancy 

for mother and child, the actual numerical influence on the falling rates is negligible andexplmationsofthe mortalitychanges mustbelooked 

for elsewhere. “:] 

Table E shows the stillbirth rates for the 

main causegroups byparityamong married wornen. The meager effect on the total rate of the 

higher parities bears out the conclusion that improvement in the rate indeed must be looked for 

elsewhere than in age and parity. The table itself 

shows a somewhat heavier rateamongfirstbirths 

in respect oftoxemias, placental andcordconditions, and fetal defects, but their rate is more 

favorable for antepartum hemorrhage and other 

defined causes. It would seem, therefore, thatso 

far us the obstetrician is concerned even more 

attention in research, antenatal, and intranatal 

care should be paid to the primigravida. 

Stillbirths by Gestational Age 

and Birth Weight 

Stillbirths bycause of death, gestational age, 

and birth weight were registered for the first 

time in 1961 andas the actual numbers by cause 

of death for a single yearare toosmall to permit calculation ofrates ofany real value the figures for the years 1961-63 have been combined. 

Even with a 3-year combination some rates are 

still small. 

TableF shows stillbirths bycauseandperiod 

of gestation. About 60 percent take place between 

the 36th and the 43dweeks ofpregnancy. In this 

period the chief causes of death are placental 

conditions including antepartum hemorrhage and 

fetal defects—indeed these are the main causes 

inal..l periods ofgestational age. 

In table 7 stillbirths by cause of death and 

birth weight have been computed over the same 

9 
---------

--------------

----------------

---------------

--------------

Table G. Quarterly stillbirth rates by cause of death: Scotland, 1961-63 

Quarter 

Cause of death First Second Third I?ourth 

All 

quarters January- April- July- March June September 

OctoberDecember 

Rate per 1,000 total btrths 

All causes (Y3O-Y39) 20.0 20.1 19.8 20.2 19.8 

Acute and chronic diseases 

in mother (Y30, Y31) 0.6 0.4 0.6 0.6 0.7 

Toxemias-(Y32.1, Y32.3-Y32.5, Y33) 1.7 2.0 1.6 1.6 1.4 

Antepartum and other 

hemorrhages-- (Y32.2, Y36.1-Y36.4) 3.2 2.7 3.2 3.2 3,5 

Other placental and cord 

conditions-- (Y36. O, Y36.5, Y36.6) 3.8 

Fetal defects (Y38) 2:: ::: 2:$ 5.1 ::; 

Difficult labor and birth 

injuries (Y34 ,Y37) 1.8 2.0 1.8 1.8 1.7 

Other defined 

causes--(Y32.O, Y35, Y39.O-Y39.3) 1.0 1.0 1.1 1.1 1.1 

Ill-defined and unknown 

causes (Y39 .4-Y39 .6) 3.0 3.3 3.0 3.0 2.9 

3-year period. Ofthese approximately 70percent pear to be more frequent in summer. As the 

occurred before the fetus reached aweightof 7?4 majority of these originate early in intrapounds and ofthese one-quarterwere attributable 

to fetal defects. 

In determining viability theperiodofgestation is of considerable importance totheobstetrician especially in circumstances where too 

early interference may jeopardize theinfant’slife 

and even more its future mental ability. These 

considerations have to beweighedagainstthepossibility of damage to the mother. It is difficult 

to assess the relative effect of birth weight and 

gestation age as both are interdependent. Tables 

Fand7 are chiefly of importancein showing that 

present knowledge of placentalpathology requires 

that much more study and considerationbe given 

to the infant during parturition. 

Seasonal Incidence 

To determine whether seasonal changes have 

any effecton the causes of stillbirth, tableG has 

been compiled for theyears 1961- 63.Frommonth 

to month the incidence in each causegroupvaries 

comparatively little except that fetal defects ap10 

uterine life it may have been that the women 

concerned had been exposed to more infections 

than usual in early pregnancy. When quarterly 

rates are considered it would seem to confirm 

that stillbirths due to fetal defects are slightly 

more common in summer. But, on the whole the 

season of the year has no effecton the probability 

of a pregnancy resulting in a stillbirth. 

Social Class 

In the Scottish Registrar-General’s Reports 

social classes are defined according to the occupation of the fatheras stated at birth registration in accordance with the “Classification of 

Occupations, 1960.”4 

Social class I—professional, etc., occupations 

H-intermediate occupations 

lll—skilled occupations 

IV—partly skilled occupations 

V—unskilled Occupations 
-----------------------

---------------

---------------------

---------------- ------------------------------

-----------------------

---------------

---------------- ------------------------------

Table H. Stillbirth rates of legitimate births by cause of death and social class:


Scotland, 1950-63


1959-63 1956-58
 I

I 

1 I I 

Cause of deathl 1


and


11


Rate per 1,000 total


legitimate births


All causes (Y30-Y39) 14.8 19.8 23.8 19.5 22.0 27.1 

Acute and chronic diseases in mother--(Y3O, Y31) 0.5 0.6 0.7 0.6 0.6 0.8 

Toxemias (Y3201, Y32.3-Y32.5, Y33) 1.3 1.7 1.8 2.0 2.1 2.1 

Antepartum and other hemorrhages (Y32.2, Y36.1-Y36.4) 2.3 3.3 4.2 2.7 3.3 4.6 

Other placental and cord 

conditions (Y36.0, Y36.5, Y36.6) 

Fetal defects (Y38) 

3.2 

2.8 ::; 

4.2 

5.8 

4.1 

3.8 

4.1 

5.0 

4.7 

6.1 

Difficult labor and birth injuries----(Y34,Y37) 2.0 2.4 2.2 2.6 3.2 

Other defined causes---(Y32.O, Y35, Y39.O-Y39.3) 

Ill-defined and unknown causes-----(Y39.4-Y39.6) 

::? 

2.5 

1.0 

2.9 ::: 

1.2 

3.0 

1.0 

3.3 M 

1953-55 I 1950-52 

Cause of death


Rate per 1,000 total


legitimate births—Con.


Acute and chronic diseases in mother--(Y3O, Y31) 

Antepartum 

Toxemias 

and other hemor-

(Y32.1, Y32.3-Y32.5, Y33) m 0.6 

2.0 

0.7 

2.5 

1.0 

2.4 

rhages---------------------(Y32.2,Y36.1-Y36.4) 2.7 3.5 4.2 3.3 3.6 4.5 

Other placental and cord 

conditions (Y36.0, Y3605, Y36.6) 3.7 4.4 5.2 3.9 4.0 4.9 

Fetal defects (Y38) 3.3 5.0 :.; 5.7 

Difficult labor and birth injuries----(Y34,Y37) 3.4 . 2:; ;:: 5.2 

Other defined causes---(Y32.O, Y35, Y39.O-Y39.3) i:; 1.1 0.6 1.1 

Ill-defined and unknown causes-----(Y39.4-Y39.6) 3.0 3.5 U 3.3 3.9 

All causes (Y30-Y39) 21.5 25.4 ] 29.5


1 r 

Isee APPendix II_ffor exPl~n~tio~ of comparability of CaUSf? -of-death classifications. 

Table 8 shows stillbirth
 ratesaccordingto


these socialclasses.The actualnumbers in


classesI and IIare smalland so make therates


somewhat unstable,
but the tableshows clearly


thatthoughtherateshave falleninallclasses,


disparity
of theratesbetweenclassIandclass


Vis now greaterthanin1939.


Mw-635 O - G6 - 3 

When thenumbers of stillbirths
 in classes


Iand II,and IV and Varecombined,itimpossible


to calculatemore stablerates for groups of


causes of death by socialclass,as shown in


tableH. Itis in such conditions
 asantepartum


hemorrhage, fetaldefects,difficult
 labor,and


11

ill-defined and other causes that there is the 

greatest difference between the combined classes 

I and II, and IV and V. In 196390 percent of stillbirths took place in maternity institutions where 

obstetrical skill is available, so lack of adequate 

attention should seldom be called in question. 

There is always a difference of between 8 and 

10 per 1,000 stillbirths between combined classes 

I and II, and IV and V; this difference has persisted despite a falling rate during the past 12 

years. The excess is greatest as has already been 

said in antepartum hemorrhage, fetal defects, and 

difficult labor. Presumably the biological condition of women in classes I and II is better than 

that of women of the less privileged classes; also 

it is highly probable that their intelligence is such 

that they themselves are able to give consideration 

to and to secure treatment for any early departure 

from complete well-being. Such women are also 

likely to ensure that their pregnancies will be so 

spaced that they are fully restored to health in the 

intervals. It is difficult to account for the preponderance of fetal defects in classes IV and V, 

except by biological selection, lack of intelligence, 

or a greater liability to infection by viruses or 

other organisms. 

PERINATAL AND NEONATAL 

MORTALITY 

First Year of Life 

In Scotland the infant mortality rate, which 

had been falling gently since the turn of the centur y, began to fall rapidly after 1941. Analysis 

shows that the improvement was chiefly in the 

postneonatal period. Such betterment as there was 

in the first month of life was between the ages of 

1 week and 1 month. There was some improvement in the 1-6 day period but very little in the 

first 24 hours. In table 9 the infant mortality rates 

by ages under 1 year show the yearly progress at 

all age periods from 1936 through 1963. The table 

shows that the infant mortality rate has now fallen 

to less than one-third of its value in 1936, but the 

rate for deaths in the first day of life shows 

comparatively less change and has fallen about 

28 percent in that period. 

First Week and First Month 

For some time attention had been focused on 

infants during their first month of life. Soon the 

realization followed that it was almost a matter of 

chance whether some infants would be born live 

or still, and that many of the causes of early infant 

deaths, similar to those of stillbirth, were attributable to conditions of intrauterine rather than 

extrauterine life. Because of the similarity of the 

causes of stillbirth and early infant deaths, the 

term ‘‘perinatal mortality” has been adopted to 

cover stillbirths and deaths in the first week of 

life. The perinatal mortality rates now are approximately half those of 1939, when stillbirths 

were first registered. 

The attention already directed on stillbirths 

and deaths in early infancy emphasized the differences between the stillbirth and infant death 

codings and because of these differences the need 

for a perinatal death rate was felt to be essential. 

Considerable thought and discussion were given to 

the matter of a cause list for the combined mortalities. It was felt that the stillbirth cause list 

in use was in the main satisfactory and that any 

combined list should interfere as little as possible. 

In 1958 as an experiment the causes of infant 

deaths in the first month of life were coded to the 

stillbirth rubric. This classification has been 

continued. 

The figures tabulated for the years 1958 and 

1959 showed that about 98 percent of deaths occurring in the first 24 hours of life and 95 percent 

of those occurring in the first week of life could 

be satisfactorily classified to the stillbirth cause 

list. Indeed in the first 28 days of life over 90 

percent of deaths could also be so allocated. 

Table 10 has been compiled for the years 

1960-62. In this table the stillbirth and neonatal 

death rates per 1,000 total births are classified 

according to the stillbirth rubric. 

Table 10 brings out the contention that most of 

the important individual causes of death operate in 

both parts of the perinatal death rate. With respect 

to stillbirth, causes ascribed to diseases and conditions of pregnant y and childbearing, placental 

and cord conditions, and congenital malformations 

operate more importantly than in early life. Conditions which survive birth and cause death in the 

12 
first 6 days of life are birth injuries, congenital 

malformations, and asphyxia and atelectasis. 

The outstanding causes ofneonatal deaths are 

likewise immaturity, asphyxia, and birth injury. It 

would appear that environmental influences on the 

whole play little part in the causation of death in 

the first month of life as long as the child is born 

fit and strong. 

Throughout the period 1931-63 the death rates 

from congenital malformations at all ages have 

shown no improvement. In recent years much research has gone into the causes of fetal abnormality and, though more is now known about their 

origin and development, not enough information is 

available to prevent their occurrence or even to 

have any real effect on the stillbirth or infant 

death rates. Presumably one of the reasons for 

this is that these abnormalities originate early 

in pregnant y— some even before the woman is fully 

aware that she is pregnant. 

Injury at birth has shown no improvement 

thoughout the period under review (1939-63), 

which is surprising in view of the great extension of maternity hospital provision and of the 

increase in the number of skilled obstetricians 

since 1931. Also in the earlier decades of the 

century rickets and in consequence deformed 

pelves were causes of difficult labor in large 

numbers of women, but nowadays a deformed 

pelvis is comparatively rare. It is not easy to 

account for this lack of improvement in the rate 

for birth injury in the Iiveborn child, although 

there has been some reduction of injuries sufficient to cause stillbirth. 

Of the causes of diseases of early infancy the 

greatest decrease has been shown in debility and 

prematurity, the combined rate for these conditions having fallen from 27.3 to approximately 

3.8 per 1,000 live births. 

Table 11 has been compiled to show the effects 

of age of mother, birth order, and social class on 

perinatal mortality. At all ages and for all parities 

the rates increase with lowering social status. 

For all social classes the death rates of children 

born to parturients under 20 years of age are 

higher than those for children born of women in 

the 20-30 age groups; above age 30 the rates increase rapidly. For most classes and most ages 

the rates for firstborn children are higher than 

those born of the second and third pregnancies; for 

the fourth and subsequent pregnancies the rates 

rise steeply. Parity and age of the woman indicate that when pregnancies follow too rapidly 

the prognosis for the latest child is poor. 

It would seem therefore that increasing care 

of the pregnant woman, improvement of her physical condition, and reasonable spacing of pregnancies all play a part in the successful outcome 

of any individual pregnancy, but these factors are 

difficult to measure and evaluate separately. 

Table J shows that though women of all 

social classes have benefited from modern care 

during pregnancy, parturition, and the early postnatal period, at present the rates for classes I and 

II are approximately half of those of IV and V. 

This disproportionate smial class difference has 

persisted since these rates were first calculated 

in 1939, despite equal hospital and specialist care, 

and probably lies in the physical superiority of 

the higher class woman and in her greater intelligence in making full use of the services available 

and in successful family planning so that each 

newly born child can have adequate maternal care 

for perfect nurture. 

The reason for these class differences in 

reproductive efficiency is not easy to evaluate and 

it would appear that measurable biological indices 

such as age and parity are not the whole story. 

There seem to be other biological and social factors which affect pregnancy outcome despite 

readily available medical care during the antepartum, intrapartum, and postpartum periods. 

Kincaid working on information collected in the 

National Perinatal Survey and also on more detailed aspects of the social data studies in Aberdeen maintains that it is “not isolated factors but 

whole patterns of behaviour” 5 which must be considered, in fact the whole way of life of the women 

concerned. The close association between maternal stature and the outcome of pregnant y was first 

noted by Sir Dugald Baird and confirmed by the 

results of the Perinatal Mortality Survey.b It 

has been found that tall women tend to have lower 

stillbirth rates than women of medium height 

and these women in turn experience lower rates 

than women of even lower stature. Illsley and 

Kincaid (1963)7 showed that the association between maternal stature and perinatal mortality 

holds even when socioeconomic group and parity 

are simultaneously controlled. Kincaid has suggested that a tentative explanation of this may be 

that though potential height may be determined 

13 
Table J. Neonatal mortality rates by social class: Scotland, 1939 and 1946-63 

Social c’lass 

Year 

I II III Iv v 

1963-------------------------------

1962-------------------------------

1961-------------------------------

1960-------------------------------

1959-------------------------------

1958-------------------------------

1957-------------------------------

1956-------------------------------

1955-------------------------------

1954-------------------------------

1953-------------------------------

1952-------------------------------

1951-------------------------------

1950-------------------------------

1949-------------------------------

1948-------------------------------

1947-------------------------------

1946-------------------------------

1939-------------------------------

Rate per 1,000 live births 

13.2 15.8 19.3 22.3 12? 12.9 17.2 20.2 22.9 

13.3 13.2 17.7 19.5 21.6 

13.0 17.2 17.1 20.7 21.0 

13.7 16.4 18.8 20.5 24.0 

15.0 14.2 18.4 18.4 24.2 

14.1 16.4 19.5 20.1 22.2 

11.0 13.5 19.0 22.0 22.1 

15.8 16.7 18.3 22.4 24.3 

13.4 16.0 20.8 20.7 25.6 

14.8 16.2 19.0 21.4 22.0 

12.9 18.2 21.8 23.2 24.2 

14.6 15.2 22.1 23.3 29.7 

20.0 16.5 22.7 24.9 28.5 

13.7 17.9 22.6 24.4 31.3 

15.0 16.4 24.6 28.7 30.5 

17.8 19.3 27.2 29.7 :;.: 

16.7 25.0 29.3 31.1 

25.9 25.1 38.6 34.8 39:9 

genetically, actual height depends inexperience 

of nutrition and family care during the periodof 

growth. In other words as the number ofchildren 

in the family increases, scarcityofresourcesand 

maternal care begins tohavealong-termeffecton 

the stature of the children. In women who have 

been born into families of nonmanual workersa 

steep rise in the stillbirth rates does not come 

until the woman hasfourormore siblings whereas 

in the unskilled manual group there is an appreciable rise between the no-sibling and the onesibling categories. Thus, it would seem, thatin 

some measure thereproductiveoutcome ofwomen 

reaching childbearing ageispredeterminedwithin 

a matrix of biological, medical, and social influences; therefore, in this country long-term 

measures are necessary to improve the physical 

and social environment of the future childbearing 

women now growing up. 

POSTNEONATAL MORTALITY 

Earlier in this study it was stated that, while 

the first year of life is a convenient statistical 

unit of time, insofar as the individual causes of 

14 

death are concerned it can be divided into two 

periods. It has been shown already that in the 

first month oflife the maincauses ofdeath derive 

from intrauterine conditions andintrapartum procedures. Those occurring after the first monthof 

life withone exception,congenital malformations, 

are connected chiefly withenvironmentalcircumstances. In the neonatal period deaths from infectious fevers , and respiratory and gastrointestinal conditions are rare, as are deaths from 

accidental mechanical suffocation and violence. 

Death from congenital malformation could bedescribedas the only cause of death which persists 

significantly after the 28th day of life. 

Of what might be termed environmental 

causes, respiratory disease now takes firstplace 

(see table 12) followed by accidents, including 

accidental mechanical suffocation. Diarrhealdiseases, which used to be a potent cause of death, 

are gradually disappearingas hygieneandhousing 

improve. Deaths from the ordinary infectious 

diseases and tuberculosis which two decades ago 

were responsible for many infant deaths, have 

now regressed almost completely. It would appear, therefore, that later infant mortality is 
----

11


m ,,., 

: 30 -

i 

o


0


0
_.


@ 20 -

E 

u


1-


g 10


0


I II


I SOCIAL CLASS I 

Figure 1. Postneonatal mortality rates by social class: Scotland, 1939, 1952, 1962, and 1963.


closely related to social and economic circumstances. 

The differences between the rates exhibited 

by the five social classes have alreadybeen commented upon in the discussion on stillbirths and 

perinatal and neonatal deaths, but these differences are even more markedin the postneonatal 

period. The rates for the different classes make 

this clear as figure 1 shows. The extent of the 

difference is fully appreciated by medical and 

other social workers but it occasions some surprise that the relative order has barely altered 

in the years for which such data have been available in Scotland. Since 1939 there has been a 

great reduction in the infant mortality rateforthe 

country as awholefrom 68.5 to the present 25.6 

per l,OOOlive births. Therateofimprovementhas 

been the same for all social groups; in other 

words, the causes of improvement have operated 

at all social levels, a fact previously noted by 

McKinlay in 1948~ and again in more detail in 

1952.9 

Though the general downward trend of the 

rates shows a similarity irrespective of class, 

there are considerable differences in individual 

causes; viz., deaths from infectious,respiratory, 

and digestive diseases are rare in children of the 

more prosperous families; but respiratory diseases—pneumonia especially—still cause losses 

among those financially and intellectually less 

privileged. Medical, nursing, and institutional 

facilities are now readily available to all. Prevention of infection, however, is difficult in overcrowded houses with small children where isolation is impossible. Considerable time and effort 

are spent in educating the mothers of these 

families, but even the most intelligent woman must 

find it well-nigh impossible to put such teaching 

into practice while trying to cope with adverse 

housing conditions. As education and, even more, 

family spacing and limitation take effect, domestic 

overcrowding may improve. Only as women take 

more care to space their children to enable them 

to devote as much attention as possible to each 

infant, will the infant receive the attention necessary for optimum rearing. 

EFFECT OF ILLEGITIMACY ON 

INFANT MORTALITY 

Few branches of social medicine present 

such difficult and complex problems as the care 

of the unmarried mother and her child. In few 

fields of human endeavor has the work been so 

15

exacting. It is of the utmost importance that help 

should be wisely directed, for the effect of mistakes may last for the lifetime of mother and child 

and may even be the cause of difficulties in the 

next generation. 

In this country of all live births the percentage of children born illegitimately reached its 

highest point about a hundred years ago (1863— 

10.0 percent). It fell gradually to 6.5 percent in 

the quinquennium 1901-5, then rose gradually to 

an average of 7.6 percent during the World War I 

years. Subsequently the rate improved, except in 

1941-45, until 1958 when it showed a tendency to 

rise and it now stands at 5.2 percent of live births. 

(See table 13.) It is difficult to give a good reason 

why this recent rise should have taken place 

especially as there are fewer women than men 

below the age of 35 years. Certainly young people 

are maturing earlier than formerly and this may 

lead to sexual relationship before they are fully 

able to realize the consequences of their actions. 

There tends to be a high rate of pregnancy among 

delinquent girls who are often themselves illegitimate so that the problem seems to be self-perpetuating. 

About one-third of the children legally defined 

as illegitimate are no problem because the parents 

are cohabiting and make a good home for them. 

In 1962, 325 births were reregistered. These 

children were born legally illegitimate but under 

Scottish Law they are legitimized by the subsequent marriage of the parents, provided there was 

no bar to marriage at the time of birth. Also in 

1962, 1,486 illegitimate children of all ages under 

21 years were adopted and of these 1,170 were 

under 2 years of age. Many other illegitimate 

children are received into the family of the 

mother’s parents. Local authorities are legally 

responsible for the welfare of the remainder. 

Much comment has been made of the fact that 

the infant mortality rate of illegitimate children 

is higher than that of those legitimately born. It 

has already been shown that if parents are classified according to the Registrar-General’s five 

sccial classes, the infant mortality rate of children 

born into classes I and II is much lower than that 

of those born into classes IV and V. The better 

mortality rate experienced in classes I and H has 

a considerable effect on the national figure. In 

1962 only 10 births to women in class I were 

illegitimate, and few were born illegitimately to 

women in class II. So any modifying effect of the 

low mortality rate in these classes has little 

weight when the total mortality rate is computed. 

These illegitimate births are more numerous in 

the social classes III-V, so the children of women 

in these classes carry with them the biological 

inheritance of the mother. 

There is ample provision in maternity hospitals and homes and unmarried women are sure 

of admission. Such women usually stay in the 

hospital for 10 to 14 days after delivery. 

In spite of the much higher death rate in the 

neonatal period for illegitimate infants (31.9 as 

against 17.2 for legitimates), this makes a difference of only 0.7 in the national rate of 17.9. 

For deaths between 28 days and 1 year the infant 

mortality rate of legitimate children is 8.5 per 

1,000 and of illegitimate children 11.2 per 1,000; 

the difference from the national rate is 0.1 per 

1,000 live births. The difference made by illegitimate stillbirths to the national rate is 0.5 per . 

1,000 live births. 

SUMMARY 

It has been demonstrated that the infant mortality rate fell steadily from the quinquennium 

1896-1900 until 1941-45, then fell steeply until 

1951-55, after which it fell only gradually until 

1956-60, and since when there has been little 

improvement. Reasons have been put forward to 

explain why the rate gradually rose before 1897 

despite improving environmental conditions. It is 

probable that house overcrowding, especially in 

urban areas, was an important factor. It is of 

interest to note that the 5-year curve of the infant 

mortality rate correlates almost exactly with the 

curve of the legitimate birth rate for married 

women. Presumably as the birth rate decreased, 

with the resultant smaller size of family there 

was a lessening of tlie burdens, both biological 

and physical, on the mother. The decrease in 

household density would tend to lessen the virulence of infections introduced to the home. The 

reduction of the numbers of dependent children 

with the wider spacing of births allows more 

maternal care to be given to each infant. Further, 

modern preventive inoculation and vaccination, 

combined with modern drugs, have saved many 

16 
young children and have prevented much of the 

disabling sequelae in the survivors. 

At the turn of the 19th century and in the 

early years of this century it was realized that 

many of the defects in men presenting themselves 

for enlistment in the Boer War and in the First 

World War had their origins in childhmd. This 

led to a widespread interest in child nurture, but 

at the same time obstetricians and pediatricians 

realized that many of these defects originated in 

pregnancy and parturition, and the y directed their 

efforts to more intensive care of pregnant and 

nursing women. This interest and care, intev alia, 

was of benefit to the girl babies who in due time 

became the mothers of the succeeding generation. 

It was then that the maternal and child welfare 

services and school health services were brought 

into being. Intensive schemes were formulated by 

the Central Government and local authorities. 

These schemes, which have been detailed, not 

only included medical care with special food 

supplements, but provided for the construction 

of the necessary clinics, homes, and hospitals. 

The result of these endeavors is now seen 

in the fall in the maternal mortality rate from 

approximately 7 per 1,000 live births in 1928 

to O,4 per 1,000 live births in Scotland in 

1963. Puerperal sepsis, including postabortive 

sepsis, formerly a potent cause of death in the 

mother, has declined almost to zero, as have 

hyperemesis gravidarum, antepartum hemorrhage, ectopic pregnancy, and placenta previa. 

The obstetrical conditions showing least improvement are embolism and abortions, septic or 

nonseptic, 

It is not easy to assess how much improvement in medical procedure has been responsible 

for this gratifying fall in the number of maternal 

deaths, for undoubtedly the antibiotic and other 

drugs and readily available blood transfusion 

facilities have helped. Also the improvement in 

the biological condition, especially of women of 

the younger childbearing ages, has contributed to 

1,	 the improvement, shown by the fall in the agespecific death rate to one-tenth of the rate of 

1’311-15. 

Since 1939, when registration of stillbirths 

began in Scotland, the rate has fallen to less than 

half. Registration by cause of death emphasized 

the necessity for exactitude in diagnosis, which 

stimulated the setting up of departments in the 

study of stillbirths and neonatal pathology, so that 

exact diagnosis is now reasonably assured. Registration has revealed (a) that there is less likelihood of a stillbirth occurring with the second 

pregnancy, (b) that mothers of the 20-24 age group 

have the most favorable experience, (c) that too 

rapidly succeeding pregnancies have a higher risk 

of stillbirth, and (d) that of all the causes of intrauterine deaths fetal defects are the most intractable. Although more knowledge of the causes 

of fetal defects has been gained in recent years, 

not enough is yet known to prevent them. It has 

also been shown that the biological condition of 

the mother affects the outcome of a pregnancy; 

for example, the stillbirth rate of women in social 

class I is less than half that in social class V. 

It would seem that the dividing lines between 

a live birth, an early infant death, and a stillbirth 

are in some respects almost a matter of chance. 

This is borne out by the fact that of the deaths 

which occur in the first month of life over 90 

percent can be classified to the stillbirth rubric. 

Like stillbirths, deaths from congenital malformations have shown no improvement since the 

quinquennium 1931-35 nor has birth injury or 

asphyxia at birth. The greatest improvement is in 

prematurity and debility, the rate of which is now 

one-eighth of that in 1931-35. Neonatal and perinatal deaths show a class distinction which has 

persisted and increased since the beginning of 

registration though in all the social classes improvement has resulted from modem medical and 

public health endeavors. In the neonatal period 

deaths from infectious fevers, and respiratory and 

gastrointestinal diseases are comparatively rare, 

but in the posmeonatal period deaths from what 

might be termed environmental and social conditions still take toll of infant life. Deaths from the 

acute infectious diseases are now few and those 

from gastroenteritis are decreasing with improved education in child care. If it were possible 

to eliminate respiratory diseases the posmeonatal 

deaths would be very few indeed. Accidents of 

various kinds will decrease only with continuous 

awareness. It is in deaths due to environmental 

conditions that social class distinction is most 

obvious—the rate for class I being now about 

one-fifth of that for class V. Illegitimacy y is increasing slightly in Scotland, but the rates are 

17 
lower than those of many more prosperous generations it cannot be said that it affects the 

countries. While this is a grave social problem infant mortality rate to any great extent. 

and one which may well cause difficulties in future 

Acknowledgment 

Theauthorgratefu lly acknowledges the important help received 

from Mr. William Robertson, M. B. E., in the planning and preparation of this report. 

000 

18 
Table 1.


2.


3.


4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13. 

DETAILED TABLES 

Page


Maternal mortality ratea by cause of death: Scotland, 1931-63--------------------- 20


Stillbirth rates by geographic area: Scotland, 1939-63---------------------------- 21


Stillbirth rates by cauae of death: Scotland, 1939-63----------------------------- 22


Stillbirth rates attributed to congenital defects by sex: Scotland, 1950-63------- 23


Stillbirth rates by age of mother: Scotland, 1939-63------------------------------ 24


Stillbirth rates of legit~te births, of previous children born to


mother: Scotland, l946-63------------------------------------------------------- 25


Stillbirth rates by cause of death and birth weight: Scotland, 1961-63------------ 26


Stillbirth rates by social class: Scotland, 1939 and 1949-63---------------------- 27


Infant mortality rates by age: Scotland, 1936-63---------------------------------- 28


Perinatal mortality rates by age, sex, and cause of death aa classified to the


stillbirth rubric: Scotland, l96O-62---------------------------------------------- 29


Perinatal mortality rates by age of mother, social claaa, and number of previous


children: Scotland, l96l-62------------------------------------------------------- 30


Postneonatal mortality rates by cause of death: Scotland, 1936-63----------------- 31


Number of live births, live birth rate, and percent illegitimate live birtha:


Scotland, l856-l963--------------------------------------------------------------- 32


19
 23G-63?I0- G6 -4

-----------

----------

-------

--------

------------

----------

------------------

Table 1. Maternal mortality ratea by cauae of death: Scotland, 1931-63


Cause of death 1	 L961- 1958- 1955- 1952- 1949- 1946- ;;::- ;;:- ;;;;- ;;w~- 1931-
 1963 1960 1957 1954 1951 1948 1933


Rate per 100,000 live births


All causes (640-689) 38 41 49 91 119 194 317 450 473 602 605
 _ _ _
 -
 + 

Eclampaia, antepartum and postpartum (642.2, 642.3, 686) 4 6 7 19 16 30 53 72 76 83 85 

Hyperemesia gravidarum (642.4) 1 1 1 3 18 21 21 32 

Other toxemias of pregnancy and parturition---(642.0, 642.1, 642.5) 3 2 5 5 8 9 11 25 15 18 23 

Placenta previa---------- (643, 670A) 1 1 2 3 3 7 12 12 22 22 34 

Antepartum and intrapartum hemor -

rhage------------------- (644, 670B) 4 4 4 7 11 12 19 18 24 23 

Ectopic pregnancy-------------- (645) 1 1 3 2 7 6 7 9 12 14 

Other complications of 

pregnancy (reaidual 640-649) 2 2 1 3 2 3 3 7 3 4 6 

Abortion nonseptic--------- (65O,652) 3 3 3 7 7 11 11 13 15 19 13 

Postabortive senses (651) 3 3 2 3 9 8 27 39 35 44 31 

Postpartum hemorrhage (672) 4 3 4 12 7 30 36 43 41 46 35 

O:::hcomplications of child-

------------(residual 670-678) 5 5 5 10 30 43 54 55 63 56 52 

Puerperal aepsia--------------- (68l) 3 3 2 3 5 13 54 92 111 205 215 

Embolism (682, 684) 7 5 10 15 13 18 31 39 40 39 32 

Other unspecified causes--- (640-689) 3 3 3 4 9 3 4 9 5 9 11


— —


Isee APPendix 111 for explanation of comparability of cause-of-death claasif icationa.


20


i 
Table 2. Stillbirthrates by geographicarea: Scotland, 1939-63


Counties Region


Counties (excluding 

Year All of cities counties areas and large of cities East West 

1963---------------------


1962---------------------


1961---------------------


1960---------------------


1959---------------------


1958---------------------


1957---------------------


1956---------------------


1955---------------:-----


1954---------------------


1953---------------------


1952---------------------


1951---------------------


1950---------------------


1949---------------------


1948---------------------


1947---------------------


1946---------------------


1945---------------------


1944---------------------


1943---------------------


1942---------------------


1941---------------------


1940---------------------


1939---------------------


burghs and large ‘orthem Central Central Southern 

burghs) , 1 I f 

Rate per 1,000 total births 

19.1 19.6 1s.4 17.3 18.8 19.8 19.6 

19.9 20.3 19.5 16.6 18.4 21.7 21.6 

20.8 2L.5 19.8 17.3 20.0 22.1 23.0 

21.7 22.2 21.2 1s.5 21.2 23.0 22.9 

22.2 22.8 21.4 20.7 20.3 23.3 26.2 

22.8 23.7 21,8 19.1 22.3 24.1 25.9 

23.7 23.3 24.2 19.9 22.7 25.4 24.7 

23.9 24.4 23.2 22.1 23.4 24.8 22.7 

24.6 24.7 24.4 18.4 26.1 25.8 25.5 

25.3 26.4 24.1 20.7 25.3 27.0 25.5 

24.8 25.5 23.9 21.5 25.0 25.9 23.9 

26.2 26.6 25.6 22.1 26.2 27.9 23.S 

26.6 27.1 26.0 23.5 26.4 28.0 25.7 

26.9 28.2 25.3 22.7 25.9 28.8 29.7 

27.1 27.7 26.4 22.6 27.4 28.6 21.4 

28.7 29.8 27.4 26.6 27.7 30.3 26.1 

30.5 29.8 31.5 27.6 29.2 32.3 31.6 

32.3 34.7 29.3 28.6 32.0 33.9 32.2 

32.8 3301 32.5 29.9 32.4 34.4 29.1 

32.5 33.6 31.2 28.4 31.5 34.8 29.0 

35.6 37.0 33.9 32.6 35.9 36.5 35.8 

38.2 40.2 35.9, 33.7 38.0 40.8 30.5 

39.6 41.9 36.8 32.1 38.7 43.1 35.9 

I 

42.1 42.4 41.7 40.1 43.1 42.7, 37.6 

42.2 42.1 I 42.5 39.3 42.4 43.2 42.0 

J J 

21

Table 3. Stillbirthrates by cauae of death: Scotland, 1939-63


Acute Ante- Other Diffi­


and partrn placen- cult Other Ill-


All chronic Toxemias tal and labor defined defined


Year in 

mother (;::.;, 

hemorrhage conditiona defects birth 

injuries (;:;.o, 

unknown 

causes 

(~;:.~ (:::~:, 

(Y30- (:::3 Y32:5; (;:;5 Y39:o- (Y39.4-

Y39) Y33) Y36:4~ Y36.6\ (Y38) Y39.3) Y39.6) 

causesl diseasea other cord Fetal and causes and


1963-----------


1962-----------


1961-----------


1960-----------


1959-----------


1958-----------


1957-----------


1956-----------


1955-----------


1954-----------


1953-----------


1952-----------


1951-----------


1950-----------


1949-----------


1948-----------


1947-----------


1946-----------


1945-----------


1944-----------


1943-----------


1942-----------


1941-----------


1940-----------


1939-----------


Rate per 1,000 total births 

19.1 0.5 1.4 3.1 3.8 4.8 1.8 1.0 2.6 

19.9 0.6 1.7 3.5 3.6 4.4 1.8 1.0 3.4 

20.8 0.7 1.8 3.4 3.3 5.5 1.9 1.1 3.2 

21.7 0.7 108 3.5 3.9 5.1 2.3 1.0 3.5 

22.2 0.7 1.9 4.0 3.9 4.9 2.7 1.0 3.2 

22.8 0.5 2.1 3.4 4.3 5.3 2.3 1.1 3.9 

23.7 0.7 2.2 4.0 4.3 5.1 2.8 1.0 3.4 

23.9 0.8 2.1 3.5 4.5 5.2 3.3 1.1 3.5 

24.6 0.8 1.8 3.8 4.5 5.3 3.4 0.9 4.1 

25.3 0.5 2.5 3.9 4.4 5.1 4.0 1.3 3.7 

24.8 0.7 2.3 3.4 4.8 5.1 3.5 1.2 3.7 

26.2 0.8 2.1 3.8 4.8 5.6 3.9 1.1 3.9 

26.6 0.8 2.7 3.8 3.9 5.1 4.8 1.1 4.2 

26.9 0.8 2.3 3.9 4.1 4.8 5.4 0.9 4.7 

27.1 0.8 2.4 3.8 4.3 4.8 5.3 1.1 4.5 

28.7 0.9 2.1 3.9 4.4 5.0 6.2 1.1 5.1 

30.5 1.1 2,7 3.5 5.2 4.8 6.9 1.2 5.2 

32.3 1.1 2.7 3.7 4.9 5.6 6.8 1.0 6.4 

32.8 l.O 3.0 3.7 4.6 6.0 7.0 1.2 6.2 

32.5 1.0 2.8 3.9 4.8 5.5 7.6 1.0 5.9 

35.6 1.2 3.4 4.3 4.6 5.6 8.0 0.9 7.4 

38.2 1.2 4.2 5.2 5.1 6.4 8.5 0.9 6.7 

39.6 1.3 4.0 5.1 4.9 6.1 8.5 1.1 8.4 

42.1 0.9 4.4 5.0 4.3 5.6 6.9 0.7 14.3 

42.2 0.8 3.8 5.5 4.1 5.4 7.5 0,7 14.4 

Isee Appendix 111 for explanationof comparabilityof cause-of-deathclassifications.


22

-------------------------------------

-----------------------------------------

-----------------------------------------------

-------------------------------------

Table 4. Stillbirthrates attributedto congenitaldefects by sex: Scotland, 1950-63


I I I 

Cause of deathl	 1962- 1959- 1956- 1953-


1963 1961 1958 1955


Rate per 1,000 total


M&e male births


Total (Y38.O-Y38.7) 2.8 3.6 3.4 3.8
 — —


Anencephalus------------------------------------------(y38.O)
1.3 1.7 1.5 1.5


Rydrocephalus (Y38,1) 0.8 1.1 1.1 1.3


1950-


1952


3.7
 —


103


1.4


0.2


0.2


0.1


0.2


0.0


0.3


6.8


Spina bifids------------------------------------------(y38.2)001


Other malformationsof the central nervous system-----(3)8.3) 0.1


Malformationsof the cardiovascularsystem------------(Y38.4) 0.l


Malformationsof other specified systems--------------(y38.5) 0.2


Monster (Y38.6) 0.0


Other and unspecifiedmalformations-------------------(y38.7) 0.2


Female


Total (Y38.O-Y38.7) 6.4
 —


Anencephalua--------------------------------------.---(y38.O)
4.3


Hydrocephalus-----------------------------------------(y38.l)
1.0 

Spina bifida------------------------------------------(y38,2)0.3


Other malformationsof the central nervous system-----(3)8.3) 0.2


Malformationsof the cardiovascularsystem------------(y38.4) 0.1


Malformationsof other specifiedsystems--------------(y3805) 0.2


140nater
 '----------------------------------------------(Y38.6)0.O


Other and unspecifiedmslformationa-------------------(y38.7) 0.3


0.2 0.1 0.2


001 0.2 0.2


0.1 0.1 0.1


0.2 0.2 0.2


0.O 0.O 0.0


0.3 0.2 0.3


Rate per 1,000 total


female births


608 701 6.6
 . — — —


4.6 4.5 4.2 3.9


1.0 1.4 1.4 1.4


0.3 0.4 0.3 0.5


003 0.,2 0.2 0.2


0.1 0.0 0.0 0.l


D.2 0.2 0.2 0.2


D.O 0.0 0.1 0.0


2.2 0.3 0.3 0.4


Isee APPendi~ 111 for explanationof comparabilityof cause-of-deathclassifications.


23

Table 5. Stillbirthrates by age of mother: Scotland, 1939-63


Age of mother


Year ,


All Under 20 20-24 25-29 30-34 35-39 40-44 45 years


ages years years years years years years and over


Rate per 1,000 total births


1963------------ 19 17 16 16 22 31 40 66 

1962------------ 20 18 16 17 23 30 44 40 

1961------------ 21 19 17 19 23 28 47 51 

1960------------ 22 23 18 18 24 31 49 79 

1959------------ 22 21 19 19 24 33 43 38 

1958------------ 23 21 19 20 24 34 49 91 

1957------------ 24 21 18 21 25 37 51 94 

1956------------ 24 22 19 21 25 35 50 60 

1955------------ 25 20 20 19 28 38 49 90 

1954------------ 25 23 20 22 28 36 48 51 

1953------------ 25 17 20 22 27 36 51 58 

1952------------ 26 23 20 23 27 39 56 61 

1951------------ 27 23 19 22 28 40 64 87 

1950------------ 27 23 19 23 27 41 59 73 

1949------------ 27 21 21 20 31 40 63 104 

1948------------ 29 23 22 23 32 41 55 88 

1947------------ 31 24 23 26 33 41 60 77 

1946------------ 32 27 23 29 33 44 61 94 

1945------------ 33 25 25 27 34 46 67 61 

1944------------ 33 24 24 27 35 44 57 98 

1943------------ 36 25 25 31 38 49 71 66 

1942------------ 38 32 29 32 42 55 66 98 

1941------------ 40 27 30 35 43 56 65 67 

1940------------ 42 35 31 36 45 61 77 95 

1939------------ 42 30 31 35 46 63 74 132


—


24


i 
-----------------------

Table 6. Stillbirthrates of legitimate births, by number of previous children born to mother: 

Scotland, 1946-63 

. . . II Number of previous children ALL Year parities


o 1 2 3 4 5 6 7 8 9 10+


. Rate per 1,000 total legitimatebirths 

1963----------------------- 19 lg 14 16 21 24 36 37 27 36 47 55 

1962----------------------- 20 2C l? 18 24 29 32 33 37 46 47 46. 

1961----------------------- 20 21 15 18 24 27 31 32 47 48 40 34 

1960----------------------- 21 21 15 19 23 29 33 40 51 46 79 83 

1959----------------------- 22 22 15 21 25 30 41 39 38 38 25 52 

1958----------------------- 23 24 17 23 22 30 27 34 40 62 40 60 

1957----------------------- 23 25 17 20 27 36 34 39 38 75 43 76 

1956----------------------- 23 25 16 23 25 33 40 31 44 50 49 49 

1955----------------------- 24 24 18 23 26 30 40 41 49 65 56 76 

1954----------------------- 25 26 18 24 27 33 38 49 46 48 45 50 

1953----------------------- 24 26 17 23 26 31 34 39 56 50 35 53 

1952----------------------- 26 28 18 24 25 33 36 39 48 50 58 69 

1951----------------------- 26 27 18 23 30 36 41 60 56 41 67 78 

1950----------------------- 27 27 18 25 32 36 36 50 45 49 36 64 

1949----------------------- 27 28 17 24 31 32 43 54 64 42 61 80 

1948----------------------- 28 30 20 26 31 36 41 42 59 47 66 75 

1947 30 33 21 26 31 38 39 42 53 48 47 76 

1946----------------------- 32 36 21 26 33 40 42 46 52 57 61 74


— — — —


25

-----------

Table 7. Stillbirth rates by cause of death and birth weight: Scotland, 1961-63


Cause of death


Acute Ante- Other Diffi-


part? placen- cult Other Ill-
 and
 Birth weight of fetus All chronic Toxemias tal and labor defined de~~d
 other cord Fetal and causes
 causes diseaaes hemOr- cnndi- defects birth unknown
 in
 mother rhages tiona ‘- cauaea
 (;;;.:, j=ies (;:;.0, , (;;~.:, (Y36.0, 

(Y30- (Y30, Y32:5; Y36.5, (Y39.4-

Y39) Y31) Y33) Y36:4; Y36.6) (Y38) (Y34, Y39:o- -L . 3) Y39.6) Y37) Y39 

Rate per 1,000 total births 

All births weights-- 19.9 0.6 1.6 — 3.1 — 3.8 — 4.9 . 

1.8 — 1.0 — 3.0 

Under 3 lbs--------------- 3.4 0.1 0.4 0.4 0.4 1.3 0.1 0.2 0.5 

3 lba.-3 lbs., 15 ozs----- 2.7 0.1 0.3 0.5 0.4 1.0 0.1 0.1 0.3 

4 lbs.-4 lba., 15 ozs----- 2.4 0.1 0.3 0.5 0.4 0.6 0.1 0.2 0.3 

5 lbs.-5 lbs., 15 OZS----- 2.2 0.1 0.2 0.5 0.5 0.3 0.2 0.1 0.3 

6 lbs.-6 lbs., 15 OZS----- 2.4 0.1 0.1 0.5 0.6 0.4 0.3 0.1 0.4 

7 lbs.-7 lba., 15 oza----- 2.1 0.1 0.1 0.3 0.6 0.3 0.3 0.1 0.3 

8 lbs.-8 lba., 15 oza----- 1.2 0.1 0.l 0.1 0.3 0.1 0.2 0.1 0.3 

9 lbs.-9 lbs., 15 OZS----- 0.5 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.1 

10 lbs. or more 0.2 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 

Not stated---------------- 2.8 0.1 0.2 0.4 0.6 0.8 0.3 0.1 0.6 

26 
------------------------ ----

----------------------------------------------------

----------------------------------------------------

--------------------------------------------

----------------------------------------------------

----------------------------------------------------

------- --------------------------------------

----------------------------------------------------

---------------- ----------------

---------------- ----------------------------

Table 8. Stillbirthrates by social class: Scotland, 1939 and 1949-63


Social class


Year I I I I


I II III Iv v


Rate per 1,000 total births


l963----------------------------------------------------10.8 15.6 18.2 21.0 25.1 

1962 -.---------.--------.--- 11.1 16.6 19.1 21.7 27.0 

1961 12.9 16.4 20.1 23.2 25.7 

1960 12.8 16.8 20.8 24.7 26.4 

l959----------------------------------------------------13.5 15.4 21.8 24.4 26.9 

1958----.--- 16.5 20.7 21.9 24.7 27.1 

l957----------------------------------------------------17.1 20.8 21.5 29.2 29.7 

1956 17.4 19.9 22.8 25.5 29.5 

l955----------------------------------------------------16.1 17.3 23.2 29.5 30.6 

l954----------------------------------------------------17.6 22.0 24.1 28.3 29.9 

1953 13.2 21.0 23.9 27.4 29.7 

1952 --.---- 19.7 23.9 25.3 27.8 29.9 

1951 14.7 22.9 25.1 3101 32.2 

1950 -----.-- ----.-----.- 16.3 22.5 26.3 29.0 32.1 

l949----------------------------------------------------17.3 21.4 26.5 28.7 35.0 

1939 ..------- 34.1 38.1 44.9 38.3 42.7 — 

27

Table 9. Infant mortality rates by age: Scotland, 1936-63


Year


Age


1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950


Under 1 year------


Under 28 days---


Under 1 day---


1-6 days------


7-13 days-----


14-20 days...-


21-27 days----


28 days-


2 months-------


3-5 months------


6-8 months------


9-11 months-----


Age


Under 1 year------


Under 1


month----------


Under 1 day---


1-6 days------


7-13 days-----


14-20 days----


21 days to


1 month------


1-2 months------


3-5 months------


6-8 months------


9-11 months-----


Rate per 1,000 live births


25.6 z6.5 25.8 26.4 28.4 27,7 28.6 28.6 30.4 31.0 30.8 35.2 37.4 38.6
 -


16.8 17.9 17.9 18.2 19.4 18.7 19.6 19.1 19.7 20.6 L9.3 21.7 ?2.3 23.0


8,6 9.3 9.2 9.3 10.0 8.9 9*3 8.9 9.3 9.6 8.6 9.3 9.1 9.5


6.0 5.9 6.4 6.5 6.6 7.3 7.4 7.4 7.6 8.2 7.7 8.7 8.9 9.3


1.0 1.3 1.3 1.1 1.3 1.3 1.4 1.6 1.4 1.4 1.5 1.8 2.1 2.1


0.6 0.9 0.6 0.8 0.8 0.6 0.8 0.7 0.8 0.8 0.7 0.9 1.1 1.2


0.7 0.5 0.5 0.6 0.6 0.6 0.8 0.5 0.6 0.6 0.8 0,9 1.0 1.1


3.2 3.5 3.4 3.4 3.4 3.8 3.6 4.2 4.4 4.3 4.9 4.9 6.o 5.9


3.3 3.2 2.7 2.6 3.3 3.1 3.2 3.3 3.7 3.6 4.0 5.2 5.4 5.4


1.5 1.3 1.1 1.3 1.4 1.4 1.3 1.3 1.5 1.5 1.6 2.2 2.2 2.5


0.7 0.7 0.7 0.9 0.9 0.7 0.8 0.8 1.0 1.0 1.0 1.2 1.5 1.7


Year


I


1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936


Rate per 1,000 live births


41.4 %4.7 55.8 53.8 56.2 65.0 65.2 69.3 82.7 78.3 68.5 69.5 80.3 82.3


23.2 ?5.1 28.5 29.9 28.5 32.8 32.9 35.1 39.9 37.3 36.6 35.0 38.3 37.6


9.3 9.9 10.0 11.3 10.8 10.9 11.1 12.0 13.0 12.0 13.3 11.6 12.0 11.9


9.0 8.8 10.0 11.0 9.9 10.5 11.0 11.5 12.8 13.4 13.0 12.7 13.1 13.0


2.1 2.8 3.5 3.3 3.6 5.1 4.5 5.1 5.8 4.6 4.0 4.3 5.4 4.7


1.4 1.8 2,6 2.2 2.1 3.4 3.6 3.7 4.6 3.9 3.3 3.2 4.1 4.1


1.3 1.8 2.4 2.0 2.1 2.9 2.8 2.7 3.7 3.3 2.9 3.1 3.6 3.9


7.4 7.4 9.8 8.7 10.7 11.4 11.3 12.1 15.1 12.8 10.5 11,2 13.0 13.3


6.3 7.0 9.1 8.7 9.9 11.8 11.1 12.3 14.0 13.8 10.7 10.7 13.9 14.1


2.7 3.4 5.5 4.3 4.3 5.8 6.1 5.9 8.3 8.3 6.3 7.3 8.5 9.6


1.9 1.8 2.8 2.2 2.8 3.2 4.0 3.9 5.5 6.1 4.4 5.3 6.7 7.7


28

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----------------------------

----------------

--------

-----

------------------

-----------------------

---------------------------

----------------------------

----------------

--------

-----

------------------

Table 10. Perinatalmortality rates by age, sex, and cause of death as classifiedto the still.


birth rubric: Scotland, 1960-62


-


Cause of death	 21-27


days


Male Rate per 1,000 total male births


All causes (Y30-Y39; 40.9 20.4 10.6 7.2 1.2 0.8 0.6 _ —

Acute and chronic diseases in mother--(Y3O,Y31) 0.6 0.6 0.0 0.0 

D~~;ss and conditionsof pregnancyand child-

‘----------------------------(Y32.1-Y32.5]2.0 1.8 0.1 0.1 0.0 0.0 -

Difficult labor (Y34) 1.8 1.6 0.1 0.0 0.0 

Birth injuries-----------------------------(y37)3.5 0.6 1.3 1.4 0.1 0.1 0.0 

Antepartumand other 

hemorrhages----------------(y32.2,y3601-Y36c4) 4.5 4.1 0.3 0.1 

Other placentaland cord 

conditions (Y36.0,Y36.5, Y36.6) 3.8 3.7 0.1 0.0 -

Congenitalmalformations-------------------(y38)7.1 3.4 1.2 1.3 0.6 0.3 0.2 

Other defined causes (Y32.O,Y35.O-Y35.3,Y39.O-Y39.3) 1.8 1.2 0.4 0.2 0.0 0.0 -

prematurity-cause not stated------------(y39.5) 4.9 0.4 3.2 1.1 0.2 0.0 0.1 

Asphyxia Y39.5C) 7.7 1.5 3.7 2.4 0.1 0.0 0.0 

Ill-definedand unknown causes (Y39.4-Y39.6) 1.7 1.6 0.0 ‘0.0 - 0.0 . 

No comparablestillbirthcause 1.6 0.2 0.6 0.3 0.3 0.3 

Female Rate per 1,000 total female Lrths 

and atelectasis--------(y39.5b,


All causes (Y30-Y39) 35.8 21.1 7.4 5.0 1.2 0.7 0.4
 —


Acute and chronic diseases in mother--(Y3O,Y31) 0.6 0.6 0.0 0.0 

Di,,;es and conditionsof pregnancyand child- --(Y32.l-Y32.5) l.a 1.7 0.1 0.0 0.0 -

Difficult labor (Y34) 1.4 1.3 0.1 0.0 0.0 

Birth injuries-----------------------------(y37)2.1 0.5 0.9 0.6 0.1 0.0 0.0 

Antepartumand other


Y36.1-Y3604) 3.0 2.8 0.2 0.0 

Other placentaland cord 

conditions (Y36.0,Y36.5, Y36.6) 3.6 3.5 0.1 -

Congenital malformations-------------------(Y38) 10.3 6.6 1.3 1.2 0.6 0.4 0.2 

Other defined 

causes (Y32.O,Y35.O-Y35.3,Y39.O-Y39.3) 1.4 0.9 0.2 0.2 0.0 

prematurity-cause not stated------------(Y39.5) 3.5 0.3 1.9 1.0 0.1 0.1 0.0 

hemorrhages----------------(y32.2,


Asphyxia and atelectasis--------(Y39.5b,
 Y39.5c) 5.3 1.5 2.3 1.4 0.1 0.0 0.0


Ill-definedand unknown causes (Y39.4-Y39.6) 1.4 1.4 0.0 0.0 0.0 0.0


No comparablestillbirthcause 1.3 0.2 0.4 0.3 0.2 0.2


29

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Table 11. I?erinatal
mortality rates	by age of mother, social class, and number of previous chil­


dren: Scotland, 1961-62


Number of previous children


Age of mother and social claas


Total o 1 2 3 4 or more


All ages Rate per 1,000 total specifiedlegitimatebirths


All classes 34.4 35.8 26.1 30.8 I 37.7 49.5 

I and 11--------------------------- 25.1 26.0 21.5 32.0 

111-------------------------------- 33.9 36.3 24.6~ 49.4 

IV and V--------------------------- 40.1 40.6 32.1 53.2 

Under 20 years 

All classes 36.3 36.1 34.4 46.2 I * 

I and 11--------------------------- 34.8 34.7 41.7 

36.1 36.2 32.0 54.9 * 

IV and V--------------------------- 36.4 35.9 36.1 42.1 * 

20-24 years


All classes 29.6 32.0 25.0 28.8 33.4 44.5 

I and 11--------------------------- 22.7 23.2 21.6 17.0 43.0 45.5 

111--.----- . 28.8 32.1 22.9 29.7 26.5 29.5 

IV and V--------------------------- 33.2 35.8 29.2 29.2 39.4 55.1 

25-29 years


All classes 30.2 35.6 23.8 38.0 

I and II--------------------------- 21.6 25.0 19.8 19.6 

111-------------------------------- 30.3 36.9 23.4 37.8 

IV and V--------------------------- 35.2 44.2 27.9 40.3 

30-34 years


All classes 36.5 47.2 28.4 48.5


I and II--------------------------- 25.9 33.0 19.9 21.7 29.9 38.6


111-------------------------------- 36.0 48.1 27.1 29.3 33.4 52.1


IV and V--------------------------- 44.9 62.3 42.6 34.2 41.6 49.0


35-39 years


40 years and over


All classes 50.2 57.0 32.1 38.8 45.5 51.3 

I and 11------------------- 25.7 25.6 29.6 14.1 29.1 21.8 

111-------------------------------- 56.0 68.7 26.1 39.5 45.0 53.2 

IV and V--------- 55.7 63.8 49.7 51.4 56.4 57.1 

All classes 61.4 46.4 49.4 

T 

69.6 

I and 11--------------------------- ::.; 31.3 37.7 53.3 49.3 48.9 

III-------------------------------- 49.6 59.7 51.9 68.1 63.5 

IV and V--------------------------- 71:3 55.6 40.7 65.6 48.3 84.6 

30


111
----------------------------

---------------------

------------

----------------------------

Table 12. Poatneonatalmortality rates by cause of death: Scotland, 1936-63


Cauae of deathl	 Ifjl- 1956- 1951- 1946- 1941- 1936-

163 1960 1955 1950 1945 1940 

Rate per 1,000 live birtha


All causes (001-E999) 8.5 8.9 12.2 21.2 33.9 33.9
 -
 — -


Infectiousdiseases (001-138,340) 0.4 0.4 0.9 1.7 3.9 5.2 

Respiratorydiseasea-------------------------(47O-483, 

490-493, 500-502, 510-527) 3.2 3.0 4.1 6.5 11.1 14.4 

Digestive diseaaes---------------------------(543-587) 0.8 1.0 1.7 5.6 7.8 7.9 

Congenitalmalformations---------------------(75O-759) 1.9 1.4 1.9 2.1 2.3 2.3 

Certain diseases of early infancy------------(76O-776) 0.2 0,6 1.1 2.4 4.7 4.5 

All other natural causea (residual140-795) 0.7 0.7 0.9 1.8 3.2 3.9 

Accidentalmechanical suffocationand 

other violence (E800-E999) 1.2 1.4 1.6 1.1 0.9 0.7 

Isee Appendix 111 for explanationof comparabilityof cause-of-deathclassifications.


31

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--------------------------------------------------------

--------------------------------------------------------

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------------------------------ --------------------------

----------------------------------------------------

---------------------------------------------------

--------------------------------------------------------

-----------------------------------------------------

---------------- ----------------------------

-----------------------------------------------------

----------------------------- ------------------------

---------------------------------------------------

-----------------------------------------------------

--------------------------------------------------

-----------------------------------------------------

-----------------------------------------------------

-----------------------------------------------------

---------------------------------------------------

Table 13. Number of live births, live birth rate, and percent illegitimate live births: Scot­


land, 1856-1963


of Live birth ------------------------dumber
 Percent


Year live rate per Illegitimate
 1,000
 births population Live births


102,691 19.7 5.2 

1962 104,334 20.1 4.8 

1961 101,169 19.5 4.6 

1960 101,292 19.6 4.4 

l959--------------------------------------------------------99,251 19.2 4.2 

l958--------------------------------------------------------99,481 19.4 4.1 

1957 97,977 19.1 4.1 

l956--------------------------------------------------------95,313 18.6 4.3 

l955--------------------------------------------------------92,539 18.1 4.3 

l954--------------------------------------------------------92,315 18.1 4.5 

l953--------------------------------------------------------90,913 17.8 4.7 

l952--------------------------------------------------------90,422 17.7 4.8 

1951 90,639 17,8 5.1 

1950 92,530 18.1 5.2 

l949--------------------------------------------------------95,674 18.7 5.5 

1948 100,344 19.7 5.8 

l947--------------------------------------------------------

104,413 20.3 6.7 

l945--------------------------------------------------------86,924 16.9 8.7 

1944 95,920 18.5 7.9 

1943 --.-- 94,669 18.4 7.6 

l942--------------------------------------------------------90,703 17.6 7.2 

113,147 22.3 5.6


l946--------------------------------------------------------


1941 89,748 17.5 6.6


1936-40 87,734 17.6 6.2


1931-35 --------=
 89,306 18.2 6.9


1926-30 96,674 19.3 7.3


l92l-25-----------------------------------------------------
112,245 23.0 6.8


1916-20 109,750 22.8 7.6


1911-15 120,654 26.4 7.2


1906-10 128,987 27.6 7.1


l9ol-5------------------------------------------------------
132,399 29.2 6.5


1896-1900 130,209 30.0 6.8


l89l-95-----------------------------------------------------
125,800 30.5 7.4


1886-90 123,977 31.4 8.0


l88l-85-----------------------------------------------------
126,409 33.3 8.3


126,086 34.8 8.5


l87l-75-----------------------------------------------------
120,376 35.0 9.1


1866-70 114,394 34.9 9.9


1861-65 109,764 35.1 9.8


1856-60 102,462 34.1 8.7


32

APPENDIX 1 

HISTORICAL AND GEOGRAPHICAL BACKGROUND OF SCOTLAND 

Census Population 

From the beginning of Census taking in 1801 when 

the population of Scotland numbered 1,608,420 persons 

(in 1961 it was approximately 5,200,000) Census data 

have been and are still published at decennial intervals 

and it is possible to show the trend of population growth 

and movement. From figure I it will be seen that there 

has been a great change in the geographical distribution 

of the population. 

At the beginning of the 19th century almost half of 

the total population of Scotland was located in the counties north of the industrial belt, but from then onward 

the proportion resident in that area has steadily declined 

until at present less than a fifth remains. In the Southern 

counties, also predominantly rural, a similar trend is 

apparent and the proportion located in these districts 

has fallen by more than 50 percent. 

60-


50


I


40 -


30 -


20 –


10 –


o_


Northern East Central 

Population growth has been relatively greatest in 

the large burghs, especially in the western industrial 

area. The rate of growth has been so great that at the 

present time in the Central Clydeside Conurbation of 

Glasgow and the surrounding burghs and counties there 

is contained approximately one-third of the total population of the country in barely 2 percent of the total land 

area of Scotland. 

Between 1921 and 1931 this redistribution slackened 

somewhat and aggregated estimates show that since 1931 

this trend has continued. The fall in the proportion located north and south of the industrial belt between 1931 

and 1939 amounted to less than 1 percent and in the 3 

postwar years the proportional distribution in the four 

regions was roughly similar to the prewar proportion 

with a slight rise in the East Central and no great change 

(if anything a very slight fall) in the West Central area. 

During the Second World War, the only feature of interest 

1801 

1931 m 

1S61 

I 

West Central Southern 

GEOGRAPHIC DIVISION 

Figure 1, Percent distribution of populat on by geographic division: Scotland, 1801, 1931, and 1961.


33 
Table 1. Age distribution of the population: 

Scotland, 1861, 1891, 1921, 1951, and 1961 

Year Population Under 15 15-64 65 years 

(Census) years year a and over 

I ] Percent distribution 

1961----- 5,179,344 25.9 63.5 10.6 

1951----- 5,096,415 24.6 65.4 

1921----- 4,882,497 29.5 64.5 ::; 

1891----- 4,025,647 35.6 59.4 4.9 

1861----- 3,062,294 36.1 59.1 4.9 , r , 

in the regionalestimates wastheanticipated changeconsequent principally on evacuation from danger areas. 

‘13mstheproportion ofthepopulationin theEast Central 

counties fell from the 19391evel duringtheyears 1940-

44. In the West Central part the proportion fell from 

48.5 percent in 1939-40 to 47.5 percent in1941, butit 

rose in thenext3 years, nearly but not quite to prewar 

levels in the years 1944 and 1945. The increased proportion was ~orenoticeable in the north and northeast 

part of the country as these are reception areas. 

Coincident with the changes in the total population 

of the four main divisions of thecountrythere have been 

changes in the age constitution of the population. Table 

I shows the percent distribution of the population according to age at certain censuses since 1861. The figures 

indicate clearly the progressive aging of the population 

over the period of 100 years. Because the birth rate 

began to rise only in 1953 the increases at both ends of 

the age span must be due chiefly to decreased mortality 

made possible by medical discoveries combined with 

better public health measures, better housing, and improved general living conditions. 

Population Migration 

There has been a population increase due Imth to a 

higher birth rate and even more so to greater longevity. 

There has been an average loss of 28,000 people each 

year, chiefly in recent years to England and not so much 

aa formerly to overseas countries. This migration is, 

however, of the younger and more able people and their 

loss means a greater strain on the population of the 

working age group, especially on the people available 

to care for the needs of the young and the old. Though 

the numbers of each sex migrating are much the same, 

one of Scotland’s recent socioeconomic problems has 

been the shortage of unmarried women of the working 

age period, i.e., of 15-44 years of age. 

The effect of reduction of the birth rate from 1939 

to 1953 on the main working age groups (male and female) of the population coupled with war losses and 

migration has been to reduce the labor force from its 

state in 1939. On the distaff side the increase in the 

number of married women and decrease of the unmarried has greatly reduced the working capacity of women 

in the reproductive age periods. Probably a proportion 

of married and widowed women are employed in industry 

but for the average married woman with two or three 

children steady fill-time employment is out of the 

question for 10 to 15 or more years. This shortage of 

women available for Ml-time employment is already 

being felt in nursing, teaching, and other employments 

normally predominantly women’s occupations. In spite 

of loss of population by migration and in spite of change 

in total working capacity of the female population, the 

ratio of earners to dependents (taking earners as those 

between 15 and 64 years of age and dependents as those 

of all other ages), reached the high level of 1.9 in 1951 

and was 1.7 in 1961, compared with 1.4 in 1861. The 

prosperity of a people depends to a large extent on that 

ratio. The “affluent society” is so, at least in part, by 

virtue of having a high proportion of earners to dependents. 

It is customary for statistical purposes to divide 

Scotland into four regional divisions, the East Central 

. 

Figure Il. Counties of Scotland. 

34 
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------------------------------------------ ------- ------- ------- ------- ------- ----

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Table II. Distributionof populationby age,	sex, and sex ratio: Scotland, 1911, 1931, 1951, and


1961


+ 

Both I Sex Year and age sexes Male Female ratiol II 

yJ. 

All ages 92
 = 

Percent distribution


Under .,.
 5 yeara 105
 3-7 years ;:: ::; 105


10-14 years 105


15-24 years --------.-------. 1::; 1;:; 96


25-34 years 12.7 13.0


45-54 years 13.2 13.2 

55-64 yeara 11.0 10.5 ;: 65-74 years 6.9 5.9 67 

75 years and over 3.7 2.9, 59 

35-44 years 12.9 13.0 ;:


l=


All ages 5,096,415[1”
2,434,358]2,662,507 91


Percent distribution 

ype:rys 9.2 8.6 105 ------. ::; 104 

li-lX years 

15-24 years 

25-34 yeara 

R ;:: 14,2 1;:: 14.3 

14.3 14.5 14.0 

103 

91 

35-44 years 14.5 14.7 14.3 :2 

45-54 yeara 12.9 1:.; 13.1 89 

55-64 years 10.2 79 

65-74 years ::: 6:1 

75 year~ and over 3.2 2.6 ;:; :; 

1931


All agea L,842,980I 2,325,52312,517,457 92 

Percent distribution 

y~e:rys 8.7 9.2 8.3 102 

9:4 9.9 101 

l&lX years ::: 102 

15-24 years 1;:: 1::: 17.3 

25-34 years 15.2 15.0 15.5 a 35-44 yeara 12.6 12.0 13.1 

45-54 years 1;.; 11.0 1:.: % 

55-64 years 8.9


65-74 years 5:3 4.9 5:6 :;


75 yeara and war-------------------------------------- 2.0 1.6 2.4 63


1911


All ages \,760,904I 2,308,83912,452,965 94 — 

Percent distribution 

~~e~r~ars 11.2 11.6 10~8 101 

10.8 11.2 10.4 101 

1;-11 years 10.3 10.7 101 

15-24 years 18.5 18*8 1::: 

25-34 years 15.6 15.3 15.9 H 

35-44 years 12.6 12.6 12.6 94 

45-54 years---.-----.-------- 9.2 

55-64 years ::; 6;0 ::: ;; 

65-74 years 3.9 3.4 4.4 

75 years and over 1.5 1.2 1.9 ;; 

~~a~es per 100 females.


35 
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------------------

------------------

------------------

------------------

------------------

------------------

------------------

------------------

TableII1. percent distribution of population 

by geographic division and urban and rural area: Scotland, 1891, 1921, 1931, and 1951 

@herewasmC.IIS.S in 1941 owing to the Second World War. Figures 

for 1961 not yet available] 

Region 1951 1931 1921 1891 

Scotland Percent distribution 

Urban 82.9 80.1 77.3 70.6 

Rural 17.1 19.9 22.7 29.4 

Northern Di.vishn 

Urban 55.4 50.3 49.5 43.7 

Rural 44.6 49.7 5005 56.3 

East Central 

Division 

Urban 89.3 87.6 84.3 79.4 

Rural 10.7 12.4 15.7 20.6 

West Central 

D.ivi.sion 

Urban 93.9 91.9 89.4 87.0 

Rural 6.1 8.1 10.5 13.0 

Southern Division 

Urban 52.0 48.8 45.7 ;:.; 

Rural 48.0 51.2 54.3 . 

and the West Central. comprising what is sometimes 

called the “Industrial Belt” of Scotland, the Northern 

Division, and the Southern Division. The East Central 

Division comprises the City ofllmdee and the counties 

of Fife, Clackmamon, Stirling, West Lothian, Midlothian, and East Lothian, The West Central Division comprises the counties of J3umbarton, Renfrew, Ayr, and 

Lanark. The Northern Division is made up of all the 

counties to the north and west of the Central Divisions, 

but excluding the City of Ilmdee, and the Southern Division of the counties to the south and east of the Central 

Divisions. (See fig. II for counties of Scotland.) 

Tables H and III show the distribution of the population in Scotland. 

The following extracts from a paper by McKinlay 

in 1948 give a description of Census taking andregistrationin Scotland. 

AVAILABLE ROUTINE DATA 

(1) The Census provides us with the basic knowledge of the main features of the population at 

risk—numbers, distribution by age, sex and civil 

status, geographical location, occupation and social 

status of adults and general housing conditions. 

With Census data published at decennial intervals 

since 1801 it is now possible to indicate the trend 

of these population factors and their inter-relationships. The population figures are accepted as 

enumerated—redistribution to place of normal 

residence of individuals located elsewhere at the 

time of Census taking is not attempted. . . . 

The Census being only taken at decennial intervals, 

post-censal estimates of population have to be made. 

For the country asawhole, total populationfigures 

and age and sex distributions, based on the births, 

deaths andmigration data with theprevious Census 

enumeration, are now reliable . . . . 

(2) Compulsory registration of births, marriages 

and deaths has been in operation in Scotland since 

1855 and stillbirths (by cause) were included only 

from 1939. For births, available data relate to 

totals by sex, season, legitimacy and geography; 

for deaths there is additionally information on 

cause of death and age. Under the Population Statistics Act, data inrespectofbirths arenow further 

elaborated to show age of mother and numberof 

previous children, duration of marriage, etc. 

In connection with causes of death, several points 

have to be noted when analysis is attempted. 

(i) These deaths subdivided in cause groups have 

been published since the outset of registration, 

but the list of causes in use has been subjected 

to repeated and extensive revision. This isnecessary tokeep pace with improving certification and 

extending medical knowledge. The trouble is that 

with each revision the difficulty of obtaining comparability over a period of years progressively 

increases, and there are in factotdyafew diseases 

or causes of death the course of which can be 

followed for any great Iengthof time; and even in 

these, inviewof changing accuracy of certification 

by cause, it is difficult to believe some of the 

obvious deductions from the figures. (ii) A further 

point of necessary knowledge isin respect of joint 

causes. In an appreciable proportion of death 

certificates two or more causes are stated, and 

the methods of selecting theprimary cause of death 

differ internationally. Most countries with up-todate statistical organisations have amore or less 

elaborate system of preferences, even although the 

certificate haa provision forthecertifier toindicate 

what in his opinion was the primary cause. In 

Scotland elaborate arbitrary rules for selection 

have never been used=more attention is paid to the 

order of events indicated by the practitioner in 

attendance at the time of death. This would seem 

the most sensible approach since he is the only 

person in aposition togiveany worth-while judgment on the matter, and any office alteration of 

such judgment is liable merely to perpetuate past 

knowledge (or beliefs) asto relative fatalities and 

36 
may distort or obscure in mortality returns the 

effects of advances in treatment. (iii) Of importance 

mainly when interest attaches to some special 

causes of death is the fact that the death certificate 

is not a confidential document, and in diseases to 

which stigma may attach (e.g. syphilis, cancer) 

there will be a tendency towards concealment of 

the real facts and consequent understatement of 

the true number of deaths from such causes. 

(iv) One other point relative to both births and 

deaths should be noted. Prior to 1911 these were 

debited to place of occurrence, no redistribution 

to usual residence being made. This makes difficult 

any study of geographical variations especially 

when certain individual causes of death are being 

considered. In general, localities with the greater 

provision of institutions (usually urban areas) would 

have their birth and death rates artificially increased, rural areas artificially decreased. Since 

1911 this source of distortion has been eliminated, 

and the geography of births and deaths is now 

exact. 

(3) Under various acts and regulations certain 

specified infectious diseases have to be notified 

to the Medical Officer of Health. The primary 

object of notification is to permit the institution of 

the usual public-health measures in these diseases 

of isolation of the individual, disinfection of premises, etc.; but the provision of statistical data 

is an important by-product. The local returns are 

collected by the Central Department and the totals 

for each of these diseases are published weekly for 

each local authority area and an annual statement 

shows subdivision of the data by age and area (and 

in recent years by sex). In these annual figures 

corrections of initial wrong diagnoses are incorporated. The weekly (uncorrected) figures provide expectancy (median) values as the basis for 

comparison with current events; the annual corrected data, associated with mortality returns, 

permit of epidemiological studies on a wide scale 

based upon incidence, mortality and case fatality 

rates. 

. . . . . 

(5) Further routine data emerge from school 

medical inspections. Children are medically examined on entrance to school, on leaving and at 

some intermediate date. Previous histories of 

infectious illnesses, weights and heights and the 

presence of disease or defect of any kind are 

recorded on individual case record cards. The 

annual findings are amalgamated in each local 

authority area and provide a further indication of 

health levels for this section of the population. 

(6) These are the only main sources of routine 

data. Additional to those mentioned there are now 

fairly trustworthy figures on the frequency and 

causation of blindness, and the new Disabled Persons register (Ministry of Labour)_may in time provide other viewpoints on health in adult life. 

From this brief r&um6 of the data available it 

will be abundantly clear how defective are the 

means for anything like adequate description of 

the health of all sections of the community. Yet 

from their analysis comes most of our knowledge 

of present status and past trends.10 

37 
APPENDIX II 

MATERNAL AND CHILD WELFARE 

The ideal of every service for maternal and child 

welfare is to provide conditions in which a woman will 

be kept in perfect health during pregnancy, parturition, 

and the puerperium, and also .to ensure that her child, 

after a good start in life, will remain fit and well and 

will grow into perfect adulthood. Progress toward this 

ideal has certainly been made, but many circumstances 

not controllable prevent its complete attainment. 

For instance, two factors are outside of the control 

of any service. These are heredity and social status. 

Heredity lays the basis of physical and mental stature 

and even some measure of the social backgroun&, the 

social background itself determines the extent to which 

the national benefits available are used by the family 

group. Not all women are of good heredity and a fair 

proportion are in the lower social groups. Nevertheless, 

the effect of the general and particular health services 

of a country can so influence the contemporary generation that future generations may be improved. The degree of achievement, however, depends on the woman’s 

willingness and ability to cooperate with the services 

provided, to keep herself fit, and above all to Plan her 

pregnancies so that she will have the physical and mental 

reserves to make a good and happy home in which there 

is careful nurture of the children. Each improvement 

in one generation raises the quality of the succeeding 

generation, so making it more able to avoid or to withstand the hazards of life which asaailed its predecessors. 

Beginning of Health Services 

In the evolution of medicine the personal services 

were first in the field and in the main were available 

only to those wealthy enough to secure them. Poor 

people even in serious illness had to live or die without 

medical aid. As time went on it was realized that as 

sicknesses could be infectious and contagious, provision 

had to be made for some help to be given to the 

destitute—especially to helpless children-and so the 

idea of communal help began. 

Certain types of women who by experience had 

gained some knowledge helped their fellow women in 

pregnancy and confinements and presumably gave advice 

on other matters relating to sickness. The authorities 

of the time had few or no supervisory powers but it is 

on record that in Aberdeen in 1600 a midwife was put 

in prison for some offense not clearly defined. 

Religious bodies from early times had been the 

forerumers of medical services and in Scotland the 

Kirk (Church) became active in caring for its adherents 

with its blessing on training courses for midwives which 

were begun in Glasgow, Edinburgh, Aberdeen, and llmdee in 1758. Kirk Sessions selected suitable women for 

training and the valuable help given by those women is 

described for one rural parish by McPherson in “The 

Kirk’s Care for the Poor.” 11 At times if a nursing 

mother was seriously ill or had died the Kirk Session 

provided the services of a wet nurse for the infant. 

Many real dangers can beset a young child, e.g., 

-that of overlying, and as early as 1236 the Constitutions 

of Saint Edmund of Canterbury forbade parents to have 

young infants in bed witi them lest the child be 

smothered. A similar statute was promulgated in the 

Diocese of Aberdeen in the 13th century. The same 

statute also prohibited unattended children being left 

near fire or water. 

Following the Reformation these statutes were extended and enforced by the Kirks and toward the end of 

the 16th century local councils began to make provision 

for destitute children by establishing homes where they 

could be cared for at the expense of the community. In 

1595 a plan for the adoption of infants was initiated 

in Aberdeen and in 1733 a home for orphans was established in Edinburgh by Andrew Gairdner and survives 

as the Dean Orphanage to the present day. There are 

many other institutions of a like nature in the country 

and it is clear that our modern services for maternal 

and child welfare follow on from the beginnings made by 

these early pioneer schemes. 

Sanitation and Infectious Disease 

In Scotland, as in other countries in the early and 

middle years of the 19th century, there was a realization among the thinking public generally and health 

authorities in particular that all was not as well as it 

should be in so far as environmental hygiene was concerned. This was especially true of parts of cities and 

towns, and public attention was thus focused on the poor 

environmental conditions then prevailing in these areas. 

38 
A great deal of effort was devoted to the provision of 

pure water, adequate means of disposal of sewage and 

refuse, of street cleaning, etc. It was as recently as 

1854 that Queen Victoria turned the sluices at Loch 

Katrine to give the City of Glasgow an adequate and pure 

water supply, which was followed shortly after by a 

water-carried sewage system accompanied by improvements in scavenging and street cleaning. 

As such provisions extended all over the country 

the general condition of the people improved and the 

numbers and size of families increased. Indeed, the 

increase of ppulation was more rapid than the increase 

in house-building. T’he result was overcrowding with 

the concomitant increase in frequency and severi~ of 

infectious diseases and insofar as infants were concerned deterioration of housing tended to offset the 

benefits of improved sanitation. While the general mortality rate fell slowly as did the death rate for children 

aged 1-5 years, the infant mortality rate rose and continued to rise until the quinquennium 1896-1900. 

At the same time it was beginning to be realized 

that maternal and infant health were inextricably interdependent, and the attack on the combined problem began 

spasmodically in the early years of the 20th century. 

Stimulus was given to voluntary and otier efforts in 

1903 when the Royal Commission on Physical Training 

(Scotland) included in its report many adverse comments 

on the health of school children. Shortly afterward these 

comments were corroborated by the Inter-departmental 

Committee on Physical Deterioration, with the result 

that throughout Great Britain a system was established 

for the medical inspection of school children. Such 

inspection soon showed that many of the diseases and 

defects found in children of school age were largely the 

result of ignorance or neglect in infancy and in the preschool age, Meantime factual information had been collected and reports made on the conditions relating to 

the nurture of infants. These reports contained valuable 

information regarding he high infant death rates and 

suggested possible ways of reducing them since it was 

felt that many of the contributing causes were preventable, 

Infant Mortality 

As has already been pointed out, during the latter 

half of the 19th century, though the birth rate and the 

general death rate had fallen gradually, the infant 

mortality rate steadily rose to its peak in the quinquennium 1896-1900, Such improved environmental measures as had been achieved had until then been without 

effect on the health and lives of infants. Apart from 

prematurity and congenital defects the main causes of 

death were respiratory and diarrheal diseases. Indeed, 

in those years the so-called “Summer Diarrhea” took 

on epidemic characteristics and its onset with each 

summer was a recurring tragedy. This disease excited 

considerable concern as it appeared to be preventable 

and investigations showed that (a) it was chiefly a 

disease of urban life; (b) it was a disease of the 

artisan and even more of the laboring classes; and 

(c) the severity ‘appeared to be less in towns which 

had a good water supply, a system of water-carried 

sewerage, and good scavenging. 

At the present time the death rate from gastroenteritis is only 0.7 per 1,000 live births compared 

with almost 10 per 1,000 live births even as recently 

as 1936. 

Before the turn of the century the number of deaths 

from prematurity and congenital malformations also 

was causing concern. Obstetricians and pediatricians 

began to appreciate that. the wellbeing of the unborn 

child was in a greater measure than hitherto realized 

dependent on and influenced by the health of the mother 

during pregnancy. The publication in 1902 and 1904 

of Ballantine’s Manual of Antenutal Pathology and 

Hy&”ene12(Vols. I and II, respectively) was epochmaking in obstetrical and pediatric circles. 

Interest thus aroused became more intensive, and 

soon it was apparent that, though the first year of life 

was a convenient statistical age-division, it was from 

the point of view of mortality a collection of age 

periods differing widely in etiological factors, and 

that certainly much of the mortality in the early part 

of the first year depended on prenatal conditions and 

intrsnatal procedures. The practical outcome of the 

interest aroused was the beginning of measures for 

the care of the pregnant woman. 

Legislation for Care of Mothers and Infants 

The Notification of Births Act, 1907, gave to the 

local authorities adopting it an opportunity to obtain 

information necessary to formulate schemes in an 

attempt to reduce the infant mortality rates within their 

area. Despite all efforts, however, the infant mortality 

rate fell only very slowly and in the years that followed 

the public conscience was again much disturbed. This 

concern was increased when at the beginning of World 

War I in 1914 as at the begiming of the Boer War 

nearly two decades previously, the poor physical condition of many men presenting themselves for enlistment showed physical defects which might have been 

prevented in childhood. The general interest thus 

aroused resulted in the passing of the Notification of 

Births (Extension) Act, 1915. The act extended the 

provisions of the Notification of Births Act of 1907 

to all Scotland empowering local authorities to make 

such arrangements as they thought fit and as might 

be sanctioned by the Local Government Board for 

Scotland for care of the health of expectant and nursing mothers and children under 5 years of age. 

In the same year the Midwives (Scotland) Act, 

1915, was passed. This act empowered the setting up 

of a board to regulate the practice of midwifery, to 

arrange standards of training, and to examine midwives 

39 
presenting themselves for examination. ‘Thus the Central Midwives Board was constituted and by giving 

effect to the provisions of the act has raised and maintained the standard of midwifery practice. 

General interest in the factors affecting maternal 

and child health received further publicity in 1917 in 

the reports of the Carnegie United Kingdom Trust 

on the Physical Welfare of Mothers and Children. 

Reports covered England and Wales, Scotland, and 

Ireland. The report on Scotland, by Mackenzie, stated 

that “If the care of mothers and children is to reach a 

level worthy of Western Civilisation the problems of 

prematurity will claim increasingly intensive study.” *3 

Sir Leslie Mackenzie, Dr. Hsig Ferguaon, and Dr. J.W. 

Ballantine fully appreciated that many of the ills of 

childhood, and even of adults, had their origin in the 

prenatal environment. 

When hostilities ceased in 1918 local authorities 

began to implement the obligations they had assumed 

under the Notification of Births Extension Act, making 

arrangements for attending to the health of expectant 

and nursing mothers and children up to the age of 5 

years, and much latitude was given in the adaptation 

of administrative machinery toward this goal. The 

schemes which local authorities were required to submit to the Local Government Board for Scotland included the provision, in conjunction with voluntary 

agencies, of home care by health visitors; maternity 

and child welfare centers; maternity hospital provision 

for abnormal conditions of pregnancy and parturition; 

provision for sick childre~ day nurseries, nursery 

schools, and centers to teach mothercraft, cookery, 

and general child care. In other words, local authorities 

were encouraged to provide a comprehensive service 

for expectant, parturient, and nursing mothers, and 

children up to school entrance age. 

In effect the act placed a two-fold duty on local 

authorities-firstly to provide educational facilities 

to make women realize that it was to their advantage 

and at the same time a biological duty to make themselves as fit and well as possible during pregnancy 

to ensure the birth of a healthy infant, and secondly 

to provide adequate facilities to obtain this end. 

In 1929 there were 150 authorities responsible 

for maternity and child welfare. Some were of sufficient size and value, and had the financial resources 

to make adequate provision, but others were hampered by their small size and insufficient funds. These 

difficulties were overcome by the Local Government 

(Scotland) Act, 1928, which reduced the number of 

authorities from 150 to 55. This act also replaced 

the former 50 percent grant system by a block grant. 

The powers and duties of the new authorities were 

enlarged to include reorganization of the hospitals at 

their disposal and to provide new hospital accommodation for all classes of sick as well as maternity 

hospital accommodation. Since that time the number 

of maternity beds in the country rose from just over 

300 to the present 3,200. These hospitals and others 

reconstructed and enlarged since 1948 can now accommodate about 80 percent of the total births in the 

country. 

In the 20 years between 1928 and 1949 so much 

intensive and good work had been done in the field of 

maternity and child welfare that the infant mortality 

rate fell from 86 in 1928 to 45 in 1948 per 1,000 live 

births and the maternal mortality rate from 7.0 to 

1.6 per 1,000 live births. Of course the improvement 

in both rates could not be ascribed wholly to the 

work of local authorities and other agencies. The 

use of sulfonamide drugs and in the later war years 

antibiotics and the blood transfusion service helped 

to reduce the rates, but notwithstanding the educational 

work had had its effect and many women and their 

children benefited thereby. 

National Insurance 

From 1912 everyone working and earning below 

a certain amount paid a weekly health insurance contribution to a voluntary insurance society. ‘fhis entitled the payee to the service of a family doctor and 

at times other benefits. Doctors were paid a cavitation 

fee for all insured people on their lists. This form of 

insurance, however, did not cover the insured personls 

wife and children, so payment had to be met for these 

dependents. Also insured people had to pay for sighttesting and spectacles, dental care and dentures, hearing aids, and other medical appliances. 

National Health Service 

In 1948 the National Health Service came into 

being,the result of a promise made to the nation in 

the middle of the Second World War. ‘Ihia promise 

was the outcome of the Beveridge Report which envisaged a service that “.. . will ensure that for every 

citizen there is available whatever medical treatment 

he requires, in whatever form he requires it, domiciliary or institutional, general, specialist or consultant, and will ensure also the provision of dental, 

ophthalmic and surgical appliances, nursing and midwifery and rehabilitation after accidents. ”14 

The new legislation retained the principle that 

general practitioners should be paid a cavitation fee 

for every patient on their lists, and the new service 

became available to everyone. It is now financed mainly 

from national taxation (80 percent), from weekly contributions (12 percent), and by local taxes and certain 

limited charges for particular services (8 percent). 

In 1948 all hospitals became State owned. The 

reason for this was to ensure that their resources 

would be deployed to the best advantage both locally 

and nationally and also so that any deficiencies in 

services which formerly existed could be made good. 

In Scotland since the advent of the National Health 

40 
Service many more hospital beds have been added to 

those existing in 1948; many hospitals have been 

adapted to other uses; some have been rebuilt or 

otherwise modernized; and new ones have been or 

are to be built. In order to forestall the question of 

why so little has been accomplished since 1948 it 

should be remembered that in view of possible enemy 

bombardment and lack of materials and labor in 

World War II, no house building was permitted so 

that the first tremendous need in the postwar period 

was for new housing. Thus, the housing shortage was 

the most vital public health measure and all other 

building had to give way to this. The hospital service 

is not yet adequate but even so at present there is 

one bed for every 80 people in the country and so 

far as maternity provision is concerned, there is sufficient to meet most requirements; where necessary 

to meet changing needs, further provision is being 

made, 

Educatian 

In the history of the Maternal and Child Welfare 

Service of Scotland, the provision and execution of this 

service was made a duty on local authorities to provide education and care for expectant, parturient, 

and nursing mothers, and children up to 5 years of 

age. This duty was implemented by the local authorities’ schemes promoted by each council assisted 

by ita Medical Officer of Health. me proposed schemes 

were submitted to the central government department, 

and when subsequent approval was granted the schemes 

then became operative. These main basic schemes 

are still in operation though from time to time modifications have been effected to suit changing needs. 

The Medical Officer of Health of the local authority 

was and still is the administrative officer of the 

service. He is assisted in the working of the scheme 

by doctors who have an interest in and specialized 

knowledge of child health and who preside at aH sessions of child welfare clinics. It is these doctor’s who 

direct the scheme of work and to whom health visitors 

and other ancillary workers are responsible. These 

officials become very experienced in health standards 

and are alert to deviation, however slight, from the 

normal, as well as being responsible for the procedure 

necessary for a return to normality. 

It was felt by the public health authorities that the 

educational part of the program could best be achieved 

by fully trained nurse-midwives who had undergone a 

specialized training in the prevention of disease—comparable to health nurses in the United States. These 

nurses are known as Health Visitors in Britain. Their 

duties include the care and education of the pregnant 

and postparturient woman in respect both of her own 

health and of inculcation of the best modern ideas of 

child nurture, both physical and emotional, up to school 

age, when the child passes into the care of the local 

educational authority medical service. To augment this 

service prenatal, postnatal, and child welfare clinics 

have been established either in the local authority’s 

own premises, at a maternity hospital, or in other 

suitable places convenient for the women concerned. 

Frequently the same premises serve the dual purpose 

of child welfare and prenatal or other specialist 

sessions. 

Attendance at a clinic does not mean that home 

visitation by the health visitor should be lessened except at the visitor’s discretion as it is felt that it is 

only in the home that the domestic and other problems 

can be assessed. In the cities and larger industrial 

towns, visiting, educational, and clinic work absorbed 

the full time of the health visitors so that sick nursing 

and midwifery had to be undertaken by two other types 

of nurses, who now devote their whole time to these 

callings. In tie rural areas one nurse only is necessary for all the work—an all-purpose nurse upon whom 

all duties devolve. 

These educational ideals still exist and the health 

visitor is expected to work with the general practitioner 

during the prenatal period, and after the birth to pay 

the first infant welfare visit about the 10th day of life 

with subsequent monthly visits until the child reaches 

the age of 1 year. Thereafter six visits are made 

during the second and third years and four visits in the 

2 years prior to school age (normally age 5). The 

health visitor is expected also to notify any abnormality or deviation horn health in the child and to 

endeavor to persuade the parents to have corrective 

treatment given. 

At first much persuasion was required and it was 

some time before the service was fully accepted, but 

now most women rely on it for help and assistance in 

even minor troubles and for the reassurance that all 

seems well with the child. 

Other Services 

Apart from instruction to women on health in 

pregnancy and child nurture, local authorities have 

responsibilities for other branches of health education, 

viz.: 

1.	 OYd hy~”ene d caye of the teeth through dentists 

and dental officers. 

2.	 Youth and $avent organizations through medical 

officers of all kinds. 

3.	 Specific campaigns against disease which can be 

controlled by immunization, e.g., diphtheria, tetanus, whooping cough, tuberculosis, poliomyelitis, 

smallpox, etc. Immunizing measures have been so 

successful that in 1962 there was no death among 

children from diphtheria, tetanus, or poliomyelitis, 

and only two deaths from whooping cough. 

41 
4. Womenfs institutes, women’s guilds, etc., through 

which	 lectures are given by doctors, nurses, and 

other qualified people. 

There is also a Central Council for Health Education which covers the whole field. It holds service 

training courses for staffs and members of local 

authorities. It also holds conferences and each year 

a residential summer school for doctors, nurses, teachers, etc. Women’s magazines and journals also make a 

valuable contribution to the educational field in respect 

of child welfare. 

Welfare Foods 

Through the medium chiefly of clinics, welfare 

foods are distributed nationally from public funds for 

pregnant and nursing women and children under 5 years 

of age. The amount of milk supplied is estimated at 

95 percent of the potential demand. Cod liver oil, vitamin A and D tablets, and orange juice are sold at cost 

price or given free in cases of need. 

Financial Aid 

To assist in meeting the expense of a confinement 

the National Insurance Scheme provides two maternity 

benefits. Where the conditions for each benefit are 

satisfied, both may be paid. They are paid to both 

married and single women and are: 

1.	 Matemzity grant of 322 ($61.60). —If more than one 

baby is tirn additional grant may be paid. 

2. ikf&ynity aUowance.—The standard rate of this k 

24 ($11 ._20) per week normally paid for 18 weeks beginning 11 weeks before the expected week of confinement if no paid work is undertaken during the period. 

These allowances are undoubtedly of great value to 

women whether married or single in alleviating financial worry, in helping to meet the cost of equipment 

for the infant, and in providing some measure of 

domestic assistance before and after the confinement. 

It is difficult to estimate whether or not these financial 

grants help to reduce infant mortality, but undoubtedly 

they do in great measure bring peace of mind with the 

provision of extra food and other essentials in the 

more necessitous cases. 

Family Planning 

Probably one of the greatest benefits to the women 

of reproductive age and their families is the service 

for family planning. Information and suitable appliances 

are given at local authori~ postnatal clinics, at postnatal and gynecologic hospital clinics, and at 20 

voluntary clinics in the country. Parents who plan 

their families ensure that the mother will be fit and 

and that her child will have had a good start in life 

before another pregnancy is begun. 

42 
APPENDIX Ill 

EXPLANATION OF TERMS USED IN THIS REPORT 

Stillbirth .-A child which has issued forth from its mother after the 

28th week of pregnancy which did not breathe or show any other 

sign of life. 

Infant mortality.— All deaths in the first year of life. 

Neonatal moytality. —Deathsinthefirst4 weeks of life. 

Postneonatal mo9-tality.— Deaths after the first4 weeks but before the 

end of the first year. 

Pevkwtal movtality. —Stillbirths and deaths in the first week of life. 

Mother~s age. —The stated age at last birthday of themother at the 

birth of the child. 

Mothe#s pavWy.- Urdess otherwise stated, the number of themother’s 

previous children (living, dead, and stillborn) of all marriages. 

Social class. —Social classes are assigned according to the occupation 

of the father as stated at birth registration in accordance with 

classification of occupations. Examples of the occupations included 

are given below: 

Social class I—professional occupations 

II—farmers, teachers, shopkeepers, managerial occupations 

111—skilled occupations-fitters, clerks 

IV—semiskilled occupations-farm workers, machine 

minders 

V—laboring occupations-railway porters, kitchen 

hands 

Total births. —All stillbirths and live births. 

Cause of death. —Causes of death registered since 1958 have been classified in accordance with the Seventh Revision of International 

Classification of Diseases (1955),and those during 1950-57with 

the Sixth Revision (1948). Deaths prior to 1950 conform, as far as 

possible, with the cause classifications in the Sixth and Seventh 

Revisions. Differences between the Sixth and Seventh Revisions are 

relatively minor. 

ooo — 

43 
REFERENCES


lDouglas, C. A., and McKinlay, P. L.: Report on Ma$emal 

Morbidity and Mortality in Scotland. London. His Majesty’s 

Stationery Office, 1935. 

2McKinlay, P. L.: Social class differences of maternal 

mortality in Scotland. Health Bulletin 12(2):29-31, Apr. 1954. 

3McKinlay, P. L.: The influence of changes in the age 

and parity constitution of mothers on the trend of fetal and maternal mortality in recent yeare. Health Bu.Uetin 3(1):16-19, 

Jan. 1950. 

4General Registrar Office: Classification of Occupations, 

1960. London, 1960. 

5Kirrcaid, J. C.: Social pathology of fetal and infant loss. 

Brit. M. J. 5441:1057-1060, Apr. 1965. 

6Butler, N. R., and Bonham, D. G.: Perinatat MortaZity. 

Livingston. Edinburgh and London, 1963. p. 52. 

7111sley, R., and Klncaid, J. S.: Social correlates of perinatal mortality, in N. R. Butler and D. G. Bonham, Perirwtal 

Mortality. Livingstcme. Edinburgh and London, 1963. 

8McKinlay, P. L.: The war-time change in the social 

clase distribution of the mortalities of infancy. Health Bulletin 6(1):8-9, Jan. 1948. 

9McKinlay, P. L.: Social claee differences in causes of 

infant mortality. Health Bulletin 10(4):78-79, Oct. 1952. 

10McKinlay, P. L.: Vitat Statistics-Their Collection and 

Analysis. Transaction of the Faculty of Actuaries. vol. !?8. 

part IV (169):265-280, 1948. 

llMcPherson, J. M.: The Kirk’s Care for the Poor. Aberdeen. Avery and Co., c.1941. pp. 120-122 and 136. 

12Ballantyne, J. W.: Manual of Antenatal Pathology and 

Hygiene, VOIS. I and II. Edinburgh. William Green and %ns, 

Publishers, 1902, 1904. 

13Mackenzie, W. L.: The Carnegie United Kingdom Trw t 

Report on the Welfare of Mothers and Children, Scotland, vol. 

111. Edinburgh. Neill and Co., Ltd., 1917. 

14Beveridge, w. H.: Social [nsurance and Allied SerlJice,~. 

London. His Majesty’s Stationery Office, 1942. p. 158. 

000


44 U. S. GOVERNMENT PRINTING OFFICE , 1966 0 - 236-635 
OUTLINE OF RtFUKl 3tKlt3 FUK VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

SeYies 1.€ programs and collection pYoceduYes.— Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

SeYies 2.	 Data evaluation and methods Ye search. —Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

SeYies 3.	 Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Series 4.	 Documents and committee repoyts. — Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

Se7-ies 10. Data from the Health Intemiew .% ’vey. —Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected 

in a continuing national household interview survey. 

Sevies 11	 Data fyom the Health Examination Survey. —Data from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

analysis of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

SeVies 12.	 Data from the Institutional Population Surveys. —Statistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

SeYies 13.	 Data J70m the Hospital DischaYge Sumey. - Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national samPle of hospitals. 

Series 20.	 Data on mo~tality. —Various statistics on mortality other than as included in annual or monthly 

reports— special analyses by cause of death, age, and other demographic variables, also geographic 

and time series analyses. 

SeYies 21.	 Data on natality, ma?v’iage, and divoyce. — Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports — special analyses by demographic variables, also 

geographic and time series analyses, studies of fertility. 

SeYies 22.	 Data fvom the National Natality and MoYtality Suneys. —Statistics on characteristics of births and 

deaths not available from the vital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, etc. 

For a list of titles of reports published in these series, write to: Office of Information and Publications 

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201