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which they use, are well worthy of study. Governmental agencies, health departments, private health organizations of all kinds, may well imitate the quack in devising clever ways to reach the immigrant, in learning to understand him and what will appeal to him. They will use this knowledge and power, of course, not to rob him and ruin his health, but to give him larger facilities for life and the pursuit of happiness.

IX

BIRTH RATES AND MATERNITY CUSTOMS

THE kind of care which women receive during the puerperal period is not only of great importance to the mother's comfort and future health, but also determines to a considerable degree the infant mortality rate and the health and efficiency of the next generation. If there is a difference in the care received by the native and the foreign-born woman during and after childbirth, it may account for the high infant mortality rate of our white stock of foreign extraction.

FECUNDITY AND MATERNITY DEATH RATES

Maternity care is particularly important to the health of the foreign born because of the high fecundity of immigrant women, and the high death rate for mothers as well as infants. The Immigration Commission's Report on the "Fecundity of Immigrant Women" records in 1900 that the average number of children born to women less than forty-five years of age and married ten to nineteen years was 2.7 for native-born mothers and 4.4 for foreign-born mothers. Further comparisons made in 1909 of the fecundity of married women of the "old" and "new"

1 Reports of the Immigration Commission, vol. ii, p. 497.

immigration show that the former averaged 3.5 children and the latter 4.9.1 The use of the terms "old" and “new” immigration has been discredited since the report of the commission was published, but the contrast in birth rates between certain races is nevertheless worth observing.

A more recent study of comparative birth rates was made by Eastman for New York State in 1916.2 Although his figures are not exactly comparable with the foregoing, the same marked difference between the fecundity of the native and the foreign-born mother is apparent. The average number of legiti

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1 Peter Roberts, The New Immigration, 1914, pp. 368–369. (Appended material abstracted from Immigration Commission's Report on "Fecundity of Immigrant Women," pp. 46-52.)

2 P. R. Eastman, New York State Department of Health. A Comparison of the Birth Rates of Native and of Foreign-born White Women in the State of New York During 1916, 1916, p. 3. 3 Peter Roberts, The New Immigration, 1912, p. 373.

mate births to every 1,000 married women fifteen to forty-four years of age was 137.1 for the native born and 253.2 for the foreign born. On an average almost twice as many children were born to foreign-born mothers as to native born. There is also evidence that a greater proportion of births were to mothers of the more recent immigration, for "73.1 per cent of all births to foreign-born women were to Italian, Russian, and Austro-Hungarian mothers." These high fecundity rates among the four races-Poles, Bohemians (or Czechs), Russians, and Italians-are of interest in connection with the infant mortality rates reported from these European countries (Table XXIII).

Figures relating to maternal deaths among these

TABLE XXIV

DEATH RATES FROM AFFECTIONS CONNECTED WITH PREGNANCY, 1900.1 (DEATHS PER 100,000 FEMALE POPULATION, FIFTEEN TO FORTY-NINE YEARS OF AGE, IN THE REGISTRATION AREA)

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1 Twelfth Census of the U. S., 1900, Vital Statistics, vol. iii, p.

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races are scarce. The United States Census of 1900, however, contains some suggestive material (Table XXIV). The Italians, Russians, and Poles head the list in maternal mortality, standing in very much the same position as in the preceding table giving infant mortality rates abroad. The amount of evidence on hand is insufficient to reach any conclusion as to whether the cause of high maternity death rates is racial or environmental, or as to the relative importance of these two influences. The differences between races are so considerable and the subject itself is of so much importance that further investigation is much to be desired. It is to be hoped that figures secured from the 1920 census may be tabulated so as to bring out race elements in maternal mortality.

INADEQUATE MATERNITY CARE

It might be expected that the same resources for maternity care would be used by immigrant women as by natives of the same economic status. In large cities there are usually maternity hospitals and charitable agencies which are not found in middle-sized communities. In cities where medical schools exist and medical students are taught obstetrics, wellorganized out-patient services have been developed, through which many women receive excellent care in confinement in their own homes, the difficult cases being brought to the hospitals. In smaller places there are no organized resources for providing care in confinement, and maternity beds in hospitals to which cases can be taken in an emergency are often lacking or are far below the number needed. The

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