Maternal and Child Health Services.
64. The Government Midwifery Service, operating from nineteen centres, attended 9,087 women, delivering 8,895 successfully and 121 of still births. It was necessary to refer 140 of the cases to hospitals to deal with complications of pregnancy and child birth. Approximately 11% of all births registered have therefore been attended by the 36 midwives comprising the Government Midwifery Service. The average number of cases handled by a midwife during the year was 259, but one midwife actually delivered as many as 559 cases or rather more than one birth every sixteen hours, a truly remark- able record of service. A case load of over 100 cases per annum is regarded as putting an excessive strain on a midwife elsewhere, militating against adequate attention. Many of these cases were delivered in their own homes, particularly in resettlement areas. The 213 midwives in active private practice delivered 30,195 cases, 29,903 being delivered of living children and 292 of still births.
65. In addition to the normal duties of attending actual births all midwives, private and Government, are expected to give ante-natal supervision during pregnancy to their clients. It is hardly surprising, if a little disappointing, to find that only 66.17% of women delivered by Government midwives and 83.07% of cases attending private midwives were able to receive this attention. The average number of pre-natal examinations given to pregnant women attending all centres was a little over two per pregnancy, but in actual practice the vast majority of pregnant women tended to come only once late in pregnancy when, as often as not, it was already too late to deal adequately with any abnormality present. According to present experience it would seem that at least 8% of all pregnant women are suffering from some grave defect or complication of pregnancy endangering either their own life or that of their unborn child or making for a difficult and dangerous birth, a very large percentage of which could be avoided or ameliorated by earlier attendance and, as has already been pointed out, at least 6% are found to be suffering from unsuspected syphilis which
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discase very seriously threatens the life and health of the child. To date it has been found practicable to organize ante-natal sessions at 17 of the 19 Government centres.
66. Post natal care was started on an organized basis in 1953 and this service has been steadily expanded during the year under review. Comparatively few women as yet avail themselves of this service, the average attendance at sessions being only about 9, but that a need exists is revealed by the fact that 16% of women examined are found to be in need of corrective treatment.
67. The care of children during the first 2 years of life is now the most gratifying and highly organized of the Maternal and Child Health Services. During 1954, 16,649 children came under the care of this service, on an average each child attend- ing 12.46 times in the year, that is to say, the majority of children were brought regularly and seen at least once a month. This would seem to indicate that the services rendered are increasingly appreciated and the regular attendance makes it possible to do much systematic health education amongst mothers, an opportunity that is fully exploited by the staff. It is interesting to note that of the children brought to the 3 main urban centres, only 2.21% were found to have any defect whereas amongst those attending the rural centres 4.13% show some defect needing correction. This does not indicate that rural children are twice as liable to malady or malformation as urban children; but rather that urban mothers more fully appreciate that infant health centres are intended to guide and supervise the normal growth and development of healthy children whilst rural mothers incline to regard these centres as places to which to bring their children when sick. Children found to be in need of more than the simplest medical care or advice are of course referred to the appropriate treatment centres.
68. Much of the health education is done by the nurses during visits to the homes of the mothers. This aspect of the work, home visiting and investigation of the background living