In so far as the deaths from septic abortion can be taken as a comparative indication of the occurrence of abortion generally--and the Committee believes this is a fair index--there seems little doubt that there has been a marked increase.

A reference to the graph already given will indicate this rise.

There is reason to hope that the fall in 1935 means an improvement in the general situation.

Professor Dawson, giving evidence regarding admissions to the Dunedin Hospital, showed that in the five-year period 1931-35 there was an increase of 23.7 per cent. in the cases of abortion as compared with the previous five-year period.

The evidence of other medical witnesses was practically unanimous on this point.

HOW DOES NEW ZEALAND COMPARE WITH OTHER COUNTRIES IN THIS MATTER?

According to the report of the British Medical a.s.sociation Committee on the Medical Aspects of Abortion (1936), the position in Great Britain would appear to be very similar to that existing in New Zealand.

In that report it is stated that the incidence of abortion is generally reckoned at from 16 per cent. to 20 per cent. of all pregnancies.

The spontaneous-abortion rate is suggested as probably about 5 per cent. of all pregnancies.

The evidence set before that Committee suggested that there has been an increase in criminal abortion in the last decade.

In England and Wales 134 per cent. of the total maternal deaths were due to abortion.

That Committee concludes that "illegal instrumentation contributes to an overwhelming degree to the mortality from abortion."

One of the most interesting investigations into this aspect of the subject is reported by Parish[1] in a study of 1,000 cases of abortion treated as in-patients in St. Giles's Hospital, Camberwell, during the years 1930 to 1934.

[1] "The Journal of Obstetrics and Gynaecology of the British Empire," December, 1935, p, 1107. T. M. Parish.

In 374 of these cases where instrumentation was admitted the febrile rate was 882 per cent., and the death rate 37 per cent., while in 246 cases with no history of interference and presumably spontaneous the febrile rate was 57 per cent. and the mortality rate _nil_.

The following table compiled by the Government Statistician shows New Zealand's position in comparison with eleven other countries:--

_Puerperal Mortality per 1,000 Live Births in Eleven Countries, 1934._

------------------------------------------------------------------- | | | Total Puerperal | | | Mortality.

| | Puerperal |------------------- Country. | Septic | Sepsis |Including|Excluding |Abortion.| following | Septic | Septic | |Child-birth.|Abortion.|Abortion.

------------------------+---------+------------+---------+--------- Norway | 047 | 057 | 275 | 228 Netherlands | 030 | 073 | 320 | 290 New Zealand | 173 | 070 | 485 | 312 Switzerland | 073 | 082 | 458 | 385 England and Wales | 049 | 153 | 460 | 411 Australia | 145 | 090 | 576 | 431 Irish Free State | 007 | 173 | 468 | 461 Canada | 058 | 123 | 526 | 468 United States of America| 102 | 130 | 593 | 491 Union of South Africa | 067 | 203 | 599 | 532 Scotland | 038 | 230 | 620 | 582 Northern Ireland | 032 | 185 | 627 | 595 -------------------------------------------------------------------

PART II.--THE UNDERLYING CAUSES OF ABORTION IN NEW ZEALAND.

As seen by the Committee, the reasons which lead to a resort to abortion may be set out under the following broad headings:--

(1) Economic and domestic hardship.

(2) Fear of labour and its sequelae.

(3) Pregnancy in the unmarried.

(4) Changes in social outlook.

(5) Ignorance of effective methods of contraception and of the dangers of abortion.

(6) Influence of advertising.

(1) ECONOMIC AND DOMESTIC HARDSHIP.

(_a_) _Poverty._--Cases arise where the parents are on the bread-line and have no means of supporting a child, but the Committee is of opinion that such extreme poverty is rare in New Zealand.

More common are the cases in which income is sufficient for a small family but a larger one would const.i.tute hardship, or, alternatively, in which income is sufficient to support several small children but not to provide education, &c., in later life. The view, formerly widely accepted, that membership of a large family is in itself a valuable contribution to education and to the training of responsible citizens, appears to be at a discount, and many parents now consider that advantages which can be _given_ to a child as a result of family limitation outweigh the natural advantages of a large family in which the children develop initiative through companionship.

(_b_) _Housing._--This const.i.tutes an acute problem in crowded city areas. In many cases houses which are past repair and already condemned form the only shelter for a growing family. Ordinary domestic and hygienic conveniences are often lacking. Where a family is able to pay for better accommodation, difficulties frequently arise owing to the unwillingness of landlords to accept tenants with children, and, as the demand for houses exceeds the supply, landlords are able to pick and choose. The lack also of suitable cottages on farms for married couples with children probably has a considerable influence on the limitation or avoidance of families and leads to a premium being placed on childlessness because married couples without "enc.u.mbrances" can more easily obtain employment. This is an aspect of the problem that should receive earnest consideration.

(_c_) _Domestic._--Lack of help in the home even by those who can afford it is a factor of very great importance. This applies especially to country life, where a woman's whole physical energy is taken up by attention to domestic matters and often also to farm-work, to the detriment of family life. The following is an account given to one witness by a farmer's wife, describing an average day's work:--

"Rise 4.30, have cup of tea--wife to shed, set machines, hubby to bring cows--start milking 5 a.m., hard going to 8 o'clock; wife returns house to get breakfast, also see to children and cut lunches for them to take to school. Hubby feeds calves, fowls, and ducks, then breakfast. Load milk on express, harness horse, away to factory mile away--get whey return. Now 9 o'clock, wife has machines down and washes, hubby hose down shed. Drive whey down to paddocks and feed 40 pigs, returns, unharness horse, wash cart down, yoke team to plough, disk, &c. Wife to start housework about 10 o'clock, dinner at 12.30 to be ready, or taken down to paddocks (if harvesting 3 or 4 men are working). Usual times fencing, repairing sheds, fixing yards, besides other farm duties till 3.30--afternoon tea--children given something to eat on returning from school. Husband and wife to sheds again 4 till 7. Hubby washes machines, feeds calves, &c., wife in meantime has returned house, washed children and put to bed before sitting down to her tea at 8 o'clock--by time washed up is 9 o'clock--too tired to do anything else but crawl into bed."

The lack of adequate playing-areas, kindergartens, and other means of employing the time of the pre-school child outside the home is a matter that was brought before the notice of the Committee as another of the domestic difficulties. This is one of the factors preventing that amount of leisure which is necessary for the well-being of the mother.

(_d_) _Cost of Confinement._--This was stressed particularly by country witnesses. Where a woman is beyond the reach of medical attendance and has to travel a considerable distance to hospital this adds materially to the cost of the confinement. To some women even moderate hospital and medical fees are prohibitive, and the problem is rendered more difficult still by the necessity for providing extra help in the home or on the farm during the wife's absence. It was, however, rightly pointed out by one witness that the fees paid to an abortionist and the economic waste due to subsequent ill health would in many cases more than pay the expenses of an ordinary confinement.

(2) FEAR OF LABOUR AND ITS SEQUELae.

This was referred to by several witnesses, some of who cited cases from their own experience. An erroneous idea seems to be prevalent among certain sections of the laity that the total abolition of pain during labour is possible for every patient. The fear that such relief will be withheld has been suggested as a cause for women seeking the abortionist. It would seem, however, that, with the increasing knowledge of methods of pain-relief in labour, more extensive ante-natal and post-natal care, and the cultivation of a more normal psychological outlook among pregnant women, the fear complex will in future a.s.sume progressively less importance. The Committee believes that increasing attention is being paid to these aspects by the medical profession.

As to the bearing of this matter on the subject of abortion, several witnesses, among whom were two obstetricians of wide experience, expressed the opinion that, while fear of pregnancy and labour is rare, fear of infection following abortion is a factor the recognition of which is becoming more general.

The Committee is of opinion that fear of labour is not a major factor, and this opinion is supported by many witnesses.

Ill health was alleged as a cause in a few instances, but it would appear that, in spite of the ambiguous state of the law, no genuine ease of ill health need resort to abortion by clandestine methods. This is referred to in greater detail elsewhere.

(3) PREGNANCY IN THE UNMARRIED.

While this const.i.tutes only a small part of the general problem of abortion, it is, nevertheless, a matter of great importance, and one which merits the closest study. Undoubtedly the general att.i.tude towards the unmarried mother to-day is kinder and more tolerant than was formerly the case, but the fact remains that the single girl who determines to face the world with her child may find herself subject to unreasonable and unnecessary cruelty and injustice. Excellent work in a.s.sisting the single mother is done by various religious and charitable organizations, and where a girl is driven to the abortionist this is more likely to be due to fear of social ostracism than to lack of ways and means of caring for the child.

Several witnesses mentioned ignorance of matters relating to s.e.x as being frequently responsible for pregnancy in the unmarried. This is undoubtedly the case, and the responsibility of parents, guardians, and teachers in this matter is evident. The evil influence of drinking on young people was also stressed, medical and social workers being well aware of the importance of this factor. Alcohol consumption need not be excessive to undermine self-control and dull the moral sense.

(4) CHANGES IN THE SOCIAL OUTLOOK.

The Committee believes that, in the altered social outlook, particularly towards the rearing of large families, lies a very important cause for the present situation. This aspect of the matter is intimately interwoven with the economic considerations already set forth, but extends far beyond them.