PART I.--INCIDENCE OF ABORTION IN NEW ZEALAND._Report of the Committee of Inquiry into the Various Aspects of the Problem of Abortion in New Zealand

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1937.

NEW ZEALAND.

REPORT

OF THE

COMMITTEE OF INQUIRY

INTO

THE VARIOUS ASPECTS OF THE

PROBLEM OF ABORTION

IN NEW ZEALAND.

_Laid on the Table of the House of Representatives by Leave._

CONTENTS.

PAGE

Historical and Introduction 2

Part I.--Incidence of Abortion in New Zealand 3

Part II.--Underlying Causes 8

Part III.--Possible Remedial Measures 12

Part IV.--Medico-legal Aspects 19

Summary and Conclusions 26

Thanks 28

CONSTITUTION AND TERMS OF REFERENCE OF COMMITTEE.

In accordance with the decision of Cabinet, a special Committee was

appointed on 4th August, 1936,--

(1) To inquire into and report upon the incidence of septic abortion

in New Zealand, including--

(_a_) The incidence among married and single women;

(_b_) Whether the rate of incidence has increased during recent

years;

(_c_) How New Zealand compares with other countries in this

respect;

(2) To inquire into and report upon the underlying causes for the

occurrence of septic abortion in New Zealand, including medical,

economic, social, and any other factors;

(3) To advise as to the best means of combating and preventing the

occurrence of septic abortion in New Zealand;

(4) Generally to make any other observations or recommendations

that appear appropriate to the Committee on the subject.

The following were appointed members of the Committee:--

Dr. D. G. McMillan, M.B., Ch.B. (N.Z.), M.P., Chairman.

Mrs. Janet Fraser.

Dr. Sylvia G. Chapman, M.D., D.G.O. (T.C.D.).

Dr. Thomas F. Corkill, M.D. (Edin.), M.R.C.P. (Edin.), M.C.O.G.

Dr. Tom L. Paget, L.R.C.P. (Lond.), M.R.C.S. (Eng.).

REPORT.

The Hon. the Minister of Health, Wellington.

SIR,--

The Committee set up by Cabinet to inquire into the various aspects of

the Problem of Abortion in New Zealand has the honour to submit

herewith its report.

HISTORICAL AND INTRODUCTION.

Since the rise in the death-rate from septic abortion in 1930, the

Department of Health, the medical profession, and women's organizations

and societies have shown great concern regarding the problem. The

Obstetrical and Gynaecological Society of the New Zealand Branch of the

British Medical Association conveyed to the Prime Minister a resolution

passed at the meeting of its executive held in Wellington on 12th

March, 1936, wherein it begged the Prime Ministry to consider the

advisability of setting up a Committee of inquiry to investigate this

matter.

This recommendation having been favourably considered, the following

Committee was appointed:--

Dr. D. G. McMillan, M.B., Ch.B. (N.Z.), M.P., Chairman.

Mrs. Janet Fraser.

Dr. Sylvia G. Chapman, M.D. (N.Z.), M.B., Ch.B. (N.Z.).

Dr. T. F. Corkill, M.D. (Edin.), M.R.C.P. (Edin.).

Dr. T. L. Paget, M.R.C.S. (Edin.), L.R.C.P. (Lond.).

Although the immediate purpose of this inquiry was to investigate the

problem of septic abortion, it at once became apparent that this matter

was so inextricably bound up with the subject of abortion in general

that all aspects would require consideration.

The Committee has therefore attempted to make this wider survey and to

bring before you as complete a picture as possible.

The Committee has been guided by the Order of Reference, which was as

follows:--

I. To inquire into and report upon the incidence of abortion in

New Zealand, including--

(_a_) The incidence among married and single women;

(_b_) Whether the rate of incidence has increased during

recent years;

(_c_) How New Zealand compares with other countries in this

respect.

II. To inquire into and report upon the underlying causes for the

occurrence of abortion in New Zealand, including medical,

economic, social, and any other factors.

III. To advise as to the best means of combating and preventing the

occurrence of abortion in New Zealand.

IV. Generally to make any other observations or recommendations

that appear appropriate to the Committee on the subject.

The preliminary meeting of the Committee was held on the 18th August,

and in all sixteen meetings have been held, of which thirteen meetings

were held in Wellington, one in Dunedin, one in Auckland, and one in

Christchurch.

Evidence was heard from--

British Medical Association.

Church of England.

Crown Solicitor.

Dominion Federation of Women's Institutes.

Dominion Federation of Women's Institutes (Auckland Branch).

Government Statistician.

Lecturer in Medical Jurisprudence, Otago Medical School.

Maternity Protection Society.

Mothers Union.

National Council of Women.

National Council of Women (Canterbury Branch).

New Zealand Labour Party (Auckland Women's Branch).

New Zealand Registered Nurses Association.

New Zealand Registered Nurses Association (Auckland Branch).

New Zealand Registered Nurses Association (Christchurch Branch).

Obstetrical and Gynaecological Society.

Obstetricians and Gynaecologists attached to the Public Hospitals in

Auckland, Wellington, Christchurch, and Dunedin.

Pharmaceutical Society.

Police Department.

Presbyterian Church of New Zealand.

Roman Catholic Church.

Royal Society for the Health of Women and Children.

St. John Ambulance Association Nursing Guild.

Women's Division of the Farmers Union.

Women's Division of the Farmers Union (Otago Branch).

Women's Division of the Farmers Union (South Auckland Branch).

Women's International League for Peace and Freedom.

Women's Service Guild.

Working Women's Movement (Auckland Branch).

In addition to these, evidence was heard from twelve other persons.

The Committee would like to express its thanks to the witnesses, many

of whom have gone to considerable trouble to collect information and

prepare their evidence.

PART I.--INCIDENCE OF ABORTION IN NEW ZEALAND.

All the evidence brought before the Committee indicates that abortion

is exceedingly frequent in New Zealand.

It is quite impossible to assess the incidence with complete accuracy,

for the reason that a very considerable number of these cases do not

come under medical or hospital observation, but some definite

indication of the frequency is given by the statistics obtained from

various hospitals and practices.

In one urban district, for instance, in which the total live births for

a two-year period were 4,000, the number of cases of abortion treated

in the public hospital alone was 400.

When to this number were added the cases treated in the various private

hospitals, those attended by doctors in the patients' homes, and those

not medically attended at all, it was computed that a total of 1,000

abortions was a conservative figure. In other words, roughly twenty

pregnancies in every 100 terminated in abortion.

Looked at from a somewhat different angle, figures were presented from

one hospital showing that in a group of 568 unselected women of

child-bearing age, there were 549 abortions in 2,301 pregnancies, or 23

per hundred.

HOW DO THESE CASES ORIGINATE?

It must be explained that a certain number of cases of abortion occur

perfectly innocently as the result of some condition of ill health, or,

occasionally, as the result of accident. These _spontaneous_ cases

constitute an entirely medical problem.

All other cases are artificially produced or _induced_.

A very small number of these are honourably performed by medical

practitioners when the mother's life is seriously endangered.

This procedure is termed "_Therapeutic induction of abortion_."

Certain important questions in relation to therapeutic abortion will be

discussed at a later stage in this report.

The remainder of the induced cases are unlawfully produced by the

person herself or by some other person--_criminal abortion_.

The Committee received much evidence regarding the methods used in the

attempt to procure abortion.

In the first instance it was shown that the use of so-called

abortifacient drugs was extensively practised and was usually a first

resort.

Little need be said about the matter at this stage except to state that

the New Zealand evidence entirely supports the opinions expressed

elsewhere that drug-taking is rarely effective.

Those tempted to use these drugs should realize the futility of the

practice for the purpose intended and the frequency with which

disturbances of health are caused by taking them.

Their only value is as a lucrative source of gain to those people who,

knowing their inefficacy, yet exploit the distress of certain women by

selling them.

It is perfectly clear that the real menace is the instrumentally

produced abortion, either self-induced by the person herself or the

result of an illegal operation performed by some outside person.

These abortionists include a few unprincipled doctors and chemists, a

few women with varying degrees of nursing training, and a number of

unskilled people.

It was a matter of considerable importance for the Committee to attempt

to determine first the extent to which spontaneous abortions contribute

to the total figures: the prevalence of unlawful abortion could then be

better realized.

Here again it was found exceedingly difficult to obtain exact figures,

but the evidence suggests that probably less than seven pregnancies in

every 100 terminate in spontaneous abortion.

Taking the records of one group of 1,095 women where the incentives to

interference were probably at a minimum, it was found that out of a

total of 2,180 pregnancies only 152, or 6.97 per cent., terminated in

abortion, while in a series of 5,337 pregnancies in patients taken from

the records of St. Helens Hospitals, 6 per cent. terminated in

abortion.

Even assuming that _all_ these were spontaneous (which was probably not

the case), the incidence is approximately 6 per cent. to 7 per cent.

If, then, the total abortion rate is 20 per 100, it is clear that the

incidence of criminal abortion is at least 13 in every 100 pregnancies.

The Committee believes that this figure can be accepted as a

conservative estimate of the prevalence of unlawful abortion in New

Zealand. Some of the figures presented suggested a still higher

incidence.

Applying the figures given to the whole of New Zealand it means that

while in the year ending March, 1936, there were 24,395 live births

there were probably 6,066 abortions, of which nearly two-thirds (4,000)

were criminally induced.

The impression of the Committee is that this is an underestimate.

Serious as this is on general grounds, the matter is of particular

importance in regard to the special problem which led to the setting-up

of this Committee of inquiry--the _incidence of septic abortion_.

Septic infection, or blood-poisoning, is the most serious complication

which may follow abortion.

Grave concern has been occasioned by a realization of the frequency of

septic abortion, the most significant indication of which is the number

of women who lose their lives as the result of this complication.

Attention has repeatedly been drawn to this problem by the officers of

the Department of Health, the New Zealand Obstetrical and Gynaecological

Society, and others interested in maternal welfare.

During the five-year period 1931-35, 176 women died from sepsis

following abortion. In the same period there were only 70 deaths from

sepsis following full-time child-birth. Some of the distressing

repercussions from these tragedies have been revealed in the annual

report of the Director-General of Health, 1936, which shows that in

that period 338 children were left motherless by the death of 109

married women.

Another serious fact is that, while, owing to the strenuous efforts of

those engaged in the direction and practice of midwifery, there has

been a most gratifying fall in deaths from post-confinement sepsis from

2.02 per 1,000 live births in 1927 to 0.4 per 1,000 in 1935, deaths

from post-abortion sepsis in the same period rose from 0.50 per 1,000

live births in 1927 to 1.73 per 1,000 in 1934, with a fall to 1 per

1,000 in 1935. These figures are illustrated by the following graph and

accompanying table:--

_Maternal Mortality._

Showing the number of deaths and the death-rate per 1,000 live births

from certain causes, 1927 to 1935.

--------------------------+----+----+----+----+----+----+----+----+-----

|1927|1928|1929|1930|1931|1932|1933|1934|1935

--------------------------+----+----+----+----+----+----+----+----+-----

Number | 137| 134| 129| 136| 127| 101| 108| 118| 101

Rate |4.91|4.93|4.82|5.08|4.77|4.08|4.44|4.85|4.21

| | | | | | | | |

Number | 123| 120| 110| 106| 98| 75| 82| 76| 78

Rate |4.41|4.42|4.11|3.96|3.68|3.02|3.37|3.12|3.25

| | | | | | | | |

Number | 56| 42| 30| 27| 18| 13| 14| 17| 8

Rate |2.01|1.54|1.12|1.01|0.68|0.52|0.58|0.70|0.33

| | | | | | | | |

Married |} | | {| 26| 26| 24| 16| 29| 17

|} 14| 14| 19{| | | | | |

Single |} | | {| 4| 3| 2| 10| 13| 6

Rate |0.50|0.51|0.71|1.12|1.09|1.04 1.07|1.73|0.96

--------------------------+----+----+----+----+----+----+----+----+-----

[Illustration: Maternal Mortality.

Showing the Deathrate per 1,000 Live Births from Certain

Causes 1927-1935.]

One of the unfortunate features of this matter from the public health

point of view is the extent to which this increase in deaths from

abortion sepsis is counterbalancing and masking the very real

improvement which has been achieved by the obstetrical services in the

work for which they may justly be held responsible.

According to the international system of recording, these cases are

included in the total maternal mortality.

Actually in New Zealand in the five-year period mentioned, abortion

sepsis was responsible for one-quarter of the total maternal deaths.

In the larger urban areas the position is even more unfortunate, as the

following instance will indicate:--

_Maternal Mortality in Urban Areas for the Five-year Period, 1930-34._

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

------------+-------+-------+--------+---------+---------+--------+--------

Auckland |14,290 | 81 | 5.67 | 55 | 3.85 | 26 | 1.82

Wellington |11,690 | 61 | 5.22 | 32 | 2.74 | 29 | 2.48

Christchurch| 9,599 | 51 | 5.31 | 29 | 3.02 | 22 | 2.29

Dunedin | 5,960 | 24 | 4.03 | 17 | 2.96 | 7 | 1.17

| | | | | | |

Total, four |41,539 | 217 | 5.22 | 133 | 3.20 | 84 | 2.02

| | | | | | |

Total, |58,623 | 273 | 4.66 | 204 | 3.48 | 69 | 1.18

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

In the case of the four urban areas deaths from septic abortion account

for approximately two-fifths of the total maternal mortality.

With these cases excluded, the maternal mortality associated with

child-birth proper was 3.20 per 1,000 live births.

Clearly, any comparison between different maternity services should be

made on the basis of these latter figures alone.

WHAT IS THE CAUSE OF THIS HIGH INCIDENCE OF DEATHS FROM SEPTIC

ABORTION.

The evidence offered to the Committee by medical witnesses indicates

conclusively that sepsis, and death from sepsis particularly, is almost

entirely due to illegal instrumental interference.

Spontaneous abortion, provided that proper medical care is given,

rarely results in sepsis. Therapeutic abortion, done with all the

safeguards of modern surgical practice, is associated with very little

acute sepsis.

But criminal abortion is associated with an extremely high sepsis rate.

The reasons are not far to seek: the surreptitious nature of the

operation and the lack of skill and surgical cleanliness so frequently

shown by the operator make this result almost inevitable.

HAS THE PRACTICE OF ABORTION INCREASED IN RECENT YEARS?

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 Association 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 13.4 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 88.2 per cent., and the death rate 3.7 per cent., while in 246

cases with no history of interference and presumably spontaneous the

febrile rate was 5.7 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 | 0.47 | 0.57 | 2.75 | 2.28

Netherlands | 0.30 | 0.73 | 3.20 | 2.90

New Zealand | 1.73 | 0.70 | 4.85 | 3.12

Switzerland | 0.73 | 0.82 | 4.58 | 3.85

England and Wales | 0.49 | 1.53 | 4.60 | 4.11

Australia | 1.45 | 0.90 | 5.76 | 4.31

Irish Free State | 0.07 | 1.73 | 4.68 | 4.61

Canada | 0.58 | 1.23 | 5.26 | 4.68

United States of America| 1.02 | 1.30 | 5.93 | 4.91

Union of South Africa | 0.67 | 2.03 | 5.99 | 5.32

Scotland | 0.38 | 2.30 | 6.20 | 5.82

Northern Ireland | 0.32 | 1.85 | 6.27 | 5.95

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Report of the Committee of Inquiry into the Various Aspects of the Problem of Abortion in New Zealand · 第 1 / 4 章