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 Gynæcological 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.