Maternal Mortality In New York City: NYAM’s Landmark 1933 Study

By Paul Theerman, Director

NYAM’s 1933 maternal mortality report is one of the 30 highlights of “Celebrating NYAM Milestones,” prepared for our 175th anniversary in 2022.

In 1930, the New York Academy of Medicine began a major project that resulted in the landmark report Maternal Mortality in New York City, published in 1933. In its work, the Academy was part of a great movement in the first third of the 20th century that devoted greater efforts to the problem of maternal mortality. Many reasons led to this increased emphasis in public health communities. In the American context, though, the foundation of the Children’s Bureau in 1912 brought these issues to the fore.

In the late 19th and early 20th centuries, the settlement house movement focused attention on the plight of children in urban slums and tenements. The issue eventually reached President Theodore Roosevelt, who convened the first White House Conference on Children in 1909. Three years later President Taft signed the act establishing the U.S. Children’s Bureau as a part of the Department of Labor, the first Federal agency dedicated to the welfare of children. Under its dynamic first director, Julia Lathrop (1858–1932), the bureau mounted multi-pronged programs to address the social needs of children and mothers and helped set the agenda for increased study of maternal mortality over the following years. In 1930 the bureau mounted a White House conference on child health and protection, which included maternal mortality in its scope, and in 1933, it issued a report on maternal mortality in 15 states. Its work played a leading role in the international focus on maternal health; the Library’s collections hold over 15 professional and lay studies on maternal mortality dating between 1925 and 1937, covering such disparate geographical regions as Philadelphia, Scotland, and Birmingham, Alabama. Thus when the New York Academy of Medicine took on its study, it was adding its voice to the ongoing international effort.

Dr. Ransom Spafard Hooker, 1907

The Academy began its study of maternal mortality in New York City in 1930, with the assistance of the New York Obstetrical Society and the support of the Commonwealth Fund. Under the auspices of the Academy’s Public Health Relations Committee, Dr. Ransom S. Hooker (1874–1957), a prominent surgeon, was appointed director of the study. From 1930 to 1932, the city’s Health Department provided, and the Academy analyzed, 2,014 case reports on women’s deaths from childbirth as well as deaths of pregnant women. For each case, the physician was interviewed, and if the death took place in a hospital, that institution was inspected.

The analysis found huge gaps in perinatal care and obstetrical practice, partly among midwives but chiefly among physicians. The report’s chief recommendation was for increased education and training, both popular and professional. Prospective mothers should know and be able to ask for what they needed in perinatal care. Both generalist physicians and the newly forming specialist obstetricians should receive better obstetrical training in medical schools and through hospital internships. The report called for a reduction in surgical interventions “undertaken merely to alleviate pain or shorten labor.” It recommended that hospitals provide separate obstetrical clinics, wards, and delivery rooms, overseen by trained obstetricians, with rigid rules to maintain asepsis, including masking. Based on the data—which showed better results for midwife-assisted births—the report supported the practice of home delivery. Nonetheless it called for more training and greater supervision of midwives, preferably by physicians. The report concluded that “the rate of death was unnecessarily high . . . [and] two-third of all the deaths studied could have been prevented.”

The Commonwealth Fund published the landmark study on November 20, 1933, followed by the Academy’s summary in its publication Health Examiner. Iago Galdston, secretary of its Medical Information Bureau, provided major press outlets with a précis of the study, titled “Why Women Die in Childbirth,”. One sign of its reach: the January 1934 meeting of the Maternity Center Association, attended by over 500 people, focused on the report, and emphasized public education in the search for better outcomes. Four years later, Galdston adapted the study for lay audiences, including results from Philadelphia and the U.S. Children’s Bureau, as Maternal deaths—the ways to prevention (1937), also published by the Commonwealth Fund.

Immediately after the study’s release, however, obstetricians—and especially those of the New York Obstetrical Society, which helped guide the Academy’s research—thought that their authority and expertise were being questioned. In April the society released a “counter-report” upholding its members’ obstetrical abilities against the “unskilled hands” of general physicians and midwives. Some obstetricians raised their objections within the Academy, both on the report and the publicity around it. The Academy mounted an investigation, which confirmed both the results of the report and the manner of its release. And even as it objected to the report, the Society came together with the Academy in March 1934 to jointly advise the city’s Department of Health on productive ways forward. These efforts bore fruit: from 1935 to 1938, maternal mortality rates in New York City dropped by a third, from 51 to 38 deaths per 10,000 live births, and then dropped further, reaching 22 by 1942. The trend continued over the next 40 years.

What was missing in the Academy’s analysis? Any serious consideration of why health disparities played out along racial lines. That mortality followed race was clear. Each woman’s ostensible race was noted, and the results were reported out by race. The report stated that “the death rate from puerperal causes for the Negro [sic] population . . . greatly exceeds that for the white population.” The Children’s Bureau’s 1933 report found a rate for non-white women nearly twice that of white women—a conclusion that, sadly, remains virtually unchanged almost a hundred years on. Neither of these studies directly addressed causation, and when the Children’s Bureau did so in 1940, as one historian noted, they marked out Black women as inherently poor prospects for motherhood, the origin of “the Black maternal blame narrative.”

Begun in the 1930s, NYAM’s work continues to the present in the 2018 New York Maternal Mortality Summit and the ongoing efforts of the Women’s Health Research and Well-being Working Group.

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Sources:

King, Charles R. “The New York Maternal Mortality Study: A Conflict of Professionalization.” Bulletin for the History of Medicine 65 (1991): 476–502.

New York Academy of Medicine, Committee on Public Health Relations. Maternal Mortality in New York City: A Study of All Puerperal Deaths, 1930–1932. New York: The Commonwealth Fund, 1933. Quotation on p. 163.

Owens, Deirdre Cooper, and Sharla M. Fett. “Black Maternal and Infant Health: Historical Legacies of Slavery.” American Journal of Public Health 109(10)(October 2019): 1342–45. https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305243, accessed March 4, 2022.

“Ransom Hooker, Surgeon, Is Dead; Former Director in Field at Bellevue Made Study Here of Maternal Mortality.” The New York Times, April 12, 1957, p. 25.

Stokes, Anson Phelps. Stokes Records: Notes Regarding the Ancestry and Lives of Anson Phelps Stokes and Helen Louisa (Phelps) Stokes. 4 vols. New York: Privately printed, 1915, 3:130, is the source of the photograph of Ransom Spafard Hooker.

Taylor, Morgan. “An Untold Story: Black Maternal Mortality in the United States.” Nursing Clio, January 20, 2022. https://nursingclio.org/2022/01/20/an-untold-story-black-maternal-mortality-in-the-united-states/, accessed March 4, 2022.

Van Ingen, Philip. The New York Academy of Medicine: Its First Hundred Years. New York: Columbia University Press, 1949. Pp. 441–50.

U.S. Center for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. “Achievements in Public Health, 1900–1999: Healthier Mothers and Babies.” MMWR 48(38) (October 1, 1999): 849–58. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm, accessed March 4, 2022.

U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. The Story of the Children’s Bureau. Washington, DC: The Children’s Bureau, [2012].

U.S. Department of Labor, Children’s Bureau. Maternal Deaths: A Brief Report of a Study Made in 15 States. Bureau Publication No. 221. Washington: Government Printing Office, 1933.

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About nyamhistory

The Center for the History of Medicine and Public Health, part of the Academy Library, promotes the scholarly and public understanding of the history of medicine and public health. Established in 2012, the Center aims to build bridges among an interdisciplinary community of scholars, educators, clinicians, curators, and the general public. The Center bases its work on the Library's historical collections, among the largest in this field in the United States and open to the public since 1878.

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