Local Government Board,
Whitehall, S.W.
July 29, 1915.

Sir,

I am directed by the Local Government Board to bring to the notice of the Council the provisions of the Notification of Births (Extension) Act, 1915, which has recently been passed.

The objects of this Act are to make universal throughout the country the system of the Notification of Births Act, 1907, under which early information concerning all births is required to be given to the medical officer of health, and also to enable local authorities to make arrangements for the care of mothers, including expectant mothers, and young children.

At a time like the present the urgent need for taking all possible steps to secure the health of mothers and children and to diminish ante-natal and post-natal infant mortality is obvious, and the Board are confident that they can rely upon local authorities making the fullest use of the powers conferred on them.

Notification of Births Act, 1907, to extend to every District.

The Act provides that on and after the first of September next the Notification of Births Act, 1907, described as the principal Act, shall extend to and take effect in every area in which it is not already in force.

In the case of a county district the principal Act will come into operation as if it had been adopted by the Council of the urban or rural district.

The principal Act provides that in the case of every child born within the district it is the duty of the father of the child, if he is actually residing in the house where the birth takes place at the time of its occurrence, and of any person in attendance upon the mother at the time of, or within six hours after, the birth, to give notice in writing of the birth to the medical officer of health of the district. This notice must be given in the case of every child which has issued forth from its mother after the expiration of the twenty-eighth week of pregnancy whether alive or dead.

The notice is to be given by prepaid letter or postcard addressed to the medical officer of health, giving the necessary information of the birth within thirty-six hours after the birth, or by delivering a written notice of the birth at the office or residence of the medical officer within the same time. The local authority is required to supply without charge addressed and stamped postcards containing the form of notice to any medical practitioner or midwife residing or practising in their area who applies for the same.

The Act also provides for penalties for failure to notify a birth in accordance with the Act.

It will be the duty of every local authority in whose area the principal Act comes into force by virtue of the new Act to bring the provisions of the principal Act to the attention of all medical practitioners and midwives practising in the area [Section 1 (3)].

The Board wish especially to call attention to Section 1 (2) of the new Act, under which the medical officer of a county district, for which the principal Act had not previously been adopted, will be required to send duplicates of any notices of birth he receives to the county medical officer of health as soon as may be after they are received. The early receipt of these duplicate notices is important, particularly in facilitating the inspection of midwives, and the Board trust that arrangements will be made under which the duplicates are as a matter of routine immediately transmitted to the county medical officer.

Administrative Arrangements under the Act.

Section 2 of the Act provides that for the purpose of following up the information obtained under the powers of the principal Act and for facilitating arrangements for the care of expectant mothers, nursing mothers and young children, all the powers of the Public Health Acts may be exercised. These powers will be available not only to all sanitary authorities, but also to all County Councils other than the London County Council. In London the powers of the Public Health (London) Act, 1891, will be available for work undertaken in regard to the care of mothers and young children by Metropolitan Borough Councils.

It will be seen, therefore, that the Act definitely contemplates that the powers of sanitary authorities will be used to promote the care of mothers and young children.

The Board are anxious to insist on the importance of linking up this work with the other medical and sanitary services provided by local authorities under the Public Health and other Acts. They have already in their circular letter of the 30th July, 1914, on the subject of Maternity and Infant Welfare, indicated generally the scope of the work which they consider should be undertaken, and an additional copy of that letter is enclosed.

As indicated above, the Act contemplates that arrangements for attending to mothers and young children may be made either by County Councils or by sanitary authorities. The Board recognise that the organisation must vary to some extent with local conditions, and that a considerable degree of elasticity is necessary. They are, however, of opinion that it will generally be desirable to formulate comprehensive schemes for counties and county boroughs, although in some cases portions of the services may be undertaken by the larger District Councils with advantage. The councils of counties and county boroughs are the local supervising authorities under the Midwives Act, 1902, and they are also entrusted with the initiation and execution of schemes for the treatment of tuberculosis; if the organisation of a maternity and infant welfare scheme is also undertaken by them, it will be practicable to secure the unification of home visiting for a number of different purposes.

In all cases, however, in which a general scheme is organised for the county, the work should be carried on in close co-operation with the sanitary authority, and any insanitary conditions found by health visitors should at once be reported to the sanitary authority. Although the Board consider that general schemes should be organised for the county as a whole, and that the County Council should, as a general rule, provide for health visiting, they are prepared, in suitable cases, to recognise the sanitary district as a proper area for a scheme.

Co-operation with Medical Practitioners and Voluntary Agencies.

In the development of general schemes the Board desire that the services of hospitals and other efficient voluntary agencies should be fully utilised. They are also anxious that the co-operation of medical practitioners should be secured. The value of a Maternity Centre will be much increased by obtaining the co-operation of the medical practitioners in the area to be served by it, and in organising the arrangements it is desirable that they should be consulted.

London.

In London the Act contemplates that schemes should be organised by the Metropolitan Borough Councils. Many of the services required can be provided by the various London hospitals and the numerous voluntary agencies now at work, and in some cases the chief need is to secure that such services are properly linked up with the work of the Borough Council. In other areas existing medical services will require supplementing and extending, and it will be for the Borough Councils to consider how this can best be done.

Grants in Aid of Local Expenditure.

The Government have agreed to provide, by means of annual grants to be distributed by the Board, one-half the cost of the whole or any part of schemes for maternity and child welfare approved by the Board. The regulations under which these grants will be paid, together with forms of application for grants, have already been distributed to local authorities. A further copy of the regulations is enclosed.

Interim Schemes.

Many local authorities have already prepared and submitted to the Board schemes for Maternity and Infant Welfare, embracing some or all of the items included in the Board’s memorandum of 30th July, 1914. The initiation of a complete scheme, however, involves time, and the Board do not desire that work should be delayed until a complete scheme can be formulated. They trust that those local authorities who have not already taken steps in this matter will do so before the onset of the hot weather, which brings with it special dangers to infants and children. The Board are of opinion that the local authority should in the first instance carefully consider whether the existing arrangements for home visitation are adequate. After the provision of health visitors the next step should be to arrange in populous centres for a Maternity Centre at which medical advice and treatment may be provided for mothers, including expectant mothers, and for children, whether ailing or not. Arrangements should also be made for defraying in necessitous cases the cost of providing the services of a midwife and of a doctor. The Board will be prepared to sanction such provision under Section 133 of the Public Health Act, 1875.

Present Need for Maternity and Infant Welfare Work.

The importance of conserving the infant life of the population makes it desirable that steps should be taken in the directions indicated even at the present time when strict economy is required in the expenditure both of public bodies and of private individuals. It is not, however, intended that any large outlay should be involved in the provision of the services mentioned. No capital expenditure is needed, and the maintenance expenditure need not be heavy. The health visitors and many of the doctors required to work such a scheme will be women, and no labour need be employed which is required for the more direct purposes of the war.

Committees.

The Act provides that the powers of a local authority may be exercised in such manner as the authority direct by a committee or committees, which shall include women, and may comprise, if it is thought fit, persons who are not members of the authority.

In any such committee it will be desirable to include working women, who might with advantage be representative of women’s organisations. Where no local women’s organisation exists, some central organisation might possibly assist by suggesting suitable women.

The Board consider that on any committee appointed for the purposes of the Act there should be a majority of direct representatives of the Council.

I am, Sir,
Your obedient Servant,
H. C. MONRO,
Secretary.