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Births and Maternity Beds in England and Wales in 1970

Published online by Cambridge University Press:  26 March 2020

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Abstract

This article was prepared by Miss D. C. Paige of the National Institute of Economic and Social Research. It is part of a wider study of the long-term prospects for the British economy, which is under the general supervision of Mr. Wilfred Beckerman. The article refers throughout to England and Wales only, unless it is stated otherwise.

Type
Articles
Information
National Institute Economic Review , Volume 22 , November 1962 , pp. 22 - 37
Copyright
Copyright © 1962 National Institute of Economic and Social Research

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References

(1) A Hospital Plan for England and Wales, Cmnd. 1604, HMSO 1962.

(2) These are made by the Government Actuary's Office, and published in The Registrar General's Quarterly Return for England and Wales, 4th Quarter reports.

(1) The total number of births in institutions was 61.2 per cent in 1950 and 64.9 per cent in 1960 (table 2). These figures include births in institutions other than hospitals, such as remand homes, and those in private hospitals and maternity homes. The latter have been less than 3 per cent of all births for some years, and are not included in our estimates of future requirements.

(1) Report of the Committee on Maternity Services, HMSO, 1959.

(2) A recent investigation of perinatal mortality by the National Birthday Trust Fund suggests that fourth babies are also subject to higher than average risk.

(3) 42 per cent of hospital deliveries in 1958 were recorded as having some abnormality, although many of these were relatively trivial. If we allow nothing for abnormalities in home confinements, this is still 25 per cent of all births. Abnormalities are presumably rarer in the non-priority groups, but this calculation does not allow for potential complications which do not materialise.

(4) Ministry of Health Report, 1959, Part II, page 1959.

(5) National Birthday Trust Fund survey.

(6) The Maternity Services Committee also found that the cost of hospital confinement to public funds was not much larger than that of home confinement.

(1) Report of the Maternity Services Committee, HMSO, 1959, pages 12-15; Statistical Yearbook for Israel.

(2) Length of stay of acute hospital cases has also fallen. In general medical departments it fell from 22.8 days in 1953 to 19.9 days in 1960, and in general surgical departments from 14.3 to 12.3 days.

(3) This high proportion may be affected by National Insurance provisions (the home confinement grant is still payable if hospital stay is less than 3 days). This is only, however, a way of making the short stay more acceptable; it does not make it desirable.

(4) In Oxford 17.5 per cent of cases were unbooked and nearly half of these were sent home by the third day. In Birmingham the proportions were almost as high. These two regions were acutely short of beds. In the Metropolitan Region, where relatively more beds were available, only 10 per cent of cases were unbooked, and about a quarter of them were sent home within three days. (Hospital In-patient Enquiry 1958, Table F(i)).

(1) The 1958 figures only show 8-10 and 12-14 days groups.

(2) This follows the recommendation of the Maternity Services Committee.

(3) There is evidence that not all who would benefit get this at present. As diagnosis improves the number will probably rise. (See discussion of toxaemia of pregnancy in Hospital In-patient Enquiry 1958, page 30, and the National Birthday Trust Fund Survey).

(4) The overall rate was then 89-90 per cent. It has since fallen to 87 per cent.

(5) See Ministry of Health Reports, Part I, Appendix II.

(6) The Maternity Services Committee recommended that with 70 per cent hospital births no more than 80 per cent of beds should be booked at any one time. This does not appear inconsistent with an average occupancy of 82-83 per cent, as emergency admissions are likely to exceed cancellations.

(1) The plan aims eventually at providing about 5 per cent more : 0.58 instead of 0.55 per 1000 population. A Hospital Plan for England and Wales, page 4.

(2) P. H. Jacobson, ‘Hospital Care and the Vanishing Midwife’, Millbank Memorial Fund Quarterly.

(3) Hospital Plan.

(4) The Hospital Plan was drawn up on the basis of local needs. But there were presumably central assumptions about the proportion of births in hospital and the likely trend in the birth-rate; if these central assumptions are revised, local needs will be raised as well.

(1) The marriage rate for any age-group is the proportion of spinsters in that group who contract a first marriage.

(2) ‘Estimates of the future working population’, Economic Trends, September 1962.

(1) In 1960, 23 per cent of girls aged 20 got married. The 1960-1970 increases suggested, therefore, is roughly equivalent to a reduction of a year in the typical marriage age for girls aged 18-20.

(2) Population and labour force projections for the United States 1960 to 1975. United States Department of Labour Bulletin 1242, 1959, page 11. The figures for married women were adjusted to an ‘ever-married’ basis.

(1) No precise calculation of the number of married men has been made, but the proportions ‘ever-married’ have been extra polated and the number of men ‘ever-married’ in 1970 estimated accordingly. A rough extrapolation of recent trends for men and women, made separately, does not in fact produce inconsistent numbers of male and female marriages.

(2) However, our later estimate is alternatively compatible with the assumption that marriage rates for the 20-24 age- group do rise a little further, but then fall back temporarily when the girls of the 1946-48 baby boom have difficulty in finding husbands of the usual age.

(1) Economic Trends, September 1962, page ii.

(2) US Statistical Abstract, 1962.

(3) Population and Labor Force Projections for the United States, 1960 to 1975. Bulletin No. 1242, US Department of Labor, 1959.

(1) Unfortunately, in this country we do not have figures of births by birth order related to the specific number of women at risk (that is, the number of woman who have had a first baby and are eligible for a second).

(1) ‘Evolution récente de la fécondité des mariages dans les pays occidentaux’, J. N. Biraben, Population, January-March 1961.

(2) The fertilities relate to the year preceding a given wedding anniversary. Thus the latest set of fertilities relate to periods of one year ending between January and December 1960, and approximates to an average of 1959 and 1960 fertilities.

(3) This is the rise over 2 years between the 1959-60 average and 1961-62 average. Births in the second half of 1962 are assumed to go on rising (compared with second half 1961) but less sharply than in the first half year.

(4) The turning-point may have been 1949 or 1950, but the figures for 1950 show unusually high fertilities in all groups, and this appears to result from statistical problems in esti mation of the women at risk (this may be connected with the adjustment to 1951 Census results).

(1) As births in the 6th to 9th years of marriage make up 28 per cent of all births, it seems likely that these cohorts must have shared in the general rise in fertility rates of the last two years. Otherwise an implausibly large rise in fertilities for the first five years of marriage is implied. Even if, however, we assume that fertilities in the 6th to 9th years remained as they were in 1959-60, this still means that marriages of 1953, after having 0.5 more children than marriages of 1951 in the first five years, went on to have 0.2 more in the 6th to 9th years. Marriages of 1954, on the same assumption, had 0.2 more children in the 6th to 8th years, following 0.6 more in the first five years; marriages of 1955 had 0.3 more in the 6th and 7th years, following 0.9 more in the first five.

(2) Over half the teen-age brides married in the 1950s had non-manual or skilled manual fathers. ‘New Facts on Teenage Marriage’, Griselda Rowntree, New Society, 4 October 1962, page 12.

(3) This appears to be parallel to the fall in rural family size in the United States (‘The American Baby Boom in historical perspective’, R. A. Easterlin NBER Occasional Paper 79, 1962), and in very large families in France (‘Evolution récente de la fécondité des mariages dans les pays occidentaux’, J. N. Biraben, Population January-March, 1961), where at the same time the size of the average family has been increasing.

(4) J. N. Biraben, see footnote (3)

(5) On the average, rates are assumed to rise just over 4 per cent above the level which must have been reached in 1961-62. This is 10 per cent above the 1959-60 figures. For the first 10 years of marriage, rates for the 15-19 group were increased by 9 per cent above the 1959-60 level (mainly in the second five years); those for the 20-24 group were increased 13 per cent; those for the 25-29 group 14 per cent; and those for the 30-34 group 5 per cent. Rates after 10 years of marriage were assumed to remain at the 1959-60 level.

(6) In both assumptions, no family is assumed to have the highest fertilities throughout their married life, and conse quently the highest family size reached is 10-15 per cent below that implied if the fertility rates assumed for 1970 continued for ever.

(7) The fairly rapid rise at first does not reflect sharply rising fertilities, but the inclusion of marriage years that will have experienced present high fertilities for a whole five-year period (table 8).

(1) Illegitimate birth rates have been rising, but the number of unmarried women will decline, and so the number of illegitimate births is expected to fall slightly. The number of births to remarried women may rise but not much; little change is expected in the numbers ‘ever-married’ in the older age groups where most second marriages occur. The figure also needs adjustment for still births and multiple births : since we projected maternities, it includes still births, but only counts multiple births as one.

(2) The exact pattern of the official assumption of a fall in fertility rates from the 1961-62 level is not known. But it can hardly include a rise in average fertility rates for those having babies in the first ten years; for if these rates rose, say, 1 per cent, it would need a 30 per cent fall in fertility rates of those having babes after 10 years of marriage to bring about a fall of, say, 5 per cent in the average fertility rate.

(1) Statistical Abstract, 1961, page 13.