Jean Pakter

Out-of-Wedlock Births in New York City. I—Sociologic Aspects

IN RECENT years there has been a steady growth in the number of reported births to unmarried mothers in New York City and nationally. A steady rise has been noted in the United States since 1947, at which time an estimated 131,900 out-of-wedlock births occurred, representing 3.6 per cent of all live births. In 1958, the number increased to 208,700 (5.0 per cent) comprising a 39 per cent increase in the rate. This rising trend has been even sharper in New York City as evidenced by an increase in rate from 3.0 per cent in 1946 to 8.0 per cent in 1959, comprising a 167 per cent increase in the rate. A similar pattern has been noted in other large urban areas where the mounting numbers have served to aggravate the serious health, welfare, and social problems inherent in out-ofwedlock births. In order to determine the reasons for the sharp rise and to deal adequately with the consequences of out-of-wedlock births, all the available data of the New York City Departments of Health, Welfare, and Education relating to these births were reviewed, analyzed, and correlated. Answers to the following questions were sought.

Legal abortion: a half-decade of experience.

In the first 5 years of liberalized abortion laws approximately 850000 terminations have been performed in New York City about 1/2 of which were on city residents. There was a sharp rise in the number of legal abortions after the first year and then a subsequent drop. The increase in the number of resident women obtaining abortions has been attributed to an increased proportion of repeat abortions. In 1974 9 in 10 residents obtained abortions in the first trimester 8 in 10 of them by suction. The opposite is true among nonresidents. Difficulties in administrative procedures have apparently caused an increase in women obtaining late abortions via riskier procedures. The rise in abortions was greatest among teen-agers in the 17-year-old and younger category. Between 1971 and 1974 there was a 53% increase among residents in the ratio of legal abortions per 1000 live births and an increase by 28% in the rate per 1000 women aged 15-44. The ratios of 776 abortions per 1000 births in 1974 and 50.3 per 1000 of reproductive age were exhibited. Over the years more than 40% of resident women obtaining abortions have been nulliparous. Because of the increase in repeat abortions the proportion of never-pregnant has declined. This increase in repeat abortions is an indication of the need to produce a more reliable and safe contraceptive as well as to increase availability of family planning services.

Bladder perforation owing to a unipolar coagulating device.

A report on a patient who sustained a burn and perforation of the urinary bladder from visible sparks emanating from a unipolar coagulating device during the couse of laparoscopic sterilization is presented. It is the first report of urinary bladder burns using a unipolar coagulating device. A 24-year-old woman, gravida 10, para 3, abortus 7, underwent a laparoscopic sterilization with a unipolar coagulating device. As the physician was finishing the coagulation, a spark from the device caused a 1-2 cm burn with a central area of perforation into the urinary bladder. Conservative treatment was recommended, and consisted of Foley catheterization and drainage for 5 days. Initial urine culture revealed Klebsiella species, and oral ampicillin was prescribed. Hematuria was noted throughout the patients hospitalization, and blood clots were present in the urine on Day 2 postoperation. The patient had no abdominal or flank pain, was afebrile, and had a stable hemoglobin level during the hospital stay. Cystography was performed on Day 5 postoperatively and demonstrated no perforation. Foley catheter was removed. Patient was discharged 2 days later and remains in good health 3 months postoperatively.

A critical survey of the New York program for the care of premature infants

Summary 1. The premature program of thepast decade for New York City is described. 2. Statistics relating to mortalityrates for premature infants in 4 weight groupings under 2,500 grams are presented for hospitals with approved premature centers and for the City as a whole. 3. A downward trend is noted in themortality rate in each weight group, except in the less than 1,000 gram group. 4. Comparison of mortality rates ofpremature infants (classified by weight groups) born in a borough as yet not included in the premature program with those of infants born in hospitals with centers supports the hypothesis that premature center care increases the survival rate. 5. In each weight group infantscared for in approved centers had a higher survival rate than was the case for the City as a whole. 6. A higher proportion of motherswho delivered prematurely had late or no prenatal care than did those who delivered at term. 7. Emphasis is put on the importance of paying greater attention to the care of the “large premature infant”. 8. The need for intensive and continuedfollow-up care after discharge from the hospital is emphasized. 9. The need for continued and intensifiedresearch is indicated.