Has there been an actual reduction in the maternal mortality rate in Cleveland or only a fictitious one? The answer requires a critical analysis of all the factors involved: socio-economic conditions, completeness of vital statistics, changes in classification, medical and nursing technics and adequacy of hospital facilities. Changes in the birth rate and movements of population also enter into the problem.
Prior to 1931 Cleveland, in company with other cities of comparable size, exhibited considerable variation from year to year in official maternal mortality rates (table 1). The rate varied irregularly from 4.3 to 7.2 deaths per thousand registered live births. Careful analysis of the vital statistics for the period from 1910 to 1930 indicates, as the main factors which account for this irregularity, (1) incompleteness and irregularity in the reporting of births and the misinterpretation of stillbirths, (2) a declining birth rate due to later marriages, contraception and induction