How the U.S. decreased infant mortality by more than 90 percent in 100 years - Vox Creative

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How the U.S. decreased infant mortality by more than 90 percent in 100 years

This feature was produced by America’s Health Rankings, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.

By Anita Manning

A baby born in the U.S. today is likely to enter a world of clean. Almost all babies are born in hospitals, under the care of trained professionals with advanced medical technology at hand. The birth is a prelude to a year of milestones — the first solid food, the first steps, the first birthday celebration.

But it wasn't always that way.

For a baby born 100 years ago, the first year of life could be highly dangerous. Milk wasn't always pasteurized and transmitted tuberculosis and other diseases. Hygiene and sanitation weren't high priorities. Folic acid's role in preventing neural tube defects wouldn't be known for another 50 years. Antibiotics hadn't been discovered.

About one in ten infants died before their first birthday — far more in some cities and among some minority groups. Researchers at the time reported that "in no other period of life do deaths occur with such frequency.''

The change since then — a more than 90 percent decline in the rate of infant mortality since 1915 — is "unparalleled by other mortality reduction'' in the 20th century, according to the U.S. Centers for Disease Control and Prevention.

"Child hygiene was a major issue,'' says Regina Davis Moss, Ph.D., associate executive director for the American Public Health Association. "Back then, we were not delivering babies in the most hygienic places and we were just discovering how to intervene'' when things went wrong. At the turn of the century, fewer than 5 percent of births occurred in hospitals, and only 40 percent were attended by midwives.

While hand-washing was encouraged to reduce the spread of germs, it wasn't always done, and by the 1920s, "childbed fever,'' a bacterial infection, was causing up to 40 percent of maternal deaths. Babies died of a host of maladies, such as pneumonia, acute bronchitis, infectious diseases, and diarrhea and enteritis from poor sewage and dirty drinking water. Incubators initially were a source of fascination and even entertainment at Coney Island and Atlantic City, but few hospitals owned them and doctors weren't sold on them. The first Neonatal Intensive Care Unit wouldn't open until 1960.

Times were grim, especially for the poor and minority communities. "These profound tragedies affected some segments of the population more than others,'' wrote Dr. Charles R. King, in Children's Health in America: A History. "Most frequently, immigrant and minority children died. For example, twice as many black as white infants died.'' Desperate poverty and overcrowding in stifling tenements, inadequate medical care, and poor nutrition were a recipe for misery.

For babies born with birth defects, there were few medical remedies. One unidentified English woman described learning as an adult that she had had a brother born in the 1920s with spina bifida, a neural tube defect. In those days, she wrote, "it was often thought best that a very sick or disabled baby was left to die. Or — who knows — even ‘helped' to die. I think that is what happened with my brother.'' Her father told her a doctor had advised him to give the baby medicine each night. "The doctor had never explained what the medicine was or what it was for," she wrote, "but my dad noticed that each evening after he had the medicine, William was worse. At the end of the week, he died.''

Soon after the start of the new century, public health advocates, responding to the alarmingly high rate of infant deaths, began stepping up their efforts. In 1912, the Children's Bureau, the first agency in the U.S. or the world aimed solely at improving the lives of children and families, was established by President William Howard Taft. It set out to reduce infant deaths and address other social concerns, but it wasn't until 1915 that the Bureau of the Census even began tracking the number of births to get a better idea of the scope of the problem. The Birth Registration Area was made up of 10 states and the District of Columbia, with other states following soon after. So, while the true national picture of infant mortality at the time was not clear, the toll in human grief and suffering was apparent.

The Sheppard-Towner Maternity and Infancy Care Act, passed in 1921 and still considered a landmark in social welfare, provided federal money to states for prenatal and newborn care programs. Through the next decades the field of obstetrics and gynecology matured, antibiotics and vaccines were developed and advances were made in prenatal care, hygiene, and living conditions — and more babies survived that perilous first year of life.

United Health Foundation's America's Health Rankings provides an annual state-by-state analysis of factors affecting public health. In its 25th anniversary edition, the report found that infant mortality decreased 4 percent between 2013 and 2014, from 6.3 to 6.0 deaths per 1,000 live births, the lowest in U.S. history.

But improvements are not uniform across the country. While infant mortality rates have declined for all demographics, the rate for black infants is more than twice that of white infants, the report says, and the majority of states with high infant mortality rates are in the south. In Mississippi the mortality rate for infants is 9.1 per 1,000 live births, followed by Alabama with 8.6 deaths. Massachusetts has the nation's lowest, at 4.2, and New Hampshire and Alaska's is 4.5.

"Infant mortality is an indicator of maternal and child health as well as access to quality health care,'' the America's Health Rankings report says. The U.S. rate, though lower than ever, is still more than double that of many developed countries. In Japan, Norway, Finland, and Sweden, for instance, there are 2 infant deaths per 1,000 live births.

To bring the infant mortality rate down further, improvements are needed in women's health before conception, greater access to good prenatal care, and a reduction in elective deliveries before 39 weeks gestation.

"While we celebrate the nation's significant health gains made over the past 25 years,'' the report concludes, "we also don't want to lose sight of the sobering challenges we face. If we want to be in a healthier place 25 years from now, we must all be in this together."

This feature was produced by America’s Health Rankings, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.

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