Infant mortality : its relation to social and industrial conditions

Front matter

ITS RELATION TO SOCIAL AND

INDUSTRIAL CONDITIONS

FORMERLY OF THE DEPARTMENT OF RESEARCH

Introduction

This series of papers, all of which have been published previously in periodical form, is the outcome of a house-to-house investigation of infant mortality in four wards of Boston made in 1910-11 and 1911-12 by the Research Department of the Boston School for Social Workers under a grant from the Russell Sage Foundation. During the second year the writer was in charge of the field work. He was later commissioned to write the report of the investigation for publication. In undertaking this task it appeared that no particular service would be rendered by publishing another study of the subject which dealt only with local conditions and which was prepared with only incidental reference to the data gathered elsewhere in other investigations. It did appear, on the other hand, that there was a place for a book dealing with the problem of infant mortality in the United States and based on all the studies of the subject that are available. A number of such investigations have recently been made in different parts of the United States but, so far, the results of these have never been brought together and compared with a view to finding the common relationships and laws involved. This series of papers is an attempt to meet this need. The sources of the study, therefore, are very numerous. Since, however, they are cited in footnotes in the various chapters they need not be mentioned here.

In view of the prominence given to previously unpublished data, gathered in the house-to-house investigation in four wards of Boston, it will be necessary to describe briefly the scope and method of this investigation. The four wards were 6, 8, 13, and 17, the boundaries of which correspond roughly with the sections commonly known as the North End, the West End (both of these lying in the oldest parts of the city). South Boston (lower half), and Roxbury (in part). The investigation was based on the calendar year 1910. Transcripts of the original records of all the births and infant iv Infant Mortality

deaths which occurred in these wards were made from the copies on file in the office of the registry department of the city and visits were made to the homes of the mothers by Fellows in the Research Department of the School for Social Workers.* Interviews were obtained with the mothers of 2,063 infants.!

The infant mortality rates in this investigation, like those in the investigation by the U. S. Children's Bureau into infant mortality in Johnstown, Pa., were obtained by comparing the number of infants (whose parents could be located) who were born in the four wards in 1910 with the number of these same infants who died before they were one year of age, whether the death occurred in 1910 or 1911. The comparison was upon the basis of deaths to 1,000 births, stillbirths not being included.

The writer is indebted to Dr. Jeffrey R, Brackett, director of the School for Social Workers, and Dr. T. W. Glocker, formerly director of the Research Department, for the use of the data collected in the Boston investigation.

As the title indicates, the series of papers deals with the relation of social and industrial conditions to infant mortality. Certain conditions, however, that may be properly classed as industrial or social have been necessarily omitted. Among these omitted factors may be mentioned the character of the milk supply, J the influence of artificial feeding, § and the form of the medical attendance. It has also been necessary to omit all consideration of infant mortality in institutions, of the mortality of illegitimate infants, and of stillbirths.

Finally the reader should be warned that the various factors that produce infant mortality are so closely interrelated and so difficult of measurement!] that conclusions stating the exact extent of the influence of each are not to be expected. It has thus been impossible to determine except very roughly

*Mi8s Helen C. Schindler, Miss Margaret 0. Cook, Miss Helen L. Spencer, Miss Charlotte I. Claflin, Miss Bertha C. Lovell, Miss Alice M. Mclntire, Mr. A. H. Lord, Mr. T. Eaton, and Mr. P. E. Shannon.

fThis represents visits to about 4,000 homes, as about half the families sought for could not be found.

J See, however, p. 63.

§There have been many excellent studies made of this subject. In consequence no extended treatment of it was considered necessary in this essay. See references on p. 49 and also pp. 25-28, 79-80, and 112.

llSee for example pp. 59, 88-92, 95-9G, and 113.

Introduction v

the relative influence of the various factors involved.* It has been possible, however, to show clearly that the social and industrial conditions studied do exercise an influence on infant mortaHty and to indicate roughly the extent and importance of their influence. If this warning is carefully heeded the reader will not be hkely to feel that the writer has been led to over-emphasize the influence of certain conditions at the expense of others.

The greater part of the actual writing of the book was done in the statistical laboratory of Columbia University. The writer wishes to express his sincere appreciation to Prof. R. E. Chaddock, director of the laboratory, for this privilege but especially for his unstinting advice and help throughout the writing and preparing of the book for publication.

The writer wishes also to acknowledge the courtesy of the editors of the Quarterly Journal of Economics and the Quarterly Publications of the American Statistical Association and the secretaries of the Southern Sociological Congress and the American Academy of Medicine in allowing the papers to be reprinted in book form.f

•See for example pp. 21, 42-45, 81, and 115.

tThe papers were written, however, with a view to their publication in book form. The work as a whole, therefore possesses a unity that it would not have had if each chapter had been written independently.

The papers are reprinted without changes except for slight modifications of titles. The reader will understand, therefore, that references in footnotes to " other articles" on infant mortaUty by the writer may be read as references to papers now included in this book.

TABLE OF CONTENTS INTRODUCTION

I

THE PRESENT POSITION OF INFANT MORTALITY: ITS RECENT DECLINE IN THE UNITED STATES

The problem of infant mortality; why made an object of special study; the infant mortality rate. Infant mortality in foreign countries; in the United States; significance of the wide variation in rates. The recent decline in infant mortality; in foreign countries; in Massachusetts and Boston; in the registration area. The decline in the infant mortality rate compared with that in the general death rate for all ages. Comparison of the decrease in the death rate for certain age groups in the registration area since 1900. Conclusion 3

II. The Influence Of Prenatal Conditions On Infant Mortality

Study of the causes of infant mortality not to be confined solely to period of infancy. Subdivisions of the periods of infant development; importance of the germinal period before conception and the intra-uterine period. The influence of prenatal conditions partly hereditary and partly environmental or social. Preventive methods. Extent of the influence of prenatal conditions : as seen in the mortality of infants in the early weeks and months of life; in the death rate from the diseases of early infancy; conclusion. Comparison of the recent decline in the relative influence of prenatal and postnatal conditions. How the lesser decline in the influence of prenatal conditions is to be accounted for. The future 19

III. Infant Mortality And The Size Of The Family

The influence of the birth rate on the rate of infant mortality. The relation between the rate of child mortality and the order of birth; between the rate of infant mortality and the number of children previously born to the mother, the order of birth, and the number of the mother's previous pregnancies. Other factors which must be considered in interpreting the relationship between viii Contents

the rate of infant mortality and the size of the family; conclusion. The relation of the length of the interval between the mother's pregnancies to infant mortality; importance of the adequate spacing of births 37

IV. The Mother And Infant Mortality

Proportion of infant deaths to births varies among families as widely as among states, cities, or other subdivisions of population; the "domestic " factors of infant mortality. The influence of the age of the mother. The influence of the character and intelligence of the mother. To what extent infant mortality is a question of motherhood. Preventive methods; the extent to which these depend upon the mother for their effectiveness; education for parenthood 53

V. Infant Mortality And Urban, Housing, And Living Conditions

Wide variation in infant mortality rates for different countries, states, cities, etc., and its significance. The influence of urban conditions of life on infant mortality. The relative decline in infant mortality in urban and rural districts; significance of the greater decline in the cities. The influence of congestion and overcrowding. The influence of housing and living conditions; housing conditions proper; home sanitation, cleanliness, ventilation, care of home, etc 77