Table of Contents:
I Mortality and Burial Practices through History
A Brief History of Child Mortality
Infancy, like old age, was a time to die.1
Before investigating the sociological and psychological reactions of a society, and specifically parents, to the death of a child, it is helpful to frame the discussion within the matter of actual mortality among regions across time. This chapter gives an overview of conditions that existed during times, and in places, where child mortality was particularly high. This chapter does not seek to provide a complete history of child mortality. Throughout this book wherever possible I provide mortality rates, but these numbers should be accepted with caution as they can drastically change in one country within just a few decades. Social and political changes often facilitate the decrease of mortality rates and these efforts will also be discussed.
Achieving one’s fifth birthday is an extraordinary milestone in many developing countries, and is usually indicative of a life that is likely to mature to a healthy adulthood. In fact, according to the World Health Organization (WHO), the mortality of children under the age of five is the leading indicator of overall health and development of countries. At the United Nations’ 2000 Millennium Summit, 189 world leaders committed themselves to ending “extreme poverty” by 2015 by addressing eight specific Goals.2 Millennium Goal 4 calls for reducing the under-five mortality rate by two thirds between 1990 and 2015.
The United Nations Inter-agency Group notes that substantial progress has been made towards Goal 4 in that mortality of children under the age of five dropped thirty-five percent from 1990 to 2010. Nevertheless, 6.6 million children under the age of five perished in 2012, and forty-five percent of these deaths were attributed to malnutrition.
The highest rates of child mortality exist in Sub-Saharan Africa where one of every eight children dies before the age of five, and in Southern Asia where the rate is one in fifteen. In developed nations the mortality rate for children under the age of five is one in every 143, and is acutely declining, contributing to an ever widening disparity between Sub-Saharan Africa and Southern Asia and the rest of the world. Fifty percent of under-five deaths are concentrated in India, Nigeria, Democratic Republic of the Congo, Pakistan and China. India and Nigeria account for thirty-three percent of these deaths.
While the majority of under-five deaths occur within the first year of life, the first month of life (the neonatal period) is the most vulnerable. Thirty percent of neonatal deaths occur in India. Worldwide the major killers of children under five are pneumonia, diarrheal diseases (such as cholera), preterm birth complications, and birth asphyxia. Malnutrition and under nutrition are the underlying causes of one third of these deaths. In Sub-Saharan Africa malaria is responsible for sixteen percent of under-five deaths.3
Between 2011 and 2012 a famine in Somalia, caused by drought, high food prices and political conflict caused a large portion of an entire generation of Somali children to be lost. The United States Center for Disease Control and Prevention (CDC) estimates that 29,000 Somali children under the age of five had died within a ninety day time period.4 En route to Mogadishu, thousands of families looking to escape the famine and find aid in the capital, lost child after child to starvation. This dire situation was further exacerbated by the inability of nations offering aid to gain access to the region, due to interventions on the part of Al Shabab, a rebel militia, which ordered those fleeing the famine back to their farms in light of incoming rain.
While making the nearly three week trek on foot to refugee camps, many parents had to make the difficult decision to leave a dying child behind in order to save a sibling still showing promise of survival. Some parents, not wanting to waste what little water they were carrying, denied a drink to children about to perish. Mothers lamented that they had to abandon children who were barely breathing in order to save themselves and their other children. One mother hurriedly buried her three year old son under dried branches in order to tend to her remaining five children. Many such children have been buried in make shift graves by mothers and fathers with barely enough energy to do anything more. The memory of these children, buried in shallow graves along the side of the road or wrapped in white clothes buried in refugee camps, will forever haunt their parents. Experts expect these parents to experience post-traumatic stress disorder, and interviews with these families reveal an overwhelming feeling of remorse.
The causes of high mortality in regions across the world and throughout history have been myriad; yet they fit a pattern. Factors that affect mortality rates include whether or not the child is breastfed and by whom, the education of the mother, the availability of clean drinking water, the ability to live in less densely populated areas, as well as socioeconomic status. Nevertheless, ignorance and neglect have been the chief causes of infant death up until the 1920s.
Historically, doctors were aware that infant deaths represented a large portion of the total mortality rate but did little to prevent it. Doctors were also aware that it was maternal ignorance that caused so many infant deaths; from offering improper food to neglect and unsanitary and unsafe living conditions. Physicians publicly stated that a practice as simple as avoiding cold baths for young babies could improve mortality. But mothers were being sent contradictory messages; on the one hand, infant death was common and to be expected, and on the other hand mothers were believed to be solely responsible for their children’s health and well-being.5