Parent Education, Child Rearing, and Other Examples of Actions Taken to Improve Mortality
From 1890 to the early 1900s, in the United States, the child mortality rate for children under the age of five was twenty percent. Fifty-nine percent of those deaths were infant deaths. Primary causes of death were diseases such as cholera, diarrhea, pneumonia, meningitis and accidents. Thus, “germ theory” came to explain high mortality rates in many areas of the world. Additionally, impure milk and water were causes of death, although in communities where the mother worked at home and was able to breastfeed her children, illness was usually avoided or short-lived (as noted earlier in reference to European families).
In the 1800s smallpox killed one in three children in America. Inoculation to the disease, discovered by Edward Jenner in 1798, from cows with cowpox greatly alleviated the epidemic.30 As parent education, access to vaccinations and public health policy improved, so did the mortality rate; however, a theme often heard about urban parents in the late nineteenth century was that they wailed for their child’s death but were slow to take advice about their child’s health.31
From 1760 to 1860 half of the children born in Russia did not survive to adulthood. While poor climate was blamed as a cause of death in Russia, other regions such as Norway, which has a harsher climate, had a lower mortality rate. Child-rearing practices such as cold (ice) water baptisms of newborns, swaddling, and improper feeding (e.g., foods in lieu of mother’s milk) were ultimately deemed the cause of infant death. So devastating was the mortality rate, a Russian mother, who doted upon her infant, rocking it to sleep, was told “such exaggerated love.. .god will surely punish it”.32
While ignorance about what children needed to survive in Imperial Russia may have been a major contributor to the high mortality rate, child murder (one of every eighty) was a shockingly common cause. It is possible that the actual murder rate was much higher since these crimes were only recorded if they were prosecuted in court. The government under Catherine the Great took action to reduce mortality rates. As in other regions of Europe, they created homes for orphaned and illegitimate children, released mothers and children from fasts prescribed by the Orthodox Church, and published manuals for child care.33
Changes in public health policy, coupled with parent education and sanitation innovations helped to enhance a child’s ability to survive. In 1892 in France, several protective societies were established in order to help reduce mortality, albeit without much success. Pierre Budin, however, successfully opened a clinic for post natal care. Mortality was reduced from 178 to 46 per 1000 births in five years. In 1894 milk stations, gouette de lait, helped reduced mortality rates from diarrheal diseases from fifty-one to three percent.34
Public health policy also had caused acute changes in mortality in Aranjuez (near Madrid) Spain. For people born between the years 1871 and 1950, the life expectancy was approximately thirty years of age, and infant mortality was 200 per 1000 live births. In 1950, after the implementation of sanitation and health policies, life expectancy rose to above sixty-five years of age and mortality declined to eighty per 1000 live births.
There are limitations to interpreting historical medical documents by modern historians. Terminology often varies or is vague, and there may be a misunderstanding of the symptoms of diseases, which might cause a misdiagnosis.35 Additionally, mortality rates and causes might be skewed due to the fact that seasonal diseases might be disguised by the uneven distribution of births (and deaths) throughout the year. For example, mortality during the eighteenth century in Europe peaked May through July, while it was low from December to February. The peak in late winter and early spring is associated with respiratory diseases due to the cold. A bad harvest could also affect a child’s nutrition, which in turn could adversely affect his or her resistance to a disease. A peak in the summer was generally due to gastrointestinal disease caused by bacteria that thrived in food and water. Many contagious diseases, such as small pox, also peaked in the summer. Young infants who were fed artificially were even more susceptible to these diseases as they lacked their mother’s immunity and were prone to exposure to contaminated foods, milk and water. Further, death as a result of respiratory disease was more likely to occur in the second six months of the first year of life. In a further demonstration of the “Matthew Effect” (the rich get richer, the poor get poorer), other researchers have shown that gastrointestinal disease, such as diarrhea, lowers the child’s resistance to other infections. Again, breastfed children were less likely to submit to these types of diseases.36 Living conditions also predicted mortality. Clean houses, open space between families (lack of overcrowding), access to clean water, and garbage collection systems were all aspects of communities for which child mortality was low.
From these data and anecdotes we can surmise a pattern of behaviors and environments that are conducive to the welfare of children, patterns that were used to inform public health policy and practice. As George Kent states in The Politics of Children’s Survival, criticizing child survival programs, “good nutrition does not come from nutrition programs, and good health does not come from health services”. Good health comes from a variety of elements: income, sanitary housing and food, as well as education, among as many other factors. Programs may help improve survival but it is the social structure and citizen’s ability to command change that truly will improve health and therefore child mortality.37