Report on Condition of Women and Child Wage-Earners in the United States
Report on Condition of Women and Child Wage-Earners in the United States
Maternal, Infant Mortality in the U.S. Decreases During the Twentieth Century
By: Charles P. Neill
Source: Charles P. Neill. Report on Condition of Women and Child Wage-Earners in the United States. Vol XII. Washington; Government Printing Office, 1912, pages 11-16.
About the Author: Charles P.("C. P.") Neill held a PhD in Economics from Johns Hopkins University, and was the Commissioner of Labor for the United States government from 1905 to 1913. After leaving the federal government, he worked as an arbitrator for several railroad companies, and fought for injury and workman's compensation laws for laborers.
As the government and the private sector initiated and completed Progressive Era reforms in the United States—such as improved public health campaigns, better labor laws, sanitation systems, and anti-poverty programs—an underlying assumption that infant mortality rates would improve was shattered by turn of the century government reports and progressive literature that documented extremely high mortality rates for children under twelve months of age.
Most writings for the public consisted of sensationalistic exposes, designed to familiarize the middle class with the plight of the poor. Government reports, however, were designed for bureaucrats, public health officials, and politicians; as time passed, the results of these reports were benchmarks for determining progress.
Charles P. Neill (1865–1942), United States Commissioner of Labor and author of the following excerpt, ordered the creation of a series of reports on the conditions of women and children laborers in the United States. These reports, published from 1910 to 1912, investigated and catalogued laborers' age, hours of labor, term of employment, health, illiteracy, sanitary conditions, and other industry matters pertaining to public health and safety. Although infant mortality rates did later drop sharply as a result of intensive maternity health and infant care education campaigns, this series was the driving force behind such programs; as this document reveals, one out of every six children born in "registered" states died before the age of one in the United States at the time of these reports.
IMPORTANCE OF DEATH RATE UNDER ONE YEAR AS COMPARED WITH GENERAL DEATH RATE
Infant mortality, or the deaths of children under twelve months of age, is generally recognized as one of the most complex social problems of the present day. The first fact which entitles it to a place among our most serious social problems is its magnitude as compared with the general death rate. Despite the lack of mortality records for the whole United States, and the many and serious defects of those for many of the registration States, the registration area of the Twelfth Census was sufficiently large to produce in its figures an approximate index of the mortality of the country at large. Checked up as are these figures of mortality in various age groups by those of England and Wales, France, and various other foreign countries with established systems of registering vital statistics, they probably record with approximate accuracy the death rate under age one, as compared with the ratio of deaths at other ages. In a recent statistical study of this subject, [Edward B. Phelps: A Statistical Study of Infant Mortality. Quarterly Publications of the American Statistical Association, new series, No. 83 (September, 1908), pp. 266-268] it was shown (the figures being restricted to the registration States and omitting the registration cities in nonregistration States in order to eliminate the abnormally high mortality of the colored population in the registration cities of the South) that the rate of deaths per one thousand living population under age one, in the registration States in 1900, apparently was 159.3, as contrasted with a death rate of only 14.1 per one thousand population over age one. In other words, the death rate of the census year 1900, in the registration States, in the case of infants under one year of age was more than eleven times as high as at all other ages of childhood and adult life, as measured by the ratio of deaths to living population in both age groups. This comparison is probably approximately correct, though the returns of all censuses of population under age one are somewhat unreliable owing to the carelessness of parents in reporting as "one-year-old" babies within a few months, under or over, that age.
2 MORTALITY AND EMPLOYMENT OF MOTHERS: STABILITY OF DEATH RATE UNDER ONE YEAR
The second fact concerning infant mortality which has attracted the attention of those who have investigated the subject is, that the infant death rate as compared with that at higher ages has shown so little improvement during a long period. It has not responded adequately to improvements in public sanitation and medical practice. A recent English writer on the subject has commented on this aspect of the problem: "Whilst during the last half century, a time of marvellous growth of science and of preventive medicine, human life has been saved and prolonged, and death made more remote for the general population, infants still die every year much as they did in former times. Indeed, in many places it appears that they die in greater numbers, and more readily than in the past." In many cities and in some countries there apparently has been a decrease in the infant death rate of late years, but this decrease has not been sufficiently widespread or extended through a sufficiently long period of years to lessen the seriousness of the situation.
INFANT MORTALITY RATE DEFINED
Before proceeding further, it is necessary to explain the method by which the infant mortality rate is usually computed, and the difference between that rate and an ordinary death rate. By the infantile mortality rate is meant "the proportion which the deaths of such infants bear to every one thousand births. An ordinary death rate is the proportion which the total deaths of a community bear to one thousand of the population in such a community. But it is clear that a more accurate death rate for infants is obtained if we compare the total number of infant deaths not to one thousand of the general population, but to one thousand births in the same year." In the presentation of infantile mortality rates, stillbirths are usually excluded, and this practice has been followed in the present case. The only exception in this study to the above method of expressing the infant death rate is in the statement above from the United States Census, in which the infant death rate for the registration area for 1900 is stated as 159.3 per one thousand living population under age one.
It has frequently been argued that a high infant mortality has a selective influence; in other words, that it acts as a "weeding-out process," and hence tends to reduce mortality at later ages. Doctor Newshoime, with the records of the registrar-general of births, deaths, and marriages as a basis, concludes as follows: Infant mortality is the most sensitive index we possess of social welfare and of sanitary administration, especially under urban conditions. A heavy infant mortality implies a heavier death rate up to five years of age; and right up to adult life the districts suffering from a heavy child mortality have higher death rates than the districts whose infant mortality is low. A careful study of the death rate in England and Wales during the last fifty years, at each of the first five years of life, leaves it doubtful whether any appreciably greater selection or "weeding out' is exercised by a heavier than by a lighter infantile mortality. Any such effect, if it exists, is concealed behind the over-whelming influence exerted by the evil environment to which children are exposed in districts of high infant mortality. It is strictly correct, therefore, to say that a high infant mortality implies a high prevalence of the conditions which determine national inferiority.
Although the single largest factor in reducing the rate of maternal deaths from childbirth occurred after the germ theory of disease was elucidated in the 1860s, when physicians and midwives attending births began to wash their hands and sanitize equipment, infant mortality rates decreased at a slower pace. As the report documents, the commonly held assumption that high infant mortality rates would leave only the hardiest in a population to survive, therefore leading to lower mortality rates at later ages, was false. High mortality rates in infancy among a population led to high mortality rates across all ages within a specific group. The alarming statistic—nearly one in six dead before the age of one—gave progressives the proof they needed to fight harder for an intensive public health campaign aimed at reducing infant mortality rates.
Neill's final statement in this excerpt is a direct stab at factory owners and industrialists who claimed that wage slavery, factory conditions, pollution, and poverty in urban centers with high concentrations of immigrants were all simply part of economic progress and capitalism. In addition, the focus of this Report on Wage Earners was to examine the impact of mothers' factory work on infant mortality; by linking labor to infant deaths, the report not only gave an objective, statistical viewpoint on the relationship between mothers' labor and child deaths, but also provided progressives with a moral tool to use against industrialists.
In 1912, the same year this report was issued, the Children's Bureau was formed, to help infants and children via improvements in the environment, housing standards, nutrition, education, and medical services. By 1949, infant mortality rates had declined 49 percent; by 1997, eighty-five years after this report, infant mortality for children under twelve months in the United States had dropped to one in 140. The Children's Bureau was eliminated in 1969, largely a function of bureaucratic reorganization; by this time maternal and child health was treated as part of a wider public health campaign, with programs such as Women, Infants and Children (WIC) and Children's Health Insurance Programs (CHIP) helping to improve infant mortality and morbidity rates.
Almgren, Gunnar, Susan Kemp, and Alison Eisinger. "Appraising the Legacy of Hull House: The Role of the United States Children's Bureau in the American Mortality Transition." Center for Studies in Demography and Ecology Working Papers (University of Washington) (1999) No. 99-11.