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In Terms of Child Mortality, It’s a Good Time for Public Health


But the vinegar was not enough, and two days later, he wrote: “She went to her final sleep most tranquilly, most sweetly at 12 oclock today. Our poor dear dear child has had a very short life but I trust happy, & God only knows what miseries might have been in store for her.”

My grandmothers knew that a lot of children didn’t live to grow up, that if you asked any group of adults born, like them, at the end of the 19th century, having their own children in the first decades of the 20th, most of them had lost a sibling, lost a baby, lost a school friend. They both grew up among the urban poor, and their own childbearing experience, in the poorer parts of immigrant Brooklyn, in the East End of London and then the Lower East Side of Manhattan, took place at a time when social reformers were taking on the project of bringing down infant mortality, especially among the urban poor.

In 1906, a British physician, George Newman, published “Infant Mortality: A Social Problem,” citing mortality rates all over Europe of 100 to 300 babies out of every 1,000 dying before their first birthdays, “a vast army of small human beings that lived but a handful of days.” This was the historical moment when people in many countries began counting those deaths, as we still count them, and using them as an index to a society’s well-being.

Collectively, as human beings, we changed the game. It took science, medicine and public health, it took sanitation and engineering and safety legislation, and it took many different kinds of education and parent advocacy. And it took vaccines and antibiotics, those 20th century game-changers.

Keeping children safe, and making the world safer for them, was the sum of many different efforts, from international campaigns to laboratory experiments to local endeavors. Before there were antibiotics, before there were any vaccinations except for smallpox, there were the nurses who went door to door in the tenements of the Lower East Side in the summer of 1908, talking to mothers about how to prevent the cholera infantum, or summer diarrhea, which was expected to kill 1,500 babies a week.

And there were mothers who listened: In the district where the nurses were deployed, there were 1,200 fewer infant deaths than the previous summer; everywhere else, the death rate was unchanged. Dr. S. Josephine Baker, who directed the project, wrote “I had learned one certain thing: heat did not necessarily kill babies.”

We should not expect children to die; we should expect them to live to grow up; that was the foundation of my training in pediatrics, and the joy of working in this field. It was not a single project, or a simple project, and it is by no means a complete project; infant and child mortality rates remain unacceptably high in many parts of the world, though they have come down everywhere, and alarming disparities persist in this country, where the infant mortality rate, as well as the maternal mortality rate, remains notably higher among Blacks and other minority groups.



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