The rate of infant mortality has been defined by experts as the ratio of deaths during the first year to the total number of births, and not, as sometimes figured, the ratio of deaths during the first year to the number of living infants under one year of age. For the group of registration states as a whole, the infant death rate calculated under the latter plan was about eight times the death rate at all ages. The death rate of children in the first five years of life was about ten times that of children in the second five years. It is estimated that approximately three hundred thousand babies die annually in the United States before reaching their first birthday. In terms of total population, this means the annihilation of a great city the size of Chicago, or of a state like New Jersey, in a single decade. And at least half of these little lives are needlessly lost. In New York City, in the year 1910, there were 125 deaths under one year for every thousand births; in Washington, D. C, 152; in Lowell, Mass., 231; in Seattle, Washington, only 82! The wide variation is sufficient proof that many, if not most of such deaths are preventable.
Stillbirths have been unaccountably neglected in vital statistics, frequently being counted neither among births nor deaths. In American cities, it has been estimated that 4 per cent, of all babies are born dead, most of them from preventable causes. We do not know the number of miscarriages (also mainly preventable), nor of ante-natal murders, which frequently pass undetected. In France, the number of criminal abortions has been reckoned at fifty thousand to one hundred thousand a year.
Causes of Infant Mortality
It has sometimes been said that the elimination of the feebler children, such as are often exposed to die in savage lands, tends on the whole to the advantage of society. On the other hand, it is important to remember that the causes productive of a high rate of mortality also affect the resistive power of those who survive and sensibly weaken the next generation. Our aim must be to insure that all be well born, and all work for the preservation of the lives of little children helps in the realization of this aim, as will be seen by an analysis of the causes of death. About 10 per cent, of all who die within the year live less than one day, and nearly one third perish before the end of the first month, showing that prominent among the causes of infant mortality is the mother's condition before and during the birth, as affected by alcoholism, social disease and maternal overwork. These same evils tend to produce stillborn and defective children. There is also extended lack of proper care during confinement. In American cities, it is said that about one half of all births are attended by midwives, 90 per cent. of whom are inefficient (Mangold).
The next greatest cause, and one depending partly upon the former,
