Popular Science Monthly/Volume 87/August 1915/The Waste of Life
| THE WASTE OF LIFE |
By ELAINE GOODALE EASTMAN
AMHERST, MASS.
To bear a child is nothing; to suckle it, nourish it, bring it to perfection—this is bearing it for all time!—Balzac.
THE conservation of human life stands next to the giving of life and inseparably one with it as the supreme task of woman. The birth rate is affected by so many different factors that conclusions must not be hastily drawn from any given set of figures. It may be lowered from voluntary or involuntary causes; by extreme want or excessive luxury; by diseases of immorality, or by the higher education of women. It was formerly highest in the centers of population, but this condition is being reversed, and the rural birth rate is falling less rapidly than the urban.
The death rate among young children, however, is actually a touchstone of community welfare; a test of civilization. A high rate of infant mortality means individual ignorance, and social injustice. A lowering of the rate denotes a definite and positive improvement in living conditions, a prevention of economic waste and human suffering comparable only to the total abolition of war in magnitude. The number of babies dying from neglect in the United States alone, would about equal in three years the total number of soldiers killed on both sides during our Civil War!
When we ask how many died in any one year, we find, first of all, our vital statistics greatly modified in value by the surprising fact that effective registration of births and deaths is not yet general throughout this country. From the latest report of the Census Bureau (1911) we learn that birth registration is especially unsatisfactory, and that probably not over one fourth of our population is represented by records even approximately complete. The National Federation of Woman's Clubs is cooperating actively with other organizations and with the Census Bureau itself in the effort to remedy this defect, through the enactment and adequate enforcement of standard laws in the several states. The new Children's Bureau of the Department of Labor, under Miss Julia Lathrop, is bringing additional support to this important movement. It is by no means creditable to us that the accuracy and uniformity of our vital statistics should compare thus unfavorably with those of the civilized nations of the Old World.
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, is the lack of maternal nursing. It has been estimated that as many as 70 per cent. of the infants in New York City are bottle-fed, and therefore have only about one tenth the chance for life of the breast-fed child. Some of these mothers are physically unable to nurse their babies, by reason of ill-health, overwork and under-nourishment; but many more could do so if they sufficiently realized the importance of the service.
A third leading cause, operating, of course, among bottle-fed babies and after weaning, is the use of impure milk. Bad air, flies and all other unhealthful conditions naturally affect the babies more quickly than the adult population; yet experts agree that the health of the mother, her successful nursing of her child for several months, at least, and failing this, a supply of clean, sterile cows' milk, are factors of first importance.
To sum up, we find that from one sixth to one tenth of American babies die before they are one year old, and that more than half of these, perhaps nearly all of them, perish because of maternal ignorance or carelessness, or, more fundamentally, because of unjust social conditions and laws which fail to protect the makers of the new generation. It is full time that the mothers of America were roused to a sense of their grievous, their criminal neglect.
The Mother's First Duty
First of all, there ought to be an active propaganda among women concerning the importance of maternal nursing. Such a movement is needed most in the so-called educated class, since it is estimated that 60 per cent. of well-to-do women employ artificial feeding, and only about 20 per cent. among the poor. The causes underlying the decline of the American family, such as inordinate love of ease and pleasure, the entrance of women into industrial and professional life, and certain diseases of over-civilization, are doubtless responsible for much of this deterioration in the quality of our motherhood. Yet the convenience and attractive appearance of the various widely advertised baby-foods, and the common use of the obnoxious nursing-bottle, have blinded many mothers to the truth, and not a few allow themselves to be persuaded by meddlesome friends or pretty pictures that this is the modern, sanitary way of bringing up children!
Let every young wife be told bluntly that the woman who fails to nurse her child is but half a mother, and that she deprives herself of one of the sweetest pleasures in life, while robbing her little one of its birthright and enormously reducing its chances of survival, and its vigor if it lives. Tell her that artificial feeding is ten times more troublesome and inconvenient than natural feeding; and that the bottle-fed child, though fat and apparently well-nourished, is far more likely to succumb to infantile diseases, a frequent prey to rickets, and almost certain to be backward in teething, walking and talking. Moreover, a physician of wide experience has said that disuse of the mammary gland has a tendency to manifest itself in the next generation when the baby girl in turn becomes a mother, while the reverse is equally true. Impress upon her the fact that the milk is often slow in coming, and that nearly all mothers can, if they persevere and are in fair health, nurse their babies for at least three months, while a full year is better. Let it be thoroughly understood that bottle-feeding is a grave misfortune if unavoidable and, if avoidable, an unnatural wrong. Let anything and everything which may be found to interfere with this essential function—as social dissipation, overwork and worry, either before or after marriage,—be relinquished in favor of that simplicity of living and wholesome attitude toward life which should restore and preserve a normal American womanhood.
A Shining Example
The progressive little state of New Zealand has for some time boasted the lowest rate of infant mortality in the world. It was reported in 1912 at 51 per 1,000 births, or less than half the (estimated) rate for the United States as a whole. During the years from 1907 to 1912, it is said that the rate in Dunedin, a city of about sixty thousand inhabitants, was reduced 50 per cent, through the activity of a volunteer society called the New Zealand Society for the Health of Women and Children. It is earnestly to be hoped that organizations of women in this country will follow the example and methods of this society, which are described for our benefit in a pamphlet issued by the national Children's Bureau. Taking a few of our oldest cities and states for purposes of comparison, we find that in Connecticut and Massachusetts more than twice as many babies die out of each hundred born; in Rhode Island, three times as many! In the city of Dunedin, during the past year (1913), only 3.8 died in every hundred; in Los Angeles—one of our very best cities—9.7; in Pittsburgh, Pa., 15; in Lowell, Mass., 23!
The New Zealand society, though a private organization, receives the benefit of government aid and influence. Here, as elsewhere, the cooperation of public and private agencies has proved an effective means of social reform. The main features of the program for public health affecting our subject, are: (1) State registration of nurses; (2) registration of midwives; (3) government maternity hospitals; (4) supervision of infant asylums; (5) complete registration of births.
The society is officered by women and its work is mainly educational. It consists of the instruction of mothers and potential mothers through demonstration lectures, newspaper articles, pamphlets, etc.; the employment of specially qualified nurses to visit and instruct mothers before and after the birth of their children, and the promotion of needed legislative reforms. It announces itself as
less concerned with reducing the death rate than with improving the health of the people. However, the problems are practically identical.
Work at Home
These and similar methods have been followed to some extent in a few American cities, in part by boards of health, and in part by various private agencies. Already the increase in scientific knowledge, and the new social consciousness, have resulted in a marked reduction in our infant death rate within the last few years. It is estimated that during the decade 1900-1910 the decrease was 19 per cent., or nearly one fifth, which of course satisfactorily offsets, in a measure, the reduction in number of births. The mother's contribution to the world is not to be measured by the number of children she has borne, but by the number brought to a vigorous and useful maturity.
In order to make all the knowledge collected on this subject generally available, to induce comparisons, and to enable one community to profit by another's experience, the Children's Bureau has issued the first of a projected series of annual bulletins on "Baby-Saving Campaigns in American Cities." The lack of financial support is the greatest obstacle to efficient work. The motto of the health department of New York City is worthy of note.
Public health is purchasable; within natural limitations a community can determine its own death rate.
These significant words should hang upon the walls of every city hall in the land.
Surely nature's first law should be man's first concern, not only for himself, but for the community; not for his own children alone, but for all children, since none can be safe where all are not safe. Legislator, tax-payer, what would you take in exchange for the life of your child? How much are you willing to give in order adequately to safeguard its precious life and all the other precious lives in your community? A certain city of more than a half million inhabitants wrote to the Children's Bureau through its board of health as follows:
We have no funds available to organize a division for the care of infants.
Another large city, on being asked its plans for a summer campaign against children's digestive diseases, replied:
We have been unable to get an appropriation for a campaign of this kind.
Wherever this state of affairs exists—and may it not be in our own community?—it is incumbent upon individual women to organize, or through existing organizations to compel public attention to this vital matter. The final responsibility lies with the public, and the outcome of successful private work is usually that sufficient municipal funds are appropriated to take it over. This has been accomplished in Bridgeport, Conn., Milwaukee, Indianapolis, Philadelphia, Baltimore, Richmond, Va., and in many other cities and towns.
While methods vary in different localities, the program for a baby-saving campaign, as outlined by the Bureau, is something like this:
1. Insistence upon complete and prompt birth registration as a basis of work. In some cities, a letter or card is sent each mother upon the birth of a child, thus securing her interest, and with the letter of congratulation a folder may be enclosed, containing advice on the care of infants, and printed, if desirable, in several languages. A strong appeal for breast feeding is always a feature of such advice.
2. Rigid inspection of the milk supply, with frequent tests for fat contents as well as for dirt and bacteria. Recognized grades of wholesome milk include: (a) certified milk; (b) inspected milk; (c) pasteurized milk.
3. The establishment of pure-milk stations, where such milk may be obtained at or below cost, and to mothers unable to pay the price may be furnished free. Such milk must be supplied only on proof of inability to nurse the child, if too young for proper weaning.
4. Baby clinics, and the employment of trained nurses to visit the homes, especially of the very poor, both before and after the birth of a child, to care for sick babies, and to instruct mothers in the care of infants.
5. Improvement of bad housing conditions; the fight against flies and the breeding of flies; and general educational work.
Dr. Josephine Baker, of the New York City Board of Health, has stated that
babies may be kept under continuous supervision at a cost of sixty cents per month per baby, and the death rate among babies so cared for has been reduced to 1.4 per cent. In other words, the solution of the problem is twenty per cent. pure milk, and eighty per cent. care and training of mothers.
The American Association for Study and Prevention of Infant Mortality owes its existence to the American Academy of Medicine, which called the first conference on that subject ever held in the United States. The association was organized at the close of this meeting, held at Yale University in 1909, and in 1910 an office was opened in Baltimore, from which the work has since been directed. Its functions are chiefly educational, and its work is carried on by general propaganda, by investigations and special work in committees, through an annual meeting and the publication of its transactions, and through a traveling exhibit. Any person interested in the aims of the society may become a member, and the dues are three dollars a year and upward.
Besides the forms of work already mentioned, this association lays stress upon the importance of better teaching of obstetrics in our medical schools, upon the extension of maternity hospitals, out-patient obstetrical services, visiting obstetrical nurses, and either the thorough education or gradual abolition of midwives, also pre-natal instruction of expectant mothers. Many mothers lose their health or their lives, and more babies perish or become permanently crippled or blind, as a result of improper management during child-birth.
Why Poverty is Fundamental
The first field study of the Children's Bureau has just been published (1915), and inaugurates a proposed series of studies in infant mortality, to be made in typical American communities. It was undertaken by means of personal interviews with the mothers of all the babies born in the city of Johnstown, Pa., during one calendar year, 1,551 in all, of whom 196 died, or 134 per 1,000 births. The estimated rate throughout the United States is 124 per 1,000 (U. S. Census Report, 1911), which may be compared with a rate of about 261 in Russia, 105 in England, 75 in Australia, and 51 in New Zealand.
Owing to the method of enquiry, and to the absence of a physician upon the staff of the bureau, only family, social, industrial and civic factors were considered in Johnstown, omitting all reference to two important causes of infant mortality—alcoholism and venereal disease. Emphasis is placed upon the economic factor, and it plainly appears from a study of the tables presented, that, whatever the immediate cause of death, the underlying cause in a large majority of cases was that mother of all evils, poverty.
A study of environment shows that the death rate was 271 per 1,000 babies in the poorest sections of the city, or more than five times that in the best residential sections. It was 171 for foreign mothers as against 104 for native mothers. It was 214 for illiterate foreign mothers, or 66 per 1,000 greater than for foreign mothers who could read. The duration of the mother's rest period before and after confinement was found to affect the result, as was also the employment of a midwife instead of a physician. But most of these points depend directly upon the fundamental question of income. The father's earnings were discovered to be the one factor of greatest importance. Babies whose fathers earned ten dollars a week or less died at the rate of 256 per 1,000, while those whose fathers earned $25 or more a week died at the rate of 86 per 1,000. The foreigners, especially the recent arrivals, were generally those who lived in the poorest and most unsanitary quarters, whose women were ignorant and overworked, forced to carry water, to keep lodgers, or to work for wages, and all these misfortunes were commonly due to the lack of a proper living wage for the men.
Although only 47 per 1,000 died of the babies breast-fed at least three months, as against 166 per 1,000 of the artificially fed, even this advantage was outweighed by the terrible handicap of poverty, as will be at once recognized when we recall that about three times as many of the poorer mothers nurse their babies as of the well-to-do. The death rate among the illegitimate was about twice that of the legitimate, a difference generally recognized as due to almost universal abandonment of such children by the father, and frequent abandonment or neglect by the helpless girl-mother.
The disease directly causing most deaths was found to be bowel trouble or enteritis (usually caused by improper feeding, especially in summer), closely followed by the respiratory diseases (most fatal in winter), and prematurity or congenital weakness, causing death usually within a few days. About 5 per 1,000 were stillborn.
To sum up, although a certain amount of treatment of symptoms may be necessary or desirable, we should bear steadily in mind that whatever tends to modify social inequalities and to give to labor a fair share in the products of labor will do most to save the lives of three hundred thousand babies, yearly offered up in America an innocent sacrifice to the Moloch of selfish greed. And since the whole social body must suffer with the least of its members, is not the idol as short-sighted as he is hideous?