Historical Perspectives on Infant and Child Mortality

by

Lucia Pozzi, Michail Raftakis

• LAST REVIEWED: 22 August 2023
• LAST MODIFIED: 22 August 2023
• DOI: 10.1093/obo/9780199791231-0281

Introduction

Infant mortality refers to the death of an infant before reaching the age of one, while child mortality refers to the death of a child between the ages of one and four. Infant and child mortality rates have proved to be significant indicators of the health of past populations, and since they are related to several factors (including poverty, inadequate food, and lack of public health or hygiene) that affect the health of a population, they are often seen as indicators of living standards in the past. Even today, they are considered an important factor in measuring the level of child health and overall development in countries. Infant and child mortality and its main determinants have been investigated by scholars of different disciplines, including demographers; social, medical, and economic historians; epidemiologists; and anthropologists. Although infant and child mortality has been steadily declining over the past two centuries, in the past nearly a quarter of all children died within the first year of their lives. The decline in child mortality in most developed countries across Europe, North America, and Australia had halved by the mid-twentieth century, accounting for less than 5 percent of all deaths, while at the beginning of the twenty-first century, about one in two hundred children died before their fifth birthday. However, the fall in child mortality has not been universal: many countries in sub-Saharan Africa and Southeast Asia still today experience large numbers of child deaths. In 2021, for instance, five million children under the age of five died, with the majority dying in the first year. Reductions in child mortality contributed significantly to the overall mortality decline during the late eighteenth, nineteenth, and twentieth centuries and brought about large increases in the life expectancy of historical populations. The decline in infant and child mortality has been attributed to a variety of causes, including biological, socioeconomic, cultural, environmental, and geographical determinants; successive sanitary reforms; improvements in medical science, standards of living, and maternal education; changes in childcare practices; and the decline in fertility.

General Overviews

Few historical demographic topics have attracted more interdisciplinary scholarly attention than infant and child mortality—the death of an infant before its first birthday and the death of a child between the ages of one and four, respectively. The first approximate demographic measurements date back to the ancient origins of demography; however, as emphasized by Armstrong 1986, it was not until the second half of the nineteenth century that the measurement assumed its modern characteristics. Later, in the first decades of the twentieth century, the awareness of the social relevance of early-life mortality led to the introduction of vital registration in most countries. The decline in infant and child mortality favored the increase in life expectancy that initiated the demographic transition in most Western countries and played a key role in the variation in health transition patterns that characterized different countries and regions. Bideau, et al. 1997 address this in great detail. Numerous other studies are devoted to infant and child mortality in the nineteenth and twentieth centuries. Pozzi and Ramiro-Fariñas 2015, for instance, have provided a thorough review of the state-of-the-art literature. Two notable publications, Corsini and Viazzo 1993 and Corsini and Viazzo 1997, resulted from a collaborative European project that reconstructed levels and trends in infant and child mortality using vital statistics along with other sources and investigated other aspects, such as seasonality of infant deaths and the geographical variations as an age pattern of mortality in the first years of life. In recent decades most studies, for instance, Mosley and Chen 1984, Breschi and Pozzi 2004, and Garrett, et al. 2006, have moved from a descriptive approach to a more analytical one, focusing on the biological, environmental, social, and cultural determinants of infant and child survival. The new approach was also favored by the publication of an innovative book, Preston and Haines 1991, based on indirect estimates derived from national censuses. It not only has allowed a deeper understanding of the wide range of determinants of different natures but also, according to Oris, et al. 2004, has made clear the necessity of considering their respective roles in the specific phases of early life. The most recent studies have allowed significant progress to be made, particularly in relation to socioeconomic, environmental and public health, while for others that are more difficult to measure (for instance, cultural factors), there are still aspects that need to be further clarified.

• Armstrong, David. “The Invention of Infant Mortality.” Sociology of Health & Illness 8.3 (1986): 211–232.

  DOI: 10.1111/j.1467-9566.1986.tb00298.x

  The introduction of a specific mortality rate for infants was more than a new demographic indicator. The adoption of this measure reflected the awareness of the social and medical problems that young deaths represented and the social recognition of children as individuals who were no longer seen as young adults.

• Bideau, Alain, Bertrand Desjardins, and Hector Pérez-Brignoli, eds. Infant and Child Mortality in the Past. Oxford: Clarendon Press, 1997.

  The volume contains a selection of papers presented at a conference organized in Montreal in 1992 by the International Union for the Scientific Study of Population. The authors trace the evolution of infant and child mortality across time and space and address the problems arising from employing historical data. They argue that an interdisciplinary approach is necessary to comprehend the social and cultural determinants that influence early-life mortality.

• Breschi, Marco, and Lucia Pozzi, eds. The Determinants of Infant and Child Mortality in Past European Societies. Udine, Italy: Forum, 2004.

  This book originates from a seminar held in Alghero, Italy, in 2002 to foster a debate among scholars from different fields on the determinants of early-life mortality in the past. The contributions, based mainly on individual-level datasets from various countries, deal with specific aspects related to the influence of socioeconomic factors, biological and maternal determinants, and the role of medical care.

• Corsini, Carlo A., and Pier Paolo Viazzo, eds. The Decline of Infant Mortality in Europe. Florence: UNICEF, 1993.

  The volume includes four comprehensive contributions on infant mortality in Sweden, England, France, and Austria, originating from a European Research Project seminar held in Florence in 1992 to review the state-of-the-art literature, the available sources, and their comparability. The four case studies, based on extremely long national time series, make clear the existence of significant differences in the levels, trends, and timing of the decline in infant mortality.

• Corsini, Carlo A., and Pier Paolo Viazzo, eds. The Decline of Infant and Child Mortality: The European Experience, 1750–1990. The Hague: Martinus Nijhoff, 1997.

  The book originates from the second meeting within the European Research Project, held in Florence in 1994. The twelve contributions—preceded by a stimulating introduction—are offered by scholars from different countries and disciplines and cover the broader topic of the decline in early-life mortality in Europe for over two centuries. Based on a wide variety of sources and methods, the contributions provide substantial results and methodological insights.

• Garrett, Eilidh, Chris Galley, Nicola Shelton, and Robert Woods, eds. Infant Mortality: A Continuing Social Problem. Aldershot, UK: Ashgate, 2006.

  The volume celebrates one hundred years since the publication of one of the most influential British books on the social causes of infant mortality. In their critical review of George Newman’s considerations, the authors propose stimulating insights in the light of current knowledge of the history of early-life mortality. They show that early child mortality still represents a significant social problem and suggest new ways of identifying persistent mortality disparities.

• Mosley, Henry W., and Lincoln C. Chen. “An Analytical Framework for the Study of Child Survival in Developing Countries.” Population and Development Review 10 (1984): 25–45.

  DOI: 10.2307/2807954

  The article provides an analytical framework of the determinants of child survival in developing countries. The rationale is the idea that certain economic and social determinants act on a child’s risk of getting sick and/or dying through a set of biological variables or proximate determinants (maternal factors, environmental contamination. nutrient deficiency, injury, and personal illness control). The framework has also become an essential reference for historical demographic studies.

• Oris, Michel, Renzo Derosas, and Marco Breschi. “Infant and Child Mortality.” In Life under Pressure: Mortality and Living Standards in Europe and Asia, 1700–1900. Edited by Tommy Bengtsson, Cameron Campbell, and James Z. Lee, 359–398. Cambridge, MA: MIT Press, 2004.

  This painstaking chapter of the first volume of the Eurasian Population and Family History Project provides a comprehensive comparative analysis of infant and child mortality in the long run. While supporting the need to examine the role of various determinants at each specific phase of early life, it shows the complex transition from the biological to the social and economic determinants over the life course with significant interactions.

• Pozzi, Lucia, and Diego Ramiro Fariñas. “Infant and Child Mortality in the Past.” Annales de Démographie Historique 129 (2015): 55–75.

  The article is part of a special issue devoted to a historiographical review of fifty years of historical demographic research. The authors, aware of the impossibility of a complete review of the large volume of studies on early-life mortality, focus on two main aspects: problems of definition, classification, and measurement and the causal determinants and the transition from a macro to a micro approach.

• Preston, Samuel H., and Michael R. Haines. Fatal Years: Child Mortality in Late Nineteenth-Century America. Princeton, NJ: Princeton University Press, 1991.

  DOI: 10.1515/9781400861897

  The first systematic study of child mortality in the United States at the turn of the twentieth century was based on a novel longitudinal individual approach applied to the 1900 US Census. The book not only addresses essential questions for understanding the high early-life mortality there but also represents an essential reference for the methodological contribution and new perspectives provided to the search for the causal mechanisms affecting child survival.