It is a tragic “fact of life” that many babies die, often of preventable causes, before they reach their first birthday. My current book in progress, The Quiet Politics of Infant Mortality, focuses on the problem of infant death, an individual and collective trauma that impacts families, communities, and nations. Looking specifically at North America, I investigate the structural relations—including racial and class inequality—that contribute to infant loss, asking a fundamentally biopolitical question: How and why are we letting these babies die?
In 1906, Dr. George Newman published Infant Mortality: A Social Problem, the first comprehensive account linking infant death to social, cultural, and economic conditions. A practicing physician, he was concerned that the infant mortality rate (IMR) in England and Wales was very high between the years 1850 and 1890, despite improvements in other areas of public health at the time. In diagnosing and proposing solutions to this epidemiological mystery, Newman looked to social context, particularly the role of environmental factors (e.g., poverty, sanitation). In an edited volume commemorating the centenary of Newman’s book, Garrett et al. (2006) write, "while we may know far more about certain aspects of infant health than we did 100 years ago, the core of Newman’s thesis remains unchallenged.”
Perhaps more startling than the continuing vitality of Newman’s ideas more than a century post-publication is the epidemiological fact that babies continue to die at high rates, both in the developing world and in pockets of deprivation in the developed world. Even now, in the twenty-first century, modernity and its benefits remain fragmented and unequal. Health and disease are socially produced, and global inequality is a leading factor in worldwide health disparities. This means that typically countries with the fewest resources and the poorest people tend to have the highest infant mortality rates. The further one travels down the list to higher mortality rates, the further one moves from “developed” countries in North America and Europe to those in the so-called “Third World” or global south.
According to the CIA World Factbook, the nations with the worst infant mortality rates in 2012 were Afghanistan, Mali, Somalia, Central African Republic, and Guinea-Bissau. Bottom-ranked Afghanistan reported 121.63 deaths per 1,000 live births (and one can presume that being occupied has something to do with this high rate). The nations with the lowest infant mortality rates were: Monaco in the number one spot with a rate of 1.8 deaths per 1,000 live births, followed by Japan, Bermuda, Singapore, and Sweden. These numbers clearly are linked to structural relations and reflect deep and persistent global disparities. For example, in 2011, 36 percent of the Afghani population lived at or below the poverty line, while the number living below the poverty line in Monaco was too small to register statistically.
Yet there is one oddity in infant mortality rate tabulations, namely how poorly the United States fares in the rankings. In 2012, the U.S. ranked a distant 50th from the top, in-between Croatia and the Faroe Islands. Although considerably lower than the rates of the highest-mortality nations such as Afghanistan, in 2012 the overall U.S. infant mortality rate was 6.0 deaths per 1,000 live births. (In 2002, the first year since 1958 in which the infant mortality rate went up, it was 7.0 per 1,000 live births.) A majority of the approximately 25,000 infant deaths in the United States annually are due to preventable factors such as lack of access to health care, maternal health, and low birthweight/preterm labor.
The U.S. rates are disquieting, as the reduction of infant mortality here was long considered one of the major public health success stories of the twentieth century (Combs-Orme 1988). In 1900 in some American cities, thirty percent of infants died before reaching their first birthday; from 1915 through 1997, infant mortality declined more than ninety percent. Improvements in standard of living and nutrition, advances in clinical medicine, increased educational levels of parents, and better surveillance and monitoring of disease contributed to this achievement, as did a determined policy focus on maternal and child health as embodied in the Sheppard-Towner Act of 1921. Also known as the Maternity and Infancy Bill, the Act’s goal was a reduction in infant mortality through provision of matching grants to states, inspection of maternity homes, and creation of facilities and programs (Ladd-Taylor 1994). As the IMR decreased in the wake of structural improvements so, too, did public attention to the issue and dedicated government resources.
But significant disparities in infant mortality have persisted in the U.S. across racial and ethnic divides. The history of infant mortality in this country is, I suggest, also the history of immigration, race, poverty, and other structural inequalities. Non-white infants, especially African Americans, die at much higher rates in their first year of life than do white babies. In 2008, the mortality rate for African American infants was 13.1 deaths per 1,000 live births, a rate comparable to that of many developing nations. The percentage of newborns at low birth weight—a leading indicator of infant mortality—has risen steadily since 1984 and, in 2007, was at the highest level recorded in three decades. African American babies are three times as likely to die of causes related to low birth weight than white babies, and they are also twice as likely to succumb to SIDS, or Sudden Infant Death Syndrome.
In The Quiet Politics of Infant Mortality, I argue that contemporary inattention to infant mortality in the U.S. has as much to do with race as the numbers themselves. Unlike the turn of the 19th century, when national biopolitical strategies were aggressively pursued, it was just last year that the first national initiative in almost a century was announced. Interventions such as preconception care feature individual-level solutions, such as reproductive health plans and folic acid, and not community- and structural-level interventions such as poverty reduction. Thus, while it is gratifying to see a hint of federal attention to the problem of infant mortality in the United States, contemporary strategies thus far have failed to address chronic inequality and structural violence while also placing the burden of failure squarely on women’s shoulders.
Monica J. Casper
Combs-Orme, T. 1988. Infant mortality: Legacy of success for social work. Social Service Review, 62, 83-102.
Garrett, Eilidh, Chris Galley, Nicola Shelton, and Robert Woods. 2006. Infant Mortality: A Continuing Social Problem. Hampshire: Ashgate.
Ladd-Taylor, Molly. 1994. Mother-Work: Women, Child Welfare, and the State 1890-1930. Univesity of Illinois Press.
Newman, George. 1906. Infant Mortality: A Social Problem. London: Methuen.