Infant mortality

Edward Higgs

There are certain aspects of the death of children under the age of one year that sets such mortality apart from that of other people. Foetuses can fail to mature properly or be damaged in the womb, leading to stillbirths or death through congenital causes in the early days of life. Very young children lack the immunity to diseases found in adults, and in unhygienic conditions are susceptible to death from diarrhoea, especially when they are not breastfed. Modern epidemiologists therefore study infant mortality via the calculation of special statistical measures. The infant mortality rate (IMR) is usually calculated as the number of deaths per year of children under the age of one year who were born alive in a particular defined area, expressed as a rate per thousand live births per annum in that area. There are also similar rates for mortality in specific fractions of the infant population, relating to perinatal mortality (stillbirths plus deaths at 0–6 days after live birth); neonatal mortality (deaths at 0–27 days after live birth); early neonatal mortality (deaths at 0–6 days after live birth); late neonatal mortality (deaths at 7–27 days after live birth); and post-neonatal mortality (deaths at 1–11 months after live birth).

It is possible to begin to calculate some of these rates in Britain from the mid-nineteenth century onwards. Data on mortality were captured by the civil system for registering births, marriages and deaths set up in England and Wales under the provisions of the 1836 Marriage and Registration Acts (6 & 7 Will. IV, cc. 85 and 86). These set up the modern system of civil registration to replace the parochial registration of baptisms, marriages and burials that had been established in the early sixteenth century. The whole of England and Wales was divided into registration districts based on the Poor Law Unions and registrars appointed to them. These local officers were to issue certificates of birth, marriage and death. They also sent copies of the certificates to the General Register Office (GRO), which created indexes of these and made them available to the public in a central site at Somerset House. A Registrar General for England and Wales was appointed to head the GRO and to supervise the local registration system (Higgs, 2004a, 1–90). A similar system was set up in Scotland in 1855.

The death certificate carried the cause of death and age at death, and so enabled the calculation of infant mortality rates, although the failure to register stillbirths until 1927 made the calculation of perinatal mortality rates impossible until that date (Higgs, 2004b, 92). Almost from its inception, the GRO began publishing tables showing age of death, including data on the death of infants, in its annual reports. In the Second annual report of the Registrar General, covering the year ending 30 June 1839, the GRO published a table showing the infant mortality rates for collections of registration counties (Second annual report of the Registrar General, 34). By the Annual report for 1846 the GRO was giving data on deaths in terms of months of ages in similar areas (Ninth annual report of the Registrar General, 55). From 1889 onwards the GRO published tables showing infant mortality in the first and second three-month periods of life, and in the second six-month period. It is certainly possible to calculate national infant mortality rates for England and Wales from 1846 onwards, and for Scotland and Ireland for later dates (Macfarland and Mugford, 43).

The GRO addressed the issue of infant mortality sporadically in the text of its Annual reports in the course of the late nineteenth century. In the Annual report for 1875, for example, William Farr, the GRO's medical statistician, spent 13 pages discussing the differences in local and national infant mortality rates (Thirty-eighth annual report of the Registrar General, xl-liii). Farr had also discussed the frequency and causes of the mortality of infants in the decennial supplements to the Annual reports, which were produced from 1865 onwards (Supplement to the Registrar General's twenty-fifth annual report, v-xiv). But in the early twentieth century infant mortality became a much more central feature of the Annual reports. In the Annual report for 1905 the Office began publishing tables on a continuous basis, showing mortality from the principal causes of death in each of the first four weeks after birth, and in each month in the first year of infant life (Sixty-eighth annual report of the Registrar General, cxviii-cxxxiii). As well as the new tables, a distinct section on mortality amongst infants and young children was introduced as a standard component of both the Annual reports and Decennial supplements. In the 1920s such mortality was usually the first subject to be discussed in the GRO's annual Statistical review.

The heightened national interest in population and questions of infant and child mortality in the early twentieth century, in which the GRO shared, reflected broad geo-political concerns. A declining birth rate implied a problem with respect to the maintenance of the British population in an age of imperial rivalry. The registered birth rate in England and Wales had fallen from 35.33 per thousand in the decade 1871–80 to 26.59 in the period 1901–11, whilst the infant mortality rate had failed to improve in the late Victorian period in line with the experience of other age cohorts. As John Tatham, the GRO's superintendent of statistics, noted in the Decennial supplement for 1891 to 1900, published in 1907:

it appears that, although in the course of the last four decennia the death rate of all ages has fallen by 15 per cent., and the death-rate at ages one to five by not less than 33 per cent., nevertheless at ages under one year the death-rate in 1891–1900 has shown no reduction from the high rate recorded in 1861–70. The infant portion of the community has not shared in the common benefit (Supplement to the sixty-fifth annual report of the Registrar General, cv).

Such an eventuality would have dire consequences for British society, the economy and the Empire, especially when the populations of rivals such as Germany and the USA were larger and expanding rapidly.

This led to the development of a general child-welfare movement that sought to prevent the loss of infant life. As historians have argued, predictions with respect to the declining size of the population encouraged a public debate over infant and maternal welfare, especially after the debacle of the Second Boer War. This led the President of the Local Government Board (and thus the minister responsible for the GRO), John Burns, to hold National Conferences on Infant Mortality in 1906 and 1908. These were attended by large contingents of local medical officers of health (MOHs), who were responsible for local public health. The GRO's officers appear to have seen their introduction of a more detailed analysis of infant mortality in terms of an administrative response to the 1906 National Conference on Infant Mortality. As Tatham noted in the Annual report for 1906, the form of the new GRO tables conformed to that in the MOHs' reports now required by the Local Government Board, 'so that MOHs have at hand reliable standards with which to compare the infant mortality in their own districts' (Sixty-ninth annual report of the Registrar General for 1906, lxix). A similar heightening of interest in infant mortality can also be found in the Annual reports for Scotland in the Edwardian period (e.g., Fifty-first detailed annual report of the Registrar General, xliii-li).

REFERENCES

Fifty-first detailed annual report of the Registrar General of births, deaths and marriages in Scotland, BPP 1907 XVI (Cd.3650). [View this document: Fifty-first detailed annual report of registrar-general of births, deaths and marriages, Scotland]

Edward Higgs, Life, death and statistics: civil registration, censuses and the work of the General Register Office, 1837–1952 (Hatfield, 2004).

Edward Higgs, 'The linguistic construction of social and medical categories in the work of the English General Register Office', in S. Szreter, A. Dharmalingam and H. Sholkamy, eds, The qualitative dimension of quantitative demography (Oxford, 2004b), 86–106.

Alison Macfarlane and Miranda Mugford, Birth counts. Statistics of pregnancy and childbirth, volume 1, text (London: HMSO, 2000)

Ninth annual report of the Registrar General (1846), BPP 1847–48 XXV (996). [View this document: Ninth annual report of the registrar-general]

Second annual report of the Registrar General (1838–1839)], BPP 1840 XVII (263). [View this document: Second annual report of the registrar-general ]

Sixty-ninth annual report of the Registrar General (1906), BPP 1907 XVII (Cd.3833) [View this document: Sixty-ninth annual report of the registrar-general ]

Sixty-eighth annual report of the Registrar General (1905), BPP 1906 XX (Cd.3279) [View this document: Sixty-eighth annual report of the registrar-general ]

Supplement to the Registrar General's Twenty-fifth Annual Report, BPP 1865 XIII (3542). [View this document: Supplement to registrar-general's twenty-fifth annual report]

Supplement to the Registrar General's sixty-fifth annual report [Part II], BPP 1905 XVIII (Cd.2619). [View this document: Decennial supplement to registrar-general's sixty-fifth annual report [Part II]]

Thirty-eighth annual report of the Registrar General(1875), BPP 1877 XXV (C.1786) [View this document: Thirty-eighth annual report of the registrar-general ]