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U . S. D E P A R T M E N T



C H IL D R E N ’ S B U R E A U
Publication 294
Federal Reserve Bank of St. Louis



For sale b y the Superintendent o f D ocum ents, U . S. Governm ent Printing Office
W ashington, D . C . - Price 10 cents
Federal Reserve Bank of St. Louis

\© oo ©\ if*. W

How many children are there in the United States?......................
How many babies are bom in the United States?..........................
How are the children distributed?........................ ......................
What does a child need for health and grow th?........
B y whom must the health needs o f children be met?
How can all children have their health needs m et?..
How well are children’s health needs being m et?. . . .
How is the war affecting mothers and ch ild ren ?.. . .
Is progress being made in promoting the health o f children?. . . .
W hat are the chances o f survival o f children and you th ?..............
What are the plans for the days ahead?....................................« . . .


O p p ortu n ity fo r every ch ild to o b ta in th e essen tial elem en ts
o f w h olesom e, h e a lth fu l liv in g — g ood n u tritio n , h e a lth fu l recrea­
tio n , an d su fficie n t rest— an d to lea rn to give d u e value to p h y si­
ca l, e m o tio n a l, an d in te lle ctu a l d ev elop m en t; n o t o n ly fro m th e
p o in t o f view o f h is person al w elfare, b u t o f th e w elfare o f th ose
w h o su rrou n d h im .
This is one o f the objectives o f the Americas for their
children, as stated in the Final A ct o f the Eighth Pan American
Child Congress, which m et in W ashington in M a y



act further states:
T o th is en d it is n ecessary to safegu ard th e p h y sica l an d
m en ta l h e a lth o f th e ch ild . . .
req u ired :

fo r w h ich th e fo llo w in g are

(a ) A dequ a te n u tritio n .
(b ) P e rio d ic m ed ica l an d p sy ch o lo g ica l su p ervision , an d
m ed ica l care d u rin g illn ess.
(c ) E xpert g u id an ce in recrea tion .
(d ) A dequ ate rest.
(e ) G u id a n ce in th e p rop er fo rm a tio n o f th e p erson a lity , in
a ll its asp ects.
(f) P rep aration fo r life in th e co m m u n ity .
Facing the challenge o f wartime conditions within the United
States, the Children s Bureau Commission on Children in
Federal Reserve Bank of St. Louis

W artim e adopted A

Children’s Charter in W artim e, which

begins with the following words:
W e are


to ta l

w ar again st aggressor n a tion s.



fig h tin g a gain fo r h u m a n freed om an d esp ecially fo r th e fu tu re
o f o u r ch ild re n in a free w orld .

C h ild ren m u st be safegu arded—

an d th ey ca n be safegu arded— in th e m id st o f th is to ta l war
so th a t th ey ca n live an d share in th a t fu tu re .

T h ey m u st be

n ou rish ed , sh e lte re d ,, an d p ro te cte d even in th e stress o f w ar
p ro d u ctio n so th a t th ey w ill b e stron g to carry forw ard a ju s t
an d la stin g p eace.
Action to attain this objective— to safeguard our children by
providing for every child opportunity to obtain the essential
elements o f wholesome, healthful living— m ust he founded upon
certain hasic information

about our children,

about their

health needs, and about how these needs can be m et and are
being m et.

Some o f this information has been gathered to ­

gether in—


Federal Reserve Bank of St. Louis

How Many Children Are There in the United States?
Children under 20 comprise slightly more than one-third o f the total
population o f the N ation; those under 15 comprise one-fourth.
Final figures from the 1940 census show 45,305,604 persons under 20
years o f age in the United States, grouped by ages as follows:
Under 5 years o f age.................,...................................... ..............
5 to 9 years.......................................................................................
10 to 14 years................................................................ ..................
15 to 19 years...................................................................................


The White House Conference on Children in a Dem ocracy (1940)
stated: "F or numbers alone, if for no other reason, these voteless fellow
citizens who hold the national future in their bodies and minds are
necessarily a first interest o f the N ation."

How Many Babies Are Born in the United States?
In 1941, the latest year for which figures are available, 2,513,427
infants were born alive in the United States. This is a birth rate o f 18.9
per 1,000 population. In 1915, when the birth-registration area was
first established, the birth rate was 25.
The trend in the birth rate in the United States was downward for
many years. The decline reached its low point in 1933, when the rate
was 16.6.
B irth

B irths
R ate
1933 ...........................................................................
1934 .................................................................................
1935 .......................... .................... ...................... . ...................... 2,155,105
1936 ...............................................................
2,144,790 16.7
1937 ..............................................................
2,203,337 17.1
1 9 3 8 :.................................................................................
1939 ...........................................................
1940 ...........................................................
1941 ................................................................
2,513,427 18.9

How Are These Children Distributed?
There are more children in proportion to the number o f adults in the
productive age groups in some parts o f the country than in others.
Counties having an extremely high ratio o f children to adults are located,
in the main, in the Southeastern States.
Federal Reserve Bank of St. Louis

The latest available data (final figures from the 1940 census) show
that among the geographic regions the ratio o f children under 20 years
o f age to adults 20-64 years o f age varied as follows:
C hildren to
100 adults

C hildren to
100 adults

Far W est........ ..................... . 44 Northwest.......................................... 64
N ortheast..................................... 51 Southwest..................................... 70
M iddle.......................................... 54 Southeast............................. ....... 77
For the most part, areas with the lowest level o f income carry relatively
the heaviest load for child nurture and education.
The number o f children o f school age in relation to adults 20-64 years
o f age is lowest in cities o f 100,000 or more and is also low in small cities.
It is higher in rural nonfarm areas than in cities and is highest in farm
In every region o f the United States except the Far West the farm
population has a percentage o f children o f school age far in excess o f its
percentage o f the national income. Since the dominant feature o f
migration within the United States in recent years has been the m ove­
ment from farms to cities, it is as important to cities as to rural areas
that children in rural areas receive adequate care.

W hat Does a Child Need for Health and Growth?
To be well bom.— Heredity determines certain o f a child’s character­
istics, such as the color o f the eyes and hair. Heredity is also a factor
in the size of the child. Short, stocky parents should not be surprised
that their child is not so tall as one whose parents are tall and slender.
Heredity plays a role in many other ways.
Being well born depends also on the health o f the mother during the
prenatal period and upon the child’s being bom safely. In order that the
baby may have the best possible chance o f starting out in life with a
well-developed body the mother’s health must be protected during
pregnancy. She must be assured proper food, exercise, and rest. If
abnormalities develop they must be recognized early and the necessary
steps must be taken to correct them.
In order that the baby may have the best possible chance o f being born
safely* without injury, the delivery must occur under safe conditions,
with a skilled attendant who knows in advance whether any difficulties
are to be expected and is prepared to meet them.
To be well housed.— For the child’s health, good housing means freedom
from undue crowding in the home, fresh air, warmth, sunshine, quiet,
and cleanliness. It means a neighborhood where a pure water supply is
available and where there are proper provisions for disposal o f excreta
and garbage.
To be well fed.— For the young infant, being well fed means having his
mother’s milk, if possible, or cow’s milk (made safe by boiling) in a mix-

Federal Reserve Bank of St. Louis

ture suited to his individual needs. Vitamins that promote health and the
development o f a sound body should be supplied early by giving codliver oil and orange juice or their substitutes in the proper amounts.
As the baby grows older, other essential foods are added to his diet, but
milk remains important. Good food habits should be developed during
After infancy, being well fed means that the child has foods in sufficient
variety and amount to provide for all the needs o f his growing body. It
means good food habits.
To have good daily care.— The child is well cared for if he is loved, if he
is kept com fortable and clean, if he is helped to learn good health habits,
and if he is given the opportunity to develop his growing powers.
Keeping a child com fortable means attention to such things as suitable
clothing, bedding, room temperature. Cleanliness is important, but
keeping a child clean does not mean that he should not be allowed to get
dirty in active play.
T o develop good health habits, the baby should from the first have
regular hours for eating, sleeping, sunshine, and play, but the schedule
should be flexible and adjusted to his individual needs. Later, good hahits
o f outdoor exercise and personal hygiene must be established.
In order that he may develop his growing powers to their full capacity,
the child needs opportunities for activity, play, and companionship.
He needs a chance to learn independence; he needs guidance in directing
his activities into proper channels; and he needs education.
To be protected against disease.— Against some diseases, the only protec­
tion possible is to make sure that the child’s feeding and care are adjusted
to his needs. Against communicable diseases, avoidance o f exposure is
im portant: A child should be kept away from persons known to have
colds or other communicable diseases; young children should be kept
away from crowded places.
For a few diseases, specific methods o f protection are available. Every
child should be immunized against smallpox and diphtheria during the
first year o f life.
Smallpox is a serious disease. Even though there is no known small­
pox in the community, exposure may occur at any time. In these days
o f rapid travel, a person who has been exposed to smallpox in one com ­
munity may travel to another community far distant before he knows
that he is developing the disease and is capable o f spreading it.
Vaccination against smallpox is simple. Every baby should be vacci­
nated during his first year. The child should be vaccinated again when
he is 6 years old and when he is 12, or at any time if an epidemic o f small­
pox occurs. I f there is any reason to doubt whether a child is immune,
it is wise to vaccinate him again.
Diphtheria is another serious disease against which special protection
can be given. For immunization, plain toxoid in three injections or
Federal Reserve Bank of St. Louis

alum-precipitated toxoid in two or three injections is given at 4-week
intervals. Six months after the last dose a Schick test should be given;
for the occasional child who has a positive Schick test one or two more
injections o f toxoid will be needed.
Diphtheria immunization should be started when the child is 9 months
old. I f it is not given then, it should be started as. soon thereafter as
possible. A t the time he enters school the child should be given a re­
inforcing inoculation against diphtheria.
M any doctors recommend that inoculations to immunize the child
against tetanus and whooping cough also be given during infancy.
To receive proper treatment fo r defects or illness.— I f a child has any
physical defects, it is important that they should be recognized early and
corrected at the most suitable time. Defects that could be corrected
often impair a child’s health or lim it his activities. I f they are recognized
early, it may be possible to correct them before they become serious.
Dental defects are common in children. They should be corrected
prom ptly, since dental health is an integral part o f general health.
The sick child needs diagnosis and appropriate treatment. I f these
are given early, more serious illness may be prevented.
To learn how to protect his own health.— Health education begins with
learning good health habits. As the child grows older, he needs to learn
what is important for the protection o f his health in order that he may
assume an increasing share o f the responsibility every individual has—
to maintain himself in the best possible state o f health.

By W hom Must the Health Needs o f Children Be Met?
B y the parents.— It is the parents who provide the child’s daily care and
who are responsible for seeing to it that every possible measure is taken
for the protection o f his health. Parents alone cannot meet all the
child’s health needs. In order that they may plan wisely for the child’s
care from day to day and may know what measures are important for the
protection o f the child’s health, they need guidance from persons whose
special training equips them to give such assistance. Certain measures
for health protection cannot be carried out by the parents themselves
because technical training or special facilities are required. But it is
the duty o f the parents to make the best possible use o f such expert aid
as is available to them to the end that all the child’ s health needs may be
With the aid o f the doctor.— The doctor is the expert to whom the parents
should turn for guidance and assistance in anything that pertains to the
health o f the child.
The doctor should examine the mother early in pregnancy, supervise
her health throughout the prenatal period, and treat her for any abnor­
malities that occur* It is the doctor who can give skilled care at the
Federal Reserve Bank of St. Louis


baby’s birth in order that the child may have the best possible chance o f
coming into the world safely.
The doctor who is experienced in the care o f children is the person who
can best judge what foods are specially suited to the child’s needs during
infancy and what special care the child may need. In infancy and
throughout childhood it is the doctor who can tell, by careful examination,
whether the child’s health needs are being met and whether defects exist
that should be corrected. It is he who can advise the parents about the
child’s health hahits and about protecting him from disease. He can
give the immunizations that will make the child safe from certain diseases.
Only he can give the medical or surgical care necessary for correction o f
defects or cure o f disease.
There are times when the general practitioner needs advice and assist­
ance in the care o f the mother or child. For such times there should be
available the consultation services o f specialists in the various medical
and surgical fields, including obstetrics, pediatrics, internal medicine, and
With the aid of the public-health nurse.— The public-health nurse can
help the parents to protect the child’s health in many important ways—
by explaining and demonstrating how to carry out the doctor’s recom­
mendations; by helping the doctor to know the special needs o f the mother
and child; by aiding the doctor when the baby is born and by giving expert
care to the mother and baby in the days that follow ; by teaching the
mother how to care for the baby and aiding her in establishing routines
for the care so that her responsibilities for the well-being o f all members
o f the family may be met most effectively; by guiding the parents in
securing any special types o f assistance they require.
With the aid of the dentist.— Among the most common o f the physical
defects that should be recognized and treated prom ptly during child­
hood are those o f the teeth. Early and regular dental care is so
important to the health o f the child that ¡all parents [should have the
assistance o f a dentist in meeting the child’s health needs. N o one else
can make the repairs necessary to prevent tooth decay from advancing
With the aid o f the hospital.— In many serious illnesses o f children and in
conditions requiring surgical treatment or in obstetric emergencies,
hospital care for the child or the mother may be essential for recovery.
A good hospital, equipped to give suitable care to maternity patients and
to infants and children, with obstetricians and pediatricians on its staff,
gives assistance o f a type that most families are likely to need at some time.
With the aid of other experts.— There are other types o f special assistance
that parents may need from time to time as special situations arise and
for which they should be able to turn to experts— to the nutritionist, who
can advise regarding the child’s food requirements and the selection,
purchase, and preparation o f foods; to the mental hygienist, who can
524660°—43---- 2
Federal Reserve Bank of St. Louis



advise regarding problems o f behavior and management; to the social
worker, who can advise regarding problems o f family adjustment.
Certain types o f assistance are indirect. The housing authority and
the sanitarian who are engaged in improving the living conditions in the
community give services that help to meet the child’s needs to be well
housed and well fed, though often the parents are scarcely aware o f their

How Can All Children Have Their Health Needs Met?
M ost children have parents who are eager to give them every oppor­
tunity for health. But not all parents can by their own efforts obtain
the assistance they require in meeting their children’s health needs. In
order that all children may have their rightful opportunity for health,
health departments are making assistance to parents more and more
The local health departments o f most cities and many counties have
physicians and public-health nurses on their staffs who give all or much
o f their time to health services for mothers and children. In some
areas where the health department does not provide these services, the
town, the county, or the school board employs at least one public-health
nurse to give some measure o f protection to the health o f mothers and
children. These needed services are comparatively rare, however, in the
smaller towns and rural areas.
The maternal and child-health services that are most frequently
offered by health departments include the following:
Prenatal clinics conducted by physicians, with the assistance o f
public-health nurses, to provide medical and nursing supervision
and instruction for expectant mothers.
Child-health conferences conducted by physicians, with the assistance
o f public-health nurses, to provide medical and nursing super­
vision for infants and young children and instruction to their
parents regarding the care o f the children.
School health services to safeguard the health o f school children by
medical and dental examinations, by nursing supervision, and by
the teaching o f hygiene.
Home visiting by public-health nurses to advise parents regarding the
care o f their children and to demonstrate to them how such care
may be given, also to assist the expectant mother to protect her
health and plan for her confinement.
Immunization services to protect children against smallpox and
diphtheria. These services are frequently given as a part o f the
child-health conference and the school health services.
Dental inspection or educational services to help children and parents
to appreciate the importance o f dental care and dental hygiene.

Federal Reserve Bank of St. Louis

These services are frequently given as part o f the prenatal clinic,
child-health conference, or school health services.
Nutrition services to guide and assist parents in the selection, purchase,
and preparation o f foods so that their children may be well fed.
The nutrition services are an important part o f all the other
services that have as their purpose the guidance o f parents or
children in the promotion o f general health.
Other valuable health services for mothers and children that are pro­
vided by health departments in a smaller number o f communities, include:
Consultation services by specialists in obstetrics and pediatrics.
Nursing assistance to physicians attending deliveries in the home, and
nursing care and supervision for mother and baby during the
lying-in period.
Special services fo r premature infants by nursing care and supervision
in the home, or by provision for special care in hospitals.
Corrective dental services for school and preschool children and for
expectant mothers.
Medical care fo r the mother when, the baby is bom and fo r mother and
baby during the lying-in period.
Medical and nursing care fo r sick children.
Hospital care fo r mothers who have special need fo r such care at the
time of childbirth.
Hospital care fo r sick children.
As the result o f a need arising directly from the war situation, many
States have, within the past year, initiated a special wartime service:
Maternity care fo r the wives, and pediatric care fo r the children, o f
those men in military service who are not commissioned officers.
T o aid local health agencies in carrying on their maternal and childhealth programs, each State has a maternal and child-health division
in the State health department, with a physician in charge o f the State­
wide program. Public-health nurses, and in many States additional
physicians, dentists, nutritionists, and health educators, are on the State
health-department staffs to assist the local agencies.
Each State also has a crippled children’s agency with facilities for lo­
cating crippled children and for giving them medical, surgical, hospital,
and aftercare services to aid in their physical restoration and social
readjustment. (These services are described in the Children’s Bureau
publication: Facts About Crippled Children.)
T o assist the State and lo^al governments in their programs to promote
the health o f mothers and children, the Federal Government under the
Social Security A ct is making available, through the Children’s Bureau,
$5,820,000 a year for grants to the States for maternal and child-health
services. In M arch 1943 Congress passed an additional appropriation
Federal Reserve Bank of St. Louis

o f $1,200,000 for grants to State health agencies for medical, nursing,
and hospital maternity and infant care for the wives and children of
enlisted men in the armed forces. The Children’s Bureau cooperates with
the States in the development o f their programs by providing the con­
sultation services o f physicians, public-health nurses, and nutritionists on
its staff. Through the United States Public Health Service the Federal
Government makes available an additional sum o f $11,000,000 a year for
strengthening State and local public-health organization.

How W ell Are Children’s Health Needs Being Met?
There are no figures that tell how many children have health needs
that are not being met. Studies and surveys have been made in various
communities, but since conditions differ from one area to another the
results o f a study o f the children in one community cannot be applied
to the children elsewhere. M oreover, different methods and different
standards have been used in the various studies, so that the results o f
one study are often not comparable with the results obtained in another.
It is generally recognized that there are in practically every com ­
munity families that cannot from their own resources obtain the aid they
require to meet their children’s health needs. Assistance must be made
available to these families if the needs o f the children are to be met.
How widely is such assistance available? The answer to this question
will give an idea o f how well children’s health needs are being met.
M ost o f the large cities are generally fairly well provided with health
and medical services for children. But o f the small cities (10,000 to
25,000 population) one-fourth have no child-health conferences, and
nearly one-half have no prenatal clinics. Only 2 percent o f cities with
less than 10,000 population have an out-patient clinic to which sick
children may be sent.
M ost o f the well-organized health services available for mothers and
children in small towns and rural areas are provided by health depart­
ments supervised by State health agencies, or, in the case o f school
services, by sjchool authorities. Outside the cities the health services
provided by voluntary agencies are very few. Welfare departments
provide some medical care for illness in a number o f counties and some
county and town boards appoint physicians; but the medical care that is
available is often confined to those receiving public relief, is frequently
poorly organized or limited in scope, and in many counties is lacking
entirely or is o f very poor quality.
The number o f counties 1 in the United States in which the different
health services for mothers and children were provided under the super­
vision o f State health agencies in the year ended June 30, 1942, was as
shown in the table on page 9.
1 R eports coyer 2,988 counties in 47 States, the D istrict o f C olum bia, Alaska, H awaii, Puerto R ico; no
figures are included for Nebraska.

Federal Reserve Bank of St. Louis


N um ber o f counties

Prenatal clinic^, conducted b y physicians at least m onthly....................................
Child-health conferences, conducted b y physicians at least m on th ly...................... 1,047
Exam ination o f school children.....................................................................•; •..........
Public-health-nursing service which includes services for m others and ch ild ren .. 2,199
Corrective dental services:
M aternity.....................................................................
Preschool. .....................................................................
S ch ool......................................... ......................... .. •••
H om e-delivery-nursing services.............................................
H ospital care:
For children................................ .................................
For m others at delivery............................................


I t'is obvious from examination o f these figures that there are many
counties in the United States where there are no health services for mothers
and children under supervision o f State health departments. Approx,
imately one-third o f the counties do not even have a public-health nurse
giving maternal and child-health services; in nearly two-thirds o f them
public-health authorities have not made child-health conferences avail­
able. In only a comparatively few counties have health departments
provided for medical or hospital care of obstetric patients or o f children,
or for home-delivery-nursing services.

How Is the W ar Affecting Mothers and Children?
Rapid increase in civil population in defense areas has created many
problems affecting the health o f the mothers and children in those areas.
Immediate problems relate to housing, water supply, sewerage, milk,
malaria prevention, and hospital and clinic facilities. These services
are basic to the health o f mothers and children.
In addition, special measures to provide maternal arid child-health
services, including medical and nursing care, are imperative. Serious
shortages in maternal and child-health facilities and in medical and nursing
personnel available for service to mothers and children exist in many
defense areas. M any o f the communities affected by the defense program
had made little or no provision for maternal and child-health clinics and
public-health-nursing service before "th e emergency and so were ill
equipped to care for the increased population. Shortage o f obstetric
attendants and o f doctors and nurses for maternal and child-health con­
ferences is acute in some areas, and hospital facilities for maternity care
are often seriously overtaxed and far below standards o f safety.^ The
situation is often especially serious for newcomers, who are considered
nonresidents and therefore not eligible for public medical care.
There is one large group o f mothers and children who are in special
need o f aid in obtaining health services— a group that exists because o f
the war, and a group to whom a grateful Nation owes special considera­
tion. These are the mothers and children who have given husbands and
fathers to the armed forces. The families o f enlisted men receive allow­
ances that can be made to cover their daily needs but leave little or no
margin for medical care. M any States have started programs to provide
Federal Reserve Bank of St. Louis

maternity care and pediatric care for the wives and young children o f
men in military service below the rank o f commissioned officers.
New responsibilities are falling on the shoulders o f the Nation’s youth.
High-school students are engaged in many activities in addition to their
regular school work. Some have civilian-defense duties; some are working
after school or during vacations on farms, in stores, and in many other
types o f jobs. Other young people are leaving school to go to work.
A t 18 the boys are called into the armed forces.
The Nation needs the help o f these young people now, but it will also
need their work and their strength in the months and years ahead.
Their health and vigor must be protected. Measures must be developed
for determining the physical fitness o f the individual, who is entering em­
ploym ent so as to guide him into work commensurate with his capabilities.
Measures are needed, too, for control o f hours o f work and for protecting
the health o f boys and girls while on the job. There is need for extension
o f programs for supervision o f the health o f young people still in school
and for assuring them sufficient nourishing food and sufficient oppor­
tunity for sleep and recreation.
The war effort need not mean the sacrifice o f the health o f the young
people who are still at home if the steps necessary for their protection
are taken.

Is Progress Being Made in Promoting the Health
o f Children?
Since it is not possible to determine what proportion o f the children
o f the country are in good health, progress in promoting child health can
be judged best by studying the proportion o f mothers and babies who
die each year. For each mother or baby who dies it is safe to assume
that there are others whose health is impaired. The m ortality figures
therefore give an index o f general health.
How many mothers die?— The health o f the mother is so closely related
to that o f the baby that any decrease in the maternal m ortality rate may
be interpreted as a sign o f improvement in child health.
During 1941, 7,956 mothers died from causes due directly to pregnancy
and childbirth— a rate o f 32 deaths o f mothers per 10,000 live births.
This was 920 fewer deaths than in 1940, when the maternal m ortality
rate was 38, and 1,195 fewer than in 1939, when the rate was 40.
The 1941 maternal mortality rate was the lowest on record for the
United States. There are still, however, far too many maternal deaths.
O f the 7,956 deaths o f mothers in 1941, 3,034 (38 percent) were due to
infections; 2,031 (25 percent), to toxemias o f pregnancy; 2,032 (26 per­
cent), to hemorrhage, trauma, or shock; and 859 (11 percent), to other
puerperal causes. Abortion was responsible for 1,384 maternal deaths
(17 percent), 1,014 with mention o f infection and 370 without.

Federal Reserve Bank of St. Louis

The lowest maternal m ortality rate in 1941 was in Montana 16 deaths
o f mothers per 10,000 live births. Four other States had rates below 20.
Twenty-six States had rates between 20 and 29; 9 had rates between 30
and 39; 5 had rates o f 40 to 49; and 4 had rates o f 50 or higher. The low
rates in some States emphasize the fact that further reduction o f the
National rate is possible.
The maternal m ortality rate per 10,000 live births in 1941 was 27 for
white mothers and 69 for Negro mothers.
For 1940, the last year for which maternal m ortality figures are avail­
able by residence o f mothers, the maternal m ortality rate for women who
lived in rural areas was 40, as compared with 36 for women who lived in
How many babies are stillborn?— In 1941, 75,133 infants were stillborn
(29.9 per 1,000 live births); in 1940, 73,688 (31.2 per 1,000 live births); in
1939, 72,598 (32.0 per 1,000 live births); and in 1938,73,467 (32.1 per 1,000
live births). The findings o f the Children’s Bureau study o f stillbirths
in hospitals emphasize the importance o f good prenatal and delivery care
in prevention o f stillbirth. M ore than half (58 percent) o f the stillborn
infants included in the study died before labor; the remainder (42 per­
cent) died during labor. The causes of death o f the stillborn infants who
died during labor are similar to those for infants dying during the first
day o f fife.
How many babies die?— In 1941 there were 113,949 deaths m the first
year o f life. The infant mortality rate for the year was 45 per 1,000 five
births. In other words, 1 baby out o f every 22 born alive died before his
first birthday. The 1941 infant mortality rate was lower than that o f any
previous year.
Utah set a new all-time low State record with an infant m ortality rate
o f 30. Connecticut and Oregon came next with a rate o f 31. Twentyone States had rates o f less than 40 per 1,000 live births; 15 States and
the D istrict o f Columbia had rates o f 40 to 54; 9 had rates o f 55 to 69;
and 3 had rates o f 70 or more. Ten o f the 12 States with rates o f 55 or
higher were Southern States and 2 were Western States.
Since 1915 the trend o f the infant m ortality rate in the birth-registration
area has been downward. The rate in 1915 was 100 as compared with
57 in 1936, 54 in 1937, 51 in 1938, 48 in 1939, 47 in 1940, and 45 m 1941.
The reduction in infant mortality between 1915 and 1941 was due
largely to reduction in the rate for infants dying from the second through
the twelfth month o f life and especially to decreasing m ortality from
gastrointestinal and communicable diseases.
The death rate o f infants under 1 month o f age (neonatal m ortahty)
has declined (1915, birth-registration area, 44; 1940, United States, 29),
but much less than the general infant m ortality rate (1915,100; 1941, 45).
The rate o f death on the first day o f life has been reduced very little.
The deaths o f 67,866 babies occurred in the first month o f life in 1940.

Federal Reserve Bank of St. Louis

Eighty-four percent died as a result o f conditions arising before birth or
at the time o f birth; included in this group are the 46 percent bom pre­
maturely and the 15 percent injured at birth. Deaths in the first month
o f life constituted 61 percent o f the deaths in the first year.
How many mothers and babies could be saved?— The low infant and
maternal m ortality rates and stillbirth rates reported by some States
emphasize the fact that further reduction o f the National rate is possible.
I f for each type o f m ortality the 1941 rate for the country as a whole had
been that o f the State with the lowest rate for that year, approximately
81,000 lives would have been saved; 4,000 mothers and 39,000 infants
would not have died, and 38,000 stillhirths would not have occurred.

W hat Are the Chances o f Survival o f Children
and Youth?
I f a child is bom alive and is strong enough to survive the hazards o f
the first month, his chance o f reaching maturity is good. - United States
preliminary life tahles for 1930-39 (United States Bureau o f the Census)
show that the expectation o f life at birth o f a white boy baby is 61 years
and o f a white girl baby is 65 years. B oy babies who survive the first
year live, on the average, to the age o f 63; girl babies who survive the
first year live, on the average, to the age o f 67.
Causes o f death among persons under 20 years o f age in the United States,
T otal
Causes o f death
Num ber


Under 1

1 to 4

5 to 9

10 to 14 15 to 19

A ll causes...................................








The 10 leading causes..........................








Prem ature b irth ............................
Pneum onia (all form s).................
A ccidents. ...................................
Congenital m alform ations...........
Diarrhea and enteritis.................
In ju ry at b irth ..............................
Tuberculosis (all form s). . . . . . .
Diseases o f the heart...................
A ppendicitis ............................












A ll other causes.....................................








l Based on data from U . S. Bureau o f the Census.

M ortality rates for boys and girls decrease rapidly after the first year
until the lowest rate is reached at the age o f 11 or 12. From then on the,
m ortality rates increase with each year o f age.
Study o f the major causes o f death o f children and young persons
throws light on the high incidence and relative importance o f certain
causes o f death. It also gives some indication o f the number o f children

Federal Reserve Bank of St. Louis

affected by similar conditions who, though they recover, may have suffered
injury,to their health.

W hat Are the Plans for the Days Ahead?
“ The war should not be a cause for minimizing the care and
protection of children, since they represent the future and sym­
bolize the realization of ideals for which the present generation
strives.” 2
Effort to conserve and advance the health o f children not only must
not be relaxed during wartime but must, indeed, be intensified. Broad
outlines for the guidance o f such effort during the days ahead have been
formulated in several national conferences, such as the W hite House
Conference on Children in a Dem ocracy (1940), the National Nutrition
Conference for Defense (1941), and the Children’ s Bureau Commission
on Children in Wartime (1942).
In these conferences representatives o f National, State, and local
organizations and agencies from all parts o f the country reviewed the
needs o f children, considered the measures by which the needs o f all
children could best be met, and proposed methods o f organization by
which such measures could be put into effect.
In the States and in local communities special committees have been
organized to put into action the recommendations o f these conferences.
The W hite House Conference on Children in a Dem ocracy met while
war was still only a threat, but the members were keenly aware o f the
meaning to children o f the conflict then raging in many parts o f the world.
The recommendations o f the W hite House Conference included the
1. The health and well-being o f children depend to a large extent upon the health
o f all the members o f their fam ilies. Preventive and curative health service and
m edical care should be made available to the entire population, rural and urban, in
all parts o f the country.
, .
2. For all women during m aternity and for all newborn infants com plete service for
m aternity care and care o f newborn infants should be available through private
resources or public funds.
3. For all infants and children preventive and curative m edical services should be
available, including adequate means for control o f communicable disease.

Citizens committees have been organized in a number o f the States to
follow up the recommendationls o f the W hite House Conference. Pro­
motion o f health services for mothers and children is an important part
o f the programs o f these committees.
As the threat o f war grew closer, the National Nutrition Conference
for Defense was called to consider how the Nation might be strengthened
through better nutrition o f its people. One subsection o f this Confer­
ence was devoted to consideration o f the special needs o f mothers and
* Final A ct, Eighth Pan American Child Congress, M ay 1942«

Federal Reserve Bank of St. Louis

children. Now each State and nearly every county has a nutrition
committee, organized to carry on the nutrition program.
W ith shortages and rationing o f certain foods a program that offers
guidance in the wise selection and use o f foods is more than ever im­
portant to the well-being o f people o f all ages, but particularly for growing
In August 1942 the Executive Committee o f the Children’s Bureau
Commission on Children in Wartime met to consider methods by which
the Children’s Charter in Wartime, adopted by the Commission the pre­
vious M arch, could be translated into action. In consultation with the
Office o f Defense Health and Welfare Services and the Office o f Civilian
Defense, the Commission adopted A Program o f State Action for Our
Children in Wartime. Ten measures were listed that each State’s pro­
gram o f action should include. The first two pertain to the health o f
children. They are measures that will assure:
1. Health service and m edical and dental care for mothers and for children, including boys and girls in the age groups that m ay soon be called upon for war production or
m ilitary service, with special provision as needed for wives and children o f servicemen
and war workers. These services should be so organized as to overcom e or com pen­
sate for overcrowding o f existing health facilities, shortages in m edical and nursing
personnel, and difficulties in transportation.
2. Adequate nourishing food for all children during the period o f rising costs o f liv ­
ing and rationing o f food supplies, through such means as nutrition education, school
lunches, and low -cost milk.

A Program o f State Action outlined certain steps that should be taken
to put into operation the recommended measures. These include the
Fixing responsibility for planning, coordination, and leadership on some representa­
tive State group. W herever practicable this group should be a com m ittee or sub­
com m ittee o f the council o f defense.
Organization o f a representative local com m ittee, when practicable, as part o f the
local defense council.

M any States and local communities have organized committees or
subcommittees o f their defense councils to take responsibility for action
in behalf o f children. In some cases the functions o f such committees
have been limited to certain specific aspects o f child care, but in others
they include all matters pertaining to the health and welfare o f children.
The function o f these various committees is to stimulate and coordinate
the activities o f the organizations and agencies already serving within
the State or local community, and to initiate the development o f new
services or the expansion o f existing services where these are needed.
The responsibilities o f existing agencies are not lessened; the committees
are a means whereby the existing agencies can coordinate their services
and adjust them to changing needs.
Health services for mothers and children must be administered by
professionally trained' personnel, but volunteers working under the di-

Federal Reserve Bank of St. Louis


rection o f professional workers can enable the technically trained staff
to serve larger groups effectively. Present shortages o f professional
workers in the field o f maternal and child health make volunteer partici­
pation vital if adequate services are to be provided.
Programs for training volunteers in child care have been developed in
many communities, chiefly under local councils o f civilian defense, and
trained volunteers are providing much valuable assistance in maternal
and child-health services. Additional training programs need to be
developed. Individuals eager to be o f use to their country in time o f
war will find in working with agencies that provide health services for
mothers and children opportunities for a real contribution to the strength
o f the Nation.

Federal Reserve Bank of St. Louis

Selected Publications
Single copies m ay be obtained free o f charge from the Children’ s Bureau. Purchase
orders should be sent to the Governm ent Printing Office, W ashington, D . C.
For additional references send for Selected List o f Publications, Children’s Bureau,
U . S. Departm ent o f Labor.
Standards o f Child H ealth, Education, and Social W elfare; based on recom ­
mendations o f the W hite House Conference on Children in a D em ocracy and
conclusions o f discussion groups. Pub. 287. 21 pp. 1942. 10 cents.
The Child-Health Conference; suggestions for organization and procedure. Pub.
261. 42 pp. 1941. 10 cents.
M aternal and Child-H ealth Services Under the Social Security A ct; developm ent
o f program , 1936—39. Pub. 259. 109 pp. 1941. 15 cents.
Services for Crippled Children Under the Social Security A ct; developm ent o f
program , 1936—39. Pub. 258. 95 pp. 1941. 15 cents.
Food for Young Children in G roup Care. Pub. 285. 34 pp. 1942. 10 cents.
Defense o f Children Series: Children Bear the Promise o f a Better W orld.
$3 per 100.


N o. 3. Are They G etting the Right Start in Life?
N o. 4. H ave They the Protection o f Proper Food?
N o. 5. Are W e D efending Their R ight to Health?
Facts A bout Crippled Children. 16 pp. 1943.
State Program s for Care o f Children W ith Rheum atic Fever; under the Social
Security A ct, title V , part 2. 7 pp. 1943.
M aternity Care for W ives o f M en in M ilitary Service and M edical Care for Their
Children. 1943.
Standards for M aternity Care and Em ploym ent o f M others in Industry.
4 pp.
Volunteers in Child Care. Issued b y U . S. Office o f Civilian Defense with the
cooperation o f the Children’ s Bureau and the Office o f Defense Health and
W elfare Services. 12 pp. 1942.
Protecting the Health o f Young W orkers in W artim e. Pub. 291. 12 pp. 1943.
W hich Jobs for Young W orkers?
N o. 1. Em ploym ent o f Young W orkers in W ar Industries. 4 pp. 1942.
N o. 3. Advisory Standards for Lead and Lead-Using Industries. 6 pp. 1942.
N o. 4. A dvisory Standards for Em ploym ent Involving Exposure to Carbon
D isulfide. 6 pp. 1942.
N o. 5. Advisory Standards for Em ploym ent Involving Exposure to Chlorin­
ated Solvents. 6 pp. 1943.
Guides to Successful Em ploym ent o f Non-Farm Y outh in W artime Agriculture.
14 pp. 1943.

FOR parents (folders also available).

Prenatal Care. sPub. 4. 58 pp. Revised 1942. 5 cents.
Infant Care. Pub. 8. 135 pp. Revised 1942. 10 cents.
The Child From One to Six; his care and training. Pub. 30. 150 pp.
Child M anagement. Pub. 143. 107 pp. 1937. 10 cents.
Guiding the Adolescent. Pub. 225. 93 pp. 1933. 10 cents.
The R oad to G ood N utrition. Pub. 270. 54 pp. 1942. 15 cents.
T o Parents in W artim e. Children in W artim e, N o. 1. Pub. 282. 20 pp.

Federal Reserve Bank of St. Louis