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FACTS About Child Health 1943 U . S. D E P A R T M E N T OF LABOR C H IL D R E N ’ S B U R E A U Publication 294 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis C O N TE N TS Page H For sale b y the Superintendent o f D ocum ents, U . S. Governm ent Printing Office W ashington, D . C . - Price 10 cents https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 1 1 \© 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?....................................« . . . 10 12 13 IN T R O D U C T IO N 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 1942. The 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 https://fraser.stlouisfed.org 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 in to ta l w ar again st aggressor n a tion s. We are 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— FACTS ABOUT CHILD HEALTH IV https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis FACTS ABOUT CHILD HEALTH 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................................................................................... 10,541,524 10,684,622 11,745,935 12,333,523 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 Year* B irths R ate 1933 ........................................................................... 2,081,23216.6 1934 ................................................................................. 2,167,63617.2 1935 .......................... .................... ...................... . ...................... 2,155,105 16.9 1936 ............................................................... 2,144,790 16.7 1937 .............................................................. 2,203,337 17.1 1 9 3 8 :................................................................................. 2,286,96217.6 1939 ........................................................... 2,265,58817.3 1940 ........................................................... 2,360,39917.9 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. 1 https://fraser.stlouisfed.org 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 areas. 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- 2 https://fraser.stlouisfed.org 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 infancy. 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 3 https://fraser.stlouisfed.org 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 met. 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 4 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis f 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 dentistry. 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 rapidly. 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 5 v 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 activities. 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 available. 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. 6 https://fraser.stlouisfed.org 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 7 https://fraser.stlouisfed.org 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. 8 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Services N um ber o f counties Prenatal clinic^, conducted b y physicians at least m onthly.................................... 789 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: 175 M aternity..................................................................... 386 Preschool. ..................................................................... 633 S ch ool......................................... ......................... .. ••• 170 H om e-delivery-nursing services............................................. H ospital care: % For children................................ ................................. For m others at delivery............................................ 37 30 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 9 https://fraser.stlouisfed.org 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. 10 https://fraser.stlouisfed.org 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. 11 https://fraser.stlouisfed.org 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, 194V T otal Causes o f death Num ber Percent Under 1 year 1 to 4 yefers 5 to 9 years 10 to 14 15 to 19 years years A ll causes................................... 180,787 100.0 113,949 24,302 10,921 10,948 20,667 The 10 leading causes.......................... 126,774 70.1 85,613 14,380 6,361 6,884 13,536 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). . . . . . . Influenza........................................ Diseases o f the heart................... A ppendicitis ............................ 33,341 19,316 20,310 13,322 11,731 10,889 6,069 5,215 3,752 2,829 18.4 10.7 11.2 7.4 6.5 6.0 3.3 2.9 2.1 1.6 33,341 13,687 2,719 11,796 9,220 10,889 495 3,042 395 29 3,688 4,333 895 2,259 652 3,347 289 135 551 3,355 177 47 738 6,556 165 70 1,111 1,270 288 536 443 288 580 627 763 272 973 746 3,257 343 1,516 891 A ll other causes..................................... 54,013 29.9 28,336 9,922 4,560 4,064 7,131 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 12 https://fraser.stlouisfed.org 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 following: 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« 13 https://fraser.stlouisfed.org 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 children. 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 following: 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- 14 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis l 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. 15 https://fraser.stlouisfed.org 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. LEAFLETS. Defense o f Children Series: Children Bear the Promise o f a Better W orld. $3 per 100. 1942. 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. 1942. 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. bulletins 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. 16 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1937. 1942. O . 9 . GOVERNMENT PRINTING O P PICE : l » « S