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U. S. DEPARTMENT OF LABOR J A M E S J. D A V I S , Secretary CHILDREN’S BUREAU J U L IA C . L A T H R O P . Chief INFANT MORTALITY IN PITTSBURGH AN ANALYSIS OF RECORDS FOR 1920 WITH SIX CHARTS By GLENN STEELE IN F A N T M O R T A L I T Y SERIES N o. 12 Bureau Publication N o. 86 WASHINGTON GOVERNMENT PRINTING OFFICE 1921 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis CONTENTS. Page. Letter of transmittal---------------------------------------------------------------------------------------------3 Comparison with other large cities--------------------------------------------------------------5 Birth registration in Pittsburgh--------------------------------------------------------------------6 Analysis of infant death certificates--------------------------------------------------------------10 W ard distribution of infant deaths--------------------------------------------------------------------10 Foreign mothers in Pittsburgh-------------------------------------------------------------------------14 Deaths in early infancy--------------------------------------------------------------------------------------15 16 Causes of death----------:--------------------------------------------------------------------------------------Infant-welfare work in Pittsburgh-------------------------------------------------------- *-------18 Conclusions________________________________________________________________________ 23 IL L U S T R A T IO N S . Trend of infant mortality in nine cities---------------------------------------------------------7 Infant mortality rates by wards--------------------------------------------------------------------9 Infant deaths in Pittsburgh, 1920------------------- j-----------------------------------------------12,13 Deaths under 1 year of age grouped by causes--------------------------------------------17 Summer and winter peaks of infant deaths--------------------------------------------------19 Equipment for infant-welfare service, Pittsburgh, 1920---------------------------------21 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis kv-l U.b'SC' **<» LE T TE R OF TR A N SM ITTA L. U n it e d S tates D e p a r t m e n t of L abor, C h il d r e n ’s B , ureau, Washington June 20, 1921. S ir : I transmit herewith a report on infant mortality in Pitts burgh, which is an analysis o f official records for 1920. The material was gathered and the report written by Miss Glenn Steele. Respectfully submitted. J u l ia C . L Hon. James J. D a v is , Secretary of Labor athrop, Chief. . 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY IN PITTSBURGH. COM PARISON W IT H O TH ER LARG E CITIES. Pittsburgh lost more babies in 1920 in proportion to its births than any other o f the large American cities for which reliable records are available. Its wastage o f young life for the year exceeded that o f 17 cities of more than 250,000 population in the birth registration area. The measurement o f this loss by an infant mortality rate—the number o f deaths o f infants under 1 year o f age per 1,000 born alive— shows that for every 1,000 babies born in Pittsburgh in 1920, 110 failed to survive throughout the year. Approximately, this means a loss during infancy o f 1 life out of every 9. For the same year, Boston had 1 infant death to 10 births; Philadelphia, 1 to 11; New York, 1 to 12, and Seattle but 1 baby death for 18 births—a rate twice as favorable as that for Pittsburgh. Absence o f complete and accurate data prevents comparisons of in fant mortality for all of the larger urban centers o f the United States. Federal bookkeeping o f babies did not begin until 1915. In that year the United States Bureau of the Census established the birth registration area, an area including only those States where at least 90 per cent o f all births were completely recorded. With the collection o f statistics for the area it then became pos sible to keep a national ledger showing the net human gains o f the first year o f life. A complete count o f births in the credit columns o f communities balanced against the debits of infant deaths affords a cost accounting o f the loss o f young life. The following table shows this cost, expressed in infant mortality rates, for a five-year period in the large cities in the birth registra tion area. Comparable figures are not available for great cities not in the area—notably Chicago, St. Louis, and New Orleans. 5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 6 IN F A N T M O R T A LITY IN PIT T SB U R G H . Infant mortality rates for cities in the Mrth registration area having a popu lation of 250,000 or more in 1920; 1916 to 1920. Infant m ortality rates.1 K jiiy. 1920 Pittsburgh.................................. B altim ore..................... Buffalo..................................... D etroit........................................................... B oston ................................................... Indianapolis...................... Washington, D. C ...................................... Milwaukee........................... Philadelphia....................... Cleveland........................................................... N ew Y ork................................... Rochester................. ............ Cincinnati................................... Los Angeles................................................... San Francisco.......................... Minneapolis.......................... Portland, Oreg...................... Seattle........................................................... 110 104 104 104 101 92 90 89 89 86 85 85 83 71 67 65 60 56 1919 114 98 no 97 97 80 85 101 91 95 81 74 88 67 62 65 69 55 1918 139 149 121 100 115 93 112 106 124 98 92 92 104 (2) !*) 73 (*) 61 1917 120 118 104 103 99 95 97 100 108 109 89 84 88 (2) (s> 71 (2) 61 1916 115 122 114 112 105 (2) 106 (2) 105 (2) 93 86 (2) (2) (2) 82 (2) (2) 1 Rates for 1916 to 1919 from U. S. Bureau of the Census. Birth Statistics; for 1920, from city departments of health. J * A dded to registration area at a later date. The chart on page 7 shows the trend jof infant mortality in the nine large cities which have been in the birth registration area since it was established in 1915. The Pittsburgh line indicates a markedly higher rate than that for the other eight cities. Fluctuations o f its rate show a decline after the high peak in 1918, the year o f the influenza epidemic, but no improvement for the five-year period. The rate had receded in 1920 only to the point from which it began to rise in 1915. Wash ington, Philadelphia, and New York show the most satisfactory progress toward a reduction of rates. Although the decrease for Minneapolis is somewhat less than for these cities, the Minnesota city began with a much more favorable position. An analysis o f the death certificates o f infants under one year of age who died in Pittsburgh in 1920 has been made by the Children’s Bureau in order to present such facts concerning the city’s infant mortality in that year as are obtainable from official records. Data concerning the age at death, cause o f death, color, and na tivity o f mother and the ward of residence were copied from the original files of registered deaths kept by the State o f Pennsylvania. The count of registered births used to compute infant mortality rates was secured from the Pittsburgh Department o f Public Health. BIRTH REG ISTRATION IN PITTSBURGH. The validity o f the city’s infant death rate per thousand births de pends upon the extent to which Pittsburgh physicians, midwives, or parents reported the births of babies. Reporting o f deaths is ad- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y IN P IT T SB U R G H . T R E N D O F IN F A N T M O R T A L IT Y IN N IN E C IT IE S . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 7 8 IN F A N T M O R T A LITY IN P IT TSB U R G H . mittedly more complete. Therefore, if a considerable number o f births occurring in Pittsburgh in 1920 were not registered, the infant mortality rate is overstated. Birth registration in Pittsburgh is under State control. Penn sylvania has had a good registration law since 1905. When the law went into effect in 1906, birth registration in Pittsburgh was incom plete. Prosecutions for failures to report births under the new law were so effective that the number o f registered births in Pittsburgh in 1907 was increased by 68 per cent in 1908. p In 1915 the registration o f births in Pennsylvania was accepted as up to the standard by the United States Bureau o f the Census. Any laxity in reporting births in Pittsburgh may have been due in part to the fact that in 1920 local registration o f births and deaths was still being paid for by the fee system. Payment to the local registrar was made under a section o f the law providing that in cities o f the first and second class where the registrar, appointed by the State commissioner o f health, is fur nished by the city with suitable office room for carrying on his duties as registrar, he shall be paid but 10 cents fo r each birth and death registered. For a city the size o f Pittsburgh, such payment is not sufficient to provide for an adequate registration office, which should give valu able service in the matter o f checking birth registration and report ing negligent physicians and midwives. An act providing for more adequate compensation for registra tion in cities o f the first and second class was passed by the State legislature in 1921. A study o f birth rates does not offer evidence which can be re garded as conclusive that registration is less complete in Pittsburgh than in other cities. Pittsburgh maintained a relatively high birth rate for the period from 1915 to 1919, as is shown by the following comparison o f its birth rates per 1,000 population with those for the * entire birth registration area: Area. P ittsburgh1........................................................................................... B irth registration area1....................................................................... 1915 28.6 25.1 1916 28.9 25.0 1917 28.8 24.7 1918 27.4 24.6 1919 24.8 22.3 1 TJ. S. Bureau of the Census, B irth Statistics, 1919, p. 8. While the birth rate for the city decreased from 28:6 in 1915 to 24.8 in 1919, a difference o f 3.8, the decline was in accordance with a Nation-wide falling birth rate. Pittsburgh’s birth rate in 1919 was still above that for 14 o f the 17 other large cities in the registra tion area, including Baltimore, Philadelphia, and New York, all with large numbers o f foreign born. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A LITY IN PITTSBU RG H , <© https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 IN F A N T M O R T A LITY IN P IT T SB U R G H . In 1920, when the recent census figures for the population o f Pitts burgh made it possible to compute a rate on actual rather than esti mated population, the birth rate was 25. AN ALYSIS OF IN FA N T D EATH CERTIFICATES. The number o f registered live births as reported by the Pitts burgh Department o f Public Health and used in this study was 14,694. In addition, there were 814 stillbirths registered, making a total o f 15,508 births for the city. The infant death certificates, transcripts of which were secured by the Children’s Bureau, numbered 1,626— seven more than re ported by the city department o f health. On this basis the infant mortality rate was 110.7 instead o f 110.2, the rate announced by the department o f health. O f the 1,626 deaths, 185 were nonresident cases; for one, a found ling, residence was not reported. Nonresident babies who died in Pittsburgh came for the most part from homes in the large metro politan area surrounding the city. The use this area makes of the city’s hospital facilities affects the infant mortality rate, but the rates o f all large cities which furnish hospital service to adjacent districts are similarly affected. The infant death rate for Pitts burgh, exclusive o f nonresident births and deaths under 1 year, was 105 instead o f 110.7. W A R D D ISTRIBU TIO N OF IN FA N T DEATHS. The distribution o f the 1,440 deaths of infants whose homes were in Pittsburgh is shown on the map on page 12. Each dot repre sents an infant death in the ward and location designated. Deaths in hospitals were allocated to the ward o f residence. Thickly clustered dots in any ward do not necessarily indicate the most unfavorable conditions, since wards with densely populated areas may have a larger number o f deaths but a smaller proportion in relation to the number o f births. Six wards had higher rates than that for the fifteenth ward, where the greatest number o f deaths (94) occurred. # Therefore the map on page 9, showing infant mortality rates by wards, must be considered in connection with the spot map. This map shows that while the city rate o f 110.7 represents a general level for the city, baby death rates for some sections of the city are much higher and for other sections much lower. In the twenty-second ward, with an infant mortality rate o f 157, a baby’s death hazard was more than twice that o f one born in the fourteenth ward with a rate o f 64. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A LITY IN PIT T SB U R G H . H The rates for the 27 wards o f Pittsburgh are given in the follow ing table: Infant mortality rates by wary, of residence; Pittsburgh, 1920. W ard. Rates more than 125: Twenty-second............................................ First................................. Second........................ Twenty-third............. Rates 100 to 125: Sixth................................. Twenty-first................ Fifteenth.................. T en th ...................... Sixteenth.................. E ighth...................... Seventeenth.................. F ifth ........................ Twenty-sixth............. Twentieth...................... Twenty-fourth.................... Infant mortality rate. 157 156 143 138 121 120 119 118 113 112 109 105 102 102 100 W ard. Infant m ortality rate. Rates 90 to 100: T h ird ................................. Rates less than 90: 94 90 64 That the ward o f residence was not in all cases accurately stated by the persons supplying the information for the death certificates was an interesting fact brought out by the analysis. For the purpose o f locating the deaths accurately on the spot map, in accordance with the addresses given on the death certificates, it was necessary to make a correction o f the ward o f residence stated on 75 certificates. The wards in black on the shaded map focus attention on the areas o f Pittsburgh, where the hazards to young life are the greatest. The four black wards are river wards in the heart o f the city. The twenty-second ward, with a rate o f 157, the highest for the city, and the twenty-third ward, with a rate of 138, are adjoining areas on the north side o f Pittsburgh, bordering the Allegheny River. The business district o f the former city o f Allegheny is within the confines o f these two wards. A considerable portion o f the areas of both wards, therefore, is occupied by business property. In the twenty-second ward the residential fringe circling the manu facturing and mercantile territory is known as a rooming-house district. The twenty-third ward is one o f the most densely populated neighborhoods o f the entire city. The first ward, with an infant mortality rate o f 156, is a section teeming with mercantile houses, mills, and factories, and the second ward, with a rate of 143, contains the city’s largest center o f wholesale and retail trade. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 14 IN F A N T M O R T A LITY IN P IT TSB U R G H . The dots, representing infant deaths in the second ward, string for the most part along Penn Avenue and Mulberry Way. More than half the babies who died in this ward were from homes on those two thoroughfares. Wards with somewhat lower mortality rates, but whose infant losses varied from 112 to 121 per 1,000 births, were the sixth, tenth, and eighth, the twenty-first on the north side and the fifteenth and sixteenth on the south side. A signficant rate was that for the third ward. This ward is a triangle, two sides of which abut the black area on the shaded map. In many respects it is not dissimilar in character to those wards which were the least safe for babies. It has a large foreign element, and in density o f population and consequent congestion it resembles the twenty-third ward. Yet its baby death rate was but 94, compared to 147 for the four black wards combined. The map on page 21 indicates a relationship between infant-welfare work and the favor able rate for the third ward. Located in the ward were two free maternity clinics, two city milk stations, a substation o f the Public Health Nursing Association, and the only well-baby clinic in Pittsburgh in 1920, which was main tained by the Irene Kaufmann Settlement. In addition, the ward had had the advantage o f 19 years of neighborhood nursing service supplied by the Kaufmann Settlement. The rate of 89 for the eleventh ward was identical with that for the urban part o f the birth-registration area in 1919. Wards with more favorable rates than this were the seventh, thirteenth, and four teenth. The most favorable rate for the city was that of 64 for the fourteenth ward, a high-class residential section. FOREIGN M OTHERS IN PITTSBURGH. The proportion o f the foreign-born white in Pittsburgh in 1920 is fixed at about one-fifth of the total population by preliminary figures o f the United States Bureau o f the Census. Yet more than one-third of the resident births in Pittsburgh for that year were to foreign-born white mothers. Considering the white resident group, the infant mortality rate for babies of foreign mothers was 110, compared to that o f 95 for babies of native mothers. The findings in this respect for Pittsburgh are in agreement with general findings for the country. That the babies whose mothers come from other countries have less chance to survive than those whose mothers are born in the United States is shown by the infant mortality rates for white children given for the entire birth registration area in 1919— 93 for the foreign group and 78 for the native group. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O RTALITY IN P IT TSB U R G H . 15 Studies of the Children’s Bureau in eight cities also indicate higher rates for the foreign born but wide variations for different racial groups. Thus for the babies of Jewish mothers, included in these studies, the infant mortality rate was but 54 while for the babies o f Slavic mothers the rate was 159. From material available for this study, such racial influences re flected in infant mortality rates can not be shown, but comparisons must be limited to a classification by country o f birth. A distribution o f the foreign population o f Pittsburgh in 1920, by country o f birth, shows that nearly one-fifth came from what was Austria-Hungary. The next largest groups were from Russia, Ger many, Poland, and Italy, each o f which contributed about 18 per cent of the total foreign element. About 12 per cent were Irish and 10 per cent came from England, Scotland, and Wales combined.1 A classification of resident babies, by mother’s nativity, affords the following comparisons among these predominant groups: Mothers from Italy were the most fortunate in bringing their babies safely through the first year. The infant mortality rate for babies o f Italian mothers was 92, lower than that o f 95, the native rate. Rates for all other o f the predominant foreign groups were notice ably higher than that for babies o f native mothers. Rates higher than are usual among the children of mothers coming from lands where English is spoken were found for Pittsburgh. The rate for babies of mothers from England, Scotland, and Wales was 140 and for babies o f Irish mothers, 129. Owing to the shift in boundaries, due to the war, the returns for mothers stated as coming from Austria-Hungary, Russia, and Poland are not clear-cut, nor do data permit o f comparisons between Jewish, Polish, and other racial groups common to the three countries. For the babies o f mothers from Austria-Hungary, the largest foreign group, the rate was 128. Since 1910, the Negro population o f Pittsburgh has increased by 47 per cent, according to 1920 returns o f the Federal census, consti tuting 6 per cent of the total population in 1920. The death rate for Negro infants was 164 per 1,000 births. DEATHS IN E A R L Y INFANCY. The first few days and weeks of life constitute the most perilous period o f infancy. Nearly one-half of the babies in Pittsburgh who failed to survive their first year succumbed before they were a month old. The mor tality under 1 month of age was 48 per 1,000 births. 1 Preliminary figures, U. S. Bureau of the Census. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 16 IN F A N T M O R T A LITY IN P IT TSB U R G H . That such deaths are largely preventable has been clearly demon strated. What can be accomplished by good prenatal care in saving babies at and shortly after birth is shown from the following experi ences in Cleveland, Boston, and New York. A study of records of 442 mothers receiving prenatal care dur ing 1919 in one district o f Cleveland, made by the hospital and health survey, showed that it was possible to reduce the mortality rate among babies under 1 month of age to 24.8 per 1,000 births as compared with the city rate o f 31.4 per 1,000 births. This was in a district where the baby death rate was found to be much higher than the rate for the city as a whole. In the city of Boston in 1920 infant mortality under two weeks o f age was 37 per 1,000 births. For births to 4,036 mothers who were given prenatal care by the district nursing association, it was 13 per 1,000— a marked reduction. From figures o f the New York Maternity Center Association it is known that among 4,496 women who were supervised through pregnancy and for a month after the baby was born, the proportion o f babies dying before the end of the first month was only 42 per cent of that of the city as a whole. These mothers lived under the low-income handicap; yet with proper care they were able in a large number of cases to bring healthy babies to birth. CAUSES OF DEATH. The deaths in early infancy are closely identified with those occur ring from natal and prenatal causes. In this group are assembled deaths from prematurity, congenital debility, injuries at birth, mal formations and syphilis—causes for the most part directly connected with the care and condition o f the mother. That the well-being of the mother is the key to the safety of the child is shown by the highest shaft on the chart on page 17. The number o f babies in Pittsburgh deprived o f even a fair start in life in 1920 was 704, 43 per cent of all the babies who died in 1920. The most effective method by which the community can cut the high ratio of these losses is by providing care and instruction for the mother before her baby’s birth and skilled attendance during her confinement. The second shaft on the chart indicates the group of deaths caused from gastrointestinal diseases, deaths occurring for the most part in the heat o f summer. This column can be cut by instructions to mothers in the proper care and feeding of babies, and by adequate civic supervision to insure purity and proper handling o f milk sup plies. Bespiratory diseases claimed the third largest group o f babies. Bronchitis and pneumonia, combined in this group, take their largest https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 17 IN F A N T . M O R T A L IT Y IN PIT T SB U R G H . DEATHS UNDER ONE YEAR OF AGE GROUPED BY CAUSES PITTSBURGH 1920 704 6& A ll other to fia ta / an d Prenota/ causes Intestinal Diseases https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Diseases Diseases C loses. 18 IN F A N T M O R T A LITY IN PIT TSB U R G H . toll o f young life in congested districts. Crowded homes and lack o f fresh air leave babies easy prey to these diseases. O f the 124 deaths from epidemic diseases represented in the fourth shaft o f the cause chart, whooping cough, influenza, and measles were the chief causes. The effect o f the seasons with relation to deaths from gastro intestinal and respiratory diseases is shown by the summer and winter peaks o f baby deaths illustrated on the chart on page 19. The summer peak o f deaths from gastrointestinal diseases in stances the hazard o f hot .weather to baby life. Deaths from those causes showed marked increases in June and July, culminating in August and September, when 137 deaths were recorded. Infant deaths from respiratory causes reached the highest peak in February, when 73 babies were victims o f bronchitis and pneu monia. That the immediate causes o f death thus analyzed have their sources in those more remote and infinitely complex factors touching the social, economic, and civic conditions in Pittsburgh can be in ferred. The subject o f infant mortality in its various aspects has had a large share o f the attention o f the Children’s Bureau during the nine years o f its existence. Careful investigations which have in cluded surveys o f civic conditions and inquiries into family life in communities o f diverse types have furnished certain unvarying conclusions. Low wages, poor housing, insanitary surroundings, ignorance, illit eracy, the lack o f nursing and medical care were everywhere coin cident with high infant mortality rates. The housing problem Pittsburgh shares in common with all large cities, where building has not kept pace with the growth in popula tion. The population o f Pittsburgh in 1920 was 588,343, an increase o f 10 per cent over that o f 1910, and in 1910 the lack o f adequate housing provisions for Pittsburgh was a matter o f serious concern. That the waste of infant life due to ignorance and neglect can be cut by effective preventive measures has been demonstrated by ex periences in this and other countries. Much has been accomplished by providing maternity or prenatal centers, baby health centers, and home service by the public health nurse. IN F A N T -W E L F A R E W O R K IN PITTSBURGH. The specialized equipment for such service available in Pittsburgh in 1920 is shown on the map on page 21. The city’s contribution to this service is indicated by the milk stations which are operated by the bureau o f child welfare, Pitts burgh Department o f Public Health. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A LITY IN P IT TSB U R G H . S U M M E R A N D W IN T E R PEAK S OF IN F A N T D E A T H S . ------- GASTRO-INTESTINAL ------- RESPIRATORY Number of deaths from gastro-intestinal and respiratory diseases by calendar months. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 19 20 IN F A N T M O R T A LITY IN P IT TSB U R G H . The bureau had a permanent staff o f 35 physicians, 18 nurses, and 14 assistants in 1920, but the major part of the work during ten months o f the year was devoted to school medical inspections. Parttime service by ten physicians and by the nursing staff was given to the infant-welfare work conducted by the bureau. The bureau operated 14 permanent milk stations during 1920 and six additional stations during the summer when the schools were closed. The stations were usually located at public-school buildings or settlement houses and were kept open one hour a day during the winter and each morning during the summer. Milk was given free or below cost for infants under 2 years of age, and in exceptional cases for nursing mothers and older children in need o f nourishment. Weekly visits to the station were made by mother and child. A physician examined each baby and gave the mother written instructions for milk modification. Nurses visited the mothers at their homes to demonstrate methods of milk modifica tion and to advise about the care o f the baby. More than 32,000 visits were made to the stations in 1920 by the 1,485 patrons registered. The city’s milk bill for this service was more than $21,500 in 1920. O f this about $4,400 was returned by patrons who paid in part for the milk received, making a net expenditure o f about $17,000 for milk. In addition to medical inspections in the schools and the main tenance of milk stations, the bureau o f child welfare was in charge o f the supervision of midwives. The practice o f midwifery in Pittsburgh is controlled by the State, but examining, licensing, and inspection are carried on through the bureau. Nurses o f the bureau who were paid by the State for in spections visited the homes and filled out schedules o f information concerning all births attended by midwives. In 1920, the bureau had supervision over 78 licensed midwives who reported 2,809 births. The Public Health Nursing Association is the only private organi zation in Pittsburgh engaged in public health nursing. The association was not organized until July 1, 1919; has since united all the* independent organizations engaged in visiting nursing. Although its service is general in character, it has recognized the need for prenatal and infant care, and is emphasizing that feature o f its program. The service given in 1920 consisted o f home visits, to advise the expectant mother, nursing care for the mother and new born child, and instructions in infant hygiene and home cleanliness. This service was extended to all mothers referred to the association by various agencies, to all patients o f the university maternity clinics, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A LITY IN PIT TSB U R G H . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 22 IN F A N T M O R T A LITY IN PIT T SB U R G H . to patients coming under private physicians, upon request, and to the policyholders o f a large life insurance company. The association received pay for its work for the insurance com pany, but was otherwise maintained by private subscription. Its expenditures in 1920 were about $70,000. A ll instructive service to mothers, both before and after the baby’s birth, was given free. Nursing service was free to those unable to pay. To others the cost of the service was graduated in accordance with each family’s financial resources. The association had an average o f 42 field nurses on its staff in 1920 for service in Allegheny County. Since all the nurses re ceived general assignments, the exact amount o f time given to infant and maternal service can not be measured, but it is estimated that at least one-third o f the cases handled can be so classed. About 3,000 mothers came under the care o f the association from July 1, 1919, to December 31, 1920. The map on page 21 shows the location o f the six substations of the association in 1920, from which it carried on its prenatal service and infant hygiene work. The University o f Pittsburgh maintained seven free maternity clinics in 1920. The location o f these are shown on the map on page 21. The staff for this work was composed o f a graduate physi cian, a nurse, and a social worker. Each dispensary was open one day a week. Prenatal service was given and the physician in charge at tended all confinement cases in the homes. Nursing care following the confinement was giveh by the public health nursing association, with which the university clinics cooperate. Medical students at the university secure their obstetrical training through the work o f these dispensaries, but each delivery is under the direction o f a trained obstetrician. The community and settlement houses at which the university clinics and the substations of the Public Health Nursing Association were located gave generous cooperation to the work and contributed to the equipment by supplying free quarters for the services. Out-patient maternity service was supplied in 1920 by seven Pitts burgh hospitals, which maintained dispensaries for patients to be confined in the hospitals. Special clinics for infants were main tained by two hospitals, and a well-baby clinic was operated by the Irene Kaufmann Settlement. The Pittsburgh and Allegheny Milk and Ice Association operated a baby clinic and distributed milk and ice free to needy families having young children. Milk was delivered to the homes o f 463 families in 1920. The expenditures of the association, which is wholly financed by private subscriptions, were $23,000 in 1920. More than $17,000 o f this amount was expended for milk. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFAiTT MORTALITY IN PITTSBURGH. 23 CONCLUSIONS. The need for an amplification o f such services in Pittsburgh is evidenced by the infant mortality rate o f 110 in 1920. Experts have estimated that a city should have one public health nurse for every 2,000 of population in order to protect adequately the health o f its mothers and children.2 On this basis Pittsburgh, with a population o f 588,343 in 1920, needed 294 public health nurses, a force far in excess of that provided. It must be noted, too, that the public health nursing association had rounded out only its first year of existence on July 1, 1920, so that the results o f its prenatal and infant-welfare work could not be fully measured for 1920. A further standard for public protection o f maternity and infancy requires maternity or prenatal centers sufficient to provide for all cases not receiving prenatal supervision from private physicians.2 An example of the inadequacy of this service in Pittsburgh is illus trated by the map on page 21, which shows that only one ward in the entire south-side section o f the city had prenatal clinic service in 1920. To comply with minimum standards set up, additional health cen ters to give health instruction under medical supervision for all in fants not under the care o f a private physician also are needed. In the city department o f health the staff o f the bureau o f child welfare was used largely for medical inspections in the schools. An increased force which would permit o f a staff o f physicians and nurses giving full-time service to infant-welfare work is needed, and has been requested by the superintendent of the bureau. Figures o f the bureau show that for the maintenance o f milk sta tions by the city the amount spent for milk was $21,798 and for salaries $14,578. An adjustment that would permit o f a larger proportion o f expendi tures for salaries to provide instruction for the mothers and less for milk would be in accordance with the practice o f a number of cities where work for the reduction o f infant mortality has been effective. Speaking o f the reduction of infant mortality in New York City, Dr. S. Josephine Baker, director bureau o f child hygiene, New York City Department o f Health, says: The evolution of the infants’ milk station is essential. Pure milk, however desirable, will never alone solve the infant mortality problem. Without over looking the value of pure milk, I believe this problem must primarily be solved by educational measures. In other words, the solution of the problem of infant 2Minimum Standards for Child Welfare, adopted by the Washington and Regional Con ferences on Child Welfare, 1919, Children’s Bureau Publication No. 62, Washington, 1919. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 24 IN F A N T MORTALITY IN PITTSBURGH. mortality is 20 per cent pure milk and 80 per cent training of the mothers. The infants’ milk stations will serve their wider usefulness when they become educational centers for prenatal instruction and the encouragement o f breast feeding and teaching better hygiene, with the mother instructed to buy the proper grade of milk at a place most convenient to her home.8 Only by complete and prompt birth registration can Pittsburgh measure the extent of its infant mortality and locate the areas where the problem is most pressing. A campaign for better birth registration would awaken the public to the importance o f complete local records. Many cities have en listed the interest o f parents by sending them copies o f their babies’ birth certificates. Physicians, midwives, and others who fail to report births as re quired by law should be vigorously prosecuted. The large number o f infant deaths occurring in the first weeks of life, and the high shaft representing the deaths from natal and pre natal causes indicate that the preventive measures outlined are needed to reduce infant mortality in Pittsburgh. A study based on an anlysis o f official records is too limited to afford conclusions in regard to all factors known to be linked with excessive infant losses. While a survey alone could determine the extent to which economic conditions, poor housing, and poor sanitation have been reflected in high infant death rates for Pittsburgh, it is known that only by community responsibility for decent living conditions can every child be given a fair chance. 3 Transactions of the International Congress of Hygiene and Demography, 1912 vol 3 I>. 141. o https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis
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