Infant mortality in the 20th century, dramatic but uneven progress

Abstract

Infant mortality has declined in dramatic fashion in our country throughout the 20th century; although all have benefited to some extent, the decline has not been even among the various segments of society. Of the racial and ethnic groupings recorded by the NCHS, non-Hispanic African-Americans have shown least improvement and Asian and Pacific Islanders the most. Causes of infant mortality are drastically different from those prevalent early in the century, which were closely connected with living conditions and the environment. The current leading causes are more amenable to medical technology; those for Caucasians include congenital malformations, disorders related to short gestation and low birth weight, and SIDS, whereas for African-Americans, short gestation and low birth weight lead by a wide margin. SIDS, although quantitatively half of what it was two decades ago, is still at 10% of all causes for both Caucasians and African-Americans; it is less prominent among Hispanics. Internationally, three fourths of the world's population live in countries in which records are too incomplete to permit detailed analysis. Nevertheless, estimates of the world's total fertility rate, closely related to infant mortality, suggest that it has halved in the last four decades. WHO attributes 7 out of 10 childhood deaths in developing countries to just five main causes, or a combination of them, i.e., pneumonia, diarrhea, measles, malaria and malnutrition, causes of death of very low incidence in the United States. Throughout most of the century, infant mortality in the United States has declined more slowly than in many other countries, moving from 6th on the list to a current 23rd. The United States is the only one of the developed countries without some form of universal health coverage.