Second Opinion: Causes of infant mortality are the same today as they were in the 1920s

By Jacky Jones
Irish TimesJacky Jones
June 17, 2014

http://www.irishtimes.com/life-and-style/health-family/second-opinion-causes-of-infant-mortality-are-the-same-today-as-they-were-in-the-1920s-1.1834183

Babies’ clothing on the railings of the Dáil during a march from the Department of Children and Youth Affairs, Mespil Road, Dublin to the Dáil, in solidarity with the babies and mothers from Tuam, and all mother and baby homes as a gesture of rememberance and care.

Why are we so shocked about the 796 infants and children who died in St Mary’s mother-and-baby home in Tuam, Co Galway? The Sunday World referred to Ireland’s Holocaust, killing fields, and Cambodia. The Daily Mirror had a story entitled “My pals are buried in septic tank.”

This ignorant commentary, implying that there was something sinister about the deaths of children in mother-and-baby homes, is no help to anyone, especially the women whose children died in these institutions.

So far, no child health expert has reminded us that high infant mortality rates were normal for certain groups of people in Ireland until the 1970s. This was not right, but neither was it sinister.

Children died in mother-and-baby homes for the same reasons as those who died in Dublin’s slums: poverty and their mothers’ low status as citizens.

The rate of infant mortality among Travellers was about five times the national average. Children from poor families were four times more likely to die before their first birthday. Unmarried mothers were pariahs, so infant and child mortality rates in mother-and-baby homes were probably about 10 times the national average.

No one knows for sure because the figures have never been properly analysed. Records from the Central Statistics Office show that until 1987 children’s births and deaths were recorded as legitimate or illegitimate. Both categories of children died from the same causes but infant mortality rates have not been calculated separately.

Causes

The causes of infant and child mortality were the same in 1920s’, 1940s’ and 1960s’ Ireland as they are today.

In the 1960s, children up to one year old died mainly of birth complications, congenital malformations, pneumonia, diarrhoea and infectious diseases such as measles, meningitis and whooping cough.

A 2014 progress report from the World Health Organisation’s (WHO) department of maternal, newborn, child and adolescent health shows that children everywhere in the world, including Ireland, die in the first years of life for the same reasons.

Health policymakers have known for at least 50 years that poverty and women’s educational attainment levels are the biggest influences on children’s health.

The WHO, the World Bank and the Organisation for Economic Co-operation and Development have produced a plethora of reports describing the links between family income, women’s education and children’s health.

Several studies have confirmed the importance of socioeconomic status and women’s education to children’s health. Social Economic and Political Determinants of Child Health by Nick Spencer (2003) noted, “Poverty and low socioeconomic status are associated with higher risk of death in infancy and childhood, chronic childhood illnesses, and many acute illnesses.”

A 2004 study, The Determinants of Child Health and Nutrition: A Meta-analysis, by researchers from the University of Maryland and the World Bank, found the mother’s education level and income are among the most important factors determining children’s health.

“There can be little doubt that household income is a crucial factor in determining both child health and nutrition.”

Longitundinal study

Research carried out in 193 UN member countries, including Ireland, between 2000 and 2009 – Global determinants of mortality in under-5s: a 10 year worldwide longitudinal study – published in the BMJ in 2013, found eight major determinants of infant and child mortality, confirming the findings of previous studies.

Those most relevant to Ireland are gross domestic product (GDP) per capita, public health expenditure per capita, and the mean number of years in school for women of reproductive age.

Nowadays, few Irish babies die before their first birthday. Infant mortality rates have reduced from 66 per 1,000 live births in the 1940s to four in 2012 because, according to the HSE, “92 per cent of children are appropriately vaccinated”.

However, Irish Government policies have created a society that will have severe consequences for children’s health in the long term.

Today’s equivalent of mother-and-baby homes is a blend of poverty, long-term unemployment, unaffordable housing, minimum wages, and low educational attainment in girls from lower socioeconomic groups.

The synergistic effects of these social conditions keep whole communities trapped in unhealthy environments and lifestyles.

Children from today’s poor families will develop acute and chronic health conditions – such as obesity, diabetes and mental health problems – at three times the rate of their better-off counterparts, just like the children who survived the mother-and-baby homes and the Magdalen laundries.

Let’s hope it doesn’t take another 50 years to develop an equal society, something we signed up to in 1955 called The Universal Declaration of Human Rights.

Jacky Jones is a former HSE regional manager of health promotion.