In order to conform to the practice of other countries, it would be necessary to use as a standard the annual number of deaths of infants under one year of age per thousand living births occurring in the same area. But birth registration in the United States has been noticeably lax. The area of state birth registration, originating 1915, was at the end of 1919:
States Included in the U.S. Birth Registration Area, 1919.
Infant Mortality Rates, U.S. Birth Registration Area, 1915-9, by Cities and Rural Communities.
Deaths per 1,000 births 1919 1918 1917 1916 1915 Cities in the registration area
(total) .... 89 108 100 104 103
Whites 86 105 96 102 102
Negroes 148 197 185 177 181
Rural part of the registration
Year Year
area (total) .
. . 84
94 97 94
State Admitted State Admitted
Whites
. 80
90 84 95 94
Connecticut 1915 Indiana . . . 1917
Negroes
. 123
143 134 203 182
Maine . . I9'5 Kansas . . . 1917 Massachusetts 1915 Kentucky . . 1917 Michigan . 1915 North Carolina . 1917 Minnesota . 1915 Ohio .... 1917
Study of the infant death-rates in the registration area shows high rates for negroes in both cities and rural communities. This racial characteristic affects the rates in the various states.
New Hampshire 1915 Utah .... 1917 New York . 1915 Virginia . . . 1917
Rates in the States
of the Birth
Registration Area, 1919.
Torn! Tlrhpin Rural
Pennsylvania 1915 Washington . . 1917
All States
87 8q 84.
Rhode Island l 1915 Wisconsin. . . 1917
Ccilifornici
"/ **y ^T- 7O 6d. 7Q
Vermont . 1915 California . . 1919
/ / "
86 86 87
District of Columbia 2 1915 Oregon . . . 1919
In.di3n3.
'
79 88 74
Maryland . . . 1916 South Carolina . 1919
Kansas .
70 88 65
The pop. in the birth registration area for 1915 was 31 % of the
Kentucky
82 105 78
total estimated pop. of the United States. In 1919 this had in-
Maine
91 89 91
creased to about 58 %. During a slightly longer period of time, 149
Maryland
.
105 98 115
cities were included in the registration area.
Massachusetts
.
88 90 82
The standard accepted by the U.S. Census Bureau is based upon
Michigan
.
90 97 82
what is known as the Model Law, and its requirements are:
Minnesota
.
67 68 66
I. Registration of births within 10 days.
New Hampshire
.
93 ioi 85
2. Use of standard birth certificates.
New York
.
84 85 77
3. Checks on registration, chiefly by (a) tracing records of deaths
North Carolina
.
84 124 82
of infants under one year of age to see whether birth was recorded,
Ohio.
.
90 94 85
and (b) tracing records of births reported in newspapers.
Oregon
.
63 69 59
4. The work of an efficient state registrar possessing full power
Pennsylvania .
.
100 99 ioi
and responsibility to enforce the law, in direct connexion with
South Carolina
.
113 139 in
local registrars.
Utah
.
71 74 69
5. Prompt monthly returns of the original certificates from the
Vermont .
.
85 121 79
local registrars to the state registrar, with report of "no births " or
Virginia .
91 106 87
" no deaths " where such is the case, and official statement of
Washington
63 59 67
completeness of registration or report of delinquents.
Wisconsin
80 94 71
6. Enforcement of penalties for non-compliance.
District of Columbia
85 85
It was reported in 1921 that no state had obtained complete registration of births. The statistics in the area, however, were generally assumed to be approximately correct. It is evident, there- fore, that infant mortality statistics in the United States, up to the
As will be seen, the rates vary from 63 in Oregon and Washing- ton to 113 in South Carolina (for 1919).
Rates by Sex in the Birth Registration Area, 1919.
end of 1921, were based entirely upon births reported in the regis-
1919 1918
tration area and that the total mortality must be estimated. It was
Males
95-8 1 10-9
believed, however, that the infant death rates in the states having
Females .
77-0 90-4
unsatisfactory registration of births do not differ essentially from those recorded in the birth registration area.
The statistics of U.S. birth registration of sex to infant mortality in that country
area show that the ratio is about the same as that
Infant Mortality in the United States and Some Foreign Countries
in other countries. In
all years reported, the death-rate of male
or Provinces (per 1,000 living births).
infants is appreciably higher than the death-rate of female infants.
Chile (1919) . . 36 Denmark (1919) . 92
This applies to both cities and rural
communities, in 1919 the city
Hungary (1915) . 264 England and Wales
rate for males being 98-7 as against a
rural rate of 92-9, the city rate
Spain (1918) . . 183 (1919) ... 89
for females being 79-3 as against a rural rate ol 74-7.
Japan (1917) . . 173 Ireland (1919) . Germany (1918). . 154 Switzerland (1918) . 88 Italy (1915). . . 147 United States (birth Q lebec (1917) . . 138 registration area, France (1919, 77 de- 1919) ... 87 partments) . . 119 Netherlands (1919) . 84 Finland (1917) . . 118 Sweden (1915) . . 76 Scotland (1919) . . 102 Australia (1919) . 69 Uruguay (1919) . ioi Norway (1917) . . 54 Ontario (1918) . . 99 New Zealand (1919). 45
Rates for 10 Largest Cities of the United States 1914-20. 1914 1915 1916 1917 1918 1919 1920 New York . 94-6 98-1 93-1 88-8 91-7 81-6 85-4 St. Louis 3 . 103-3 82-1 89-4 79-7 94-5 75-2 76-5 Boston . . 103-7 103-0 104-9 98-9 114-9 96-8 ioo-8 Pittsburgh . 115-2 107-7 H3'8 116-2 122-5 H5'3 no-8 Cleveland. . 116-4 no-6 107-0 104-9 95-4 . 90-8 86-0 Philadelphia . 117-6 106-2 101-0 lio-o 126-0 89-8 88-6 Buffalo . . 121-5 108-2 113-9 103-7 121-5 109-8 loi-o Detroit . . 122-4 IO 4'3 1 12-8 103-6 100-7 96-8 104-2
Note: The figures given are the latest available. It is possible
Chicago 3 . . 132-7
102-5 I ll'9 106-4 l4'3 9I-O 85-5
that the relative position of the United States would vary if all the
Baltimore. . 154-6
119-8 118-2 119-3 !47'8 97-o 104-2
statistics were for 1919.
As the above table shows, New York
Citv has had the lowest
There was a steady and persistent decline in the rates in the birth registration area during 1916-21 with the exception of the year 1918, when there was an increase over the preceding year, due very largely to an epidemic of influenza. The further reduction of the infant death-rate to 87 during the year 1919 supports the belief that the factors which had to do with the general reduction of the rate were exercising a cumulative and progressive effect.
rate of any of the 10 largest cities of the United States in the years 1914-20 inclusive, except for St. Louis in 1915, 1916, 1917 and 1919. St. Louis is not in the birth registration area because its birth registration reports are not accepted by the U.S. Census Bureau. Rates in American Cities. Philip Van Ingen states that a report from 432 or 87-8 % of the cities of the birth registration area, with a population of 30,063,288 or 95-2 % of the total urban population of
Infant Mortality Rates, U.S. Birth Registration Area, 1915-9. Deaths per 1,000 births
this area, shows the infant mortality rates for the five years 1915-20, grouped according to population, to be as follows:
1919 1918 1917 1916 1915 Registration area (total) . . 87 ioi 94 ioi 100
Population Over 250,000 .
1916 . 98-8
1917 1918 1919 1920 95-4 102-3 87-0 88-6
Whites 83 97 91 99 99
100,000 to 250,000
- 103-1
100-8 ni-8 91-0 92-2
Negroes 131 161 151 185 181
50,000 to 100,000
105-3
98-8 103-3 89-0 92-3
The rate for 1919 showed that of every 12 infants born alive, one
25,000 to 50,000
. 103-8
99-9 107-9 9i-o 90-3
died before reaching the age of one year.
10,000 to 25,000
. 105-8
100-8 114-1 94-7 91-5
O7'6 IO^*7 80* I QO"2
1 Dropped from registration area in 1919.
All cities in area
> .IOI '4
2 Included in registration states.
5 Not in birth registration area.
