to ways of further reducing the total maternal mortality. If in 1943 the maternal mortality rate for Negroes had been reduced by a half but the number of both white and Negro births and the mortality rate for whites had remained unchanged, the rate for both races would be reduced more than 10 percent. INFANT MORTALITY In 1933 a total of 120,887 infants died before their first birthday. In 1943 the number dropped to 118,484 in spite of the increased number of infants born in the latter year. The infant mortality rate dropped from 58 to 40 per 1,000 live births-a percent change of 31, as is shown in the following comparison: This reduction, although not so great as the reduction in maternal mortality rate, nevertheless represents a real improvement and is not due to chance variations. For this 10-year period the percentage reduction in mortality rates has been about the same for white and Negro infants, but during the last 2 years of the decade the infant mortality, like the maternal mortality, has declined proportionately more for Negro infants than for white infants. The amount of change for each race is as follows: More infants died during the first month of life in 1943 than in 1933 but because of the larger number of births in the later year, the neonatal mortality rate declined 27 percent during the 10-year period. Until 1940 the rates for deaths during the first day of life had decreased very little, but in the last 2 years there has been a noticeable drop in this rate. This decrease in rate for the first day possibly is related to improved maternal health, since the largest proportion of the early infant deaths are due to prenatal and natal causes. More of the infant deaths occurred in the first day of life in 1943 than in 1933 (29 percent in 1943 and 26 percent in 1933). Also, more of the infant deaths occurred during the first month of life in 1943 than in 1933 (61 percent in 1943 The rapid changes in the birth rates during 1942 and 1943 have not been considered in the calculation of the infant mortality rates used here. For discussion of this factor see Effect of Changing Birth Rates Upon Infant Mortality Rates, by Iwao M. Moriyama and Thomas N. E. Greville, in Vital Statistics-Special Reports, vol. 19, No. 21 (Bureau of the Census, Department of Commerce, Washington), and the very brief note in Maternal and Infant Mortality in the U. S., 1942, by Marjorie Gooch, The Child, vol. 8, pp. 179-185 (June 1944). and 58 percent in 1933). The decrease in the rates for different ages at death are as follows: Because of changes in the International List of Causes of Death and in the basic tabulations of causes of infant death published by the Bureau of the Census, the groupings of causes previously used by the Children's Bureau cannot now be followed exactly. It is possible, however, to make comparisons for the most important causes of infant death. In 1933, 53 percent of the infant deaths were due to prenatal and natal causes; in 1943, 60 percent. The mortality rates, however, decreased for all the major cause groups, as is shown in the following comparison: Between 1933 and 1943 the greatest reduction was in the death rate for the dysentery, diarrhea, and enteritis group (45 percent), although the rate for the group, epidemic and other communicable diseases, was reduced almost as much (44 percent). These diseases are the ones most easily affected by publichealth measures, such as pure water and milk supplies, adequate sewage disposal, and immunization, and therefore would be expected to show marked decreases. The reduction of 34 percent for influenza and pneumonia is undoubtedly the result of the use of sulfa drugs. The numerically largest group, prenatal and natal causes, showed a reduction in the mortality rate of 21 percent although this was a smaller gain than was shown by the other groups of diseases. In 1943 there were 5,000 more infant deaths than in 1942, but because of the larger number of births the rates for the 2 years were the same, 40.4 per 1,000 live births. The prenatal and natal causes showed a slight drop (3 percent) in mortality rate. The other specific causes were higher in 1943 than in 1942 (table 7). Infant mortality by States In 1933 New Mexico had the highest infant mortality rate (136.1) and Washington the lowest (38.8). In 1943 New Mexico still had the highest rate but it had dropped to 91.6, a reduction of almost one-third. The lowest rate in 1943 was for Connecticut-29.8. In 1933 half the States had rates above 55.4 and half below that figure; in 1943 the point which divided the States equally was 39.6 per 1,000 live births. Every State showed a reduction in infant mortality rates during the 10-year period. The greatest reduction was for North Dakota (42 percent). The least reduction was shown by Washington (10 percent), which had the lowest rate in 1933. The infant mortality rate, unadjusted for the changing number of births, was the same, 40.4 per 1,000 live births, for 1942 and 1943. For 21 States the rate was higher in 1943 than in 1942. New Hampshire showed the highest percentage increase, 28 percent. The largest decrease was 18 percent, for Wyoming (table 8). Possibility of further reduction in infant mortality Although it may not be possible to reduce the infant mortality rate for the country as a whole to the low rate of 30 per 1,000 live births attained by 2 States in 1943, certainly the fact that 23 States showed rates above the national rate would indicate that some reduction is possible. The goal of reducing neonatal deaths by a half, which was suggested in the 1930's, was not reached during this 10-year period. The most important single cause of death is premature birth. Better prenatal care of mothers should reduce the number of infants prematurely born and better care of prematurely born infants should reduce the number of infants dying from this cause. TABLE 7.-Causes of death in the first year of life; United States, 1943 and 1942 1 Measles, scarlet fever, whooping cough, diphtheria, cerebrospinal (meningococcus) meningitis, and tuberculosis. |