Infant and child mortality by socioeconomic status in early nineteenth century England

by Jaadla Hannaliis (University of Cambridge)

The full article from this blog (co-authored with E. Potter, S. Keibek,  and R.J.  Davenport) was published on The Economic History Review and is now available on Early View at this link

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Figure 1. Thomas George Webster ‘Sickness and health’ (1843). Source: Photo credit: The Wordsworth Trust, licenced under CC BY-NC-SA

Socioeconomic gradients in health and mortality are ubiquitous in modern populations. Today life expectancy is generally positively correlated with individual or ecological measures of income, educational attainment and status within national populations. However, in stark contrast to these modern patterns, there is little evidence for such pervasive advantages of wealth to survival in historical populations before the nineteenth century.

In this study, we tested whether a socioeconomic gradient in child survival was already present in early nineteenth-century England using individual-level data on infant and child mortality for eight parishes from the Cambridge Group family reconstitution dataset (Wrigley et al. 1997). We used the paternal occupational descriptors routinely recorded in the Anglican baptism registers for the period from 1813–1837 to compare infant (under 1) and early childhood (age 1–4) mortality by social status. To capture differences in survivorship we compared multiple measures of status: HISCAM, HISCLASS, and also a continuous measure of wealth which was estimated by ranking paternal occupations by the propensity for their movable wealth to be inventoried upon death (Keibek 2017).  The main analytical tool was event history analysis, where individuals were followed from baptism or birth through the first five years of life, or until their death, or leaving the sample for other reasons.

Were socioeconomic differentials in mortality present in the English population by the early nineteenth century, as suggested by theorists of historical social inequalities (Antonovsky 1967; Kunitz 1987)? Our results provide a qualified yes. We did detect differentials in child survival by paternal or household wealth in the first five years of life. However the effects of wealth were muted, and non-linear. Instead we found a U-shaped relationship between paternal social status and survival, with the children of poor labourers or wealthier fathers enjoying relatively high survival chances.  Socioeconomic differentials emerged only after the first year of life (when mortality rates were highest), and were strongest at age one. Summed over the first five years of life, however, the advantages of wealth were marginal. Furthermore, the advantages of wealth were only observed once the anomalously low mortality of labourers’ children was taken into account.

As might be expected, these results provide evidence for the contribution of both environment and household or familial factors. In infancy, mortality varied between parishes, however the environmental hazards associated with industrialising or urban settlements appear to have operated fairly equally on households of differing socioeconomic status. It is likely that most infants in our eight  reconstitution parishes were breastfed throughout the first year of life – which  probably conferred a ubiquitous advantage that overwhelmed other material differences in household conditions, for example, maternal nutrition.

To the extent that wealth conferred a survival advantage, did it operate through access to information, or to material resources? There was no evidence that literacy was important to child survival. However, our results suggest that cultural practices surrounding weaning may have been key. This was indicated by the peculiar age pattern of the socioeconomic gradient to survival, which was strongest in the second year of life, the year in which most children were weaned. We also found a marked survival advantage of longer birth intervals post-infancy, and this advantage accrued particularly to labourers’ children, because their mothers had longer than average birth intervals.

Our findings point to the importance of breastfeeding patterns in modulating the influence of socioeconomic status on infant and child survival. Breastfeeding practices varied enormously in historical populations, both geographically and by social status (Thorvaldsen 2008). These variations, together with the differential sorting of social groups into relatively healthy or unhealthy environments, probably explains the difficulty in pinpointing the emergence of socioeconomic gradients in survival, especially in infancy.

At ages 1–4 years we were able to demonstrate that the advantages of wealth and of a labouring father operated even at the level of individual parishes. That is, these advantages were not simply a function of the sorting of classes or occupations into different environments. These findings therefore implicate differences in household practices and conditions in the survival of children in our sample. This was clearest in the case of labourers. Labourers’ children enjoyed higher survival rates than predicted by household wealth, and this was associated with longer birth intervals (consistent with longer breastfeeding), as well as other factors that we could not identify, but which were probably not a function of rural isolation within parishes. Why labouring households should have differed in these ways remains unexplained.

To contact the author:  Hj309@cam.ac.uk

References

Antonovsky, A., ‘Social class, life expectancy and overall mortality’, Milbank Memorial Fund Quarterly, 45 (1967), pp. 31–73.

Keibek, S. A. J., ‘The male occupational structure of England and Wales, 1650–1850’, (unpub. Ph.D. thesis, Univ. of Cambridge, 2017).

Kunitz, S.J., ‘Making a long story short: a note on men’s height and mortality in England from the first through the nineteenth centuries’, Medical History, 31 (1987), pp. 269–80.

Thorvaldsen, G., ‘Was there a European breastfeeding pattern?’ History of the Family, 13 (2008), pp. 283–95.