History Can Guide Fixes for America's Abysmal Maternal and Infant Health Outcomes

This month, the United States celebrated its first Maternal Health Action Day on Dec. 7. In a national address, Vice President Harris harked back to rhetoric popularized 100 years ago, when women first entered the federal government and directed its attention to the problems of high maternal and infant mortality. Harris pointed out the “hard truth” that “women in our nation are dying … before, during, and after childbirth at a higher rate than any other developed nation in our world.”

The United States has abysmal maternal mortality rates. Data for the year 2019 showed that in the United States, for every 100,000 live births, 20 women died. That same year, Poland lost just two. The Centers for Disease Control and Prevention (CDC) has estimated that 2 out of 3 of these deaths were preventable. Babies fare even worse. In 2019, the United States lost six infants per 1,000 live births — three times more than Slovenia, which lost two. Moreover, U.S. maternal mortality numbers are nearly three times higher for Black mothers than for White mothers, and infant death rates are more than twice as high for Black and Native American babies as for White babies.

Poor health outcomes for mothers and babies in the United States have been a problem for over a century, and the federal government has been largely indifferent. For a brief period in the 1920s, lawmakers mounted a national effort to begin addressing the problem. But it came to an abrupt end after only eight years, and Congress has tried nothing so ambitious since. This history shows that treating maternal and infant health as a national issue can be key to addressing this problem.

World War I exposed the ill health of the country’s young men: nearly one third of eligible draftees were unable to serve because of preventable illnesses contracted in early childhood. These new statistics shaped ideas about the nation’s health and drove changes in public policy.

The U.S. Children’s Bureau, established in 1912, just before the war, was the first federal agency run and staffed by women. World War I and new state statistics provided the bureau with an effective rallying cry: Mothers and babies were in as much grave danger at home as young American men were on the war front. In the 1910s, pregnancy was notably risky for women, with more than 700 mothers dying for every 100,000 live births, and extremely dangerous for babies. Nearly 10 percent of infants did not survive their first year of life.

Julia Lathrop, chief of the Children’s Bureau, seized upon the war effort to publicize the problem. She organized national publicity campaigns to raise awareness about infant mortality rates, including national Baby Week in 1917 and Children’s Year in 1918. Lathrop said these efforts were “device[s] for arousing public opinion.” With wartime headlines such as “The Cradle More Fatal Than The Trench” and “America’s Waste of Babies,” her efforts worked.