Race and Infant Mortality from Slavery to the Great Migration

Today, we largely take for granted that most babies will survive to see their first birthday. But a century ago, that wasn’t the case. In the early 20th century, the high number of infants who died prompted many American newspapers to refer to the public health crisis as the “slaughter of the innocents.” Additionally troubling, a baby’s race significantly affected its chances of survival. African American infants died at a rate twice as high as that of whites, and although mortality rates for both whites and blacks have drastically decreased, this two-to-one disparity still exists today.

The road leading me to study the social and cultural history of infant death has involved several stops at Radcliffe. As a Harvard undergraduate, I spent part of my junior year as a Radcliffe Research Partner, working with fellow Martin Summers RI ’08 to examine the experiences of African American patients at Saint Elizabeth’s Hospital, a federal insane asylum in Washington, DC. The project sent us deep into Harvard’s libraries. We combed through slave narratives for descriptions of black healing traditions, analyzed how early-20th-century black newspapers covered stories on madness, and reviewed medical journals to see how physicians discussed racial differences in their diagnoses and treatment of mental illness. It was a crash course in the methods historians use to examine the intersections of race, gender, health, and society, and the experience helped me develop an appreciation for what historians do.

Such tools proved indispensable when I started researching the history of a birth-control clinic for my senior thesis. Margaret Sanger’s campaign for universal access to birth control led her to open a clinic in Harlem in 1930, and I became interested in the challenges the clinic faced as it attempted to serve the surrounding black community. Sanger sought the support of local leaders, including ministers and medical professionals, to help bolster the clinic’s reputation. Additionally, the clinic’s staff distributed pamphlets meant to address black women’s fears that scientific birth-control techniques could result in unwelcome medical experimentation and infertility. Descriptions of the debates that took place between Sanger’s white staff and black community members were scattered throughout the clinic’s records. I was amazed that old microfilmed documents could yield such details and took special pleasure in coming across a report that noted the clinic’s original location—a mere five blocks from where I grew up.

In 2008, I applied for and received a Carol K. Pforzheimer Student Fellowship from the Schlesinger so that I could figure out how the story of Sanger’s clinic fit within a broader history of the role of black communities in the early reproductive-rights movement. Archivists pointed me to the library’s collection of periodicals, which included Sanger’s monthly magazine Birth Control Review. The magazine contained articles written by respected black intellectuals, such as W.E.B. Du Bois and Charles Johnson, arguing that birth control should be considered part of a “new emancipation” for blacks. And primary-source collections such as the Black Women’s Oral History Project Interviews, 1976–1981, offered invaluable insights into black women’s experiences with family planning, abortion, and labor throughout the 20th century.

As a doctoral student at Princeton University, I am returning to the library to analyze the racial and gendered politics of infant health work. Who were the individuals and organizations behind these early-20th-century efforts? What role did the “save the babies” campaign—as it was popularly referred to—have in drawing government attention to African American health experiences? How did the campaign affect the work and role of traditional lay healers, such as midwives?

Through their involvement with the US Children’s Bureau and the Sheppard–Towner Act (its official and more descriptive title, the Promotion of the Welfare and Hygiene of Maternity and Infancy Act), reformers such as Dorothy Kirchwey Brown and Martha May Eliot promoted infant health work throughout the country, including in southern regions where many African Americans lived. As an active member of the League of Women Voters and chair of its Child Welfare Committee, Brown was deeply engaged in child welfare legislation. She maintained correspondence with public health officials throughout the country, keeping abreast of the work carried out on the ground in rural counties. Having received reports on the work done among black midwives in the South, Brown found the accounts “so fascinating,” she noted, “that I should like to come and join a midwife class myself.” Instead, she focused her efforts in Massachusetts and the District of Columbia to lobby for the passage of Sheppard–Towner, the first federally funded program of its kind.

After Eliot graduated from Radcliffe (Class of 1913) and studied medicine at Johns Hopkins, she traveled between New Haven, where she taught at Yale’s School of Medicine, and Washington, DC, where she steadily rose through the ranks at the Children’s Bureau. Her initial bureau appointment in 1924 was as director of the Division of Child and Maternal Health, and she eventually served as the bureau’s chief director in the 1950s. While the bureau engaged in a number of projects—including health demonstrations, nutrition studies, child labor legislation, and juvenile court reform—Eliot maintained a deep commitment to protecting children’s health. Among the numerous awards she received was one from Mary McLeod Bethune, head of the National Council of Negro Women, who honored Eliot in 1949 for her lifelong work in maternal and child health.

The Eliot and Brown collections have allowed me to explore interactions among federal agencies, state boards of health, and black health professionals, including physicians, nurses, and midwives. And I hope such sources will shed more light on important moments in the history of American health and health care.

A doctoral student in history at Princeton University, Wangui Muigai earned her undergraduate degree from Harvard in 2009. The Schlesinger Library recently awarded her a dissertation grant to conduct research at the library.