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The century that stopped burying babies

The century that stopped burying babies

New Capabilities

How Clean Water, Germ Theory, and Public Health Transformed Child Survival

December 31st, 2017: UK and US Infant Mortality Below 6 per 1,000

Overview

In 1900, one in seven babies born in the United States or United Kingdom died before their first birthday. By 2017, the rate had fallen to roughly 4-6 per 1,000—a decline exceeding 95%. This transformed how families experience childbirth and early childhood.

The causes were not primarily high-tech medicine. Before widespread vaccination or antibiotics, infant mortality had already plummeted—driven by clean water, pasteurized milk, sanitation systems, and public education campaigns that taught mothers about hygiene. The 20th century proved that most infant deaths were never inevitable; they were infrastructure failures waiting to be fixed.

Key Indicators

140→4
Deaths per 1,000 (UK, 1900-2017)
UK infant mortality rate fell from approximately 140 per 1,000 live births in 1900 to 3.8 in 2017
95%+
Reduction in infant mortality
US and UK infant mortality declined by more than 95% over 117 years
3.1%
Annual decline rate (US, 1915-2000)
US infant mortality fell from 99.9 to 6.9 per 1,000 at a pace of 3.1% per year
5→99%
Hospital births (US, 1900-1963)
Hospital delivery rose from under 5% in 1900 to 99% by 1963

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People Involved

Organizations Involved

Timeline

May 1847 December 2017

19 events Latest: December 31st, 2017 · 8 years ago Showing 8 of 19
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  1. UK and US Infant Mortality Below 6 per 1,000

    Latest Milestone

    UK infant mortality reaches 3.8 per 1,000; US reaches 5.9 per 1,000. Both countries have achieved more than 95% reduction since 1900.

  2. Surfactant Therapy Transforms Preterm Survival

    Medical Advance

    Synthetic surfactant therapy becomes standard care for premature infants, dramatically improving survival for extremely preterm babies.

  3. Smallpox Declared Eradicated

    Global Health

    WHO certifies global eradication of smallpox—the first (and still only) human disease eliminated through vaccination.

  4. WHO Launches Expanded Immunization Programme

    Global Health

    WHO establishes the Expanded Programme on Immunization, aiming to vaccinate all children against six major diseases by 1990.

  5. Measles Vaccine Licensed

    Vaccination

    First measles vaccine licensed in the US. Measles vaccination would eventually prevent an estimated 60% of all vaccine-preventable deaths worldwide.

  6. First American NICU Opens

    Medical Advance

    Louis Gluck opens the first American neonatal intensive care unit at Yale New Haven Hospital. By the 1970s, NICUs become standard in developed countries.

  7. Salk Polio Vaccine Approved

    Vaccination

    Jonas Salk's polio vaccine is declared safe and effective, launching mass immunization campaigns that would nearly eliminate paralytic polio.

  8. Infant Mortality Reaches ~30 per 1,000

    Milestone

    US and UK infant mortality falls to approximately 30 per 1,000 live births. Hospital delivery has risen from 5% (1900) to 88%.

  9. Penicillin Mass Production Begins

    Medical Advance

    Industrial production of penicillin enables widespread antibiotic treatment, reducing infant deaths from bacterial infections including pneumonia and sepsis.

  10. Infant Mortality Reaches ~56 per 1,000

    Milestone

    US and UK infant mortality falls to approximately 56 per 1,000 live births—a 60% decline from 1900, achieved largely before antibiotics or widespread vaccination.

  11. London Milk 85% Pasteurized

    Public Health

    Pasteurization of London milk supply reaches 85%, contributing to sharp decline in infant deaths from tuberculosis and diarrheal disease.

  12. Sheppard-Towner Act Signed

    Legislation

    President Harding signs the first federal social welfare law, providing matching grants to states for prenatal clinics, visiting nurses, and midwife training.

  13. Infant Care Pamphlet Published

    Public Health

    Children's Bureau publishes first edition of Infant Care pamphlet, providing hygiene and nutrition guidance. Over 50 years, 45 million copies reach American families.

  14. US Children's Bureau Established

    Policy

    President Taft signs legislation creating the Children's Bureau, the first federal agency dedicated to child welfare. Julia Lathrop becomes its first chief.

  15. US Cities Begin Chlorinating Water

    Infrastructure

    American cities begin large-scale water chlorination. Filtering and chlorinating water supplies becomes a central public health strategy against waterborne disease.

  16. Infant Mortality at ~140 per 1,000

    Baseline

    UK and US infant mortality rates stand at approximately 140 deaths per 1,000 live births. In US cities, up to 30% of infants die before age one.

  17. Infant Incubator Invented

    Medical Technology

    Stéphane Tarnier develops the infant incubator in Paris, adapting technology used for chicken eggs to keep premature babies warm.

  18. Pasteur Develops Pasteurization

    Scientific Advance

    Louis Pasteur demonstrates that heating liquids kills microorganisms. Applied to milk, this process would eventually prevent an estimated 500,000 infant deaths from contaminated milk (1850-1950).

  19. Semmelweis Implements Hand-Washing

    Medical Discovery

    Hungarian physician Ignaz Semmelweis orders hand-washing in chlorinated lime at Vienna General Hospital, reducing childbed fever deaths from 18% to under 2%.

Historical Context

3 moments from history that rhyme with this story — and how they unfolded.

1831-1866

Victorian England Cholera Epidemics (1831-1866)

Four cholera epidemics killed over 100,000 people in Britain. In 1854, physician John Snow traced a Soho outbreak to a contaminated water pump, providing early evidence that disease spread through water rather than "bad air." His findings were initially rejected by authorities committed to miasma theory.

Then

Snow's pump handle removal stopped the Soho outbreak, but London's medical establishment remained skeptical for years.

Now

Snow's work eventually catalyzed massive investment in water and sewer infrastructure. The 1866 epidemic, largely confined to areas still using contaminated water, proved his theory correct and transformed public health policy.

Why this matters now

The cholera epidemics established that infrastructure—not individual behavior—was the key to preventing waterborne disease. The same insight drove the early 20th-century infant mortality decline: clean water and sanitation saved far more infant lives than medical treatment.

1918-1919

1918 Influenza Pandemic

The deadliest pandemic in modern history killed 50-100 million people worldwide. In the United States, it caused the only 20th-century increase in child mortality rates. Pregnant women faced mortality rates as high as 27%, and surviving mothers suffered elevated rates of miscarriage and preterm birth.

Then

US child mortality rate temporarily increased in the late 1910s, interrupting the steady decline.

Now

The pandemic demonstrated the vulnerability of public health gains to infectious disease outbreaks and accelerated investment in public health infrastructure and research.

Why this matters now

The 1918 pandemic shows that progress in infant mortality is not guaranteed—infectious disease outbreaks can reverse decades of gains. This parallel informs current concerns about antimicrobial resistance and emerging pathogens.

1890-1927

US Milk Wars (1890s-1920s)

Contaminated milk killed an estimated 500,000 infants between 1850 and 1950 through tuberculosis, diarrheal diseases, and other infections. Despite pasteurization being available since the 1860s, many physicians and dairy interests opposed mandatory pasteurization, arguing it diminished nutritional value or represented government overreach.

Then

Cities that adopted pasteurization requirements saw immediate drops in infant mortality; those that resisted did not.

Now

By 1927, 85% of London's milk supply was pasteurized. Universal pasteurization became standard practice, eliminating one of the leading causes of infant death.

Why this matters now

The pasteurization debate mirrors modern vaccine hesitancy: a life-saving technology resisted on grounds of perceived naturalness, government overreach, or disputed science. Public health progress often required overcoming commercial and ideological opposition.

Sources

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