Social intervention and the decline of infant mortality: Birmingham and Sheffield, c. 1870-1910.

The beginning of the secular decline in infant mortality in England and Wales can be dated fairly precisely, since from 1900 substantial and sustained decrease in the national infant mortality rate (IMR) occurred and continued throughout the twentieth century. The causes of long-term infant mortality decline are relatively easy to understand in general terms and are related to the process of modernisation which resulted in lower levels of fertility, increased female status and improvements in child care practices, medical care, living standards and educational provision. However, it is still not clear why infant mortality began to decline at or around 1900, some 30 years later than childhood mortality.1 The fact that decline occurred almost simultaneously in every English and Welsh Registration District (RD) tends to suggest that some exogenous factor was at work and with many local authorities introducing specific measures aimed at reducing IMRs at about the same time, the role played by social intervention in infant mortality decline has been the subject of considerable debate.2 As yet few detailed local studies have been undertaken on this subject, although source material in the form of the under-used Medical Officer of Health (MOH) reports is readily available for most places. The main aim of this paper is therefore to examine the extent to which local initiatives were capable of influencing the IMR in the period before the First World War. It will also draw a number of tentative conclusions about the nature of infant mortality decline in an attempt to stimulate further debate.