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The infant mortality conundrum in Uruguay during the first half of the twentieth century: an analysis according to causes of death

Published online by Cambridge University Press:  14 January 2011

ANNE-EMANUELLE BIRN
Affiliation:
Dalla Lana School of Public Health, University of Toronto.
WANDA CABELLA
Affiliation:
Both of the Population Program, Faculty of Social Sciences, University of the Republic, Uruguay.
RAQUEL POLLERO
Affiliation:
Both of the Population Program, Faculty of Social Sciences, University of the Republic, Uruguay.

Abstract

Around 1900 infant mortality rates (IMR) in Uruguay were among the world's lowest. By 1910, however, the IMR began a decades-long stagnation, while other countries experienced ongoing improvements. This article examines the conundrum of Uruguay's infant mortality stagnation, highlighting the leading causes of death – diarrhoeal and respiratory diseases – and their relation to social, economic and political conditions.

Drawing on an array of demographic, medical eyewitness and social sources, we explore why, despite Uruguay's precocious social welfare investments, its IMR stagnated and what enabled its eventual decline circa 1940. We conclude that a confluence of public health, medical and social factors enabled disease-specific improvements, but only after political pressure for large-scale redistribution of wealth was translated into extensive welfare state measures.

L'énigme de la mortalité infantile en uruguay au cours de la première moitié du xxe siècle

Vers 1900, l'Uruguay avait l'un des plus bas taux de mortalité infantile du monde. Mais, à partir de 1910, ce taux stagna pendant plusieurs décennies, alors que d'autres pays connaissaient des améliorations notables. Nous examinons dans cet article l'énigme de la stagnation de la mortalité infantile dans ce pays en relevant les principales causes de décès (maladies respiratoires et intestinales) ainsi que le lien qu'elles pouvaient avoir avec d'autres conditions locales, tant sociales qu'économiques ou politiques. A partir de témoignages de source médicale, démographique ou sociale, nous analysons pourquoi ce taux de mortalité infantile a stagné malgré les investissements sociaux précoces qu'avait connus l'Uruguay ainsi que ce qui a pu causer un relatif déclin de ce taux autour de 1940. Nous concluons que la conjonction de facteurs de santé, médicaux et sociaux a permis des progrès en ce qui concerne le traitement des maladies – mais cela seulement après que la forte pression politique qui s'était manifestée en faveur d'une redistribution à une grande échelle se fut convertie en un ample système de santé publique.

Das rätsel der säuglingssterblichkeit im uruguay während der ersten hälfte des 20. jahrhunderts

Um 1900 zählte Uruguay zu den Ländern mit der geringsten Säuglingssterblichkeitsrate (infant mortality rate, IMR). Ab 1910 jedoch stagnierte die IMR für Jahrzehnte, während sie sich in anderen Ländern fortlaufend verringerte. Der Beitrag geht dem Rätsel dieser Stagnationsphase nach, indem er die hauptsächlichen Todesursachen – Durchfall- und Atemwegerkrankungen – vor dem Hintergrund der sozialen, ökonomischen und politischen Verhältnisse analysiert. Auf der Basis einer Vielzahl demographischer und medizinischer Augenzeugenberichte und sozialgeschichtlicher Quellen untersuchen wir, warum die IMR stagnierte, obwohl Uruguay frühzeitig in soziale Sicherungssysteme investierte, und wodurch der endgültige Rückgang ab etwa 1940 bewirkt wurde. Wir kommen zu dem Ergebnis, dass ein Zusammenwirken gesundheitspolitischer, medizinischer und sozialer Faktoren krankheitsspezifische Verbesserungen ermöglichte, aber erst nachdem politischer Druck in Richtung großflächiger Umverteilung tatsächlich in umfangreiche sozialpolitische Maßnahmen umgemünzt wurde.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2010

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References

ENDNOTES

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6 A. M. Damonte, ‘Uruguay: transición de la mortalidad en el periodo 1908–1963’, working paper 16, Facultad de Ciencias Sociales, Universidad de la República (Montevideo, 1994); A. Migliónico, La mortalidad en Uruguay en el siglo XX: cambios, impactos, perspectivas (Montevideo, 2001).

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24 Bauzá, J., ‘Mortalidad infantil en el Uruguay durante el decenio 1901–1910: Sociedad de Medicina de Montevideo, sesión del 23 de octubre de 1912, Revista Médica del Uruguay 16, 3 (1913), 96–8Google Scholar, ‘La mortalidad infantil en el Uruguay: sus causas y su profilaxis’, Boletín del Consejo Nacional de Higiene 15, 161 (1920), 167237Google Scholar, and La mortalidad infantil en Montevideo’, Boletín del Instituto Internacional Americano de Protección a la Infancia 10, 4 (1937), 563–79Google Scholar; Ponce de León, M., ‘Marcha de las fiebres eruptivas en el Uruguay’, Archivos de Pediatría del Uruguay 8, 5 (1937), 294307Google Scholar; Lorenzo y Deal, J., ‘Vivienda, salario y patología del lactante’, Archivos de Pediatría del Uruguay 14, 4 (1943), 227–33Google Scholar.

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29 Bértola et al., ‘Southern’; Bertino et al., ‘La larga marcha’.

30 B. Nahum, Manual de historia Uruguaya, 1903–1990, vol. II (Montevideo, 1996).

31 Bertino et al., ‘La larga marcha’.

32 A. M. Damonte, ‘Uruguay: transición de la mortalidad; A. Migliónico, La mortalidad en Uruguay; D. Jaspers and H. Orellana, ‘Evaluation of vital statistics for the study of causes of death’, in I. Timaeus, J. Chackiel and L. Ruzicka eds., Adult mortality in Latin America (Oxford, 1996), 45–68.

33 The estimation of the omissions in the period between 1900 and 1910 was carried out by Adela Pellegrino in 2001 for the database of the Population Program of the Faculty of Social Sciences (University of the Republic of Uruguay). Pellegrino's estimate was based on a comparison of the numbers of young children in each age group covered by the 1908 census (from ages 1 to 9) with the actual birth statistics from the corresponding years. The post-1910 evaluation of birth omissions is our own. Between 1908 and 1963 no national census was carried out in Uruguay, preventing us from undertaking an identical exercise. Instead we employed a 1963 CIDE (see below in this endnote) birth analysis based on late registrations by birth cohort and year of registration. We added further information on late registrations and reconciled census distribution of the age cohorts for ages 1–20 with birth registration and death figures (but not migration) for the 1943–1963 period. The urban and rural corrections are included within these corrections. The magnitude of birth corrections ranges from 12 per cent in 1905 to 4.5 per cent in 1949–1950. With the exception of the corrections for the 1900–1910 period, our estimate and the two cited here are very similar. See Comisión de Inversiones y Desarrollo Económico (CIDE), Estudio económico del Uruguay: análisis demográfico, Serie Estudios Sectoriales, Comisión de Inversiones y Desarrollo Económico (Montevideo, 1963); J. J. Pereira, and R. Trajtenberg, Evolución de la población total y activa del Uruguay, 1908–1957 (Montevideo, 1966).

34 Bauzá, ‘La mortalidad infantil en el Uruguay; Pereira, and Trajtenberg, Evolución de la población total.

35 L. Cincinatti Bollo, Manual práctico del Registro del Estado Civil dedicado a la administración pública (Montevideo, 1894); C. Devicenzi and R. Barrutti. Disposiciones relativas al registro civil compiladas, anotadas y concordadas con arreglo al Código Civil, seguidas de un manual de procedimiento para el oficial del estado civil (Montevideo, 1922).

36 Dirección General del Registro de Estado Civil, Manual teórico práctico del oficial del estado civil (Montevideo, 1892), 30.

37 Bauzá, ‘La mortalidad infantil’; Langón, M., ‘Sobre mortalidad infantil en niños menores de un año: informe del médico del servicio público de Cerro Largo’, Boletín del Consejo Nacional de Higiene 22 (1927), 7388Google Scholar.

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40 The English case reveals a somewhat different dynamic. Although the overall mortality rate began to decline from 1870 onwards, infant mortality increased in the late nineteenth century, only to fall sharply in subsequent decades. See R. Schofield, D. Reher and A. Bideau, The decline of mortality in Europe (Oxford, 1991); Bell, F. and Millward, R., ‘Public health expenditures and mortality in England and Wales, 1870–1914’, Continuity and Change 13 (1998), 221–49CrossRefGoogle Scholar; Szreter, S., ‘The importance of social intervention in Britain's mortality decline c. 1850–1914: a reinterpretation of the role of public health’, Social History of Medicine 1 (1988), 137CrossRefGoogle Scholar.

41 Birn, ‘Doctors’.

42 This is a higher proportion of infant mortality due to these causes than in three industrial towns in England circa 1890, where approximately 35 per cent of infant deaths were due to diarrhoeal and respiratory causes, as reported in Williams and Galley, ‘Urban–rural differentials’.

43 The label ‘other endemic and epidemic infectious diseases’ includes the following: whooping cough, smallpox, measles, scarlet fever, diphtheria, influenza, tetanus, syphilis, purulent infection, septicemia and tuberculosis.

44 The information for ‘early childhood ailments’ is derived by adding the figures from the categories ‘diseases of early infancy’ and ‘congenital malformations’ from the Anuarios estadisticas, according to Bertillon's classification. Between 1901 and 1925 ‘diseases of early infancy’ included ‘congenital debility, jaundice and sclerema neonatorum’, ‘other diseases peculiar to early infancy’ and ‘lack of care’. After 1926 ‘premature birth’ was added. After 1944 the category was renamed ‘illnesses peculiar to the first year of life’ and ‘injuries during birth (except stillbirth)’ was added. For the entire study period, ‘congenital malformations’ only included ‘congenital defects’ (excluding stillbirths).

45 Despite the seeming contradiction between the decline of the overall neonatal mortality rate and the increase in neonatal mortality due to ‘diseases of early infancy’, an identical phenomenon has been observed for Europe. See G. Masuy-Stroobant, ‘Infant health and infant mortality in Europe: lessons from the past and challenges for the future’, in Corsini and Viazzo eds., Decline. The explanation is generally attributed to improvements in the diagnosis of these diseases in the first half of the twentieth century.

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47 Birn, A.-E., Pollero, R., and Cabella, W., ‘No se debe llorar sobre leche derramada: el pensamiento epidemiológico y la mortalidad infantil en el Uruguay, 1900–1940’, Estudios Interdisciplinarios de América Latina y el Caribe 14 (2003), 3565Google Scholar.

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57 Bertino and Tajam, ‘La industria’.

58 Langón, ‘Sobre mortalidad infantil’.

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60 Morquio, ‘Los desarreglos’, 104.

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62 Saldún de Rodríguez and Portillo, ‘Etiología’.

63 Etchelar, Consideraciones.

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67 Zerbino, Bronco y neumopatías en el lactante.

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69 Zerbino, ‘Bronco y neumopatías en el lactante’.

70 Zerbino, ‘Bronco y neumopatías en el lactante’.

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