Historical Perspectives on Infant-Child Deaths
by Joanne Cacciatore-Garard, Founder of the MISS Foundation
-this article originally appeared in The MISS Foundation: When a Child Dies newsletter

Relationships, attachments, and emotions are all very complex aspects to the individual human condition. The way our brains regulate emotional responses, even bereavement, can differ based on many variables including physiology, gender, hormones, age, and the most capacious category of all, culture.

I met an older woman a few months ago during a business transaction. Somehow, in our casual conversation, my involvement with the MISS Foundation became the topic. She responded, “Oh, well, I had a baby a long time ago that died.” Surprised I responded, “Oh my goodness, I am so sorry. What happened?” She responded, “Oh, don’t be sorry. It’s okay. She died in her crib.” She seemed very nonchalant about her daughter’s death so many years ago. I thought perhaps so much time had passed that she was able to detach from the trauma of her death. She continued to explain how, ‘back in those days,’ babies just died and you ‘accepted it and went on with your life.’ Within a few months, she was pregnant again and went on to raise several children to adulthood. No one talked about the experience. She couldn’t recall whether the baby died in 1967 or 1969, something I thought was unusual since, nine years later, I still remembered the day, month, year, and time (nearly to the second) of my daughter’s death. But when I asked what her baby’s name was, she hesitated for a moment looking into my eyes as if to say ‘thank you for asking.’ With a disquieting quiver in a nearly inaudible voice, she responded, “Nancy.”

I have always been mystified at the way women experienced child death in the past. My own grandmother’s first two children died at just under one year of age. No one in our family knew about them until we were going through her old photographs just before she died. “Nanny,” we asked, “who is this baby?” She responded with her aged, Sicilian intonation, “That’s the first Josephine.” I was confused knowing that my mother’s name was Josephine. “The first Josephine? What do you mean?” I asked. She went on to tell us that the first Josephine died at eleven months of age. (I felt horrible that I had never known this). Then, she said she had another baby just one year later, again named Josephine. That baby also died at just under one year of age. Her third child, a girl she named Mary because she was convinced that the name ‘Josephine’ was “bad luck,” lived to adulthood. Finally, her fourth child, the third and only Josephine to live past childhood, was born—my mother. It was very difficult for me to understand my grandmother’s stoicism and the viewpoint of her generation and culture that children are somehow replaceable.

I began to do some research on how responses to child death have been socialized throughout history. From a socio-cultural perspective, the roles of children in society have changed dramatically. Until the late nineteenth century, children played a significant role in labor production and agriculture during the transitory stage between early feudalism and capitalism. But as the United States emerged into the industrial revolution, profound economic changes, improvements in transportation, communications, and textile machinery, reformed the demand for child labor. “Family size declined between 1800 and 1900 from 7.0 to 3.5 children. Another significant historical change was also occurring during this period of time. In 1916, Margaret Sanger opened the first birth control clinic in the U.S. and by 1933, with the help of modern contraception, the average family size had declined to 2.3 children.

Mortality statistics reveal even more about this framework. Long before the plague epidemics of the fourteenth century, disease, malnutrition, and wars took the lives of countless. The most vulnerable ages, infants and toddlers, most often fell as victims. Still, more than 500 years later in 1900, six to nine of every 1000 women died in childbirth, and one in five children died during the first 5 years of life” (Morbidity and Mortality, December, 1999). Historically, children were often not included in family trees, and in some cultures not even named, until after their first birthday. Deaths, especially of children, were a familiar occurrence.

Even in contemporary society, infants remain the most vulnerable. Perinatal mortality rates during 1999, including stillbirths from 27 weeks gestation to one month of age, were 7.4 per 1,000 (Center for Disease Control, 2000). These data are certainly more favorable than the 1950 statistic of 32.5 per 1,000, yet still significant. Infant mortality rates, ages one month to one year, were 7.1 per 1,000 live births during 1999 and 29.2 per 1,000 live births in 1950. Generations preceding experienced even more infant deaths although they were not formally recorded until the late 1800’s. Certainly, in my grandmother’s era, the deaths of children were perceived as a grievous, yet somewhat ‘normal,’ experience.

When society cares about an issue, we legislate it, creating laws, task forces, watchdog groups, and agencies to monitor it. Certainly, another consideration affecting the historical implications of child death has to do with society’s realization and acknowledgement of child abuse. The inception of the feminist and anti-domestic violence crusades during the mid-twentieth century played a key role in promoting the interests of the abused. These movements carried children’s rights on the wings of their political trajectories. A new value was attached to children. The first key federal legislation addressing child abuse and neglect, known as the Child Abuse Prevention and Treatment Act (CAPTA), was enacted in 1974. Despite this watershed legislation, much work remains to be done in this arena. As a bereaved parent, I find it incomprehensible that any parent could harm his or her own child. Yet, during 1999, 15 out of every 1,000 children were substantiated as victims of child abuse. In fact, the National Institute of Health declared homicide as the leading cause of infant death due to injury (NICHD, 1998).

What does all of this say about the perspective of some individuals as parents? Perhaps, there are those who came from a cultural intersection of time that, due to the anticipated nature of their child’s death, enabled them to be better prepared for the inevitable and helped them to accept death as a part of life. Maybe, some are predisposed to deny and repress the most visceral emotions, conforming to the social mores of society. Perhaps, there are just individual differences in responses to child death or perhaps others who honestly do value one child over another. Perhaps there are even those parental abusers who would intentionally harm, injure, or even kill their own child. But for most in our generation, the death of a child will evoke the deepest, inexplicable feelings of grief, despite the cause, age, or perceived societal value of their child. There are so many different individual and societal dimensions to child death, all influenced by just as many variables. Understanding these factors helps me on many levels.

The social value of children has evolved remarkably throughout history. Couples are having fewer children and they are waiting longer to have them. The advent of ultrasound, more recently three dimensional technology, brings mothers, fathers, and siblings closer to the mystical world of the womb and the bonding process becomes a tangible aspect of early pregnancy. In today’s world, couples have children to add dimension to their lives, bringing joy, love, and hope. Children are often treated as autonomous individuals deserving of respect and rights from society.

Perhaps then, it is this culture that has championed the shift of the historical implications of infant-child death in society. In egalitarian societies, with the emergence of technological and medical advancement, plentiful resources, and public health education, children are expected to outlive their parents. The expectation is that in western civilization babies do not die- such that when it does occur, it is recognized as an uncommon event. These factors have influenced the way families grieve in the culture of our century. While we have a long way to go at improving psychosocial support of the bereavement community, families certainly have increased recognition of the mourning process and compassion is given more freely without boundaries of race, gender, or religion.

Retrospectively, I am honored that I was born in an era when the sublime, irreconcilable grief of my child’s death can be fully expressed. Occasionally, however, I’m reminded that our attitudes toward child death, particularly of the very young, still clench to antiquated responses of generations past. I recall an incident very early in my grief journey, when I met a neighbor at our local grade school. My 2nd grader and hers were running around our legs as she and I talked. She asked about my children and I told her that I had five altogether, but that my fourth child died during her birth. “Well,” she replied without much thought, “you probably feel fortunate it wasn’t your older child who died.” I stood there speechless. Startled, I responded with the only logical thing I could think of, “You know, I’ve heard that there were people who loved their older children more than their younger children, but I’m not one of them.” I walked away hurt, angry, and confused. I felt that my response was not offensive, but rather, it was a spontaneous, innate defense. I felt compelled to defend the memory of a child whom I loved. I love all my children in the same way and certainly do not feel that it would be harder to lose one just because he or she were older or younger in age and thus, held some quixotic value above the other.

Article offered by
Joanne Cacciatore-Garard
MISS Foundation Founder


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