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Making Economic Sense
by Murray Rothbard
(Contents by Publication Date)

Chapter 15
The Infant Mortality "Crisis"

I first heard of the Infant Mortality Question last summer, when I had the misfortune to spend an evening with an obnoxious leftist who claimed that, despite any other considerations, U.S. capitalism had failed and the Soviet Union had succeeded, because of the high "infant mortality" rate here. She must have been ahead of the left-wing learning curve, for since then the press has been filled with articles proclaiming the selfsame doctrine.

First, on the Soviet Union, I learned from Soviet economist Dr. Yuri Maltsev that the Soviets had achieved low infant mortality rates by a simple but effective device, one that is considerably easier than medical advances, nutritional improvement, or behavioral reform for pregnant women. Namely: by holding up the statistical reporting of a death until the mortality is beyond "infant" status. No one, apparently, pays much attention to the death rate of post-infants.

But what of the U.S. infant mortality record? Well, in 1915, 100 infants died for every 1,000 live births in the U.S. Since then, the mortality rate has fallen spectacularly: to 47 for every 1,000 in 1940, 20 by 1970, and down to 10 per 1,000 by 1988. A 90% drop in the infant mortality rate since 1915 does not seem to be a record calculated to induce an orgy of breast-beating and collective guilt among the American people.

So why should Dr. Louis W. Sullivan, our official scourge as Secretary of Health and Human Services, denounce the U.S. record as "shameful and unconscionable?" And why should a proposal by President Bush for an additional federal prenatal care program of $171 million be denounced by some Congressmen as amounting only to a net increase of $121 million, since $50 million would be deducted from existing programs? Why is it assumed on all sides that more federal spending is necessary?

The problem seems to be that many countries have lowered their infant mortality rates even faster, so that the U.S. now ranks 22nd in infant mortality; rates in Japan and in Scandinavia are less than half that in the U.S.

As in economic statistics, it helps our understanding to disaggregate; and we then find that black infant mortality has long been far higher than white; specifically, the 1988 U.S. rate was 17.6 for blacks and 8.5 for whites.

Apparently, the key to infant mortality is low birth-weight, and low birth-weight rates in the U.S. have long been far greater for black than for white infants. The white rate has remained at about 7% of live births since 1950, while the black rate has hovered around 10 to 14% of births. Starting at 14% in 1969--the first year black birthrate figures were kept separately--black low-weight births fell after abortion was legalized, only to go back up since the mid-1980s to over 13 %.

So central is the birth-weight problem that Christine Layton of the Children's Defense Fund, a left-liberal "health advocacy group" (is anyone opposed to health?) in Washington, welcomed the recent news that infant mortality rates fell to 9.1 deaths per 1,000 live births in 1990 only grudgingly. She pointed out that this decline since 1988 is due only to new medical advances in drugs for treating lungs of premature babies; apparently this decline doesn't really count, since it will not "have the kind of lasting effect we need to see on the problems of being born too soon or too small."

But how come the low birthrate problem among blacks has persisted for decades even though, with it usual energy in spending taxpayer money, the federal government has been tackling the problem since 1972 by its immensely popular WIC (Special Supplemental Food Program for Women, Infants, and Children) program? WIC costs the federal government $2.5 billion a year, in addition to federal subsidies to states administering the program. 

In the left liberal worldview, every social problem can be cured by federal spending, and so the government assumed that low birth-weight among black babies was due to malnutrition, which was in turn due to poverty. WIC, therefore, has been providing poor American women with vast amounts of milk, cheese, eggs, cereal, and peanut butter. WIC has been supplying all this food to half of the eight million pregnant women, infants, mothers, and children eligible- family incomes must be below 185% of the official poverty line and the family must be officially judged to be at "nutritional risk."

So why is it that impoverished black mothers, despite the intake of all this federally sponsored nutrition, have not seen the low birth-weight or the mortality problem reduced over these two decades? Why has the only accomplishment of WIC been to provide massive subsidies to dairy and peanut farmers? (We set aside the rising obesity and cholesterol rates among poor blacks.)

The answer is that, remarkably enough, nutrition, and therefore low incomes, is not the problem. It turns out, according to an article by prominent nutritionist and pediatrician Dr. George Graham of Johns Hopkins Medical School (Wall Street Journal, April 2, 1991), that the key cause of low birth-weight, and especially of very low birth-weight, in the U.S. is premature birth, and that malnutrition plays virtually no role in causing premature birth. In Third World countries, on the contrary, low birth-weight is caused by malnutrition and poverty, but premature birth in those countries is not a particular problem.

Unlike Third World countries, low birth-weight, and therefore high mortality rates, in the U.S. are a problem of prematurity and not malnutrition. In fact, the infant mortality rate on the island of Jamaica, almost all of whose population is poor and black, is substantially lower than in Washington D.C., whose blacks enjoy a far higher income than in Jamaica, and two-thirds of whom were beneficiaries of the WIC program.

The cause of premature births, in fact, is not nutritional but behavioral, that is the behavior of the pregnant mother. In particular tobacco smoking, ingestion of cocaine and crack, previous abortions, and infections of the genital tract and of the membranes surrounding the fetus, which often are the consequence of sexual promiscuity. And there we have it. 

These are not facts that left-liberalism likes to hear, and obviously no federal mulcting of taxpayers is going to improve the situation. Left-liberals might try to evade the truth by charging that this is the old conservative tack of "blaming the victim." They're wrong. No one is blaming the babies.

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