This week's discussion in my global MCH class focused on the history of maternal and child health, especially in the contexts of the industrial revolution and the social reforms of FDR's era. In the readings for this week one name in particular was mentioned in brief - to my great excitement because this person is one of my favorite historical figures - but the name was not mentioned at all in the class discussion. I thought this would be a fitting place to discuss this person, who was a pioneer in public health, MCH, and medicine. Sara Josephine Baker.

These past couple of days have been much cooler, and I am such a fan of that. After a few days of high heat and high humidity, I welcome the lower temperatures and actual breathable air. (In case it's not obvious, I hate humidity.) When I was little I despised turtlenecks, but now I can't get enough of them. They keep your neck warm! They streamline your silhouette! It's one of the few top options that don't involve a plunging neckline!

This outfit even sort of kind of relates to my topic today (though a blazer rather than a cardigan would be more relevant), but I'll get into that in a minute. First, a few things about Sara Josephine Baker. She was born in 1873 in Poughkeepsie, New York. Against the advice of some of her family members, she attended the Woman's Medical College of the New York Infirmary which was founded in part by Dr. Elizabeth Blackwell, the first American woman to earn an MD. After earning her medical degree, Dr. Baker opened a private practice in New York, but she took on a few other jobs to help pay the bills. One of those was with the city government as a medical inspector. During that time she observed a wide variety of lifestyles and living conditions, including some of the poorest living conditions of the time. She also helped investigate epidemics, including a typhoid epidemic, during which she helped track down and bring in the person believed to be the index case, a woman named Mary Mallon. That woman is otherwise known as "Typhoid Mary".

While serving as a medical inspector, Dr. Baker also developed a plan for infectious disease investigation and prevention for the city's children. In 1908, she implemented a program to teach hygienic practices like proper ventilation, breastfeeding, and bathing to young mothers. Later in that same year Dr. Baker was named the chief of the new Division of Child Hygiene within the New York health department. In this position she developed programs to teach young girls infant care, called the "Little Mothers' Leagues", and for the next several years, she continued to implement new hygiene programs and teach a new generation of healthcare workers the importance of child health and hygiene. 



Dr. Baker also had a somewhat distinctive style of dress. She attempted to appear as unfeminine as possible, and wore tailored men's suits and ties. Unfortunately, she also was quick to cut down female doctors and the poor. Still, her work on children's health helped bring New York City's infant mortality rate down from 144 per 1000 live births in 1908 to 66 per 1000 live births in 1923.

The history of MCH in the US is full of people like Dr. Sarah Josephine Baker, who focused on the poorest and most disadvantaged populations. Yet still we see an infant mortality rate of 6.1 per 1000 live births in the US while countries like the UK and France have rates of 4.2 per 1000 live births and 3.6 per 1000 live births respectively.*  The reason for this disparity is, according to the CDC, due to the high percentage of preterm births in the United States. But why does the US have more recorded preterm births than European countries? It could be that the US has a higher reporting rate of preterm births than Europe as a whole. I could certainly imagine this being the case for developing European countries. I distinctly remember listening to a visiting Romanian professor talk about low reporting rates for a number of health issues - including hospital-acquired infections - and although I know that instance is anecdotal perhaps it is the case, at least for Romania. Perhaps the ethnic disparity of infant mortality rates in the US plays a part. Non-Hispanic blacks have a much higher infant mortality rate than any other ethnic group in the country, at 11.11 per 1000 live births compared to rates at or below 7.61 per 1000 live births in 2013.** 

The data in the paragraph above makes me wonder where we stand today in the timeline of maternal and child health. How much lower can infant mortality rates in the US be brought? Who is our S. Josephine Baker or our Martha May Eliot? What kind of work still needs to be done? Certainly I believe there should be better support systems for parents who have difficulty supporting their children financially or otherwise and for children who are survivors of abuse. I have and likely always will be someone who believes in the value of life, and for me this includes helping support those who without assistance would not be able to support the lives they bring into this world. WIC programs, stronger emphasis on the importance of adherence to vaccination schedules, and parental leave are, I think, steps in the right direction, But I also think we can do more. Adoption rates could be higher, infant mortality rates - especially among specific ethnic groups - could be lower. This would take a public health approach, looking at the issues on a population scale rather than an individual scale in order to enact the greatest amount of change, and then sustaining that change through stronger patient-provider relationships (which would mean somehow reaching those people who don't have a provider, or don't want one) as well as continued outside (private or public is a different issue) assistance. Will that happen? I hope so. But that remains to be seen.

* "International Comparisons of Infant Mortality and Related Factors: United States and Europe, 2010" CDC. 2014
** Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set". CDC. 2015

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