,5 - : : ' ' Class. Bonk H2_l ___ XhA. Public Health Is Purchasable. Within Natural Limitations Any Community Can Determine Its Own Death Rale A COMPARISON OF THE BIRTH RATES OF NATIVE AND OF FOREIGN-BORN WHITE WOMEN IN THE STATE OF NEW YORK DURING 1916 P. R. EASTMAN Division of Vital Statistics HERMANN M. BIGGS, M.D. Commissioner New York State Department of Health Albany, N. Y. Issued by the Division of Public Health Education D. of $. JUN 24 1918 <*>% .* °\ v A COMPARISON OF THE BIRTH RATES OF NATIVE AND OF FOREIGN-BORN WHITE WOMEN IN THE STATE OF NEW YORK DURING 1916 P. R. Eastman Division of Vital Statistics The following matter is not intended as a scientific study of the relative fecundity of native and of foreign-born women. This will be immediately apparent to all students of the question. The first essential of a study of this nature would be a careful and accurate census of the population according to nativity, race, sex, age and marital condition, which, of course, is not available at the present time. Moreover, the long time which has elapsed since the 1910 census and the abnormal situation exist- ing since August, 1914, preclude reliable estimates of the population based on that census. The tables herein presented were compiled primarily as an aid to the officials of the New York State Department of Health in their efforts to improve birth registration, to control the practice of midwifery, and to reduce the infant mortality. In this regard they have practical value which seemingly warrants their publication. According to the annual reports of the Commissioner General of Immigration, approximately 28 per cent of all immigrant aliens entering this country in recent years have done so with the intention of settling in the State of New York. In the case of those coming from Southern Europe, Austria-Hungary and Russia the percentage is probably even higher. Bearing in mind the fact that these people are generally poor, illiterate, and ignorant of the first principles of sanitation, the effect which a large percentage of them in a community might have on the health of that community is readily conceivable. Particularly is this likely to be true in regard to the health of infants during their first year of life. Accord- ingly, as a first step in the direction of ascertaining just how great an effect, the existence of this element in the population has on infant mortality, a comparison of the birth rates of the native and foreign- born elements has been attempted in the tables following ; birth rates and birth registration bearing a most important relation to the subject. These tables all relate to New York State, excluding New York City. This is due to the fact that no certificates of births, deaths or marriages, either in original or copied form, are forwarded to the State Department of Health, the New York City Department of Health compiling and pub- lishing its own statistics and forwarding only monthly and annual reports to the State authorities. The data contained in these reports are usually in such form as not to permit their inclusion in the tabulations. Efforts have been made to make these tables as self-explanatory as possible; consequently no extended analysis is contemplated and atten- tion will be directed only to the most important features of each. The opinion has long been prevalent that the birth rate of foreign- born women is much greater than that of native women. Reliable data as to the exact difference, however, are very scarce and particularly so regarding the State of New York. Table I is an attempt to estimate the birth rates of the most important nationalities. Table I Births to White Mothers According to Nativity of Mother Nationality of Mother Total white 4 Native white 3 Foreign-born white English, Scotch and Welsh . Irish German (includes German Poles) Italian Russian (includes' Finland and Russian Poland) . . Austro-Hungarian (includes Austrian Poles) Canadian Other foreign-born Estimated popula- tion in 1916 643-786 777-685 866,101 97.695 124,467 I7L435 141.845 82,195 81,256 104,270 62,938 Number of births '102,834 64,889 37.914 1 , 869 1-879 2,421 12,998 7,281 7.307 2,219 1,940 Number of births per 1,000 estimated popula- tion 22. 1 17.2 43-8 19. 1 I5-I 14. 1 91 .6 21.3 308 Crude birth rate of native country- according to last report before war f2 4 .I tt25-5 22.8 44.0 U36.3 §24.0 Date of last report before the war 1913 1913 1913 1913 1909 1912 1913 * Nativity of mother unknown in the case of 31 births. t England and Wales, ft Scotland. X Austria. XX Hungary. § Province of Ontario. This table shows the number of births per thousand total population of each of the principal nationalities living in New York State, according to the nativity of the mothers. The population estimates are based on the Federal Census of 1910 and the New York State Census of 191 5, the total population for 1916 being computed According to the rate of arithmetical increase between the two censuses. The proportions of the different nationalities are assumed to be the same as existed in 1910. From a strictly scientific standpoint these figures are not thoroughly reliable. For all practical purposes, however, there seems to be no adequate reason why they should not be used. If anything the birth rates of the foreign-born are probably too low, since it is likely that the percentage of each foreign nationality to the total population was not as great in -1916 as it was in 1910, owing to the practical cessation of all immigration during the years 1915 and 1916. This would probably more than offset any increase that may have occurred in the foreign population of the State from an influx of these people from other states, attracted "by better industrial conditions, etc. It may therefore, be assumed, that whatever error there may be, would, if corrected, but emphasize the point that the birth rate of native women in New York State is so low that it is undoubtedly as low, or lower, than that of France, and that the birth rate of the foreign-born woman is almost twice as great as that of the native woman. The above birth rates (17.2 for native women and 43.8 for foreign women) are not fairly comparable owing to the great difference between the age constitution of each element. There is not only a greater proportion of married women from 15 to 45 years of age among the foreign class (according to the 1910 U. S. Census it amounted to 70 per cent as against 52 per cent for native women) but a larger per- centage of them are between the ages of 21 and 30, the period of greatest productivity. This is well illustrated by Table II. Table II A Comparison of the Crude, Legitimate and Illegitimate Birth Rates of Native and Foreign-born Mothers Birth Rates •\ Excess Births Births to percentage to native foreign of births born born to foreign mothers mothers born • mothers Number of births per 1,000 inhabitants 17.2 43-7 154 Number of legitimate births per 1,000 married women 1 5-44 years of age I37-I 253 -2 85 Number of illegitimate births per 1 ,000 single, widowed and divorced women, 15-44 years old 2. 1 3-2 52 After a perusal of this table it is clear that instead of the birth rate of the foreign woman being 154 per cent greater, as evidenced by the crude birth rates, it is in reality only 85 per cent greater when computed according to the number of married women of childbearing age. Before proceeding further it is interesting to compare the rates pre- vailing in the State of New York in 1916 with those estimated by Dr. R. R. Kuczynski in his well-known study of the birth rates of native and of foreign-born women in Massachusetts in 1895. Table HI A Comparison of the Birth Rates in Massachusetts in 1895 AND IN New York IN I916 Massa- chusetts, 1895 New York, 1916 Births per 1 ,000 native population Births per 1 ,000 foreign-born population Births per native adult female population Births per foreign-born females Births per married native women of child-bearing age Births per married foreign-born women 17.2 43-7 *io7 t48.6 fl04-2 P I42 "251 1-1371 t253 • 2 * Ages 14-50. t Ages 15-44. The remarkable similarity in the above rates seems to prove that the amount of inaccuracy in the population estimates for New York State in 1916 is probably not very great, and that the} r are apparently quite trustworthy for all practical purposes. Reverting to Table I, the features of interest that at once attract the attention are the extraordinarily high rates of the Italians, Russians and Austro-Hungarians (which amount to from 100 per cent to almost 200 per cent higher here than in the mother countries) and the exceptionally low rates of the Irish and the Germans. A study of the statistics of immi- gration as contained in the reports of the Commissioner General of Immigration of the United States will reveal the probable cause of these remarkable differences. Of the total number of Italians, Austro- Hungarians and Russians, who were admitted into this country since July 1, 1880, 75.3 per cent, 73.1 per cent and "jj per cent respectively, arrived here during the period from July 1, 1900 to June 30, 191 4, while of the total number of Germans admitted since 1880, 60 per cent arrived prior to June 30, 1890 and only 19.4 per cent since July 1, 1900. The exact data regarding the Irish were not obtainable from the records from which the above figures were extracted* but it is very probable that the percentages are more or less similar to those of the Germans, assuming that the difference of age upon arrival does not differ materially between the two nationalities. This means that the three nationalities in New York State first mentioned are mostly composed of young adults in the most productive period of life, while the Germans and Irish are mostly people past the childbearing age, or at least in the later stages of that period when the birth rate is much lower. It is notable that the Canadians and British have lower birth rates in New York than in their respective countries of birth. This may be due to the greater similarity of their age constitution to that of the native class and to their greater inclination and ability to adopt the American standard of living. Attention is directed to the fact that 73.1 per cent of all births to foreign-born women were to Italian, Russian and Austro-Hungarian mothers and that these races accounted for nearly 27 per cent of all the births occurring in the State outside of New York City, although they furnished less than 7 per cent of the total population. In view of the foregoing, it appears obvious that in order to compute the degree of completeness of the birth registration of a district, greater attention should be given to the constitution of the population and par- ticularly to the number of Italians, Russians, Austro-Hungarians and Poles residing in the district. A method more or less practiced, of settling on a certain standard rate, such as 25 births per thousand total population (which ma}' be said to be the average for most of the civilized nations) and assuming thereby that any community falling below that rate is deficient in birth registration, is likely to be very inaccurate and misleading. A community containing a large percentage of these peoples is bound to have a birth rate much in excess of 25 to the thousand popu- lation and a community comprised almost entirely of people of native birth is quite certain to have a birth rate of less than that figure. In order to test the truth of this assertion a glance at Table IV will be instructive. It will be noted that of those cities having a crude birth rate of less than the average (26), only two, Mt. Vernon and New Rochelle, had in 1910 proportions of Italians, Russians and Austro-Hungarians greater than 6.8 per cent. On the other hand the lowest percentage of these people found in a city with a birth rate above the State average was 7.6 per cent. The average percentage of Russians, Italians and Austro- Hungarians in the populations of the first named group of cities is 6.3 per cent against 10.2 per cent for the latter group. * Commissioner General of Immigration's Report June 30, 1914 »p C/3 ti tf &* 0*0 -O V) CO HI CO C\ O, »o CO loco Cirfi-^O. Ot^OiO OO GOOO o C-S-d p E 5 Oi 01 rf w M *C t- 0»vO rj-mo n t> r- 0\ o W H M CI W CI 01 CI 01 Ol M 01 rfio^OO "O o O t- 01 Ol Ol Ol COCO o ci CJ Ol 01 CO Vh hoc lilt 2. O.Q OOCOCO'O ciloOO vO O^TO C^O m CO OOOOlOlO OOv^^J- J3" W2 <0 -*•<•> O O N 00 r*> "t^O O O O O* r~ r- OOOOO 2~ S"3 S3 S3 >> C n ^ n £ < WH£< o s o »-< a 3 p^ o ^ rt H a a 52 It is possible that in the cases of Mt. Vernon and New Rochelle there has been a considerable decrease in the proportions which these people form of the respective populations since 1910. Evidence of this fact seems supplied in the unusually low birth rates prevailing in each city among the women of foreign birth, who were 15 to 44 years old. Judging from a comparison of the exceptionally high birth rates of the foreign-born women, 15 to 44 years old, with the comparatively small number of Italians, etc., resident in 1910 in. the cities of Utica, Binghamton, Poughkeepsie and Auburn, it is probable that the propor- tion of these people has greatly increased in these cities since 1910 through improved industrial conditions or from other causes. The rates in this column (births per 1,000 women 15 to 44 years of age) have been computed under the assumption that the same percentages of women of these ages existed in 1916 as in 1910. For reasons already- stated, however, they are not thoroughly reliable and must be taken with much reserve, as is quite apparent from the instances cited above. It is nevertheless interesting to note the generally low birth rates of the foreign-born women from 15 to 44 years of age, in those cities which shelter a small percentage of the people under discussion and the gener- ally high rates prevailing in those cities containing a large number of them. Special instances of the importance of carefully considering the com- position of the population before passing on the degree of completeness of its birth registration, are the four cities with the lowest crude birth rates, Albany, Troy, Newburgh and Kingston. These cities have long been considered to be greatly deficient in this regard, but it is quite evi- dent from the above table that while it may be true that there is con- siderable laxity in this direction in these cities, it is by no means the only reason for their low birth rates, the principal cause probably lying in the composition of their female populations. Each of these cities has few Italian, Russian or Austro-Hungarian residents; each has a small percentage of foreign-born females of child-bearing age; in each the number of married women is much below the average ; while the most numerous foreign races in each are those of low fertility, namely, Irish, British or German. The question that naturally arises from a study of the preceding tables is, " How does the foreign-born mother compare with the native mother in her ability to rear her children after they are brought into the world? " Some evidence regarding this question is furnished by Table V which purports to be a study of the 1916 living births according to the number of children born to and the number of children living to each mother at the time of and including the 1916 birth. J 5 2 fa j H co-* C O Cv u ^ f -f CO O >0 t- H CO f If. ■«*- IO 01 00 C\ CO fl OivC O O O if wjp Tto iot~ \00 0\0 coco »O00 O ci OI l>>£ O O OOOC r*-i> o-o iC't -^tro roro row c*w w»-< a w t- Succ RING ST Boi HEM J! CM C nO< CO CO M 1- £ Hui t-« i> co^c 1-- Tf ro o. CI l- ►H h 3 lO OI 01 a w £ £c.S < 3 S 3f OI o c 01 CO M H aoc t^l> \0»O -^ N ts O Ot- COfO **t 0\ O *t- M N COCO -^-^- lO»0 vO»0 vCO l>0 OO t^ 5 3s t 56 ►J fa o 3oiz rfM o c w ro Oi «/^ On »- iOO\ hO\ "O On Oc- t^oc Sac 9£ bo aJ o _, o d o\ it- O C ro w O Ch CO c- t^ ^t vO Cs io c •*Ov w-C a ■* 1-t 00 00 o c O C\ O\0C 00 oc CO oc 00 OC CO oc 00 l- - oo r- < ^ m f- 1 a 53 ■< H es m r~ o Oi (OO M C\ 00 CO ^- f- sO W ■*« 3 O 05 ■*o O O u «gz os > s 3.5 © t- t|-m oo^c fO lO 0\ O >-<\C \00 00 CO oo oc VO ^ IOH oi o \n o Ol ro lO m ^-Tt O CO oo^f io oi roc w t~ O* rt r-O CMvO t^ IO COCO Ot- t^OC ro 01 lOsC 00 01 CO M- vO 01 5 j £" M H lO H or> mm sO l> O^C O 1/ ) ooc 00 v > ov: M l> O O t^00 ^■ m oooc vO CO *0 Cs IO c* ) CO CO Mf sO 01 CO00 Total Nuw AND BlRl oo oi oj co r~ co h w oooc ^ co hi t- h ic ooo ifoc ro cs Ooc c- c H O O O VO H N ■* Cv O O OC COO M- IO JS.Q oo "3" N ro h ro h CM 1- W H ■z MM -p ^ - o c co -^1- IO CO io o *0 Tf COC O t- I> co oo^ M ^j- 1^ IO o c 01 0\ -^C io\C o\ o •o C\ rj- r- mi/ 5 M ro mo o o o c CO H N C\ W J- CO OS w On ° H O t^ \f O 0\ oo cmC\ »cO\ O io O ro ^tv Oi co cooc 2 ■st-io tJ-o. 00 1> \a o w a r^ 'T N t- ro C CO t" oi •»\C 00 00 0) CO 00 O a h- cn t^ o<: o->c r- c M (O l> C\ M; in <+0 Mb- Wt- OO NO ^t ^J- co w c l-i c\ H <- 3 O t*J 0} £ "o >, .5 o 3 gg 1 Pi 3 i.l i sjoi = ££ 1 ^s 3 iH 3 |l i ^ bi ' ^.i fc ■5 £ rt c rt c •^3 a cd c aj c ►5 c 2PL '■5 J d o P OS (5 fa C ti W Q OS o *c t T •c •c TE ■c m ,C ^ ^ J3 ^3 rC ^3 X J3 ^3 J3 o o CJ ooo O0 sO a a m o 3 ro vO •* Oip) H 00 (N 01 01 O t- ■* r~*o a o CO C- o D P0 o t- moo in *d- in ro ^-o o io r-. o ro H ■* t- coo I>0 r~vo oo l^>0 \Q ") *o m ■* ro 1/3 rj- ro ^f lO o sO^O 00 O 00 l/} -^J-00 00 ■* r-- en WW r~ C\ o oo m o B .£f z;ph ££ >.§> >.s> SJS SJS 8>J> 8>m OS rt a d c9 <« O 384 760 428 208 98 4i 15 1 23 -5 22.6 17.8 13.2 9-i 6.1 3-7 2.0 1 . 1 •5 •3 . 1 The chief value and interest of Table VI (showing the number of mothers according to the number of their living children) depends upon a comparison with the section of Table V, which shows the number of mothers according to the number of children born to them. The practice of midwifery and its proper control has come to be recognized in recent years by health officers as so important a matter that a certain amount of space may appropriately be given here to the subject. Table VII Births Attended by Midwives, According to the Nativity of the Mothers Nativity of Mother Total births Births Attended by Midwives Number Per cent of total births Native white Foreign-born, white England, Scotland, Wales Ireland Germany Italy Russia Austria-Hungary Poland (includes German, Austrian and Russian Poles) Canada Other foreign-born 64,889 37.9H 2,504 14-165 3-9 1,879 2,296 12,998 3.665 6,345 4.703 2,219 1,940 28 29 633 5.276 1. 174 3.630 3. 112 44 239 i-5 i-5 27.6 40.6 32.0 57-2 66.1 2.0 12.3 The first fact made evident by Table VII is that if it were not for the foreign-born part of the population, there would be no midwife problem. Less than 4 per cent of the births to native mothers were attended by midwives, while more than 37 per cent of the births to foreign-born women were, so attended. Here again the highest percentages are found among the Italians, Russians, Austro-Hungarians and Poles, although the Germans also employ a large number of these women in preference to physicians. In contrast to these, attention is directed to the exceptionally small number of confinements of British, Irish and Canadian mothers attended by midwives. Apparently they employ midwives even less frequently than do native women, but it seems likely that the majority of the mid- wives attendant on the latter were employed by women of native birth who were of Italian, Russian or Austro-Hungarian parentage and with whom the custom of the native country of their parents still held considerable sway. Table VIII is a tabulation of the 49 cities or villages, each having a population of 10,000 or more, arranged in order according to the extent to which midwifery is practiced in each and showing, at the same time, the relation of this practice to the number of German, Italian, Russian, Polish and Austro-Hungarian residents. The correlation of these two is so obvious that further commentary seems unnecessary. J 3 Table VIII The Practice of Midwifery in the Cities and Villages of 10,000 or More Inhabitants City Total births Births Attended by Midwives Number Percentage Per cent of total population comprised by Germans. Italians, Poles, Russians and Austro- Hungarians Lackawanna North Tonawanda Amsterdam Dunkirk Port Chester Buffalo Rome Schenectady Utica -. . . Yonkers Mt. Vernon Binghamton Little Falls Poughkeepsie Auburn Watervliet Albany New Rochelle Cohoes Niagara Falls Ossining Troy Syracuse Hudson Rochester Newburgh Peekskill Saratoga Springs . . Olean Oswego Jamestown Watertown Rensselaer Elmira Ogdensburg Kingston 812 394 993 543 504 13,064 706 2,135 2,441 2,504 891 1,508 455 759 854 256 2,283 732 57i i,437 224 i,336 3,851 356 6,825 533 320 257 502 572 827 685 162 983 336 469 474 178 438 235 206 ,196 275 828 911 917 313 527 145 221 217 55 466 141 107 255 38 222 587 53 66 36 27 5i 53 88 33 5 28 6 5 43-6 23-5 26.3 23.6 23.2 18.4 14.0 ■17-3 19.6 20. 1 16.9 9.0 23.0 9-9 11. 9 6.4 10. 1 8.2 8-5 16.6 14-5 8.0 13-4 15-2 15-9 7-i 9.2 5-5 9-2 7-9 4.2 4-9 3-4 8.0 1.8 14 Table VIII {continued) The Practice of Midwifery in the Cities and Villages of 10,000 or More Inhabitants {continued) City Total births Births Attended by Midwives Number Percentage Per cent of total population comprised by Germans, Italians, Poles, Russians and Austro- Hungarians Johnstown . Gloversville Cortland . . . Ithaca Corning .... Lockport . . . Middletown Glens Falls. Hornell Batavia .... Geneva .... Fulton Plattsburg . 418 269 34i 343 357 285 303 291 337 354 296 222 In the final summary, therefore, it seems obvious that although the preceding tables relate to the single year of 191 6 only, there is no ques- tion but that the foreign element in the population of New York State affects the general birth rate in this State to an extraordinary degree. This particularly applies to the large number of Italians, Russians, Poles and Austro-Hungarians, the greater number of whom have settled in this country during the past fifteen years, having arrived here for the most part during early adult life, married at an early age and reared large families, the birth of each child following closely upon the preceding one. The majority of them are still in the most fertile period of life and very few of them are past the reproductive age. Furthermore, considering the general poverty among these people, their propensity to settle in the most crowded and densely populated districts of the large industrial and manufacturing centers, that many of the women help in earning the livelihood of the family through out- side work and that most of them are not only unable to read and write English, but also unable to speak it, being thereby incapable of under- standing and of following the sanitary regulations, etc., it is to be 15 "expected that their effect on the infant mortality of the State is also very considerable. The logical conclusion to be arrived at from a study of the foregoing data is therefore manifest. It is that in all future campaigns for the improvement of birth registration or for the conservation of child life, more careful consideration must be given to parental nativity. This should be determined beforehand in each community selected for study along these lines. It is the sine qua non of all real progress and efficiency attainable in this direction.