By Timur Natkhov (HSE University) and Natalia Vasilenok (Stanford University)
This blog post is based upon the authors’ article forthcoming in the Economic History Review.
At the beginning of the twentieth century, Nikolai Gundobin, the founder of Russian pediatrics, called infant mortality a deadly epidemic that annually takes hundreds of thousands of lives. In no other European country was the epidemic of infant mortality as severe as in Russia, where the rate was approximately 250 deaths per 1,000 live births in 1900. For comparison, the infant mortality rates in 1900 were 230 in Germany, 174 in Italy, and 160 in France. In our forthcoming paper in the Economic History Review, we demonstrate that infant mortality in the Russian Empire differed dramatically across ethnic groups and was primarily driven by ethnic Russians.
Figure 1 shows that the aggregate infant mortality rate in the Russian Empire hides substantial geographic variation. Northern and eastern provinces experienced much higher rates than western and southern provinces. For example, the infant mortality rate was 379 in Perm province in north-eastern Russia, where Russians comprised 90 per cent of the population, and only 184 in the Ukrainian province of Kherson. Using data on districts (uezd) of the European part of the Empire in 1900-3, we demonstrate that infant mortality was highly associated with the share of ethnic Russian population, but not with the level of economic development, access to healthcare, or literacy. Remarkably, the share of Russians did not exhibit any relationship with mortality for the older cohorts of children. We reproduce this result when we focus on infant mortality among the Orthodox population in a single province with a notable Ukrainian minority. Contrasting Ukrainians and Russians in Saratov province, we find that Russians exhibited significantly higher infant mortality but did not differ from Ukrainians in child mortality.
Figure 1. Infant mortality across provinces, 1900-3
Notes: Infant deaths are per 1,000 live births. The map is coloured using the quantile scale.
Figure 2 shows the shares of deaths caused by different infectious diseases in 50 provinces of the European part of the Russian Empire. The most frequent cause of death was child diarrhoea, comprising 31 per cent of recorded pathogen-induced deaths. However, the high frequency of child diarrhoea was driven mainly by provinces with a predominantly Russian population, where it amounted to 41 per cent of deaths. In contrast, in non-Russian provinces, child diarrhoea accounted for only 17 per cent. Zooming in on Voronezh province—another province with a substantial Ukrainian population—we find higher child diarrhoea mortality among Russians than among Ukrainians, and no difference in adult diarrhoea across the two ethnic groups. It appears there must have been something unique about Russian households that affected infants, but not toddlers, and caused higher death rates from child diarrhoea.
Figure 2. Death from infectious diseases, average over 1903, 1906, and 1907
Notes: Deaths are per 1,000 population. Data are for 50 provinces of European Russia. Russian provinces are 25 provinces with the share of Russians above the median of 67%. Non-Russian provinces are 25 provinces with the share of Russians below the median.
To explain this puzzle, we turn to the contemporaneous medical studies conducted by rural doctors among Russian and Ukrainian peasants in different parts of the Empire in the late nineteenth and early twentieth centuries. The studies reveal that infant feeding practices differed dramatically between Russians and Ukrainians. The unique quantitative evidence collected by the rural doctors suggests that up to 90 per cent of Russian infants got introduced to supplementary food before they reached six months of age, in contrast to 43 per cent among Ukrainians. Therefore, following imperial doctors, we can link the Russian mortality pattern to unhygienic infant feeding practices widespread among ethnic Russians. Contemporary epidemiological studies support this explanation showing that exclusive breastfeeding protects an infant’s digestive system, which fully develops only by at least six months of age, against potentially lethal gastrointestinal diseases.
The origins of Russian infant feeding practices are yet to be uncovered. However, we can hypothesize that the timing of the introduction of solid food may have been an environmental adaptation to the length of a growing season. In central Russia, the growing season lasts about four months, in contrast to about six months in Ukraine. It means that in four months, Russian peasants had to plow the land, sow the seeds, reap the harvest, and prepare the land for the winter crops. This required extensive labor inputs in a relatively short period of time, and additional labor was provided by women. Figure 3 depicts Russian women working in the fields alongside men.
Figure 3. Haying, near rest time, 1909
Source: Sergei Prokudin-Gorski, Library of Congress, LC-P87- 5215 [P&P] LOT 10332-B.
Our evidence, reported in the paper, shows that around 45 per cent of infant deaths in Russian provinces took place in summer and only 20 per cent in winter. In Ukrainian provinces, infant deaths spread more evenly within a year: about 28 per cent in summer and 25 per cent in winter. It appears that summer fieldwork accentuated the trade-off between maternal care and women’s labor inputs, compelling Russian peasant women to reallocate their time to agricultural work at the expense of infant care.
Overall, our study emphasizes the importance of cultural practices in shaping infant mortality and points to the questions that need to be answered next. Why do some communities maintain unhealthy health care practices? Can the best practices spread from high to low performing groups? What would affect the success of this diffusion?
To contact the author:
Gundobin, N. P., Detskaya smertnost v Rossii i meri bor’bi s nei (St Petersburg, 1906).
Lamberti, L. M., Walker, C. L. F., Noiman, A., Victora, C., and Black, R. E., ‘Breastfeeding and the risk for diarrhea morbidity and mortality’, BMC Public Health, 11 (2011).
Mitchell, B., International historical statistics: Europe 1750-2005, 6th ed. (Basingstoke, 2007).