Infant-feeding practices and infant survival by familial wealth in London, 1752–1812

Abstract

Anecdotal evidence indicates that high-status women in England generally did not breastfeed their children in the seventeenth and early eighteenth centuries. Metropolitan families of varied social status also often sent their children out of London for wet-nursing. However, anecdotal sources and rural burial registers also suggest that these practices declined rapidly from the mid-eighteenth century, and were replaced by a culture of maternal breastfeeding in all social classes. These changes in infant-feeding practices have been argued to explain much of the dramatic improvement in infant mortality rates in London in this period. Here we used quantitative evidence from a partial family reconstitution of the London parish of St. Martin in the Fields to test these claims. Using birth interval analysis to infer breastfeeding patterns in families by four categories of wealth, we found that birth intervals were close to the national average in pauper and poor families, but much shorter in wealthier families, in the period 1752-74. We also found evidence that many infants especially in wealthier families were missing from observation, consistent with high levels of rural wetnursing. Both these phenomena declined between 1775 and 1812, suggesting a convergence in breastfeeding practices to the national norm. We used event history analysis, with corrections to aggregate rates for missing infants, to compare mortality rates over time and by wealth category. We found that infant mortality was initially higher in wealthier families, but declined in all groups over the period 1752-1812. We conclude that increases in maternal breastfeeding were probably important in improving survival of infants from wealthier families, however changes in breastfeeding patterns were insufficient to account for the ubiquitous improvements in mortality of urban-born infants in this period.

Mortality, migration and epidemiological change in English cities, 1600–1870

“…133-50; Newton, 2011 ). In St Martin in the Fields, adjustments for the effects of rural wet-nursing revealed a distinct survival disadvantage for wealthier infants across the first year of life, consistent with shorter average birth intervals and lower rates of maternal breastfeeding in wealthier families in the mid-eighteenth century ( Davenport, 2019 ).…”

“…In the wealthy central London parish of Cheapside 80 % of children aged under 3 years and assumed to be alive were omitted from the 1695 assessment, compared with only 20 % of older children ( Newton, 2011 ). Indirect estimates of child absence suggested that nearly a quarter of all infants were absent at nurse in the large parish of St Martin in the Fields in the mid-eighteenth century, and 40 % of infants in the wealthiest decile of families ( Davenport, 2019 ). The tendency to bury nurse children in their nurse’s rural parish is therefore likely to cause an underestimation of infant mortality rates, and to bias comparisons by social status (whether based on urban parish registers, or on archaeological evidence from urban burials) (e.g.…”

“…Anecdotal and indirect demographic evidence (from birth intervals) indicates that the practice of rural wet-nursing waned in the late eighteenth century, in tandem with a rise in maternal breastfeeding, and also possibly a rise in hand-feeding of infants at home ( Davenport, 2019 ; Fildes, 1986 ; Landers, 1990 ). The decline of private wet-nursing coincided in London with the establishment of the London Foundling Hospital and its adoption of the practice of rural wet-nursing for its charges, which may have lowered the social status of rural wet-nursing, as well as making it more difficult to obtain the services of wet-nurses.…”

“…Other environmental and domestic factors were also key. Water provision and quality improved markedly in English cities over the period c.1850-1900, in tandem with marked declines in water-borne diseases including cholera, typhoid and dysentery ( Davenport et al, 2019 ; Hamlin, 1988 ; Hassan, 1985 ; Hinde and Harris, 2019 ; Wohl, 1983 ). Infant diarrhoeal mortality however showed no improvement until after 1900.…”

Why were infants dying and what were they dying from? Infant mortality patterns in the Greek urban centre of Hermoupolis, Syros (1860–1940)

“…On the other hand, weaned infants are exposed to higher risks related to inadequate nutrition and/or contaminated food, especially during the summer months. These summer peaks in infancy are often associated with large occurrence of diarrhoeal diseases in this age-group and less often with non-universal or early cessation of breastfeeding (Davenport, 2019). Therefore, despite the widespread practice of breastfeeding in the city, the persistence of summer peaks after the first month of life may indicate the early initiation of supplementary food.…”