Healthy babies, to be specific. Because worldwide, infant and child mortality has fallen greatly; and is still falling; and will almost certainly continue to fall.
In premodern societies, meaning pretty much the entire world before 1820 or so, between a fifth and a quarter of all kids died before their first birthday. Then, of the survivors, roughly about another fifth-to-a-quarter died before their fifth birthday. Then, of those survivors, about 10% died before their 20th birthday. If you do the math, that means that every baby had roughly a coin-flip chance of living to adulthood. The exact numbers varied by place, time, and circumstances. But worldwide, that was the general state of affairs.
Today, worldwide about 96% of babies survive their first birthday. Of all babies born worldwide, about 90% live to reach age 20.
That’s a worldwide average. In developed countries, those numbers are “over 99%” and “around 99%”. In the most dangerous, backwards and unhappy corners of the world the numbers are much lower, but they’re still high by historical standards. A baby born in Afghanistan or Niger or the Democratic Republic of the Congo today, in 2026? Has better odds than a baby born in the England of George III and Pitt the Elder.
Nigeria today has an infant mortality rate about what the US had in 1946, when the Baby Boom got started. The Boom peaked around 1952. The infant mortality then (a bit over 3%) is about what you find in current-day Bangladesh. Pretty much the entire human race today faces a lower rate of infant mortality than that faced by our parents and grandparents.
This doesn’t get much discussed, perhaps because it’s a “what about all the planes that land safely” kind of story. Also, when one discusses long-term positive trends, academic friends may become restive and start murmuring about teleological errors and Whig History.
But I think it’s really interesting. That’s partly because it really is very good news, but also — putting my nerd hat on — because this almost certainly represents a permanent and irreversible change in the human condition.
(A pause here to define the topic: we’ve been talking about pro-natalism lately. This isn’t that. Today’s discussion is not about whether people should have more babies. It’s about what’s happening with the babies that people are actually having.)
Right, so. Infant mortality has been falling steadily, worldwide. Why?
Well, a lot of reasons. Here’s one: there’s a cluster of technologies around childbirth. And, neat thing: many of those technologies? Including ones that have a dramatic effect on infant mortality? Are cheap; simple; pretty easy to make and use; and widely, almost universally available. (1) A few examples:
— Basic medical equipment. Stethoscope, blood pressure cuff, thermometer, scalpel, forceps… all of those are simple devices that are available everywhere. Hypodermics are ubiquitous and very, very cheap. Reliable pulse oximeters are $10 on Amazon.
— Antisepsis. You can do basic antisepsis with alcohol. Alcohol is everywhere. (Reasonably pure alcohol solutions are a late medieval technology.)
— Antibiotics. A bunch of different antibiotics are very cheap, and several are surprisingly easy to produce. All the antibiotics that end in -cillin, for instance? Those can literally be made by a careful high school student in a cellar. Even the poorest developing country can make them (though as a practical matter, it’s usually cheaper and easier to import). (2)
— A bag-and-valve mask, with oxygen. B&V masks are everywhere; decent quality reusable ones are less than $50. Bottling oxygen, also very widely available — it’s 19th century technology. (Really. Oxygen was first bottled in 1868, and bottled oxygen was fist used in medicine in 1885.)
— The germ theory of disease. Just knowing that microbes cause infection, and can be transmitted by touch, fluids, coughing, etc., is a huge leap forward. And you can implement that with things like masks and disposable gloves that, say it again, are dirt cheap, widely available, and easily made anywhere. And “newborns have weak immune systems, so keep them clean and away from sick people” — we didn’t know that a couple of hundred years ago! But now we do know it, and we’re not going to un-know it.
— And of course, basic education in maternal health and childbirth. Basically, training midwives up to a certain standard. To grossly oversimplify, most of the world is already doing this. The certification standards in developed countries are pretty high (some years of experience plus several years of higher ed), but that’s almost certainly overkill. It turns out that while advanced education is nice to have, you can get significant reductions in infant mortality from even very basic education and training.
(1) There’s also an intermediate class of childbirth-related technologies that are not simple in the sense that they could be locally manufactured in a developing country, but that are nevertheless cheap and widely available. Ultrasound machines, for instance, are moderately complex bits of tech that are manufactured mostly in wealthy and middle-income countries. But you can buy a Chinese-made portable ultrasound scanner for a few thousand dollars, well within the reach of a hospital or clinic in a developing country. Similarly, oxytocin — a very useful tool for inducing labor, empowering contractions, and reducing uterine bleeding — requires a somewhat delicate solid-state chemical synthesis, and so is produced in only a dozen or so countries. But it’s available everywhere, worldwide. (3)
(2) These days, developing countries have a lot more industry than you might think. To give one example, Uganda currently has a couple of million college graduates, a modest but real local chemical industry, and several large pharmaceutical factories. (I visited a couple of them back in my former career.) The money may be South Asian, the equipment may be Chinese, but the technical staff are almost entirely Ugandans, and they know their stuff. I’m not sure if they currently produce antibiotics or oxytocin, but there’s no question that they could if they wanted to.
(3) Although — deep cut nerd here — oxytocin was first used medically in 1909, while its modern synthesis wasn’t developed until around 1960. Where did medical oxytocin come from, for those fifty years? From slaughterhouses. Oxytocin can be extracted from the pituitary glands of mammals. We use the synthetic stuff because it’s purer and safer, but we could still get it from the local meat packer.
So: because these technologies are cheap, simple, robust, useful, and very widely distributed, their uptake and use is likely to be permanent. It’s very hard to imagine a global catastrophe that would eliminate the ability to distill alcohol or the knowledge that microbes cause disease. In order to go back to premodern levels of infant mortality, we would literally have to bomb ourselves back to the Stone Age.
Okay, that’s the technological side. What about the political / social aspect?
Well, it turns out that keeping babies alive is a very popular policy. So much so that even truly corrupt and extractive regimes, overseeing unpleasantly patriarchal societies, will usually invest some resources in maternal and infant health. Like, the infant mortality rate in the Islamic Republic of Iran? Currently about 1/10 of what it was when the Islamic Republic was founded back in 1979.
And if your leadership is obsessed with National Greatness, well, healthy babies make sense there too. (4)
(4) Authoritarian and blood-and-soil regimes tend to converge on iconography of a happy / contented mother with a healthy baby (with baby usually either ungendered or male).
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Which is very obnoxious, but healthy babies? Still a good thing anyway!
And creepy propaganda aside, maternal and child health makes economic sense too. From a cold blooded fiscal /economic POV, modest investments in basic maternal and infant health? Can give ridiculously large payoffs down the line.
And then of course, healthy babies are better than sick or dead babies. Isn’t that pretty close to a moral absolute? The advances that have reduced infant mortality have eliminated millions and millions of heartbreaks and tragedies, saving countless human lives. You have to work pretty hard (4) to not see that as a vast and great Good Thing.
(4) Although I’ve seen people try.
The limited available evidence suggests that hunter-gatherers and human societies of the deep past also had very high infant, child, and pre-adult mortality. Whether it was as bad as premodern agricultural societies is less clear, but it was definitely much worse than pretty much anywhere in the modern world. A baby born in Somalia today almost certainly has much better odds than a baby born into some Paleolithic tribe of wanderers.
So, to loop it back: the case for this being a permanent and irreversible change in the human condition is pretty strong. And I’d suggest that this has implications for everything from current political economics to the long-term evolutionary future of humanity.
But as noted, for some reason it doesn’t get much talked about. It’s a huge departure from the historical norm that just seems to be… taken for granted.
Some of this is because in the developed world it’s old news (although not /that/ old — again, as recently as the 1940s, the US had infant mortality rates worse than much of the developing world today). And today it’s happening in the developing world, and who really cares about good news from Senegal or Laos? Also, even though it affects everyone and everything, issues relating to childbirth and infancy are hard-coded as Woman Stuff.
Oh, and it annoys people who want to be relentlessly negative about the future.
Which, whatever, guys.
But anyway. Permanent and irreversible change in the human condition — for the better.





