Table 2.

Efforts to Address Infant Mortality in the United States (1850‐1950) and in LMICs (2000‐2015)

	United States, 1850‐1950		LMICs, 2000‐2015a
Intervention Area	Structural	Individual/Household	Structural	Individual/Household/Health Facility
Sanitation	Sewage systems Sanitary conventions Sanitary engineers as designated positions Filtration Chlorination	Education about infant hygiene	Boreholes or pumps	Stand‐alone toilets Education on the safe disposal of child feces and how to purify water at home Hand washing Subsidies to build latrines Direct provision of toilets to schools or households Provision of oral rehydration therapy Soap distribution
Civil and vital registration	Birth registration area created and expanded Congressional resolution on birth registration Birth registration prioritized by Children's Bureau State and national registration system	Parents receive information about birth registration	Biometric identification Technical assistance and interventions to improve civil registration and vital statistics systems	National surveys as a replacement for poor national data
Breastfeeding and milk purification	Inspection and testing of milk Pasteurization of milk Milk stations	Education about breastfeeding	None	Initiation of early breastfeeding (within the first hour) Education on exclusive breastfeeding for 6 months and continued breastfeeding and complementary feeding from 6 months Home pasteurization of milk
Medical care	Improvements in obstetric care Shift from miasma to germ theory of disease Improvements in medical education and the growth of pediatrics		Training of skilled birth attendants Strengthening of pre‐ and postnatal care Shaping global and local markets for life‐saving commodities	Simplified antibiotic therapy for neonatal infections Provision of 13 life‐saving commoditiesb Immediate thermal care (to keep the baby warm) Hygienic cord and skin care Neonatal resuscitation with bag and mask Kangaroo mother care for preterm (premature) and for less than 2,000‐gram babies Case management of childhood pneumonia, diarrhea, respiratory distress syndrome, sepsis, meningitis Postnatal contact with a skilled health care provider Care for children with developmental delays
Vaccination	Pertussis and diphtheria vaccination introduced but not widespread		Vaccine delivery infrastructure, including cold chain	Vaccine campaigns Routine immunization plus H. influenzae, meningococcal, pneumococcal, and rotavirus vaccines Incentives for vaccination
Health behavior	None	Children's Bureau messaging to change health behavior Maternal education about infant hygiene and feeding	None	Hand‐washing interventions Chlorine tablets Maternal education Incentives to deliver in hospitals
New institutions and policies	Children's Bureau American Medical Association American Public Health Association Sheppard‐Towner Act State‐level health boards National Board of Health		Global Millennium Development Goals and Sustainable Development Goals 2016‐2030 Global Strategy for Women's, Children's and Adolescents' Health UN Commission on Life‐Saving Commodities for Women and Children Every Newborn: An Action Plan to End Preventable Deaths Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) National Health Ministry Ministry of Woman and Child Development or equivalent Ministries overseeing sanitation infrastructure Registrar General
Other	None	None	Girls’ education	Birth spacing Insecticide‐treated bed nets and quality‐assured artemisinin‐based combination therapies Management of severe acute malnutrition: ready‐to‐use therapeutic foods, micronutrient supplements, vitamin A capsules, antibiotics, therapeutic food formulations

Sources: UNICEF, World Health Organization 201558; Every Woman Every Child 201559; Every Woman Every Child 201260; UN Commission on Life‐Saving Commodities 201561; The Partnership for Maternal, Newborn & Child Health 201162; Guiteras et al. 201563; Arnold et al. 201364; Dangour et al. 201365; World Health Organization and UNICEF 201366; United Nations General Assembly 201518; World Health Organization 2014123; United Nations General Assembly 200068; Abbott 192346; Tisdale 193370; Shapiro 195042; Condran and Crimmins‐Gardner 197823; Gaspari and Woolf 198524; Combs‐Orme 198871; Meckel 199072; Preston and Haines 199121; Fee 199444; Preston 199641; Hetzel 195049; Brosco 199947; Centers for Disease Control and Prevention 199926; Almgren et al. 200034; Fishback et al. 200138; Stern and Markel 200227; Wolf 200373; Markel and Golden 200431; Condran and Lentzner 200420; Cutler and Miller 200548; Nathanson 200750; Lee 200774; Moehling and Thomasson 201275; Stoll 201325; Alsan and Goldin 201576; Bhutta and Black 2013104; US Children's Bureau 191491; Darmstadt et al. 2014.15

^aLMICs, low‐ and middle‐income countries. These are largely donor‐funded efforts to reduce infant mortality.

^b13 commodities: oxytocin (postpartum hemorrhage); misoprostol (postpartum hemorrhage); magnesium sulfate (eclampsia and severe preeclampsia); injectable antibiotics (newborn sepsis); antenatal corticosteroids (ANCs) (preterm respiratory distress syndrome); chlorhexidine (newborn cord care); resuscitation devices (newborn asphyxia); amoxicillin (pneumonia); oral rehydration salts (diarrhea); zinc (diarrhea); female condoms; contraceptive implants; emergency contraception.