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Premature births and malnutrition: how infant mortality in one home rose to 900% of national rates

The findings were revealed in the final report of the Mother and Baby Homes Commission today.

The infants graveyard at Sean Ross Abbey in Roscrea
The infants graveyard at Sean Ross Abbey in Roscrea

IN ITS LONG-AWAITED report, the Mother and Baby Homes Commission of Investigation singled out the “appalling” levels of mortality among children born to unmarried mothers who were institutionalised by religious orders in the 20th century.

Infant mortality at the homes under investigation was described by the commission as “probably the most disquieting aspect of the institutions”.

The commission’s final report – which can be read here – was published today.

It states that prior to 1960, mother and baby homes did not save the lives of children born to mothers outside of marriage; rather, they “significantly reduced their prospects of survival”.

The homes under investigation sought to provide a refuge to unmarried women and their babies when their families would not provide one at all.

But the commission’s report lays bare just how harsh that refuge could be for women and children who had been shunned by Irish society.

Around 9,000 children died in the institutions under investigation by the commission – about 15% of all the children who were in the homes.

A statistical analysis by TheJournal.ie using figures from the Central Statistics Office (CSO) also found that infant mortality rates in some homes were much higher than that in certain years.

Certain institutions saw rates up to six times the equivalent of the national infant mortality rate in some years, with the rate in one home during one year being more than nine times the national equivalent.

According to the CSO, the highest rate of infant mortality in Ireland occurred in 1943, when 8.3% of children out of every 1,000 born that year died before their first birthday.

Infant mortality rates recorded in mother and baby homes were often multiples of this, particularly during their initial years in operation.

Hundreds of children died in some homes over a period of a few years, and most of those that did not experience such high numbers of mortality still reported dozens of deaths during their worst years.  

Here’s how rates compared in each of the institutions examined by the commission:

St Patrick’s Mother and Baby Home, Pelletstown

St Patrick’s in north Dublin was one institution where hundreds of infant deaths were recorded during its first years in operation.

Although this tailed off in latter years, almost one in five children who was admitted to the Pelletstown home between 1920 and 1998 died.

Approximately 18,829 children passed through the home over nearly eight decades, 3,615 of whom (roughly 19%) died at the home or shortly after their birth to a mother who lived there.

Reflecting a wider trend in Irish society at the time, infant and child mortality at the home was particularly high during the years 1920 and 1942, when 78% of child deaths at the institution occurred.

But in a departure from what was happening in Ireland at large, institutional records show that the highest year of infant mortality at Pelletstown, 1920, was 50% compared to a national rate of 8.3% for the same year.

Even a low of 23.8% that decade in 1927 was more than treble the national rate of 7.1%.

Children died in the hundreds that decade, with 596 dying between 1924 and 1929 alone. 

Infant mortality trended upwards for much of the 1930s, peaking in 1937 when a rate of 41.2% was recorded (compared to a national average of 7.3%), but began to decline from then.

By the 1960s the rate had fallen to 6.5% (compared to 2-3% nationally) before bottoming off at about 1% in the late 1970s.

Pelletstown 2 Source: Mother and Baby Homes Commission of Investigation

Pelletstown Source: Mother and Baby Homes Commission of Investigation

The majority of deaths for which information is available (81.2%) occurred during infancy and institutional records show that 2,048 children (59%) were unaccompanied at the time of their death.

Information relating to cause of death was available for 3,511 children.

The majority of deaths were due to non-specific causes (19.2%) and included things like “congenital debility”, “delicacy from birth”, prematurity and inanition (exhaustion from lack of nourishment).

Other deaths included respiratory infections (18.4%), mainly pneumonia, bronchopneumonia and bronchitis, and gastroenteritis (15.6%).

There were also deaths from tuberculosis (8.7%), “malabsorption” (8%), mainly marasmus (undernourishment causing a child’s weight to be well below normal) and malnuitrition.

Other causes (5.8%) included peritonitis and a range of one off causes of death such as meningitis/encephalitis (4.8%), spina bifida (4.4%), congenital syphillis (3.2%), congenital heart disease (2.9%) and measles (2.1%).

Tuam

Tuam, where the discovery of children’s bodies in a disused septic tank became one of the catalysts for the commission’s investigation, also saw mortality rates in children far higher than national averages.

Almost three in every ten children linked to the home over a forty-year period from 1921 to 1961 died.

Approximately 3,251 children were born or admitted to Tuam; 978 of them (roughly 29%) died.

Hundreds of deaths were recorded in the 1940s in particular, but there were outliers to this, including more than 40 deaths in 1926 and more than 50 deaths ten years later.

Seven in ten children admitted to the home during its existence were born outside of marriage, but out of all the children who died, 79% were considered ‘illegitimate’.

Like St Patrick’s and Irish society in general, infant mortality at the home was highest during the 1920s. The figure peaked in 1922, when the home was located in Glenamaddy and there was a mortality rate of 41.3% (compared to a national rate of 6.9% that year).

The figure fell after the home relocated to Tuam: infant mortality stood at 13.56% in 1927, around twice the national rate of 6.8% that year.

But there were further increases in the 1930s and 1940s.

The infant mortality rate rose to 38.95% in 1933 – six times the national average of 6.5% - and remained above 30% intermittently until 1949.

The number gradually fell, except for a jump in 1953, and trended downwards until the closure of the home in 1961.

Tuam deaths Source: Mother and Baby Homes Commission of Investigation

Tuam 2 Source: Mother and Baby Homes Commission of Investigation

Unaccompanied children made up 33.5% of all admissions to Tuam, and accounted for 22.2% of child deaths in the home.

Information relating to the age of death was available for 932 of children who died. As with other homes, the vast majority of children (80%) died in infancy.

Information relating to cause of death was available for 972 children.

The leading cause of death was also non-specific causes, and included prematurity and congenital debility (18.2%).

A significant number of deaths were also caused by respiratory infections – mainly pneumonia, bronchopneumonia and bronchitis (18.1%).

Over 11% of deaths were notified as being due to convulsions, 10.8% were due to other causes, mostly whooping cough.

A further 8.4% were notified as tuberculosis, 5.7% were due to influenza and 5.5% were due to gastroenteritis/gastritis.
4.7% were notified as meningitis, 3.9% as measles; 2.8% as congenital heart disease and 2.6% as being due to haemorrhage.

Bessborough

Cork home Bessborough saw a lower number of child deaths as a percentage of admissions compared with the total number of deaths across Ireland’s mother and baby homes.

However, as was the case with Pelletstown and Tuam, infant mortality rates were multiples of the national rate in certain years.

During its worst years in from 1939 to the mid-1940s, close to 400 child deaths were reported at the home.

Approximately 8,938 children were admitted to the home between 1922 and 1998, with 923 children’s deaths linked to the institution – roughly 10% of all children admitted.

The infant mortality rate at the home was particularly high during the 1920s, owing in part to the low number of births at the home that decade.

For example, 16 deaths among infants born in 1926 represented an infant mortality rate of almost 46% that year.

The infant mortality rate decreased to 13.6% in the first year of the next decade, but was exactly twice the national rate of 6.8% that year and the figure increased from 1931 onward.

Mortality peaked in 1943, when a staggering 75% of babies born in the home that year died during their first year of life – nine times the national rate of 8.3%.

Infant mortality rates fell in the following years, dropping to around 12% in 1946 and continuing a downward trend. By 1952 the rate stood at 2.15% – this time around half the national average of 4.1%.

Despite an increase between 1958 and 1960, when there were around nine deaths each year, the mortality rate decreased to around 2% in 1961 and remained in that range until the closure of the home in 1998.

Bessborough2 Source: Mother and Baby Homes Commission of Investigation

Bessborough Source: Mother and Baby Homes Commission of Investigation

Available records show that almost 79% of children who died were accompanied by their mothers at the time of their death, with 21% – or one in five – dying unaccompanied.

Infant mortality made up the vast majority of deaths of children at the home: 96% who lost their lives died before first birthday.

Information relating to the cause of death was available for 912 children.

Around 20% of deaths were notified as non-specific, including congenital debility, being “delicate from birth”, prematurity, or “weakness from birth”.

A further 18% were due to malabsorption (including malnutrition) and another 18% were due to respiratory issues such as bronchitis, pneumonia and congestion of the lungs.

Gastroenteritis was attributed to 16% of deaths, while tuberculosis caused 4% of deaths.

Sean Ross

Revelations that infant human remains had been located during an excavation at Sean Ross home in Co Tipperary was one of the stand-out aspects of the commission’s final report.

The home was in operation from 1931 to 1969 and operated under the care of the Order of the Sisters of the Sacred Hearts of Jesus and Mary.

Approximately 6,079 children were born or admitted to the home in those years, 1,090 of whom died in infancy or early childhood – around 18% of the total.

Close to 800 of these deaths were reported in a thirteen-year period between 1932 and 1945.

Institutional records show that most infant and child deaths (79%) occurred between 1932 and 1947, and that 95% of deaths occurred in infants.

Infant mortality in Sean Ross was highest in the 1930s. In its first year of operation, an infant mortality rate of almost 31% was recorded – comparable to a national rate that year of 6.9%.

That increased to 41% during 1932 and peaked at almost 50% in 1936, almost seven times the national infant mortality rate of 7.4%.

By 1939, infant mortality at the home declined to just under 18%, but increased again during World War Two, reaching 42% in 1942 (compared to 6.9% nationally).

Sean Ross Source: Mother and Baby Homes Commission of Investigation

Sean Ross 2 Source: Mother and Baby Homes Commission of Investigation

Infant mortality declined to around 10% in 1947 and remained at that rate on average over the intervening decade.

Between 1958 and the closure of the home in 1970 average infant mortality was around 3% – in and around the national rate.

Information relating to cause of death was available for 1,061 children.

Most deaths at the home (15.5%) were medically certified as being due to respiratory infections, such as pneumonia, bronchitis and atelectasis.

Another 13.3% were assigned to non-specific causes such as congenital debility, prematurity and being delicate/weak from birth.

A further 13% were attributed to generalised infections such as toxaemia, sepsis and septicaemia. 12% were due to gastroenteritis, gastritis and epidemic enteritis/diarrhoea.

Meanwhile, 8.1% were assigned to malabsorption, 8% to influenza, and 7.5% to asphyxia pallida and a range of mostly one off causes such as pertussis, chickenpox, jaundice, heatstroke and sunstroke.

Castlepollard

Compared to other homes and the overall percentage of children and infants who died in institutions, the overall number of deaths at Castlepollard in Co Westmeath were comparatively low.

Infant mortality rates in Castlepollard were by far the lowest recorded across all three homes run by the Congregation of the Sacred Hearts of Jesus and Mary, which also ran Sean Ross home.

However, like other homes, rates of infant mortality at the home were drastically higher than those across the country in certain years.

The commission found that a total of 4,559 children were born or admitted to the home between 1935 and 1971, of whom 247 died – roughly 5% of all children.

Infant mortality peaked in the home in 1940 when a rate of 26% was recorded, around four times the national rate of 6.6% that year. 

The rate had decreased dramatically in previous years to just 1.52% in 1937 and 6.25% in 1938, compared to national rates of 7.3% and 6.7% respectively.

But overcrowding at the home saw infant mortality increase to 26% in 1940 and 25.58% in 1941, multiples of the respective national rates of 6.6% and 7.4% in those years.

Restrictions on admission to the home in 1941 and an easing of overcrowded living conditions saw infant mortality decrease to 5.56% in 1942, with relatively low figures in most years until its closure thereafter.

Castlepollard1 Source: Mother and Baby Homes Commission of Investigation

Castlepollard Source: Mother and Baby Homes Commission of Investigation

In 93% of cases, the child’s mother was resident in the home at the time of the child’s death. Figures also show that most deaths (96.15%) occurred among infants.

Information relating to cause of death was available for 230 children, with the most frequently notified cause of death (26.1%) being congenital debility and prematurity.

Another 22.2% children were notified as dying from respiratory infections – mainly bronchopneumonia.

13% died from gastroenteritis and gastritis, 9.1% died from whooping cough and one off causes, and 6.9% died from congenital heart disease.

Another 5.2% deaths were attributed to malabsorption, and 3% as influenza.

Regina Coeli

Figures for Regina Coeli hostel for homeless and unmarried mothers in Dublin are more limited compared with other homes.

Statistics on infant mortality per year were not made available by the commission.

However, figures show that 5,434 children passed through the hostel between 1930 and 1998, with 734 associated child deaths – around 13.5% of the total.

Information relating to the age of children at their death was available for 626 children (85.3% of all child deaths), and showed that most children (90.4%) died in infancy.

No information was available about cause of death in the report.

Regina Coeli Source: Mother and Baby Homes Commission of Investigation

Bethany

Dublin’s Bethany Home, a residential institution mainly housing women of the Protestant faith, also saw higher percentages of child deaths.

Figures provided by the commission show that approximately 1,376 children were associated with the home between 1922 and 1971, of whom 262 died  – roughly 19% of all children.

Infant mortality at the home was deemed by the commission to be “high from the beginning of its operation”.

A rate of 33.3% was recorded in its first year of operation in 1922, almost five times the national infant mortality rate of 6.9% that year.

The commission noted that the administrators of the home “appear to have brought infant mortality under control” by 1931, with no child born in or to Bethany that year subsequently dying.

However, the rate soon began climbing again.

By 1936, infant mortality rate had increased to 34.6% and by 1943 had reached 62.1% – almost two in every three children born in or admitted to the home that year, more than seven times the national rate of 8.3% that year.

Bethany2 Source: Mother and Baby Homes Commission of Investigation

Bethany1 Source: Mother and Baby Homes Commission of Investigation

The rate reduced substantially to 17.6% by 1945 and declined further in 1948, when a rate of 3.6% was recorded – less than the national rate of 5%.

Rates remained relatively low thereafter; no deaths occurred among children born in or admitted to the home in 1950 and 1951 and in the years 1956-62 inclusive.

Information relating to cause of death was available for 256 children (97.7% of child deaths).

Most deaths (32%) were notified as being due to malabsorption. 15.2% were notified as gastroenteritis and 13.7% as respiratory infections – mainly bronchopneumonia and bronchitis.

A further 6.3% were notified as being due to non-specific causes – mainly congenital debility and prematurity.

Denny House

Like Regina Coeli, statistics for Denny House in Dublin were limited.

No breakdown of infant mortality was provided in the report, but the commission found that 1,134 children were born in or admitted to the home between 1920 and 1994.

Approximately 55 child deaths were associated with Denny House in that time – roughly 5% of the total number of children who passed through the home.

Available records show that 94.4% of these deaths occurred in infants.

Information relating to cause of death was available for 48 children, with the most frequently notified cause of death (35.4%) non-specific – mainly congenital debility and weakness from birth.

A further 16.6% of deaths were notified as gastroenteritis and 12.5% were notified as respiratory infections.

Ard Mhuire, Dunboyne

Records about mortality provided by the commission about the Ard Mhuire home in Dunboyne, Co Meath were also limited, largely due to the relatively small number of child deaths that occurred there.

Of the approximately 1,148 children who were admitted to the home between 1955 and 1990, just 37 died – roughly 3% of all children.

One child died at the home, five were admitted to the home and died elsewhere, and 31 were never admitted but their mothers had been living in the home prior to their birth.

Of the 37, 20 died in Holles Street hospital, five died in Our Lady’s Children’s Hospital, in Crumlin; three died in Temple St Children’s Hospital, and two died in the Rotunda Hospital.

All deaths occurred in infants.

Dunboyne Source: Mother and Baby Homes Commission of Investigation

Information relating to cause of death was available for 32 of the 37 child deaths (86.5%).

Most deaths (37.5%) were notified as being due to one off incidents of sudden infant death syndrome; potter syndrome; pyloric stenosis; congenital malformation and perinatal asphyxia.

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Respiratory infections – mainly bronchopneumonia – accounted for another 28.1% of deaths. 15.6% were notified as spina bifida, 12.5% were notified as non-specific causes, generally prematurity.

Cork County Home

Although (and perhaps because) relatively fewer children passed through Cork County Home compared to other institution, a higher percentage of children died there than in any other home.

Figures provided by the commission state that 2,408 children born to unmarried mothers were born in or admitted to the institution between 1920 and 1960.

Of these, 545 – or 22% – died.

Information relating to age at death was available for 526 of these children, and shows that 93.27% of those who died were infants. Almost half (44.5%) were not accompanied by their mother at the time of their deaths.

Infant mortality at Cork County peaked in 1925, when a rate of 33.7% was recorded – around five times the national infant mortality rate of 6.8%.

From 1926 to 1947 the average infant mortality rate was 23.7%. This ranged from a low of 14.5% in 1936 (almost double the national rate of 7.4%) to a high of 31% in 1940 (compared to a national rate of 6.6%).

Cork County Source: Mother and Baby Homes Commission of Investigation

Cork County 2 Source: Mother and Baby Homes Commission of Investigation

Infant mortality rates began to reduce from the late 1940s, and by 1953 a rate of 0% was recorded.

In the years 1954 to 1956 the infant mortality rate increased from 5.9% to 10%, which represented two infant deaths in 1954 and three each in 1955 and 1956.

Information relating to cause of death was available for 512 children (93.9% of child deaths).

Records show that the leading cause of death – gastroenteritis – was responsible for 26.37% of child deaths with a further 17.19% attributable to malabsorption.

Another 16.8% were due to non-specific cause such as prematurity and congenital debility, with 13.28% recorded as due to respiratory infections, mainly bronchopneumonia, and 10.35% notified as tuberculosis.

Stranorlar County Home

Stranorlar County Home in Co Donegal also saw high rates of infant mortality during its years in operation, in part owing to the comparatively low number of children who were institutionalised there.

Only Bethany, Ard Mhuire, Thomastown and Denny House saw more children born or admitted than Stranorlar out of the homes investigated by the commission.

Figures show that 1,777 ‘illegitimate’ children were born in or admitted to the home between 1921 and 1963. Of these, 343 died – roughly 20%.

The overwhelming majority of these children, 86.8%, died in infancy.

The commission reported that the infant mortality rate in Stranorlar was highest between 1925 and 1935, peaking in 1925 with a rate of 41.67% was recorded (over six times the national rate of 6.8%).

However, the commission noted that there was a relatively low infant mortality rate were during this period also, with just 13.16% (less than twice the national rate) in 1927.

The rate decreased to 7.89% in 1937, just above the national rate, before increasing again in 1938 (24.39%).

Stran2 Source: Mother and Baby Homes Commission of Investigation

Stran Source: Mother and Baby Homes Commission of Investigation

The figure remained relatively high until 1947, when infant mortality was 23.4% – close to one in four infants born at the home that year died in infancy, compared with almost one in 15 nationally.

The rate fell from 1948 onwards, fluctuating in the 1950s before falling off ahead of the home’s closure in 1963.

Information relating to cause of death was available for 339 children (98.8% of child deaths).

The leading cause of death (60.47%) was noted as respiratory infections – mainly acute bronchitis, bronchopneumonia and capillary bronchitis.

A further 11.8% deaths were notified as being due to nonspecific causes such as congenital debility and prematurity.
10.62% of deaths were notified as icterus neonatorum and a range of other, mainly one-off, causes including whooping cough and injury at birth.

Thomastown

Despite having one of the lowest levels of child admissions out of all the homes investigated, the percentage of children who died in Thomastown in Kilkenny was close to the overall rate.

Of the 1,241 children who were admitted to the home between 1920 and 1966, approximately 177 (14%) died.

Information relating to age on death was available for all but three of these children, and showed that the overwhelming majority (85.64%) died in infancy.

Infant mortality at the home was highest during the 1920s, peaking in 1927 when a rate of 30% was recorded – over four times the national rate of 7.1%.

Thomastown Source: Mother and Baby Homes Commission of Investigation

Thomastown2 Source: Mother and Baby Homes Commission of Investigation

More than one in five children who passed through the home in the 1920s died.

An infant mortality rate of 26.67% was recorded in 1935, almost four times the national rate of 6.8% that year. The overall rate of mortality in the 1930s was around 11%, higher than the national rate of 6.8%.

The infant mortality rate fluctuated in the 1940s before falling in the 1950s.

The commission noted that infant mortality rates afterwards were distorted by the small number of births admissions and the small number of infant deaths. For example, the infant mortality rate of 50%, recorded in 1961, relates to just two births and one death.

Information relating to cause of death was available for 169 children (95.5% of child deaths).

The leading notified cause of death were non-specific – mainly inanition (failure to thrive), congenital debility and in one a fractured skull – and were responsible for 57.99% of child deaths.

A further 11.83% were notified as being due to tuberculosis, with 10.65% notified as being due to respiratory infections, mainly bronchopneumonia, and another 5.92% due to gastroenteritis.

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