Social differences in cause-specific infant mortality at the dawn of the demographic transition: New insights from German church records.

Little is known about social gradients in cause-specific infant mortality in the nineteenth century. To our knowledge, this is the first paper to explore this connection for the time prior to the epidemiologic and demographic transitions. We used the church records of Rostock, an important port city on the Baltic coast in northern Germany, and prepared and merged the baptismal and burial registers of its largest parish (St. Jakobi) for the periods 1815-1836 and 1859-1882. Based on individual-level data (N = 16,880), we classified the fathers' occupations into three social classes and estimated cause-specific infant mortality risks for these groups using event history analysis. We found a clear social gradient in neonatal and post-neonatal mortality. This gradient was driven by waterborne diseases and convulsions, suggesting severe nutritional and sanitation deficits among the lower social classes even before the city began to struggle with worsening living environments following industrialisation and population growth in the second half of the nineteenth century. Our results also suggest that deteriorating environmental conditions affect all parts of the population, leading to an increase of infant mortality rates in all social classes. Improvements in nutritional and sanitary conditions may thus reduce the risk of infant death from infectious diseases.

Supplementary information: The online version contains supplementary material available at 10.1007/s11111-025-00483-w.