Why do so many Louisiana babies die

              Eighty-seven thousand babies—which amounts to about one each hour—will be born this year in Louisiana.
But between 2,500 and 3,000 of those babies will die before they reach their first birthday.
High infant mortality rates have long been a subject of national concern. But the death rates in Louisiana exceed even the national average.
Nationwide in I960, 26 babies out of every 1,000 died before age 1. In Louisiana the figure was 32 out of every 1,000. In 1962, the Louisiana rate still was high: 31.2 out
of 1,000.  (In Mississippi last year, 39.9 deaths were recorded per 1,000 live births.)
Social and economic factors greatly affect this state's infant mortality rate, say Louisiana State Board of Health officials. For example: among Negroes, whose income and education are below average, 45 infants out of 1,003 died last year before reaching their first birthday; among whites, the rate was only 21 per 1,000. (In Mississippi in 1962 the white mortality rate was 25.6; the Negro, 52.5.)
High as they are, these figures show a vast improve*
ment over those of 1930. In that year, Louisiana's stagger-tag infant mortality rate: 78 per 1,000!
Strangely enough, although the United States leads the world in many areas of medicine and public health, it ranks 10th in saving the lives of its infants. Sweden, for instance, has an infant morality rate of only 16.6 per 1,000 deaths, The Netherlands, 16.8. Other countries with better records than ours include Norway, Australia, Switzerland, Denmark, Great Britain, Finland and New Zealand.
The eight top causes of infant deaths last year were:
postnatal asphyxia and atelectasis (collapse of the lungs); prematurity; congenital malformations; influenza and pneumonia, excluding pneumonia of the newborn; ill-defined diseases peculiar to early infancy, including nutritional maladjustment; birth injuries; pneumonia of the newborn, and accidents.
What part do social and economic factors play in these fatalities?
Consider prematurityr a term used to describe babies who weigh less than 5% pounds at birth. Such infants have less chance of survival than a normal infant because of the general immaturity of their organs.
"Studies have shown," says Dr. Marie Pareti, director of the Maternity and Child Health Service, Louisiana State Board of Health, "that mothers with the best nutrition—those who know how to eat properly and have the money to do so—have the strongest, biggest babies. The more children a woman has—and the woman who has many is often in the low-income group—the greater the likelihood that she will have a premature child."
Congenital malformation generally occurs wtien the mother contacts certain viral diseases—such as German measles—during the critical first three months, or takes certain drugs, such as thaiidomide, or is subjected to excessive irradiation of the pelvic area, etc.
"But it is suspected,*' adds Dr. Pareti, "because of the results of animal studies, that nutritional deficiencies—• which have a direct tie-in with low income and lack of education—can also cause malformations."
Accidents? Because of carelessness or ignorance on the part of parents, household items such as kerosene, lye and insect sprays are often accessible to babies.
"One of the most frequent causes of accidents," explains Dr. Caroiynn D. Talley, a pediatric consultant with the State Board of Health, "is the fact that many infants in poor rural families are left in the care of young sisters or brothers while the mother works in the fields."
But there is another factor affecting Louisiana's infant mortality rate all too few people know about. It can be summed up in two words: untrained mid wives. In 1962, a total of 231 unlicensed midwives in Louisiana, many of whom are illiterate, delivered 2,252 babies.
"They're mainly located in the rural areas," says Or. Talley, "and they're mostly Negro, (Only six are white.) The law can't do away with them because there aren't enough doctors around to deliver babies. (New Orleans is the only place in the state where midwives must be licensed.) About 70 per cent of the infant and child population is centered in rural areas where there are few or no pediatricians***
Having a doctor in the parish doesn't help pregnant women who can't afford to go to the hospital, because doctors don't ordinarily deliver in homes except in emergencies. The alternative is the midwife who delivers the baby at home, usually for a fee of $10 to $15.
One of the midwives, an elderly Negro woman in Tal-lulah, La., in Madison Parish, has given birth to 24 babies of her own, say local health officials. She delivers an estimated 75 per cent of the babies born in Madison Parish.
Deliveries handled by untrained midwives in homes instead of hospitals are often thought to be the cause of birth injuries and infections in the mother and the baby. In one area, there was an outburst of tetanus which resulted in the death of five infants. It was attributed to the unsanitary techniques of the midwife.
"The midwife doesn't usually recognize internal abnormalities or malformations the infant may have at birth,"