The impact of water supply and sanitation on infant mortality: Individual-level evidence from Tartu, Estonia, 1897–1900

Abstract

Evidence from a number of historical studies has demonstrated a strong impact of the provision of clean water on mortality risks, while no clear effect has been reported in others. We investigated the relationship between water supply, sanitation, and infant survival in Tartu, a university town in Estonia, 1897-1900. Based on data from parish registers, which were linked to the first census of the Russian Empire, the analysis reveals a clear disadvantage for infants in households using surface water, compared with families that acquired water from groundwater or artesian wells. The impact is stronger in the later stages of infancy. Competing-risk analysis shows that the effect is more pronounced for deaths caused by diseases of the digestive system. Our findings suggest that it may have been possible to improve the water supply, and consequently reduce infant mortality, before the introduction of piped water and sewage systems.

Socioeconomic and cultural differentials in mortality in a late 19th century urban setting: A linked records study from Tartu, Estonia, 1897-1900

“…This implies that the mortality difference between Baltic Germans and the majority population was fully accounted for by disparities in socioeconomic status, in accord with findings from a recent study of infant mortality in the same setting (Jaadla and Puur 2016). Although the population of Tartu was divided along ethnic/language lines, socioeconomic differentials in mortality clearly prevailed over those related to culture.…”

“…To account for this we used water supply, type of privy, and the presence of carters as controls. The two former measures were found to be significant in an earlier study on the impact of sanitation on infant mortality in the same setting (Jaadla and Puur 2016) and the effect of horses in near proximity to the residence has been demonstrated in other contexts (Morgan 2002;Thornton and Olson 2011). Previous research has also indicated the importance of individuals' geographical mobility to their subsequent chances of survival (Hautaniemi, Swedlund, and Anderton 1999;Kesztenbaum and Rosenthal 2011).…”

“…The small number of events prevents us from presenting the results separately for early and late childhood mortality. Results for infant mortality are available from earlier studies (Jaadla and Klesment 2014;Jaadla and Puur 2016). the offspring of domestic servants (+53%) can be partially explained by the higher prevalence of single parenthood in the latter group.…”

Infant mortality in mid‐19th century Amsterdam: Religion, social class, and space

“…Several studies stressed the importance of the impact of water and sanitation on (infant) mortality rates in the 19th century, such as Van Poppel and Van der Heijden () on clean water supply, Jaadla and Puur () on water supply and sanitation, and Kesztenbaum and Rosenthal () on sanitation and sewage. The high IMRs in Amsterdam are thought to be related to the fact that much of the surface and ground water in the western provinces of the Netherlands was heavily contaminated.…”

Disparities in death: Inequality in cause-specific infant and child mortality in Stockholm, 1878‒1926

“…The early phases of the expansion of Stockholm's water network disproportionately favored the wealthier neighborhoods in Stockholm. This is significant, as recent work on the Estonian city of Tartu has shown that educational differences in infant mortality could largely be accounted for by differences in access to clean water (Jaadla and Puur 2016). The city's first water mains were laid in 1861, primarily near the royal residence and in the well-to-do surrounding areas.…”