Document 17C: Charles S. Johnson, "A Question of Negro Health," Birth Control Review, 16, no. 6 (June 1932): 167-69.
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A Question of Negro Health
By CHARLES S. JOHNSON
THE question of birth control for Negroes has been confounded by several essentially unrelated issues. There has been an assumption, invoked by certain politico-racial considerations, that overpopulation means merely too many undesirable groups, thus ruling out the essential factor of intelligent discrimination and population selection within these groups. Most discussions of the question in America have contrasted the fertility of the native born white population with that of the Negro and with certain elements of the foreign born, on some such basis as that upon which the present immigration legislation was promulgated. Not only do such views and policies obscure the important issues but invariably they set up resentment among Negroes against the implications of the contrast.
This assumption is little different from another which, equally indiscriminate, associates race, as such, with unfitness. Thus, any restriction of births whatever among Negroes is expected to be salutary since it would tend to lessen by so much existing racial pressures. Thirty years ago it was anticipated, not without a certain grim satisfaction, that the race problem in America would settle itself as a result of the excessive mortality among Negroes, notably from tuberculosis and venereal diseases. It was not until this idea was abandoned, together with the belief that the weakness was constitutional, that marked changes were noted in Negro health. Now that Negro mortality has been reduced to the point at which the whites stood a generation ago, and continues to decline, the same eugenic discrimination which applies to the whites is necessary with reference to selective fertility within the Negro group.
Throughout the history of Negroes in America they have been marked by a high rate of fertility. It was encouraged in slavery and, according to the calculation of Dr. Louis I. Dublin, it appears to have reached the limits of human fertility during that period. After their emancipation this high fertility continued, but with a violent check on population increase caused by an extravagantly high mortality. Marriage among Negroes takes place earlier than among whites. Three-fifths of them marry at the age of 20 and under, while for whites two-thirds marry at 22 or younger.1 Moreover, nine-tenths of the Negro women married ten years or more, as compared with three-fourths of the white women married for a similar period, have experienced six or more pregnancies.
In the registration area as late as 1920, out of every 100,000 Negro male children born alive, 9,600 more Negro boys than white boys died before reaching the age of one year, and 8,200 more Negro girls. Woodbury2 found the infant mortality rate for Negroes one and a half times that for all whites and about twice as high as for native whites. In the experience of the Metropolitan Life Insurance Company the colored deaths are two-thirds above that of the whites,3 and for the period from
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five years to adolescence the margin is 57 per cent excess for males and 72 per cent for females. These excesses necessarily curtail longevity, because one of the greatest factors in these high rates for Negroes is the high infant death rate. The average number of children born to Negro mothers is greater than that of the population as a whole, and for the native whites, but somewhat less than certain of the foreign born. In 1925 the average was 3.2 for the total and for the white, 3.9 for the foreign born, and 3.7 for the Negroes. However, the per cent of children surviving was lower for Negroes than for any other group of the population.4 For the registration area in 1928, the Negro mortality rate was 106.2 as compared with 64.0 for the white, and the number of still births per 100 live births just twice that of the country as a whole. In the southern states, particularly, the ratio of Negro to white maternal deaths stands fifth in a list of twenty-four, in point of excess mortality. Maternal mortality is actually increasing. In Mississippi 10.9 in every 1000 Negro mothers died in childbirth as compared with 6.6 for white; in North Carolina 10.7 as compared with 6.7; and in Kentucky 15.4 as compared with 5.4 white mothers.5 In all of these places there is a correspondingly high rate for Negro mothers who are working. In Kentucky it was 38.1 and in Mississippi it was 42.1 per cent of all Negro mothers.
ECONOMICS PLAYS A PART
Apart from the excessively high infant and maternity rates it is apparent that the problem of mortality is closely associated with economic status. The diseases from which Negroes suffer most are those related to their low income. Tuberculosis, for example, which takes such a fearsome toll, is notoriously a disease of poverty. The diseases which are largely due to difference in living conditions together with low income show the greatest disparity between Negro and white rates. These are tuberculosis, puerperal conditions, typhoid, malaria and pellagra. Here it is important to consider the actual ability of large families of low income to sustain themselves adequately in our present society. Woodbury's observations are all the more significant when he points out from a study of 20,000 infant deaths that the rates of mortality vary directly with the fathers' earnings, and that for infants over one month of age the rate of mortality in the lowest income group is ten times the rate of the highest income group.
Dr. T. Wingate Todd, of Western Reserve University, in his studies for the Brush Foundation, found Negro children lagging about six months behind the white both in height and weight. These were children from the congested districts. The difference, he suggests, was due to special environmental stresses in the early life of the Negro children.
The correction of the environment involves the equalization of economic and social opportunities, but it is still within the power of the group itself to lessen the stress by more intelligent interpretation of the obligation to maintain the race. The status of Negroes as marginal workers, their confinement to the lowest paid branches of industry, the necessity for the labor of mothers as well as children to balance meager budgets, are factors which emphasize the need for lessening the burden not only for themselves but of society, which must provide the supplementary support in the form of relief.
By no means unimportant in this connection is the present extent of venereal infection within the Negro population, which adds to unconsidered childbearing both the danger of maternal mortality and of defective children. A great amount of unscientific speculation about the prevalence of syphilis among Negroes has invaded this field, with fantastic and impossible estimates. Conservative studies place the extent among Negroes as about one and one-half times that of the white, but with extremely high rates in certain southern sections where neither the social significance nor the personal danger of the disease is fully recognized. In one county in a southern state where Wasserman tests were made of an entire section of a Negro population, some 34 per cent gave positive reactions. The most serious aspect of the findings was the number of children who by the tests gave evidence of hereditary syphilis. Of equal importance with the public health task of eradicating this disease through education and medical treatment, is the task of preserving society, for its own sake, from defective offspring.
Essentially the same course is observed among Negroes as among other American groups as regards birth control practice. The more competent economic elements already use some measure of birth control. It can be noted in the decline in size
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of families of the more advanced and economically competent Negro groups. Dr. E. Franklin Frazier has compared the size of families from which 327 Negroes listed in Who's Who In Colored America (1928-1929) sprang, with the actual number of children of 174 of them, successful Negroes 45 years of age and over. For the first group it was 5.5 and for the second 2.3 children per family. There is likewise a tendency to smaller families among Negroes living in cities. Indeed this observation at one time lead to the premature conclusion that city life was too strenuous and the North too cold for their survival. Actually the rate of decline in the most important Negro diseases was greater between 1930 and 1931 in northern than in the southern and border cities.6 An important present circumstance is the inaccessibility of reliable information centers for those elements of the Negro population, which, on the one hand, are unable to secure high priced professional advice, and on the other hand do greater violence than good to themselves through reliance upon dangerous folk measures.
1 Children's Bureau Publication No. 33.
2 Woodbury, Robert Morse: Infant Mortality and Its Causes.
3 Dublin, Louis I.: The Health of the Negro,—Annals of the American Academy, November, 1928.
4 Census Monograph 1926, Births, Stillbirths and Infant Mortality.
5 U. S. Children's Bureau Publication No. 119, p. 80.
6 Tuberculosis Mortality in 45 Large American Cities During 1930 and 1931, compiled by G. J. Drolet (New York Tuberculosis and Health Association).
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