Berachot 5b~ The Infant Mortality Rate

ברכות ה, ב

תָּנֵי תַּנָּא קַמֵּיהּ דְּרַבִּי יוֹחָנָן: כׇּל הָעוֹסֵק בְּתוֹרָה וּבִגְמִילוּת חֲסָדִים וְקוֹבֵר אֶת בָּנָיו — מוֹחֲלִין לוֹ עַל כׇּל עֲוֹנוֹתָיו

וְהָא אָמַר רַבִּי יוֹחָנָן, דֵּין גַּרְמָא דַּעֲשִׂירָאָה בִּיר

A tanna taught the following baraita before Rabbi Yochanan: If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven…

Rabbi Yochanan himself said, This is the bone of my tenth son…

Rabbi Yochanan bar Napcha (c.180–279 CE) is cited many hundreds of times in the Talmud. But it was his tragic family story that perhaps most defined who he was. He was a father who had lost ten children.

Childhood mortality in rabbinic sources

Rabbi Yochanan’s tragedy might have been extreme in its severity, but his was not a unique situation. In fact the Talmud and the Midrash are replete with stories that reflect the high rate of both infant and child mortality at the time. Rabbi Yishmael lost at least two sons, (Moed Katan 28b) as did Rabbi Akiva (Moed Katan 21b). Rabban Gamiel cried in sympathy with a neighbor who lost her child (Sanhedrin 104b), whereas when Rav Yossi of Zippori lost a son, he chose not to cry, but to expound all day long in the Bet Midrash (Moed Katan 21a). The Midrash recounts that both sons of Rabbi Meir died on a Shabbat (Midrash Mishlei 31:10), and when the sons of Rabbi Yossi ben Chaninah died, he refused to wash with warm water (Taanit 13b). Children were eaten by wolves (Taanit 22b) murdered by brigands (Semahoth 12:13) and buried in earthquakes (Semachot 11:4). In some hemophiliac families, infants bled to death after being circumcised (Yevamot 64b), while other children committed suicide rather than face either physical abuse from their father (Semahoth 2:4-5), or an unwanted arranged marriage (Seder Eliyyahu Rabbah 19).

Professor Meir Bar Ilan (from the university that bears his family name) identified over two dozen other cases. Professor Bar Ilan adds that an additional factor should not be overlooked.

…almost all the cases indicate deaths of sons, not daughters. Apparently it reflects the nature of a patriarchal society, where one's importance depends merely on his sex (as in more than few societies even today). Furthermore, since there is no reason to believe that boys were prone to death more than girls (except in the case of circumcision), it reveals that, actually, the cases are all 'males' while ignoring the females. Because of this 'male' factor, one that wishes to know the exact number of deaths in the above sources, should multiply his data with (almost) 2.25 That is to say, that usually the deaths of girls were ignored, though they, apparently, happened at the same rate.

Calculating the infant mortality rate in THE TaLmudic era

Professor Bar Ilan counted about nine cases of infant or child death among the fifety or so tannaim mentioned by name in the Talmud. After taking into account the “ignored” factor of deaths of girls, he suggested that infant mortality rate among the families of the tannaim approached 30%.

To put this number into context, the infant mortality rate in Great Britain around 1880 was about 135 per thousand live births, or about 13%.  Among the Jews of Italy,  about 40% of children under the age of three died. It is harder to calculate the mortality rate in ancient Rome, but other scholars have estimated it to be 25-30%.

Life Expectancy and Infant Mortality Rates in 16th Century Europe
Village in Devon
England, 1538-1599
Village in Essex
England, 1550-1624
Bourgeoisie of
Geneva, 1550-1599
English High
Aristocracy, 1550-1599
Average age of women at marriage 26 24.5 21.4 22.8
Infant mortality per 1000 (0-1 years) 120-140 128 - 190
Infant mortality per 1000 (1-14 years) 124 149 - 94
Infant mortality per
1000 (1-19 years)
- - 519 -
Average life expectancy 40-46 - 28-29 37
Data from Meir Bar Ilan, Infant Mortality in The Land of Israel in Late Antiquity

The Shameful infant Mortality Rate in the US

In 2017 the infant mortality rate in the US was 579 per 100,000 or just under 0.6%.  That rate is fifty times lower than the rate during the centuries over which the Talmud was compiled.  The leading cause of death is congenital malformations, but accidental injury remains a major cause of mortality in children. Just like it did in ancient Israel.

The US ranks 30th of 193 countries in infant mortality rate, the ratio of babies that die before turning one year old. In the US, there are more than three times as many infant deaths for every 1,000 births as there are in the countries leading the list.
— More infants are dying in US states that rejected expanded Medicaid. Quartz, Feb 1, 2018.

But take a look at the chart below and you will see that the rate in the US is over two or three times higher than it is in other western countries. It is shameful that the country with the highest per capita rate of health care spending finds itself so low down on this list.

Infant mortality per 1,000 births, 2010-2015. Date from the United Nations. From here.

Infant mortality per 1,000 births, 2010-2015. Date from the United Nations. From here.

Comparative studies show different data from various cultures and times, and together with the texts themselves, suggest that some 30% of all children born in the Land of Israel at the beginning of this era would not reach their maturity.
— Meir Bar Ilan. Infant Mortality in The Land of Israel in Late Antiquity.

“Neither the suffering nor the reward”

Because infant and childhood deaths were so common it is not surprising that the rabbis of the Talmud tried to inject a glimmer of metaphysical hope into this most tragic of tragedies. Rabbi Yochanan had lost no fewer than ten children, and his colleagues attempted to console him with the promise of a reward to come: “If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven.” That might have consoled Yochanan the Rabbi, but it did not console Yochanan the grieving father. Rabbi Yochanan rejected the very notion that suffering -of any sort-was worth a reward. “I want neither this suffering nor its reward - לֹא הֵן וְלֹא שְׂכָרָן.”

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