When a death is registered by the lurah, the age of the deceased is also registered. This is often an estimate by the parents or relations.
Since all the ages of deceased persons had been registered at the Statistics Office of the Health Service at Jogjakarta, it was possible to class the ages registered at death under a number of age-groups.
The ages during the first few years of life are mostly expressed in months, hence inaccuracies will be few in the first group. Because of the size of the other groups, the mistakes made will probably be of slight influence on the computations.
The classification which is used, is as follows:
- Less than one year old.
- One to four years old.
- Five to nine years old.
- Ten to fourteen years old.
- Fifteen to twenty-nine years old.
- Thirty to forty-four years old.
- Forty-five years old and over.
During the period 1952-1956 a number of 110,548 deaths were registered in the city and in the four kabupatens of the D.I. Jogjakarta. On arranging the registration data concerning the age at death, it appeared that most deaths happened in the first years of life. Over half of the total number viz. 52.1% were deaths of children under fifteen.
As this registration of deaths should be considered obviously in complete, it appeared to be of interest to investigate whether a low and a high death-rate had a corresponding distribution in the various age-groups For this reason we arranged the annual percentage distribution of deaths in the city of Jogjakarta and the four kabupatens for the period 1952-1956 according to up going death-figures. We started out from the lowest death-figure: 7.6%, registered in the kabupaten Gunung Kidul in 1955, and ended with the highest: 15.9% in the kabupaten Bantul in 1953.
A survey of these figures are mentioned in table VI-2.
All these series showed every year the same pattern of distribution of infant-and children-deaths among the total number of death during this period. Between the ages 5 till 30 year a relative small number of deaths occur. After the age of 30 year the number of death is going up again. The percentages of the total number of deaths which occurred yearly in the different kabupaten in the different age-groups fluctuated around the same average both in the kabupaten with a low crude death-rate and in the kabupaten with a higher crude death-rate.
Table VI – 1.
Percentage distribution of deaths among the population
of the D.I. Jogjakarta during the period 1952 – 1956 and
of the city of Jogjakarta during 1933 – 1936.
This distribution pattern of deaths in the various age-groups seems to be rather independent of the more or less incompleteness of the vital statistics. A more through analysis of these figures brought to light that the percentage formed by the toddlers, age 1-4, was positively correlated with the level or registered crude death-rate. It seems probable that the under-registration in this younger age-group is more than in the age-group of adults. We suppose that these figures of the percentage distribution of deaths in the D.I. Jogjakarta during the period 1952-1956 may be considered as approximated data, however the only data available. The figures concerning the younger age-group suggest probable a more favourable condition that actually exists.
From the pre-war years death-registration data appear to have been preserved in the city of Jogjakarta for the period of January 1, 1933, until July 1, 1936. During this period compulsory inquest took place here because of pestilence. After 1931 every deceased person was examined by a doctor.
Table VI – 2.
Annual percentage distribution of the deaths among the
population of the four kabupaten and the city of Jogjakarta
during the period 1952 – 1956 arranged according
to rising (registered) crude death-rate
Only in the case of infants that died within three months and in the case of deceased persons about whom a statement by a doctor could be shown from which it appeared that death was caused by another disease than pestilence, no milt puncture was made. In the case of al others it was. A strict control of this order being carried out makes the death-figures rather reliable, although there are still some sources of mistakes, among which:
- The possibility of failure to report deaths.
- The possibility that the age mentioned is too young to escape milt puncture.
- The deceased children whose ages were not given in months but as 1 year old, were classed with the infants.
- There is also the possibility of a small number of corpses being taken outside the town, where an inquest was not compulsory, thus to escape milt-puncture, something many people objected to.
- Inquest cards getting lost. In the report about inquest data we found the remark that the number of deaths registered was always somewhat greater than the number of inquests, and the presumption was made that the cars of well-to-do people and notabilities sometimes got lost. Notwithstanding these inaccuracies, which are small in all probability, great importance can be attached to these data. The inquest data for the years 1934, 1935, relate to the Indonesian population only. Those for 1933 and 1936 also comprise deaths among the small group of Chinese in the city of Jogjakarta. In 1936 there were 10,700 Chinese. The distribution of deaths among the six age-groups is shown also in table VI-1.
The classification of people over 15 years of age differs slightly from the other used in table VI-1. From these figures, too, a great infant-and child-mortality becomes apparent. Over half the number of deaths are cases of children under 15 years of age, viz. 53.4%.
Kuding’s investigations of the distribution of deaths in the various age-groups made concerning the population of 5 ketjamatans in Menado for the years 1930-1932, and those made by De Haas in Djakarta for the period 1935-1937 can serve for comparison. In Djakarta the figures are based on inquest data. After 1934 the official concerned paid great attention to the ages of the deceased at the request of De Haas. Hence the figures for this period are reliable.
The classification in to age-groups of over-15-years-old is different from that of Jogjakarta again.
The data published refer to the Indonesian population only. Same as in pre- and post-war Jogjakarta it appears to be infant- and child mortality in particular, also in the Minahassa and Djakarta, which conditions general mortality. Death-registration data in the kabupaten Wonosobo, situated in the province of Central-Java, is looked upon as “sensibly complete” by the Ministry of Health authorities.
Here a death-rate of 20.8-22.7% was registered in the years 1952-1956. At our request we received the data re the distribution of deaths in the various age-groups from the Statistics Department of the Health Service (chief R. Soerono). They are also shown in table VI-3.
Comparison with the corresponding figures concerning the percentage distribution among the deaths of the population of the D.I. Jogjakarta (table VI-1) fortifies the presumption that in completion of death-registration is not only due to a general poor notification, but that especially infants deaths remain out of registration.
Table VI – 3.
Percentage distribution of the deaths over a number of
age-groups concerning the population of Minahassa
(1930-1932) ,Djakarta (1935-1937) and the kabupaten
Wonosobo (1952-1956).
In the D.I. Jogjakarta deceased infants account for 22% of all deaths, in Wono- sobo for 40%. Deceased children of 0-14-years of age make up 65.7% of all the deaths in Wonosobo from 1952 to 1956, while in the D.I. Jogjakarta this is 52.1%.
When the percentage-distribution of deaths among the seven age-groups of the population is compared with that of Malaya, India, Ceylon, and some neighbouring Asian countries nearly the same distribution among the age-groups is found. Here the age distribution of the population in all probability almost equals that of Indonesia (40% of the population under 15). Also in some other countries viz. Egypt, Guatemala, Venezuela, Colombia and other Latin-American countries the same distribution of deaths among the different age-groups appeared to be present. Also in these countries the general picture of mortality is mainly determined by infant- and child-mortality, which is 49%-51% of the total number of deaths.
Data for the two European countries with the lowest infant death-rate (Sweden and Holland) are also shown in table VI-4. In these countries this death-rate is no longer a great problem, and constitutes 2.9 – 6.1% of the total number of deaths. In these countries with greater adult age-groups it is particularly the over-45-years-old who determine general mortality.
Table VI – 4.
Percentage distribution of deaths among seven age-groups
in some Asian and European countries in 1954.
‘) The last two age-groups: 30 – 50 year and 50 year and over.
Toddler mortality.
The enormous mortality among infants and toddlers in the D.I. Jogjakarta induced us to pay particular attention to the deaths registered of children under 5, in view of their comprising 45.5% of the total number. Official registration in the years 1952-1956, however, used the classification: infants under one year of age, and the group toddlers of 1-4 year.
In the archives of the Health Service all the death certificates for this period, arranged ketjamatan-wise, were still available. By means of a new registration of the 110,548 death certificates it was possible to make a new classification of all the children of under five according to year-groups. The percentage division of 50,235 deceased children under five years of age for the years 1952-1956 whose deaths had at least been registered was as follows:
Table VI – 5.
Percentage distribution of the deaths of infants
and toddlers in the D.I. Jogjakarta during the
period 1952-1956 and in the Minahassa during
the period 1930-1932.
‘) Refers to number of 2,930 deceased children under 5 years of age.
A high infant death-rate together with a toddler death-rate like wise high, but which rapidly decreases as the children grow older, can be found from the figures arrived at. It is particularly the first two years of life when most victims fall. Deaths at this age comprise 32.6% of the total number. These figures lead us to presume that a high infant and a high toddler death-rate are caused by the same factors. In how far this presumption is justified will follow from the investigation of the causes of death among children. Just as the percentage ratio of the crude death-rate, the precarious ratio of the death-rate in the first five years of life in the D.I. Jogjakarta for 1952-1956 was arranged according to the increasing registered crude death-rate.
The percentage distribution of the deaths among the infants and toddlers aged 1-4 year was in all these 5 years in the four kabupaten and the town of Jogjakarta of the same type. In the kabupaten with a low registered crude death-rate and in the kabupaten with a low registered crude death-rate and in the kabupaten with a higher registered crude death-rate the distribution was nearly the same and fluctuated around the same average. This percentage distribution demonstrated a rapid decrease at increasing age.
Data re the ratio of deaths in the first five years of life to those among the Indonesian population elsewhere in the country we could only find with Kündig in his studies of deaths among the population of the five ketjamatans in the Minahassa. The percentage division among infants in the Minahassa for the period 1930-1932 is also mentioned in table VI-5.
Mortality in the first five years of life amounted to 55.4% of the total mortality in Minahassa. Among the Minahassa population, too, children appeared to die particularly in the first and second year of life.
Death at the ages 5-9 is much less frequent than at the ages 1-5. Because we wanted to trace progress up till the tenth year of age, this group of 4,835 children for 1952-1956 was also subdivided into year groups. To make possible a comparison of the group of deceased children of 0-4 years of age. The size of the year groups 0-10 was expressed in percentages of the group of deceased children 1-10 years old.
The figures found are shown in table VI-6.
Table VI – 6.
Percentage distribution of the 55,070 deceased children
under ten year of age during the period 1952-1956
in the D.I. Jogjakarta.
We do find a decrease until the age of ten. Of some countries with a comparable ratio in the infant- and toddler-group the data of the percentage division for deaths among the under-fives are collected in table VI-7.
Table VI – 7.
Percentage distribution of the deaths among children under
five year of age in Ceylon, Egypt, Sweden and the
Netherlands in the year 1954.
They refer to Ceylon and Egypt. Here, too, the ratio points to may deaths among the youngest-year-groups.
From comparable data of Sweden and Holland a strong concentration in the first year of life appears to exist here also.
On further analysis of the figures for the first year of life it appears that when there is a constant decrease in infant-deaths there is always a proportionate increase in the first week of life. Even if infant-mortality can decrease because of improving conditions (greater prosperity, proper food, hygienic circumstances, medical care, including prophylactic measures, inoculation, knowledge of baby and child care on the part of the mother) pre-natal death appears much more difficult to control, and to decrease much more slowly than infant-mortality.
Infant – mortality.
As it is customary for mothers to express the ages of babies in months, and as they are thus stated in case of notification of death, it has become possible to make a more detailed investigation of the ages at death in infancy.
When in the D.I. Jogjakarta we classify infants deceased in the period 1952-1956 according to the quarter of the year of life in which they died, it appears to be the first quarter of life which accounts for the greater number: over half of the total. This ratio is also found, when we classify them according to the quarters of every separate year 1952-1956. On analysing mortality in the first quarter of the year, we find the ratio shown in table VI – 8.
Table VI – 8.
Percentage distribution of deceased infants over the 4 quarters
of the fist year of life; the three months of the first quarter
and the four weeks of the first month of life.
Concerns infants, who died in the D.I. Jogjakarta in the period
1952-1956 and in the city of Jogjakarta in the period 1933-1936.
Over half of all the babies that died in the first quarter did so in the first month of life. On Further analysis of infant-mortality within the first month of life we found the ratio shows also in table VI-8.
Almost half of those babies that died within the first month of life, did so within the first week. Indeed, this is not a matter of surprise in the case of neonate. Perinatal death, also in countries where infant-mortality has reached a minimum i.e. About 20%, appears to be strikingly slow to decrease, much slower than the infant-mortality after the first week of life.
Thus in Holland in 1926 death within the first week of life comprised 27.5% of the total infant-mortality, while a particularly strong decrease in mortality after the first week of life in the years after 1926 caused the percentage of deaths within the first week of life to make up 60.1% of the total number in 1954. From data concerning infant-mortality in the D.I. Jogjakarta can be concluded that death within the first week of life must account for about 14% of the total infant-mortality. On surveying all these data, we are struck by the following rules emerging in the mortality among the children in the D.I. Jogjakarta:
Of children under fifteen 87.2% die before they are five years old.
Of children under five 71.9% die before the end of the second year of life.
Of the infants 55.1% die within the first three months of life.
Of all the infants dying within three months, 57% die within the first.
Of all the infants dying within one month, 43.3% die within the first week of life.
It is obvious that chances of death gradually decrease as the children get older. The data of infant-mortality in the city of Jogjakarta for 1933-1 July, 1936, being still available, we also computed the percentage ratio of infant-mortality for the three-monthly periods of the first year of life, and for the weeks of the first month of life. These figures are also mentioned in table VI-8.
For this period, too, we found about the same proportions. What struck us in these figures, which because of post-mortem examinations are more reliable, was that a so much greater number of deceased infants within the first month and particularly within the first week of life was registered. Death with the first quarter of the first year of life accounted for a smaller percentage of infant-mortality in the years 1933-1936 than for the period 1952-1956. To be compared with these data of infant-mortality in the city of and in the D.I. Jogjakarta are some results of investigations published before and after the second world war. For the percentage division of infants deceased into the quarters of the first year of life the following data are available concerning the Indonesian population of other parts of Indonesia:
Mrs. S.D. Habich-Veenhuizen: On infants deceased in four Djakarta districts in 1918. (Data for January of one quarter of the city, Kebun kelapa, were not available).
M. Straub: On infants of Javanese workers deceased in some plantations of the Deli Co. (Medan district) for 1924-1926.
A. Kündig: On infants deceased in 5 ketjamatans of Menado for the period 1930-1932.
J.H. De Haas: On infants deceased in the city of Djakarta for the period 1934-1936.
Liem Tjay Tie and de Haas: On infants deceased in some ketjamatans of the regency Tasikmalaja (West-Java) for the period 1935-1937.
M.J. Bosma: On infants deceased in the city of Medan (Sumatera) for the yeas 1931-1932: 1934-1935; 1938-1939.
Liem Tjay Tie: On infants deceased in the city of Semarang 1952-1953.
The data concerning the age at death of all the infants that died in the kabupaten Wonosobo for 1952-1956 we received at our request from the head of the Health Service of this kabupaten. The investigations in Djakarta (de Haas)and in Medan (Bosma) comprised besides the Indonesian and Chinese population groups a third: In Djakarta the Europeans and in Medan the group of foreign Asiatics.
The data arrived at are shown in table VI-9.
The figures for Djakarta and Medan, quoted in table VI-9, same as those of the Menado, Tasikmalaja, Jogjakarta, and Semarang relate to the Indonesian population only. Data concerning the percentage ratio of infant-mortality for the quarters of the first year of life, the months of the first quarter, and the weeks of the first month of life, appeared to be very scarce concerning Asian countries. These data were only available concerning the infant-mortality in Ceylon. The Ceylon figures are shown in table VI-9.
Where there is a great infant-mortality such as in Wonosobo, we find deaths in the first week of life comprise a small percentage of the total number of infant-deaths, viz. 17% whereas in countries with a low infant-mortality this percentage becomes relatively higher, and e.g. In Sweden in 1954 comprised two thirds of the total infant-mortality. In Sweden and Holland where infant-mortality is indeed very low, we find a rapid decrease in the second year of life, while mortality remains very low at pre-school age.
From the D.I. Jogjakarta ratio rather a high infant-mortality can be inferred, which will decrease at a lower level and less rapidly than happens in Sweden and Holland.
The range of figures in table VI-9 shows the mortality during the first month of life to be differently distributed in the D.I. Jogjakarta than it was before the war in Jogjakarta, Medan, Menado and Tasikmalaja.
Since death-registration in these areas must have been fuller during the inquiry, than it is in D.I. Jogjakarta now, there must be a sizable difference. It is very probable that the neonate who are not viable, and who die in the first week of life are not registered in the D.I. Jogjakarta to a greater extent than older infants, children or grown-ups.
Table VI – 9.
Percentage distribution of deceased infants over the four quarters of the first
year of life, the three of the first quarter, and the four weeks of the
first month.
Figures from the literature about infant-mortality in Indonesia.
It is not customary to name a new-born until after the umbilical cord has dropped off, so about 6 t 10 days after birth. During these days the neonatus is referred to as e.g. Baby of Njonja Dwidjomartono. When viability has become apparent and the umbilical cord has disappeared the child receives its own name e.g. Sumijarsih.
This delay in giving name to a newborn is one of the expressions of a special attitude with regard to newborns. Not the happening of birth is a sufficient basis to accept every newborn as a new inhabitant of the island and as a member of the desa-society. Only after the viability becomes evident the child gets a name. In the meantime the infant is considered as “belum tentu” i.e. Not yet sure that this fragile newborn infant becomes a child. When an infant dies within the first week of life this is accepted as an indication that this reserve was not unjustly. It is very probable that the delay in the registration of newborn infants is another expression of this attitude. In this way many infants, who die within the first week of life, remain out side the registration of births and of deaths. In this region where the mortality in the first week of life is substantial the influence of this attitude on the vital statistics must be important. When a birth is registered it is necessary that the name of the child is used.
The relatively small group of infants that supposedly died in the first week after birth in the D.I. Jogjakarta can perhaps be explained from this. (see table VI-8,9).
In the D.I. Jogjakarta this group of infants comprises only 3.1% of the deaths in general, which contrasts to much higher percentages in other regions. The above custom of name-giving is very old in Java. We do not know of any similar custom in Medan, Menado, and Djakarta.
Infant-mortality and the number of births.
The percentage ratio of a number of deaths based on age at death does reveal to a certain extent the size of the age-groups with great mortality, but only the specific mortality within each age-group offers scope for comparison with other peoples. This sort of data concerning Java however is very scarce. Most data about Indonesia are observations of infant-mortality, these being computed per 1,000 babies born alive.
The data of infant-mortality in the four kabupaten of the D.I. Jogjakarta are shown in table VI-10.
Table VI – 10.
Infant-mortality in the four kabupaten and the city of
Jogjakarta in the period 192-1956, supposing a birth-rate
of 40%, of the mid-year population of the D.I.
Jogjakarta during these years.
Indicated are the number of infant-deaths per 1,000 live births. Since the number of births is not exactly known, we have assumed there are 40 births per 1,000 inhabitants per annum. The population figures on July 1 of the years 1952 up to and inclusive of 1956 we received from the head of the civil Registration. The figures must be somewhat below the real numbers.
We find that infant-mortality in the city of Jogjakarta varies from 43-68%, in the kabupaten of Sleman it varies from 36-162%. This is in Bantul 21-135%, in Kulon Progo 16-123% and in Gunung Kidul 14-119%.
This part of the registration seems also incomplete. The wide range of variability from 14-162% and the unprobable low figures in some regions give rise to this presumption.
As far as we know an infant-mortality lower than 18^ has never been registered anywhere in the world. The countries with the lowest infant-mortality viz. Sweden, New Zealand (excluding the Maories), and Holland did not reach an infant-mortality of 20% or just under until the last few years, so that this figure approaches the possible minimum of today.
The figures of a number of countries having an infant-mortality lower than 25% are shown in table VI-11.
Table VI – 11.
Infant-mortality in countries with the lowest infant-mortality
in the world. Expressed per 1,000 live born in the year of
period mentioned.
1) excl. Maoris 2) excl. aboriginal population
The figures of the ketjamatans of the D.I. Jogjakarta, being incomplete, cannot give any insight into the extent of the real infant-mortality in these parts, except for the ketjamatan Depok, which was, since 1952 largely, and after 1954 wholly, chosen as a test-area for Mother- and Child health work.
Therefore particular attention was paid to the registration of births and of deaths infants and toddlers in this area.
When mothers visit M.C.H. Consultation centres there is some check on whether the children examined were registered by the lurah desa. Only to a much smaller extent is there any check on the notification of deaths.
Also the adat which prescribes that an infant under 35 days old should not be taken out of the house prevents infants in the first month of life from being medically examined at the very time when so many die.
Course of the infant mortality in the ketjamatan DEPOK, test area of the
M.C.H. -work in the D.I. Jogjakarta, during the period 1950 – 1957.
Fig. 14.
In 1950 and 1951 the infant-mortality registered was very low. In 1952 a strong rise occurred on account of improved registration. On computing infant-mortality for 1950-1952, we started out from a birth-rate of 40%.
In 1953 and later we used the registered birth-rate which appeared to be higher than 40%. After 1952 the infant death-figure decreased almost certainly because death among infants had actually decreased in this ketjamatan by the work of the M.C.H.workers. The 1952 figure points to the real extent of infant-mortality here without influence of the M.C.H.work.
Regisration of infant deaths was paid great attention to in 1952, while results achieved by M.C.H. workers were not yet clear in that year. Mothers are eager to take especially infants to welfare centres but not toddlers. In this way milk-supply by the M.C.H.-centres also benefited especially the group of infants in this area. Regular demonstrations how to prepare baby-food, medical examination of babies, visits by M.C.H.workers where they were required, infants seriously taken ill being directed to hospitals, courses for the dukuns (native “obstetricans”) in obstetrics in order to diminish complications in delivery, and to teach them sterile working-methods, all these factors influenced infant-mortality in the years 1953-1957, and caused it to decrease to 100%.
In the other 59 ketjamatans of the D.I. Jogjakarta, where less attention is obviously paid to these matters, infant-mortality must be higher than in Depok thus above 100%. For our guidance data of infant-mortality in other parts of Indonesia were collected from the available literature and shown in table VI-12.
The oldest data are those from van Gorkum. They result from the birth- and death-registration introduced in Djakarta in 1911. The incomplete death-data were computed from the incomplete birth-data, which makes them rather insignificant. The authors comment is that civil registration is chaotic and that the figures should be looked upon as unreliable.
Infant-mortality varies from an improbable minimum viz. Lower than 20% to an impossible figure: more than 1,000 infant-deaths per 1,000 babies born alive. About infant-mortality the detailed figures of the 80 kampongs tell us very little; they merely create an impression that there must have been a considerable infant-mortality. They were mentioned all the same, because they were the very first figures relating to infant-mortality in Indonesia.
From 1917-1919 Mrs.Habich-Veenhuizen investigated infant-mortality in 4 districts in the city of Djakarta. Notification of births, which was poor, was improved by setting a small premium on it. In the years 1917-1919 a census was take in these districts, so that the number of inhabitants was rather accurately known. In 1917 Bremen had investigated the occurrence of malaria in these quarters of the city. Data of milt-index found with this population are also mentioned in the table. Observation of the number of infants deceased showed infant-mortality to be high there. This was the first inquiry to make sure of this.
In his study of hygienic conditions in the Molucca Islands, published in 1926, in which he traced the development of lepra in East-Indonesia, Kopstein also mentioned the Isle of Ambon. He states a birth-figures of 36-38%, the crude death-rate amounted to 26.7%, and infant-mortality to 160%.
These figures were based on the number of inhabitants found in the existing registration.
Straub in 1925-1926 fully inquired into the extent and the cause of the high infant-mortality among the infants of the Javanese workers in the various plantations in Deli (Sumatera). Data are accurate as a result of careful registration of all employees and their families. Afterwards Heineman also published data of infant-mortality among the infants of the Javanese workers on the estates along the east coast of Sumatera for the years 1932-1933. Infant-mortality appeared to be difficult to influence by all sorts of measures in the course of the years.
W.Brand computed infant-mortality from the data of the 1930-census. He took three quarters of a number of children of group I (children not yet able to walk) of the population of Djakarta, who in the 1930-census were supposed to have a maximum age of 15-18 months. (Estimate by Dr Pruys at Tjiteres), and put them at less than one year old. The number of deceased infants arrived at from inquest-data in 1930 amounted to 29.4 – 31.9% of this figure. This he called “infant-mortality” and so deviated from the concept of infant-mortality which is defined: The number of infants who die under one year of age, expressed per 1,000 babies born alive among the same population in the same period of time. If we repeat the same computation on a basis of the same number of inhabitants and an assumed birth-rate of 40%, but now according to the method of van Wijngaarden, we arrive at an infant-mortality of 230%.
Here a death-ratio is pre-supposed for the first year of life, as was found by de Haas in Djakarta in 1934-1936, viz.: 44% within the first three months of life, and 75% within the first six.
Table VI – 12.
Data concerning infant-mortality among the Indonesian population, collected from the literature and other sources. Period 1912-1956.
By making home-visits the above data of the Indonesian babies were collected. Chinese and European babies were left out of consideration. This clinic accommodated chiefly impecunious and indigent women. From figures also comprising Chinese, European, and Arabian babies, it appeared that there was a different prognosis for those babies who were breast-fed and for those who were bottle-fed. Mortality among the former was lower. Most Indonesian babies were breast-fed, some received additional food, and merely 30 out of 758 Indonesian babies were give bottles only.
The investigations of Kündig with a specially-trained staff also produced data of infant-mortality which are shown in the table. Birth-rate refers to registered births.
For the period 1934-1936 de Haas computed infan6-mortality in Djakarta. The data shown in the table refer to the Indonesian population and are based on a birth-rate of 40%.
In his original publications de Haas started out from a birth-rate of 35% , same as Bosma did in Medan.
The number of deaths is the figures of the compulsory post mortem inquest which happened during this period in Djakarta.
Also on a basis of inquest data M.J. Bosma computed the extent of infant-mortality among the Indonesian, Chinese, and Arabs in the city of Medan. He started out from a birth-rate of 35%. The figures of the table refer to infant-mortality among the Indonesians in this city, assuming the birth-rate to be 40%.
Of the city of Jogjakarta infan6-mortality for 1933-1934 could be computed from the data on hand. The number of inhabitants was estimated on the basis of the 1930-census. From 1920-1930 there appeared to be an annual increase of the population of 4%. For the years after 1930 this 4% increase was added to the number of inhabitants in 1930.
The birth-rate of 35% is an estimate in the repeated computation. The much lower birth-rate registered, too low in all probability because of insufficient registration, was chosen for the first computation. It is possible for the 1933-1934 birth-figure to have been lower than 40%. In the 1930-census the group of children not yet able to walk was much smaller in the city of Jogjakarta than in the four kabupatens. In the city it made up 4.6% of the total population in the kabupaten Gunung Kidul 5.2%; in the kabupaten Bantul 5.2%; in the kabupaten Kulon Progo 5.5%; and in the kabupaten Sleman 5.4% of the total population. A possible explanation is the great number of single immigrants to settle in the city from the kabupatens (expecially Sleman) according to the census data. This is very likely to cause the birth-rate (i.e. The number of births per 1000 inhabitants) to go down. The birth-rate for 1930 was computed from the data of the census taken in the four kabupatens and in the city of Jogjakarta according to van Wijngaarden’s method.
We started out from an equal infant-mortality for all the areas, viz. 150 per 1,000 live-birth, and an infant-mortality with the following percentage distribution 44% of the infants deceased were in the first three months of life, and 75% in the first six months. It appeared that the city of Jogjakarta had a birth-rate in 1930 clearly lower than that of the surrounding kabupatens viz. 35%, of the kabupatens the birth-rates computed were: Gunung Kidul 40%, Batul 40%,Kulon Progo 42% and Sleman 44%. In computing infant-mortality in the city of Jogjakarta for 1933-1934 we started out from a birth-rate of 35%.
In the kabupaten Tasikamalaja Liem Tjay tie and deHaas also investigated data obtained from inquests relating to infant-mortality in 5 ketjamatans of this kabupaten. The birth-rate which served as a basis was 39%. For the sake of comparability we started out from a 40% birth-rate. After the war Liem Tjay Tie inquired into infant-mortality in the city of Semarang, where registration in the years 1952-1953 was satisfactory. A birth-rate of 30% was found from the number of registered births. The crude death-rate of the Indonesian population in Semarang amounted to 21%. Infant-mortality based on an assumed birth-rate of 40% was 151%
The data of infant-mortality in the kabupaten Wonosobo for the years 1952-1956 are also shown in the table, for this kabupaten has the best birth- and death-registration of all Java. From all this literature it appears that the lowest infant-mortality registered is 130-150%. Many figures which are much higher such as those of the East Coast of Sumatera and of Djakarta (four inquiries), were found as a result of investigation we suppose inspired by a huge infant-mortality.
Recent data of infant-mortality in the kabupatens of the province of Central-Java are shown in table VI-13.
Here ordinary-registration is rather satisfactory. Data of infant-mortality are arranged according to an increasing crude death-rate, and are expected to reveal more about the degree of accuracy in death registration than about real mortality. Only those kabupatens having a birth-rate of 40% and over appear in the table, because their birth-registration is supposed to be rather complete. Together with a rising crude death-rate infant-mortality goes up till it passes 160 deaths per 1,000 babies born alive in the kabupaten Wonosobo, where registration must have been almost complete.
Infant-mortality according to remembered data.
Another way to get an approximate idea of infant-mortality is by questioning mothers about the course of life of the children they gave birth to. At the “Bethesda Hospital” in Jogjakarta there has been a midwifery-course since many years before the second world war. Every pregnant woman is carefully questioned by the pupil-midwives, about former pregnancies. The information is later on discussed and Judged by the head of the midwifery-classes. From the archives of the obstetrics-department we examined the data obtained from pregnant women for the years 1946-1957. We restricted ourselves to the Javaneses women that lived in the D.I. Jogjakarta. As it was our intention to find out about the babies’ first year of life, all primiparae were left out of consideration.
Of the women questioned 56% lived in the city of Jogjakarta, 30% in the kabupaten Sleman, 8% in the kabupaten Bantul, 4% in the kabupaten Kulon Progo, and 2% in the kabupaten Gunung Kidul.
Table VI – 13
Infant-mortality in number of kabupatens in central-Java
during the period 1953-1956. Arranged according to rising
crude death-rate from 17% up to 23.3%
In cases of women that had a greater number of children perhaps their memory about them became less reliable. Therefore the pregnant women were divided in two groups : 15-29-years-old, and 30-44-years-old. We found out how many living children they had previously given birth to, and left the pregnancy they were there for out of consideration.
The youngest child was practically always over twelve months old. The number of children who died in the first year is shown in table VI-14.
Table VI – 14.
Infant-mortality according to remembered data of Javanese women admitted in the
Bethesda maternity-ward during 1946-1957 and female patients visiting the
out-patients clinic.
Since women in the menopause were not considered, we extended investigations to Javanese women over 45 years old who lived in the D.I. Jogakarta, and who came to women’s out-patients clinic, by asking them about the number of living children they had given birth to, and about the number of children who died with the ages specified. It also appeared to be possible to question a number of women of the age-group 30-45 at the polyclinic.
Of the women questioned 52% appeared to live in the city of Jogjakarta, 28%in the kabupaten Sleman, 12% in the kabupaten Bantul, 4% in the kabupaten Kulon Progo, and 4% in the kabupaten Gunung Kidul. The data of these investigations are also shown in table VI-14.
Just as the patients admitted to the obstetrics department the polyclinic patients were indigent people. Most of the patients in the obstetrics department appeared to poor and unable to pay the low tariff of the ward. Admittance to the polyclinic is very cheap (Rp.2.-) in order not to place financial obstacles in the way of medical examination and treatment.
This method of investigation excludes therefore the group of well-to-do people, which, however, being very small, cannot be a very significant factor. Our method led us to assess infant-mortality at 150-165% of all the babies born alive in the D.I. Jogjakarta.
In 1936 (April-September) three midwives, viz. Soeharti soedarsono and Soenarti, questioned women in the menopause: 111 from the Kulon Progo, and 51 from the kabupaten Gunung Kidul, a total of 284 women. Of these 18 had only one child, 27 two, the others more. They were long past the climacterium (from 7 to 12 years), so that the questioning relates to a period of 3-5 decennial, and there can be some errors due to faulty memory. Of 1,442 children born alive 974 became 15 years of age, i.e. 67.6%.
The data concerned are shown also in table VI-14.
Data of infant-mortality from other parts of Indonesia, obtained through questioning, are found in Hoogenkamp regarding the population round about Kuala Kapuas (south Kalimantan). The author with much reserve states that infant-mortality was 400%, which seems improbably high.
Questioning took place in the period 1952-1954. The method employed is not clear. From his data Hoogenkamp concluded that of all the children born alive 21-24%, died in the course of several years, which does not tally with a 40%-mortality already within the first year of life among the children born alive. We expect there must be an error somewhere in his computation.
Table VI – 15.
Data about mortality in early childhood in several regions of
East-Indonesia, during 1920-1924.
1) including stillborns
Of the population of the Isle of Buru situated between Sulawesi and Ceram some data are known for the years 1921-1923. They were collected by Pieters who questioned a number of women again divided into two groups: those who were in the menopause, and those who were not.
Infant-mortality cannot be deduced from these data since deaths within the first two years of life were lumped together. Infant-mortality (i.e. Death within twelve months) must therefore be lower than appears from his figures.
Dr. A.C. Kruyt made an extensive inquiry in 178 desas in Central Sulawesi in the period 1920-1924. (Poso, Malili, Bunku, Mori). All married women were asked about their children. Two groups were distinguished again: those who were in the menopause, and those who were not. Just as in Buru still-born children are included in the number of births Only of those women questioned that were already in the menopause, it was figured out that 4.1% were barren, and 4.5% had given birth to only one child, while the mothers had already reached the climacterium.
It is obvious that infant-mortality must have been lower than appears from the figures in the column indicating the number of children 0-2 years old deceased per 1,000 births. The data of Buru and Central Sulawesi were published in the itinerary by the chemist H.F. Tillema: “No Europe without the Tropics”, 1926.
Kopstein also published some data from a similar inquiry made in 1925 in the Isle of Ceram. Married women to a total of 260 were questioned, 78 of whom were in the menopause. Infant-mortality among the children of mothers, who where before and during the menopause is not mentioned separately.
In the Tanimbar Island Kopstein made a similar inquiry, and also found an infant-mortality of over 200%.
Considering: that the infant-mortality in the demonstration area for the M.C.H. work, ketjamatan Depok in the year 1952, when the registration was improved and the influence of the M.C.H. work was not yet substantial, amounted to 162%;
that the figures of infant-mortality in the regions of Indonesia about which figures are available were all above 130%;
that the infant-mortality in the kabupaten of Central-Java, which have a satisfactory registration, viz. Wonosobo, varied between 161-194% during the period 1952-1956;
that the infant-mortality according to the remembered data of the Javanese women varied between 152-165%.
We estimate that the infant-mortality nowadays in the D.I. Jogjakarta population is 150-170%.
Mortality among toddlers and school-children.
Data about mortality among Indonesian toddlers are very scarce, and were published by M. Straub and J.H. De Haas only. Straub mentions a mortality of 20-45% among toddlers (1-4-years-old) of Javanese workers along the East Coast of Sumatera for the years 1927-1933. The data were derived from the registration of the “plantation population”, which was kept up very carefully. For the years 1935-1937 de Haas computed the mortality per 1,000 toddlers of one to four years of age.
Starting out from a birth-rate of 35%, he subtracted the number of still-born babies and the number of infants that died from the number of births. For the number of still-born babies and for the number of infants that died the average was taken of the numbers registered during this period. The number of toddlers who died that was registered during this period was also known. From these data mortality among toddlers was found to be 75%.
We repeated the computations starting out from a birth-rate of 40%, and found 61% and 59% according to the two methods mentioned by de Haas (Prof. Mijsberg’s method).
On a basis of the data collected in the previous chapter, we ventured to draw up a life-table of the population of the D.I. Jogjakarta for the year 1955. We are conscious that we must make all reserve regarding accuracy.
The size of the age-groups up till sixteen, is derived from Wertheim(Cf. Chapter 3). We set aside the correction Horstmann believed to be necessary in Wertheim’s mortality-tables because of a supposed decrease in births and an increased child-mortality during the Japanese occupation and the early part of the revolution. There are no reliable figures pointing to these, while from post-war surveys it appeared that the group of non-grown-ups comprised about 40% of the total population, so that the correction for these approximative computations is left out of consideration. The sizes of the age-groups upwards of 15, comprising 60% of the population are derived from the population-pyramids of the Minahassers, Sangiresians, Talauds, and Ambonesians in 1930. The total number of inhabitants in the D.I. Jogjakarta in 1955 (mid-year population) is derived from data from the office Civil Registration D.I. Jogjakarta.
General mortality, estimated at 22% (cf. Chapter 5) is distributed over the various age-groups in accordance with the ratio-figures found in the table 1.5 and 6 of this chapter. Thus we computed the number of deaths per 1,000 persons in every age-group and collected these figures in table VI-16.
Table VI – 16.
Lifetable of the population of the D.I. Jogjakarta (1955), of the
kabupaten Wonosobo, Central-Java (1955), and of
the Minahassa (1931).
1) This figure is not the infant-mortality, because this is computed per 1,000 live births.
Here we see a high mortality of 138% among infants under one year of age, a mortality among toddlers of 42.9%, and a mortality of 7.3% within the group of 6-10-years-old. At school-going age mortality has decreased considerably. Not until upwards of thirty is there a rise again.
The most reliable data as to mortality among the population of Central-Java, those of the kabupaten Wonosobo, are fully available, and enable us to draw up the life-table of this kabupaten for the year 1955 in the same way. The data are shown also in table VI – 16.
The age-groups were computed in the same way as those in the D.I. Jogjakarta. From Kündig’s data it appeared to be possible to draw up a mortality-table for 5 ketjamatans of Menado viz.: Air Madidi, Tondano, Kawangkoan, Kakas, and Langoan for the year 1931.
For the year 1930 the age-distribution of the population of the Minahassa was know through the census (Cf. Chapter 3). In 1930 there were well over 270,000 people, also comprising the population of the 5 ketjamatans above with their 93,625 inhabitants, who, therefore, made up 30% of the total population. Starting out from the data of the 1930-census, we computed the age-distribution for the population of the Minahassa, the death-ratio between the various age-groups, and the death-rates of these age-groups. The figures are mentioned in table VI-16.
No distinction was made between the sexes. The death-ratio between the various age-groups is based on 5,329 deaths which also comprise deaths in Air Madidi in 1930 and 1932, in Tondano in 1930 and 1932, in Kawangkoan in 1930, in Kakas in 1932, and in Langoan in 1932.
The separate data for 1931 were not mentioned by Kündig, so that we had to make shift with the above ratio-figures. In 1931 2,175 people died in the 5 ketjamatans. General death amounted to 23.2%. The birth-rate was 43.8% and infant-mortality was 157% of all the children born alive.
Data concerning infant-and child-mortality in other Asian countries are scanty because also in those countries the vital registration is not yet satisfactory.
About the infant-mortality in India the registration figures were published by Davis (1951) and by Chandrasekhar (1959). during the period 1900-1945 the quinquennial averages of the registered infant-mortality in this period were as mentioned in table VI-17.
These registration figures concern before 1921 a scattered and growing area, while during the period 1921-1945 the figures relate to the former provinces of British India. These figures are based on a deficient registration of birth and death, so these figures are therefore not accurate. These figures point to a decline of infant-mortality since 1920.
Table VI – 17.
Infant-mortality rates in India, 1900 – 1945
for registration area in India.
Table VI – 18.
Infant-mortality in Malaya (Malaysian population)
during 1933 – 1937 and in 1946 – 1947.
Smith published in 1952 the infant-mortality rates of the Malaysian population of Malaya. The data concerning infant-mortality in the 8 states with the least incomplete registration are collected in table VI-18 for the period 1933-1937 and for the year preceding the census in September 1947.
According to the computation of Smith the infant-mortality in these 8 states was in the period Sept. 1946 till Sept. 1947 121% , for the boys it was 129% and for the girls 112%. According to the official registration the infant-mortality during this period was for boys 103% and for girls 89%.
In Ceylon the infant-mortality during the period 1950-1954 ranged between 82% and 72%.
The infant-mortality in the greater part of the European countries was in the beginning of this century about 100-170%. In the course of the last 60 years the infant-mortality rate in these countries decreased to 30-60%.
In some European countries the infant-mortality was during the period 1950-1954 still above 60%. during this period the infant-mortality in Bulgaria ranged between 108-86%; in Hungary 86-61%; in Poland 108-83%; in Yugoslavia 115-102%; in Spain 70-54%; while in Portugal 89-86%.
These figures concern the countries in Europe with the highest infant-mortality rates in that part of the world.