NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Watersheds in Infant Mortality: The Role of Effective Water and Sewerage Infrastructure, 1880 to 1915

Marcella Alsan, Claudia Goldin

NBER Working Paper No. 21263
Issued in June 2015
NBER Program(s):   DAE   DEV

We explore the first period of decline in infant mortality in the U.S. and provide estimates of the independent and combined effects of clean water and effective sewerage systems on infant mortality. Our case is Massachusetts, 1880-1915, when state authorities developed a sewerage and water district for municipalities in the Boston Greater Metropolitan area. We find that the two interventions were complementary and together accounted for approximately 37 percent of the total decline in log infant mortality among treated municipalities during the 36 years considered. Considerable research has documented the importance of clean water interventions for improvement in population health, but there is less evidence on the importance of sewerage systems. Our findings are directly relevant to urbanization in the developing world and suggest that a dual-pronged approach of safe water and sewerage is important to improving infant and early child survival.

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Document Object Identifier (DOI): 10.3386/w21263

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