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This is a tumblelog, kinda like a blog but with short-form, mixed-media posts with stuff I like.
You see, the media puts this idea into women’s heads that your vagina has to look like ____, smell like ____, and work like ____. On this pro-period website, we'll be deconstructing menstruation, periods, menarches, moontimes and more. Be sure to check out the rest of the great resources we've included on the 'Sites We Like' page.
We'll do our best to answer any questions that you have while we entertain you with our absolutely absorbing period-positive posts.
NOTE: This is a sex-positive, body-positive, gender-neutral, PoC-friendly, queer-happy, LGBTerrific, and trigger-free site.
DISCLAIMER: We give lots and lots of reproductive health-related advice on this blog that is founded on our experiences, the experiences of others and our own thorough, independent research. About this Release The development of official statistics in Australia, and some possible future challenges (Feature Article) A hundred years of science and service - Australian meteorology through the twentieth century (Feature Article) Australian Federation (Feature Article) Women and government in Australia (Feature Article) East Timor - reconstruction and development (Feature Article) A short history of Australian aid (Feature Article) The Department of Foreign Affairs and Trade over the century - a chronology (Feature Article) Evolution of Australia's strategic defence policy (Feature Article) Defence expenditure over the century (Feature Article) The census, the Constitution and democracy (Feature Article) Million milestones (Feature Article) A century of population change in Australia (Feature Article) A century of change in the Australian labour market (Feature Article) Household income and its distribution (Feature Article) Changing dwelling and household size (Feature Article) Changing tenure status (Feature Article) Housing in remote Aboriginal & Torres Strait Islander communities (Feature Article) Long-term mortality trends (Feature Article) Chronic diseases and risk factors (Feature Article) Child health since Federation (Feature Article) Education then and now (Feature Article) Adelaide Declaration on National Goals for Schooling in the Twenty-first Century (Feature Article) Measuring education in Australian Censuses - 1911 to 2001 (Feature Article) Australian schools: participation and funding 1901 to 2000 (Feature Article) Crime and safety (Feature Article) Crime in twentieth century Australia (Feature Article) A sporting life!
Fiona J Stanley AC is the Director, TVW Telethon Institute for Child Health Research, and Variety Club Professor of Paediatrics, the University of Western Australia. On her return to Perth in 1977 she, along with other researchers in the NH&MRC Epidemiology Unit, established the WA Maternal and Child Health Research Data Base, a unique collection of data on births from the entire State that supports most of the research by her group. Professor Stanley became the founding Scientific Director of the TVW Telethon Institute for Child Health Research in 1990. Footnote: The staff of the Perth office of the Australian Bureau of Statistics (Elena Mobilia and Daniel Christensen) worked hard to obtain much of the data for this article. On the whole these increases were the result of considerable environmental and social changes early in the 20th century, with resulting improvements in the health of mothers and children. The social and economic environment around 1901 was harsh and difficult for many families; many children were malnourished and likely to die from infectious diseases such as gastroenteritis and pneumonia. While the perinatal and infant period is still one of life’s most risky, the chances of survival now are much higher than 100 years ago, and once through to the end of the first year, the risk of dying in childhood is very low and only starts to rise again in older teenagers (15-19 years old), particularly in males.
This article is an overview of the changes in some markers of child and adolescent health throughout the 20th century and those trends which have been most influential. The under five mortality fell from 2,604 per 100,000 in males and from 2,214 in females in 1907 to 137 and 111 respectively in 1998 (graph C6.1).
Infant mortality, defined as deaths in children from birth to the first year of age per 1,000 live births, has been viewed traditionally as an important social indicator, reflecting general population health and wellbeing. Deaths from all causes, particularly from SIDS and respiratory system diseases, are much more common in Indigenous infants. Neonatal deaths are those infant deaths occurring in the first 28 days of life, while postneonatal deaths are those occurring from 1 month to 1 year.
While their causes on the whole are unknown, they differ markedly from the adverse social conditions in infancy which caused so many babies to die in 1901-1920.
Neonatal mortality has always been influenced by pregnancy complications and fetal growth and development. Thus the challenges facing us to further reduce neonatal mortality are similar to those for postneonatal deaths. Recently in Australia, there has been a tendency in the media to use infant mortality, as well as mortality at older ages, to judge the appropriate levels of expenditure on medical, particularly hospital, services.
The death rates in children (1-4 and 5-14 years) have always been far lower than those among infants and are now very low in Australian children (only 14 deaths occur in every 100,000 5-14 year olds) (graph C6.1).
Other causes of childhood deaths include congenital anomalies (particularly those of the heart and nervous system, and chromosomal defects such as Downs Syndrome) and cancers.
The causes of death in older children (5-14 years) and teenagers (15-19 years) were dominated in the early part of the century by infectious diseases. Much of the increase and decrease in these rates is explained by accidents, and recently by road accidents. The significant social changes in families, the increasing level of child and adolescent mental health problems, the increased availability and use of addictive drugs and alcohol, the ready availability of guns and other means of suicide, and possibly other factors as well, have all contributed to these rising rates of mental health morbidities.
The decline in mortality in infants and children since Federation is obvious, the reasons for it less so. Evidence for improved nutrition comes from the observed increase in the mean height and weight of school children (Cumpston 1989). Mothers were educated about infant welfare, particularly the importance of breastfeeding, personal hygiene and clean environments. The seminal work of Australian social demographer Caldwell and his colleagues at ANU has described the important effect of parental, particularly maternal, educational level on improved outcome for a child. Caldwell (1999) developed a theory of 'health transition' to explain the changes taking place in traditional societies and communities with high mortality and high fertility to the low levels of both as countries develop.
There is a clear ecological relationship between material wellbeing, measured by income or disposable household income for families with children, and their health status. As the fertility of women decreased, the average number of births for women less than 45 years old fell from around 7 before 1900 to 3 in 1920s (Williams 1989). Throughout the century, scientific discoveries started to impact upon health and medical services. Parents' fear of polio in the 1950s and of meningitis in the 1990s resulted in high levels of participation in these vaccination programs.
Sulphonamides to treat infections were introduced in early 1940 and penicillin, dramatically effective against Streptococcal infections including bacterial meningitis, became available immediately after World War II. From 1945 until 2000, with infectious disease rates very low, and other public health measures almost taken for granted, medical care began its revolutionary impact on illness and death. The sciences of physiology, biochemistry and pathology blossomed throughout the 20th century, following fast on the tracks of bacteriology. While death rates in the early decades of 20th century probably reflected the occurrence of illness reasonably well, the rarity of death among children now means that death rates do not reflect the burden of illness and disability affecting our children and youth. Improvements in social and economic circumstances in Australia have changed the face of child health. Two other examples are asthma and juvenile diabetes, both of which have increased considerably.
A review of population data and national health surveys (Bauman 1993) showed an increase in asthma symptoms, such as recent and cumulative wheeze and diagnosed asthma between the 1970s and 1990s (graph C6.13). Both asthma and diabetes are lifelong illnesses with significant morbidity and need for complex treatments.
Population data on disability in childhood are not readily available, but suggest increases in both incidence and prevalence of several impairments across the range of severity.
The proportion of children aged 0-14 years with intellectual disability has fallen from 1970 to 1990.
Increases in autism, behaviour problems and learning disabilities in children have been reported over the 1980s and 1990s (Alessandri, Leonard et al.
Smoking and alcohol abuse are recognised as the leading drug problems in Australia, and influence deaths and illness at all ages. Regular nationwide surveys of school children document recent levels of tobacco and alcohol use in Australia (Hill, White et al. Table C6.15 shows, by age and gender, the proportions of school children classifying themselves as drinkers. The dramatic increase in females smoking and drinking over the last 50 years has been a major social change. Australia has been a leader in legislation and health education to reduce cigarette smoking levels in the community.
Similarly legislation and education about drinking and driving seems to have impacted on accident rates in young people. In the last 20 years, concern has been expressed nationally about the increasing levels of obesity and lack of physical fitness in children and adolescents in Australia (O'Connor and Eden 2000). There have been changes in our communities that have had a profound effect on child and adolescent health and wellbeing. The median age at first marriage was around 27 years for males and 24 for females in the 1920s, remained high during the 1930s Depression years and fell dramatically after 1940. Late in the 19th century the fertility rate was falling; it picked up again as the new century progressed, falling rapidly after the 1929 Depression. While there is under-registration or recognition of Indigenous births, some data are available.
Until 1940 the level of divorce in Australia was negligible, with less than 2 per 1,000 married women. Most of these factors have a negative effect on the care and mental health of children (Zubrick, Silburn et al.
Many studies have observed the detrimental effects of divorce and single parenthood on child health and wellbeing (Fergusson, Horwood et al. The costs to Australia of family breakdowns were assessed at about $3b per year, through legal and social support schemes, and when all indirect costs and the personal and emotional trauma to children is added to these figures, the cost to the nation is enormous.
Coincident with these changes in families and communities, the incidence of child abuse-physical, emotional and sexual-is thought to have risen over the last three decades.
No two vaginas are identical, and to think something is “wrong” with yours is crazy!
As young girls, in sex ed (if we even have sex ed!), we aren’t taught about vaginas and how they look. While we feel that our site is a reliable source of information about reproductive health, we do not claim to be healthcare professionals. Professor Stanley graduated in medicine from the University of Western Australia in 1970 and sought further training in epidemiology, biostatistics and public health in the UK and USA. The Institute fosters collaboration between basic, clinical and population-based research to address complex childhood diseases, with a strong commitment to translating the findings into better health and health care in the community. Dr Peter Winterton and Professor Geoffrey Bolton suggested books on medical history and commented on the text. The racial stock to which the individual belongs may direct the general course of his health, the prenatal condition of maternal health, the quality or sufficiency of food taken as an infant and indeed throughout life are factors in which the relationship between cause and effect is direct; the presence in the community of other racial stocks, age composition of the population, the existence of communicable diseases in adjacent countries, the social conditions generally, and even the forms of government, have an influence no less important although indirect.
The considerable social, educational and income changes over the century (described in Centenary Articles associated with the Population, Income and welfare and Education and training chapters), together with the conscientious efforts of those committed to improving maternal and child health in the early decades by community interventions, have had as much influence on reducing deaths and illnesses in children as has the extraordinary rise in knowledge in biomedical science in later decades, with its resulting improvements in diagnosis, treatments and prevention of disease (particularly by mass vaccination). However, there is now possibly excessive emphasis on using expensive technologies to prevent death in children who are severely compromised, with much less effort into researching the antecedents to prevent the conditions which lead to the problems in the first place. Many aspects will not be covered adequately and some left out completely, due to limitations of space and time.
It is of great interest to those assessing the social development of communities as groups with more advanced development in terms of social circumstances, educational level and income tend to have lower rates of infant mortality than those with less development.

Falls in infant and childhood deaths have been shown to be followed by declines in fertility (Caldwell 1999). The factors responsible for the decline in infant mortality varied according to the age at which an infant died and across different time periods throughout the 20th century. The modern causal pathways to postneonatal death start early in development, and while some may still be socially related, they are complex and preventive solutions are not currently obvious. Thus its reduction had to await new methods to treat the end-stage complications in the neonate, as primary prevention was not possible in ignorance of causality. Both demand research into the many causes of preterm birth, intra-uterine growth restriction and developmental anomalies. This is inappropriate as the antecedents and major contributors to these rates today have little to do with hospital services.
Medical science has made significant contributions to falls in all these causes of death by more accurate diagnosis, improved surgical techniques and chemotherapy.
And particularly among males, accidental and violent death has always been an important contributor. The fall in recent times reflects successful legislation (seatbelts, drink driving) and public education programs to avoid accidents of all kinds, including work safety, particularly aimed at young people.
In 1907 fewer than 5 per 100,000 male teenagers took their own lives in spite of the difficulties of the times. Thus children grew taller and, one imagines, healthier and more capable of resisting infections than their earlier born, less well fed and shorter parents. Mothers of sick children were advised to seek medical help and public hospitals treated children free. And artificial feeding was less worrying because special infant formulas became available and the water to make them up was clean. Even when controlling for family income and access to health services, a child’s chance of survival improves with higher levels of parental education, the relationship with maternal educational level being the strongest (Caldwell 1999).
Mortality declined through improved public health, social and behavioural changes, and the use of medical and other technology.
The extent to which one influenced the other and how more income translated into better outcomes is not known. This meant fewer children to look after, less crowding in housing and better provision of those things essential for good health for the children.
Before World War II few vaccines were available, the most significant for children being diphtheria and tetanus antitoxoid.
However, since the 1950s, mass vaccination has been the single most effective public health measure to reduce the occurrence of infections, to reduce child deaths and to improve child health (Ada and Isaacs 2000). In 1980s Haemophilus influenzae (Hib) was the most serious infection in young children (graph 6.12). As the incidence and severity of infections has fallen, parents have become apathetic about vaccination and some actively oppose it.
Other antibiotics followed, and the death and complication rates of all bacterial infections fell markedly (Williams 1989).
Children were to be beneficiaries of new knowledge in biomedical science as well as from the specialisation in paediatric care.
Knowledge about how the body worked and how diseases were caused meant that diagnosis became accurate and treatments more focused and effective. Morbidity data for all Australian children are available via surveys, such as the National Health Survey, and from data collated by AIHW. Similar to other developed countries, we have observed increases in 'complex' diseases in the cohorts of children born in the last three decades.
They head a list of complex disorders which have taken over from infectious diseases as the most serious threats to the health of our young people. It was the leading problem (present in nearly 20% of children aged 4-16 years) reported in the WA Child Health Survey in 1992 (Zubrick, Silburn et al. In 0-14 year old Western Australian children the rate rose from around 12 per 100,000 (in 1985-91) to 22 in more recent years (Kelly, Russell et al. Primary prevention, as with all these complex problems, is obviously the way forward, but will only come from further research into causes.
Some of this is clearly related to increased survival of high risk newborns and of children with established disability (Blair and Shean 1996).
Antenatal diagnosis and termination of affected Down Syndrome and Fragile X affected fetuses, newborn screening for phenylketonuria and congenital hypothyroidism, and vaccination against congenital rubella and Hib, have been the main contributors; improved social conditions may also have contributed. 1997); it is not clear the extent to which these are all true rises or due in part to parental concerns and changing fashions in diagnosis.
Due to clever advertising by cigarette companies internationally, and peer pressure, children and teenagers are starting to experiment with these drugs at earlier and earlier ages. By 14 years of age, over half of the boys and girls have started drinking, some on a regular basis. Such behaviour in women was unusual in the early and middle years of last century; now we are faced with the prospect of more young girls smoking and as many drinking alcohol as young boys. Legislation banning cigarette advertising of any kind was introduced earlier in Australia than in other countries. It increased in times of prosperity such as the early 1900s, rose before each world war, fell during it and rose again after it, and fell in times of adversity such as in the 1930s during the Depression. It continued to fall until around 1975 when, associated with marked changes in the professional and social development of women, age at marriage increased again to levels similar or even higher than those seen in 1920s. Fertility increased to 3 babies per woman in 1947 and peaked at 3.6 in 1961-during this period (1947-61) 3 million babies were born in what has been referred to as the baby boom!
During the 1960s Indigenous women had a total fertility rate of around 6 babies per woman, which fell during 1970s to about 3 and in the 1990s to 2.4. By 1947 when marriages in haste before the war had started to be tested, the rate had risen to around 5.
After separation, children of all ages were more likely to live with their mother than their father, but could have regular contact with the other parent. However the data are incomplete as much goes unrecorded even in those States with mandatory reporting of abuse. I used to be freaked out, and I wouldn’t actually let my boyfriend put his hand in my pants. You just need to be you and love your vagina (vajayjay, pussy… whatever you call it!). Professor Stanley serves on the Prime Minister's Science, Engineering and Innovation Council and is Australia's representative on the WHO Western Pacific Advisory Committee for Health Research.
In many ways, this last century has been a glorious one in which to have been involved as a child and public health professional. And in later childhood and adolescence, risks are dominated by factors associated with lifestyle and mental health problems which require a complex range of preventive strategies over many years. The hope is that the messages about the most important aspect of our future as a nation - the health of our children - will be heard and responded to. Infant mortality, influenced by preventive health measures, which include social improvements, is used as a measure of such services for a population. The rate fell from around 120 for males and 100 for females at the beginning of Federation to below 60 in the late 1920s.
The children born in conditions which result in higher infant mortality are likely to have poorer health throughout their lives.
Most neonatal deaths occurred in the first days of life and this pattern is still seen today.
As most children born with these problems today do not die, but have significant morbidity and disabilities, knowledge leading to prevention is of considerable importance.
As in 1901, the causal pathways to infants dying in the 1990s commenced well before hospital services have any influence. The most common causes of death in the age group 15-19 years in the 1990s were accidents and suicides. These death rates are markers for the high rate of injuries sustained in accidents resulting in serious and often permanent trauma and disability. Thomas McKeown in the UK (McKeown 1979) and Douglas Gordon in Australia (Gordon 1976) both suggested that changes in living conditions, particularly better nutrition (which would have increased host resistance to infection) and improved hygiene (reducing contact with infecting organisms) played a more important role than improved medical knowledge. As these young women entered the child bearing age, they would have been more likely to have healthy pregnancies. Special hospitals for sick babies, most with gastroenteritis, were also established, such as the Lady Edeline Hospital for Babies at 'Greycliff' in Vaucluse. A change in the way death is viewed culturally has driven this commitment to survival, with death being viewed as the worst of all possible outcomes (Simons 1989). More disposable income for families resulted in better food, clothes, education and better housing-all of which have been associated with improved child mortality and morbidity. In 1920s and 1930s there were still many living in crowded and poor industrial areas of large cities and in poor rural areas in inadequate housing and conditions, and unemployment made it hard for families, even those of smaller size, to provide for their children. Invasive Hib disease (meningitis, septicaemia) had a high case fatality, particularly among Indigenous infants, and left many surviving children with severe intellectual and physical disabilities (Hanna 1992).
Because of its very effectiveness, vaccination is regarded by a significant proportion of the community as unnecessary or dangerous.
However the excessive use of antibiotics has resulted in increasing numbers of organisms resistant to their effects.
X-rays, surgery and anaesthesia, fluid and electrolyte metabolism, chemotherapy and other drugs such as those for epilepsy, pain relief and many disorders, have been so effective that many now believe that everything can be cured or will be very soon. And some States, such as WA, have good record-linked and special survey data to describe the recent pattern of child and adolescent morbidity (Stanley, Read et al. Suicide and mental health morbidities have been described already and appear to be related to the social changes in our communities. Once addicted they put themselves at increased risk of smoking related illnesses such as cancer, heart disease, stroke and those risks associated with alcohol such as accidents, unsafe sex, suicide and mental illness.
Between a quarter and a third of 15 year old males and a third of females admit to smoking in the past week (table C6.14). With the knowledge about the effects of these on the future health of both boys and girls and for girls, on that of their babies, this is a major public health concern. Recent laws have banned smoking in work and public places, but novel ways need to be found to counteract the clever subliminal advertising of cigarette companies (Daube 2000). The widespread introduction of the contraceptive pill gave women easier and more sure control over their fertility, which fell along with changes in desired family size.
The age distribution of births is very different for Indigenous mothers compared with non-Indigenous, with many more teenage births (graph C6.3).

After a decline in the 1950s, divorces started to increase in the 1960s and climbed sharply in 1976, following the introduction of the Family Law Act and 'no-fault' divorce. The ABS Family Characteristics Survey of 1997 found that there were 978,000 children living with only one natural parent; most (88%) lived with their mother in either one-parent (68%) or in step or blended families (20%). Rates of mental health morbidity were highest when adult relationships were rated poor or fair. Data from the Australian Institute of Health and Welfare show increases in abuse and neglect up to 1994-95, with small falls in later years (table C6.20). Of course, I started reading more about it and found out that lots of other women were in the same situation. I am also grateful to my colleagues in the Population Sciences Division at the Institute for Child Health Research for the research they do and the environment they provide for work such as this. These dramatic improvements over the last 100 years result from reductions in mortality at all ages, but particularly in early childhood, as shown by the impact in removing under fives mortality from the life expectancy calculations-the improvement in life expectancy at age five compared to life expectancy at birth was significantly greater in the early 1900s than in the 1990s. Western countries have doubled their life expectancies from around 40 years in the mid-nineteenth century to almost 80 years at the end of the twentieth. Both male and female rates have remained below 10 since 1986, and the overall rate was 5 in 1998. Low birth weight and other early problems may well relate to many of the diseases seen in higher frequency among Indigenous adults such as cardiovascular disease, diabetes and renal failure (Mathews 1997).
It was dominated by gastroenteritis and other infections, and thus these rates fell rapidly in response to major public health interventions and improved social conditions.
While neonatal mortality in certain low gestation and birthweight categories has been used in the past to evaluate the quality of newborn intensive care, this is no longer a reasonable index.
Preventive solutions thus lie elsewhere and demand investment in research in early causal pathways. The commonest causes of accidental death in children are motor vehicle accidents, drowning and inhalation of foreign bodies. The most worrying trend in all of those shown in this article is the increasing rate of suicides in young Australian males. The rates for children have fallen steadily whereas those for teenage males rose to a peak in the mid 1970s before falling in 1990s to levels just below those in 1907 (graph C6.6). The rate for females is more variable due to the small numbers, hovering between 2 and 6 per 100,000. This was in the first few decades of the 20th century when falls in deaths in infancy and childhood were due mainly to fewer children dying from gastroenteritis, respiratory and other infections (Lancaster 1956a; Lancaster 1956b).
Infant welfare clinics and the home visitor program expanded to postgraduate training for nurses in baby health (infant welfare) at 'Tresillian centres', which sprang up all over the country and were the beginning of community child health in Australia.
While data on the prevalence of breast feeding at the time of discharge from the hospital of birth are fragmentary, it is recorded that only 40-45% of mothers were initiating breastfeeding in 1970s, a fall from over 50% in 1950s and much lower than the 90% in Armstrong’s day. In eras with high mortality rates, death was not regarded as unusual, whereas as the capacity to survive became possible, there was a strong commitment to reducing risks and to avoid death. This situation is extremely worrying and makes the case for primary prevention even more powerful. The increased rates of cerebral palsy in very preterm and low birthweight survivors following the introduction of intensive care are an unwelcome outcome of effective technologies aimed at reducing deaths (Stanley, Blair et al. While some of this increase may be due to changes in diagnosis and more awareness, research is now concentrating on the variable and complex causal pathways to this major allergic disease in relatively healthy communities. 2000) reported temporal increases in Body Mass Index (BMI, a measure of weight for height) in both Sydney and Melbourne children from age 7 to 18 years, with about 25% of children being overweight.
Over the last 20 years marriage rates have fallen, and age at first marriage and age at first birth have increased dramatically (graph C6.16). This allowed only one ground for divorce-an irretrievable breakdown in the marriage measured by the separation of the spouses for at least one year. Remarriage rates increased after the 1976 divorce peak and have declined slightly since then. The data suggest that children in single parent families fare less well socially, educationally and physically than children in two parent families (adopted as well as natural). All paediatric hospitals now have teams of highly skilled professionals to diagnose and manage these children and their families.
If we were to enter one of those competitions to nominate the greatest advance of the latter part of the millennium, it would be difficult to overlook the pushing back of the frontiers of death and the guarantee that most people will live to old age” (Caldwell 1999). The death rates in 1-4 year old children were much lower throughout the last 100 years, although the pattern of their fall was similar to infant death rates.
By the 1930s, less than a third of infant deaths were postneonatal and these rates, still dominated by infectious diseases, responded further in the 1940s and 1950s as mass vaccination and antibiotics became available. Most were due to extreme prematurity and poor fetal growth, congenital malformations and complications of pregnancy. Decreases in accidental deaths due to traffic accidents and drowning in the 1980s and 1990s followed legislation to restrain young children in cars and to make swimming pool fencing compulsory.
For females the rates are lower and the pattern is different: high rates in the 0-4 year old girls in the early decades of the 20th century with steady falls in both child age groups over time. Deaths from suicide have been more common in males than those from motor vehicle accidents since 1990, due to increases in suicide and falls in the accidental deaths.
Hospital staff were less educated about the importance of breastfeeding, and perhaps there was an influence of it not being fashionable as well! An educated mother is one who is more rational, able to be informed about ways to improve child health, is likely to breastfeed and immunise her child, seek help early if the child is sick and follow instructions in terms of health care.
Current rates of vaccination in Australian children are less than those in Viet Nam; this is another public health challenge for us in the 21st century.
Researchers blame the sedentary lifestyles and diets of children; the intake of fruit and vegetables and of physical activity decreases throughout adolescence (Wake, Lazarus et al. In contrast divorce rates rose in the 1970s, stabilised in the 1980s and have increased slightly through the 1990s.
An increasing part of this fall is contributed by women who decide to remain childless; in the 1990s 27% of women did not have any children. Divorce rates have been consistently higher in the 1980s and 1990s than at any time before 1975. Single parents are more likely to be young, poor, and have low educational levels and other social risk factors. The data on mortality below have been compiled by the Australian Institute of Health and Welfare (AIHW) Mortality Monitoring System from official death registrations. Once a child survived beyond its first year, even in early 1900s, its chances of survival were good. Population data on Indigenous infant mortality have only been available since the 1970s, although Thompson noted that the Northern Territory in the 1960s reported rates of around 150 per 1,000 live births. Changes in Western Australia which have relaxed the policing of swimming pool fencing have resulted in increases in child drowning in that State recently (Eastough and Gibson 1999; Silva, Palandri et al. Among teenage girls the rate was steady until an increase similar to that for males (but at a much lower rate) was observed from 1955 to 1985, with falling rates since then (graph C6.7). Beneath these death rates lie much larger numbers of children and young people with severe depression and other mental health problems.
His aim was somewhat delayed as his energies were diverted into an outbreak of plague in Sydney at the turn of the century! Following intensive community campaigns to reeducate women about breastfeeding, there has been a steady upward trend with recent figures in the 1990s of around 76% of new mothers initiating breastfeeding, with over 50% still fully breastfeeding at 3 months (Jain 1996). Along with higher levels of education in the first 50 years since 1900 would have come an increasing knowledge about, and belief in, modern medical science and what it could deliver for health. Coincident with the fall in marriage rates, there has been an increase in de facto relationships, which have become more socially acceptable in the last 20 years, even if children are involved.
Of those who do, 40% will have 2 children, the most common family size, and only 12% of women would have one child.
Thus the critical issue is not necessarily how many parents a child has but the social and environmental context in which the single parent family operates (Fergusson 1984). The best estimates are around 70-80 in the 1970s falling to around 25 in 1980s (Thomson 1991). Three causes accounted for nearly 80% of postneonatal deaths at the turn of this century-SIDS, birth defects and perinatal conditions. While female suicide rates are much lower, more females attempt suicide than males (Zubrick, Silburn et al. The main intervention was to encourage mothers to breastfeed, with many supports to enable this to happen, including trained health workers visiting all new mothers. At the other extreme, there is an epidemic of eating disorders and weight concerns with a desire for thinness among girls, and increasingly among boys as well. Also problems can be exacerbated if the parent remarries or enters into a new situation with a blended family.
In children aged 5-14 and 15-19 years the rates were initially much lower than in younger children and have fallen steadily. Children in poorer families and in Indigenous families are more likely to have accidents than those in other families. More recently more women being educated reflects female empowerment, which has been associated with greater control over their own lives and better health for them and their children. Deaths and cerebral palsy are the 'tip of the iceberg' of damaged children; prevention will need research to identify the best ways to avoid unwanted pregnancies, help young parents, avoid isolation of single parents and provide social support. For 5-14 year old males the rate was 187 in 1907 and 17 in 1998; for females 172 falling to 12. In 15-19 year old males, the rate was 267 in 1907 and 75 in 1998; for females 237 and 37 respectively. He was convinced from his international observations that breastfeeding was the most important protection from gastroenteritis which killed so many infants. Education is now so widespread that its continued importance to child health and care is often taken for granted.
The longer-term effects of poor adolescent growth are now starting to be described, particularly on bones and on mental health. His own investigations in Sydney showed that the mortality among infants under 3 months of age from diarrhoeal diseases was between 10 and 15 times as great among those artificially fed as among those entirely breastfed.
Armstrong maintained that breastfeeding was the most important influence on infant mortality from the early 1900s to 1914 (table C6.10).

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