Pandemic Exposure and Infant Mortality: Evidence from Early Twentieth-Century Taiwan

Chun-Hao Li, Yuan Ze University
Wen-Shan Yang, Academia Sinica
Ying-Chang Chuang, National Sun Yat-sen University

This study examines the relationship between pandemic exposure and infant mortality in early twentieth-century Taiwan. The global influenza pandemic of 1918-1920 infected roughly one-third of the world’s population and caused tens of millions of deaths, yet its impact on infant survival in historical Asian societies remains poorly understood. Using data from the Taiwan Historical Household Registration Database (1906-1945), this research analyzes 42,235 children born in four communities in the Hsinchu region, among whom approximately one-fifth died before age three. Drawing on perspectives from epidemiology, the fetal origins hypothesis, and family demography, the study investigates how epidemic exposure and household structure jointly influenced infant survival. Event-history methods, including Kaplan-Meier survival curves and Cox proportional hazards models, are employed to estimate mortality risks while accounting for demographic characteristics and family composition. In particular, the analysis distinguishes between children born during the influenza pandemic and those conceived during the pandemic period, allowing assessment of both postnatal and prenatal exposure. The findings indicate that children conceived during the pandemic experienced significantly higher mortality risks, suggesting that prenatal exposure to epidemic conditions played a crucial role in early-life health outcomes. Household composition also mattered: grandmothers and older sisters were associated with improved survival chances, highlighting the protective role of kinship networks. These results demonstrate that infant mortality during the pandemic reflected not only epidemic shocks but also the micro-level dynamics of family organization and caregiving.

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 Presented in Session 141. Twentieth-Century Medical Perspectives