The causes of the decline in mortality rates experienced by Europe in the nineteenth and twentieth centuries are still debated.1 One understudied cause that contributed to the decline in mortality is the expansion of sickness insurance. C. R. Winegarden and John E. Murray have studied the role of sickness insurance on overall mortality, but the effect of sickness insurance on infant outcomes has largely been ignored and thought to have been a second-order effect. 2 Many European countries passed sickness insurance legislation between 1878 and 1913. Sickness insurance provided women with confinement (maternity) benefits which improved access to medical care, provided supplemental income to new mothers, and promoted proper infant care practices. The empirical analysis in this article shows that the expansion of sickness insurance coverage in European nations by 1 percent was related to a decline of nearly one infant death per 1000 infants at the margin. This decline in the infant death rate accounts for 18 to 35 percent of the entire decline in the crude death rate attributed to sickness insurance.
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