Children

Ketuvot 50a ~ The Economic Costs of Raising Children

Kids Today

In a recent Pew study on the use of electronic media by children in the US was this remarkable finding: Nearly one-in-five parents of a child 11 or younger (17%) say that their child has their own smartphone. Here's another gem from the same report: More than one-third of parents with a child under 12 say their child began interacting with a smartphone before the age of 5. Some children have quite comfortable lives, it would seem.  But it wasn't always that way.

Kids Back Then 

Today's page of Talmud (Ketuvot 50a) reminds us of another kind of reality that children once faced. Back then, it was a much more harsh world. And not just because the kids were not given their own iPhone.  In fact, according to the Talmud, they were lucky just to get food and shelter. 

תלמוד בבלי כתובות דף נ עמוד א

אשרי שומרי משפט עושה צדקה בכל עת - וכי אפשר לעשות צדקה בכל עת? דרשו רבותינו שביבנה ... זה הזן בניו ובנותיו כשהן קטנים

“Happy are those who keep justice, who perform charity at all times” (Psalms 106:3). But is it possible to perform charity at all times? This, explained our Rabbis in Yavneh...refers to one who sustains his sons and daughters when they are minors.
— Talmud Bavli, Ketuvot 50a.

In yesterday's Daf, we learned that a person's legal obligation to support their children ends when those children reach the age of six. From that age, the parents' obligations to give their children water, food and clothing is not a legal one, but a moral one. If a parent refuses to support a child older than six, the courts can impose pressure to do so. But there is no legal obligation to support your child once they reach the ripe old age of six.  Because of this ruling, the Talmud considers the support of minor children to be an act of charity.  (Try bringing that argument up the next time your child asks for a cellphone upgrade.)  Here is how this law is codified.  

שולחן ערוך אבן העזר הלכות כתובות סימן עא סעיף א

 חייב אדם לזון בניו ובנותיו עד שיהיו בני שש ...ומשם ואילך, זנן כתקנת חכמים עד שיגדלו. ואם לא רצה, גוערין בו ומכלימין אותו ופוצרין בו. ואם לא רצה, מכריזין עליו בצבור ואומרים: פלוני אכזרי הוא ואינו רוצה לזון בניו, והרי הוא פחות מעוף טמא שהוא זן אפרוחיו; ואין כופין אותו לזונן...במה דברים אמורים, בשאינו אמוד, אבל אם היה אמוד שיש לו ממון הראוי ליתן צדקה המספקת להם, מוציאים ממנו בעל כרחו, משום צדקה, וזנין אותם עד שיגדלו 

A person is obligated to support his sons and daughters until they reach the age of six...From that age, he is required by rabbinic decree to support them until they grow up. If he does not wish to support them, we admonish him until he complies.  If he still refuses, we announce to the public: "So-and-so is a cruel person, and does not wish to support his children. He is worse than an unclean  bird - even that bird cares for its chicks." But we cannot force him to support his children.  

But this only applies when we have assessed that indeed he cannot support them financially.  But if we assessed him, and found that he has the money to give to charity and this would allow the children to live, we take the money from him by force, in the name of charity, and support the children until they grow up. (Shulchan Aruch Even Ha'Ezer 71:1)

The Economic Costs of Raising Children

Raising children is an expensive undertaking.  It requires parents to put in years and years of emotional, material and psychological effort. Those material costs can be calculated, and here they are:

So according to the USDA, it costs - on average - about $241,000 to raise a child in the US. That sounds like a bargain to me.  It cost that just to put one of my children through through twelve years of their Jewish school. And that's before I'd bought them a slice of bread. Or an iPhone.

Families Projected to Spend an Average of $233,610 Raising a Child Born in 2015. From here.

For someone making $60,000 a year, in America, that’s middle class...But in this Orthodox community, $60,000 means you aren’t going to make it.
— Rabbi Ilan Feldman, leader of Congregation Beth Jacob, interviewed in Tablet, July 11, 2014.

Research by the sociologists Sabino Kornrich and Frank Furstenberg has demonstrated that the way Americans spend money on their children has changed over the last several decades.  It turns out that before the the 1990s, parents spent most on children in their teen years. However, after the 1990s, spending patterns shifted, and was greatest when children were under the age of 6 and in their mid-twenties. We've also changed the where we spend on our children - and education now accounts for more than half of what US parents spend on their children. 

Average spending per child by year and percentage of expenditures in each area for all households with children age 0 to 24. From Kornrich and Furstenburg.  Investing in Children. Demography 2013. 50:1-23.

There's some good news too, for girls. In the 1970s, parents in households with only male children spent significantly more than parents in households with only female children - and nearly all of that extra money was spent on education. But by the early 2000s, the data showed a reversal: households with only female children spent more than households with only male children. 

Kronrich and Fursetnberg concluded that parents are investing more heavily in their children now than in the past. "While scholars debate exactly which resources matter most for children’s development... parents are demonstrating a substantial willingness to spend in order to better their children’s circumstances. These results mirror other shifts in parental behavior: parents are having fewer children and, through a range of activities like spending time with their children and choosing activities that impart cultural capital, are investing more intensively in the children they do have." 

Treat Your Children Well

Jewish law considers the support of a child to be an act of charity rather than a legal obligation. There is a similar ruling that shows an interesting symmetry at the other end of the spectrum. The Shulchan Aruch (הלכות צדקה סימן רנא) writes

 וכן הנותן מתנות לאביו והם צריכים להם, הרי זה בכלל צדקה

... a child who gives a gift to his parent who needs it, can include this as an act of charity

Just as you are not legally obligated to support your children when they are young, your children have no legal obligation to support you in your old age.  If they choose to do so, their act is one of charity. So treat your children well; they'll be the ones who will choose your nursing home.

Spending on children is one of the most direct ways that parents can invest in children. Parental spending can buy children experiences that build human and cultural capital: high-quality education, residence in better neighborhoods, and potentially high-quality child care while children are young and parents are at work.
— Kornrich and Furstenburg. Investing in Children. Demography 2013. 50:3.
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Mo'ed Katan 24a ~ Infant Deaths

On the last few pages of this tractate, the Talmud discusses the end of life, or more precisely, the ends of lives. Having discussed how one mourns for a parent, on this daf, the focus is on the deaths that are most painful of all: the deaths of children.

מועד קטן כד, א-ב

כל שְׁלֹשִׁים יוֹם, תִּינוֹק יוֹצֵא בַּחֵיק, וְנִקְבָּר בְּאִשָּׁה אַחַת וּשְׁנֵי אֲנָשִׁים. אֲבָל לֹא בְּאִישׁ אֶחָד וּשְׁתֵּי נָשִׁים. אַבָּא שָׁאוּל אוֹמֵר: אַף בְּאִישׁ אֶחָד וּשְׁתֵּי נָשִׁים. וְאֵין עוֹמְדִין עָלָיו בְּשׁוּרָה. וְאֵין אוֹמְרִים עָלָיו בִּרְכַּת אֲבֵלִים וְתַנְחוּמֵי אֲבֵלִים

בֶּן שְׁלֹשִׁים יוֹצֵא בִּדְלוֹסְקָמָא. רַבִּי יְהוּדָה אוֹמֵר: לֹא דְּלוֹסְקָמָא הַנִּיטֶּלֶת בַּכָּתֵף, אֶלָּא הַנִּיטֶּלֶת בָּאֲגַפַּיִים. וְעוֹמְדִין עָלָיו בְּשׁוּרָה, וְאוֹמְרִים עָלָיו בִּרְכַּת אֲבֵלִים וְתַנְחוּמֵי אֲבֵלִים

בֶּן שְׁנֵים עָשָׂר חֹדֶשׁ יוֹצֵא בְּמִטָּה. רַבִּי עֲקִיבָא אוֹמֵר: הוּא בֶּן שָׁנָה וְאֵבָרָיו כְּבֶן שְׁתַּיִם, הוּא בֶּן שְׁתַּיִם וְאֵבָרָיו כְּבֶן שָׁנָה — יוֹצֵא בְּמִטָּה.בִּרְכַּת אֲבֵלִים וְתַנְחוּמֵי אֲבֵלִים

Within the first thirty days after birth, an infant that dies is taken out for burial in one’s bosom, that is to say, he is carried to his grave in one’s arms, not in a coffin….

And for such an infant, people do not stand in a line to offer their condolences to the mourners, as is ordinarily done after a burial; nor do others recite over him the mourners’ blessing, which is recited in the courtyard of the graveyard after the burial; nor is the usual formula for the consolation of mourners recited during the seven days of mourning. 

A thirty-day-old infant that dies is taken out for burial in a coffin [deluskema]. Rabbi Yehuda says: Not in a small coffin that is carried on one’s shoulder, but rather in a coffin that is carried in the arms of two people. And for such an infant, people stand in a line to offer their condolences to the mourners. And others recite the mourners’ blessing at the cemetery. And people recite the consolation of mourners during the week of mourning. 

A twelve-month-old infant is taken out for burial on a bier, just as an adult is.

There are, unfortunately, many examples of rabbis mentioned in the Talmud who mourned their children. One of the most well-known was Rabbi Yochanan, who buried ten children.

ברכות ה, ב

תָּנֵי תַּנָּא קַמֵּיהּ דְּרַבִּי יוֹחָנָן: כׇּל הָעוֹסֵק בְּתוֹרָה וּבִגְמִילוּת חֲסָדִים וְקוֹבֵר אֶת בָּנָיו — מוֹחֲלִין לוֹ עַל כׇּל עֲוֹנוֹתָיו

וְהָא אָמַר רַבִּי יוֹחָנָן, דֵּין גַּרְמָא דַּעֲשִׂירָאָה בִּיר

A tanna taught the following baraita before Rabbi Yochanan: If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven…

Rabbi Yochanan himself said, This is the bone of my tenth son…

Rabbi Yochanan bar Napcha (c.180–279 CE) is cited many hundreds of times in the Talmud. But it was his tragic family story that perhaps most defined who he was. He was a father who had lost ten children.

Childhood mortality in rabbinic sources

Rabbi Yochanan’s tragedy might have been extreme in its severity, but his was not a unique situation. In fact the Talmud and the Midrash are replete with stories that reflect the high rate of both infant and child mortality at the time. In this tractate we learn that Rabbi Yishmael lost at least two sons, (Moed Katan 28b) as did Rabbi Akiva (Moed Katan 21b). Rabban Gamiel cried in sympathy with a neighbor who lost her child (Sanhedrin 104b), whereas when Rav Yossi of Zippori lost a son, he chose not to cry, but to expound all day long in the Bet Midrash (Moed Katan 21a). The Midrash recounts that both sons of Rabbi Meir died on a Shabbat (Midrash Mishlei 31:10), and when the sons of Rabbi Yossi ben Chaninah died, he refused to wash with warm water (Ta’anit 13b). Children were eaten by wolves (Ta’anit 22b) murdered by brigands (Semahoth 12:13) and buried in earthquakes (Semachot 11:4). In some hemophiliac families, infants bled to death after being circumcised (Yevamot 64b), while other children committed suicide rather than face either physical abuse from their father (Semahoth 2:4-5), or an unwanted arranged marriage (Seder Eliyyahu Rabbah 19).

Professor Meir Bar Ilan (from the university that bears his family name) identified over two dozen other cases. Professor Bar Ilan adds that an additional factor should not be overlooked.

…almost all the cases indicate deaths of sons, not daughters. Apparently it reflects the nature of a patriarchal society, where one's importance depends merely on his sex (as in more than few societies even today). Furthermore, since there is no reason to believe that boys were prone to death more than girls (except in the case of circumcision), it reveals that, actually, the cases are all 'males' while ignoring the females. Because of this 'male' factor, one that wishes to know the exact number of deaths in the above sources, should multiply his data with (almost) 2.25 That is to say, that usually the deaths of girls were ignored, though they, apparently, happened at the same rate.

Calculating the infant mortality rate in THE TaLmudic era

Professor Bar Ilan counted about nine cases of infant or child death among the fifety or so tannaim mentioned by name in the Talmud. After taking into account the “ignored” factor of deaths of girls, he suggested that infant mortality rate among the families of the tannaim approached 30%.

To put this number into context, the infant mortality rate in Great Britain around 1880 was about 135 per thousand live births, or about 13%.  Among the Jews of Italy,  about 40% of children under the age of three died. It is harder to calculate the mortality rate in ancient Rome, but other scholars have estimated it to be 25-30%.

Life Expectancy and Infant Mortality Rates in 16th Century Europe
Village in Devon
England, 1538-1599
Village in Essex
England, 1550-1624
Bourgeoisie of
Geneva, 1550-1599
English High
Aristocracy, 1550-1599
Average age of women at marriage 26 24.5 21.4 22.8
Infant mortality per 1000 (0-1 years) 120-140 128 - 190
Infant mortality per 1000 (1-14 years) 124 149 - 94
Infant mortality per
1000 (1-19 years)
- - 519 -
Average life expectancy 40-46 - 28-29 37
Data from Meir Bar Ilan, Infant Mortality in The Land of Israel in Late Antiquity

The Shameful infant Mortality Rate in the US

In 2017 the infant mortality rate in the US was 579 per 100,000 or just under 0.6%.  That rate is fifty times lower than the rate during the centuries over which the Talmud was compiled.  The leading cause of death is congenital malformations, but accidental injury remains a major cause of mortality in children. Just like it did in ancient Israel.

The US ranks 30th of 193 countries in infant mortality rate, the ratio of babies that die before turning one year old. In the US, there are more than three times as many infant deaths for every 1,000 births as there are in the countries leading the list.
— More infants are dying in US states that rejected expanded Medicaid. Quartz, Feb 1, 2018.

But take a look at the chart below and you will see that the rate in the US is over two or three times higher than it is in other western countries. It is shameful that the country with the highest per capita rate of health care spending finds itself so low down on this list.

Infant mortality per 1,000 births, 2010-2015. Date from the United Nations. From here.

A very recent paper by Ezekiel Emanuel and colleagues from the University of Pennsylvania addressed the question of whether the medical care given in the US was “the best in the world.” (Spoiler alert: it is not). Among their findings were that even for the most privileged on US citizens, rich white people, on most measures of health outcomes they do worse than the average individual in other countries. Here is what they found for one of those measures, infant mortality:

The infant mortality rate among White US citizens in the 1% highest income counties is 3.54 per 1000 live births, while the 5% highest-income counties have an infant mortality rate of 4.01 per 1000 live births—higher than in all 12 comparison countries. Among all US citizens, the infant mortality rate is 5.90 deaths per 1000 live births. Among comparison countries, the infant mortality rate is lowest in Finland, at 1.70 per 1000 live births, and highest in Canada, with 4.70 per 1000 live births. Only 2 of the top 157 highest-income counties in the US have White infant mortality rates below that of Norway, and none have rates lower than Finland .

Comparative studies show different data from various cultures and times, and together with the texts themselves, suggest that some 30% of all children born in the Land of Israel at the beginning of this era would not reach their maturity.
— Meir Bar Ilan. Infant Mortality in The Land of Israel in Late Antiquity.

“Neither the suffering nor the reward”

Because infant and childhood deaths were so common it is not surprising that the rabbis of the Talmud tried to inject a glimmer of metaphysical hope into this most tragic of tragedies. Rabbi Yochanan had lost no fewer than ten children, and his colleagues attempted to console him with the promise of a reward to come: “If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven.” That might have consoled Yochanan the Rabbi, but it did not console Yochanan the grieving father. Rabbi Yochanan rejected the very notion that suffering -of any sort-was worth a reward. “I want neither this suffering nor its reward - לֹא הֵן וְלֹא שְׂכָרָן.”

[Mostly a repost from Berachot 5.]

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Berachot 5b~ The Infant Mortality Rate

ברכות ה, ב

תָּנֵי תַּנָּא קַמֵּיהּ דְּרַבִּי יוֹחָנָן: כׇּל הָעוֹסֵק בְּתוֹרָה וּבִגְמִילוּת חֲסָדִים וְקוֹבֵר אֶת בָּנָיו — מוֹחֲלִין לוֹ עַל כׇּל עֲוֹנוֹתָיו

וְהָא אָמַר רַבִּי יוֹחָנָן, דֵּין גַּרְמָא דַּעֲשִׂירָאָה בִּיר

A tanna taught the following baraita before Rabbi Yochanan: If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven…

Rabbi Yochanan himself said, This is the bone of my tenth son…

Rabbi Yochanan bar Napcha (c.180–279 CE) is cited many hundreds of times in the Talmud. But it was his tragic family story that perhaps most defined who he was. He was a father who had lost ten children.

Childhood mortality in rabbinic sources

Rabbi Yochanan’s tragedy might have been extreme in its severity, but his was not a unique situation. In fact the Talmud and the Midrash are replete with stories that reflect the high rate of both infant and child mortality at the time. Rabbi Yishmael lost at least two sons, (Moed Katan 28b) as did Rabbi Akiva (Moed Katan 21b). Rabban Gamiel cried in sympathy with a neighbor who lost her child (Sanhedrin 104b), whereas when Rav Yossi of Zippori lost a son, he chose not to cry, but to expound all day long in the Bet Midrash (Moed Katan 21a). The Midrash recounts that both sons of Rabbi Meir died on a Shabbat (Midrash Mishlei 31:10), and when the sons of Rabbi Yossi ben Chaninah died, he refused to wash with warm water (Taanit 13b). Children were eaten by wolves (Taanit 22b) murdered by brigands (Semahoth 12:13) and buried in earthquakes (Semachot 11:4). In some hemophiliac families, infants bled to death after being circumcised (Yevamot 64b), while other children committed suicide rather than face either physical abuse from their father (Semahoth 2:4-5), or an unwanted arranged marriage (Seder Eliyyahu Rabbah 19).

Professor Meir Bar Ilan (from the university that bears his family name) identified over two dozen other cases. Professor Bar Ilan adds that an additional factor should not be overlooked.

…almost all the cases indicate deaths of sons, not daughters. Apparently it reflects the nature of a patriarchal society, where one's importance depends merely on his sex (as in more than few societies even today). Furthermore, since there is no reason to believe that boys were prone to death more than girls (except in the case of circumcision), it reveals that, actually, the cases are all 'males' while ignoring the females. Because of this 'male' factor, one that wishes to know the exact number of deaths in the above sources, should multiply his data with (almost) 2.25 That is to say, that usually the deaths of girls were ignored, though they, apparently, happened at the same rate.

Calculating the infant mortality rate in THE TaLmudic era

Professor Bar Ilan counted about nine cases of infant or child death among the fifety or so tannaim mentioned by name in the Talmud. After taking into account the “ignored” factor of deaths of girls, he suggested that infant mortality rate among the families of the tannaim approached 30%.

To put this number into context, the infant mortality rate in Great Britain around 1880 was about 135 per thousand live births, or about 13%.  Among the Jews of Italy,  about 40% of children under the age of three died. It is harder to calculate the mortality rate in ancient Rome, but other scholars have estimated it to be 25-30%.

Life Expectancy and Infant Mortality Rates in 16th Century Europe
Village in Devon
England, 1538-1599
Village in Essex
England, 1550-1624
Bourgeoisie of
Geneva, 1550-1599
English High
Aristocracy, 1550-1599
Average age of women at marriage 26 24.5 21.4 22.8
Infant mortality per 1000 (0-1 years) 120-140 128 - 190
Infant mortality per 1000 (1-14 years) 124 149 - 94
Infant mortality per
1000 (1-19 years)
- - 519 -
Average life expectancy 40-46 - 28-29 37
Data from Meir Bar Ilan, Infant Mortality in The Land of Israel in Late Antiquity

The Shameful infant Mortality Rate in the US

In 2017 the infant mortality rate in the US was 579 per 100,000 or just under 0.6%.  That rate is fifty times lower than the rate during the centuries over which the Talmud was compiled.  The leading cause of death is congenital malformations, but accidental injury remains a major cause of mortality in children. Just like it did in ancient Israel.

The US ranks 30th of 193 countries in infant mortality rate, the ratio of babies that die before turning one year old. In the US, there are more than three times as many infant deaths for every 1,000 births as there are in the countries leading the list.
— More infants are dying in US states that rejected expanded Medicaid. Quartz, Feb 1, 2018.

But take a look at the chart below and you will see that the rate in the US is over two or three times higher than it is in other western countries. It is shameful that the country with the highest per capita rate of health care spending finds itself so low down on this list.

Infant mortality per 1,000 births, 2010-2015. Date from the United Nations. From here.

Infant mortality per 1,000 births, 2010-2015. Date from the United Nations. From here.

Comparative studies show different data from various cultures and times, and together with the texts themselves, suggest that some 30% of all children born in the Land of Israel at the beginning of this era would not reach their maturity.
— Meir Bar Ilan. Infant Mortality in The Land of Israel in Late Antiquity.

“Neither the suffering nor the reward”

Because infant and childhood deaths were so common it is not surprising that the rabbis of the Talmud tried to inject a glimmer of metaphysical hope into this most tragic of tragedies. Rabbi Yochanan had lost no fewer than ten children, and his colleagues attempted to console him with the promise of a reward to come: “If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven.” That might have consoled Yochanan the Rabbi, but it did not console Yochanan the grieving father. Rabbi Yochanan rejected the very notion that suffering -of any sort-was worth a reward. “I want neither this suffering nor its reward - לֹא הֵן וְלֹא שְׂכָרָן.”

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Niddah 32a ~ Neonatal Menstruation

In this midst of a complex discussion of the laws of ritual impurity as they apply to an adult woman, the Talmud notes that the same laws apply to a new born infant girl.

נדה לב, א

אשה אין לי אלא אשה תינוקת בת יום אחד לנדה מנין ת"ל ואשה

What is this interpretation of the difference between “a woman” and “and if a woman”? As it is taught in a baraita that from “a woman” I have derived only that the halakhot of menstruation apply to an adult woman. From where do I derive that the halakhot of a menstruating woman also apply to a one-day-old girl? The verse states: “And if a woman.” [when the verse includes young girls through the word “and” it includes even a one-day-old.]

From here.

From here.

This ruling is codified by Maimonides in his Mishneh Torah: “קְטַנָּה בַּת יוֹם אֶחָד מְטַמָּא בְּנִדָּה”. By this point you may be asking what case could the Talmud possibly be discussing? And the answer is: a real case.

Don’t Panic - it is not unusual

While it is unlikely that you have previously encountered the phenomenon of newborn menstruation, it is a very well described medical condition. In the English literature it is called “neonatal uterine bleeding” (NUB) or “neonatal menstrual-like bleeding” (NMB;) French authors refer to it as “la crise genitale du nouveau ne” and the Germans as “Neugeborenen genitalkrisen” which is useful to know, I suppose, should you find yourself in Europe with a baby girl who has this condition.

In a review paper titled “Is my baby normal? A review of seemingly worrisome but normal newborn signs, symptoms and behaviors” the authors, who were pediatric emergency physicians (meaning they looked after children - the doctors were themselves were, I think, adult-) noted that

Hormonal fluctuations in the neonatal period can result in changes in the genitourinary area that are concerning to parents. Female infants may experience scant vaginal bleeding due to hormonal withdrawal between the third and seventh day of life.

And here is how the very popular site WebMD explains what is going on:

At 2 or 3 days of age, your daughter may have a little bit of bleeding from her vagina. This is perfectly normal; it is caused by the withdrawal of the hormones she was exposed to in the womb. It will be her first and last menstrual period for another decade or so.

And that’s pretty much all there is to say. It is caused by a progesterone withdrawal in the little girl.

Incidentally there is another phenomenon that is somewhat related. Sometimes new-born baby girls will produce milk from their nipples (and sometimes it can happen in a baby boy). This is called “witchs’ milk,” although the correct medical term is galactorrhea. One study found it in 6% of 640 baby girls examined over a five-month period. It too is a normal finding, caused by the baby’s absorption of her mothers hormones, in this case prolactin, and it usually resolves with a month.

Neonatal uterine bleeding and other problems

So although it is a normal finding in a newborn girl, there is some evidence that neonatal menstruation may be an indicator of gynecological problems that will arise later in life. For example, it may be linked to early-onset endometriosis, a condition in which cells similar to the lining of the uterus grow outside of it, most commonly in the ovaries, but sometimes in the abdomen. And it has also been associated with fetal distress and low birth weight.

Summing this up in the European Journal of Obstetrics & Gynecology and Reproductive Biology, two researchers argued for more research in this phenomenon.

First, available evidence clearly indicates that neonatal bleeding is a menstruation characterized by progesterone withdrawal. Because feto-maternal factors influencing its frequency (fetal growth restriction, preeclampsia) are characterized by a reduced blood supply to the placenta, it seems that…NMB can therefore be used as a marker of intrauterine distress and, as a sign of fetal distress the bleeding requires to be registered in medical notes of all newborns.

Secondly, NMB may represent a sign of increased risk of developing endometriosis during adolescence and, in turn that this form may be more frequently progressive, as shown by several studies. Registration of NMB will allow prospective studies aimed at validating the application to newborns of the menstrual regurgitation theory.

Thirdly, there is a need to revive scientific interest in the neonatal menstrual-like bleeding; an event that possibly plays a role, among others, in the transgenerational evolution of major reproductive disorders and adolescent endometriosis.

Although neonatal uterine bleeding is not common, it certainly occurs, which is why the Talmud explored its ritual ramifications. We should expect nothing less.

Today, the bleeding is completely neglected and considered an uneventful episode of no clinical significance
— Brosens, I.Benagiano G. Clinical significance of neonatal menstruation. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016. 196 57–59

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