1. B IRTH AND D EATH IN M ODERN B RITAIN : I NFANT W ELFARE TO I NCUBATOR B ABIES Lecture 2 From Cradle to Grave

2. LECTURE AIMS AND OUTLINE Explore the relationship of infant mortality to national concerns (national efficiency, eugenics, War) Shift to interest in social medicine around turn of 20 th century Infant mortality and maternal welfare: ‘Infant Welfare Movement’ Consider balance between concerns of state and responsibility of families, i.e. mothers Legislative change

3. F ALLING B IRTHS AND RISING D EATHS 1857 that the Registrar-General reported the number of deaths of children under the age of one (deaths first registered in 1838) – giving formal recognition to the infant morality statistic and highlighting high number of infant deaths. 1876-1899 birth rate fell 35.5 to 30.5 (per 1,000 population) – 14% 1876-1899 infant mortality increased from 146 to 156 (per 1,000 live births) – 7%

4. The Medical Officer of Health (MOH) for Marylebone pointed out in 1907 that: ‘It is of concern to the nation that a sufficient number of children should annually be produced to make good the losses by death; hence the importance of preserving infant life is even greater now than it was before the decline of the birth rate’. Article in Public Health in 1899 by William Butler (MOH conference): ‘A multitude of weaklings is less to be preferred than a handful of virile men and a healthy people pruned of its decadents by a high mortality amongst its children is better than a degenerate race weakened by the survival of its effete progeny’.

5. SOCIAL MEDICINE, 1880-1930 Shift state interest from control of disease (e.g. sanitary reform) to the active promotion of health By Improving social conditions Providing health education Increased provision of services - But not backed up usually with material assistance

6. THE BOER WAR 1899-1902 AND NATIONAL EFFICIENCY The Boer War led to a specially appointed Committee on Physical Deterioration in 1903. The Committee explored why so many army recruits were unfit – 40% of volunteers. 1904 Committee report - no evidence of long-term physical deterioration in the British population, but they did make these recommendations: a) Medical inspections of children in schools b) Free school meals for the very poor c) Training in mothercraft.

7. R EPORT OF THE I NTER -D EPARTMENTAL C OMMITTEE ON P HYSICAL D ETERIORATION, 1904

8. I NFANT W ELFARE Response to concerns about declining populations Similar responses throughout Europe and North America (scientific motherhood) France a leader in initiatives. Dr Stephane Tarnier (incubators, prematurity) Dr Pierre Budin (infant welfare reform)

9. H UDDERSFIELD S CHEME : A DVICE TO M OTHERS, C.1905 Mayor Benjamin Broadbent, MOH William Moore ‘FEED WITH THE MOTHER’S MILK’ ‘If you really love your child and would do the best for it, feed it at the breast. (Out of 100 bottlefed children 50 died during their first year – out of 100 breast-fed children only 7!) ‘NEVER give the baby soothing syrups, fever powders, or anything of that sort. NEVER give the baby bread, or sops, or gravy, or any other food, except milk, till it is not more than seven months old…. Never use a feeding bottle with a long tube…’ (Annual Report of MOH Huddersfield 1905)

10. F EEDING B OTTLE WITH LONG TUBE, C.1913

11. G RAPH SHOWING DEATHS OF BOTTLE AND BREAST FED BABIES, 1898: PREVENTABLE CAUSES

12. Legislation End of the C19, Medical Officers of Health observed and analysed infant mortality. Education Act 1906: meals to be given to school children. Education Act 1907: established medical inspection of schools. Notification of Births Act 1907: local officer of health should be informed within 6 weeks of a birth so a health visitor could visit. System of notification was made compulsory in 1915.

13. Legislation Maternity and Child Welfare Act 1918 - local authority to set up a maternal and child welfare committee - enabled local authorities to provide a range of services e.g. health visitors, day nurseries and food and milk. Ministry of Health 1919 - department devoted to infant and maternal welfare Maternity benefits 1911 (pressure of Women’s Cooperative Guild) Family Allowances 1946

14. The photographer’s caption for this vivid illustration of domestic poverty was ‘Distressing scenes in the East End. All the food in the house – a little butter, sugar and a nearly empty tin of milk. July, 1912’.

15. MOTHERHOOD AND EDUCATION General method of education was leaflets on infant management. Lectures (poorly attended) and infant consultations also offered. Voluntary agencies opened Schools for Mothers. First ‘School for Mothers’ – St. Pancras, 1907. Combination of classes and health talks, individual consultations, advice on feeding and weighing the baby. Infant welfare clinics – by 1917 446 centres. Target audience = working class (poor with irregular earnings or small earnings).

16. ST PANCRAS SCHOOL FOR MOTHERS 1907

17. I NFANT W ELFARE C LINIC. ( C.1914 )

18. A CHARITY, FOUNDED IN 1907, THE S T P ANCRAS W ELCOME OFFERED A COMPREHENSIVE RANGE OF SERVICES TO MOTHERS AND BABIES. T HESE WERE NOT FREE, BUT AVAILABLE FOR A SMALL FEE. Leaflet advertising the new Mother’s and Babies’ Welcome in St Pancras, London, 1907.

19. B ABY W EEK, C.1924

20. M ATERNTY : L ETTERS FROM W ORKING W OMEN, EDITED M ARGARET L LEWELYN D AVIES, 1915 (W OMEN ’ S C OOPERATIVE G UILD ) ‘From the time I married till just previous to the birth of my third child, my husband earned 28s. per week; then followed two years’ shortness of work. When my forth was born, we had no food or anything to eat… The past struggle left its mark on the physique of my children… My home was very dirty, the children got ragged, meals worse than usual… I have resorted to drugs, trying to prevent of bring about a slip… after the birth of my first baby I suffered from falling womb… doctors who attended me never told me anything concerning my babies or myself.’ Wages 30s, eight children, two still-born, three miscarriages.

21. CONCLUSION Infant and maternal welfare was an important part of the state’s objective to improve national efficiency. It is unclear whether infant and maternal welfare policies were primarily responsible for the fall in infant mortality. It did fall: From 128 (per 1,000 births) in 1905 to 105 in 1914 (babies dying before first birthday), 30 in 1950, 9 in 1985. Policies upheld a strong ideology of motherhood. Emphasis on better child-care and motherhood reinforced women’s traditional role. Working-class women were thought to be in greatest need of instruction.