Legacies of the War: Maternity and Child Welfare

After rationing became necessary in the latter years of the war, controlling food supplies became another responsibility of the British state. This in particular had an impact on children’s health.3Durbach, Many Mouths, 9. In August 1914, Newman warned that at some point during the conflict, depending on its duration and economic disruptions, it would become “inevitable” that the state must “make itself responsible for the feeding of children.” He estimated that the cost of feeding a child two meals a day for three months would be £1 per child.4Newman, Board of Education Memorandum, August 4, 1914. In actuality, though, by the end of the war the state was regulating foodstuffs for all Britons, not just children, under William Beveridge’s system of rationing, which was designed to ensure that Great Britain did not experience a shortage of the essential foodstuffs (first, sugar; later, meats and fat) necessary to maintain an adequate national diet for the duration of the war. Other notable examples of increased state regulations that emerged over the course of the war included liquor controls (including limiting the hours that public houses could remain open as well as the strength of spirits and beer) and rent controls (the Ministry of Munitions invested £4.3 million in building 10,000 affordable new homes for workers).5Beckett, The Great War 1914–1918, 271–73.

For our purposes, however, no change in British governance was as important as the changes in welfare programs targeting English mothers and their children that emerged during the Great War. Robb attributes these reforms to intensified “demographic and eugenic anxieties” that emerged from the war.6Robb, British Culture and the First World War, 43. I agree. The data collected and reported in the Report on the Physical Examination of Men of Military Age certainly reflects a high degree of “demographic anxiety.” But the historical origins of expanded interwar infant and maternal welfare programs can actually be traced back to earlier in the wartime years.

We see some early evidence of increased attention to infant and maternal welfare right on the eve of the First World War. In July 1914, F.J. Willis, assistant secretary to the Local Government Board, indicated in a letter to the Treasury that he was still concerned about the deleterious influences of urban life on children’s health. Willis lamented that “more active measures are urgently needed” to remedy this, and he urged the Treasury to bear the costs of “necessary measures” for infantile, maternal, and early childhood health care, because costs had created barriers for even “the most active authorities.”7Willis to the Secretary of the Treasury, July 15, 1914. A Local Government Board circular issued just days before the outbreak of the Great War, on July 30, 1914, similarly called on Parliament to expand maternal and child welfare services and offer state funding to support these services. While commending the good work of many local authorities, which the secretary of the Board, H.C. Monro, believed “undoubtedly helped to secure improved conditions for children,” the memorandum argued that “more extended and systematic measures . . . are necessary” to establish a welfare program from “before birth until the time when the child is entered upon a school register.”8Monro, Maternity and Child Welfare Memorandum, July 30, 1914, 1–2. During the war, the value of these programs became clearer to local authorities, and the Local Government Board would offer more grants in the years to follow.9Winter, The Great War and the British People, 194.

Expanded national legislation also followed. The 1914 Education (Provision of Meals) Act compelled local authorities to feed necessitous school children and removed the halfpenny limit that could be spent to feed them. Although the immediate passage of this revised Act raised some concerns about rising costs, Newman argued that the need to “carry on the public education . . . with as great regularity as possible” should outweigh any financial concerns.10Annual Report for 1913 of the Chief Medical Officer of the Board of Education, 257. In 1915, the Notification of Births (Extension) Act made the permissive 1907 Notification of Births Act compulsory, which allowed local committees to “prepare measures to improve the care of expectant mothers.”11Winter, The Great War and the British People, 194. With more methodical and regular notification of births, health visits became standard practice, which in turn benefited the health of more newborn children.12Reid, “Health Visitors and Child Health,” 118. In short, policies that were normative in Birmingham, Liverpool, and Manchester were becoming the national standard under new Acts of Parliament passed during the Great War.

But, as late as 1917, there was still substantial variance in infant and maternal welfare services across English counties. Not all local authorities saw the need for state-sponsored welfare as did the Medical Officers of Health in our three progressive cities.13For numerous examples, see Winter, The Great War and the British People, 196–204. To take one particularly extraordinary example, we might look at the South London borough of Camberwell, where Medical Officer of Health Dr. Francis Stevens refused to employ health visitors. By January 1917, this was the only borough in the country without them. Stevens’s justification was that “(1) a health visitor had no power to punish in a case where neglect was proved, and (2) had no power to help in a case where help was needed.” This was widely criticized in both the medical and popular press as “oblivious to the immense amount of good that can be done by co-operation with other and voluntary agencies.”14“Camberwell’s ‘Non-Conformity.’”

Nevertheless, the Great War was a force for change. Making sense of the motivation for legislative reforms, Dwork argues that the Great War had opened eyes to a “spectre of imperial decline” that began on the bloody battlefields of France and in turn made it “imperative to protect the life of each infant,” especially as the national birth rate fell.15Dwork, War Is Good for Babies, 208. We see convincing evidence of this sentiment throughout contemporary medical and scientific discourse. For example, in one 1915 editorial in the British Medical Journal, the author described babies as of “greater import than battalions” and “the true dreadnoughts of a nation,” using militarized language to emphasize children’s critical role in the future health of the nation.16“The War and the Falling Birth Rate,” 649–50. Dr. H.T. Ashby, of the Manchester Children’s Hospital, expressed similar concerns in his 1915 book on Infant Mortality. He warned that “carelessness in connection with infant life is a sure sign of degeneracy in any country.”17Ashby, Infant Mortality, 6. James Cossar Ewart, a Scottish zoologist, offered a particularly poignant perspective on the war’s impacts on children in his 1917 essay on “The Saving of Child Life.” According to Ewart, the war caused the nation to “rapidly wak[e] up to the necessity of putting an end to the present appalling waste of child life.”18Ewart, “The Saving of Child Life,” 117. This discourse put increasing pressure on the British state to take greater action to protect children’s health.

Perhaps the greatest example of a public campaign to draw national attention to infant and child welfare occurred during Great Britain’s first “National Baby Week,” held from July 1 to 7, 1917. National Baby Week, which was first envisioned by Jeanette Halford, the honorary secretary of the National Society for the Prevention of Infant Mortality, sought to raise awareness of the continued severity of infant mortality in Great Britain.19Bryder, “Mobilising Mothers,” 3, 6, argues that the Baby Week event has not received sufficient historical attention and offers an important attempt to recenter the importance of this event in the historiography on infant and child welfare. In London, National Baby Week featured forty-two exhibits on everything from examples of germ-laden environments to clean rooms. The Women’s Imperial Health Association presented films featuring health visitors offering educational tutorials. Even the Eugenics Education Society participated with displays about the dangers of alcoholism, and professed the importance of strong and healthy parentage influencing the health of children. A 15-foot wingspan replica of a fly magnified 252 times was particularly evocative of the dangers of summer diarrhea.20Bryder, “Mobilising Mothers,” 11–13. The highlights of National Baby Week included a meeting between the queen and 120 mothers and children from maternal and infant welfare centers around London, and a speech by the bishop of London in which he lamented that the “loss of life in this war had made every baby’s life doubly precious.”21Robb, British Culture and the First World War, 43–44.

The organizers of National Baby Week sought to shock their audiences with the assertion that it was “more dangerous to be an infant in England than to be a soldier in France.”22Report of the National Baby Week Council, quoted in Bryder, “Mobilising Mothers,” 2. Motherhood was described as a “battle” with threats to children’s health.23Bryder, “Mobilising Mothers,” 14. In employing rhetoric that leaned into the patriotic support for the Great War, the organizers of National Baby Week sought to press for greater state support for maternal and child welfare as a matter of patriotic national duty. But, as historian Linda Bryder convincingly argues, they used the “wartime situation . . . to promote a pre-existing cause.” Bryder argues that the “demographic panic, exacerbated by fears of the effects of the loss of young male life in the war,” may have been a catalyst for increased national attention to child health, but the origins began beforehand.24Bryder, “Mobilising Mothers,” 4. I concur with her assessment. As I argued in Chapter 3, we can trace the origins of this politicization of infant and maternal welfare back to at least the early 1890s, at least at the local level, when philanthropy converged with municipal governance to expand welfare through professional health visiting. But, in order to achieve nationwide attention, the issue of infant and maternal welfare needed a catalyst. Wars twice provided a catalyst – in 1899–1902 and in 1914–18. National Baby Week exemplified the potential of a wartime catalyst, and the Great War gave way to yet another, perhaps the most important, Act in the history of children’s welfare: the Maternity and Child Welfare Act of 1918.25Bryder, “Mobilising Mothers,” 23, arrives at the same conclusion.

Intended to reduce local variation in the administration of infant and maternal welfare, the Maternity and Child Welfare Act of 1918 empowered municipalities to “make such arrangements . . . for attending to the health of expectant mothers and nursing mothers, and of children who have not attained the age of five years and are not being educated in schools recognised by the Board of Education.” The Act codified the establishment of local committees to oversee these programs composed of “persons specially qualified by training or experience in subjects relating to health and maternity,” including “at least” two women. Finally, the 1918 Act provisioned national funding for the expense of maternal and infant welfare from the Local Government Board.26Maternity and Child Welfare Act, 1918, ch. 29 (United Kingdom). These committees had the power to provide services including hospital treatment for children up to five years of age, lying-in homes, food for expectant and nursing mothers and children under the age of five, nursery care, convalescent homes, and homes for children of widowed and deserted mothers. The Act further determined that local authorities could also fund midwifery services, but these services should also be regulated and supervised by the Medical Officers of Health. Lastly, this Act established that each health visitor should not be responsible for more than four hundred cases per year, so that she could perform her functions most effectively. This Act was, as Dwork argues, an “explicit recognition of the responsibility of the State to protect the health of its citizens.”27Dwork, War Is Good for Babies, 214.

The immediate effects of the 1918 Maternity and Child Welfare Act varied. In Birmingham, Liverpool, and Manchester, the Act codified work that was already ongoing. The Local Government Board provided funding for expanding welfare services, paying up to 50 percent of the costs for new public health efforts. Our three cities took advantage of this funding. In Birmingham, for example, during the 1918–19 fiscal year, a Local Government Board grant accounted for £9,620 of the £22,008 spent by the city on maternal and child public health.28Local Government Board Application of the Borough Council of Birmingham for Grant in Aid.

In Manchester, James Niven praised the new Act because it “unifie[d] and extends the work already being carried out.” Niven hoped that, with greater financial support offered by the 1918 Act, the Sanitary Committee would be able to further extend care for children until the age of five, at which time the child came under the supervision of the education authorities. Niven believed that the expansion of Maternity and Child Welfare programs would create a “close nexus . . . between the health visitors, the Infant Welfare Centres, and the Childrens [sic] Hospitals,” but believed that more work could be done regarding antenatal work beyond “advice given to mothers at the Child Welfare Centres.”29Niven, “Memorandum on the Maternity and Child Welfare Act.” The Manchester and Salford Women Citizens’ Association, which worked closely with the city’s health visitors, was similarly optimistic about the Act creating “a peculiarly opportune moment for pressing for these reforms.” However, they worried that health visitors attending to a maximum of four hundred births per year was still too high “if the Health Visitor is to do the visitation of infants properly.” The Society reiterated what experts had suggested for some years: “to be successful in giving advice the health visitor must be able to establish sympathetic relations with every mother she visits, and this takes time.”30“Interim Report on Child Welfare in Manchester,” 7–8.

Doubtless, the war and the ensuing Act of Parliament had entrenched the “urgency of saving the babies and building up the health of the nation.” It was clear to contemporaries by 1919 that “it only remains to find the best way of achieving this end.”31“Interim Report on Child Welfare in Manchester,” 4. By 1919, the Medical Officers of Health in Birmingham, Liverpool, and Manchester had clearly established a model for other cities to follow. For other cities, the 1918 Maternity and Infant Welfare Act created opportunities to “catch up” in their efforts to improve children’s health by allocating financial resources to local authorities to establish infant welfare clinics.32Marks, “Mothers, Babies and Hospitals,” 50. Health visitors were at the “bedrock” of infant and maternal health care in Britain, and the 1918 Act increased the funding necessary to support them.33Marks, Metropolitan Maternity, 171. Thus, we should pay special attention to their continued, and even expanded, wartime work. But the work of expanding infant and maternal welfare was only made possible with more financial support.

Faced with the increasingly clear reality that children were at the “foundation” of a healthy nation, national funding for their care rose in the aftermath of the First World War. Between 1915 and 1920, government grants to local municipal authorities to establish maternity and infant welfare programs rose from £56,809 to £770,000.34Fenton, “Maternity and Infant Welfare Service in England and Wales,” 1340. The rising trend in expenditures on maternal and infant care continued throughout the 1920s. By 1922, maternal and child welfare accounted for 14.1 percent of English national health expenditure (amounting to approximately £5.82 million). This budget was managed by a newly formed Ministry of Health.35Levene, Powell, and Stewart, “Patterns of Municipal Health Expenditure in Interwar England and Wales,” 648.