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Economics and maternal health
THE LANCET
Economics and maternal health Women and Childbirth in the Twentieth Century A History of the National Birthday Trust Fund 1928–93. A Susan Williams. Gloucestershire: Sutton. 1997. Pp 331. £19.99. ISBN 0-7509-1209-X.
In the post-war years, the NBTF mounted large survey investigations in 1946, 1958, and 1970. Data collected from this research have revealed the strong relation between social class and quality of life and health standards. Lower birth weights and stunted growth in childhood as well as illhealth, difficult behaviour, and poor educational achievement have all been shown by these surveys to be strongly influenced by social and economic deprivation. Moreover, the surveys indicate that while many in Britain have
he danger of death during for women in childbirth.The aim of the childbirth has been a recurrent NBTF was that all women, regardless concern since time immemorof income, should be given pain relief ial. Although the death of a mother in in childbirth. The organisation not only childbirth or that of a newborn baby is helped to galvanise new methods and always shocking, the significance techniques for relieving pain in childattached to such tragedies has altered birth, such as gas-and-air machines, over time, reflecting shifts in cultural but also radically challenged the westand social attitudes as well as changes in medical standards of care. In the UK, maternal mortality, for example, was a particularly strong political and social issue between the two World Wars, partly reflecting its persistently high rate in the face of the dramatic decline of all other forms of mortality since the late 19th century. Many different organisations across the political spectrum took up the cause. One such body was the National Birthday Trust Fund (NBTF), which is the focus of Women and Childbirth in the Twentieth Century. Set up in 1928, the NBTF provides a fascinating study of the ways in which wealthy philanthropic ladies wielded their influence in the corridors of governmental There has been enormous progress in patient care at the Bethlem Royal Hospital during the power to improve the quality past 750 years. Reforms reached a climax in the Victorian era when 28-year-old Charles of maternity care for poor Hood took up the post of Medical Superintendent in 1852. “The humane and enlightened mothers. Yet, as Susan principles which now guide us in the moral and medical treatment of insanity may be said to Williams indicates, while the have been recently discovered, and we may therefore look forward to many improvements”, work was well intentioned, he wrote in 1855. One of the many changes that followed the swingeing criticisms of the the overall approach of those Commissioners in Lunacy in 1852 was the introduction of separate wards for men and running the NBTF and the women, as shown in this engraving by from London Illustrated News 1860 of a women's ward types of work they undertook in 1860. Taken from Scenes from Bedlam. David Russell. London: Baillière Tindall. 1997. in the interwar years was Pp 226. £22.95. ISBN 1-873853-39-4. biased by their upper-class background and their ignorance about ern religious and cultural tradition that experienced a rise in standards of living the lives of the mothers they aimed to depicted the agony of childbirth as the since World War II, many poor and sinhelp. The NBTF’s close affiliation with natural retribution for women’s sin. gle mothers have actually suffered a the Conservative party, also meant its The provision of pain relief also raised decline in their health and living stanwork was not without political bias. the expectations of poor women who dards. For anyone interested in the hisDespite the political and class outinitially were very suspicious of such tory of maternal and child health and look of NBTF organisers, they were a help in the 1930s. Yet poor women frethe role of economic and social policy significant force in the improvement of quently suffered the most pain during in health Williams’ book provides much UK maternity services. The NBTF was childbirth due to their high incidence food for thought. highly instrumental in the passing of of pelvic disorders as a result of inadethe Midwives Act of 1936, which entiquate nutrition during childhood. tled mothers to good maternity care Many general practitioners and medprovided by the state and established a ical specialists also opposed NBTF Lara Marks salaried domiciliary midwifery service provision of analgesia on the grounds Centre for the History of Science, throughout England and Wales. that it was to be given by midwives and Technology and Medicine, Imperial The NBTF was also a powerful force that it would undermine their own College of Science, Technology and in the development of better pain relief authority and professional status. Medicine, London SW7, UK Wellcome Institute Library, London
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Economics and maternal health Women and Childbirth in the Twentieth Century A History of the National Birthday Trust Fund 1928–93. A Susan Williams. Gloucestershire: Sutton. 1997. Pp 331. £19.99. ISBN 0-7509-1209-X.
In the post-war years, the NBTF mounted large survey investigations in 1946, 1958, and 1970. Data collected from this research have revealed the strong relation between social class and quality of life and health standards. Lower birth weights and stunted growth in childhood as well as illhealth, difficult behaviour, and poor educational achievement have all been shown by these surveys to be strongly influenced by social and economic deprivation. Moreover, the surveys indicate that while many in Britain have
he danger of death during for women in childbirth.The aim of the childbirth has been a recurrent NBTF was that all women, regardless concern since time immemorof income, should be given pain relief ial. Although the death of a mother in in childbirth. The organisation not only childbirth or that of a newborn baby is helped to galvanise new methods and always shocking, the significance techniques for relieving pain in childattached to such tragedies has altered birth, such as gas-and-air machines, over time, reflecting shifts in cultural but also radically challenged the westand social attitudes as well as changes in medical standards of care. In the UK, maternal mortality, for example, was a particularly strong political and social issue between the two World Wars, partly reflecting its persistently high rate in the face of the dramatic decline of all other forms of mortality since the late 19th century. Many different organisations across the political spectrum took up the cause. One such body was the National Birthday Trust Fund (NBTF), which is the focus of Women and Childbirth in the Twentieth Century. Set up in 1928, the NBTF provides a fascinating study of the ways in which wealthy philanthropic ladies wielded their influence in the corridors of governmental There has been enormous progress in patient care at the Bethlem Royal Hospital during the power to improve the quality past 750 years. Reforms reached a climax in the Victorian era when 28-year-old Charles of maternity care for poor Hood took up the post of Medical Superintendent in 1852. “The humane and enlightened mothers. Yet, as Susan principles which now guide us in the moral and medical treatment of insanity may be said to Williams indicates, while the have been recently discovered, and we may therefore look forward to many improvements”, work was well intentioned, he wrote in 1855. One of the many changes that followed the swingeing criticisms of the the overall approach of those Commissioners in Lunacy in 1852 was the introduction of separate wards for men and running the NBTF and the women, as shown in this engraving by from London Illustrated News 1860 of a women's ward types of work they undertook in 1860. Taken from Scenes from Bedlam. David Russell. London: Baillière Tindall. 1997. in the interwar years was Pp 226. £22.95. ISBN 1-873853-39-4. biased by their upper-class background and their ignorance about ern religious and cultural tradition that experienced a rise in standards of living the lives of the mothers they aimed to depicted the agony of childbirth as the since World War II, many poor and sinhelp. The NBTF’s close affiliation with natural retribution for women’s sin. gle mothers have actually suffered a the Conservative party, also meant its The provision of pain relief also raised decline in their health and living stanwork was not without political bias. the expectations of poor women who dards. For anyone interested in the hisDespite the political and class outinitially were very suspicious of such tory of maternal and child health and look of NBTF organisers, they were a help in the 1930s. Yet poor women frethe role of economic and social policy significant force in the improvement of quently suffered the most pain during in health Williams’ book provides much UK maternity services. The NBTF was childbirth due to their high incidence food for thought. highly instrumental in the passing of of pelvic disorders as a result of inadethe Midwives Act of 1936, which entiquate nutrition during childhood. tled mothers to good maternity care Many general practitioners and medprovided by the state and established a ical specialists also opposed NBTF Lara Marks salaried domiciliary midwifery service provision of analgesia on the grounds Centre for the History of Science, throughout England and Wales. that it was to be given by midwives and Technology and Medicine, Imperial The NBTF was also a powerful force that it would undermine their own College of Science, Technology and in the development of better pain relief authority and professional status. Medicine, London SW7, UK Wellcome Institute Library, London
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Vol 350 • July 26, 1997
301