Denyse Baillargeon. Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910-1970. Trans. W. Donald Wilson. Studies in Childhood and Family in Canada Series. Waterloo: Wilfrid Laurier University Press, 2009. 342 pp. $38.95 (paper), ISBN 978-1-55458-058-3.
Reviewed by Robyn Braun (University of Alberta)
Published on H-Canada (January, 2010)
Commissioned by Stephanie Bangarth
Babies for the Nation: The Envy of All
Babies for the Nation is a book of extraordinary historical detail and fine analytic insight. Through remarkably thorough historical research, Denyse Baillargeon has effectively opened to newcomers the empirical field of the history of maternity in Quebec. English-speaking Canadian historians are lucky to have the translation available. The writing in the book is smooth and elegant, an attribute for which we owe the translator, W. Donald Wilson, as much as we owe the original author. The book demonstrates Baillargeon's mastery not only of the field and its analysis but also of the writer's craft.
The book deals with the socio-medical transformation that Baillargeon calls "medicalization of maternity," the process by which pregnancy, birth, and newborn care become matters that require medical attention. Specifically Baillargeon focuses on the medicalization of maternity in Quebec society, which the author tells us emerged with the struggle against infant mortality that began at the turn of the twentieth century. She links the increasing attention given to this problem with growing concern in industrialized countries to develop and maintain a productive labor force. This state concern only increased after the losses of lives in WWI, followed by the flu pandemic of 1918-19. Increasingly then the "traditional" methods of child rearing were replaced with more modern ones better attuned to the industrialized nation Canada had become. Baillargeon sets out to examine the specificities and complexities of these processes as they took place in Quebec. Ultimately, she writes a detailed history of the interests of the different actors involved and analyzes with insight and clarity the alliances and power plays that both united and divided the players in the field.
The first chapter, "A 'Bad Mother' Called Quebec," considers and details the medical, social, and cultural causes behind infant mortality in the province, and examines the differences that accounted for the gaps in infant mortality rates between Anglophones, Catholics, Protestants, and Jews within the province. In developing these detailed sociohistorical accounts, Baillargeon is able to show that poverty was generally an aggravating factor in child mortality rates among Catholic French speakers in Quebec. She also demonstrates, however, that for doctors and social care elites, the infant mortality rates only raised questions of maternal responsibility and the development and survival of a nationalist project.
Chapter 2, "A Very National Infant Mortality Rate," delves further into the nationalist aspects of the discourse produced by French doctors in Quebec in response to the infant mortality rate. Baillargeon argues that a nationalist discourse was unavoidable for doctors debating and dealing with infant mortality through the twentieth century in Quebec. She argues that infant mortality was a "national" phenomenon not only because, as she showed in chapter 1, it was a larger problem in Quebec than in other industrialized societies but also because it represented a stake in Quebec's political aspirations. This chapter examines the "medico-nationalist" discourse, and Baillargeon demonstrates the permeability of the public/private divide as she details the close association made in the discourse between the nation's survival and the role of mothers in caring for their children and therefore the continued existence of the nation. In a moment of writerly panache, Baillargeon concludes chapter 2 by making obvious something that was hidden in plain sight throughout the chapter, that in the campaign against infant mortality in French Canada, doctors also intended to increase their own prestige. And thus she takes us into chapter 3.
"Let Us Have the Mother and the Child is Ours" considers the details of medical advice aimed at mothers about maternal and prenatal care and the evolution of this advice in light of the economic and political landscape of the time as well as the changes to infant mortality and health that resulted from this advice. Throughout their evolution, Baillargeon tells us, these messages aimed to convince women that they should turn to no one but their doctors for advice concerning pregnancy, childbirth, or child care. Baillargeon argues that the medicalization of maternity effectively dominated an area that had previously been the domain of women and women's expertise and knowledge. Because women were both the cause and the solution to the problems of infant mortality, medical experts encouraged women to model their behavior on the needs of a society in which they lived and therefore to rely on medical expertise for information on what to decide and how to act.
Of course, medical services needed to be available for women in order to convince women to seek the advice of medical experts. Thus, chapter 4, "A School for Mothers," reviews the establishment of many of these services as well as their aims, methods, and clientele. This inventory of subtle differences allows Baillargeon to analyze the mixed social economies of public and private services and to consider the scope, reach, and effect of various efforts. In this chapter, Baillargeon details the developments of clinics for newborns and milk distribution centers from their arrival in Montreal in 1901 to the 1960s. This chapter also includes histories of the work done by nurses with the Victoria Order of Nurses from 1898 to 1947; the work funded by the Metropolitan Life Insurance Company from 1910 to 1953; and the Assistance maternelle de Montreal (AMM), a philanthropic organization aimed at Catholic mothers, founded in 1912. Baillargeon documents services available outside major city centers; prenatal clinics available through the 1920s; and the efforts to reach women through public lectures, radio and TV, films, advertising, newspaper and magazine columns, and brochures and pamphlets. The development of these free services, Baillargeon argues, gave real impetus to the medicalization of maternity.
Chapter 5, "Bitter Struggles," documents the power struggles between different actors and agents in the field and between the private and public authorities. These power struggles arose from and testified to the diversity of interests within the campaign against infant mortality. Baillargeon takes us through the details of these battles and shows us how the medicalization of maternity was shaped not only by a social urgency but also by the very power struggles of the actors involved. In this chapter, again we see Baillargeon shine as a researcher and a writer as she notes that in the early decades of the twentieth century, the medical profession relied on the support of women's groups, women volunteers, nurses, and clergy to ensure the dissemination and acceptance of their precepts. She then goes on to detail specific negotiations and alliances between doctors and nurses, between general practitioners and the AMM specifically, between physicians and maternalist feminists, and between church and state. Throughout, Baillargeon effectively demonstrates the specific ways these power relations shaped the medicalization of maternity. Never dropping a thread, Baillargeon argues that these power struggles and tensions need necessarily be understood with reference to the Quebec nationalist question. She suggests that because the movement against infant mortality attracted so many people, the diversity of interests was bound to be wide and eminently political.
Finally, Baillargeon turns her attention to women's response to these developments that constituted the medicalization of maternity. She relies on some sixty interviews with women who raised children between the 1930s and the 1960s, and pays attention to the uses these women made of the services offered, the changes they made to their mothering practices, and their motivations for doing so. In this way, Baillargeon details how, why, and under what conditions women accepted, negotiated, or rejected the medicalization of maternity practices and discourses. From these interviews, we find that women sought advice and expertise concerning infant care but not regarding prenatal care, and Baillargeon suggests that this was because the women had very low expectations for their own health during pregnancy anyway and because they were disappointed to find themselves pregnant once again. She shows through these interviews that during this time period of increasing medicalization of maternity, participation in some of these activities and programs were sources of social respect and prestige for women. For example, women used "well-baby" clinics as a social occasion and would take the opportunity to dress up a bit, both their babies and themselves. These clinics, therefore, also provided women a space where they could meet and exchange competencies and show some pride in their child care practices. The chapter includes some really charming photos of these well-baby clinics and again the historical detail is extraordinary.
In a tightly written epilogue, Baillargeon considers the effect of contraception on the medicalization of maternity. A decrease in infant mortality went hand in hand with a decrease in fertility rates and it is not apparent whether the medicalization of maternity or contraception was more responsible for the effect. What is apparent, according to Baillargeon, is that as women had fewer children and as the standard of living increased in the province in the post-WWII period, women became less preoccupied with household tasks and could devote more of their time to accessing and following the medical advice available to them. She tracks developments in contraception and the distribution of contraception in the province and argues that by the late 1960s, the problem was largely considered to be a lack of contraception available to the poor and a need to induce the poor to have fewer children. Thus, Baillargeon sees that we have come full circle; from the medicalization of maternity to reduce infant mortality among the poor to a medicalization of contraception to reduce the birthrate among the poor. Women's bodies have been at the center of these attempts to control death and to control birth, and thus in presenting us with a detailed historical account of the medicalization of maternity, Baillargeon has given us a detailed historical account of feminist concern.
If there is additional discussion of this review, you may access it through the list discussion logs at: http://h-net.msu.edu/cgi-bin/logbrowse.pl.
Robyn Braun. Review of Baillargeon, Denyse, Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910-1970.
H-Canada, H-Net Reviews.
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