"Populate or perish" : aspects of infant and maternal health in Sydney, 1870-1939

Abstract

This study tries to explain the remarkable declines in the infant and maternal death-rates in Sydney between 1870 and 1939 and to indicate significant attitudes shaping the infant and maternal welfare movement. Poor nutrition interacted with infection to decimate the infant populations of Sydney and other Western cities of the late nineteenth and early twentieth centuries. Improvement in the sanitary environment of Sydney from the 1880s was an important factor in the reduction of infant mortality. Improvement in the quality of the metropolitan milk supply was a less clearly significant cause of the reduction. Establishment of infant welfare services was the factor which accelerated the decline in mortality after the early 1900s. The core of infant welfare work was encouragement of breast-feeding. This acted to reduce mortality despite economic disadvantages putting the workingclass infant at greater risk. The movement in Sydney, the pioneer movement in Australasia, shared with movements overseas the powerful motivating force of concern about population size and quality. The movement in Sydney was a blend of state and voluntary effort. Wide acceptance of the notion of individual responsibility for health care limited the advance of state intervention. But state provision and universal eligibility were achieved in infant welfare not only because the saving of infant lives was seen as an important national interest, but because the work did not trespass on the preserves of private medicine. The failure to develop universalism in maternity services had much to do with the fact that it would have required a change in the balance between private and public medicine. Significant reduction of the maternal death-rate did not occur until the 1930s when the advent of effective chemotherapy and fuller knowledge of the problem of puerperal infection produced a dramatic decline in deaths from sepsis. Reformers urged improvement of obstetric education as the way to reduce the death-rate. Improvement, beginning in the later 1920s, did not contribute much to the reduction of mortality in the short term. Nor did the hospitalisation of birth and antenatal care contribute much in the short term. To a considerable extent, it was the capacity to pay that determined access to good-quality medical care, although the poorer woman could use the charitable services of the public hospital. Unequal access in a maternity care system monopolised by private practice contributed to the failure to reduce maternal mortality significantly before the later 1930s. Concern about population growth powerfully aided the development of infant and maternal welfare work. It also gave rise to efforts to reinforce the child-bearing and child-rearing responsibilities of women. If education for motherhood now required expert instruction, such was offered by the government baby health clinics. Both Labor and its political opponents supported infant welfare work. They both endorsed population expansion in the interests of national development and defence. Labor did not clearly repudiate the notion of individual responsibility for health care provision until the 1930s. This notion influenced organisation of infant and maternal welfare services as importantly as the desire to encourage the growth of a healthy, nativeborn population influenced the emergence of systematic infant health work. Show more