Birth Weight and Economic Growth: Women's Living Standards in the Industrializing West.

As the title and subtitle of this important book promise, it is a study of the relationship between the birth weight of infants, and the living standards of the working-class women who bore them, within the context of economic development. And the centerpiece of the inquiry consists of impressive bases of birth weight data garnered from thousands of hospital clinical records in Boston, Dublin, Edinburgh, Montreal, and Vienna, covering (depending on the hospital) much of the second half of the nineteenth century and the first two or three decades of the twentieth century.

What the title does not disclose, however, is that the work is essentially one on the nutrition of the populations of these cities over time and on the relationship of maternal nutrition to birth weight - with the latter serving as proxy for nutritional status. This is potentially tricky. As the author acknowledges, especially in the nineteenth century, practically everyone who could afford it gave birth at home. Lying-in hospitals were for the poor, the homeless, the unwed - those women most likely to be poorly nourished. Yet, there is no reason why the nutritional status of the disadvantaged cannot speak to questions about the societies in which they lived and, in this case, they speak very eloquently indeed.

The work begins with a valuable discussion of the relationship between maternal nutrition and the weight of an infant at birth, which necessarily involves questions of prematurity and fetal growth retardation. Professor Ward makes the point that our understanding of the significant of low birth weight as an indicator of the health and nutritional status of the mother is a recent one, then proceeds to examine other elements that can influence birth weight, such as genetic factors, environmental influences, diseases, smoking, and alcohol consumption. He closes this initial chapter with a historical look at medical care in pregnancy and childbirth in hospitals.

The next five chapters deal, respectively, with birth weights in Edinburgh, 1847-1920; Vienna, 1865-1930; Dublin, 1869-1930; Boston, 1872-1900; and Montreal, 1851-1904. The chapters are set up in more or less parallel fashion so that each begins with a treatment of the population of a city and its economy, moves on to a discussion of the hospital whose records are under analysis (hospitals in the case of Boston), then examines and analyzes the data on birth weight over time, and concludes with a look at the "Nutrition and Disease Environment" of the city in question.

In addition to comparing the birth weights registered in five cities, the study is also a comparison of the Old and the New Worlds, in which infants of the disadvantaged in Boston and Montreal (until the 1880s) considerably outweighed their Old World counterparts (by about 10 percent). In fact, American nutrition was such that birth weights in Boston and Montreal do not reveal the seasonal variations in fetal development common to the European cities. Among these, Viennese infants consistently weighed the least, save for a brief few years at the turn of the century when Edinburgh claimed last place.

The occupation of a woman (or that of her husband) had a significant impact on birth weight. But in addition to those with adequate incomes to purchase good nutrition, women who were in food-related occupations or were servants tended to have the largest babies. In the European cities birth weight varied significantly with business cycles, although the "crucial variable was the level of economic development characteristic of each city" (p. 139). In none of the cites was there a secular trend in birth weights.

Other findings have to do with a variety of interesting matters such as the importance for the weight of the offspring of the length of time its mother was hospitalized, and evidence which may figure into the still unresolved question of the contribution of race and other genetic factors to birth weight.

The study is undergirded by sampling techniques and quantitative tools such as multiple and linear regression analysis. Yet the tools and techniques do not intrude - the reader is not lectured in methodology, and those who are interested can venture beyond the concluding chapter into the three appendices which reveal, respectively, "Sources and Samples"; "Annual Birth Weight Means" for each of the five cities; and "One-Way Analysis of Variance" of the variables in the data. Following the appendices is a lengthy bibliography and a brief index.

Throughout the text the author does a fine job of placing his discussions and findings within the larger frame of the history of health and nutrition, of economics, and of women in general, and the book will surely be of considerable interest to scholars in all of these areas. In addition it ought to be of interest to persons concerned with policy-making in the whole of the developing world.

Kenneth F. Kiple Bowling Green State University