Every Child a Lion: The Origins of Maternal and Infant Health Policy in the United States and France, 1890-1920.

A comparative history of social policy in two countries must meet the test of making clear the ideological and political parameters of policy-making in each country to historians who are not specialists in that nation's history. Alisa Klaus rises to the challenge in this timely, well-written study whose subtext is the need for better family policies in Western democracies today.

How did social provision for maternal and infant health and welfare develop so differently in the United States and France? Klaus shows that deep differences already existed in the late nineteenth century when reformers began to take an interest in mothers and infants as part of a new national accounting. In France, strong central government and a powerful Catholic influence on issues of morality dominated efforts to protect motherhood while guaranteeing that women's influence on policy-making would be negligible. In the United States, weak central government allowed voluntary associations, many of them women's organizations, to take the initiative in protecting infant and maternal health. The U.S. Children's Bureau, created in 1912, institutionalized what Klaus calls this "maternalist vision" of reform at the federal level in an agency staffed with female social workers and physicians.

In one way, the debate on maternal and infant health was similar in both countries: both the French "Solidarist" Radical Republicans and the American Progressives rejected class conflict and tried to build policy on class harmony and interdependence. But there the similarities ended, for Klaus shows how, beginning with the Roussell Law of 1871 which created a national system of intervention in infant care and resulted in a decline in the mortality rates of children placed out to nurse (58), child-saving policy was shaped by political conflicts between conservative Catholic and anticlerical groups but supported by physicians. In addition, infant and maternal policy in France was driven by fears of depopulation and of the external threat from Germany. Thus the rhetoric of the French infant-saving campaign stressed strategic and military factors, that of the American movement emphasized themes of economic prosperity and conservation of child-life, and was tainted with eugenic and racist concerns over the quality of the nation's human stock, not its quantity. The threat perceived by American infant welfare advocates was internal: the supposed degeneration of the nation's population as a result of the immigration of substandard, "defective," and racially inferior types. Klaus acknowledges the racism of the American child-saving movement and its middle-class, white bias but she is less critical of the movement than others have been. She quotes letters from U.S. Children's Bureau staff to show that they respected the rights of communities to have a say in infant health programs and claims that, unlike their French counterparts, American infant health advocates "assumed that women's lives had inherent value separate from the lives of their children and argued that maternal suffering and death was in itself intolerable" (229-30).

The results of three decades of efforts to protect infant and maternal health were paradoxical in both countries. French policy, while going much further to protect women's health, did so under the banner of patriotism and military necessity, not that of women's rights. The creches established in French factories to encourage nursing mothers, allowances for childrearing, and maternity leaves were defended as measures to safeguard the nation's female labor-power and combat the supposed decline of maternal instinct. Moreover, "the belief that a declining birth rate imperiled national security brought with it an idealization of motherhood and efforts to intimidate or cajole women into devoting their lives to bearing and raising children" (279). In the United States, the Progressive-era campaign for maternal and infant health culminated in the Sheppard-Towner Act of 1921 which established federally funded infant and maternal health education whose central figure was the public-health nurse. But this triumph was short-lived. Funding for Sheppard-Towner was not renewed partly as a result of the opposition of physicians to social insurance which Klaus characterizes as "blatantly self-serving" (224, 279). By the 1930s the ideology that had linked healthy motherhood and infancy to national prosperity gave way to a more traditional discourse that conflated "dependency" and immorality.(1) How different from France, where state support for motherhood meant financial aid to mothers, aid which was not seen as "pauperizing" since the goal of French pronatalist policy was to make French women "the paid nurses of their own children" (175)!

Every Child A Lion represents a further much-needed rapprochement between public-policy history and women's history and deserves the attention of historians of early twentieth-century social policy, medical professionalization, public health, and women's history. It should be read along with other work such as that by Robyn Muncy which explores the professional conflicts of female physicians and social workers caught between a male definition of professionalism and a "maternalist vision" of what clients needed. Future work may well focus on gender, that is, on women and men relationally, not just women: it would be interesting, to say the least, to discover how concepts of fatherhood changed symbiotically with the changes in the ideology of motherhood traced here.

ENDNOTE 

1. Nancy Fraser and Linda Gordon, "A Genealogy of 'Dependency': Tracing a Keyword of the U.S. Welfare State," Signs: Journal of Women in Culture and Society 19, 2 (Winter 1994): 309-36.