Modern Mothers in the Heartland: Gender, Health, and Progress in Illinois, 1900-1930.

Modern Mothers in the Heartland: Gender, Health, and Progress in Illinois, 1900-1930. By Lynne Curry (Columbus: Ohio State University Press, 1999. x plus 206pp. $18.50/paperback $40.00/cloth).

As Progressive reformers sought to improve the health of infants and children, as part of a wider attempt to modernize America's heartland, they placed the responsibility into the hands of mothers themselves, a notable shift away from altering the environment to improve the public's health. In the wake of the development of the germ theory, reformers, cognizant of the fact that bacteria caused disease, focused primarily on hygiene as a means of prevention. Many new roles for women developed in the public sphere, as they were not only the objects of health reform but its promoters as well. The burgeoning new field of home economics advocated advanced education and specialized training in order that mothers be qualified to raise their children scientifically in a healthy environment. Wartime helped to escalate the movement even further, as preservation of child health was seen as a way to protect the national interest. Unfortunately, as the social value of motherhood became a public issue, women leaders became the victims of widespread criticism and political targets. A statewide debate, mirroring national debate, ensued as the role of the government in safeguarding health came into question. Following the war, it became increasingly difficult to delineate between public and private spheres in the area of health reform, resulting in tensions that were difficult to resolve. Surprisingly, in light of the perceived success of health reform in the state, Illinois was one of only three states that did not participate in the Sheppard-Towner Act, serving as a prophecy that health care would soon become a marketplace commodity, completely medicalized and privatized and not a concern of government or volunteers.

Although there is little here that is new and insightful, Curry, by focusing on just one state, and by utilizing a wide variety of primary and secondary sources, reveals the interactions between different socioeconomic classes, races and regions in greater depth, thus offering a window through which these relationships are illuminated in Progressive Era America. Much of Progressive health reform has been viewed by other scholars as a method of social control as the white Protestant middle class attempted to inculcate their values on immigrant and poor rural mothers in an attempt to assimilate them into a more modern American culture. Curry warns against this social control model, however, noting that middle class women were just as likely to be victims of disease and high infant and maternal mortality, and would themselves benefit from health reform. Further, immigrant, rural and African American women often chose to adopt middle class values, acting as agents of change as they molded health reform tactics t o conform to their own cultural ideals.

Lacking any uniform statewide strategy, reform tactics varied depending upon geographic region. Urban white middle class reformers sought to change the health habits of immigrant mothers, implicitly suggesting that their ethnic and cultural differences were to blame for high infant death rates. In the process, immigrant mothers partially shaped the policies and practices of the public health movement by negotiating with reformers, who recognized that they were powerless to enforce change without acceptance from immigrant mothers. Urban infant mortality rates began to show some improvement by the 1910s, presumably a reflection of the numerous newly established public health initiatives, but rural infant mortality rates remained high. Farm women themselves initiated much of the rural reform through previously established farmer's networks and organizations. Crucial to the success of their program was the "necessity of overhauling women's place in agricultural production" (p.72). One aspect of rural reform was an attempt to teach leadership skills and empower women who were used to being controlled by their husbands, but in contrast, the attempt to minimize woman's role as an economic producer drew her further into the realm of feminine domesticity. With the onset of America's involvement in World War I, health reform, linked to patriotism and national pride, became a distinct war measure. Women's organizations collaborated more efficiently while there were increasing new leadership roles for women in the effort. The war effort, however, began to illuminate new questions of government obligation and responsibility for the health of the nation's mothers and children.

The tension in the statewide battle over Illinois' participation in the federal Sheppard-Towner program mirrored national debate. In spite of the active roles played by women in the health reform movement, they were unable to convert that activism into any political clout. Proponents of Sheppard-Towner, public health officials and women's organizations, lobbied in earnest against the opposition, grounded in the medical profession, which was allied with businessmen. Physicians had two major objections. In addition to their increasing wariness over the growing strength and control of government health departments, doctors felt a potential threat to their professional development and income. Importantly, a gender dimension was part of the debate. As opponents criticized increasing government control, they emphasized the leadership positions in the Children's Bureau held by women who they claimed were motivated by sentimental reasons.

Although precise cause and effect relationships cannot be accurately ascertained, infant mortality rates did decline in the United States, surely, albeit only partially, as a result of Progressive reform. In spite of the success, however, there were limitations. African Americans were largely excluded from organized reform movements and cultural differences limited the extent to which immigrants adapted to new health practices. Further, affluent mothers were in a greater position to benefit from reform initiatives, as they had extra time to participate and the money to afford technological change. As the state became more urban, the discourse empowering mothers as agents of modernity disappeared and woman's role as consumer was emphasized. Numerous products were developed to help modern mothers raise their children in a healthy environment, increasingly placing greater control into the hands of the affluent. Whereas Progressive reformers argued that better health for babies was within the mother's control, b y the end of the 1920s, as infant mortality rates had dropped, it was, therefore, easy to blame poor health in certain populations on the negligence of mothers themselves, ignoring socioeconomic factors, such as poor sanitation, inadequate housing, limited access to medical care and poverty.