The whole point of this book lies in the letters which it contains; and
it might therefore have seemed advisable to leave the reader untroubled
by an introduction to gather that point from the letters themselves.
The material is, however, in form and in subject of so unusual a kind
that it has been thought necessary to explain something of its origin
and its authors, and even to touch upon some of the problems which the
letters so vividly show to exist. The letters are written by married
women of the working-class, all of whom are or have been officials
of the Women’s Co-operative Guild. The Guild is a self-governing
organisation within the Co-operative Movement, and deals with subjects
which affect the Co-operative Movement and the position of married
women in the home and the state. It might justly claim to speak with
greater authority than any other body for the voteless and voiceless
millions of married working-women of England, for it has a membership
of nearly 32,000, distributed in 611 branches over the whole country.
The Guild has for several years given special attention to the subject
of “The National Care of Maternity.” Before the Insurance Bill was
introduced, the Guild asked for the inclusion of Maternity benefit,
and when the Amending Bill was before the House in 1913, an agitation
by the Guild secured the benefit as the mother’s own property. Later on
it placed a scheme for the national care of Maternity before the Local
Government Board, which issued a Circular on July 30, 1914, largely
embodying the various suggestions of the Guild. In the course of this
work it was considered advisable to obtain information from the members
themselves of the conditions under which they had brought children into
the world. These letters are the result. The barest indication of the
information wanted was given, and the only questions used were those on
p. 191, as it was thought that it would be more valuable to allow the
women to tell their own story in their own way.
We claim for these letters that for the first time are presented in
them the real problems of Maternity seen through the women’s own
account of their lives. If the writers are uneducated in the ordinary
sense of school and university, a long schooling in life and suffering
has given them a peculiar simplicity and dignity of language in place
of the more usual literary style. The letters are left exactly as
written by the women, the only alterations made being in the spelling,
in the addition of punctuation, and in the omission of a few medical
details. All names and places have also been omitted in order to
prevent identification.
The women are the wives of men who earn their daily bread by manual
labour. The husband’s trades cover over one hundred different
occupations, and their rates of wages vary from 11s. to £5. The letters
show how often the nominal wages are reduced by periods of short time
and unemployment, such periods constantly coinciding with childbirth.
It should also be remembered that a wife does not usually receive the
whole of the weekly wage for her family expenditure.
The earnings and conditions of life of these men are certainly above
rather than below the level of their class. It is true on the whole
to say that the Co-operative Movement is largely composed of the
better-paid manual workers, and there is no doubt that the woman who is
secretary of a Guild branch lives in better conditions than the average
working woman. If the conditions of their lives are as described in
these letters, the suffering and waste of life, the overwork and
poverty, must be tenfold and twentyfold where wages are less and
employment more precarious. That the women themselves are well aware
of this is shown by the occurrence in the letters of such sentences as
“I was more fortunately placed than most women,” or “I have not had to
go through so much pain and suffering as many poor mothers have to go
through.”
These letters then give for the first time in their own words the
working woman’s view of her life in relation to maternity. Now, what
is the general impression that the reader gets of the life at such
times of these more fortunate working-class mothers? It is on the
whole an impression of perpetual overwork, illness, and suffering.
The stories and records of 400 lives have been received, taken at
random out of the million similar lives lived in our cities. In this
book 160 letters have been published, and the unpublished letters
describe similar experiences. The evidence of such witnesses cannot
be impugned; it is that to bear children under such conditions is to
bear an intolerable burden of suffering. The cry of a woman in travail
has become a commonplace of literature, and the notion that pain and
motherhood are inevitably connected has become so fixed that the world
is shocked if a woman does not consider the pain as much a privilege
as the motherhood. And this attitude of the world towards the pain of
travail has been extended to all the sufferings attending motherhood.
These letters show that this is the view of women themselves, for which
doctors have been largely responsible. It is hardly too much to say
that the ordinary professional attitude might have been summed up in
the saying, “You’ll be worse before you’re better.” It would be foolish
to cry aloud against the inevitable minimum of maternal suffering. And
it is to be noted that there is no foolish note of self-pity in these
letters. The brave words, combined with a stoic resignation to fate,
the invincible optimism shown in such letters as Nos. 33 and 47, are
characteristic of the spirit of them all. But if it be folly to kick
against Nature’s pricks, what is more foolish is the facile fatalism
with which we resign ourselves and other people to unnecessary and
useless suffering. And a very short consideration of the suffering
disclosed in these letters will show that it is both unnecessary and
useless.
The roots of the evil lie in the conditions of life which our
industrial system forces upon the wage-earners. It is useful to
consider the different conditions under which the middle-class and
the working-class woman becomes a mother. The middle-class wife
from the first moment is within reach of medical advice which can
alleviate distressing illness and confinements and often prevent future
ill-health or death. During the months of pregnancy she is not called
upon to work; she is well fed; she is able to take the necessary rest
and exercise. At the time of the birth she will have the constant
attendance of doctor and nurse, and she will remain in bed until she is
well enough to get up. For a woman of the middle class to be deprived
of any one of these things would be considered an outrage. Now, a
working-class woman is habitually deprived of them all. She is lucky
if her husband hands her over regularly each week 25s. with which to
provide a house, food, and clothing, for the whole family. It has to be
remembered that the ordinary family wage leaves nothing over for the
additional outlay upon maternity. This ought to amount to £5 if the
expenses are properly met. Too poor to obtain medical advice during
the months of pregnancy, she “learns by experience and ignorance,”
comforting herself with the belief that however ill she be it is only
“natural.” Meanwhile she has to scrape and save to put by money for the
inevitable expenses that lie before her. She often goes out to char
or sits at her sewing machine, to scrape together a few shillings.
She puts by in money-boxes; she lays in little stores of tea, soap,
oatmeal and other dry goods. At a time when she ought to be well fed
she stints herself in order to save; for in a working-class home if
there is saving to be done, it is not the husband and children, but the
mother who makes her meal off the scraps which remain over, or “plays
with meat-less bones.” One woman writes: “I can assure you I have told
my husband many times that I had had my dinner before he came in, so as
there should be plenty to go round for the children and himself, but he
found me out somehow, so that was stopped.” Another woman says: “Many a
time I have had bread and dripping for my dinner before my husband came
home, and said I had my dinner, as I would not wait.”
If the mother is not working long hours in a factory, she is working
even longer hours in her own home.
Writers on infant mortality and the decline of the birth-rate never
tire of justly pointing to the evils which come from the strain
of manual labour in factories for expectant mothers. Very little
is ever said about the same evils which come from the incessant
drudgery of domestic labour. People forget that the unpaid work of the
working-woman at the stove, at scrubbing and cleaning, at the washtub,
in lifting and carrying heavy weights, is just as severe manual labour
as many industrial operations in factories. It is this labour which the
mother performs often up to the very day on which the child is born,
and she will be at it again perhaps six or eight days afterwards. The
Factory Acts make it an offence for an employer knowingly to employ
a woman within four weeks after confinement. “In Switzerland a total
absence from employment in factories of women during eight weeks before
and after childbirth must be observed, and on their return to work
proof must be tendered of an absence since the birth of the child of
at least six weeks.” In Germany four weeks’ absence is compulsory,
and “must be extended to six weeks unless a medical certificate is
furnished approving of employment at the end of four weeks.”
We propose to deal now shortly with the causes of those conditions,
then with the results, and finally with the methods of cure and
prevention of the resulting evils. The main causes seem to be three:
(1) Inadequate wages.
(2) Lack of knowledge regarding maternity and of skilled advice and
treatment.
(3) The personal relation of husband and wife.
We have already dealt to some extent with the first cause. Thirty
shillings a week for a manual worker is reckoned to be “good wages,”
and there are, of course, thousands of men earning far less than that.
Now, what most people do not realise is that 30s. a week is itself a
wage utterly inadequate for rearing a large or even small family. It
is inadequate because the whole burden is placed upon the woman who
has to bring up a family on 30s., and that burden is excessive. She can
only do it at all by incessant labour which inevitably cuts her off
from every higher human activity except one. That one which is left to
her is maternal affection, and the wonder is that even that endures as
it does the strain of poverty, overwork, and illness.
The second cause, the lack of knowledge on the part of the women,
receives remarkable testimony in these letters. Again and again the
writers come back to this subject. They are convinced of the evils that
resulted to themselves and their children from their own ignorance of
the functions and duties of motherhood. And there can be no doubt that
they are right. Much of the suffering entailed in maternity, much of
the damage to the life and health of women and children, would be got
rid of if women married with some knowledge of what lay before them,
and if they could obtain medical advice and supervision during the time
of pregnancy and motherhood. It is not the women’s fault that they are
ignorant, for the possibilities of knowledge have not been within their
reach.
The personal relation of husband and wife is a subject as difficult
as it is delicate. Reading these letters one is often struck by
the fact that that relation remains so good under the most adverse
circumstances. But despite the extraordinary loyalty of the writers,
there is clearly a consciousness among them that the position of a
woman not only impairs the value of that relationship, but is directly
responsible for some of the evils we are considering. In plain
language, both in law and in popular morality, the wife is still the
inferior in the family to the husband. She is first without economic
independence, and the law therefore gives the man, whether he be
good or bad, a terrible power over her. Partly for this reason, and
partly because all sorts of old half-civilised beliefs still cling to
the flimsy skirts of our civilisation, the beginning and end of the
working woman’s life and duty is still regarded by many as the care of
the household, the satisfaction of man’s desires, and the bearing of
children. We do not say that this is the case in every working-class
home, or that there are not hundreds of husbands who take a higher view
of married life and practise it. What we do say is that these views
are widely held, often unconsciously, and are taken advantage of by
hundreds of men who are neither good men nor good husbands and that
even where there is no deliberate evil or viciousness, these views are
responsible for the overwork and physical suffering among women and for
that excessive child-bearing, of which more will be said later.
The effects of the conditions we have described and of the causes
which produce them can be conveniently grouped under three heads.
They concern, first the woman herself, secondly the children borne
by her, thirdly the children that remain unborn of her. So far we
have deliberately insisted only upon the evil effects upon the women
themselves, and it still remains to insist upon them. The disastrous
results of maternal ill-health and overwork upon the children cannot
be exaggerated, but in the contemplation of them, people are too apt
to forget that the mother herself is an individual with the right to
“equality of opportunity,” which is the right as a human being to be
given the opportunity of understanding and enjoying those things which
alone make life tolerable to humanity.
It was perhaps inevitable that the mother should have been publicly
overlooked, for the isolation of women in married life has, up to now,
prevented any common expression of their needs. They have been hidden
behind the curtain which falls after marriage, the curtain which women
are now themselves raising.
The general effect upon women is the useless suffering inflicted upon
them, and one of the chief causes of this is undoubtedly excessive
childbearing. This evil is directly due to those semi-civilised notions
which were touched upon above, and though, as we shall see when we
deal with the decline of the birth-rate, nature is taking her own way
of reacting against it, it still exists. We would draw attention to
the conditions disclosed in such letters as 1, 20, 36, and 71. In the
first case we find a woman married at nineteen having 11 children and
2 miscarriages in 20 years, her husband’s wages being 20s. a week. In
the second case there are 5 children and one miscarriage in 9 years;
in the third 5 children and 5 miscarriages in 12-1/2 years; and in
the fourth 9 children and 1 miscarriage in 24 years. These cases
have been taken more or less at random, and nothing could be more
significant than the bare fact that out of 386 women who have written
these letters, 348 have had 1,396 live children, 83 still-births,
and 218 miscarriages. These figures speak for themselves: the mere
physical strain of pregnancy and childbirth succeeding each other with
scarcely an interval for ten or twenty years renders a healthy bodily
and intellectual life impossible. And when the additional strain of
insufficient means and incessant labour are added, the suffering which
becomes the daily concomitant of life is unimaginable to those who are
born in the more fortunate classes of society.
If any further evidence is wanted of the direct effect of such
conditions upon the health of women, we would draw attention to the
number of miscarriages and still-births. It is probable that not all
the writers have included miscarriages; but even as it is the number
of miscarriages is 15·4 per cent. of the live births, while the
number of still-births is 5·9 per cent. Taken together, these figures
show a pre-natal death-rate of 21·3 per 100 live births, as against a
national infant death-rate of 10·9. According to some medical writers
the frequency of abortions “is believed to be about 20 or 25 per
cent. of all pregnancies”; while Dr. Amand Routh estimates that the
number of deaths during pregnancy probably equals the number of deaths
in the first year after birth. The following letters are a pathetic
endorsement of the view that fatigue, strain, and domestic conditions
are responsible for large numbers of miscarriages, and point to the
urgent need of pre-natal care.
We have now come by a logical sequence from a consideration of the
effect of the conditions of women’s lives upon themselves to the
further effect upon the life and death of their offspring. We have, in
fact, travelled the same road as, but in the opposite direction from,
those who in the last ten years have conducted the campaign against
Infant Mortality. It was about ten or twelve years ago that many people
were suddenly horrified to learn that out of every 1,000 children born
in England and Wales, about 150 died before they have lived twelve
months. A vigorous campaign against Infant Mortality by means largely
of what is called Infant Welfare work followed. Government departments
and private persons and organisations have co-operated with such
success that the death-rate of infants under one year of age per 1,000
births has fallen from 145 in 1904 to 109 in 1913. But the point which,
for our present purpose, is most illuminating is to note the course
which that campaign has pursued and is pursuing. It has become more
and more clear that if you wish to guard the health of the infant,
you must go back from it to the mother; it is the circumstances
of the mother--her health, her knowledge, her education, and her
habits--before the child is born no less than at the time of and after
birth, that again and again determine whether the child is to have
health or disease, to live or to die. In fact, from whatever point you
regard the question, the words of the writer of letter 63 are true: We
shall not get “a race in the future worthy of England until the nation
wakes up to the needs of the mothers of that future race.”
Infant mortality in the first year of life is still appallingly
high, and there is good reason for believing--though the fact cannot
be absolutely proved--that this high rate is very largely due to
the circumstances in which the great mass of working-class women
are obliged to bear children. As is well known, it is in the first
month after birth that the death-rate is highest, and it is this
rate which reformers have been least successful in reducing. Now, if
the causes of deaths of infants in the first four weeks of life are
examined, an enormous proportion are due to “immaturity.” “It needs
no argument,” says Dr. A. K. Chalmers, “to show that until we have a
clearer conception of the causes which lead to death from immaturity,
we cannot but fail to make any considerable impression on the volume
of deaths which occur during this period of infant life.” But as a
matter of fact there is high authority for debiting the greater number
of these deaths from immaturity to the physical health and condition
of the mother. “It is evident,” writes Sir George Newman, “that if
infants die within a few days or hours of birth, or even if dying
later show unmistakable signs of being unequal to the calls of bare
physical existence, that there must be something more than external
conditions or food or management which is working to their hurt. The
explanation is clearly to be found in ante-natal conditions.” Dr. Noel
Paton considers that the “malnutrition of the mother helps to explain
the very high infant mortality among the very poor. The infant starts
life at a low level, and readily succumbs to the hardships to which
it is too often subjected.” Dr. Ashby writes: “My own experience in
the out-patient room entirely confirms the opinion that nutrition of
the mother has a very important bearing on the nutrition of the fœtus,
and that the statement that the percentage of unhealthy births among
the poor is small is not justified by facts. We constantly see fully
developed infants a day or two old ... clearly ill-fitted, as the event
proves, to withstand the conditions of external existence.... There
is no question of syphilis; they are the children of poor mothers who
have lived hard lives of wear and tear during pregnancy, are themselves
badly nourished and weakly, and have felt the pinch of poverty, though
often perhaps poverty of the secondary sort.”
No better comment upon, or illustration of, these opinions of experts
could be found than the facts contained in these letters. You can
read in them the little details of existence which made the writers
“mothers who have lived hard lives of wear and tear during pregnancy,”
and watching those details you can see how the everyday working of
the machine, which we call industry and society, leads to suffering,
and wastes and destroys human life as soon as it is born. The results
which can already be shown of care in the pre-natal period, bear out
the contention that the suffering and loss of life which exists is
unnecessary. The Women’s Municipal League in Boston, U.S.A., has had
1,512 women in five years (1910-1914) under its care. Amongst these
women there have been no miscarriages in the last three and a half
years; there were 60 cases of threatened eclampsia in the first year,
there were only 2 in the last year; and the total number of infant
deaths under one month was 2 per cent., while Boston’s rate was 4·3 per
cent. The Johns Hopkins Hospital, U.S.A., obtained similar results, and
in the Glasgow Maternity hospital more exact methods have reduced the
infant mortality and morbidity.
If the problems raised by these letters throw light upon the terrible
waste of women’s health and infant life, they no less certainly throw
light upon another phenomenon of modern society--the decline of the
birth-rate.
One of the most remarkable and important signs of change in the
habits and aspirations of society, has been the sudden decline in the
birth-rate which, noticeable in many countries, began in this country
about forty years ago, and has continued steadily down to the present
time. In every locality and class the number of children born yearly to
married women is declining, but the fall is not the same everywhere;
in the industrial population it is greater among the better-class
and better-paid workers, and it is distinctly greatest among textile
workers where wages are comparatively high and a large proportion
of women work in factories. Now, it is absolutely certain that this
decline is mainly due to the deliberate limitation of the family. There
is, of course, a wide divergence of opinion as to the result of this
conscious check upon the growth of population; some regard it as the
clearest solution of the inextricable tangle in which the industrial
system has enmeshed humanity, others see in it the suicide of a nation
and the doom of a race. But people are so anxious to dispute about
the good and evil of its effect that they often fail to see that for
society itself the important good and evil lie in the conditions which
cause the phenomenon. For the State it may be vital to know the result
of men and women refusing to give her citizens; but it is still more
vital for her to recognize the conditions within her which are leading
men and women to this refusal.
These letters give the skeletons of individuals’ lives, and individual
thoughts and feelings; but in those facts and thoughts and feelings one
can see clearly the general mould of life and the sweep of the current
of general opinion which is among the working classes, resulting in
the refusal to have children. There is a kind of strike against large
families, and it is not, among the workers, a selfish strike. The
motives of this strike are admirably given in the following words
from Letter No. 71, the whole of which is very illuminating on this
point: “All the beautiful in motherhood is very nice if one has plenty
to bring up a family on, but what real mother is going to bring a
life into the world to be pushed into the drudgery of the world at
the earliest possible moment?...” The fact that the decline in the
birth-rate is greatest among the better-paid wage-earners is often said
to prove that a growing love of ease and luxury is causing a declining
birth-rate. The words “ease and luxury” are grotesque when applied
to the lives of manual wage-earners. The fact is that the industrial
worker took the first seventy years of last century to learn that
the conditions such as described in these letters make a human and
a humane life impossible alike for the mother and children of large
families. This consciousness has spread slowly and surely during the
last forty years, and, as is natural, it has spread most amongst the
more educated and intelligent workers and those whose wages have given
them at least the opportunity of realising that there are other things
in life besides poverty and work. The numbers of such men and women
will continue to grow who refuse to have children except under two
conditions. Those conditions are that society shall pay its debt to the
manual worker in such a way that his children can be born into a home
where there is something better than bare existence, and that the woman
has the means and the leisure to live a life of her own without which
she is unfit to give life to her children and to direct it during their
most impressionable years.
It is impossible to leave this question without touching upon one point
which crops up occasionally in these letters. Opinions may differ as to
the good or evil of the general limitation of families, but there can
only be agreement upon the evil which results from the use of drugs to
procure abortion. There are many facts which go to prove that the habit
of taking such drugs has spread to an alarming extent in many places
among working women. Several of these letters confirm that conclusion.
The practice is ruinous to the health of women, is more often than not
useless for procuring the object desired, and probably accounts for the
fact that many children are weakly and diseased from birth. But here
again the cause of the evil lies in the conditions which produce it.
Where maternity is only followed by an addition to the daily life of
suffering, want, overwork, and poverty, people will continue to adopt
even the most dangerous, uncertain, and disastrous methods of avoiding
it.
This introduction has been mainly concerned with pointing out certain
evils deeply seated in national life. These evils have their origin
in social conditions, and they touch life at so many points that they
must, if allowed to work unchecked, modify the whole future of the
race and state. There is no sign that society, if left to itself, will
secrete some antitoxin to purge its own blood. The industrial and
capitalist system tends to become continually more industrial and
capitalistic; the gulf between the rich and poor, the fortunate and the
unfortunate widens; ideals become higher and broader while the means
to satisfy them are narrowed in the possession of a narrow class; only
discontent seems to rise while the birth-rate falls. Society cannot
cure itself, and the last hope, therefore, is for the State to attempt
a cure.
The State has first to realise that if it wants citizens, and healthy
citizens, it must make it possible for men and women to have families
while living a full life themselves and giving a full life to their
children. At the present moment this is not possible from top to bottom
of the working class, unless the economic position of the working-class
family be improved. The first requisite is, then, the improvement of
the economic position of the family.
But it is impossible to treat here the broad question of how this can
be attained; it is only possible to deal with the points in which the
State can to-day take immediate steps to improve the economic position
of the working-class family as regards maternity, and bring specialised
knowledge, adequate rest, nourishment and care, medical supervision and
treatment, within reach. And though the story told in these letters,
in the statistics of infant mortality, in the figures of a declining
birth-rate, be dark, a really bright sign for the future is that the
women so vitally concerned have themselves become aware of the evil
and are eagerly demanding that the State shall adopt those measures
which will most surely mitigate or remove it. The Women’s Co-operative
Guild have brought out a scheme which would greatly enlarge the scope
of State action, precisely in those ways in which it has already
proved itself most beneficial. This scheme, which has already to a
large extent received the blessing of the Government Department most
nearly concerned--the Local Government Board--is given in detail on p.
196. Meanwhile, up and down the country the Guild and other women’s
organisations are pressing Public Health Committees to adopt the
measures recommended. The presence of women on Town and County Councils
is another hopeful sign, and it is greatly to be desired that the
numbers of working-women councillors will increase. Dr. Newsholme says:
“Women could help forward the care of maternity and infants by getting
themselves voted on to Local Authorities, and by bringing pertinacious
pressure to bear on members of Local Authorities.”
It should be noted that the essence of the Guild scheme is that
municipal, not philanthropic, action is wanted. It is not charity,
but the united action of the community of citizens which will remove
a widespread social evil. The community is performing a duty, not
bestowing a charity, in providing itself with the bare necessities for
tolerable existence. That is why the end at which the Guild aims is
that the mothers of the country shall find themselves as free to use
a Municipal Maternity Centre as they are to use a Council School or a
Public Library.
The following words of the Chairman of the Bradford Health Committee,
spoken at the opening of the Municipal Maternity Home on March 15,
1915, show that the needs expressed in these letters are beginning
to be met by the methods desired by the writers: “We stand on the
threshold of an age which is to herald the recognition of the mother
and her child, to give public health work that human touch it has
hitherto lacked, and to modify those glaring inequalities in social
life and conditions which are destructive alike of infancy and the
ideals of Christian citizenship.”