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    Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910-1970
    Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910-1970
    Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910-1970
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    Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910-1970

    By Denyse Baillargeon

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    Described by some as a “necropolis for babies,” the province of Quebec in the early twentieth century recorded infant mortality rates, particularly among French-speaking Catholics, that were among the highest in the Western world. This “bleeding of the nation” gave birth to a vast movement for child welfare that paved the way for a medicalization of childbearing.

    In Babies for the Nation, basing her analysis on extensive documentary research and more than fifty interviews with mothers, Denyse Baillargeon sets out to understand how doctors were able to convince women to consult them, and why mothers chose to follow their advice. Her analysis considers the medical discourse of the time, the development of free services made available to mothers between 1910 and 1970, and how mothers used these services.

    Showing the variety of social actors involved in this process (doctors, nurses, women’s groups, members of the clergy, private enterprise, the state, and the mothers themselves), this study delineates the alliances and the conflicts that arose between them in a complex phenomenon that profoundly changed the nature of childbearing in Quebec.

    Un Québec en mal d’enfants: La médicalisation de la maternité 1910—1970 was awarded the Clio-Québec Prize, the Lionel Groulx-Yves-Saint-Germain Prize, and the Jean-Charles-Falardeau Prize. This translation by W. Donald Wilson brings this important book to a new readership.

    LanguageEnglish
    PublisherWilfrid Laurier University Press
    Release dateNov 4, 2010
    ISBN9781554581092
    Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910-1970
    Author

    Denyse Baillargeon

    Denyse Baillargeon is a professor in the History Department at the Université de Montréal.

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      Babies for the Nation - Denyse Baillargeon

      Babies for the Nation

      STUDIES IN CHILDHOOD AND FAMILY IN CANADA

      Studies in Childhood and Family in Canada is a multidisciplinary series devoted to new perspectives on these subjects as they evolve. The series features studies that focus on the intersections of age, class, race, gender and region as they contribute to a Canadian understanding of childhood and family, both historically and currently.

      Series Editor

      Cynthia Comacchio

      Department of History

      Wilfrid Laurier University

      Manuscripts to be sent to

      Brian Henderson, Director

      Wilfrid Laurier University Press

      75 University Avenue West

      Waterloo, Ontario, Canada N2L 3C5

      Babies for the Nation

      The Medicalization of Motherhood in Quebec 1910–1970

      Denyse Baillargeon

      Translated by W. Donald Wilson

      This book has been published with the help of a grant from the Canadian Federation for the Humanities and Social Sciences through the Aid to Scholarly Publications Program using funds provided by the Social Sciences and Humanities Research Council of Canada. We acknowledge the support of the Canada Council for the Arts for our publishing program. We acknowledge the financial support of the Government of Canada through the Book Publishing Industry Development Program for our publishing activities.

      Library and Archives Canada Cataloguing in Publication

      Baillargeon, Denyse, 1954–

      Babies for the nation : the medicalization of motherhood in Quebec, 1910-1970 / Denyse Baillargeon ; translated by W. Donald Wilson.

      Translation of: Un Québec en mal d’enfants

      (Studies in Childhood and Family in Canada series)

      Includes bibliographical references and index.

      ISBN 978-1-55458-058-3

      1. Obstetrics—Social aspects—Québec (Province)—History—20th century. 2. Social control—Québec (Province)—History—20th century. 3. Maternal health services—Québec (Province)—History—20th century. 4. Newborn infants—Québec (Province)—Care—History—20th century. 5. Newborn infants—Québec (Province)—Mortality—History—20th century. 6. Child care—Québec (Province)—History—20th century. I. Wilson, W. Donald, 1938–II. Title.

      RG963.C32Q8 2009       362.198’2009714       C2008-907641-9

      Cover photo by Rosemarie Gearhart/iStockphoto.

      Cover inset photo courtesy Archives de la Ville de Montréal, Z-96-4.

      Cover design by HandsDesign.ca. Text design by Kathe Gray Design.

      French edition, Un Québec en mal d’enfants

      © 2004 Les Éditions du Remue-Ménage

      English translation

      © 2009 Wilfrid Laurier University Press

      Waterloo, Ontario, Canada

      www.wlupress.wlu.ca

      This book is printed on FSC recycled paper and is certified Ecologo. It is made from 100% post-consumer fibre, processed chlorine free, and manufactured using bio-gas energy.

      Printed in Canada

      Every reasonable effort has been made to acquire permission for copyright material used in this text, and to acknowledge all such indebtedness accurately. Any errors or omissions called to the publisher’s attention will be corrected in future printings.

      No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, without the prior written consent of the publisher or a licence from The Canadian Copyright Licensing Agency (Access Copyright). For an Access Copyright licence, visit www.accesscopyright.ca or call toll free to 1–800–893–5777.

      Contents

      List of Tables

      List of Acronyms

      Acknowledgements

      Introduction

      CHAPTER 1 A Bad Mother Called Quebec

      An Early Death

      Dying While Giving Life

      CHAPTER 2 A Very National Infant Mortality Rate

      The Nation in Peril, 1910–1940

      A National Dearth of Children, 1940–1970

      CHAPTER 3 Let Us Have the Mother and the Child Is Ours

      The Ignorance of Mothers

      Teach Over and Over

      CHAPTER 4 A School for Mothers

      Clinics for Newborns

      Home Care

      The Victorian Order of Nurses

      The Nurses from the Met

      The Assistance maternelle

      Services for Mothers Outside the Major Centres

      Prenatal Clinics

      Public Lectures and the Distribution of Documents

      CHAPTER 5 Bitter Struggles

      All for One

      General Practitioners and Public Health Officials

      General Practitioners and the Assistance maternelle de Montréal

      Doctors and Nurses

      Physicians and Maternalist Feminists

      Church and State

      CHAPTER 6 The Quebec Mother and Child

      Care for Expectant Women

      Care for Babies

      To Read While Caring for Baby

      Relations with Doctors and Nurses

      Epilogue: To Have or Not to Have …

      Appendix 1: Sources

      Appendix 2: Infant Mortality Rates, Canada and the Provinces, 1926–1965

      Notes

      Bibliography

      Index

      List of Tables

      List of Acronyms

      Acknowledgements

      It has taken me over ten years to complete this book, so my debts are numerous and varied. I wish first of all to thank those who have assisted me in my research throughout so many years: Marie-Josée Blais, my collaborator from the outset, who conducted and transcribed the first series of interviews used in this book and who also generously made those she carried out for her Master’s thesis available to me; Suzanne Commend and Karine Hébert, who, among other things, analyzed various archives and wrote reading and research reports; Nathalie Pilon, who, while pregnant, serenely collated statistics of maternal and infant mortality before it occurred to me to entrust her with other tasks better suited to her condition, in particular the transcription of the final series of interviews; Catherine Cournoyer, Vincent Duhaime, Cheryl Gosselin, Christine Payeur, Anne Pelletier, Louis-Raphaël Pelletier, and Ariane Venne-Hébert, who shared the reading of annual reports, daily newspapers, periodicals, and other serial documents. Without the outstanding work of all these, the research on which this work is based would have been much less complete. My gratitude also goes to all those, friends, colleagues, and students of the Université de Montréal History department, who referred mothers and grandmothers to me for my interviews. A special thanks is owed to all those women who agreed to confide their experiences of maternity and of the medicalization process—not always happy ones—to a not always discreet microphone. The insider perspective made possible by their accounts represents a very important, and I would say essential, contribution to this book.

      Michel Barsalou, who at the time was head of the Metropolitan Life Insurance Co. in Ottawa, Hélène Paradis, who was for a long time a coordinator for the Assistance maternelle de Montréal, and Martine Sirois, information officer with Centraide, allowed me to consult the archives of their organizations and made previously untapped collections available to me. They deserve my warmest thanks. I also wish to stress the valuable assistance provided by several archivists: Denis Chouinard and Hélène Charbonneau of the City of Montreal Archives, Rénald Lessard of the Quebec National Archives, Daniel May of the Metropolitan Life Insurance Company archives in New York, and Denis Plante of the Université de Montréal Archives Division.

      Some of my in-laws live in the Ottawa Valley and others close to Quebec City: how fortunate for a historian like myself! Many thanks to Roch, Carole, Audrey, and Sébastien, who welcomed me into their home in Gatineau when I was working in the Metropolitan Life archives; to Paulette, who lent me her house in Hull to stay in when I was doing research in the Canadian National Archives in Ottawa (and she, I might add, was lazing around at her cottage!); and to Luc, Carole, Andréanne, and Caroline, my hosts on my forays to Quebec City.

      Since money forms the sinews of war, I must not forget the contribution of the various agencies that have provided funding for this project over the years: the Social Sciences and Humanities Research Council, which awarded me a post-doctoral fellowship that was the launching pad for my research on the medicalization of maternity; Associated Medical Services, through the Hannah Institute for the History of Medicine acting as its intermediary, which awarded me grants on three occasions; and the young scholars’ program of the Quebec government’s Fonds pour les chercheurs et l’aide à la recherche, which allowed me to extend this study through the period from 1940 to 1970.

      Before it took its final form, the idea of this book was the subject of numerous discussions with colleagues and friends. My thanks to Aline Charles, Cynthia Comacchio, and Michèle Dagenais for the time they spent thinking about my project, and for their suggestions. A big thank you also to Danielle Gauvreau, Nadia Fahmy-Eid, Andrée Lévesque, and Susan Mann, who generously agreed to read and comment on several chapters or the entire manuscript; their comments and criticisms have been most useful and appreciated. It goes without saying, however, that I bear the entire responsibility for the interpretations presented in this study. Finally, I wish to extend my sincere thanks to the members of the Groupe d’histoire de Montreal, who, for more than ten years, have provided me not only with their friendship, but also with an extremely stimulating intellectual environment. They were there for me especially at difficult times; I wish to express my deep gratitude to them once again.

      I am also very grateful to everyone at Wilfrid Laurier University Press for having supported the publication of this book in English. Thanks are also due to W. Donald Wilson for the excellent work he did in translating my often too-long sentences.

      A special thought goes to Guy, with whom I share my life and with whom I shared my doubts and anxieties, probably more often than I should. Thank you for always having been there, even when I was at the computer!

      This book takes a rather critical view of medicine and of physicians. But life, as we well know, is a paradox—that is indeed what gives it its savour and makes history so fascinating. So, finally, I would like to thank Drs. Jacques Lemire and Mikaël A. Sébag, ophthalmologists, whose expertise allowed me to begin and to complete this book.

      Introduction

      In the early 20th century very few women consulted a doctor during pregnancy. When they did, it was often in order to confirm their condition after feeling the baby move, or during the third trimester to obtain a better idea of the birth date, or sometimes simply to warn the doctor that his services would soon be needed. In urban areas, women were indeed calling increasingly on the services of a doctor when giving birth (an event that always took place at home), but this was the only part played by the doctor. He—for at the time only male doctors attended at births—would not see the mother for postpartum examinations, nor would he examine the infant, for whom the mother would care, adopting the methods of family and friends and the advice of other mothers she knew. If, officially, the practice of midwifery had ceased to exist at the end of the 19th century, it still happened that in outlying areas and in working-class city neighbourhoods women often delivered their baby with the help of female relatives or neighbours known to possess midwifery skills.¹

      The great-granddaughters of this generation of women would adopt a very different approach. Indeed, by the 1960s it had become almost unthinkable not to see a doctor regularly all through the pregnancy. Blood and urine tests, and sometimes X-ray examinations, had became imperative; a diet had to be followed, vitamin supplements taken, and the mother-to-be was even expected to attend prenatal classes, a novelty at the time. She was also encouraged to read The Canadian Mother and Child by Dr. Ernest Couture—unless of course she preferred to take her information from his celebrated American colleague, Dr. Benjamin Spock. The birth would take place in hospital with only hospital staff attending, and regular visits to the doctor would follow, as much to ensure the mother’s proper recovery from the delivery as to check the progress and health of the child. The part played by doctors during pregnancy and birth, like the medical care of young children, had come to be taken for granted, a practice required by common sense that no one would dream of questioning.

      This book deals with the socio-medical transformation outlined above, which we call the medicalization of maternity. The expression refers to the transformation of the pregnancy, birth, and newborn care into matters that required medical attention or the mediation of medical science, a process that took place throughout the entire Western world in the 20th century. Why did these changes occur? What social, economic, political, and ideological forces contributed to the medicalization of maternity and determined its evolution? What form did this development take in the specific context of Quebec society? Apart from doctors, who else played a part? How could doctors convince women that they had to be consulted? Why, and under what conditions, did the latter decide to follow their recommendations? Such are the fundamental questions that provide the starting point of this study. Situated at the intersection of several different historiographies, it draws on studies dealing with the history of women, of the family, and of feminism, as well as on the history of health and of the health professions, and with the new political history as it takes a closer look at the medicalization of pregnancy and early infancy in Quebec between 1910 and 1970. While it is not entirely overlooked, the medicalization of the delivery itself will be treated in less detail, given that this has already been dealt with elsewhere.²

      For almost 20 years, feminist historiography³ has paid considerable attention to the study of maternity. In establishing its historicity, these studies have shown in particular that maternity, seen as an entirely private and personal matter, has long been the target of social measures aimed at defining the obligations of motherhood in relation to the economic and political requirements and values of the surrounding society.⁴ Referring to Jean-Jacques Rousseau’s exhortations to mothers to breastfeed their babies, or to the pro-birth policies of Jean-Baptiste Colbert during the colonial period, to quote only two examples, these analyses clearly show that motherhood was already considered an issue of national importance in the 17th and 18th centuries.⁵ According to a recent analysis of the rhetoric of separate spheres, an ideology characteristic of the 19th century that considered the home to be the specific sphere of women’s activity, this period encouraged a closer-than-ever association between femininity and motherhood, while heavily stressing mothers’ responsibilities to society and to the nation.⁶ In short, motherhood was viewed by the great majority of these studies as far from a merely physiological function confining women to an eternal feminine nature, but as a social phenomenon or construct, i.e., as an experience varying across time and space as it was shaped by dominant ideologies and power structures, and particularly by relations of domination based on gender and on the expectations of the social environment.

      If, according to a number of writers, maternity has constantly been the subject of public discourses seeking to shape and exploit it, most feminist historians agree that it was mainly from the end of the 19th and especially the early 20th century that a genuine project to oversee maternity emerged and took effect. Henceforth it was no longer merely a matter of convincing women of the importance of their role as mothers in order to better subordinate maternity to the service of society or the nation, but of dictating their behaviour down to the smallest detail. Since the middle of the 1980s, the fundamental part played by physicians in this endeavour to transform the practice of maternity has been the subject of a great deal of research in the West.⁷

      Overall, these studies show that the medicalization of pregnancy and care for the newborn came about as a result of the struggle against infant mortality (and, incidentally, maternal mortality) that began at the turn of the 20th century. Although it was an age-old phenomenon, the death of infants aged under one year was identified as a serious social problem and became the object of increasingly vehement condemnation. As several studies have stressed, this growing preoccupation with the death of newborns arose at a time when the industrialized nations were growing uneasy about their ability to preserve their integrity and to ensure the replenishment of a productive labour force.⁸ International and intra-national tensions, increased social conflicts, and the accelerating decline in urban living conditions that resulted from industrialization were all factors that compelled reformers (composite groups whose membership was drawn from the middle classes and included numbers of physicians) to take up arms for this cause.⁹ These groups, which could be found all throughout the Western world, fed into a vast child welfare movement that set out to eradicate infant mortality and introduce various free preventive and educational services for mothers.

      The re-reading of the history of early 20th-century feminism that has been in progress now for about 20 years has shown that there were often groups of women motivated by an ideology that could be termed maternalist¹⁰ behind the earliest initiatives aimed at mothers and newborns. Acting as members of charitable and reformist organizations or ones identified with the feminist movement, these volunteers argued that their ability to be mothers endowed women with distinctive qualities, and in particular a natural tendency to feel concern for others and care for them. This conviction led them to claim that the experience of motherhood, shared by all women, transcended class or ethnic barriers. Such a rhetoric, subscribing to the notions of a feminine nature and preordained feminine roles, allowed them to invoke their domestic and maternal competencies as a way to legitimize a social activism that in fact led them to transcend the frontier between the public sphere and the private sphere that was still dear to patriarchal society in the early 20th century.¹¹ Even before women obtained the right to vote these ladies from the most well-to-do social classes formed groups, organized and created various associations, and in general acted increasingly to save children born to needy mothers. In several Western countries they also demanded that motherhood be granted tangible social recognition in the form of improved state support, including measures such as family allowances. Everywhere they themselves established various services, notably distribution centres for pure milk intended to prevent diarrhoea, the major cause of infant death early in the 20th century.¹²

      However, this charitable female activism soon became circumscribed. A careful study of the initiatives undertaken by women’s groups in the West shows that in many countries after World War I, public health authorities, at the urging of physicians, would take over the institutions created by these women, often reducing or radically transforming the services provided when they did so. Simultaneously, nurses trained in public health replaced female volunteers. Armed with a scientific knowledge that gave them considerable social power, the doctors, with the backing of these new women health professionals, portrayed themselves as the sole guardians of infant health—a discourse to which the government authorities increasingly subscribed. The human losses resulting from World War I, followed by the influenza pandemic of 1918–1919, did indeed sharpen the sensitivity of governments to the need to preserve the life of future generations, something that medicine was promising to do. As Cynthia Comacchio has clearly shown in her study of medical discourse in Ontario from 1919 to 1939, the solutions doctors proposed to eliminate infant mortality bear the stamp not only of their class interests and prejudices, but also of their patriarchal ideology. Minimizing the importance of poverty, even though it was in fact the principal cause of infant mortality, and refusing to consider free medical care, something that would have placed them under the authority of the state and undermined their professional status and social prestige, doctors put forward a plan of action based essentially on the diagnosis (but not the treatment) of childhood ailments and on the prevention of infant deaths by educating women in the hygiene of pregnancy and newborn care.

      In this medical discourse, mothers were held individually responsible for the survival and health of their babies and found guilty when they refused to follow doctors’ instructions, to make use of the free services available to them (such as the infant care clinics that became numerous at the time), or to consult a family doctor at their own expense. Infant care, the major responsibility of women, had become a medical matter: henceforth, a good mother was one who understood that she could not do without the advice of the appropriate expert. Initially, this discourse sought above all to define the maternal responsibilities of working-class and immigrant women in terms of middle-class values and attitudes, but it was not long before it targeted women in general. As Comacchio concludes, it was a matter of replacing traditional methods of child rearing with more modern ones better attuned to the requirements of the efficiency-minded industrial society that Canada had become in the early 20th century while confirming women in their age-old role as homemakers and reasserting the private nature of motherhood.¹³

      Comacchio’s analysis, like several others, led to a consideration of the medicalization of maternity as a manifestation of power relations based on class, gender, and ethnicity that characterized Canadian society in the early 20th century. While this perspective should certainly not be overlooked, other studies highlight the importance of also considering alliances that bridged the divisions between these social categories and also the conflicts that arose within these same categories. Thus, the maternalists, the first to enter the field of child welfare, saw their competence questioned by the nurses, who, like the doctors, denounced their amateurism.¹⁴ Similarly, it must be remembered that though the volunteers and the nurses who replaced them were the most likely to come into direct contact with the needy women who made use of the public health services, they often acted as mouthpieces for the doctors, whose social class, and notions and prejudices regarding working-class mothers, they shared. Furthermore, these women also fell foul of the hostility of an authoritarian medical profession eager to become sovereign in matters of infant health.¹⁵ More particularly, the history of nursing has cast light not only on the part played by public health nurses in the structure of public health, but also on the power struggles in which the profession had to engage against doctors jealous of their prerogatives.¹⁶ As for doctors, while they spoke with one voice in saying that mothers should submit to their instructions, a sometimes ferocious struggle broke out between the medical elite, i.e., public health physicians and pediatricians with university or civil service appointments that provided them with a stable income and a certain prestige, and general practitioners, who derived the major part of their earnings from private practice. For fear of losing their clientele, the latter maintained their opposition to the growth of free clinics, even though these were restricted to preventive measures.¹⁷

      Finally, several feminist historians have also noted that the medicalization of maternity could not have taken place if women had not sought out the assistance offered them by the medical profession, becoming aware of the very real benefits it could provide for them and their children. On the whole, studies dwelling on the reaction of women to the medicalization of maternity testify to a certain resistance on the part of mothers, one that was expressed less by a complete, radical rejection of medical precepts than by an acceptance of it that was conditional and dependent on circumstance. This explains, as several studies have shown, why mothers could adopt certain practices for reasons diametrically opposed to those advocated by doctors, just as they could refuse to adopt others and ask for increased medical care rather than merely advice.¹⁸ As Wendy Mitchinson has stressed in her study of giving birth in Canada during the first half of the 20th century, mothers were themselves products of their time and their society. Just as the great majority of them accepted the ideas about female nature and the fundamental importance of the maternal function that were current at the time, most of them subscribed to the medical credo, believed in its scientific objectivity, and yielded to its promise to do away with complications during pregnancy and pain in childbirth.¹⁹

      In fact, the work of Michel Foucault and of historians inspired by it suggests that women were not so much controlled by doctors as previously supposed²⁰ as exposed to discursive and institutional practices that they tended to assimilate and adopt because in return this brought them the reward of social approval.²¹ This self-regulation, testifying to the power that certain types of discourse are able to exercise not on but through individuals, contributes to the normalization of particular types of behaviour at the expense of others, which become marginalized and subject to disparagement, disapproval, and condemnation. In these circumstances, a refusal to conform to a social norm—to consult a doctor regularly throughout pregnancy, for instance—meant adopting a very uncomfortable position that very few wished consciously and deliberately to defend. As Mitchinson has stressed, in the case of a medical norm claiming to rest on a scientific foundation, any attempt at rejection can even seem utterly irrational.²² Yet this process of normalization is not immediate, linear, automatic, or comprehensive. Before it is complete, and certain types of behaviour, like the discourses underlying them, becomes hegemonic, fringe areas survive in which normalcy still remains poorly defined and different rationalities, disagreements, and contentions can be expressed. And even when the process has been completed, the norm will encounter opposition,²³ though probably in covert form, or at the risk of vigorous social sanctions. For a norm to become effective, it seems to us that material conditions also must allow it to be actualized by a majority; otherwise it is much easier to justify transgressions.

      Overall, and in the light of these various studies, the medicalization of maternity appears as a process that cannot be understood without reference to the economic, political, and social relations that shape industrial societies. The desire to save the lives of the newborn was rooted in the vast transformations that threatened the stability of these societies in the early 20th century, at a time when various groups (reformers, health professionals, and feminine or maternalist charitable organizations) were attempting to assert their authority in the social realm. The implementation of a vast preventative and educational program concerned with maternal and infant health encouraged public debates about the obligations of maternity and required the collaboration of the state, which granted ever greater room within its bureaucracy to the medical profession and approved funding to develop certain services and communicate the health message to mothers. Several feminist historians have already noted that, while it was reduced to its simplest form, the care provided to mothers and babies was nevertheless one of the first health services to be financed from the public purse.²⁴ These government measures, even if they were adopted in the name of the sacred nature of the family and if they constantly reaffirmed the necessity of keeping the private and public spheres apart, show clearly, like the medical discourse that inspired them, that the survival of young children was an eminently political matter.

      The political and social consensus that emerged around the need to redefine the duties of motherhood in medical terms nevertheless gave rise to tensions that became apparent in the arena where confrontations took place between the various groups seeking to bring about this medicalization, and where their interests collided with those of mothers. If in the end the medical power would be able to impose new behavioural norms where pregnancy and infant care were concerned, it can be said that it was in this conflict of interests, in this crucible of collaborations, demands, resistances, and conflicts, that the process of medicalizing maternity really took shape.

      In this perspective, the present study set out to examine the process of the medicalization of maternity in Quebec from a variety of viewpoints in order to bring out its complexity and specific nature. In particular, while taking the response of mothers into account, it will look at the discourse of French-Canadian doctors (something that has never yet been subjected to systematic study) as well as the involvement of the women’s groups and feminine charitable organizations, both anglophone and francophone, devoted to the well-being of mothers and babies that operated in Montreal, throughout the province of Quebec, and even Canada-wide. In addition to the contribution of government, our analysis also considers the initiatives undertaken by private enterprise, particularly the Metropolitan Life Insurance Company, which made a major contribution to the creation of public health services all across North America and played a significant role in this respect in Quebec. We will also examine the actions of municipal health authorities, responsible until the 1960s for public health in their jurisdictions; of the provincial government, whose contributions became more apparent beginning in the 1920s; and of the federal government, which, from World War I on, assumed increasing responsibility for health on the national scale. Finally, our analysis also considers the part played by the Roman Catholic Church, whose involvement in the areas of health and public assistance in Quebec long carried considerable weight. While wishing to cast light on the existence of a vast network of interdependent institutions aiming to oversee mothers more closely, the ultimate objective of this study is to illuminate the interests of the different actors that contributed to the development of services by studying the alliances and power plays that united or divided them.

      It goes without saying that power relations based on social class and gender—a concept that refers to the socio-historical and interdependent construction of sexual identities²⁵—will be at the heart of our analysis. This dual relation of domination did indeed have a very profound effect on the relations between mothers and doctors. But class relations also pervaded relations between poor mothers and women in positions of authority, whether volunteers or nurses attached to private and public organizations and agencies. As for the latter, they found themselves in a subordinate position vis-à-vis the doctors, not only because they did not possess as much knowledge, but by the very fact that they were women. We should also add that the concept of gender includes a symbolic dimension that will allow us to consider other types of social relations, and the relations between groups or institutions, in feminine and masculine terms. As a number of feminist historians have shown, the concept of gender—the notion societies hold of the roles, place, and attributes appropriate to men and women, of the relations between them, and of their respective value—can indeed be applied to every dimension of social and political life, for the entire social fabric is so permeated with these perceptions that they even influence political decisions. The way in which femininity and masculinity are viewed played a part, for instance, in the creation of the welfare state after World War II: in developing its social policies (especially the unemployment insurance and family allowance programs)²⁶ it called on a gendered conception of the sharing of family responsibilities between a breadwinner father on the one hand and a homemaker mother on the other. This, in turn, helped to reinforce the legitimacy of the allocation of roles and responsibilities, and ultimately of power, between the couple. During the first decades of the 20th century, i.e., even prior to the creation of the welfare state, the metaphor of gender also served to establish the limits of state action, as several authors have shown, with public authorities restricting themselves to the introduction of measures corresponding to the male responsibilities of a provider while leaving it to private charitable organizations to provide care.²⁷ It is also from this angle that we will consider the establishment of public health programs and the measures directed at mothers and children during the period under study.

      The national question, and that of relations between Church and state, will also occupy a large place in this book. It was indeed in the name of the survival and advancement of the French-Canadian collectivity that French-speaking supporters of the campaign against infantile mortality, especially doctors, often ardent nationalists, wished to transform the practices of motherhood. Here, as elsewhere, medical discourse adopted a scientific, rationalist tone in making its case for the changes it was calling for. But here more than elsewhere, perhaps, it was a matter of demonstrating the salutary power of medicine to deal with infant mortality rates that early in the 20th century had soared to peaks unequalled in all the Western hemisphere and that remained above the Canadian average throughout the entire period. Ending this situation, which was considered a national humiliation, and reviving national pride by eliminating such a hecatomb, became, at least on the level of medical rhetoric, an important driving force behind the medicalization of maternity.

      The prominence of the national question in the combat against infant mortality, the links established between national and religious identity up to the end of the 1950s, and the place the Church, with the consent of the state, had carved out for itself since the 19th century in the areas of education and social and health services, are all interrelated phenomena of which we shall also have to take account if we wish to understand how the network of institutions dealing with the well-being of mother and child in Quebec was structured.²⁸ As several authors have stated, and contrary to what one might think, the Quebec state demonstrated its readiness to intervene in the realm of maternal and infant health well before the 1960s, for the nation’s future was at stake. Likewise, the Church, generally allergic to any state involvement in social matters, in this case supported the government initiatives because they corresponded to its own nationalist concerns.²⁹ But we must also consider the contrary hypothesis, namely that the provincial and municipal governments ratified the activities of those charitable organizations that were connected to the clergy and that remained active into the 1950s and even 1960s. Their presence in several municipalities outside Montreal, and above all the growth they experienced there, where they completely took over from the public authorities, can be partly explained by financial considerations, for it allowed local health authorities to make considerable economies. Their prolonged survival nevertheless indicates that the political elites had long recognized the legitimacy of confessional philanthropic activities in the field of maternal and infant welfare for the reason that, historically, the Church had been granted a pre-eminent role in the immense undertaking of defending the nation. For the Church and the nationalist traditionalists within its sphere, it was in any case important that the organizations concerned with child welfare should adhere to Catholic values and communicate these to the female population they served.

      The research dealing with the relations between feminism, nationalism, and the state also suggests stimulating avenues of reflection for a better understanding of the dynamics at work in the realm of mother and infant welfare in Quebec. Feminist analysis shows, for instance, that women, on whom the continued existence of the nation depended, were especially targeted by those nationalist discourses that linked maternal and feminine patriotic duties. Even while failing to grant them any kind of citizenship, political, social, or economic, the nation’s leaders expected women to produce the very national community from which they were excluded by this lack of rights. Furthermore, nationalists were often the most virulently opposed to the elevation of women to the status of citizens, fearing that such new attributes might divert them from their maternal role.³⁰ We know to what extent the Church’s encouragement to procreate could become inquisitorial within French-speaking Quebec, at least between the 1900s and the 1940s, while at the same time most of the clergy was violently opposed to women’s suffrage.³¹ Women did not always respond positively—far from it—to these exhortations, yet it so happened that the high rate of child-bearing among French-Canadian women was for long a source of national pride, as well as of uneasiness when it declined, and it was against the yardstick of the birth rate that nationalists considered the matter of infant mortality.

      The new political history, with its interest in various aspects of the state and in its links to social institutions and civil society, as well as research dealing with the relationship between maternalism and the development of the welfare state, also provides essential vantage points for our analysis. In particular, the concept of a mixed social economy—meaning the system prevailing since the 19th century in which the state and a range of private agencies intervened simultaneously in the social realm—allows us to add a further dimension to the analysis of the relationship between the Church and the state, too often viewed as binary and exclusive. The concept of a mixed social economy stresses the importance of looking at the public financing, partial or total, of private aid institutions that provided services to the population in order to reach a better understanding of the nature and scope of state intervention. In order to better define the extent and profile of state power, it also emphasizes the need to study the mechanisms by which this financial support was dispensed, and the procedures for inspection and administrative control put in place by the public authorities.³² Such an approach also makes it possible to include in the equation women’s groups that were involved in the provision of services, thereby helping to depolarize the picture.

      Furthermore, and complementarily, the connection made by several historians between the disappearance or marginalization of certain women’s voluntary organizations and the establishment of state programs or policies to deal with mothers and their babies leads to a better understanding of the longevity of the feminine philanthropic groups that held such a prominent place in Quebec up to the 1960s.³³ On the one hand, indeed, their survival can be seen as a result of support from the priesthood and from nationalists, always ready to champion the social involvement of women’s groups as long as it was of a purely charitable nature and the women concerned displayed no inclination to turn it into an instrument of power. On the other hand, it seems that the disappearance or takeover of women’s volunteer organizations that occurred immediately before or during the Quiet Revolution marked the entry into the arena of a Quebec welfare state that, in the name of a newborn nationalism, of a new way of thinking, and of new, more modern values, would seek to bureaucratize and professionalize public services—in other words, entrust their entire control to a corps of male administrators.³⁴

      This study deals with the period between 1910 and 1970, during which the simultaneous involvement of the Church, the state, and women’s groups in the realm of maternal and infant welfare would become most evident. These decades also correspond to a golden age of public health that lay at the heart of the process of medicalizing motherhood. The 1910s indeed witnessed the development of the first initiatives of the Montreal child welfare movement, in particular the permanent opening of the first clinics for newborns. These health infrastructures, which were soon to be found in other Quebec cities, were aimed initially at mothers from the urban working class, thought to be particularly ignorant and whom the doctors and the health authorities wished to educate in the elements of infant care. Though these services, which were free, were restricted to the prevention of illnesses associated with early infancy, one consequence was that nevertheless they brought an increasing number of mothers into contact with health professionals and with medical teachings, an essential condition if the medicalization of motherhood was really to take root. This period ended in 1970 when Quebec introduced its medicare program and dismantled its preventative medicine services, now considered obsolete as access to private medical visits became free.

      From the point of view of women and motherhood, the 1960s also marked an important transition, characterized

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