Progressive Mothers, Better Babies: Race, Public Health, and the State in Brazil, 1850–1945 by Okezi T. Otovo (review)

Between the 1850s—when imperial Brazil began irresolutely unraveling its slavery-based economy—and the mid 1940s—when republican Brazil emerged as a hallmark, if stratified and incomplete, welfare state—the lives of black and brown mothers (and their infants) were a bellwether for the country's destiny. Okezi Otovo adeptly traces public health and national aspirations through the interplay of medical ideologies, maternal expectations, and evolving state responsibilities as unfolded in the northeastern state of Bahia, a region perennially overlooked in Brazil's postcolonial historiography.

The "Mulata velha"—the old Black mammy—represented Bahia's problematic role at both symbolic and household levels. Metaphorically, Bahia, once the colonial administrative epicenter and "sugar bowl," was now culturally, politically, and economically eclipsed by Rio de Janeiro and São Paulo in the south. More literally, the Mulata velha was the nanny, wet-nurse, and child-rearer to the offspring of Bahia's elite as well as caregiver to her own children; she, like Bahia, was considered traditional and backwards, if not downright dangerous, even while serving as indispensable nurturer. As the author lucidly explicates, the gendered and racialized renderings of the Mulata velha, the "mãe preta" (wet-nurse), and other mothering and birthing archetypes did not mean that racial and class positions mapped out simply—instead they played out along a range of hierarchies established in relation to women's status under slavery that persisted thereafter.

Following emancipation in 1888, Bahia's tropicalista physicians and their politician-allies stepped up efforts to rein in midwives ("curiosas") for their incompetence and endangerment (not to mention competition). Experts also culpabilized domestic servants, many of whom were wet-nurses, for spreading disease, and decried the "denatured" mothers who anonymously abandoned their infants to almost certain death in foundling homes. Physicians applied healthy mothering expectations broadly, making, at least rhetorically, childbirth, breastfeeding, and child-rearing responsibilities equally valid for elite women and their servants. Lacking an institutional scaffolding, however, doctors' moral appeals initially garnered little receptiveness.

By the early twentieth century, staggering infant mortality rates motivated a series of new puericultural institutions: maternal protection programs, milk depots, infant hygiene clinics, modernized foundling institutions that aimed to return wards to their mothers, "little mother" training programs, breastfeeding incentives, robust baby competitions, and so on. Rather than deferring to, and narrowly emulating, policy and institutional developments in Brazil's metropolitan south, Bahian medical and political authorities crafted regional maternalist approaches, melding maternal and child health improvement experiences from abroad with local ideas and needs.

A trio of agencies collaborated (sometimes sharing leaders) to purvey free services: public federal-regional infant and child hygiene agencies, the physician-led Bahian League Against Infant Mortality, and the Catholic confraternity for the destitute. Combining charity and benevolence with patronizing interventions, these institutions interacted with a range of working class and poor women of color, also enlisting elite women as interlocutors for scientific motherhood, for example in an effort to reject empirical midwifery.

But racialized condescension did not drive Bahian women away; instead they demanded access to an ever greater range of services, so much so that when Brazil's populist president-cum-dictator Getúlio Vargas came to power in the 1930s and delivered on his promise of an "Estado Novo" —a new welfare state, at least for male, urban industrial workers—Bahia had its own welfare state variant in place, but this one was maternalist, not paternalist, and derived from the expectations and needs of black and brown women.

Otovo's epilogue seamlessly moves discussion of racialized maternity to the present: health and welfare remain a conduit to the state for poor and working class women and children. Yet, she argues, excessive C-section rates constitute a form of institutionalized violence that troublingly reflects historical patterns.

Parts of this story have been told by Gisele Sanglard, Maria Freire, Ana...