Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910–1970 (review)

In 1927, Canadian Child Welfare News reported that "Canada enjoys the apparently unenviable distinction of attaining the highest infant mortality rate in recent years." The journal placed the blame for this shameful achievement entirely on the province of Quebec, whose startling high rate of infant deaths had been added to the national registry of births and deaths for the first time, raising the national average of infant mortality from 78.6 to 101.9 per one thousand live births (p. 17). Denyse Baillargeon's absorbing Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910–1970 uses extensive archival research and oral history to interrogate the reasons for Quebec's notorious ranking and how this changed the way pregnancy, childcare, and motherhood were conceptualized. Building on previous work in the history of health, children, and women by Wendy Mitchinson, Cynthia Comacchio, and Andrée Lévesque, Babies for the Nation offers a complex analysis of the constellation of stakeholders—physicians and nurses, the government, insurance agents, women's groups, and mothers—dedicated to solving Quebec's infant mortality crisis for the sake of children and their families and, by proxy, for improving the province's reputation as a vital nation.

Baillargeon's study is grounded in a presentation of the range of economic, cultural, and medical variables that could affect a baby's well-being during pregnancy and after childbirth. Her quantitative research shows that while Quebec's infant mortality rate was much higher than anywhere else in Canada, it was not equally distributed throughout the province. By comparing the mortality rates in urban and rural centers; among the middle and working classes; and within Protestant, Jewish, and Catholic households, Baillargeon reveals how factors such as the availability of medical care, access to clean milk and water, breastfeeding practices, family size, birth order, and type of orphan care contributed to a baby's chances of survival. She also considers how the way information about a child's death was tabulated could be affected by cultural differences, noting, for example, that francophone doctors may have inflated the rate of infant mortality by being "inclined to a liberal interpretation of the slightest sign of life in a newborn" as a way to allow for baptism still to occur, rather than doom a stillborn child to limbo (p. 25). Most strikingly, Baillargeon argues that above all, the most important determinant of health was poverty, which was especially present throughout industrial Montreal and in areas of rural Quebec. The high rate of infant mortality was viewed as a glaring symbol by Quebec politicians and nationalists as a consequence of the province's broader economic and political marginalization. Therefore, investing in child welfare would assist the province's development and save the French race from destruction.

Rather than confront the complex causes and consequences of poverty directly, the various parties tasked with improving children's health targeted the behavior of mothers as the most accessible and influential factor in determining child welfare. The infant mortality rate suggested that mothers must be ignorant, negligent, and indifferent to their children's welfare and therefore should be subjected to medical supervision from pregnancy through early childhood. This medicalized version of motherhood took many decades to become the norm. By the 1960s, most Quebec women regularly used the services of a physician during pregnancy and labor and relied on visiting nurses and baby clinics known as gouttes de lait for medical services and childcare advice. As motherhood became increasingly medicalized, infant mortality did decline; however, Baillargeon argues it was not an automatic cause and effect since at the same time there was a coinciding drop in Quebec's fertility rate. She ends her book by asking whether it was contraception or medicalization that had more to do with the reduced number of infant deaths.

What is really remarkable about Baillargeon's study is that she does not only...