Historical Linkages between Reproduction, Pronatalism, and Professional Institutions in North America

While there are many histories of pronatalist polices and their impact on the family and society at large, and separate histories of the development of professional care for women during pregnancy and childbirth, rarely are the two topics linked together analytically. The three books under review here—two based on U.S. historical data and the third on Canadian sources—shed light on entrenched patriarchal traditions in North America that have emphasized women’s primary responsibility to reproduce the next generation and of their female care providers as subservient to a male medical elite. Issues of race and class also run through these interconnected histories: the regulation of reproduction and population at the turn of the twentieth century in the United States was mainly focused on encouraging “better” families (white, Anglo-Saxon Protestants) to reproduce the next generations. Likewise, nurse-midwives, in their struggle to professionalize and gain the respect of the nursing and medical professions, denounced lay midwives, most of whom were poor and black, labeling them as “backward” and dangerous to birthing women. Nurse-midwives instead advocated for professional training of mainly middle-class white women to work as guardians of normal birth and safeguard the health and well-being of the best of the “American stock” (i.e., white families). Likewise, even as late as the 1980s in Canada, midwives struggling to gain a foothold in the Canadian public health care system did so in part by marrying premodern notions of the midwife as women’s helper and proponent of the normal with an elite form of professionalism that largely excluded membership of women of non-white backgrounds. Below I examine these central themes found in the three books under review, showing how the three main axes of diversity—gender, class, and race—run through reproductive and professional developments during this crucial historical period when gendered rights over reproduction and professional care of pregnant women were hotly debated.

The Three Books

Conceiving the Future is focused on the historical period from the late nineteenth century to the late 1930s, a time in U.S. history when “coercive means of reproductive regulation were created, articulated, and woven into cultural constructions such as the “home on the land” or the “fitter family.” These constructed ideals helped to create social pressure by enrolling the cultural forces of tradition and nostalgia to justify intrusions into what had been private deliberations concerning reproduction” (2).

With the movement of people from rural to urban areas during the early stages of industrial capitalism, children became economic liabilities rather than economic assets. Many European countries, including France and Germany, enacted formal pronatalist policies to try to boost their dwindling domestic populations due to these changing economic conditions. While the United States did not follow this overt approach to encourage childbearing, Lovett provides convincing evidence of an implicit pronatalist policy throughout this period. This was evident, for example, in a series of national campaigns for land reclamation, conservation, country life, and eugenics. Lovett labels this “nostalgic modernism,” an ideology that connected seemingly contrasting ideas of romantic agrarianism and scientific racism and eugenics to help curtail falling birthrates among “native-born” Americans. These efforts were largely in vain—during the five decades covered by this book (1890–1940), the fertility rate of white native-born women continued to drop from nearly four children per women to just over two, which is in fact the current national rate.¹ But Lovett is not concerned about whether...