Gender, Fertility, and Modern Medicine

Few issues are as central to women's history as reproduction, which, in many societies, has defined women's role. The importance of having children has made infertility a major social stigma, borne primarily by women, while the inability to limit the number of births has also placed a burden on women who historically have been responsible for raising children. None of this is news, of course. What is new in this latest crop of books on the topic of fertility and reproductive health is the subtlety with which the authors approach the subject, no longer dividing the world into feminist heroes and villains, but respectfully examining the flawed, all too human protagonists who tried to help women in difficult circumstances whether that involved assisting women with too many children, helping women gain access to birth control, or helping infertile couples (but usually focusing on the women) to conceive.

Women themselves have been central in providing reproductive health care to other women. In two biographies, one of Mary Breckinridge by Melanie Beals Goan and one of Mary Zakrzewska by Arleen Marcia Turner, the history of women working as midwives, nurses, and physicians is entwined with the history of reproductive health and childbirth, since this was one of the only areas where women were allowed to practice. Marie Zakrzewska and Mary Breckinridge, born more than fifty years apart at either end of the nineteenth century, were as different as women could be in terms of their approach to the appropriate role of women as practitioners, and in their motives in founding institutions that primarily served the health needs of poor women and children. Born in Germany and trained as a midwife at Charité Hospital in Berlin, Zakrzewska's major motive for emigrating to the United States in 1853 was to seek training as a medical doctor, an option closed to her as a woman in Germany. She justified women's entry into the field on the basis that medicine was grounded in science, an idea that was part of the German tradition but not yet fully accepted in the United States, and that women were as rational as men. By contrast, Breckinridge's "maternalist" beliefs emphasized women's distinctive virtues as nurturing and caring to argue for their roles as nurses. In practice, because initially Breckinridge's Frontier Nursing Service was the only health care available in Leslie County, Kentucky, the nurses performed many of the functions normally reserved for doctors.

The differences between these two women extended to the sphere of politics and race. Influenced by the radical politics of Karl Heinzen and a group of abolitionists, Zakrzewska saw herself as committed to social justice in providing health care for poor women, rather than as dispensing charity. She complained that charity "is what an opiate is to a patient: it soothes for the time but the same bad consequences result as follow the drug" (164). The teaching hospital that she founded in 1862, the New England Hospital for Women and Children, provided medical assistance to "colored" women as well as white women, but this happened only occasionally. For example, only three patients...