Gossage, Peter

English

Histoire sociale / Social History (E-Journal, York University)

Comptes rendus / Book ReviewsBAILLARGEON, Denyse — Un Québec en mal d’enfants. La médicalisation de lamaternité, 1910–1970, Montréal, Les éditions du remue-ménage, 2004, 373 p.Denyse Baillargeon’s new book is an impressive and original contribution to the his-tories of women, medicine, childhood, and social welfare in twentieth-century Que-bec. Staking out a 60-year period that witnessed major changes in all of these areas,Baillargeon applies her considerable skill as a researcher to the expert, scientific dis-courses and practices around pregnancy, childbirth, and child care then rising tohegemonic status in Quebec, as elsewhere. Quebec’s history in this respect followeda pattern already established for other Western societies; it is well studied in EnglishCanadian contexts, for example, by scholars such as Katherine Arnup, CynthiaComacchio, and Wendy Mitchinson. As the century progressed an increasingly well-organized and self-important medical profession imposed its “modern” vision of pre-ventive pre-natal care, hospital births, and “scientific” child rearing on women, par-ticularly women of the popular classes, whose traditional knowledge and practicesthe profession challenged and ultimately marginalized. This familiar story takes onnew dimensions when transposed to Quebec, where the medicalization of maternityoccurred against the backdrop of the continent’s largest families and highest levels ofinfant mortality, where the campaign was couched in the language of French-Cana-dian nationalism, and where a powerful Catholic Church both influenced the wayQuebecers thought about motherhood and provided the infrastructure for many of theinstitutional responses to maternal, infant, and child mortality.As in so many other areas, then, the history of scientific motherhood in twentieth-century Quebec was “the same ... only different”. Baillargeon has spent over a decadecoming to grips with its complexities — and they are legion. Un Québec en mald’enfants is comprised of six chapters, the first three of which are based on a thoroughvetting of the relevant prescriptive literature, especially from French-Canadian med-ical journals. In chapter 1, the author ably marshals this material to paint a two-stageportrait (pre- and post-1940) of the public health problems to which most of the med-ical attention was addressed: infant mortality and, to a lesser extent (since it was muchless common), maternal mortality. In chapter 2, she builds on this analysis by focus-ing on the campaign to promote higher levels of child survival in a province where,Histoire sociale – Social History, vol. XXXIX, no 77 (mai-May 2006)268 Histoire sociale / Social HistoryHistoire sociale – Social History, vol. XXXIX, no 77 (mai-May 2006)as recently as the 1920s, 13 per cent of all infants died before their first birthday(Table 1). We have seen many discussions of infant mortality in Quebec since 1974,when Terry Copp first brought to light H. B. Ames’s shocking statistical study ofworking-class Montreal in The Anatomy of Poverty. Baillargeon’s work is the first tomy knowledge to frame the debate in terms of its nationalist content and to situate thecampaign for improved infant care in terms of the ideology of la survivance.Chapter 3 maintains the focus on medical prescriptions for “scientific” motheringas the modern solution to the persistent scourge of infant mortality. Here, however,the scope of the analysis broadens to encompass a wider range of actors and issues.Infant mortality was a complex problem, the roots of which might variously be tracedto poverty, overcrowding, artificial feeding, unpasteurized milk, large families, or,saliently, the “ignorance” of French-Canadian mothers. The array of solutions offeredin the literature was similarly wide and included education, pre-natal care, breastfeed-ing, improved living standards, medically approved methods of bottle feeding, hos-pital births, and other innovations, all of which served to empower doctors and other“experts” and to disempower women. Throughout this discussion, Baillargeonemphasizes the arrogance of the medical profession, the unrealistic assumptions thatunderlay much of its advice, and the negative impact of this campaign on women’spower and autonomy in the realm of sexuality, reproduction, and child rearing.In chapters 4 and 5, Baillargeon shifts away from the medical discourse andtowards institutional responses to the public health problems at hand. What is strik-ing here is the sheer breadth of the campaign and the number of different individualsand agencies involved. Hence chapter 4 provides an inventory of the various agen-cies and programmes, both public and private, which came to be involved in l’encad-rement de la maternité. These included the well-known Gouttes de lait, or milkdispensaries, that emerged early in the century in the large cities, sometimes spon-sored by private agencies such as the maternal feminists of the Fédération nationaleSaint-Jean-Baptiste. They also included home nursing programmes such as thoseinstituted by the Victorian Order of Nurses, the Metropolitan Life Insurance Com-pany, and l’Assistance maternelle de Montréal, as well as a wide range of services,programmes, and educational literature offered by federal, provincial, and municipalpublic health authorities. Chapter 5 revisits this impressive and heterogeneous insti-tutional network, but this time with special attention to the tensions, rifts, and openconflicts that divided these groups. This intriguing chapter highlights, among otherthings, some very significant differences among doctors on the issue of free pre-nataland neo-natal clinics, not least between public health specialists (most of them publicemployees) and family physicians in private practice.In chapter 6, Baillargeon moves from the institutional archives and back to her rootsin oral history. Readers who have come this far will be curious about how the pre-scriptions outlined in the first three chapters and the institutional networks exploredin the next two were received by the women they targeted. They are rewarded herewith an analysis of some 66 interviews with women married between the 1920s andthe 1960s (just over half formed their families in the 1940s) and who had given birthto at least one child (most had had between three and five children). Baillargeon pro-vides a lively discussion of the various reasons why women might or might not choose,Histoire sociale – Social History, vol. XXXIX, no 77 (mai-May 2006)Comptes rendus / Book Reviews 269for example, to consult a doctor regularly during pregnancy, to breastfeed their infants(a practice she suggests was tacitly discouraged by the Catholic Church), or to obtainpasteurized milk and have their infants examined, weighed, and inoculated at a Gouttede lait or other free clinic. Also based largely on these interviews is a brief epiloguethat completes the book by addressing the related issues of fertility, family size, andcontraception in this period, most of which, of course, preceded the sharp fall inFrench-Canadian birth rates associated with the Quiet Revolution.There is much more here than this brief outline can convey, including a subtle dis-cussion of the relationships between private philanthropy (including church initia-tives) and state-run programmes and between expert professionals and volunteerworkers, many of them maternal feminists. In general, this is a fine book based onthree distinct, richly complementary, and challenging types of sources: prescriptiveliterature, institutional archives, and oral histories. Baillargeon masters all three,although I admit to having been a little overwhelmed by the thick alphabet soup ofagencies and their acronyms presented in chapters 4 and 5 and rather more impressedby the skill with which she marshals oral evidence in chapter 6.My only real quibble is with the absence of a general conclusion, especially givenwhat seems to me to be an unresolved tension in the book. As Baillargeon admits inher acknowledgements, she is at times rather harsh towards the medical profession,attributing to doctors a range of motives — personal financial gain, professional impe-rialism, class- and gender-based chauvinism — that had nothing to do with healing orsaving lives. This is fair enough, yet it is hard to deny (as the author would, I think,concede) that medical progress in this period, including in the area of puericulture, wasreal and substantial. Alongside the invasive medicalization of maternity, in otherwords, the years from 1910 to 1970 saw infant mortality rates in Quebec fall dramat-ically (from over 165 to about 32 per 1,000 live births — see Table 2), while maternalmortality rates declined even more sharply, albeit from much lower initial levels (fromabout 4 to 0.4 per 1,000 live births — see Table 8). At various points in the book, Bail-largeon presents the not unreasonable claim that improving living standards in thepostwar period go further towards explaining these trends than do advances in medicalscience. It seems to me, however, that this argument should have been made moreforcefully and, furthermore, that the question of whether or not the new methods actu-ally worked is central enough to merit sustained attention in a concluding discussion.These comments notwithstanding, this is an exemplary monograph on an impor-tant topic by one of Quebec’s best social historians. I am sure this is what RonaldRudin meant when he called for more “post-revisionist” studies: those that demon-strate how Quebec’s development was on one hand connected to and reflective ofwider trends in liberal, Western societies, and on the other full of specificities andparticularisms born of a distinct cultural, religious, and colonial heritage. Recentlyawarded a Clio Award and short-listed for the John A. Macdonald prize by the Cana-dian Historical Association, Un Québec en mal d’enfants will surely attract the atten-tion of other prize committees in the near future, and with good reason.Peter GossageUniversité de Sherbrooke

Baillargeon, Denyse — Un Québec en mal d'enfants. La médicalisation de la maternité, 1910-1970

https://hssh.journals.yorku.ca/index.php/hssh/article/download/4220/3418

Baillargeon, Denyse — Un Québec en mal d'enfants. La médicalisation de la maternité, 1910-1970

Abstract

Similar works

Full text

Available Versions

Histoire sociale / Social History (E-Journal, York University)