Philippa Mein Smith, Mothers and King Baby. Infant survival and Welfare in an Imperial World: Australia 1880-1950. Macmillan, London, 1997.

Reviewed by Sheryl Brennan.

Philippa Mein Smith explores the decline in infant mortality in relation to the rise and subsequent influence of the infant welfare movement in Australia between 1880 and 1950. Mein Smith uses the infant welfare movement as ‘a prism’(p. 246), through w hich to examine the intersection of social change, health policy and politics during this period. It is an eminently readable book, which presents an interesting analysis from a social history perspective of an important part of our collective national past.

Of interest is the material which links the decline in married fertility around the turn of the century with an increase in the numbers of girls completing elementary education. Mein Smith stresses the role of primary education in developing higher levels of ‘oral literacy’ in women - the increased ability to articulate needs and problems in conversation with health workers (p. 29). Mein Smith suggests that a rise in self-esteem, stemming from increased education and enhanced masculine respect, ‘empowred’ women. This increase in confidence enabled them to make decisions regarding family size, which took into account the future costs of educating and caring for their children. Women began to act independently, and when required, consulted doctors and health centres in the interests of their children’s health.

The recognition by early 20th century parents of the expense of raising children is an important value shift from the mid 19th century view which saw children as potential economic assets for their families. This shift in thinking in part underlies what Mein Smith describes as the ‘white health transition’ which occurred during the decades after 1880. Mein Smith uses primary sources to demonstrate that there was a five year time-lag in the adoption of birth control practices between middle-class women and women belonging to the unskilled working-class, and there were therefore significant class differences in declining fertility rates within Australia.

The book covers in depth the relationship between artificial infant feeding and diarrhoea - the big baby killer of the time. Mein Smith highlights how, once some of the major environmental problems had been dealt with, reformers focussed on mothering practices in an effort to reduce infant mortality rates. Thus the supposed ignorance of women in relation to ‘proper’ feeding and infant care came under scrutiny, leaving the way open for the advent of Dr Truby King.

The chapters dealing with the early efforts to establish infant welfare centres around Australia, and the internecine struggles between Truby King supporters and those Australian infant welfare reformers advocating a more relaxed approach, make fascinating reading. Of particular interest is the section dealing with the varied approaches toward infant welfare adopted by Australian states in response to different political and geographical considerations.

In chapter seven Mein Smith profitably explores mothers’ practices. So often women are cast as passive victims of a medical and scientific take-over rather than selective consumers of the services presented to them. We cannot really know what degree of contestation and negotiation took place between nurses, doctors and women in relation to infant care, because the voices of the women who used infant welfare services in the early years are largely lost, but the material in this chapter does something to make up for this loss. Mein Smith uses the reports of the infant welfare nurse in Wonthaggi to analyse the effect of her practice and the home conditions of families on the mortality rate of infants in the town between 1927 and 1941. In addition, she int erviewed 13 women aged in their eighties and nineties from Wonthaggi about their own child rearing practices. The interviews confirm the nurse’s reports that most mothers exercised autonomy in child rearing, choosing from the advice given them by their ow n mothers, friends and infant welfare nurses, that which most suited their individual circumstances. As Mein Smith states ‘Both the mothers responses and the nurses’ advice varied with the people concerned’(p. 179).

As Mein Smith points out, the history of the decline in the Australian infant birth, illness and death rates offers insights into how health institutions deal with demographic and broad social change (p. 246). It also offers a vehicle for understanding the nationalistic, eugenic and political debates occurring at a fascinating time in Australia, as well as the way in which ideology can direct health policy. Such an understanding is highly relevant for the 1990s.

For those interested in the history of women and children’s health in Australia, Mothers nd King Baby provides a considerable number of new insights. It has plenty to offer students from a wide range of disciplines.

Sheryl Brennan is a lecturer in the Tasmanian School of Nursing, University of Tasmania.