Introductory.—The physical, mental, and moral health of human beings depends very largely upon the conditions in which they are brought up, upon the conditions which operate upon them while still within the mother’s womb, and upon the circumstances in which they were born. Was the child the offspring of a legitimate1 or of an illegitimate sexual relationship? At the time of procreation, were its parents mentally and physically2 healthy, or were they diseased? During pregnancy3, was the mother obliged to work for her living, or could she take proper care of herself; did she or did she not deliberately4 attempt to injure or destroy the fruit of her womb? During parturition5, did she or did she not receive proper medical aid? These are the stars with a knowledge of which we can accurately6 forecast the individual human horoscope.
Before Birth.—It is a matter of great importance that pregnant women should regulate their lives in accordance with certain elementary rules of hygiene7, and for this reason it is urgently necessary that women should be properly instructed in this respect. Syphilis is one of the most potent8 causes of intra-uterine death and of abortion9 and premature10 labour. Everything possible should be done to prevent persons suffering from syphilis practising sexual intercourse11, and to protect the fruit of conception from subsequent syphilitic infection. One of the most effective means of prevention would be the abolition12 of prostitution. Abortion[119] is possible from the very outset of pregnancy, and attempts at its prevention must therefore be taken in hand thus early. In the later stages of pregnancy care should be taken to prevent pregnant women doing any arduous13 work. The data obtainable from lying-in hospitals show that the vitality14 of the new-born infant is greater in proportion as a longer time is spent by the mother in the institution prior to delivery. The best course, but one which is at present almost impracticable, from considerations of cost, would be for pregnant women to enter a public lying-in hospital during the sixth month of pregnancy, and to remain there till the time of delivery, doing nothing more than the lighter15 household duties of the institution. A less radical16 procedure would be to prohibit pregnant women from working for wages for a certain time—such as eight weeks—before the expected termination of pregnancy. (At the present day, the only restrictions17 imposed are upon wage-earning by women for a certain period after childbirth, and this prohibition18 relates only to employment in factories and workshops.)
The following are the objections to the enforcement of such a prohibition as has been suggested. (a) Administrative19 difficulties would make it impossible of application except in the case of women employed in factories and workshops. (b) The prohibition would force pregnant women, if they received no material compensation, to earn a living, either by prostitution or else by some work—perhaps even more arduous than that which has been forbidden to them—outside the purview20 of the Factory Acts; in domestic service, as sempstresses, washerwomen, ironers, &c. To-day, in large factories and workshops, the employer pays no attention to the question whether his female employees are or are not pregnant; and other employers than those are disinclined to employ pregnant women at all. Consider, for instance, the case of women servants. To-day, many pregnant women go to work in a factory or a workshop, simply because there is no other employment open to them. (c) The prohibition would necessitate21 the compulsory22 notification of pregnancy.
[120]
During Birth.—The health both of the mother and of the child suffers in many cases, unless during and after delivery the mother is attended by a qualified23 midwife or by a medical practitioner24. The reasons for the frequent lack of skilled help in such cases are as follows: (a) Poverty; (b) desire for secrecy—this particularly in unmarried mothers; (c) in thinly-populated districts the help of a qualified midwife or that of a medical practitioner is not always easy to obtain; and even should such help be forthcoming, in the event of serious difficulty in delivery, the assistance of a skilled specialist will be unattainable.
With regard to (a), it is necessary for poor pregnant women that the services of midwife and physician should be available gratuitously25. This may be arranged, either through the woman being attended gratuitously in her own home by a monthly nurse or midwife and a doctor, the fees of these latter being paid out of charitable or public funds for poor relief; or else by her free admission to a public lying-in hospital. In many countries, the Krankenkassen[4] support women (in most cases only women employed in factories and workshops) for some weeks after delivery, and provide for the free attendance of doctor and monthly nurse or midwife.
(b) It is necessary that unmarried mothers should be legally compelled to arrange for the attendance of a midwife or medical practitioner, and, on the other hand, that the services of these should be provided for unmarried mothers in childbirth. Of course, it would be going too far to insist that unmarried mothers, or other persons who are aware of their condition, should, under heavy penalties, notify the local authorities of the state of affairs. Although such a provision does exist in the legal system of several countries, it is unworkable in practice.
(c) With regard to provision for proper midwifery attendance in thinly-populated districts, what is needed is a proper organisation26 of the services of medical practitioners27 or midwives[121] in such a way that these are equitably28 distributed throughout the country in proportion to population, and so that in every local governmental area there shall be at least one midwife and one doctor. The proper training of midwives is a matter of great importance, but, above all, a midwife should understand that at the least sign of danger it is her duty to send for a doctor. It is also a matter of great importance that all medical practitioners should have an adequate training in midwifery.
After Birth.—In public lying-in hospitals, women usually remain no more than one to two weeks after delivery; they are then discharged, regardless of their condition (physical and mental helplessness, &c.). Those institutions which are connected with a foundling hospital are exceptions in this respect, for some of the women enter the foundling hospital as wet nurses. In the interest of the child it is, above all, necessary that the mother should be well cared for after delivery, for it is during the first three or four weeks after birth that the child is most of all dependent upon the maternal29 breast. The resumption of work by the mother very soon after delivery, before the resolution of the uterus is completed, and before the abdominal30 walls have recovered their tone, plays a great part in the causation of the numerous acute and chronic31 diseases of women. If the woman is sent back into the street almost immediately after delivery, she has no option but to return to work. She must do this, first, because pregnancy and childbirth have exhausted32 her savings33, and, secondly34, because she is afraid, if she delays to return, that she will find her place filled. To-day this is becoming generally understood, and institutions are arising in which women can be properly cared for during and after childbirth. Homes for lying-in women and convalescent homes, in which mothers with their children can remain for a considerable time after delivery, subserve this purpose. Quite recently, organisations have been founded for the domestic care of women in childbed—the so-called Hauspflegevereine (Domestic Care Clubs). They send out Hauspflegerinnen (Domestic Assistants), who do the housework of the woman during her confinement35, and thus secure for her the necessary rest and[122] quiet. But, unfortunately, in most cases, these associations help married women only. Very little has as yet been done by the State to help women in childbirth. All that communal36 activity has effected in this direction has been the work of the community at large. Institutions are now being founded, equipped with proper apparatus37 (incubators, warm chambers38, &c.), in which prematurely-born children can be cared for until they acquire the normal powers of resistance of the full-time39 infant.
The Insurance of Motherhood.—Recently, the insurance of motherhood has been recommended, especially by the advocates of the emancipation40 of women, on the following grounds. Neglect of women during pregnancy, childbirth, and the lying-in period, and neglect of new-born infants, are responsible for numerous and serious disadvantages. Childbirth is very painful and extremely arduous, and the woman who gives birth to a child performs a supremely41 valuable social service. The suggestion is, that the insurance of motherhood should provide for every aspect of women’s task of reproduction. It should support women during pregnancy; during parturition, and during the lying-in period; a full allowance should be provided for eight weeks before and eight weeks after delivery; free attendance of a midwife, with free medical help if requisite42, and such other care as may be needed, should be provided for the delivery. In connection with the insurance of motherhood, suitable homes should be erected43 for pregnant women, lying-in women, and new-born infants, and the women and children admitted to these institutions should be gratuitously supported. The insurance of motherhood, it is suggested, should be compulsory, on the one hand, for all wage-earning women, and, on the other, for all married women whose husbands earn less than a certain minimum wage. All these women should pay contributions. In other respects, the cost of the insurance of motherhood should be met on the same lines as the cost of the Krankenkassen (see note on page 120). Thus it is not proposed that the insurance of motherhood should take the form of an entirely44 independent branch of national insurance. Many contend that child-bearing is just as necessary a branch of national economy as the[123] wage-paid labour of men, and that for this reason women should be directly remunerated for this social service; they wish that the insurance of motherhood on these lines should provide for the child’s upbringing until it becomes old enough to earn its own living. But even the most radical advocates of the insurance of motherhood regard this idea of the endowment of motherhood as extreme, and as impracticable at present.
The following objections have been raised against the insurance of motherhood. (a) No sound actuarial foundation can be provided for such insurance. The birth-rate cannot be predicted with certainty, so that the amount of contributions and the benefits cannot be calculated with the requisite precision. (b) Motherhood depends upon physiological45 processes, and has nothing whatever to do with illness.
The objection (a) is based upon ignorance or upon misunderstanding of the facts. The expected number of births can be calculated with the same precision as the expected number of deaths. The objection (b) is also erroneous. Women need medical aid during pregnancy, childbirth, and the lying-in period. Moreover, the aim of sickness insurance is not merely the care and the cure of sick persons, but also the prevention of the diseases, which in many cases can be prevented by the proper treatment of women in pregnancy, childbirth, and the lying-in period. Since, in the case of pregnancy and parturition, malingering (for fear of which liberal payment during sickness is considered undesirable) may be almost entirely excluded, the insurance of motherhood can be effected on very liberal terms, and there is all the more reason for this, because pregnancy and childbirth entail46 upon the mother greatly increased expenditure47. It is hardly conceivable that women would incur48 pregnancy and parturition solely49 on account of the proposed pecuniary50 advantages.
Insurance of motherhood is to-day of considerable importance in Germany, France, and Italy. In Italy it was introduced some years ago on national lines. In France and Germany, mutual51 co-operative associations for this purpose have been founded by the women concerned. The principal[124] contributors to the expenses are the insured themselves, all contributing alike, irrespective of the fact whether they are poor or well-to-do—that is to say, motherhood insurance is entirely free from the characteristics of poor relief. The co-operative organisations for motherhood insurance are run upon similar lines to the Krankenkassen, with which, indeed, they are sometimes closely associated (Mutterschaftskassenverb?nde). The local authorities have nothing more to do with the matter than to co-operate in the foundation, organisation, and management of these Kassen. The results of this development have been extremely satisfactory; for example, experience shows that a much larger percentage of insured mothers than of non-insured suckle their own children.
The Tendency of Evolution.—It is as yet impossible to predict the future course of development in this matter, and to foresee whether it will take the form of a further elaboration of motherhood insurance. This much only is certain, that all women will receive proper care in pregnancy, and during and after childbirth. From a certain stage in her pregnancy until a certain period after delivery, no woman will be allowed to work for wages. Women far advanced in pregnancy, during delivery, and throughout the lying-in period, will be cared for almost exclusively in institutions. Such institutions will be very numerous, if only for the reason that the domestic care of childbirth will become rarer and rarer, that the institutional care of such women is far better and cheaper than any other, and that the extension of institutional care is a tendency of evolution.
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1
legitimate
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| adj.合法的，合理的，合乎逻辑的；v.使合法 | |
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physically
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| adj.物质上，体格上，身体上，按自然规律 | |
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pregnancy
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| n.怀孕，怀孕期 | |
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deliberately
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| adv.审慎地；蓄意地；故意地 | |
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parturition
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| n.生产，分娩 | |
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accurately
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| adv.准确地，精确地 | |
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hygiene
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| n.健康法，卫生学 （a.hygienic） | |
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potent
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| adj.强有力的，有权势的；有效力的 | |
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abortion
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| n.流产，堕胎 | |
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premature
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| adj.比预期时间早的；不成熟的，仓促的 | |
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intercourse
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| n.性交；交流，交往，交际 | |
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abolition
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| n.废除，取消 | |
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arduous
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| adj.艰苦的，费力的，陡峭的 | |
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vitality
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| n.活力，生命力，效力 | |
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lighter
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| n.打火机，点火器；驳船；v.用驳船运送；light的比较级 | |
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radical
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| n.激进份子，原子团，根号；adj.根本的，激进的，彻底的 | |
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restrictions
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| 约束( restriction的名词复数 )； 管制； 制约因素； 带限制性的条件（或规则） | |
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prohibition
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| n.禁止；禁令，禁律 | |
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administrative
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| adj.行政的，管理的 | |
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purview
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| n.范围；眼界 | |
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necessitate
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| v.使成为必要，需要 | |
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compulsory
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| n.强制的，必修的；规定的，义务的 | |
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qualified
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| adj.合格的，有资格的，胜任的，有限制的 | |
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practitioner
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| n.实践者，从事者；(医生或律师等)开业者 | |
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gratuitously
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| 平白 | |
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organisation
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| n.组织，安排，团体，有机休 | |
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practitioners
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| n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师） | |
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equitably
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| 公平地 | |
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maternal
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| adj.母亲的，母亲般的，母系的，母方的 | |
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abdominal
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| adj.腹（部）的，下腹的；n.腹肌 | |
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chronic
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| adj.(疾病)长期未愈的，慢性的；极坏的 | |
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exhausted
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| adj.极其疲惫的，精疲力尽的 | |
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savings
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| n.存款，储蓄 | |
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secondly
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| adv.第二，其次 | |
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confinement
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| n.幽禁，拘留，监禁；分娩；限制，局限 | |
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communal
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| adj.公有的，公共的，公社的，公社制的 | |
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apparatus
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| n.装置，器械；器具，设备 | |
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chambers
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| n.房间( chamber的名词复数 )；（议会的）议院；卧室；会议厅 | |
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full-time
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| adj.满工作日的或工作周的，全时间的 | |
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emancipation
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| n.（从束缚、支配下）解放 | |
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supremely
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| adv.无上地，崇高地 | |
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requisite
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| adj.需要的，必不可少的；n.必需品 | |
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43
ERECTED
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| adj. 直立的，竖立的，笔直的 vt. 使 ... 直立，建立 | |
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entirely
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| ad.全部地，完整地；完全地，彻底地 | |
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physiological
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| adj.生理学的，生理学上的 | |
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entail
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| vt.使承担，使成为必要，需要 | |
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47
expenditure
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| n.(时间、劳力、金钱等)支出；使用，消耗 | |
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48
incur
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| vt.招致，蒙受，遭遇 | |
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solely
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| adv.仅仅，唯一地 | |
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50
pecuniary
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| adj.金钱的；金钱上的 | |
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51
mutual
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| adj.相互的，彼此的；共同的，共有的 | |
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