Between Public Health and Social Welfare: Contending Approaches to Maternity and Infancy Protection in the Early Twentieth Century

Nuannuan Xiang, Columbia University

The early twentieth century witnessed the first time that modern states intervened in maternal and infant health systematically. But mothers and infants were often treated differently, although their health was closely connected. This paper identifies two contending approaches to maternity and infancy protection—the public health approach and social welfare approach and explains why they were applied unevenly to mothers and infants. The two contending approaches also reflect a general jurisdiction conflict between two frontiers of state expansion—building the infrastructure power that “transformed” the people and establishing the welfare state that improved social security. This paper compares two extremely different cases: the United States, which applied the public health approach to protecting infants, and the social welfare approach to protecting mothers, and Japan, which used the opposite ways to protect mothers and infants. By the end of the 1920s, the United States had taken the lead in reducing infant mortality, but it was also one of the world’s most dangerous places for childbirth. Japan had the lowest maternal mortality rate but the highest maternal mortality rate among industrialized countries. The paper explains why the two countries adopted divergent institutions despite similar sequential features in institutional development, the shared experience of learning from European forerunners, and the exchanges of experience between themselves. This paper shows that the public health approach implies an aggressive intrusion into the family. When public health reformers could strategically link direct public health interventions with public concern over social stability, the public health approach would take root. Otherwise, the social welfare approach, which preserved the authority of the family, would dominate. The macro-level sociopolitical environment— mass immigration in the United States and export-led industrialization sustained by women labor in Japan, decided how maternity and infancy protection were connected to social stability.

No extended abstract or paper available

 Presented in Session 126. Public Health and the American Welfare State