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Child Welfare
1911 Encyclopedia Britannica
or "=='CHILD WELFARE==
During 1905-21 the question of Child Welfare became one of continually increasing interest to social reformers.
Before that, the interest in it was mainly from the philanthropic point of view, but the steady decline of the birth-rate in the United Kingdom made it a pressing necessity to endeavour to preserve the vitality of the nation. Though it is true that the efforts to preserve infant life have been in great measure successful, this has not made up, from a population point of view, for the reduction in the number of infants brought into the world; but the most strenuous and successful efforts are being made to minimize the evil. France was in even a more serious condition as regards reduction of population than England and she very early directed her energies towards the encouraging of breast-feeding and the supply of institutions for the supply of good milk known as gouttes de lait, a plan which for a time was followed in the United Kingdom. It was about the year 1905, however, that the system which obtains of home visitation, combined with centres for teaching and helping mothers, began to take firm root in England, and, like so many other agencies for social amelioration, it began through voluntary agencies, in which experiments of various kinds could be freely tried. It is to their credit that the work of assisting the mother and child has been developed as it has, and it is on the lines that they started that the work has been followed up. Hampstead, Westminster and other London boroughs set to work in these early days and the records then begun are now proving most useful with the next generation.
Registration of Births
The necessity for work of this kind depends largely on the keeping of accurate registers, and on their availability. It is only in Great Britain, Germany and France, of European countries, that records of a satisfactory kind can be had. Up to 1837 there were registers of baptisms obtained from churches and chapels, but they were far from complete. After this date registration by the parent was made compulsory within 42 days from birth. This, however, was not sufficient for early visitation of infants and their mother, even could permission to use the registers be obtained. In 1906 Huddersfield obtained parliamentary powers for the compulsory notification of birth to the Medical Officer of Health, and in 1907 a Notification of Births Act was passed which permitted local authorities to adopt a system of compulsory notification, subject to the consent of the Local Government Board. This was given when it was ascertained that the adoption of the Act would be followed by the utilization of the information given by a system of home visitation. When adopted, the birth had to be notified within 36 hours to the Medical Officer of Health for the district. This Act was largely adopted, and it was made to extend to the whole population in 1915 by the Notification of Births Extension Act. 'Phis Act took the important step of giving definite power to local authorities of levying rates for infant welfare work. Before it became law, although Exchequer grants became available, many authorities were unwilling to incur expenditure; much voluntary work was, however, being carried on, births being discovered through the lying-in and other hospitals as well as through district visiting. In 1921 home visitation was largely done by the local authorities, more especially in the provinces. In spite of all that was done beforehand, however, notification has been the key to all welfare work, and it is the carrying of it out in respect both of births and infectious diseases that has allowed such work to develop. The World War proved a great incentive to this work by bringing home to Great Britain the need for the preservation of the young population.
Infant Welfare Centres
The first task has been to coordinate the work at the Infant Centre and the visitation of the mothers in their own homes. The former were often termed " Schools for Mothers," since they specialized in teaching the mothers what was considered necessary for good motherhood. It was soon found that medical advice was required in addition to the usual classes for cookery, garment-making, etc., and that infant consultations were of little use without helping the mothers to carry out the advice given in their own homes. The medical inspection of school-children showed how essential it was that the alarming conditions that were discovered in children of school age should be dealt with before the child came to school, and, indeed, that it was necessary to go back to ante-natal conditions. Some of the advanced health centres had already realized this fact and were carrying on that work. It was brought home to those interested that the work required was preventive far more than curative, and that the whole social condition of the family was involved - the health and habits of the parents, sanitation, and general surroundings. Above all the housing question was, it was felt, intimately bound up with this question. The task was now to link up, so far as might be, the various ameliorative efforts that were being made with the end of bettering the chances for the infant, as well as the agencies for invalid aid, country holidays and so on for the child. It is certainly true that curative work is required as well, but the child welfare movement primarily aims at bringing into the world a healthy population and endeavouring to preserve for it healthy and natural conditions. At the same time it must be in touch with hospitals and other directly curative agencies.
Though every birth may be notified to the Medical Officer of Health, some (about 20%) are not as a rule visited. Visits are usually made about 14 days after birth, since before that time the mother is being attended by a midwife or doctor. A record card is presented in each case, and this has to be carefully filled in. This card is preserved and kept up to date till the child goes to school, when the information it contains is invaluable to the school medical officer.
The "Centre" varies in size from two rooms to many. There are now many large buildings devoted to the work, in which there are not only the waiting rooms and doctor's rooms of the old days, but also a weighing room, toddlers' room, where the older children are looked after while the mother is engaged at classes or otherwise, perambulator shed, and an open-air shed where the children can sleep. Then at a large centre there is a dental room, a pre-natal consulting room, and frequently observation wards, where sickly children can be kept for a time under notice. This involves nurses and servants' accommodation. Sometimes there is also accommodation for mothers. Then a day is often given up for the medical examination of older children under school age. Thus a large centre has become a varied conglomeration of activities, and it probably has small branch centres dependent on it, so that no mother may have more than a short distance (say a mile) to walk. Much stress is laid on the matter of clothing, and every effort is made to obtain the best patterns for the clothing of both infants and mothers and older children and then to get the mothers taught to use them. A system of card-indexing for record is adopted, so that all information is easily available. For the classes (cookery, mending, cutting-out, etc.) a trained teacher is often, and in the large centres usually, employed. In addition, lectures on health matters are given to the mothers as well as to voluntary or other social workers. Ante-natal work brings the welfare work into touch with the work of doctors and midwives (see Nursing), and though in some cases it leads to midwives being appointed for the work of the centre, the usual plan is simply to see that the woman in some manner secures adequate and suitable provision for her confinement. If a medical examination is required by a midwife for her patient, although the power to pay doctors' fees was conferred by the Maternity and Child Welfare Act of 1918, the arrangements for providing it are very limited, and the woman therefore often prefers to take advantage of the opportunities offered at the Child Welfare Centre. At these centres nursing mothers are sometimes provided with dinners, though there is a difference of opinion as to the desirability of doing this. Under the Act just quoted these dinners may be paid for from the rates. The provision of milk has also been frequently carried out. The first form of milk used was that which is known as "pasteurized," and it was followed by dried milk, which is often bought wholesale and sold at cost price. The question of how far milk depots are desirable, and whether 'they discourage breast-feeding, is still being discussed. 1 The shortage of milk during the World War and its high price made the question acute.
The maternal and infant centre is in some cases provided with a garden where the mothers can sit with their little ones, or where infants may be left to sleep under guardianship while the mother is indoors. Occasionally a play centre for young children is combined with an infant centre. 'These play centres are instituted in crowded districts for the use of young children. Though they may be acquired and supported by the local authority they are sometimes given by private donors and occasionally equipped by them or by bodies like the Carnegie U. K. Trust. The movement was naturally retarded by the World War and its after effects. In play centres provision is usually made for toddlers, children below five years of age and also separately for older children who can play organized games. A portion of the ground is often covered with asphalt for use in bad weather and a pavilion is provided for storing apparatus and for shelter. There must of course be adequate supervision and possibly an expert instructor. The nature of these developments depends on the size of the ground available and the amount of money that can be spent on it.
The limitation of the legitimate activities of the infant centre has never been defined. Thus, not only does the relationship of the pre-natal work with that of the ordinary midwife come to be a somewhat difficult one, but there arises the further question of what amount of treatment and drugs should be given. In any case it seems clear that it would be wholly unsuitable to convert an infant centre into anything of the nature of a small and expensively run hospital.' At the same time there is frequently difficulty in obtaining the hospital treatment suitable for infants and very young children, and certainly no opportunity is given for teaching the mother how to carry on that treatment at home. It has been matter of complaint that the health of children between two and five (school age) has not been cared for sufficiently owing to the dual authority (Public Health Department and Education Authority) which respectively controlled infant welfare and school-children. But under the Ministry of Health the case may be different.
Health Visiting
The number of visits paid to a mother by a health visitor naturally varies, but about 400 cases are allowed to one visitor, though of course it may be that the visitor is called upon to visit children up to school age, when not nearly so many could be allowed. The visitor is called on to visit all homes where stillbirths are reported, and it is necessary to report all births taking place after the twenty-eighth week of pregnancy. A certain amount of ante-natal visiting may also be done if the visitor has midwifery qualifications, but this might be regarded as interfering with the work of the midwife or doctor engaged by the mother.
Organization of Child Welfare Work
The movement has made rapid progress. It was estimated that in 1921 there were in England and Wales 1,754 infant centres, mostly in the hands of municipalities or county councils, though 693 were worked by voluntary agencies' The municipal centres are carried on by the Public Health Committee under the local authority. The county, city or borough council elects its Committee for Public Health, and in 1918, under the Maternity and Child Welfare Act, a statutory committee was made necessary for the purpose of carrying out its requirements, the majority of whose members must be members of the council. Before the 1918 Act these duties fell on the Public Health Committee, though sometimes it devolved them on a sub-committee which alight become the statutory Welfare Committee. At least two members of this committee must be women and it has to report to the Public Health Committee. In counties this Welfare Committee is usually a separate one, and is granted considerable power. The staff of visitors work as part of the staff of the department of the Medical Officer of Health. In the towns the visitors endeavour to get the mothers to bring their infants to the centres and in some places half of those visited do so. Of course, not all these children necessarily go before the doctor on each occasion. There are many variations in the manner of working the centre, depending on the nature of the area. In the country the visitors usuall y undertake the threefold duties of infant, school and tuberculosis visiting. The visitors are usually stationed in small towns or villages within the area and visit around these. " Centres " may or may not be established in these towns or villages. In most counties there are nursing associations for the supply of parish nurse and medicines, and the Education Committee often helps in the training of the nurse. These nurses are sometimes employed as visitors for infant welfare work as well as for school work and occasionally for tuberculosis and i During 1920 fifty new maternity homes with over 500 beds were a p rovided by local authorities and voluntary agencies in England nd Wales. On June I 192 there were 1,789 infant welfare centres in England alone, 710 of which were voluntary.
are subsidized for such visiting through the association. Of course they must be under the Medical Officer of Health in respect of such work. The superintendent of the county nursing association may also be appointed inspector of midwives for the county. Usually wholetime visitors are employed in the larger towns. It is thought by some that the whole nursing service should be placed under the councils and the voluntary element done away with; others are strongly opposed to such a policy as tending to bureaucracy.
Work of Education Authorities
It is difficult to consider infant welfare work in Great Britain without taking into consideration also the work of Education Authorities to whom power was granted to carry on the work of medical inspection in 1908. As with infant consultations it was soon found that following up the cases in their own homes was essential if good was to be done, and very often the infant visitor carries out the visiting for both infants and schoolchildren. The Mental Deficiency Act of 1913 also requires county and borough councils to do work which requires visitation. Unless care is taken there is serious danger of overlapping.
Training of Visitors
The training of infant visitors cannot as yet be said to be standardized. The training of a nurse is useful, but hospital experience alone is not sufficient, any more than is that of midwifery or the sanitary diploma. The Board of Education has now issued a regulation for the training of health visitors which is.
fairly complete, and includes theoretic training in physiology, hygiene, and social work, as well as practical training in cookery and housewifery, and much work of various kinds at health centres. Voluntary workers with social knowledge and wide experience are of great use. There were in 1920 3,359 health centres in England and Wales, and probably many more will be required.
Day Nurseries and Creches
In addition to the recognized infant welfare work, there are numerous day nurseries and creches which are eligible to receive Government aid. The mothers contribute a proportion of the cost. Nursery schools receive grants from the Board of Education under the Act of 1918 and creches come under the Ministry of Health. Children up to school age are taken by the former and infants by the latter. During the World War, when married women were working, these institutions were invaluable and, if well conducted, day nurseries form an excellent training ground for young women and girls. An endeavour has been made to obtain a service of " home helps " of a domestic sort to provide assistance for the mother before and after childbirth, but it has been found difficult to obtain candidates for training.
Infant Mortalit y
It appears that the association of a high birthrate with a high infant mortality is a rule to which exceptions are rare. Thus it is the high birth-rate, despite its accompanying waste, rather than the low birth-rate and the greater saving of life that accompanies it, that dominates the increase of population. There is no doubt that the efforts made to preserve infant life have been a very effectual method of preserving the population, but this has not made up for the reduced number of babies born. The chief cause of the deaths of infants are (I) developmental, wasting diseases and convulsions; (2) diarrhoea and enteritis; (3) measles and whooping-cough, bronchitis and pneumonia. One-third of the deaths during the first year occur during the first months of life. What is called the " infant mortality-rate " is the number of infants dying under one year of age per 1,000 infants born. The following table shows the infant mortalit y -rate for England and Wales and the birth-rate for the corresponding year.
| Infant Mortalit y -rate (per 1,000 births). | Birth-rate (per 1,000 of pop.). | 1901-5 | 138 | 28.2 | 19 0 6-1 0 | 117 | 26.3 | 1913 | 108 | 28 o | 1916 | 91 | 20.9 | 1917 | 9 6 | 17.8 | 1918 | 97 | 17.7 | 1919 | 89 | 18.5 | 1920 | 80 | 25'4 This shows that the birth-rate has tended to fall as well as the infant mortality-rate, but the fall of the latter is remarkable and may be ascribed partly to the improved social conditions during and since the war, and partly to the definite work for child welfare, as well as to the decrease in the number of births. Where there is overcrowding and bad sanitary conditions child welfare work seems to do little to prevent infant mortality. The rate of mortality amongst illegitimate children is approximately twice as great as that amongst legitimate infants. The Ministry of Health has approved a number of Homes for single women before and after confinement as well as hostels where the mothers and children can live when the mother is able to take up daily work. The highest mortality amongst infants in England and Wales is found in the northern county boroughs which include the great industrial centres, and the least in the southern rural areas. It is to be hoped that with good midwifery and ante-natal service and better social conditions, the large infant mortality that now exists may be decreased, for it is clear that the health of the mother and child is the first step towards the health of the community. The Midwives Act of 1902 and the provisions for maternity benefit in the Insurance Act of 1911 have no doubt been contributory measures to the improvement in this matter, as well as the School Medical Service that was organized in 1907, and the Maternity and Child Welfare Act of 1918. The death-rate of women in childbirth, however, has remained about the same during the last 25 years, and there is a large amount of abortion, miscarriage, etc., and many children are disabled when born and become chronic invalids. The maternity mortality-rate from all causes remains between 4 and 5 per 1,000 births. The steps necessary to be taken are to secure (t) the supervision of pregnancy and the wise administration of maternity benefit; (2) the supervision of midwifery, including the establishment of maternity homes; (3) health visiting and nursing and (4) the establishment of infant welfare centres. In this work voluntary assistance is most desirable. A very important fact is that by the Ministry of Health Act of 1919 the physical care of maternity, infancy and childhood is now under one state department and the work of the Education Authority is coordinated so far as possible with that of the Sanitary Authority which primarily deals with the child to its fifth year. The same centres and clinics are now used for both. There is a special department of the Ministry for supervising this work. A scheme of maternity and child welfare has been inaugurated in every county (excepting one county in Wales), and in every county borough and many of the large urban districts. On March 31 1920 not only were there 1,754 maternity and infancy welfare centres and 3,359 visitors as stated before, but also 221 day nurseries or crèches, and 89 maternity homes with 1,360 beds. The hospital provision for infants is not (1921) large, and there is often a high mortality found in hospitals owing to the spread of infectious conditions which are rather obscure. About 220 new beds have been provided for infants and young children in connexion with welfare schemes. In cases where young children must be separated from their mothers a good foster-mother sufficiently remunerated is recommended as being the most satisfactory guardian. ScotlandThe Maternity and Child Welfare Act of 1918 does not apply to Scotland, but in the Notification of Births (Extension) Act of 1915 it is provided that any local authority " may make such arrangements as they think fit, and as may be sanctioned by the Local Government Board for Scotland, for attending to the health of expectant mothers and nursing mothers and of children under five years of age within the mea ing of Sect. 7 of the Education (Scotland) Act 1908." As in England, Exchequer grants-in-aid are given for certain services in connexion with child welfare, and the extent to which these services extend depends on the local authority concerned. There is, however, an important difference between England and Scotland. In England certain institutions such as schools for mothers and play centres receive grants direct from the Board of Education and are under its control. In Scotland all the institutions included in a child welfare scheme were controlled by the Local Government Board and are now controlled by the Ministry of Health. In Scotland, also, the grants are only made to the local authorities and not, as in England, to the institution. These grants cannot exceed 50% of the local authority's approved outlay. The schemes that are carried on are similar in character to those in England. The infant mortality (deaths of children under one year old per 1,000 births registered) is considerably higher than in England and Wales and Ireland though it is gradually decreasing. In 1917 it was 107; in 1918, too; in 1919, 102; and in 1920 it was 92. Since the coming into operation of the Scottish Education Act of 1918 there has been a considerable accession of energy in the matter of attending to the health of school-children, and that Act gives powers to the Education Authority to carry on nursery schools. Education Authorities often take advantage of the services of district nurses in following up their cases in the rural areas, and this is sometimes also done by the county council in regard to its schemes for infant welfare. In such cases the nurses may work through a County Nursing Federation. The Highland districts naturally present special difficulties owing to the scattered nature of the population and the difficulty of providing adequate attendance. IrelandA system of Imperial grant for child welfare obtains in Ireland similar to that in England. The infant mortality in Ireland has always been low as compared with that in England and Wales and still more with that of Scotland, but it has not declined in the same regular manner that it has done in the other countries. The deaths of infants under one year per 1,000 births in the years 1891-1900 averaged 104. In 1918 they were 86, and in 1919, 88. It is notable that the infant mortality in the towns in Ireland is immensely higher than in the rural districts. In 1919 the infant mortality in Dublin area was 141 per 1,000 births, while in London it was 85. Notification of births was made compulsory in all urban districts by the Extension Act of 1915. There are many voluntary societies, such as the Women's National Health Association and the United Irishwomen, working in connexion with infant welfare, and in establishing milk depots, etc., and since the Treasury grant became available a number of authorities have submitted schemes of a comprehensvie character. See Annual Report of the Chief Medical Officer 1919-1920 (Ministry of Health); First Annual Report of the Scottish Board of Health 1919 (Appendix to ditto pub. 1920); Twenty-fifth Final Annual Report of the Local Government Board for Scotland 1919 (pu b. 1920); Annual Report of the Local Government Board for Ireland 1918-1919; Janet E. Lane-Claypon, The Child Welfare Movement (1920); Nora Milnes, " ` Child Welfare " from the Social Point of View (1920); Edith V. Eckhard, " The Mother and the Infant (Social Science Library 1921); Carnegie United Kingdom Trust's Report on " The Physical Welfare of Mothers and Children " for (1) England and Wales, E. W. Hope; (2) Scotland, W. Leslie Mackenzie; (3) Ireland, E. Coey Bigger (1917). Sir J. E. Gorst, The Children of the Nation and how their Health and Vigour should be Promoted by the State (1906); Margaret Macmillan, Early Childhood (1900), The Nursery School (1919). (E. S. H.) L T Nited States In the field of child welfare considerable progress was made in the United States during the decade 1910-20. The first work of the Federal Children's Bureau (established 1912) was a number of remarkable studies on infant mortality, particularly its social and economic aspects. As a result of emphasis by the American Medical Association, by the Children's Bureau and by other children's agencies of the necessity of basing any programme for reducing the infant mortality upon reliable statistics, all but three of the states had adopted in 1921 the uniform registration plan recommended by the Census Bureau, and all but five states now have good registration laws. Popular education in child care has been greatly developed in the last decade. Aided by the Children's Bureau, Baby Week Campaigns were inaugurated in a few large cities in 1914. In 1916 the General Federation of Women's Clubs and the Children's Bureau cooperated in a nation-wide " Baby Week " campaign, as a result of which Baby Week was observed in every state. In 1918 the Bureau and the Child Conservation Section of the Women's Committee of the Council of National Defense cooperated in a year's educational propaganda known as " Children's Year." As a result of the interest awakened through these campaigns as well as by the previous efforts of many child welfare organizations, child hygiene divisions were established by law in 30 states from 1918 to 1921, as compared with eight states between 1912 and 1918. There were also in 1921, special child hygiene divisions in the health departments of 45 municipalities. The Children's Bureau report on maternal mortality in 1917, followed in 1919 by one on maternity benefit systems in certain foreign countries, resulted in a general demand by women's organizations for public provision for the protection of maternity. Prior to 1910 pre-natal care for mothers was confined to maternity hospitals. During the decade 1910-20 there were demonstrations in Boston, New York, and a number of other cities of the reductions that can be f 'ffected in maternal mortality and in infant mortality due to maternal causes, through maternity centres, where pre-natal and post-natal instruction and care have been given. As a result of the wide-spread interest in the subject, bills have been introduced in a number of the state legislatures; and the Sheppard-Towner bill, providing for Federal aid toward public provision for maternity and child care, was passed by the U.S. Senate in 1921. Medical inspection of school-children was in 1921 required by Iaw in 39 states, and the first legislation had been passed making specific provision for dental inspection. Without this specific legislation increased attention has been given to the care of school-children's teeth in recent years. Nutrition clinics for undernourished children have been widely established during the past five years in connexion with schools, dispensaries, and child welfare agencies. Since 1915 eight states, including, Illinois and New York, have passed laws providing for physical education in elementary schools. REFERENcEsInfant Mortality Series, Nos. I to 8; Grace L. Meigs, Maternity Mortality (Miscellaneous Series, No. 6, 1917). (G. AB.) Copyright Statement These files are public domain. Bibliography Information
Chisholm, Hugh, General Editor. Entry for 'Child Welfare'. 1911 Encyclopedia Britanica. https://www.studylight.org/encyclopedias/eng/bri/c/child-welfare.html. 1910.  Ads FreeProfile |