Thursday 13 April 2023
08.30 - 10.30
Mothers at Risk in Socialist East-Central Europe. Medical and Psychological Expertise on Healthy Motherhood in a Comparative Perspective, the 1950s-1980s
Västra Hamngatan 25 AK2 134
Ema Hresanova :
No Room for ‘Rooming-in’? Gender, Risks and Competing Moralities around Birth Care Innovations in Czechoslovakia in the Early 1980s
Women and Gender
In the early 1980s, several revolutionary innovations were introduced in some Czechoslovak hospitals. Among these, the ‘rooming-in’ (RI) presented a radical departure from an established postpartum regimen of care, as it allowed new mothers to have their newborns with them all – or most of - the time. Until then, ... (Show more)
In the early 1980s, several revolutionary innovations were introduced in some Czechoslovak hospitals. Among these, the ‘rooming-in’ (RI) presented a radical departure from an established postpartum regimen of care, as it allowed new mothers to have their newborns with them all – or most of - the time. Until then, newborns and their mothers were placed in separate units and saw each other only when pediatric nurses brought babies to be breastfed. Despite obvious health benefits for both a newborn and his/her mother and their mutual bonding that significantly improved rates of breastfeeding and neonatal outcomes, innovation sparked heated debates among health professionals in gynecology, pediatrics, and nursing on pages of their leading journals as well as among lay people in daily and popular lifestyle magazines. Although psychologists called for immediate rebuilding of the maternity wards into appropriate rooms, several head obstetricians together with pediatric nurses were reluctant to adopt such changes and/or were outspoken against this practice. Critics denounced a new practice as a ‘Western fad’ while pointing to several risks and disadvantages: there were economic costs of rebuilding the wards, legal issues (the new arrangement was not addressed in the official Neonatal Concept even though it did not explicitly prevent healthcare providers from establishing the rooming-in), and health concerns about the spread of nosocomial infections. However, subsequent studies showed that in some facilities the RI regimen in fact reduced the rates of nosocomial infections among neonates. The printed lay opinions oscillated between the appraisals of the practice and its condemnation as a ‘tyranny against a postpartum woman’ who has no time for rest (e.g. The Mladý svet Magazine, 1983).
This paper focuses on the practice of ‘rooming-in’, and on various constructions of ‘risks’ that it evokes. I build here on the qualitative analysis of printed contributions in medical journals such as the Czechoslovak Gynecology, Czechoslovak Pediatric, or The Female Health worker and in popular mass media (e.g. Rudé právo Daily; Mladá fronta Daily; the Mladý svet Magazine, etc.). I take the debates around the RI regimen as a point of departure to explore broader shifts in thinking about mother-newborn relations and ‘healthy family’, appropriate postpartum care, professional disputes and how they were gendered, and a shifting position of an individual person in the healthcare system with a ‘collective’ ethos. My aim is to grasp a changing paradigm of what matters in postpartum care, and what competing moralities accompany arguments for (or against) change. (Show less)
Natalia Jarska :
Women, Preterm Birth and Socialist Medicine. The Understanding of Women’s Health in East Central Europe, 1950s-1980s
Preterm birth, whose rate in postwar societies ranged from 6 to 15 percent, preoccupied both gynecologists and pediatricians, because of high mortality and morbidity rates among premature babies. From the 1940s on, experts agreed that while some diseases could lead to preterm delivery, in a considerable number of cases the ... (Show more)
Preterm birth, whose rate in postwar societies ranged from 6 to 15 percent, preoccupied both gynecologists and pediatricians, because of high mortality and morbidity rates among premature babies. From the 1940s on, experts agreed that while some diseases could lead to preterm delivery, in a considerable number of cases the reasons remained unknown. This uncertainty, together with socialist medicine’s special interest in the relation between health and social factors, led them to inquire and investigate the possible socio-economic conditions related to preterm birth, with the aim to identify causes beyond purely medical considerations. This paper will discuss debates about the causes of preterm birth in Czechoslovakia, GDR, Hungary, and Poland, which unfolded, with diverse intensity, throughout the four postwar decades.
In the 1950s, medical doctors in the four countries unanimously agreed that social factors such as malnutrition, poor housing, or heavy housework could be responsible for preterm birth. Improvement of healthcare and general living conditions under state socialism would mitigate these negative consequences. In the subsequent decade, though, new concerns arose around sociodemographic factors such as the age and marital status of the mother, as well as the psychological impact of stress and emotional burden. Guided by gendered ideas of women’s health, experts identified causes such as “mental tiredness” (Czechoslovakia), “careless attitude towards pregnancy” (Poland), or “bad marriage” (Hungary). Medical doctors from the analyzed countries usually also shared their opinion about the negative impact of being unwed. In the 1970s and 1980s, gynecologists turned their attention to smoking and drinking alcohol as risk factors for premature birth, and – especially in the GDR – to a polluted environment.
One of the factors which came back repeatedly in the medical experts’ assessment of the causes of preterm birth was women’s work. Here approaches slightly differed by country and decade. Women’s employment, especially in industry, was commonly believed to have a negative impact on pregnancy. ?However, numerous surveys carried out from the 1950s to the 1980s in all the countries in question led to the conclusion that, in fact, it was rather housework and/or the double burden which posed a threat to a healthy pregnancy than women’s work outside the home. Some Polish experts, in addition, saw work outside the home as even beneficial to women, pointing to emancipation, satisfaction, and better healthcare as improving chances for carrying the pregnancy to term.
The analysis of the expert approach to preterm birth sheds light on gendered medical discourses on healthy pregnancy under state socialism in relation to socialist modernization including the rise of women’s employment, emancipation, urbanization, and women’s advancement in education, while a comparative approach will help to highlight particularities of the development of medical expertise in each country. (Show less)
Katerina Liskova :
Women without (Enough) Children
Socialist countries are often seen as highly pronatalist. Especially early socialism connected its future and prosperity with many children who were to be born and would become workers and parents themselves. Indeed, mothers were seen as reproducing society in both physical and symbolic sense. However, sociodemographic development marked decreasing fertility ... (Show more)
Socialist countries are often seen as highly pronatalist. Especially early socialism connected its future and prosperity with many children who were to be born and would become workers and parents themselves. Indeed, mothers were seen as reproducing society in both physical and symbolic sense. However, sociodemographic development marked decreasing fertility throughout state socialism. As fertility rates dropped rapidly over the four postwar decades in all of East-Central Europe, women's lives changed in the process. Not only were women mothering fewer children, but some of them also remained childless altogether. How did experts who were clinically tending to women, namely gynecologists and psychologists, understand these women, their condition, and what advice they gave them? How did the "risk" of childlessness – e.g., risk to the socialist future, the risk to the women, their health and their wellbeing if they do not bear (enough) children – feature in the contemporaneous expert writing.
Many social changes occurred in socialist societies that are commonly associated with fertility. Women's education and paid-work involvement rose, typically tied to growing levels of childlessness. Modern methods of contraception became available, and – for socialist states even more prominently – abortion was legalized, all of which resulted in fewer children being born. Levels of urbanization tended to increase, which is also associated with decreasing fertility. At the same time, marriage rates grew: and more married women typically mean fewer lifelong childless. Also, the occurrence of single-child families correlates with levels of childlessness on the societal level. In the context of these developments, the number of women who remained childless differed. In Czechoslovakia and East Germany, there were markedly fewer childless women as socialism progressed. On the other hand, Hungary experienced an increase in the number of women who celebrated their 45th birthday without giving birth, before the numbers dropped during the last decade of socialism. Due to its rural and catholic character, Poland had only a tiny minority of childless women, which continued to shrink further.
While we can see these macrosocial developments and demographic data, we need to understand more about the situation (and how it changed) on the ground. As the voices of many of the affected women might be lost to history, the expertise built around their lives is available for analysis. Moreover, this expertise shaped what people thought about childlessness. How did experts see the childless women? What causes did they identify for their condition? What distinctions did they make between the involuntary childless, women who did not bear "enough" children, and women who decided to forego motherhood altogether? And finally, what did experts discuss among themselves, and what opinions and advice did they present to the laypeople, particularly to the women of childbearing age? Analyzing medical and psychological scholarly journals and advice books for laypeople, I will pay attention to changes that occurred over the four decades of state socialism and across the four countries: Czechoslovakia, Poland, Hungary, and East Germany. (Show less)