For today’s post, I will examine the expansion of maternity and child welfare services during the 1930s and how the ‘Emergency’ impacted maternity and infant welfare servcies in Ireland.

During the 1930s, maternal and infant health services and preventative health services significantly expanded in Ireland. Diphtheria immunisation schemes were introduced into county Boroughs with high death rates and in 1933, the Free Milk Scheme was introduced and powder milk became available to poor children under five years of age from the maternity and child welfare centres. In Dublin, milk supply was also available from the Infant Aid Association in Dublin (Lindsey Earner-Byrne, Mother and Child: Maternity and Child Welfare Services in Dublin, 1922-60). According to Earner-Byrne, milk supply became one of the key campaigns to improve maternal health and to enable mothers to breastfeed their children making them less vulnerable to disease. Low breastfeeding rates were viewed as one of the main factors in the high infant mortality rates. By 1936, 17,656 children in county boroughs, 10,353 children in urban districts except one and 29,771 children in other areas participated in the free milk scheme (Annual Report of the Department of Local Government and Public Health, 1930-31). Campaigns were also set up to improve the mother’s nutrition, for example, The Dublin Maternity and Child Welfare Clinics and St John Ambulance Brigade provided free meals to poor mothers and ran dental clinics for ‘expectant and nursing mothers’ (Annual Report of the Department of Local Government and Public Health, 1932-33).

During the 1930s, there were increased visits to the Maternity and Child Welfare Clinics, in Cork, Limerick and Waterford. Moreover, health visits in Waterford from 4,926 in 1933 to 6,656 in 1934 (Annual Report of the Department of Local Government and Public Health, 1934-35). Ante-natal services were available in the maternity hospitals in urban areas including Limerick, Dublin and Cork but not in rural areas. Moreover, the out-patient attendances were almost doubled from 1933 to 1938 with 60,375 mothers attending these clinics (Hospitals Commission Fourth General Report 1938). However, the new housing schemes introduced in 1936 meant that in Dublin the health visitor travel longer distance and had less time with expectant and nursing mother (Ibid).

Although the maternal mortality rate remained high in Ireland during the 1930s, sulphonamide drugs aimed to reduce the maternal mortality rates from 1937 (Earner-Byrne, Mother and Child). By 1939, 148 maternity and child welfare schemes were in operation throughout the country (The child health services: report of the study group appointed for the Minister for Health to inquire into the child welfare service and school examination service). 44,566 mothers and 86,308 children were visited by the health visitor employed by local authorities and 15,464 mothers and 32,285 children by district nursing organisations including Lady Dudley nurses (Ibid). Moreover, 56,129 mothers and 70,112 children attended the local authority clinics and 3,955 mothers and 4,893 children attended the district nurse clinics (Ibid).

The outbreak of the ‘Emergency’ in September 1939 interrupted maternal and infant health services in Ireland. Laws were passed to control the spread of infectious diseases and ensure that the maternal mortality rates continued to decline. In 1941, the notification of puerperal sepsis cases became compulsory under the Public Health (Infectious Diseases) regulations. The infant mortality rate also rose, increasing from 3,759 in 1940 to 4,175 in 1941(Annual Report of the Department of Local Government and Public Health, 1943-44). Dublin County Borough, Waterford County Borough and Cork County Borough had some of the highest infant mortality rates (Ibid). In 1941, the Public Health (Infectious Diseases) Regulations made the notification of infectious diseases including polio, measles, enteric fever, whooping cough, scarlet fever compulsory. TB and gastro-enteritis were rampant during the Emergency and in 1943, Public Health (Diseases) Regulations made cases of gastro-enteritis in children under two notifiable in certain areas including County Boroughs (DLGPH 1943-44). Significantly, the neonatal death rate was extremely high and in 1943, the neonatal mortality rate was 322 per 1,000 infant deaths and the causes included congenital debility and gastro-enteritis (Ibid).

During the Emergency, food shortages contributed to the lack of nourishment of infants and children (Ruth Barrington Health, Medicine & Politics in Ireland 1900-1970). According to Bryce Evans’s ‘Food, the Emergency, and the lower-class Irish body, c.1939-45’ in D. Durnin and I. Miller (eds.) Medicine, Health and Irish Experiences of Conflict, 1914-45, p.49, ‘the transport of….medicines was seriously compromised by Britain cutting off coal and petrol supplies’. Therefore, maternal and infant mortality rates increased during the ‘Emergency’ due to the spread of disease and lack of nutrition and medicine and vaccinations. The war made it difficult to import the BCG vaccine which led to a peak in TB deaths during this period (Margaret O’hOgartaigh, ‘Dr Dorothy Price and the elimination of childhood tuberculosis’ in J. Augustin (ed.) Ireland in the 1930s). According to Dr James Deeny, the Chief Medical Advisor to the government, memoir To Cure & to Care: Memoirs of a Chief Medical Officer, ‘between 1942 and 1945, 16,186 people died of the disease’.

Maternal and infant health services were under additional strain. In 1940, the Archbishop of Dublin, Charles McQuaid established the Catholic Social Service Conference which offered food, milk and clothing to mothers at the ante-natal clinics (Earner-Byrne, Mother and Child). However during the 1940s, breastfeeding was regarded as the best method to prevent infant deaths. Dr Collis, the head of sick infant department in the Rotunda, recommended that infants should be breastfed until they were three or four months old (Irish Nurse’s Magazine November 1940). However, many mothers did not breastfeed their children as they were malnourished and many suffered from anaemia (Earner-Byrne, Mother and Child). Due to the food shortages, mothers and children receiving milk under the Free Milk Scheme from the clinics increased. Importantly, the government provided a grant of £90,000 towards the scheme (DLGPH 1943-44).  In 1943, 839, 291 gallons of milk was distributed (First Report of the Department of Health 1945-1949).

The Emergency interrupted the health visitation service and the school medical service. Barrington’s Health, Medicine & Politics maintains that fuel shortages ensured that public health nurses could not travel in a motor car to visit mothers and infants and carry out medical inspections in schools. Importantly, there was a significant increase in health visits undertaken by the district nurses. In 1941, 1,354,095 health visits were carried out to mothers and children (Annual Report of the Department of Local Government and Public Health, 1941-42). In 1943, a higher number of mothers and children were visited by nurses employed by local authorities and attended their Maternity and Child Welfare clinics (DLGPH 1943-1944,). Dublin county borough had highest number of attendance to clinics by 467,840 mothers and 51,375 children while in Limerick 3,072 mothers and 3,552 children visited the health clinics (Ibid). New clinics and specialist services also emerged, for example, children received orthopaedic treatment in various institutions such as the Sunshine Home and in general hospitals (Ibid). 

The Free Milk Scheme, the expansion of maternity and child welfare centres and the introduction of TB and diphtheria immunisation schemes helped to improve infant health and aimed to reduce the infant mortality rate in Ireland. Moreover, the introduction of sulphonamide drugs and ante-natal services in maternity hospitals heralded a decrease in maternal mortality rates in Ireland. The ‘Emergency’ disrupted the importation of drugs, fuel and food into Ireland which contributed to an increase in maternal and infant death rates. However, the government made cases of infectious diseases notifiable and public health nurses carried out more health visits and there were increased attendances to their centres.

Bibliography

Annual Report of the Department of Local Government and Public Health, 1930-31, (Stationary Office, Dublin, 1931).

Annual Report of the Department of Local Government and Public Health, 1932-33, (Stationary Office, Dublin, 1933).

Annual Report of the Department of Local Government and Public Health, 1934-35, (Stationary Office, Dublin, 1935).

Annual Report of the Department of Local Government and Public Health, 1941-42, (Stationary Office, Dublin, 1942).

Annual Report of the Department of Local Government and Public Health, 1943-44, (Stationary Office, Dublin, 1944).

Barrington, Ruth, Health, Medicine & Politics in Ireland, 1900-1970, Institute of Public Administration, Dublin, 1987.

Deeny, James, To Cure & to Care: Memoirs of a Chief Medical Officer, The Glendale Press, Dublin, 1989.

Earner-Byrne, Lindsey, Mother and Child: Maternity and Child Welfare in Dublin, 1922-60, Manchester University Press, Manchester, 2007.

Evans, Bryce, ‘Food, the Emergency, and the lower-class Irish body, c.1939-45’ in D. Durnin and I. Miller (eds.) Medicine, Health and Irish Experiences of Conflict, 1914-45 (Manchester University Press, Manchester, 2017), pp.45-60.

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Margaret O’hOgartaigh, ‘Dr Dorothy Price and the elimination of childhood tuberculosis’ in J. Augustin (ed.) Ireland in the 1930s (Four Courts Press, Dublin, 1999), p.76-7.

The child health services: report of the study group appointed for the Minister for Health to inquire into the child welfare service and school examination service (Stationary Office, 1967).

The Irish Nurse’s Magazine, Vol. 11, No. 7 (November 1940). i