The whole point of this book lies in the letters which it contains; and it might therefore have seemed advisable to leave the reader untroubled by an introduction to gather that point from the letters themselves. The material is, however, in form and in subject of so unusual a kind that it has been thought necessary to explain something of its origin and its authors, and even to touch upon some of the problems which the letters so vividly show to exist. The letters are written by married women of the working-class, all of whom are or have been officials of the Women’s Co-operative Guild. The Guild is a self-governing organisation within the Co-operative Movement, and deals with subjects which affect the Co-operative Movement and the position of married women in the home and the state. It might justly claim to speak with greater authority than any other body for the voteless and voiceless millions of married working-women of England, for it has a membership of nearly 32,000, distributed in 611 branches over the whole country.

The Guild has for several years given special attention to the subject of “The National Care of Maternity.” Before the Insurance Bill was introduced, the Guild asked for the inclusion of Maternity benefit, and when the Amending Bill was before the House in 1913, an agitation by the Guild secured the benefit as the mother’s own property. Later on it placed a scheme for the national care of Maternity before the Local Government Board, which issued a Circular on July 30, 1914, largely embodying the various suggestions of the Guild. In the course of this work it was considered advisable to obtain information from the members themselves of the conditions under which they had brought children into the world. These letters are the result. The barest indication of the information wanted was given, and the only questions used were those on p. 191, as it was thought that it would be more valuable to allow the women to tell their own story in their own way.

We claim for these letters that for the first time are presented in them the real problems of Maternity seen through the women’s own account of their lives. If the writers are uneducated in the ordinary sense of school and university, a long schooling in life and suffering has given them a peculiar simplicity and dignity of language in place of the more usual literary style. The letters are left exactly as written by the women, the only alterations made being in the spelling, in the addition of punctuation, and in the omission of a few medical details. All names and places have also been omitted in order to prevent identification.

The women are the wives of men who earn their daily bread by manual labour. The husband’s trades cover over one hundred different occupations, and their rates of wages vary from 11s. to £5. The letters show how often the nominal wages are reduced by periods of short time and unemployment, such periods constantly coinciding with childbirth. It should also be remembered that a wife does not usually receive the whole of the weekly wage for her family expenditure.

The earnings and conditions of life of these men are certainly above rather than below the level of their class. It is true on the whole to say that the Co-operative Movement is largely composed of the better-paid manual workers, and there is no doubt that the woman who is secretary of a Guild branch lives in better conditions than the average working woman. If the conditions of their lives are as described in these letters, the suffering and waste of life, the overwork and poverty, must be tenfold and twentyfold where wages are less and employment more precarious. That the women themselves are well aware of this is shown by the occurrence in the letters of such sentences as “I was more fortunately placed than most women,” or “I have not had to go through so much pain and suffering as many poor mothers have to go through.”

These letters then give for the first time in their own words the working woman’s view of her life in relation to maternity. Now, what is the general impression that the reader gets of the life at such times of these more fortunate working-class mothers? It is on the whole an impression of perpetual overwork, illness, and suffering. The stories and records of 400 lives have been received, taken at random out of the million similar lives lived in our cities. In this book 160 letters have been published, and the unpublished letters describe similar experiences. The evidence of such witnesses cannot be impugned; it is that to bear children under such conditions is to bear an intolerable burden of suffering. The cry of a woman in travail has become a commonplace of literature, and the notion that pain and motherhood are inevitably connected has become so fixed that the world is shocked if a woman does not consider the pain as much a privilege as the motherhood. And this attitude of the world towards the pain of travail has been extended to all the sufferings attending motherhood. These letters show that this is the view of women themselves, for which doctors have been largely responsible. It is hardly too much to say that the ordinary professional attitude might have been summed up in the saying, “You’ll be worse before you’re better.” It would be foolish to cry aloud against the inevitable minimum of maternal suffering. And it is to be noted that there is no foolish note of self-pity in these letters. The brave words, combined with a stoic resignation to fate, the invincible optimism shown in such letters as Nos. 33 and 47, are characteristic of the spirit of them all. But if it be folly to kick against Nature’s pricks, what is more foolish is the facile fatalism with which we resign ourselves and other people to unnecessary and useless suffering. And a very short consideration of the suffering disclosed in these letters will show that it is both unnecessary and useless.

The roots of the evil lie in the conditions of life which our industrial system forces upon the wage-earners. It is useful to consider the different conditions under which the middle-class and the working-class woman becomes a mother. The middle-class wife from the first moment is within reach of medical advice which can alleviate distressing illness and confinements and often prevent future ill-health or death. During the months of pregnancy she is not called upon to work; she is well fed; she is able to take the necessary rest and exercise. At the time of the birth she will have the constant attendance of doctor and nurse, and she will remain in bed until she is well enough to get up. For a woman of the middle class to be deprived of any one of these things would be considered an outrage. Now, a working-class woman is habitually deprived of them all. She is lucky if her husband hands her over regularly each week 25s. with which to provide a house, food, and clothing, for the whole family. It has to be remembered that the ordinary family wage leaves nothing over for the additional outlay upon maternity. This ought to amount to £5 if the expenses are properly met. Too poor to obtain medical advice during the months of pregnancy, she “learns by experience and ignorance,” comforting herself with the belief that however ill she be it is only “natural.” Meanwhile she has to scrape and save to put by money for the inevitable expenses that lie before her. She often goes out to char or sits at her sewing machine, to scrape together a few shillings. She puts by in money-boxes; she lays in little stores of tea, soap, oatmeal and other dry goods. At a time when she ought to be well fed she stints herself in order to save; for in a working-class home if there is saving to be done, it is not the husband and children, but the mother who makes her meal off the scraps which remain over, or “plays with meat-less bones.” One woman writes: “I can assure you I have told my husband many times that I had had my dinner before he came in, so as there should be plenty to go round for the children and himself, but he found me out somehow, so that was stopped.” Another woman says: “Many a time I have had bread and dripping for my dinner before my husband came home, and said I had my dinner, as I would not wait.”

If the mother is not working long hours in a factory, she is working even longer hours in her own home.

Writers on infant mortality and the decline of the birth-rate never tire of justly pointing to the evils which come from the strain of manual labour in factories for expectant mothers. Very little is ever said about the same evils which come from the incessant drudgery of domestic labour. People forget that the unpaid work of the working-woman at the stove, at scrubbing and cleaning, at the washtub, in lifting and carrying heavy weights, is just as severe manual labour as many industrial operations in factories. It is this labour which the mother performs often up to the very day on which the child is born, and she will be at it again perhaps six or eight days afterwards. The Factory Acts make it an offence for an employer knowingly to employ a woman within four weeks after confinement. “In Switzerland a total absence from employment in factories of women during eight weeks before and after childbirth must be observed, and on their return to work proof must be tendered of an absence since the birth of the child of at least six weeks.” In Germany four weeks’ absence is compulsory, and “must be extended to six weeks unless a medical certificate is furnished approving of employment at the end of four weeks.”

We propose to deal now shortly with the causes of those conditions, then with the results, and finally with the methods of cure and prevention of the resulting evils. The main causes seem to be three:

We have already dealt to some extent with the first cause. Thirty shillings a week for a manual worker is reckoned to be “good wages,” and there are, of course, thousands of men earning far less than that. Now, what most people do not realise is that 30s. a week is itself a wage utterly inadequate for rearing a large or even small family. It is inadequate because the whole burden is placed upon the woman who has to bring up a family on 30s., and that burden is excessive. She can only do it at all by incessant labour which inevitably cuts her off from every higher human activity except one. That one which is left to her is maternal affection, and the wonder is that even that endures as it does the strain of poverty, overwork, and illness.

The second cause, the lack of knowledge on the part of the women, receives remarkable testimony in these letters. Again and again the writers come back to this subject. They are convinced of the evils that resulted to themselves and their children from their own ignorance of the functions and duties of motherhood. And there can be no doubt that they are right. Much of the suffering entailed in maternity, much of the damage to the life and health of women and children, would be got rid of if women married with some knowledge of what lay before them, and if they could obtain medical advice and supervision during the time of pregnancy and motherhood. It is not the women’s fault that they are ignorant, for the possibilities of knowledge have not been within their reach.

The personal relation of husband and wife is a subject as difficult as it is delicate. Reading these letters one is often struck by the fact that that relation remains so good under the most adverse circumstances. But despite the extraordinary loyalty of the writers, there is clearly a consciousness among them that the position of a woman not only impairs the value of that relationship, but is directly responsible for some of the evils we are considering. In plain language, both in law and in popular morality, the wife is still the inferior in the family to the husband. She is first without economic independence, and the law therefore gives the man, whether he be good or bad, a terrible power over her. Partly for this reason, and partly because all sorts of old half-civilised beliefs still cling to the flimsy skirts of our civilisation, the beginning and end of the working woman’s life and duty is still regarded by many as the care of the household, the satisfaction of man’s desires, and the bearing of children. We do not say that this is the case in every working-class home, or that there are not hundreds of husbands who take a higher view of married life and practise it. What we do say is that these views are widely held, often unconsciously, and are taken advantage of by hundreds of men who are neither good men nor good husbands and that even where there is no deliberate evil or viciousness, these views are responsible for the overwork and physical suffering among women and for that excessive child-bearing, of which more will be said later.

The effects of the conditions we have described and of the causes which produce them can be conveniently grouped under three heads. They concern, first the woman herself, secondly the children borne by her, thirdly the children that remain unborn of her. So far we have deliberately insisted only upon the evil effects upon the women themselves, and it still remains to insist upon them. The disastrous results of maternal ill-health and overwork upon the children cannot be exaggerated, but in the contemplation of them, people are too apt to forget that the mother herself is an individual with the right to “equality of opportunity,” which is the right as a human being to be given the opportunity of understanding and enjoying those things which alone make life tolerable to humanity.

It was perhaps inevitable that the mother should have been publicly overlooked, for the isolation of women in married life has, up to now, prevented any common expression of their needs. They have been hidden behind the curtain which falls after marriage, the curtain which women are now themselves raising.

The general effect upon women is the useless suffering inflicted upon them, and one of the chief causes of this is undoubtedly excessive childbearing. This evil is directly due to those semi-civilised notions which were touched upon above, and though, as we shall see when we deal with the decline of the birth-rate, nature is taking her own way of reacting against it, it still exists. We would draw attention to the conditions disclosed in such letters as 1, 20, 36, and 71. In the first case we find a woman married at nineteen having 11 children and 2 miscarriages in 20 years, her husband’s wages being 20s. a week. In the second case there are 5 children and one miscarriage in 9 years; in the third 5 children and 5 miscarriages in 12½ years; and in the fourth 9 children and 1 miscarriage in 24 years. These cases have been taken more or less at random, and nothing could be more significant than the bare fact that out of 386 women who have written these letters, 348 have had 1,396 live children, 83 still-births, and 218 miscarriages. These figures speak for themselves: the mere physical strain of pregnancy and childbirth succeeding each other with scarcely an interval for ten or twenty years renders a healthy bodily and intellectual life impossible. And when the additional strain of insufficient means and incessant labour are added, the suffering which becomes the daily concomitant of life is unimaginable to those who are born in the more fortunate classes of society.

If any further evidence is wanted of the direct effect of such conditions upon the health of women, we would draw attention to the number of miscarriages and still-births. It is probable that not all the writers have included miscarriages; but even as it is the number of miscarriages is 15·4 per cent. of the live births, while the number of still-births is 5·9 per cent. Taken together, these figures show a pre-natal death-rate of 21·3 per 100 live births, as against a national infant death-rate of 10·9. According to some medical writers the frequency of abortions “is believed to be about 20 or 25 per cent. of all pregnancies”; while Dr. Amand Routh estimates that the number of deaths during pregnancy probably equals the number of deaths in the first year after birth. The following letters are a pathetic endorsement of the view that fatigue, strain, and domestic conditions are responsible for large numbers of miscarriages, and point to the urgent need of pre-natal care.

We have now come by a logical sequence from a consideration of the effect of the conditions of women’s lives upon themselves to the further effect upon the life and death of their offspring. We have, in fact, travelled the same road as, but in the opposite direction from, those who in the last ten years have conducted the campaign against Infant Mortality. It was about ten or twelve years ago that many people were suddenly horrified to learn that out of every 1,000 children born in England and Wales, about 150 died before they have lived twelve months. A vigorous campaign against Infant Mortality by means largely of what is called Infant Welfare work followed. Government departments and private persons and organisations have co-operated with such success that the death-rate of infants under one year of age per 1,000 births has fallen from 145 in 1904 to 109 in 1913. But the point which, for our present purpose, is most illuminating is to note the course which that campaign has pursued and is pursuing. It has become more and more clear that if you wish to guard the health of the infant, you must go back from it to the mother; it is the circumstances of the mother—her health, her knowledge, her education, and her habits—before the child is born no less than at the time of and after birth, that again and again determine whether the child is to have health or disease, to live or to die. In fact, from whatever point you regard the question, the words of the writer of letter 63 are true: We shall not get “a race in the future worthy of England until the nation wakes up to the needs of the mothers of that future race.”

Infant mortality in the first year of life is still appallingly high, and there is good reason for believing—though the fact cannot be absolutely proved—that this high rate is very largely due to the circumstances in which the great mass of working-class women are obliged to bear children. As is well known, it is in the first month after birth that the death-rate is highest, and it is this rate which reformers have been least successful in reducing. Now, if the causes of deaths of infants in the first four weeks of life are examined, an enormous proportion are due to “immaturity.” “It needs no argument,” says Dr. A. K. Chalmers, “to show that until we have a clearer conception of the causes which lead to death from immaturity, we cannot but fail to make any considerable impression on the volume of deaths which occur during this period of infant life.” But as a matter of fact there is high authority for debiting the greater number of these deaths from immaturity to the physical health and condition of the mother. “It is evident,” writes Sir George Newman, “that if infants die within a few days or hours of birth, or even if dying later show unmistakable signs of being unequal to the calls of bare physical existence, that there must be something more than external conditions or food or management which is working to their hurt. The explanation is clearly to be found in ante-natal conditions.” Dr. Noel Paton considers that the “malnutrition of the mother helps to explain the very high infant mortality among the very poor. The infant starts life at a low level, and readily succumbs to the hardships to which it is too often subjected.” Dr. Ashby writes: “My own experience in the out-patient room entirely confirms the opinion that nutrition of the mother has a very important bearing on the nutrition of the foetus, and that the statement that the percentage of unhealthy births among the poor is small is not justified by facts. We constantly see fully developed infants a day or two old ... clearly ill-fitted, as the event proves, to withstand the conditions of external existence.... There is no question of syphilis; they are the children of poor mothers who have lived hard lives of wear and tear during pregnancy, are themselves badly nourished and weakly, and have felt the pinch of poverty, though often perhaps poverty of the secondary sort.”

No better comment upon, or illustration of, these opinions of experts could be found than the facts contained in these letters. You can read in them the little details of existence which made the writers “mothers who have lived hard lives of wear and tear during pregnancy,” and watching those details you can see how the everyday working of the machine, which we call industry and society, leads to suffering, and wastes and destroys human life as soon as it is born. The results which can already be shown of care in the pre-natal period, bear out the contention that the suffering and loss of life which exists is unnecessary. The Women’s Municipal League in Boston, U.S.A., has had 1,512 women in five years (1910–1914) under its care. Amongst these women there have been no miscarriages in the last three and a half years; there were 60 cases of threatened eclampsia in the first year, there were only 2 in the last year; and the total number of infant deaths under one month was 2 per cent., while Boston’s rate was 4·3 per cent. The Johns Hopkins Hospital, U.S.A., obtained similar results, and in the Glasgow Maternity hospital more exact methods have reduced the infant mortality and morbidity.

If the problems raised by these letters throw light upon the terrible waste of women’s health and infant life, they no less certainly throw light upon another phenomenon of modern society—the decline of the birth-rate.

One of the most remarkable and important signs of change in the habits and aspirations of society, has been the sudden decline in the birth-rate which, noticeable in many countries, began in this country about forty years ago, and has continued steadily down to the present time. In every locality and class the number of children born yearly to married women is declining, but the fall is not the same everywhere; in the industrial population it is greater among the better-class and better-paid workers, and it is distinctly greatest among textile workers where wages are comparatively high and a large proportion of women work in factories. Now, it is absolutely certain that this decline is mainly due to the deliberate limitation of the family. There is, of course, a wide divergence of opinion as to the result of this conscious check upon the growth of population; some regard it as the clearest solution of the inextricable tangle in which the industrial system has enmeshed humanity, others see in it the suicide of a nation and the doom of a race. But people are so anxious to dispute about the good and evil of its effect that they often fail to see that for society itself the important good and evil lie in the conditions which cause the phenomenon. For the State it may be vital to know the result of men and women refusing to give her citizens; but it is still more vital for her to recognize the conditions within her which are leading men and women to this refusal.

These letters give the skeletons of individuals’ lives, and individual thoughts and feelings; but in those facts and thoughts and feelings one can see clearly the general mould of life and the sweep of the current of general opinion which is among the working classes, resulting in the refusal to have children. There is a kind of strike against large families, and it is not, among the workers, a selfish strike. The motives of this strike are admirably given in the following words from Letter No. 71, the whole of which is very illuminating on this point: “All the beautiful in motherhood is very nice if one has plenty to bring up a family on, but what real mother is going to bring a life into the world to be pushed into the drudgery of the world at the earliest possible moment?...” The fact that the decline in the birth-rate is greatest among the better-paid wage-earners is often said to prove that a growing love of ease and luxury is causing a declining birth-rate. The words “ease and luxury” are grotesque when applied to the lives of manual wage-earners. The fact is that the industrial worker took the first seventy years of last century to learn that the conditions such as described in these letters make a human and a humane life impossible alike for the mother and children of large families. This consciousness has spread slowly and surely during the last forty years, and, as is natural, it has spread most amongst the more educated and intelligent workers and those whose wages have given them at least the opportunity of realising that there are other things in life besides poverty and work. The numbers of such men and women will continue to grow who refuse to have children except under two conditions. Those conditions are that society shall pay its debt to the manual worker in such a way that his children can be born into a home where there is something better than bare existence, and that the woman has the means and the leisure to live a life of her own without which she is unfit to give life to her children and to direct it during their most impressionable years.

It is impossible to leave this question without touching upon one point which crops up occasionally in these letters. Opinions may differ as to the good or evil of the general limitation of families, but there can only be agreement upon the evil which results from the use of drugs to procure abortion. There are many facts which go to prove that the habit of taking such drugs has spread to an alarming extent in many places among working women. Several of these letters confirm that conclusion. The practice is ruinous to the health of women, is more often than not useless for procuring the object desired, and probably accounts for the fact that many children are weakly and diseased from birth. But here again the cause of the evil lies in the conditions which produce it. Where maternity is only followed by an addition to the daily life of suffering, want, overwork, and poverty, people will continue to adopt even the most dangerous, uncertain, and disastrous methods of avoiding it.

This introduction has been mainly concerned with pointing out certain evils deeply seated in national life. These evils have their origin in social conditions, and they touch life at so many points that they must, if allowed to work unchecked, modify the whole future of the race and state. There is no sign that society, if left to itself, will secrete some antitoxin to purge its own blood. The industrial and capitalist system tends to become continually more industrial and capitalistic; the gulf between the rich and poor, the fortunate and the unfortunate widens; ideals become higher and broader while the means to satisfy them are narrowed in the possession of a narrow class; only discontent seems to rise while the birth-rate falls. Society cannot cure itself, and the last hope, therefore, is for the State to attempt a cure.

The State has first to realise that if it wants citizens, and healthy citizens, it must make it possible for men and women to have families while living a full life themselves and giving a full life to their children. At the present moment this is not possible from top to bottom of the working class, unless the economic position of the working-class family be improved. The first requisite is, then, the improvement of the economic position of the family.

But it is impossible to treat here the broad question of how this can be attained; it is only possible to deal with the points in which the State can to-day take immediate steps to improve the economic position of the working-class family as regards maternity, and bring specialised knowledge, adequate rest, nourishment and care, medical supervision and treatment, within reach. And though the story told in these letters, in the statistics of infant mortality, in the figures of a declining birth-rate, be dark, a really bright sign for the future is that the women so vitally concerned have themselves become aware of the evil and are eagerly demanding that the State shall adopt those measures which will most surely mitigate or remove it. The Women’s Co-operative Guild have brought out a scheme which would greatly enlarge the scope of State action, precisely in those ways in which it has already proved itself most beneficial. This scheme, which has already to a large extent received the blessing of the Government Department most nearly concerned—the Local Government Board—is given in detail on p. 196. Meanwhile, up and down the country the Guild and other women’s organisations are pressing Public Health Committees to adopt the measures recommended. The presence of women on Town and County Councils is another hopeful sign, and it is greatly to be desired that the numbers of working-women councillors will increase. Dr. Newsholme says: “Women could help forward the care of maternity and infants by getting themselves voted on to Local Authorities, and by bringing pertinacious pressure to bear on members of Local Authorities.”

It should be noted that the essence of the Guild scheme is that municipal, not philanthropic, action is wanted. It is not charity, but the united action of the community of citizens which will remove a widespread social evil. The community is performing a duty, not bestowing a charity, in providing itself with the bare necessities for tolerable existence. That is why the end at which the Guild aims is that the mothers of the country shall find themselves as free to use a Municipal Maternity Centre as they are to use a Council School or a Public Library.

The following words of the Chairman of the Bradford Health Committee, spoken at the opening of the Municipal Maternity Home on March 15, 1915, show that the needs expressed in these letters are beginning to be met by the methods desired by the writers: “We stand on the threshold of an age which is to herald the recognition of the mother and her child, to give public health work that human touch it has hitherto lacked, and to modify those glaring inequalities in social life and conditions which are destructive alike of infancy and the ideals of Christian citizenship.”