The following objections have been raised against the insurance of motherhood. (a) No sound actuarial foundation can be provided for such insurance. The birth-rate cannot be predicted with certainty, so that the amount of contributions and the benefits cannot be calculated with the requisite precision. (b) Motherhood depends upon physiological processes, and has nothing whatever to do with illness.
The objection (a) is based upon ignorance or upon misunderstanding of the facts. The expected number of births can be calculated with the same precision as the expected number of deaths. The objection (b) is also erroneous. Women need medical aid during pregnancy, childbirth, and the lying-in period. Moreover, the aim of sickness insurance is not merely the care and the cure of sick persons, but also the prevention of the diseases, which in many cases can be prevented by the proper treatment of women in pregnancy, childbirth, and the lying-in period. Since, in the case of pregnancy and parturition, malingering (for fear of which liberal payment during sickness is considered undesirable) may be almost entirely excluded, the insurance of motherhood can be effected on very liberal terms, and there is all the more reason for this, because pregnancy and childbirth entail upon the mother greatly increased expenditure. It is hardly conceivable that women would incur pregnancy and parturition solely on account of the proposed pecuniary advantages.
Insurance of motherhood is to-day of considerable importance in Germany, France, and Italy. In Italy it was introduced some years ago on national lines. In France and Germany, mutual co-operative associations for this purpose have been founded by the women concerned. The principal contributors to the expenses are the insured themselves, all contributing alike, irrespective of the fact whether they are poor or well-to-do—that is to say, motherhood insurance is entirely free from the characteristics of poor relief. The co-operative organisations for motherhood insurance are run upon similar lines to the Krankenkassen, with which, indeed, they are sometimes closely associated (Mutterschaftskassenverbände). The local authorities have nothing more to do with the matter than to co-operate in the foundation, organisation, and management of these Kassen. The results of this development have been extremely satisfactory; for example, experience shows that a much larger percentage of insured mothers than of non-insured suckle their own children.
The Tendency of Evolution.—It is as yet impossible to predict the future course of development in this matter, and to foresee whether it will take the form of a further elaboration of motherhood insurance. This much only is certain, that all women will receive proper care in pregnancy, and during and after childbirth. From a certain stage in her pregnancy until a certain period after delivery, no woman will be allowed to work for wages. Women far advanced in pregnancy, during delivery, and throughout the lying-in period, will be cared for almost exclusively in institutions. Such institutions will be very numerous, if only for the reason that the domestic care of childbirth will become rarer and rarer, that the institutional care of such women is far better and cheaper than any other, and that the extension of institutional care is a tendency of evolution.
[CHAPTER II]
INFANT-LIFE PROTECTION
Introductory.—The protection of infant life is all the more necessary in view of the fact that it is during infancy that human beings are least able to withstand injurious external influences. The success of the campaign against excessive child mortality depends above all upon the success of our measures for infant-life protection. During intra-uterine life the relationship between the child and the mother is of such a kind that the legislator must protect the mother if he wishes to protect the child. The institutions described in the last chapter relate chiefly to the mother, and it is indirectly only that they redound to the advantage of the child. After birth the relationship between the child and its mother is a different one. The child is no longer a part of the mother’s body, but is obviously and unmistakably a separate human being, although for nine or ten months after birth (that is to say, for a period about equal in duration to the period of intra-uterine life) the child remains absolutely dependent on the mother. It is characteristic of all the mammalia that the individual young should be suckled by an animal of its own species; for the milk of every species contains certain substances peculiarly adapted for the needs of that species, so that suckling by a mammal of another species is likely to exercise an injurious influence. Man is also one of the mammalia, and in the case of human beings suckling by any other mammal is almost excluded from possibility. There are important differences between human milk and the milk of all other mammals. For example, human milk contains certain substances which exercise a preventive influence against certain human diseases, but cow’s milk contains these substances in much smaller proportion, or not at all. It follows from this, that in the nourishment of a human infant we cannot without danger replace human milk by the milk of any other mammal—and cow’s milk is an especially dangerous substitute for human milk. For this reason, numerous methods of treating cow’s milk are employed to make it resemble human milk, such as dilution, the addition of sugar, &c.
Advantages of the Natural Feeding of Infants.—The natural method of nourishment—that is to say, suckling at the maternal breast, is the only method of infant-feeding which properly complies with natural requirements. The adoption or non-adoption of this method is a matter of decisive influence upon the subsequent health of the child. The ideal is that the child should be suckled until it is nine months old. But, at least, we should insist upon the mother giving suck for the first weeks of the infant’s life, two months being regarded as an irreducible minimum. After two months, the dangers of artificial feeding are considerably less. Within certain limits, the longer infants are suckled, the lower are their disease-rate and death-rate, the greater is their power of resistance to disease, and the higher is their mental capacity. When we compare the results of natural feeding with those of artificial feeding of infants, we cannot fail to recognise that the former method gives children greater powers of resistance to and recovery from those diseases which are inseparable from the nutritive processes. Artificial feeding frequently leads to illness, life-long debility, premature death, &c. In children suckled by their own mothers, digestive disorders are usually trifling; in children suckled by a wet-nurse, such disorders are more frequent and more obstinate, but are seldom really dangerous; in artificially-fed infants, such disorders are extraordinarily common, their course is extremely serious, and a fatal issue is far from rare.
Statistical data prove beyond question that methods of feeding have a great influence upon infant mortality. The death-rate is higher in proportion to the degree to which the mode of nutrition diverges from the natural method of suckling by the child’s own mother; the death-rate is higher in children suckled by wet-nurses than in those suckled by their own mothers; it is much higher in children fed on cow’s milk than in breast-fed children. Among 1000 children dying during the first year of life, medical returns show that 450 succumb to digestive disorders and marasmus. Many physicians go so far as to ascribe 70 per cent. to 80 per cent. of all infantile deaths to artificial feeding. A statistical error arises in this way, that children dying immediately after birth, before they could have been put to the breast at all, are apt to be included among the deaths due to artificial feeding, whereby, of course, the evil effects of this practice are overestimated. Where artificial feeding is badly carried out, the infantile mortality is enormous. The children that escape death tend to become rachitic, anæmic, or weakly, and later in life readily succumb to tuberculosis.