Midwives to the Countryside
  • Chapter 1
  • Chapter 2
  • Chapter 3
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Chapter 1:
Midwives in the Headlines

This chapter explores how new-style midwifery was portrayed and promoted in the early years of the People’s Republic of China (PRC). On the map below, I have displayed the geographic distribution of newspaper articles related to midwifery training programs. The popups will show you the date, title, and a brief explanation of the newspaper articles for that location.

Introduction

In May of 1949, The People’s Daily (renmin ribao人民日报) reported on the case of Ms. Liang, a 42-year-old woman who had given birth twice and lost both children to neonatal tetanus (脐风 qifeng). Fearing for her third child, she had sought advice on how to prevent tetanus. Someone suggested "If you bite off one of the child's toes, next time you'll be able to save the child. " (你把小孩子的脚指头咬掉一个，下次孩子就保住)(2). Ms. Liang followed the advice, but without effect; she lost her third child as well. It was only when she enlisted the help of a doctor (医生 yisheng) that she received productive advice. To ensure her next child was delivered safely, the doctor told Ms. Liang that she should call comrades from the hospital to deliver the baby (请医院的同志来接生). With the help of hospital staff, Ms. Liang safely delivered her fourth child.

Although only a few lines in a news article, Ms. Liang's story is emblematic of the larger concerns about high infant mortality rates and poor maternal health servives. Three of Ms. Liang’s children suffered from tetanus – a dangerously common illness that could be contracted by both mother and infant during the course of delivery.

The Chinese Communist Party (CCP) was well aware of these problems, and began recruiting midwives and supporting midwife training programs even before the establishment of the People's Republic of China (PRC) in October, 1949. This chapter explores how newspapers communicated the importance of safe birthing practices and tried to convince people of the efficacy of new-style midwifery.

The People's Daily & the Importance of Newspapers

The newspapers displayed on the map below are primarily derived from the People’s Daily, the state-sponsored newspaper of the PRC. This relationship with the government and the CCP means that this newspaper can offer important insight into what the party wanted to communicate to the people. I am arguing that the format of these news articles were designed to convince the audience of the effectiveness of new-style midwifery and to juxtapose it against outdated old-style midwifery.

In these news articles, new-style midwives are differentiated from old-style midwives in a number of ways, but a simple a practical definition could be this:

Old-style midwives: midwives who were not trained in a medical program. They cam to midwife either through personal experience (giving birth, helping relatives give birth) or through a midwife mentor.

New-style midwives: were trained with a standardized medical training program. Although the length and form of the program did vary depending on time and place, these midwives were trained with contemporary understandings of disease transmission, sterilization techniques, and modern delivery methods.

Standardized medical training may appear enticing, but convincing people to accept new-style midwife care was not easy or straightforward. Midwives functioned in a social system. They were deeply embedded in local communities and built up their reputation through experience rather than certification. These news articles were important because they demonstrate how the government sought to address these obstacles in improving midwife care.

If you can read this, you have to kiss a salamander.

Selling New-Style Midwifery

In news reports, we can observe a pattern of information dissemination. In the newspaper article that discussed Ms. Liang, the reporter also included a local survey about infant health and mortality. According to that local survey, a group of 20 women had collectively given birth to 44 children. 32 of those births were attended by old-style delivery methods (旧法接生 jiufa jiesheng), which resulted in early infant death. 18 of which were attributed to neonatal tetanus. However, the 12 infants delivered by new-style delivery methods (新发接生 xinfa jiesheng) all survived.

This format is included in nearly every article: anecdotal and/or survey information that demonstrates the severity of infant mortality when attended by old-style midwifery and then the evidence that new-style midwifery is more effective and the suggestion to seek it out.

While this may not seem revelatory, it is important for a couple reasons. Notably, it tells us that there was a perceived need to inform people about infant and maternal health and that the government was supporting ways to improve it. The frequency of these articles also indicates that the concern about infant mortality was a major concern.

In addition, the format indicates that the People’s Daily wasn’t simply reporting on midwife training programs or even the success of these programs. They were also trying to convince people to use midwife services and train as midwives.

By including examples that proved new-style midwives were better and safer than old-style midwives, these articles communicated a desired change in behavior. This was especially important because old-style midwives were deeply embedded in their local communities, and many people resisted new-style midwives because they were unfamiliar with them and their methods.

Some of the news articles on this map show many training programs in the early 1950s not only trained new midwives, but also encouraged old-style midwives to retrain in new-style midwifery. In this way, not only could the government make use of their social connections, but the midwives could contribute their existing experience to the training programs.

Rural-Urban Divides in Health Care

In 1950, Beijing was far from the sprawling metropolis it is today, but it did have an urban center. Similarly, cities like Tianjin and Shanghai had been places of industrial and commercial development, not to mention the foreign quarters.

A consistent call in medical guide books and from Chairman Mao himself was to "take medicine into the countryside" (把医疗卫生工作的重点放到农村去). The CCP was well aware of the conditions in rural areas and that medicine was among the many disparities. These midwife training programs were dedicated, in large part, to addressing the differences in access to medical care in urban and rural areas.

On the map, you’ll notice that the news articles cover programs in North China or Northeastern China. If you zoom in, you’ll further notice that most pins are located in Hebei province, the province that surrounds Beijing. While this is certainly in part a result of the Northern China bias in the People’s Daily, it also hints at the daunting physical obstacle of China’s geography.

Bridging the rural-urban divide may begin as a bridge between Beijing and its surrounding province, but in order to improve health care in the entire country, the state and the party would have to mobilize on a much larger scale.

References

Note： Newspaper articles that did not list specific locations are available under the All Provinces icon.
(1) 李友义，救救小生命！-- 谈 农村妇婴卫生工作,人民日报，May 22, 1949.