Britain's Fertility Decline, 1870-1930 : Causes and Interpretations

There is certainly considerable debate between demographers, economists and historians about the factors and assumptions behind the revolutionary fertility decline c. 1870-1930. Perhaps the two most basic arguments can be reduced to whether one believes that attitudes had changed in the period to accommodate the wishes of both husband and wife in accepting the necessity for some form of birth control ; or whether, as Szreter argues the persistence of a ‘long Victorian era’ in Britain (dissolving only in the permissive 1960’s) had immense repercussions with regards to Britain’s fertility decline. The argument that sexual ignorance and abstinence played important roles must be considered important in the fertility decline and cannot be dismissed - yet analysed alongside other varying economic, social or cultural theories. We must be careful not to speak of the fertility decline as a single unitary process transcending class, regional and cultural barriers. The concept that as the trend was widespread throughout the Western European industrialised nations there must be some form of general causation at work is highly misleading. The role of the British state must not be ignored, neither too the changing perceptions of motherhood and the concept of ‘separate spheres’ for husband and wife merely reinforced by the Great War. Furthermore, different methods of contraception have been promulgated by various sources and their influence needs careful analysis. Therefore the concept of fertility decline is littered with varying, contrasting, sometimes overlapping theories ; what seems most plausible however is that the fertility decline was most likely not due to a single cause, the varying degrees of social class and culture and conjugal ideology behind the different social strata’s in British society suggest there may well be multiple, yet equally acceptable theories.

Undisputedly however, beginning in the 1870’s, women were starting to stop before the end of their fertile years, signalling not only a fundamental change in patterns of family limitation but also new attitudes towards fertility itself. In the space of just a few decades, longstanding childrearing patterns changed irreparably, moving toward the modern norm of two children born in early marriage. McLaren’s research demonstrates that the method of birth control chosen in Britain was strongly influenced by class culture. Generally speaking, the middle-class preference for mechanical devices owed not only to the face that the more affluent could afford such contraception, but to a class culture that promoted conjugal intimacy and encouraged co-operation between men and women in sexual matters. McLaren argued that a sharper division emerged from the working-class marriages, and that lower class women were more likely to choose abortion as the first line of fertility control. Factors of class therefore weighed heavily ; and yet views on ideal family size are still compounded and mediated by a variety of social, cultural and economic considerations. However, perhaps most importantly, the enormous stress that large families placed on working-class parents in the later 19th and early 20th centuries had significant consequences : the recognition that in a competitive and growing society it would no longer to be possible to raise a horde of children amongst the working class : and the promulgation of the ‘quality over quantity’ childrearing theory amongst the middle classes must be considered crucial to the overall fertility decline. The crucial distinction that therefore emerges is whether fertility transitions result from changes in parents motivation to limit family size or from changes in attitudes and access to birth control.

While Malthus emphasises delayed entry to marriage as the most effective control of fertility, demographers since the late 19th century have looked to neo-Malthusian controls such as contraception and abortion. However, modern economic approaches have suggested a somewhat different approach ; instead of focusing on the successes or failures of the contraceptive techniques themselves, the real problem to be explained is why couples go to the trouble to prevent another birth. They must therefore weigh the costs and benefits of life without another child plus the costs of preventing the birth of the next child. The most important example of this problem is the question of the ‘cost of children’. It is frequently asserted that children have become more expensive. Subjects in surveys and interviews by Knodel and Debavalya overwhelmingly report that children cost more now than they did in the past. However, they are not describing a change in the costs of children as much as a change in their own definition of appropriate childrearing. Historically, children have become expensive not because the prices of commodities consumed by children have risen, but rather because parents have decided to invest more goods and services into providing and caring for their children. In effect, parents have chosen to raise one or two highly cared for, educated children rather than five or six less expensive offspring. This is therefore the result of a cultural change and carries with it considerable weight in validity. Easterlin’s Supply-Demand model applies this cultural factor and adds to it extra economic significance. The model certifies that couples implicitly have in mind a desired family size. They thus compare the costs and benefits of children to the costs and benefits of alternative life-styles available with their income. Parents subjectively evaluate the costs and benefits of the family that they will have if they don’t employ birth control techniques. However, we may criticise this theory for its overt rigidity - applying economic ‘cause and effect’ and ‘planning’ principles to complex patterns of human reproductive behaviour is somewhat deterministic. Simply put, do families make these kinds of decisions? Oral testimony has often revealed that ‘family planning’, especially amongst working-class families, was often non-existent. Perhaps fertility decline would therefore be better explained through emerging and wider patterns of demographic transition.

From the demographic history of Europe we can discern a common sequence of events that were key in predicting future developments. Advances in technology beginning in the 18th century led to a rising standard of living and improved public health care. These forces thus reduced the level of mortality and increased the rate of population growth in the subsequent century. Lower mortality increased the survival, and the supply of children - yet the growth of industrialisation and urbanisation introduced new life-styles reducing the demand for children. However, critics have charged that this is not a theory at all : but only a vague description of empirical correlations. It is not entirely clear whether the changes described are economic or social in origin. Yet all currently developed societies have undergone a fertility transition, despite differences in timing and culture. Thus, a variety of specific incentives for lower fertility rates can be related to the general process of positive economic development : historiography from the 1960’s and 70’s generalised that “economic development is the best birth control pill”. However, this sketches over the degree of personal and individual conscious choice that such a personal subject warranted. We must therefore dig deeper beneath the surface to find what exactly motivated men and women to limit fertility. In 1976 Caldwell offered a restatement of the demographic transition theory that cultural changes - associating the fertility transition with a change in the direction of “intergenerational flows of wealth”. Caldwell argued that in pre-transition families ‘wealth’ tends to flow from children to parents, making large families and unrestricted fertility most desirable. In contrast, “post-transitional” societies are characterised by the heavy investments that parents make in the education and support of their children - the fertility transition thus occurs when the net flow of ‘wealth’ shifts direction. However, there are several problematic features of the wealth-flows theory, Caldwell’s terminology has caused severe confusion about the character of ‘wealth-flows’. Economists are further likely to object to ‘wealth’ being defined beyond a purely economic category as traits such as “deference” and “prestige” are part of the wealth-flow from parents to children. Although economic change is a large part of the historical explanation of fertility decline, Caldwell’s theory is a fundamentally cultural model : his description of the potential for demographic change in Africa and Asia points to the central role of ‘westernisation’, the spread of European concepts of family relationships and life-styles. It’s inherent weakness however, is glossing over the role of personal choice in relation to contraceptive advice and techniques among different sections of society.

The theory of demographic transition implies that family planning programs could do little to create a fertility transition. However, the more modern European Fertility Project has damagingly weakened the link between economic development and fertility decline and strengthened the case for family planning : economic development would not, therefore, necessarily reduce fertility. Gillis furthered the argument that family planning and shifting perceptions of motherhood were principal causes of the fertility decline : “the crucial cultural shift was from an understanding of motherhood as childbearing to an understanding of motherhood as childrearing.” The new understanding of motherhood and fatherhood therefore involved a sharp division of labour between the sexes, the male labelled as ‘breadwinner’ and the mother as the vanguard of the home. Mothering was thus transformed into motherhood, a personal identity integral to woman’s growing femininity : by 1870, it had become the equivalent to the masculine career. Now understood as childrearing, good motherhood thus ceased to be defined in terms of numbers. A woman’s claim to femininity was established by the first birth - additional children did not add to a woman’s status. The ancient middle and upper class tradition of sending children ‘out to nurse’ was terminated by the middle class especially. After 1870, most middle-class women felt fully responsible for the nurturance and training of their infants. The individuality of the mother-child relationship meant an intensification of childrearing, transforming it from a part-time occupation to a lifelong career. Can it therefore be that in this context me may begin to understand the fertility decline that occurred after 1870? The ‘rising costs’ theory fails to take into account the changing meaning of parenthood. We may argue therefore that the significant change was not the changing cost of children but the regendering process that created an everlasting bond between mother and child. However, what of working class families? One might argue that this theory fails to account for the different aspirations and ideology underpinning working-class fertility behaviour. Secombe promulgates the fertility decline “almost entirely to the reduction of marital fertility”, that in most regions the reduction of marital fertility was achieved entirely be means of ‘stopping’ - the cessation of childbirth prior to menopause. ‘Stopping’ was accomplished through either a rise in the incidence of induced abortion, frequent resort to coitus interruptus, decline in coital frequency through sexual abstention and increased use of contraceptive devices. Beginning with abortion : there is considerable attention that its incidence did rise significantly. Studies by hospital gynaecological departments and women’s clinics estimated that roughly 16-20% of pregnancies were deliberately terminated. Therefore, it seems highly reasonable to assume that a rise in the abortion rate contributed considerably to the decline of the birth rate prior to the widespread use of contraception in marriage. However, because a great many working-class women in the 19th century has sought abortions, it is unlikely that rates would have risen sufficiently in the early 20th century to account for the continuing decline at that time. With regards to coitus interruptus, Lewis-Faning’s retrospective study (1949) concluded that nine out of ten limiters before 1920 had relied upon coitus interruptus. However, the famous correspondence received by Marie Stopes in “Mother England” tells a very different story. 40 correspondents propose sexual abstinence as the method they most practised, with “withdrawal” only in 13. Data from maternal clinics in Manchester and Salford revealed that both abstinence and coitus interruptus were widely practiced by working-class couples, although the former far more frequently. Yet all sources do seem to agree that contraceptive devices were infrequently used by working-class couples before 1930. For many working people, fears of physical injury and deep moral reservations meant contraceptives were regarded as repulsive and unnatural. Furthermore, condoms had a deeply unsavoury reputation, being associated with prostitution and the permeation of venereal disease, which was indeed the principal context of their use in this period. However, despite this, there were also problems with sexual abstinence or coitus interruptus. Many husbands would not be coercive : and while wives could put off intercourse for a time, the vast majority of female respondents in the Stopes material could not steadfastly refuse a cohabiting husband his “conjugal rights”. Without the active co-operation of their husbands, celibacy was impossible. Even with husbands’ consent, abstinence and withdrawal wracked marital relations, one woman remarking, “the result is our married life is spoiled and we are gradually drifting apart.” However, in “Mother England” there are a substantial number of examples of willingness on the part of many husbands to restrain their desires. Yet to engender family limitation, both spouses must have a strong desire to cease childbearing and the capacity to take effective action towards that end. The traditional view is that women were strongly motivated to limit fertility yet lacked the “marital power” to avert conception, while men had it in their power to abstain but were, in many cases, not sufficiently motivated to restrain their sexuality. Therefore a vital aspect thus emerges : the underlying shift in the family makeup, moving men’s reproductive interests increasingly into line with that of their spouses.

The realisation by fathers that family limitation was not only necessary but also beneficial to their general standard of living is a fact that cannot be ignored. Research undertaken by Fisher exemplifies this argument through thorough usage of oral testimony. The research draws explicit attention to the vital part played by the husband in contraceptive strategies. The central assumption in the majority of analyses of the gendered dynamics of birth control is that, according to Secombe, “that women were the driving force behind family limitation”, and to Caldwell that, “common to all fertility transitions is women’s increased ability to determine their own fertility.” Thus the role men may have played has often been either understated or ignored. Importantly, the concept that men were extremely affected by the increased costs of childrearing must be considered in the process of fertility decline. Fisher interviewed 107 individuals, both male and female, from two working-class communities of Oxford and South Wales. Oral testimony suggest that men’s knowledge of birth control was far more extensive than women’s and that men’s networks of information about contraception were much more developed and varied. Over half the women interviewed claimed to have known nothing at all about any form of birth control before they were married - only three male interviewees claimed such ignorance. Women’s lack of basic sexual knowledge had profound consequences for their ability to absorb birth control advice : one testimony recorded that, “men knew all about those things long before they got married.” Hall has also referred to forms of information to which young men were far more likely to be exposed, and sexual subcultures from which young girls were vigorously sheltered from. Mass Observation’s ‘Little Kinsey’ survey from 1940 found that at the end of the 1940’s, “women are worse informed than men” about birth control - surely this must have been even greater in decades previous. Men seemingly “took the responsibility of seeing that there were no conceptions…it was the man, it was the man’s job.” Male methods of birth control (coitus interruptus and condoms) were much more frequently used than female methods (caps and abortion). The increased choice of these male methods facilitated male initiative ; taking responsibility for contraceptive choices fitted into a dynamic in which men took the central role in sexual activity.

Fisher’s study shows that fertility decisions were very often mutual, “well he knew I really didn’t want to keep on having children”, shared between husband and wife. Therefore, despite historians understanding that men often controlled sexual activity - male roles in birth control have not been presented as pivotal to the changes in contraceptive behaviour. Fisher’s research reveals that male perspectives were much more helpful than once though, and suggests that changes in male attitudes formed one of the most crucial components of the fertility decline. Furthermore, can this change in male attitudes be attributed to a relative degree of marital abstinence? Szreter argues this certainly may well have been the case. Individuals brought up in British society over many centuries accepted the norm to delay marriage and to therefore submit to coital abstinence as young adults. Sexual self-denial had been the societal norm for young unmarried adults, associated with the British institution of late marriage : average age at first marriage remained above 25 well into the 20th century. This long-term trend may well be relevant to the demographic evidence from 1911 which has show a continuing relationship between delayed marriage and restricted family size and the spacing of births from early on in marriage. These findings do suggest that during the period of declining fertility the practice of abstinence may have provided the populace with a principal means to limit fertility once married. We must not forget that abstinence within marriage may also have been associated with keeping mistresses or using prostitutes, especially amongst the upper classes. So long as the incidence of delayed marriage continues to be positively correlated with limitation of births within marriage, as has found to be the case in the 1911 occupational data analysed by Szreter, there is thus strong primary evidence that the principal method of birth control being deployed by the populace was some form of sexual abstinence within marriage. Probably the most important source of direct testimony came from the National Birth Rate Commission’s ‘voluntary census’ of 1914, distributed to assess differences in fertility and contraceptive practices between different classes of women. Of the 289 birth controllers, 13% practised coitus interruptus, 10% used condoms, 16% douches, 10% ‘artificial’ means and an overwhelming 52% ‘continence’. Abstinence certainly seems entirely plausible given the context of the period : the National Association for the Repeal of the Contagious Diseases Act commenced in 1869 and secured, by the mid-1880’s, nit only repeal but also the strictest rules against sex in the world at that time, raising the female age of consent from 13 to 16. By the 1880’s this was part of a wider ‘moral purity’ campaign whose objectives were to engender an increasingly strict formal regulation of various forms of sexuality, both public and private. The legislation and opinion on such matters as venereal disease, homosexuality and prostitution can be taken as signs that many forms of sexual behaviour were cast in an extremely negative light by the late Victorians.

Many individuals therefore may well have come to entertain strongly negative or at best guilty or ambivalent feelings towards sex - associating it with disease and dishonour. Szreter concludes the argument, that “attempted abstinence within marriage was the single most widespread and frequently used method of birth control during the period before 1920.” The argument, in its wider societal context also envelops an understanding of the important role played by the state. The role central or local government played in the fertility decline is conveyed by Johansson, who argued that state policy will always have a vital effect on fertility as “they provide an important set of institutional rules within which childrearing costs and benefits are defined and perceived.” Especially toward the end of the 19th century, the policies of the state on labour and education shifted underlying perceptions of childhood - the transition to them becoming total dependents. With regards to education, the Foster Education Act (1870), Sandon Act (1876) and the Mundella Act (1880) furthered the state’s commitment to provide elementary education for all children. Working-class parents thus found themselves faced with a compulsory set of educational expense and inconvenience in having large numbers of children. Working-class child school attendance at elementary school increased from 68% in 1870 to 82% by 1895. Small families were becoming increasingly favoured by a new set of societal, cultural and economic constraints.

Therefore, the attempt to describe fertility decline has provoked high levels of debate and theorising amongst historians. It appears that socio-economic explanations no longer have significant context with regards to the specific example of Britain. Cultural and specific examples with regards to marital behaviour by both male and female partner have shed new light on the fertility decline. Furthermore, Szreter’s stress on the importance of marital abstinence has opened up new avenues of debate and theory. It would be somewhat foolish to label one direct factor as totally responsible for the fertility decline. The change in national perceptions of childhood towards being a time of learning and financial dependence of parents, particularly mothers proved immeasurably important. Mothers thus invested their time in parenthood : fathers capital. This made having large numbers of children not only undesirable, but in many cases impossible, and led to many of the coital restraint practices that become so prevalent amongst large numbers of British married couples.

Bibliography :-

L. Hall, Sex, gender and social change in Britain since 1880
S. Szreter, Fertility, class and gender in Britain, 1860-1940
H. Cook, The long sexual revolution, English women, sex and contraception
J. Gillis (ed.), The European experience of declining fertility
L. Hall, Hidden Anxieties, male sexuality 1900-1950
M. Stopes, Mother England
K. Fisher, “She was quite satisfied with the arrangements I made” gender and birth control in Britain 1920-50, Past and Present (2000)
L. Davidoff, The family story
A. McLaren, Birth control in 19th century England

Britain's Mortality Decline : Rising Living Standards or Public Health Reform?

Historians have identified these three broad factors - that of improvements in public health, medicinal advancements and increased nutrition through a rise in ‘living standards’. It is the debate between the three which fuels such a statement - each has been shown as valid to some extent, yet there are important criticisms of each that need to be assessed in order to identify the primary cause of improvements in the nation’s health. The decline of mortality in Britain in the period 1870-1939 was on a scale unprecedented and dramatic. Crude death rates were halved, infant mortality rates reduced by 80% and mortality due to infectious diseases was reduced by 90%. Clearly, therefore, the reasons for such an improvement lie within one of the three main arguments. However, as the statement suggests, it would perhaps be foolish to label merely one of these arguments as the most successful - instead we should seek to observe where they overlap and thus make a reasoned judgement concerning which was the most successful, whilst not discounting the influence of other arguments. For factors behind mortality debate have inspired a hotbed of debate, ranging from Mckeown’s thesis, promulgating nutrition as the single most important factor in the nation’s improved health to Szreter’s emphasis on the shift away from such a conclusion, arguing instead that improvements in public health facilitation and sanitation played a key role in reducing the spread of infectious disease. Medical advancements too must not be ignored - the National Health Service may not have been founded until 1948, but the importance of such advancements before this date has often been looked over.

To claim that the main cause of improvements in the nation’s health was due to rising living standards would be to agree, to a large extent, with the work of Mckeown. There is no doubt that in the second half of the 19th Century there occurred a sustained and significant rise in real wages. Mckeown argued that better nutrition, it was on food that the working class spent 60% of their income, meant an increased resistance to viral and bacterial infection. The thesis showed that medical science had remarkably little to do with the modern mortality decline. From observing the aggregate real wage index we may see that wage rises in this period were significantly high which meant more food could be purchased for the same proportionate outlay from the average family’s budget. Mckeown’s publications have sparked a long and protracted debate about the respective roles of improvements in sanitation and nutrition in the process of mortality decline. Harris underlines Mckeown’s key assumptions, arguing that nutrition needs to be regarded as a key factor in Britain’s mortality transition. However, there are key flaws in the Mckeown thesis, and it becomes possible to suggest we may be able to draw a line under the Mckeown interpretation and simply acknowledge that its greatest strength has proven to be its enduring ability to stimulate debate. He failed to take into account factors such as changes in the virulence of infectious organisms, improvements in personal and domestic hygiene, medical intervention and most importantly the beneficial effects of the sanitary ‘revolution’ from the second half of the 19th Century. This does not mean we can dismiss nutrition and rising living standards altogether ; it is true that humans require additional quantities of food in order to enable them to perform work and war off the effects of disease. Furthermore, there is a broad consensus on the part of the epidemiological community that nutritional deficiencies do play an important part in the development of a wide range of infectious diseases. Scrimshaw, Taylor and Gordon found that nutritional factors were important in situations where there was an equilibrium between the natural resistance of the host and the virulence of the infective agent. Lunn proposed, “it has become generally accepted that malnutrition predisposes an individual to infectious disease.” However, in 1982 a group of historians, scientists and economists concluded that nutritional status had little effect on the development of such diseases as plague, typhoid, tetanus, smallpox or malaria - it only exerted a ‘variable’ impact on the outcomes of diphtheria, syphilis and typhus. The relationship between nutrition and infection appears not to be continuous and nutrient deficiencies are only likely to affect disease outcomes if they are particularly severe.

Furthermore, Mckeown’s thesis was centred around the key assumption that “the decline of mortality between 1851-60 and 1891-1900 was attributable almost exclusively to a reduction in the frequency of death from infectious disease.” Therefore, we must ask to what extent was such a reduction due primarily to living standards and increased nutrition? Szreter drew on revealing epidemiological evidence to suggest that Mckeown exaggerated the extent of the contribution made, especially by pulmonary tuberculosis, to the overall decline in mortality, and that his led him to underestimate the significance of improvements in the incidence of mortality from water and food-borne disease. Woods’ exhaustive study concluded that even though the decline in the death rate from TB accounted for more than one third of the total decline in mortality in this period - it declined at much the same rate throughout the country. How can this be, if we are to believe Mckeown’s argument that only through an increase in living standards - as a result from a higher wage from industrial work in the major cities. We may conclude that this decline was unlikely to have been caused by changes in diet. Hardy claimed that, “recent research reinforces the conclusion that, for a significant proportion of Britain’s population, rising real incomes had little direct impact on improving nutritional standards”. Furthermore, TB appears to have been responsible for only about two seventh’s of the late 19th Century decline in mortality. We can attribute to typhoid a further seventh with scarlet fever, cholera, smallpox and ‘convulsions’ completing the list. Mckeown focuses primarily on TB, yet apart from this there were two other airborne diseases which declined significantly, smallpox and scarlet fever. Neither of these examples can be used to support a thesis centred around nutritional factors. It has been medically accepted that human intervention (inoculation, vaccination, quarantine) must be granted the major role in the case of smallpox, and scarlet fever appeared to burn itself out spontaneously. Furthermore, the examples of the composite airborne group, bronchitis, pneumonia and influenza, was further overlooked - by 1900 this category was clearly the most important killer, 16% of all mortality attributable to it - a greater proportion than TB represented in the mid-19th Century. Thus Mckeown’s crucial error lies in treating the airborne diseases as a single unitary group - that rising living standards can be considered responsible for the group as a whole is highly questionable. The fall in TB, after subtraction of the increases in the bronchitis group fatalities, would be only 6% of the total fall - a fifth of the 30% reduction before 1901.

‘Rising living standards’ appears somewhat opaque. We must recognise that airborne diseases spread most effectively when humans are in close unventilated proximity - such as the industrial centres of Britain. Therefore, as Britain became further industrialised and real wages did increase it also fostered these hazardous conditions. Mckeown’s judgement that increased wages automatically meant increased health appears far too simplistic, not acknowledging that such economic advance provided a paradox - that at the same time the average families real wages did increase, yet simultaneously exerting a negative influence on average life expectancy because of crowded and chaotic living conditions. The assumption that rapid economic growth should be correlated with improvements in health of a society is fatally incorrect. Szreter highlights the “four D’s” of disruption, deprivation, disease and death which can be attributed as negative consequences of economic growth. Economic growth, even with rising real wages, seems as likely to harm as to benefit a nation’s health. During the key period of industrialisation (arguably the three middle decades of the 19th Century) the pattern between the increase in real wages and health is contradicted by mortality trends. Wrigley and Schofield found there was no significant increase in the national average for life expectancy until the 1870’s. The period of most rapid and rising economic growth rates (1800-1870) ensued little if any health improvements for the nation as a whole. William Farr illuminated this further, finding revealing regional differences in life expectancy - the Surrey countryside, for example, giving 45 as above the national average. In this study, quite a contrasting picture emerged from the two largest provincial cities - the centres of the nations new-found prosperity and ‘rising living standards’ - the average life expectancy was 28 and 27 in Liverpool and Manchester respectively. The ever-increasing proportion of the population directly involved in urban and industrial expansion experience a marked deterioration in average life expectancy well into the third quarter of the 19th Century.

Szreter’s examination of the shift of focus to local public health level provides us with an opportunity to assert that the traditional view that rising living standards were the cause of the lower mortality rates has been littered with flaws. Public health involvement from around the 1870’s must be seen as crucial in aiding the lower rates of mortality experienced by the turn of the century. Three public health acts during the 1870’s formed the backbone for a programme of increasingly effective pursuit of the nation’s health. The 1871 Local Government Act provided a minister responsible for implementation of sanitation, the following year’s Public Health Act established a national network of local sanitary authorities each with a Medical Officer of Health - and a further Public Health Act in 1875 laid down most public health functions of these local authorities. The last third of the Century especially resulted in unprecedented growth for the public health movement. After 1875, local authorities used their new powers to regulate housing standards so that by 1900 the majority were connected to WC’s. Through looking at the finances of the period we can gauge just the extent of the positive involvement that public health authorities came to exert. In the period 1845-72 local government had borrowed only 11 million for sanitation, between 1880-97 the figure spent was closer to 62 million. The 1878 Public Health (Water) Act made purchase of private waterworks financially possible. There can be no doubt that the decline of mortality due to water-borne diseases is attributable to publicly enacted improvements in sanitation. The provision of a clean water supply was essential in the cases of typhoid and cholera and clearly showcases the effectiveness of large-scale public health measures. Crucially, mortality remained stationary until the 1870s - it was in the last two decades of the 19th Century that the rate of overall mortality decline noticeably accelerated. This coincided with major spending on sanitary infrastructure, by 1896-1900 expenditure was approaching £75,000 per town per annum, increasing to £91,000 by 1905. However, the system was not perfect, it was not until the interwar years that water-carriage systems of sewerage disposal displaced privy middens in the most deprived areas. Yet its success in eradicating infectious disease is unmatchable with Mckeown’s dubious charge that nutrition and rising living standards were the cause of mortality decline.

A revealing part of the mortality decline in this period arose from infant mortality rates (IMR), which remained stubbornly high into the 20th Century. Here we may use this as an example to illustrate the positive effects of public health information to mothers about which techniques and methods are best suited to keeping infants healthy. All too often, an increase in nutrition as a result of higher real wages caused babies to be fed artificially and with potentially fatal foods. The involvement of the Medical Officer of Health in many towns and provinces had an extremely positive effect upon lowering IMR - a clear reduction in IMR only appeared after these public health institutions were in place. The example of Norwich provides a picture of how changing infant feeding practices accompanied declining IMR. A decline in the use of potentially hazardous long-tube bottles from 72-6% and the provision of sterile dried safe cows milk to 46% rather than just 2% accompanied a growth in the percentage of mothers switching to national approved feeding methods. This paralleled a decline in Norwich’s IMR from 174 per 1,000 in 1905 to 86 in 1920. Changing feeding practices, therefore, as a result of an increased involvement from local public health authorities may well have contributed significantly to the decline in infant mortality which began at the outset of the 20th Century. Therefore it must be emphasised that public health involvement can indeed claim a mostly convincing role as the main cause of improvement in the nation’s health - yet we must be careful to note the advancements in curative and medicinal technology. Banting and Best’s discovery in 1922 of insulin for diabetics was adopted as standard practice by the Medical Research Council the following year. World War One led to the introduction of new and successful techniques for the treatment of wounds and fractures. The discovery of the bactericidal properties of prontosil rubrum in 1935 by Domagk was crucial - the first of the sulphonamides. Its introduction made a major contribution to the decline of puerperal fever, a major cause of maternal mortality. The Mckeown thesis therefore might be doing medical intervention a mis-justice in understating its importance, especially into the 20th Century. There were between 1870-1939 developments in medical treatment which may have reinforced the process of the control and eradication of both infectious and non-infectious diseases. Most major innovations came after 1900 - yet it can still claim some success in having a positive effect upon Britain’s lowering mortality.

In conclusion, therefore, there are clear limitations of a ‘standard of living’ thesis alone. In the absence of collective political decisions, at both local and national level, promoting objective, economic growth in itself had no inherently health enhancing properties, perhaps far from it. Evidence has been given to suggest the exact opposite, that the key period of industrialisation had a negative impact upon the health of those supposedly enjoying a higher standard of living. The period 1870-194 especially demonstrates the effectiveness of promoting and financing public health projects in a society possessing the necessary economic resources. Furthermore, the growth of the preventive and medicinal branch deserves much praise for the modern mortality decline, yet the key reduction in deadly infectious disease can be mostly attributed to public health projects. There can be little doubt that adequate nutrition and good intake of food are essential factors for a population to achieve high levels of health - rising living standards are not to be dismissed completely, yet other factors seem to suggest that the major cause of improvements in the nation’s health was not due to a rise in living standards.


Bibliography

H. Jones, Health and Society in Twentieth-Century Britain
V. Fildes, “Infant feeding practices and infant mortality 1900-1919”, Continuity and Change (1998)
F. Bell and R. Millward, “Public Health Expenditures 1870-1914”, Continuity and Change (1998)
S. Szreter, “Economic growth, disruption, deprivation, disease and death” Population and Development Review (Dec 1997)
S. Szreter, “The importance of social intervention in Britain’s mortality decline”, Social History of Medicine (1988)
S. Szreter, “Mortality and public health 1815-1914”, in A. Digby, C. Feinstein and D. Jenkins (eds.) New Direction iin Economic and Social History II (1992)
B. Harris, “Public health, nutrition and the decline of mortality : the Mckeown thesis revisited”, Social History of Medicine (2004)
B. Harris, The Origins of the British Welfare State
J. Winter, “The decline of mortality in Britain 1870-1950” in T. Barker and M. Drake, Population and Society 1850-1980
A. Hardy, Health and Medicine in Britain since 1860

The Suffragettes : Divisive Troublemakers or Unsung Heroines?

By the turn of the twentieth century, the issue of enfranchisement of women was nothing new. Under the leadership of individuals such as Lydia Becker and Milicent Fawcett the National Society for Women’s Suffrage or National Union of Women’s Social Societies all the way from 1897 had painstakingly built up support among members of parliament by respectable constitutional means. Yet these organisations had failed to push the issue into the forefront of the British political agenda. This changed dramatically with the emergence of Emmeline Pankhurts’ Women’s Social Political Union (WSPU) in 1903. This organisation, disillusioned with constitutionalism, would force the issue into the lives of every woman in Britain - mainly through usage of anti-democratic methods. Certainly, the adoption of mass protests, heckling, petty violence, shock tactics and deliberate media attention seeking helped promote the cause of women’s suffrage. From the WSPU emerged leaders, such as Christabel Pankhurst and Annie Kenney who would come to represent the modern, crusading woman, and thus inspire ordinary women around the country to further the cause by joining. The methods of the suffragettes were new and innovative, sensationalising the cause and attracting thousands to its rallies and protests. Yet, the true success of this movement can only be fully established by looking at governmental response. By the start of the Great War, the suffragette movement had died down, indeed many of its leaders underwent a transformation from dissident to patriot. By the time of the first enfranchisement of women, in 1918, the suffragettes were not on the political scene at all, even less so by 1928. Therefore, their role in the actual passage of laws giving women the vote is debatable. Their major success appears to have been in drumming up popular support for the cause through a variety of methods, thus making it eventually unavoidable for the Government to address women’s suffrage.

Indeed, the adoption of militant anti-democratic tactics came some way from a realisation that passive constitutional methods seemed totally ineffective. The campaigns of the militant suffragettes before 1914 are so well known that we tend to regard them as an inevitable element, perhaps the only significant element, in the struggle for the enfranchisement of women. However, this is not entirely the case. Constitutional campaigners for women’s suffrage has won the argument for giving women the vote by converting a majority of MP’s, even before 1900. As a result, the 1897 House of Commons began to vote in favour of bills introduced by back-benchers to give women the vote - this represented a massive achievement for the women’s cause which has traditionally been overlooked amid the notoriety attracted by the anti-democratic suffragette campaign after 1905. This appears to cast new light on whether such militant tactics were altogether necessary and effective. However, importantly, that the politicians sympathy has been aroused did not mean they regarded enfranchisement as a matter of urgency. The Pankhurts’ organisation did not introduce any radical new ideas into the issue of attaining the vote for women, their contribution was to force the issue upon politicians by devising fresh tactics and attracting significant amounts of income into their campaigns. This independence however came only as a result of the organisations split with the Labour Party. Emmeline originally believed the new Labour Party would be the instrument of enfranchisement for women. Yet at the 1902 Conference a significant resolution passed promoting adult suffrage, rather than female suffrage as a priority. Labour men such as Philip Snowden and Glasier believed that a limited franchise to women would disadvantage the Party - indeed, Glasier suspected the Pankhurts’ motives, “they want to be ladies, not workers.” To the new and vulnerable Labour Party, fully endorsing a women’s suffrage movement represented a risky divergence, one which they could do without. Therefore a gulf emerged between constitutionalist suffragists and those willing to experiment with new shock tactics, in order to speed up the process of enfranchisement for women.

Christabel’s misgivings centred around Eva Gore-Booth and Esther Roper, ardent constitutional suffragists who believed in a close alliance with Labour. Christabel remarked, “why are we expected to have such confidence in the men of the Labour Party?” Teresa Billington, another woman attracted to the independence offered by the WSPU commented that not one of the Labour Party’s advocates “were interested in winning women’s suffrage.” Therefore, it was this disillusionment that lay at the foundation of the WSPU. The explanation for the subsequent adoption of militant tactics lies to a large extent with the Pankhursts’ frustration with the Labour Party. These women were already reacting against the constitutional forces for women’s suffrage, and had seen how little it had achieved. However, for years the WSPU ran without any formal organisation, its only real assets were the energy and enthusiasm of the Pankhurts. During 1903-04 the methods used by the WSPU continued to be constitutional and thus not essentially different to the other established suffragists. The fact that no formal plan of action had been devised goes some way towards proving the opportunist nature of the whole organisation. Experimentation with anti-democratic methods first appeared in 1904, when Christabel interrupted Churchill in Manchester’s Free Trade Hall. 1905 proved to be the key year when the WSPU leapt into national prominence and veered sharply away from constitutional methods to the militant tactics for which they were to become famous. This last point is worth highlighting, for it was the militant tactics adopted by the WSPU which catapulted them into national significance, in effect they created the image of the romantic struggle for women’s enfranchisement. The political climate helped Christabel and Emmeline exacerbate their new tactics. The credibility of Balfour’s government had dwindled and expectations of an early general election and Liberal victory escalated. Thus excitement was created surrounding local and national politics and aided the WSPU in their push for recognition. Significantly, by 1905 its membership did not even exceed thirty, therefore it had to make its presence felt beyond its numbers. Emmeline concluded that attempts to gain the vote via back-benchers votes were futile, she twisted thinking towards more direct action that would force the government to make note of the demands of the people. Indeed, the Balfour government had found time to introduce bills dealing with levels of unemployment and the Scottish Churches all because it considered these topics urgent - therefore it was the WSPU’s epiphany to make the issue of suffrage urgent and unavoidable. This accounts for crucial importance in assessing the extent to which the suffragettes militant tactics accounted for the eventual passage of bills enfranchising women in 1918 and 1928.

Christabel wrote in 1905 that the WSPU “was making no headway, our work was not counting.” This emphasises a recognition that mere political passivity would not be enough to force the issue of women’s suffrage. Thus a new wave of interventions were organised, most notable in the Free Trade Hall once again, where banners exclaiming “Votes for Women!” were unfurled. It became apparent that these episodes succeeded in creating a new momentum for the WSPU by adding a human, desperate struggle twist to women’s suffrage. Annie Kenney’s release from prison following the episode was celebrated by a crowd of 2,000 - indicative of the furore the WSPU had managed to build up. By provoking the authorities into creating martyrs of its members, the WSPU was having a bigger impact than any women’s society had ever had. “Twenty years of peaceful propaganda had not produced such an effect” wrote Hannah Mitchell, another of the new militant breed to join with the Pankhursts. Furthermore, The Times in London (which had erstwhile chosen to ignore the women’s cause) covered the events in Manchester. Examples such as this confirm the public success of the suffragette movement - they succeeded in driving the issue of women’s votes into the public domain of ordinary citizens as well as politicians. Additionally, heightened attempts to bait politicians at home and on the platform attracted considerable sympathy, a telling remark concerning the nature of British government comes from the Daily Mirror, “Parliament has never granted any important reform without being bullied.” This quote goes some way towards justifying the anti-democratic measures employed by the suffragettes - that, in some way, making a fuss over the issue would bring it to light in Parliament. The spreading of the movement to London must also be considered highly significant - with this geographical shift from the North came a new social demographic member, many of the suffragettes were now respectable middle-class ladies - which brought not only vital financial income into the organisation but also home the argument that enfranchisement was wanted by all classes of female.

However, this all-out militancy had severe drawbacks, it led to a sense of dictatorial reign by Christabel, leaving no room whatsoever for any sentiments of constitutionalism. It was a full fronted attack upon the system which had chosen not to include them, which sometimes meant the organisation actually attacked its own supporters and politicians sympathetic to the cause such as Lloyd George. Over time this weakened the WSPU and the militant doctrine alienated some of the organisations more well off members. Yet these respectable elements within the organisation had to be catered for, such influx of finance enabled the Union to develop a machine capable of taking on the major political parties. In order to sustain such a high level of organisation, it became necessary to ensure the WSPU was constantly in the public eye. The Pankhursts felt obliged to employ new and more radical forms of militancy in order to retain the impact of their campaign. In arranging more and more deputations and protests, the WSPU was causing a huge political ripple. The response of the authorities played into the hands of the suffragettes, for example in February 1907 after the Women’s Parliament, protestors were confronted by mounted police - such heavy-handedness enabled the women to gain the moral high-ground in their struggle. However, with the succession of Asquith as Prime Minister, the suffragettes prospects deteriorated sharply. This single individual, it can be claimed, held back the tide of the militant campaign - perhaps a less obstinate Prime Minister would have enacted enfranchisement sooner, but that would be to speculate. What can be asserted however is that Asquith’s intransigence directly forced the suffragettes to pursue increasingly radical techniques - therefore the best way to respond to Asquith was to offer unmistakable proof that he was wrong in assuming women’s suffrage still lacked public support. This was evidently shown in May 1908 when a crowd of 30,000 converged on Hyde Park. Asquith’s refusal to accept the vociferous demands of this peaceful protest led Christabel to interpret this as proof that he was deaf to purely peaceful pressure - Union leaders therefore agreed extended militancy was a necessity. Yet Asquith’s strength of character underpins the period up-to Lloyd George’s coalition Government in 1916. Even when faced with public disorder and violence, Asquith remained unshakable in his opposition to the women’s suffrage movement. By 1910 the issue was resolved to a clash between the suffragette campaign and Asquith’s non-moving. Even the introduction of the hunger strike in July 1910 made no change from the government’s position. Christabel felt the hunger strike “has given us new means of entirely baffling the government.” Yet it did not - even Asquith’s condoning of forcible feeding did not enrage public opinion enough to foster a change in the law. Non-conformist Reverend Campbell wrote, “there is something extremely repugnant…in the knowledge that women are being subjected to such violent indignities.” Furthermore, the crisis over the House of Lords in December had distracted attention away from the suffragettes.

The suffragettes had certainly caught the nation’s attention, never more so than after Emily Davison’s suicide at Epsom races in June 1913. Her actions indicated just how far the women were willing to go, and yet the fact that it would take another 5 years for some women to become enfranchised speaks volumes for the overall effect it had. The suffragette movement succeeded in sensationalising the votes for women campaign, it did not succeed in bringing about immediate parliamentary change for the inclusion of women into the franchise. The outbreak of war more or less finished off any momentum the movement had left by 1914. The cessation of the militant campaign involved an admission that militancy had been no more successful in winning the vote than constitutionalism. Emmeline and Christabel, the face of the WSPU, became allies of the establishment, whilst Sylvia and Adela moved further to the Left. The suffragettes had forced the Commons to regard votes for women as a serious matter, this fact cannot be disputed. But war carried such rapid social and political change that by 1917 the issue of women’s enfranchisement appeared in a fundamentally different context to that of the pre-war years. As men left jobs to fight, they were replaced by women. Women were thus doing kinds of jobs that they simply had not done before, for example by April 1918 701,000 women were employed in munitions. The War Office commented in 1916 that women “had showed themselves capable of replacing the stronger sex in practically every calling.” The praise given to women on the home front marked a change in male attitudes towards female enfranchisement. Instead of burning letter-boxes and throwing stones, they were driving the economy of wartime Britain. When the Coalition government took power in 1916 Balfour, Bonar Law, Lord Cecil and Selborne became Cabinet Ministers - all pro-suffragists, with Lloyd George becoming Prime Minister, female enfranchisement’s old foe had at last been removed. Remarkably, Asquith in 1917 noted to the Commons, “How could we have carried on the war without them?” Significantly, the war had changed his most stubborn of minds, not eight years of suffragette agitation. Lloyd George remarked, “the war had had an enormous effect upon public opinion…women’s work in the war has been a vital contribution to our success.” It is possible to argue the war had a more significant impact upon the enfranchisement of women than the suffragette campaign before it. One must recognise that there were more obstacles in the way of the suffragettes, most notably Asquith, in order to make a fair judgement. By the time of the second enfranchisement bill in 1928, Christabel had become a rejuvenated Christian, remarking in 1925, “it would be undesirable to re-open the franchise agitation”. Emmeline’s late involvement with the Tory party undoubtedly accelerated the promise made my Baldwin - and in April 1927 another 5.5 million female voters were added to the franchise. However, there had been no anti-democratic methods used to press for a further extension of the franchise, it had come as a natural progression of government policy. The WSPU neglected to develop a broader feminist agenda on which to campaign after the vote had been won - this helps to explain why the suffragettes failed to survive World War I and neither Emmeline or Christabel Pankhurst saw their future in the women’s movement after 1918.

The suffragettes, along with their innovative anti-democratic methods, will always be regarded as the vanguard of the woman’s right to vote. In 1936, Christabel was honoured with a DBE and six years earlier her mother’s statue was unveiled along with a plaque honouring over 1,000 women who endured imprisonment for the suffragette cause. Therefore there is some sort of popular legacy left behind the women and their methods. However, in the context of the Bills in 1918 and 1928, their anti-democratic methods had long since ceased - it was Britain’s involvement in the Great War which ushered in a new social phase for all British citizens, including the right of women to vote. Yet the plaque and mere name of the Suffragettes will always have great resonance in the formation of the popular conception that women should have the right to vote.


Bibliography

Andrew Rosen : Rise up Women
Susan Kingsley Kent : Making Peace : The Reconstruction of Gender in interwar Britain
Martin Pugh : The Pankhursts
Martin Pugh : Women and the Women’s Movement in Britain 1914-1999
Jane Marcus : Suffrage and the Pankhursts
Christabel Pankhurst : Unshackled : The Story of How we won the Vote