In 2013, up to 25,000 people marched in protest against the plans to close down the Accident and Emergency Department and to downgrade the Maternity Ward at Lewisham Hospital, in south-east London. A key part of this activism – convened by the Save Lewisham Hospital group – was led by a ‘buggy army’. While the ‘army’ was composed of mothers, fathers, grandparents, and carers, all of whom wheeled children’s prams to the Department of Health, mothers were the primary focus of media and campaign attention. Outside the Department of Health, assembled crowds chanted, ‘Lewisham Mums say to Jeremy [Hunt, Health Secretary], don’t you close our maternity’. Coverage on ITV London framed the protest in gendered terms, portraying women who stated that they were ‘upset’ and ‘angry’, and describing the protest as ‘enlisting the next generation to fight to save the hospital’.
Although the buggy army sought to prevent hospital closure, the relationship between mothers and the NHS has been complex since the organisation’s inception in 1948, and mothers have been both beneficiaries and critics of the health service. In the mid-1940s, one of the underlying premises shaping support for Britain’s NHS was that it was created for ‘everyone’. Constructions of ‘everyone’ were interpreted through the lens of the nuclear family. Contemporary news coverage and political campaigning visualised wholesome family groups, and the ‘family doctor’ became a key gatekeeper. Underlying this normative rhetoric, women and children were the most keenly affected by the new Service, because their health needs had been less often met by the prior system of state insurance issued to working men.
While women were significant new recipients of NHS care, the welfare state was also based on a specific model of women’s responsibilities. The Beveridge report, which played a key role in conceptualising the Service, indeed argued that, ‘Housewives as mothers have vital work to do in ensuring the adequate continuance of the British race and of British ideals in the world’. A troubling vision of the role of women in national and international futures, therefore, was ingrained in this report, and its promise of universal health care. The post-war welfare state to an extent assumed that women would be housewives, and that their husbands would contribute to the costs of state health provision. Women’s primary roles would be in creating and mothering children.
By the 1950s and through the early 1960s, mothers began to challenge the maternity services provided in this pronatalist environment, and in particular to lobby for women to be empowered during childbirth. In part, such work was conducted by new voluntary organisations. In 1957, Prunella Briance launched the Natural Childbirth Association, and in 1960 Sally Willington founded The Society for the Prevention of Cruelty to Pregnant Women. This was a new moment in terms of women discussing their experiences of childbirth on the public stage. Significantly, women were beginning to demand that the NHS met their needs – or at least the needs of highly articulate and middle-class mothers.
Briance and Willington drew on their own personal histories to criticise current practice. In a letter to the Observer in 1960, Willington wrote that mothers in hospital dealt with:
loneliness, lack of sympathy, lack of privacy, lack of consideration, poor food, unlikely visiting hours, callousness regimentation, lack of instruction, lack of rest, deprivation of the new baby, stupidly rigid routines, rudeness
(Sonia Willington, ‘Letters to the editor’, Observer, 1 April 1960, 7.)
Newspapers were not always receptive to hearing about women’s experiences, and it took a year for Willington to get this letter published. Nonetheless, women’s encounters with childbirth were aired in a variety of new forms, through newspapers but also in literature such as Sarah Campion’s National Baby (1950). This was a significant moment in histories of activism, and in relationships between state and publics, as new voluntary organisations mobilised women’s stories to challenge established practice. Based on women’s accounts of loneliness, the Society for the Prevention of Cruelty to Pregnant Women argued that mothers should be allowed company during childbirth. The Natural Childbirth Association lobbied for women to have access to information about birth in hospitals and at home.
Significantly, interventions by these groups were not only critiques of childbirth, but of the hierarchies ingrained in state welfare. Willington and Campion both advised that women should give birth in the NHS and yet also criticised the attitudes of medical staff, writing that midwives needed ‘an entirely new attitude’ or had a ‘Hospital Mind’, seeing their own authority as sacred. These mothers further suggested that such attitudes were magnified and bolstered within the NHS, which had reshaped the national and ideological contexts of birth. Briance, reflecting in 1996, stated that a hospital matron told her, ‘This is the National Health Service and you do as you are told.’ The title of Campion’s book, National Baby, likewise suggested that when the state provided welfare, it also gained new methods through which to control women.
Direct criticism was limited in these accounts, which called for change within the NHS, but did not fundamentally challenge pronatalist nor patriarchal thinking. Indeed, Willington wrote in 1960 that, ‘If the future generations and the family units in this country are considered to be important then, as a nation, we should be ready to find the necessary money to provide the best possible investment in positive health’. Further symbolising attempts to work with established medical systems, as well as against them, in the 1960s the Natural Childbirth Association became the National Childbirth Trust, and the Society for the Prevention of Cruelty to Pregnant Women became the Association for Improvements in the Maternity Services.
This brief vignette gestures towards the complex range of relationships that women have held with the NHS as mothers, activists, supporters, critics, and staff. Women have sought to defend the NHS – as in the buggy army – but also, since the organisation’s inception, women have also mobilised their experiences and emotions, often as mothers, to demand that their needs are met within a pronatalist state welfare system. Such tensions – between patriarchy, medical practice, and women’s experiences and activism – were further fuelled and lived in the 1970s and 1980s, and I will explore the NHS campaigning of second-wave feminists and conservative commentators, such as Victoria Gillick, in an upcoming article.