Varieties of Maternalist States: Health Politics in Interwar US and Japan

• In Event: Does the State Work for the People?

Abstract

Throughout most of human history, maternal and infant mortality rates were appallingly high. The interwar period witnessed an increasing state intervention into maternal and infant health to build a large healthy pool for future soldier recruitment. My project analyzes this understudied process of state-building, asking why states established different health institutions to protect mothers and infants, and what the long-term effects of different institutions are.

The United States and Japan, two rising world powers in the interwar periods, were the major cases of analysis. The two countries learned from the European experience of World War I that future wars would be total wars and they must get prepared. The two cases capture a wide spectrum of institutional possibilities. The American state regulated infant health as a stand-alone health question regarding health as a universal citizenship entitlement regardless of citizens’ socioeconomic backgrounds (the stand-alone health approach). However, in regulating maternal health, the American state integrated the health question with the wealth and race questions, improving maternal health through social aid and attaching maternal programs with poverty-relief taboos (the health-combined-wealth approach). In contrast, the Japanese state regulated maternal health via the stand-alone health approach and regulated infant health through the health-combined-wealth approach.

Why did different countries establish different health institutions? Also, why did a country develop very different institutions to govern the highly correlated maternal and infant issues? By tracing archives of bureaucracies, health professionals’ associations, and public health organizations, I show how two kinds of emerging bureaucracies in the early twentieth century — public health and social welfare bureaucracies — competed for jurisdiction over maternal and infant health issues, interacted with the powerful medical society and the rising public health professionals, and produced different maternal and infant institutions.


What were the long-term effects of different health institutions? By analyzing a panel dataset of maternal and infant mortality rates in the interwar period, I find that comparing the health-combined-wealth approach, the stand-alone health approach worked better in reducing maternal and infant mortality rates and resulted in lower health inequality. There is also qualitative evidence showing that the health-combined-wealth approach deepened social division along class or racial lines, enhanced the power of traditional social elites, and preserved the patriarchal order. In contrast, the stand-alone health approach enhanced the women-dominated public health professions, encouraged women to participate in local governance, and weakened the existing patriarchal order.

This project integrates topics of state-building, public health, and gender into a new perspective of state formation in regard to protecting mothers and infants. The institutional history of maternal and infant health is still relevant today. Whether to integrate public health questions with other social questions (i.e., poverty, race, and unemployment) and how to integrate these questions still dominate today’s policy debates. This paper helps understand the development of health institutions and shows the long-term influence of different institutions from perspectives of health, social cleavages, and gender relations.

Author

• Nuannuan Xiang