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Introduction: making modern maternity
In June 2022 when the US Supreme Court overturned Roe v Wade, the 1973 case that legalised abortion across the United States, reverberations were felt across the world. Nearly overnight, more than a dozen American states implemented anti-abortion ‘trigger’ legislation (Nash and Guarnieri 2022), with some simply reverting to the 19th-century laws that first outlawed abortion and could now be reinforced again (Keveney 2022). As we write this, in spring 2024, more than half of US states either outlaw abortion entirely or place so many restrictions on access that most people who need the procedure will not be able to obtain it (Sherman et al 2024). In the US, these laws disproportionately impact Black, Indigenous and Latinx pregnant people (Human Rights Watch 2023), as well as those without the economic means to cross state lines or seek abortion pills illegally (Ali 2022). Overturning Roe has indelibly changed maternity in the United States and on a global scale, and with uneven consequences depending on geopolitical context: the American legal ruling may have prompted France to become the first country to enshrine the right to legal abortion in its constitution (Berlinger and Xu 2024); however, in Rwanda women are still jailed for having abortions; Italian gynaecologists who offer abortion experience harassment (Ferragamo 2024); and India held its first anti-abortion march last spring (Maria 2023).
As Loretta Ross and other Black and Indigenous feminist scholars have argued, abortion access must be understood as intimately connected to every aspect of reproduction and maternity (Ross 2017; Gurr 2015). In a reproductive justice framework, they posit, the right not to have a child is inextricably linked with the right to have a child. Additionally, the rights to birth and parent children in safe, clean and healthy environments and to be assured of bodily autonomy when doing so are all at risk when rights to abortion are undermined. As Ross and Rickie Solinger note, ‘At the heart of reproductive justice is this claim: all fertile persons and persons who reproduce and become parents require a safe and dignified context for these most fundamental human experiences’ (Ross and Solinger 2017, 9). This special issue presents a genealogy of modern maternity across the globe, starting in the 19th century and extending to the present moment, to highlight histories, technologies, materialities and epistemologies that have shaped maternal experiences—as well as broader discussions about who has the right to reproduce—within this overarching context. The individual essays included here reflect on how the construction of ‘modern’ maternity—a racialised and class-based construct, defined in relation to safety, risk, medical management and supervision—has often taken place in tension with the principles of what today we understand as reproductive justice.
From the early 1800s through the present day, maternal experiences writ large have been constructed as ‘modern’ (or, alternatively, positioned as traditional, antiquated, ‘backward’ or somewhere in between), and the tensions that surround this making of modern maternity underscore the political significance of reproduction, pregnancy and birth around the globe. Several of the essays chosen for this special issue confirm the historical argument that multiple scholars of maternity and women’s history have made: the early decades of the 20th century constitute a significant period in the making of modern maternity (Leavitt 1986; Mitchinson 2002; Apple 2006). During this time, as standardisation and scientific management came to permeate so many areas of society (including the medical realm), and as eugenics took hold as a significant cultural force across the Western world (with particularly significant implications for perceptions surrounding family planning and reproductive agency), many of the core ways we still think about pregnancy and maternity crystallised. These emerging frameworks generated an understanding of maternity as fundamentally connected to phenomena such as public health initiatives, medicalised hospital spaces, politicised notions of heredity and an ethos of visibility and legibility, to name a few of the most prominent examples. Importantly, as scholars such as Gloria Filax, Dena Taylor, Brianna Theobald, Jennifer Nash and Angela Garbes remind us, these ideas and practices intersect with racial and class-based identity categories, colonial and nationality structures and issues of individual access and ability (Filax and Taylor 2014; Theobald 2019; Nash 2021; Garbes 2022). It is therefore important to attend to how the dynamics of modern maternity play out in sometimes aligned and sometimes divergent ways within different spaces, populations and time periods.
Indeed, several of the essays collected here resist the argument that the early 20th century contained a cohesive narrative of maternity or that we have solely inherited the white, often eugenicist narrative of maternity in the 21st century. As Victoria Bates, Jennifer Crane and Maria Fannin insightfully note in their contribution, ‘there are always multiple modernities that co-exist at any given time, and modernity itself is often an unstable category’ (Bates, Crane, and Fannin 2024). Within this special issue, readers will find case studies that affirm the status of modern maternity as an increasingly standardised, medicalised phenomenon, and examples and analyses that complicate those ideas and illustrate their nuanced differences when traced through varied contexts and viewed in terms of different communities and their particular values, desired outcomes and levels of agency. For example, one cluster of essays focused on the early 20th century explicitly showcases the influence of eugenics on Western, white conceptions of maternity (George 2024; Gershengorin 2024; Sanderson and Love 2024); another instead illuminates the ways in which eugenics narratives and notions of compulsory motherhood that circulated at this time were anticipated, resisted or refracted in differently racialised or non-Western, colonial spaces (Albrecht 2024; Hemming 2024; Maranhão 2024; Schnur 2024). Furthermore, along with Tiago Fernandes Maranhão’s contribution, Mary Elizabeth Leighton and Lisa Surridge’s analysis nuances the notion of the 20th century as the birthplace of modern maternity; their argument allows us to see how the desire to cast pregnancy according to a standardised timeline was already evident in 19th-century tracking tools that were widely available to both professional and lay audiences (Leighton and Surridge 2024). At the other end of the historical timeline, a range of contributions show us how some of the central ideas of the early 20th century eugenics movement linger in late 20th-century and even 21st-century contexts, where they assume new guises within our increasingly digital technological discourse networks (Cattapan and Mastromatteo 2024; Gregorio and Mantri 2024; Pramanik and Mishra 2024; Xu 2024).
A recurring theme throughout the special issue is agency, a signal that perhaps one of the most important and enduring features of modern maternity is its contested status. As Lynn M Thomas argues, while agency remains a tenacious concept across disciplinary divides, it should not serve as the ‘end point’ of scholarly argument and analysis (Thomas 2016). Indeed, as many of the papers included in this special issue show, people invested in maternity—in the past and present—hold multiple and often contradictory motivations, and agency serves, in many ways, as a terrain on which issues of control, authority and risk must constantly be (re)negotiated. Among the case studies on display here, creative rhetorical assertions of agency from mothers (and mothers-to-be) abound: American women demand pain management interventions even when their doctors question the necessity or safety of the twilight sleep procedure (Sanderson and Love 2024); Indigenous communities in the US Midwest resist federal field nurses’ efforts to promote hospital-based births as a new norm (Sanders 2024); women in modernist literary narratives refuse traditional motherhood roles (Hemming 2024; Schnur 2024); Black and Latinx birthing people feel more empowered during childbirth and in the days after when they have the support of doulas during labour (Gregorio and Mantri 2024); the ‘Big Heroine’ television genre prompts audiences to reflect on contemporary political and social issues and depicts the complex feelings that emerge around modern motherhood in 21st-century China (Xu 2024); and Indian celebrities normalise the representation of pregnancy—and its myriad medical and social ramifications—on film, creating a space for Indian mothers to talk openly about maternity (Pramanik and Mishra 2024).
By contrast, more ‘institutional’ communities also seek to assert control over dominant maternity narratives: 19th-century medical professionals deploy reckoning tables and periodoscopes as normative devices for standardising a typical pregnancy trajectory (Leighton and Surridge 2024); state and medical authorities in Brazil position reproduction as a factor in biological risk related to national defence (Maranhão 2024); European Jewish doctors caution families against relying on ‘grandmothers’ for obstetric care (Gershengorin 2024); 21st-century news and social media direct readers’ focus away from pregnant people and towards the growing fetus in their repeated use of ‘#headlesspreggo’ stock photographs (Cattapan and Mastromatteo 2024), or they promote potentially damaging ‘bounce back’ postpartum behaviour through pervasive online influencer culture (Johnson, Quinlan, and Curry 2024); and Aotearoa New Zealand public health officials frame maternal age as a key factor for women to consider when making decisions about reproduction (Greenhalgh 2024). In fact, the field of public health emerges, across several essays, as a significant source of initiatives intended to shape (and ideally improve) the experience of modern maternity (Albrecht 2024; Errington 2024; George 2024; Gershengorin 2024). These initiatives often blend expert and lay voices, which come together in fascinating ways within specific publications (eg, Vienna’s Die Mutter, in George 2024), around particular objects (eg, the birthing pool, in Bates, Crane, and Fannin 2024), and on emerging communication channels (eg, TikTok, in Johnson, Quinlan, and Curry 2024).
Content and themes
As the catalogue of examples above indicates, the papers included in this special issue explore a breadth of topics as they interrogate the lines of power that define modern maternity across the various guises it assumes. In their individual contributions, authors critically interrogate a diverse body of sources, including medical records, scientific publications, expert advice, training manuals, advertisements, popular magazines and newspapers, other print media, fiction, television, film, qualitative research data and more. The contributors approach their analyses from a variety of perspectives we might group together under the broad term ‘medical humanities’, demonstrating the generative possibilities of exploring maternity across disciplinary divides.
The special issue’s official table of contents runs in approximate chronological sequence, according to the primary period and area of focus for each contribution. When we considered the rich thematic variety on offer, however, several additional organisational possibilities emerged. We therefore are pleased to provide several ‘Alternative Tables of Contents’ as a online supplemental appendix, which invite readers to explore the content according to their individual interests and inclinations. For example, it is possible to pursue a side-by-side analysis of three periodicals (Die Mutter, Folksgezunt, McClure’s Magazine) that emerged at about the same time historically (the early 20th century) but were published in different languages (German, English) for different audiences (the lower-class to middle-class Viennese public; Eastern European Jews; middle-class to upper-class white Americans). While the publications covered similar topics, their juxtaposition allows us to see the ways in which each catered to its specific audience and advanced its particular goals and purposes. We hope that these types of ‘clusters’ foster a generative reading experience and afford readers of Medical Humanities the opportunity to track multiple connections related to ‘making modern maternity’ across time and media.
Supplemental material
Alongside these broader possibilities, we suggest that five overarching themes emerge in the making of modern modernity.
Moral expectations of good mothers
Multiple authors explore the way that modern maternity has developed in conjunction with specific social, cultural and medical expectations about what it means to be a ‘good mother’. Considering 20th-century expectations, Kate Errington discusses how the You and Your Baby pamphlets promoted a specific version of British motherhood over the course of the postwar decades, as the British Medical Association’s popular and wide-reaching advice series called on mothers to defer to medical authority while maintaining responsibility for their home and husband (Errington 2024). Exploring the changing demographics of maternity in 1980s Aotearoa New Zealand, Charlotte Greenhalgh draws attention to the ways in which physicians, public health officials and the media implicitly make arguments about who ‘should’ (and should not) choose to become a mother when emphasising the risks associated with maternal age (Greenhalgh 2024). Tracing how expectations around ‘good’ parenting have evolved in the 21st century, Bethany Johnson, Margaret M Quinlan and Audrey Curry investigate how social media platforms craft narratives about how modern mothers should behave, particularly after giving birth by engaging in postpartum bounce-back culture (Johnson, Quinlan, and Curry 2024). As these articles explore, under the guise of medical authority, media (and social media) impose moral expectations on the behaviour of mothers. This through-line also appears in the articles that analyse texts from earlier in the 20th century (Albrecht 2024; George 2024; Gershengorin 2024; Sanderson and Love 2024).
Complicating maternity through narrative genres
The expectations around motherhood are also shaped by the narratives about motherhood that are depicted in literature, film and television. Matty Hemming describes the way that Nella Larsen’s modernist novel Quicksand (1928) represents modern Black motherhood and draws on Larsen’s experience as a nurse to critique the model of white motherhood that was used as the medical standard in 20th-century America (Hemming 2024). Also exploring modernist literature, Kate Schnur introduces the term ‘unmotherhood’ to describe ‘living outside of motherhood’, and discusses a range of literary depictions of unmotherhood, including in Larsen’s Quicksand (Schnur 2024). Moving closer to the present, Chelsea Xu investigates the Big Heroine genre, and describes how the show Left, Right illustrates the complex and challenging emotions that emerge throughout pregnancy, childbirth and motherhood in the context of the political landscape in 21st-century China (Xu 2024). Pratyusha Pramanik and Ajit K Mishra focus on contemporary Indian films to explore the shift in India from viewing pregnancy as private and hidden to a topic fit for representation, particularly as popular actresses began discussing and showing their pregnancies publicly and representing pregnancy-related issues on film (Pramanik and Mishra 2024). As each of these articles demonstrates, narrative depictions of motherhood across novels, television series and films have provided a platform for navigating the cultural, social and political dimensions of modern maternity by calling attention to how specific experiences of motherhood are often stigmatised or omitted.
Medical expertise, colonialism and resistance
Another central theme across the special issue is the exploration of how ‘modern’ maternity has been shaped by expectations around medical expertise, particularly due to the influence of colonialism and nation-building on motherhood. Challenging conventional periodisations of ‘modernity’ in relation to motherhood, Maranhão unpacks the ‘intricate interplay’ between race and reproductive politics in 19th-century Brazil, contending that discussions of maternity writ large played a crucial role in the ideological makings of the emerging nation-state (Maranhão 2024). Several articles in the special issue also consider how communities resisted colonialism. Moving forward to the early 20th century, Laurel Sanders explores how federal field nurses in the United States championed ‘modernity’ through maternity care; though nurses, often unfamiliar with the Indigenous communities they served, sought to repress Indigenous birthing traditions as part of the settler-colonial project, Indigenous mothers-to-be resisted assimilation and institutionalised medical interventions in a number of ways, exercising self-determination as both pregnant patients and practitioners (Sanders 2024). As discussions of ‘modern’ maternity have often prioritised the experiences of white women, Victoria Gregorio and Sneha Mantri analyse print media to explore how doulas can empower Black and Latinx women and reclaim the childbirth experience (Gregorio and Mantri 2024). Across these articles, we see how medical authority has intersected with eugenics and colonialism to shape broader conceptions of maternity, and how various communities have resisted those influences and asserted the validity of alternative models and narratives.
Scientific motherhood, nation-building and eugenics discourse
A closely related theme is the way that ‘modern’ maternity in the 20th century was frequently equated with ‘scientific motherhood’, an approach that prioritised medical expertise while also often engaging with eugenics discourse. Several articles track the diverse ways that eugenics has shaped modern maternity throughout the 20th century. For example, in her investigation of Mary Rutnam’s influence on girls’ education in Sri Lanka, Jessica A Albrecht notes that Rutnam engaged with eugenics discourse and contributed to white imperial feminism and classism in Sri Lanka (Albrecht 2024). These themes also appear in articles that focus specifically on the role of early 20th-century magazines in defining motherhood, including Ethell Gershengorin’s discussion of how the Yiddish newspaper Folksgezunt incorporated medical authority to define Jewish motherhood as integral to nation-building; Jerika Sanderson and Heather A Love’s analysis of the American periodical, McClure’s Magazine, and how 20th-century proponents of twilight sleep drew on eugenics discourse to encourage more (white, middle-class) women to give birth to more children; and Alys X George’s analysis of the short-lived Viennese periodical, Die Mutter, which balanced professional and lay perspectives as it both engaged with and resisted some of the more typical eugenics-focused approaches of contemporary periodicals (George 2024; Gershengorin 2024; Sanderson and Love 2024). These articles call attention to the diverse ways in which ‘scientific motherhood’ was promoted throughout the 20th century, and how this discourse intersected with nation-building and eugenics rhetoric.
Material and visual cultures, objects, practices
Drawing inspiration from recent projects rooted in the study of maternity through the lens of material culture (Fishar and Winick 2021; Morgan 2022; Weingarten 2023), the articles included as part of this final theme focus on concrete, cultural objects and new forms of visualisation and media that render modern maternity an ever more legible phenomenon. Leighton and Surridge explore how pregnancy was tracked in the 19th century using medical charts that standardised the expected experience of pregnancy as well as the type of risks one could anticipate needing to address throughout the process (Leighton and Surridge 2024). Taking up an even more literally substantial object, Bates, Crane and Fannin provide a cultural history of the birthing pool, arguing that it allowed some birthing people (especially affluent white women) to prioritise the experiential aspects of labour, but that this emphasis on experience was less relevant within socioeconomic and demographic contexts where managing risk and ensuring safety were still key concerns (Bates, Crane, and Fannin 2024). Focusing on the visual trends that have emerged on news and social media over the past couple of years, Alana Cattapan and Danielle Mastromatteo introduce the term ‘headless preggos’ to describe images of disembodied pregnant torsos that are frequently accompany media stories about maternity; they argue that these images problematically centre the fetus rather than the pregnant person, a visual stance with consequential import within our fraught present-day, post-Roe culture (Cattapan and Mastromatteo 2024). Additional engagements with visual rhetoric and material culture appear throughout the special issue (George 2024; Johnson, Quinlan, and Curry 2024; Pramanik and Mishra 2024; Sanderson and Love 2024; Xu 2024), demonstrating the tangible ways in which the objects, images and visually legible patterns that accrue to maternity shape and influence broader societal perceptions, attitudes and behaviours.
Conclusion
The chronological and thematic frameworks we have provided for navigating the special issue are only intended as a starting point for readers, and we recognise that the articles that follow in the special issue can each fit into multiple categories, intersecting in interesting and important ways not emphasised here. At the same time, we recognise there are gaps and oversights, with a single special issue unable to adequately address the diverse ways maternity has been constructed across the globe, in different communities and throughout time periods. Our emphasis on making modern maternity is intended to highlight to readers how both the modern and the maternal are constructions that are neither stable nor singular. Because of this flexibility and fluidity, we hope that readers will find their own threads or connections across the articles, taking these case studies as a starting point for rethinking ‘modern maternity’. We hope that researchers will continue to engage with the multifaceted and conflicting ways that modern maternity is constructed across time, locations, media and objects. Bringing attention to various forms of ‘modern’ maternity can nuance our understanding of the ways that maternity is shaped by objects and technologies, how medical ‘expertise’ is ascribed, how communities (re)claim agency during pregnancy and childbirth and the role of narratives about maternity. From 19th-century England and Brazil to 21st-century China, India and America, ‘modern’ motherhood has navigated, to various degrees, the standardisation and management of pregnancy, childbirth and the maternal body from conception to the postnatal and child-rearing period. The authors who have contributed to this special issue have explored the ‘making’ of modern maternity in myriad ways, and we hope that as you chart a path through their case studies, you find points of connection and resonance that complement, challenge and enrich your own perspectives.
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Footnotes
Contributors W Wood, HA Love, J Sanderson and K Weingarten contributed to the writing and editing of this Introduction.
Funding W Wood's work on the "Making Modern Maternity" Medical Humanities special issue was supported by the Canada Research Chair in the Historical Dimensions of Women's Health (CRC-2018-00338). HA Love and J Sanderson’s contributions to this project draw on research supported by the Social Sciences and Humanities Research Council of Canada (Insight Development Grant 430-2020-00454).
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.