The New Midwives: Nineteenth-Century State Intervention in Reproduction

Among the great shifts across the march of the nineteenth century we see the rapid rise of state intervention. Beyond just the use of economic mechanisms in expansion and development, the state’s most daring frontier became the decidedly modernist bent of moulding its citizens into a more desirable shape. The rise of public schools, with nationally planned and managed curricula being the most obvious example. Interestingly, this process occurred alongside the rapid professionalization of scientific disciplines. Indeed, the latter was very much part of the former. After all, as historians of science, like Roy Porter, have emphasised, it was structural transformations that facilitated this professionalisation, barring scientific practice behind doors of formal training and regulatory institutions.

The training and regulation of midwives provides an insightful look at these phenomena, as this was the period when they were increasingly professionalised in many countries. Cases as disparate and yet similar as the Ottoman Empire and the Netherlands provide us with a useful overview of the various motivations involved in turning domestic reproduction into a public moral concern. For the former it emerged as a notedly imperial anxiety about population disparities against a backdrop of increasing internal pressure for Westernisation, fomenting a struggle against autonomous domestic and legal spheres. In the latter the Dutch state constrained itself to its role in domesticating enduring rural ways of life in conformity with bourgeois modernity. As we will see, it was more than just repression that facilitated this dramatic expansion into everyday life. A look at the work of Louis Althusser, a twentiethcentury French philosopher, might be useful to understand these dynamics.

The Ottoman ruling class suffered increased anxiety over Muslim population stagnation compared to their Christian counterparts. This led them to try and remove the right to abortion, as part of the Tanzimat reforms, commenced over the early nineteenth century. This proved easier said than done, due to the peculiar institutions of Islamic law. Though not independent from the state apparatus by any means, the Shari’a legal system retained an autonomous character – basing itself on judgements and interpretations separate from the whims of empire. This proved inconvenient for the reform project, since the legal school prevalent in the Ottoman Empire, the Hanafi School, ruled that a woman had the right to abortion, as long as she had her husband’s permission. A situation reflecting the autonomous sphere of domestic life in Muslim households, where women had agency and room to manoeuvre, though ultimately under male authority.

With limited options, the state had to direct its efforts into managing this domestic sphere by professionalising midwives to reflect state values and ideology. Perhaps more so than in the West, midwives played a critical role in all roles relating to the coming of children, through acting as central parts of the rituals of pregnancy, birth and after birth social initiations. This influential role curiously also meant that they were the main practitioners of abortion. As a result, starting with the first school of its kind in Constantinople in 1842, midwives were educated in the ever increasingly powerful influence of medical science coming westwards. Beyond just the emphasis on hygiene and infant mortality, the trainees were also instilled with strong sentiments against abortion as an immoral action. In great part this was inspired by certain Sufi mystic strains that had already become prevalent among the ruling class. Regardless, the combination of real improvements in infant mortality combined with stricter state regulation and licensing, made the efforts a great success in supplanting the old midwives in the capital. Successful enough in fact to be later sent out and expanded into the provinces.

That said, though these measures were successful to a large extent, population increase did follow, they remained unsatisfactory to both the Tanzimat era and later Young Turk leadership. Representing the real limitations of their power, but also the enduring practice of women seeking abortions, which after all remained legal and fairly widespread. It would take until Atatürk’s general secularisation and westernisation programme, starting in the 1920’s, that abortion was finally criminalised, on the same populationist grounding like the century prior. It would take until 1975 before this was repealed, reverting it back to a law essentially identical with the former Hanafi practice, a woman has the right with the husband’s permission, testifying something to its social memory. In any case, the Ottoman state struggled and ultimately succeeded, after its metamorphosis into the Republic of Turkey, in consolidating the formerly autonomous domestic and female spheres into an integrated secular framework. These efforts to change civil society indirectly, more so than raw coercion, shows the need for greater reflection on this topic.

We find a different view in a similar situation in the Netherlands. There the state was spared similar concerns about abortion, long since criminalised with the then autonomous religious institutions acting as head opposition to the practice, rather than its pragmatic defender. Instead, the anxieties around enduring rural traditions must be understood as urban ruling class concerns about backwardness in the countryside. By the early nineteenth century midwives had acquired the reputation in the cities for being unhygienic and instilling superstitions in mother and child. This practice was widespread, remaining active in the Dutch countryside well into the early twentieth century. Its longevity was tied to its role in close-knit, community practice. The women participated in the spirit of helping out fellow women, from mutual obligation and a form of good will: a picture strengthened by the fact they, for the most part, were older, local widows of similar status to their clientele. This was unlike the professional ones, who were usually younger, unwed and from the urban middle and lower-middle classes.

State encroachment into the sphere of rural ways of life, took a similar form to the Ottoman example through professionalising midwifery with new training institutions and regulation about who could and could not practice. Legislation came in the form of the Medical Laws of 1865, which reshaped the space of gendered medical practitioners. Only licenced, i.e. trained through medical school, midwives and the male doctor could manage childbirth, with former practitioners or surgeons and lay midwives banned from the practice and liable to criminal persecution if they did do so. This legislation was enforced using inspectors. It is worth noting that such disciplining also applied to licensed midwives, amounting to negligence, unauthorised drug inducement, and even abortion. The latter being few, but distinct among the professionals who were connected to the Neo-Malthusian League, with quite the opposite concern of the Ottoman rulers.

Many historians, like William de Blécourt, have been sceptical of the effectiveness of the new regime, arguing instead that it was the gradual penetration of health infrastructure into the countryside that ended the practice of lay midwifery. That said, any criminalised repression would have established an oppressive backdrop for gradual social shifts, not to mention that the new midwifery should be merely one of several state-initiated processes for the reshaping of the countryside into acceptable bourgeois domesticity. After all, not only midwives but lay medical practitioners and healers, who tended to be male, were also prosecuted by the medical laws. This centralising angle is worth thinking about because, after all, lay midwifery had existed with unified approval from doctors’ authorities in many local communities, having been an accepted part of the rituals of childbirth. In any case, this process sheds further light on the relationship of professionalisation with centralising state control over previously more autonomies communities and ways of life: a link that will need further examination.

Perhaps the most interesting system for thinking about this is Althusser’s theory of state apparatuses. In Althusser’s view, the state is a machine. A machine that produces power: converting class violence and domination into seemingly neutral legal power. This machinery operates as three distinct, though not exclusive apparatuses: the political, the repressive, and the ideological.  The political are the institutions of state government: the monarchy, head offices, the parliament, etc. The repressive apparatus are the institutions with the power of violence, or the threat thereof, including the army, police, and so on. The ideological state apparatus concerns itself with instilling compliance in its subjects, justifying and legitimising ruling class domination inherent in state formation. Among these would be the education system in its various forms, often religious institutions and more recent institutions, like television broadcasting. As Althusser points out, all state institutions contain elements of all three, though one is usually clearly dominant, with the exception of the legal system, which remains both truly repressive and fundamentally ideological.

With this schema in mind, the efforts to professionalise midwifery appear as a means to expand the role of the ideological apparatus into new sectors of the population and expand the scope and role of state involvement in society. In the Ottoman case this also involved infra-state conflict, with the political apparatus struggling to reign in the autonomous ideological apparatus of the legal system. This gives us a much clearer insight into the process, as one where state apparatuses shape existing heterodox and autonomous communities into their pre-conceived ideological notions of what they should be. In this case, through the increasing professionalisation of knowledge previously integrated into everyday life. The gendered dimension to this is critical, with existing female knowledge and experience disciplined and restricted into knowledge systems commanded by the, essentially male, political and medical establishment. In large part dissolving the domestic sphere into the public one to gain command of domestic reproduction. Hence, altering existing societal reproduction into a more streamlined and regulated social space, forming the basis for increased national consciousness and identity. The new midwives of the nineteenth century therefore offer us a valuable glimpse into the forces involved in the creation of present reality, with a hint to potential futures.

Written by Inge Erdal


Althusser, Louis. “Marx at his limits.” In Philosophy of the Encounter: Later Writings, 1978-1987, translated by G.M. Goshgarian, 7-162. London: Verso, 2006.

Blécourt, William de. “Dutch difference? The prosecution of unlicensed midwifes in late nineteenth-century Netherlands.” In Gender and Crime in Modern Europe, edited by Margaret L Arnot and Cornelie Usborne, 44-74, 189-203. London: UCL Press, 1999.

Foucault, Michel. The Birth of the Clinic: An Archelogy of Medical Perception, translated by A.M. Sheridan. New York: Pantheon Books, 1973.

Demirci, Tuba and Selçuk Akşin Somel. “Women’s Bodies, Demography, and Public Health: Abortion Policy and Perspectives in the Ottoman Empire of the Nineteenth Century.” Journal of the History of Sexuality Vol 17, No.3 (2008): 377-420.

Porter, Roy. “Gentlemen and Geology: The Emergence of a Scientific Career, 1660-1920.” The Historical Journal, 21 (1978): 809-839.

Mossucci, Ornella. The Science of Woman: Gynaecology and Gender in England, 1800-1929 Cambridge: Cambridge University Press, 1990.

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