BUILDING THE NATION THROUGH WOMEN’S HEALTH: MODERN MIDWIFERY IN EARLY TWENTIETH-CENTURY CHINA by Tina Phillips B.A. in Economics, Oklahoma State University, 1990 M.L.A., Johns Hopkins University, 1997 M.A. in History, University of Pittsburgh, 1999 Submitted to the Graduate Faculty of Arts and Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2006 UNIVERSITY OF PITTSBURGH ARTS AND SCIENCES This dissertation was presented by Tina Phillips It was defended on August 23, 2006 and approved by Evelyn Rawski, PhD, University Professor, Department of History Seymour Drescher, PhD, University Professor, Department of History Maurine Greenwald, Associate Professor, Department of History Ann Jannetta, Associate Professor, Department of History Nicole Constable, PhD, Professor, Department of Anthropology Dissertation Advisor: Evelyn Rawski, PhD, University Professor, Department of History ii Copyright © by Tina Phillips 2006 iii BUILDING THE NATION THROUGH WOMEN’S HEALTH: MODERN MIDWIFERY IN EARLY TWENTIETH-CENTURY CHINA Tina Phillips, PhD University of Pittsburgh, 2006 China’s nation-building agenda in the early twentieth century embraced the causes of women’s rights and medical modernization. Modernizers considered the poor health of the Chinese population to be a major impediment to progress. Specifically, modern midwifery would improve the health of the nation at its most fundamental level, both by lowering the high infant mortality rate and by securing the well-being of future generations. Amid growing interest in maternal and child health, women entered the Western medical profession as midwives, nurses, and obstetrician/gynecologists. Local and national governments in China supported midwife training and research for the health of future generations. China’s central government established a National Midwifery Board in 1929 to create and oversee training programs and enact laws to regulate modern midwives and physicians. Medical professionals and associations had enough political clout to transform public health policy. They successfully lobbied for legislation and actively advocated adopting aspects of Western medicine for women. Midwives engendered better and stronger generations by using new methods and equipment. Furthermore, midwife training allowed Chinese women to participate in modernization by joining the labor force, thus challenging traditional Chinese notions of female passivity and seclusion. At the same time, however, these modern midwives displaced the traditional old-style “birth grannies” who had served as social and ritual mediators within the iv family and community. This research examines midwifery and childbirth technologies introduced into China in the early twentieth century in relation to nation building, modernization, and changing gender ideologies. By using biographical data, legislation, and articles in the popular press, among other sources, I explore the changing notions of gender propriety that prompted Chinese women to utilize Western-trained midwives, read literature dealing with such intimate matters as childbirth and prenatal training, give birth in hospitals or maternity clinics, and enter the medical profession as midwives. v TABLE OF CONTENTS PREFACE..................................................................................................................ix INTRODUCTION .....................................................................................................1 CHAPTER ONE. LAYING THE FOUNDATION: MISSIONARY AND GENTRY ATTEMPTS AT MEDICAL EDUCATION AND REGULATION............34 CHAPTER TWO. MIDWIFERY EDUCATION AND CONTROL IN THE NATIONALIST ERA......................................................................72 CHAPTER THREE. THE JIESHENGPO MEET ZHUCHANSHI: MARION YANG AND THE FIRST NATIONAL MIDWIFERY SCHOOL...............116 CHAPTER FOUR. THE PROFESSIONALIZATION OF MIDWIVES IN EARLY TWENTIETH- CENTURY CHINA ...............................................173 CHAPTER FIVE. THE MOTHER AND THE MODERN: MATERNAL AND CHILD HEALTH IN REPUBLICAN PRINT MEDIA.......................207 CONCLUSION..........................................................................................................254 APPENDIX A. RULES GOVERNING THE ADMINISTRATION OF THE FIRST NATIONAL MIDWIFERY SCHOOL..............................................270 APPENDIX B. NATIONAL MIDWIFERY BOARD CONSTITUTION...............271 APPENDIX C. TRANSLATION OF FIGURE 5.7..................................................273 BIBLIOGRAPHY......................................................................................................274 vi LIST OF TABLES 3.1 Curriculum for the Two-Year Midwifery Course of the First National Midwifery School, Beiping, 1932-33 ..................................134 3.2 Curriculum for the Six-Month Midwifery Course of the First National Midwifery School, Beiping, 1932-33 ........................................136 3.3 Curriculum for the Six-Month Course for Graduate Nurses of the First National Midwifery School, Beiping, 1932-33..............................138 3.4 First National Midwifery School Delivery Service ..........................................154 3.5 First National Midwifery School, Morbidity and Mortality of Confined Mothers and Newborn Babies ......................................................167 3.6 First National Midwifery School Clinic Attendance, 1930-1934.....................168 vii LIST OF FIGURES 5.1 Dr. Williams’ Pink Pills........................................................................222 5.2 Chujoto .................................................................................................224 5.3 Health teacher showing the pregnant mother a picture of the foetus in utero ..............................................................227 5.4 Fetal development.................................................................................229 5.5 Monthly position of pregnant woman’s uterus .....................................230 5.6 Mother’s Club, Peking Health Demonstration Station. ........................233 5.7 Good Methods for Protecting Newborns and Infants ...........................235 5.8 Tuqiang Advanced Midwifery School graduates .................................240 5.9 First National Midwifery School class of trained old-style midwives....................................................................241 5.10 Guangzhou Municipal Hospital Report ................................................244 5.11 Visiting bag with equipment for prenatal and postnatal care ...............245 viii PREFACE This work would have not been completed without the help and support of numerous institutions and individuals. I am very grateful for the financial support provided by a Chiang Ching-kuo Foundation Fellowship, an Andrew Mellon Fellowship, U.S. Department of Education Foreign Language Area Studies Fellowships, a Rockefeller Archive Center grant, a University of Pittsburgh Nationality Rooms Scholarship, a University of Pittsburgh History Department C.Y. Hsu Fellowship, and grants from the University of Pittsburgh’s China Council, Women’s Studies Program, and Asian Studies Center. I would especially like to thank Zhang Haihui of the University of Pittsburgh East Asian Library for facilitating research at home and abroad. I am grateful to the staff at the Rockefeller Archive Center, especially Tom Rosenbaum; the Philadelphia College of Physicians; the Number Two Archives in Nanjing; the Shanghai Municipal Archives; the Tianjin Municipal Archives; the Beijing Municipal Archives; the Guangzhou Municipal Archives; the Guangdong Provincial Archives; and the Guangzhou Cultural Library. I would also like to thank Zhongshan University in Guangzhou, which housed me for a significant portion of my research. Friends and colleagues have helped me in so many ways throughout this journey. Ted Johnson, Diana Wood, Liu Shiyung, Elizabeth Remick, Michelle Renshaw, Stefani Pfeiffer, Rebecca Clothey, Frayda Cohen, Vanessa Sterling, and Eric and Carol Lynne Barto all graciously offered scholarly and emotional support. All of my friends in China who are not named, you know who you are, and I thank you wholeheartedly. Finally, my gratitude goes to Kelli Maloy for careful proofreading, though all mistakes are, of course, my own. I have used the pinyin system of romanization throughout, except proper names in which alternate spellings are common, such as Chiang Kai-shek and Sun Yat-sen. ix INTRODUCTION Childbirth changed dramatically in early twentieth-century China. Jieshengpo (接生婆), or “birth grannies” (also called wenpo 稳婆, chanpo 产婆, or laolao 姥姥), were older, married, or widowed women, usually multiparas (women who had given birth to more than one child) with birth experience. Like European or American midwives of the time, they received their knowledge casually from older, experienced women. They wore traditional padded jackets, skirts, and slippers, with their long hair parted in the middle and bound or braided at the back. Over their doorways they hung a placard signifying their profession: “shousheng laolao” (收生 姥姥, granny who attends births) or “jixiang laolao” (吉祥姥姥, lucky granny). Some signs used more colorful language: “kuai ma qing che, mou shi shou xi” (快马轻车，某氏收洗: fast horse and light cart [speedy birth], and cleanup afterwards). The jieshengpo’s responsibilities centered around the birth itself, while pre- and postnatal care were the responsibility of the pregnant woman and her immediate