Welfare Problem (Dependent, Defective and Delinquent Classes Series, No. 9, 1920); Ernst Freund, Illegitimacy Laws of the United States (Legal Series, No. 2, 1919). See also S. P. Breckinridge and Edith Abbott, The Delinquent Child and the Home (New York: Charities Publication Committee, 1912); Bernard Flexner and Roger N. Baldwin, Juvenile Courts and Probation (1914): William Healy, Individual Delinquent (1915); Mental Conflicts and Mis- conduct (1917); Honesty: a Study of the Causes and Treatment of Dishonesty among Children (1915); Annual Reports and Proceed- ings of the National Probation Association ; Annual Reports of Massa- chusetts Commission on Probation; Reports of New York (Slate) Probation Commission; Proceedings of National Conference of Social Work, Section on Children. (G. AB.)
CHILD WELFARE. During 1905-21 the question of Child
Welfare became one of continually increasing interest to social reformers.
Before that, the interest in it was mainly from the philanthropic point of view, but the steady decline of the birth-rate in the United Kingdom made it a pressing necessity to endeavour to preserve the vitality of the nation. Though it is true that the efforts to preserve infant life have been in great measure successful, this has not made up, from a population point of view, for the reduction in the number of infants brought into the world; but the most strenuous and successful efforts are being made to minimize the evil. France was in even a more serious condition as regards reduction of population than England and she very early directed her energies towards the encouraging of breast-feeding and the supply of institutions for the supply of good milk known as goultcs de lait, a plan which for a time was followed in the United Kingdom. It was about the year 1905, however, that the system which obtains of home visitation, combined with centres for teaching and helping mothers, began to take firm root in England, and, like so many other agencies for social amelioration, it began through voluntary agencies, in which experiments of various kinds could be freely tried. It is to their credit that the work of assisting the mother and child has been developed as it has, and it is on the lines that they started that the work has been followed up. Hampstead, Westminster and other London boroughs set to work in these early days and the records then begun are now proving most useful with the next generation.
Registration of Births. The necessity for work of this kind depends largely on the keeping of accurate registers, and on their availability. It is only in Great Britain, Germany and France, of European countries, that records of a satisfactory kind can be had. Up to 1837 there were registers of baptisms obtained from churches and chapels, but they were far from complete. After this date registration by the parent was made compulsory within 42 days from birth. This, however, was not sufficient for early visitation of infants and their mother, even could permission to use the registers be obtained. In 1906 Huddersfield obtained parliamentary powers for the compulsory notification of birth to the Medical Officer of Health, and in 1907 a Notification of Births Act was passed which permitted local authorities to adopt a system of compulsory notification, subject to the consent of the Local Government Board. This was given when it was ascer- tained that the adoption of the Act would be followed by the utilization of the information given by a system of home visita- tion. When adopted, the birth had to be notified within 36 hours to the Medical Officer of Health for the district. This Act was largely adopted, and it was made to extend to the whole population in 1915 by the Notification of Births Extension Act. This Act took the important step of giving definite power to local authorities of levying rates for infant welfare work. Before it became law, although Exchequer grants became available, many authorities were unwilling to incur expenditure; much voluntary work was, however, being carried on, births being discovered through the lying-in and other hospitals as well as through district visiting. In 1921 home visitation was largely done by the local authorities, more especially in the provinces. In spite of all that was done beforehand, however, notification has been the key to all welfare work, and it is the carrying of it out in respect both of births and infectious diseases that has allowed such work to develop. The World War proved a great
incentive to this work by bringing home to Great Britain the need for the preservation of the young population.
Infant Welfare Centres. The first task has been to coordinate the work at the Infant Centre and the visitation of the mothers in their own homes. The former were often termed " Schools for Mothers," since they specialized in teaching the mothers what was considered necessary for good motherhood. It was soon found that medical advice was required in addition to the usual classes for cookery, garment -making, etc., and that infant consultations were of little use without helping the mothers to carry out the advice given in their own homes. The medical inspection of school-children showed how essential it was that the alarming conditions that were discovered in children of school age should be dealt with before the child came to school, and, indeed, that it was necessary to go back to ante-natal conditions. Some of the advanced health centres had already realized this fact and were carrying on that work. It was brought home to those interested that the work required was preventive far more than curative, and that the whole social condition of the family was involved the health and habits of the parents, sanitation, and general surroundings. Above all the housing question was, it was felt, intimately bound up with this question. The task was now to link up, so far as might be, the various ameliorative efforts that were being made with the end of better- ing the chances for the infant, as well as the agencies for invalid aid, country holidays and so on for the child. It is certainly true that curative work is required as well, but the child welfare movement primarily aims at bringing into the world a healthy population and endeavouring to preserve for it healthy and natural conditions. At the same time it must be in touch with hospitals and other directly curative agencies.
Though every birth may be notified to the Medical Officer of Health, some (about 20%) are not as a rule visited. Visits are usually made about 14 days after birth, since before that time the mother is being attended by a midwife or doctor. A record card is presented in each case, and this has to be carefully filled in. This card is preserved and kept up to date till the child goes to school, when the information it contains is invaluable to the school medical officer.
The "Centre" varies in size from two rooms to many. There are now many large buildings devoted to the work, in which there are not only the waiting rooms and doctor's rooms of the old days, but also a weighing room, toddlers' room, where the older children are looked after while the mother is engaged at classes or otherwise, perambulator shed, and an open-air shed where the children can sleep. Then at a large centre there is a dental room, a pre-natal con- sulting room, and frequently observation wards, where sickly chil- dren can be kept for a time under notice. This involves nurses and servants' accommodation. Sometimes there. is also accommodation for mothers. Then a day is often given up for the medical examina- tion of older children under school age. Thus a large centre has become a varied conglomeration of activities, and it probably has small branch centres dependent on it, so that no mother may have more than a short distance (saty a mile) to walk. Much stress is laid on the matter of clothing, and every effort is made to obtain the best patterns for the clothing of both infants and mothers and older children and then to get the mothers taught to use them. A system of card-indexing for record is adopted, so that all information is easily available. For the classes (cookery, mending, cutting-out, etc.) a trained teacher isoften, and in the large centres usually, employed. In addition, lectures on health matters are given to the mothers as well as to voluntary or other social workers. Ante-natal work brings the welfare work into touch with the work of doctors and midwives (see NURSING), and though in some cases it leads to midwives being appointed for the work of the centre, the usual plan is simply to see that the woman in some manner secures adequate and suitable provision for her confinement. If a medical examination is required by a midwife for her patient, although the power to pay doctors' fees was conferred by the Maternity and Child Welfare Act of 1918, the arrangements for providing it are very limited, and the woman therefore often prefers to take advantage of the opportunities offered at the Child Welfare Centre. At these centres nursing mothers are sometimes provided with dinners, though there is a difference of opinion as to the desirability of doing this. Under the Act just quoted these dinners may be paid for from the rates. The provision of milk has also been frequently carried out. The first form of milk used was that which is known as "pasteurized," and it was followed by dried milk, which is often bought wholesale and sold at cost price. The question of how far milk depots are desirable, and
