“Cut off in the prime of their usefulness and activity”: maternal mortality rates in Belfast during the first half of the twentieth century (Kirkpatrick History of Medicine Award 2025 winner)

This blog post was written by Dr Caitlín Smith, PhD graduate of Ulster University and one of the winners of the 2025 Kirkpatrick History of Medicine Award. The award encourages engagement with the history of medicine in Ireland. Dr Smith was asked to write about her winning piece of research, which looked at maternal mortality in Belfast during the first half of the twentieth-century.

In 2020, I began researching infant mortality rates in Belfast during the First World War for my MA dissertation. While the focus was on infants, I referenced the care their mothers received during pregnancy, childbirth, and the post-natal period. It was this additional research that made me realise 1) that pregnancy and childbirth brought serious risks for girls and women across Belfast in the early decades of the twentieth century and 2) that very little attention had been given to this important area of women’s lives. This led me to pursue a PhD at Ulster University on the development of maternity care in Belfast during the twentieth century. This research, conducted between 2021 and 2025, focused predominantly on the experiences of pregnant girls and women across the capital of Northern Ireland. It looked at the development of ante-natal care, childbirth experiences, and the rates of maternal mortality throughout the twentieth century.

Maternal mortality rates- the number of women dying in, because of, or following pregnancy and childbirth- in Northern Ireland were strikingly high throughout the first half of the twentieth century. This was despite the gradual reduction of these rates in many countries from the 1930s. Indeed, a Northern Irish Labour Party MP, Mr Sam Kyle, argued in 1929 that “it is four times as dangerous to become a mother in Ireland as it is to work in the mines of Great Britain.”[1] Belfast had been chosen as my city of focus because of the high proportion of women making up its population. In 1901, women made up 53.7% of the population, with 1,290 adult women to every 1,000 adult men. On top of this, by 1901 women headed over one quarter of Belfast households. Between 1901 and 1926, they made up 40% of the workforce in the city, mainly concentrated in the linen industry, where three of every four workers was a woman.[2] Belfast also had the highest percentage of women in waged work in Britain and Ireland at this time.  Belfast was a “woman’s city” during the twentieth century. Therefore, these high mortality rates that I was analysing had the ability to impact a large section of the city’s population.

I researched different causes of maternal deaths in Belfast, including deaths from puerperal fever, puerperal sepsis, and haemorrhages following childbirth. These were listed in a report on maternal mortality and morbidity in Northern Ireland, published in the 1940s, as preventable causes of deaths among women during childbirth. Indeed, infection and haemorrhage represent causes of deaths among a group of patients that may not have died if not for parturition. One explanation given for the high rates of deaths from these complications was the role of birth attendants. Handywomen, those who were unqualified as midwives but offered to assist women during childbirth, were often associated with maternal deaths from puerperal infections. For instance, the Belfast News-Letter in a report on puerperal fever in September 1911 suggested that deaths from puerperal fever were “proof of the baneful effect of allowing unqualified practice to be carried on in the city.”[3] Now, it is a possibility that handywomen were unfamiliar with, and therefore unlikely to, carry out sanitising measures. However, little attention was placed on doctors who also attended women in childbirth and could therefore spread the illness. Indeed, although the Belfast News-Letter blamed handywomen, it failed to recognise the role doctors played in the spread of puerperal fever in the city.

One thing became abundantly clear while conducting this research and writing my thesis, and that was how ‘officials’ in society and certain medical professionals viewed this topic of women’s health. My talk for the Kirkpatrick Award was entitled “Cut off in the prime of their usefulness and activity,” quoting Belfast’s Medical Officer of Health in 1931.[4] Such assertions display the attitude of some medical professionals toward women; their ‘usefulness’ was linked firstly to surviving pregnancy and childbirth, and secondly, to being good mothers. Alongside this, the sources I relied on to understand this topic of women’s health were predominantly investigations into maternal mortality, government records, records of the Belfast local authority (the Belfast Corporation), various annual health reports and investigations into patient deaths. As a result, the voices that were  being heard and written about in the thesis were generally those of various authorities and are often male. Rarely did the voices of women who were pregnant and gave birth during the twentieth century in north of Ireland/Northern Ireland come to the fore. Despite this, I focused on highlighting how women were at a disadvantage in Belfast in terms of maternity care and chances of dying because of pregnancy and childbirth, putting them at the fore of this research.

Thus, over the course of completing my PhD, it became clear that both politically and medically, women’s health was not dealt with as it should have been. Women died from preventable causes during childbirth, and blame was placed on those who held a weak position in the medical hierarchy. My talk for the Kirkpatrick Award allowed me to discuss the inadequacy of the medical care given to mothers in Belfast during the first half of the twentieth century, and put them front and centre.