The sorry state of motherhood in post-industrial societies
In some important ways, things are better now
By many measures, mothers in contemporary post-industrial societies like the US and Europe have it good. Maternal mortality in the United States was about 33 deaths per 100,000 in 2021, and we are far from being exemplary. In many other post-industrial countries like the UK, Australia, New Zealand and Finland, the rate is closer to 5 or 10 in 100,000. In contrast, evidence from contemporary hunter gatherer societies and archeological records suggests that maternal mortality in the Paleolithic was closer to 1 in 150, although estimates vary widely and anthropologists continue to hotly debate the numbers. In short, women are probably about twenty times less likely to die in childbirth in contemporary post-industrial societies than they were in the Paleolithic. Most of these deaths were probably due to obstructed labor, hemorrhage, infection and other tragic and painful means.
By the same token, we have radically decreased infant mortality rates in the last few centuries. According to the CDC the infant mortality rate in the United States in 2022 was 5.6 infant deaths per 1,000 live births. Other post-industrial countries have done even better in this regard. For instance in the UK in 2021 it was 4 per 1,000 and in Finland it was 1.5 per 1,000 in the same year. In the Pleistocene, however, more than half of children died before their 15th birthday, and 20% perished within the first year after birth.
Most of the improvement in maternal and child mortality have occurred very recently - within the last century. For a long period of time following the transition away from a nomadic foraging lifestyle to sedentary agriculture, the rates of maternal mortality actually dramatically increased, even as child mortality rates remained roughly the same. Archeological evidence shows that some early agricultural societies had maternal mortality rates as high as 30%, compared with less than 1% in the Paleolithic. This was likely due to closer interbirth intervals, younger age at first birth, and frequent malnutrition and stunted growth (including stunted pelvic growth) that became far more common following the shift to agriculture. This rate dropped back down to about 1% in post-industrial societies in the 1950s, following trends in better nutrition and sanitation practices, but poor obstetric and delivery practices still claimed many mothers’ lives. The rates only began to decrease substantially after 1930 due to medical advances. In the 1960s, the legalization of induced abortion contributed to an 89% decline in deaths from septic illegal abortions (though I am afraid we are actively backpedaling on this bit of progress). Sadly, rates of maternal mortality in this country are once again on the rise, and rates for Black women and other minorities are growing disproportionately.
Child mortality took a longer time to decline. As late as 1950 child mortality was still a staggering 30% in America, and only reached its current low level in the last few decades (see chart below).
But mothers are suffering in this country
In short, we have gained a lot in the last century. The stark differences in maternal and child mortality are enough to convince me that there was never a better time to be alive, and yet many mothers in contemporary post-industrial societies are suffering in ways that would probably have been extremely rare in the Paleolithic. Perinatal mood disorders now affect nearly 20% of women in the United States, and 17% of women worldwide. These disorders are defined as any kind of severe mood or anxiety disorder appearing in women from conception to within the first year after birth, and may include depression, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and postpartum psychosis. Unfortunately, many perinatal mood disorders go undetected until it is too late. Death from “psychiatric causes” has become a leading cause of maternal mortality in many Western countries, including the United States. Mostly these are death by suicide, but increasingly they include deaths from drug overdose associated with an underlying mental illness. From 2010 to 2019 there was a 190% increase in drug-related deaths of mothers in the postnatal period.
Even when they do not lead to suicide or overdose, maternal psychiatric disorders are a source of much suffering for mothers and are frequently associated with adverse psychological and developmental outcomes in children. Children of depressed parents may be more likely to experience depression themselves in adulthood, thus perpetuating a vicious cycle.
Furthermore, rates of perinatal mood disorders are probably underreported, due to a combination of surrounding stigmas and difficulty in accessing psychological help. More than 80% of mothers will experience some form of baby blues in the postnatal period and in many cases this will turn into a longer, recurring mental health issues from which the mother will suffer, undiagnosed. I was personally never diagnosed with postpartum depression, but in the year after my daughter was born, I fantasized about suicide on my darkest days. Sometimes it seemed like the only way out of the crushing responsibility of parenthood and the endless loop of exhausting days and nights - in short, the only way to rest, to opt out. I no longer have these fantasies, but I hate to think what might have happened if I had had an oxycontin prescription with a bottle full of easy-to-access pills in my child-locked nightstand drawer.
Other mothers, who would never qualify as having an official mood disorder, whether diagnosed or not, are simply overworked, overwhelmed, exhausted, anxious and sad. There is accumulating evidence to suggest that in most contemporary post-industrial societies around the world, parents are less happy than non-parents. Interestingly, this gap is most pronounced for White women, as compared with Black and Latino women, probably due to a combination of complex factors such as resilience in the face of stressors, support from family and community, and perhaps the relative opportunity cost of parenthood. The United States has the largest parent happiness gap of any OECD country, and countries with better family policies, such as paid time off and childcare subsidies, have significantly lower gaps.
Abominable support for parents
The stories of mothers in this country being forced to return to work, still bleeding and broken from birth, at a time when both mother and baby are desperate for continuous contact with one another, are heartbreaking. The United States is one of only six countries worldwide offering no paid parental leave, and only about 20% of mothers have access to paid leave through their employer. One in four women are returning to work within two weeks of giving birth, citing financial necessity as the primary reason.
In a recent article published in The Guardian, one mother shared her experience of returning to her job as a waitress working night shifts two weeks after her C-section delivery, carrying heavy trays, on her feet all evening, praying that her c-section scar would not reopen, for $4.25/hour, to help pay the family bills. She would get home from work and take over childcare duties from her husband so that he could go to work during the day. I find it ironic that a British newspaper would be the one to publish this article, which goes to show how little attention this issue is getting here at home.
I get so angry about our lack of support for mothers in this country, I see red. I can’t believe it’s not even on the ballot most of the time. We talk endlessly about abortion, but where’s the conversation on support for mothers once they do have a child? Our treatment of mothers in this country is inhumane. We have stripped women of the social support we evolved to rely on over tens of thousands of years, by forcing them far from family and into single-family homes with proximity to work, out of economic necessity, and then we fail to compensate for that lack of family support through state-funded programs. We engage in this endless, pointless debate on social media about the drawbacks and merits of going back to work or staying at home with your children, pitting women and mothers against one another, as if it were a choice. Most of the women being forced to return to work would gladly stay home if they could.
Sick of girl-boss feminism
The other thing that I have a negative visceral reaction to these days is the you-go-girl, boss-bitch brand of feminism that we have all come to associate with the modern take on the movement. Don’t get me wrong, I believe women deserve equal pay for equal work, and the fight to allow women’s participation in the workforce was an important one. A woman who earns her own money has more influence on household economic decisions, invests disproportionately in her family and children’s well-being, and is more able to leave an abusive or failing marriage. She is not, however, any less likely to take on the lion’s share of housework. Study after study has shown that women who earn more than their male partner still do vastly more domestic labor. At some point, the feminist fight for a woman’s right to workforce participation became an obligation for women to do it all - paid work, domestic work, and childcare - alone.
Research has shown that following women’s entry into the labor force en masse in the 1960s, real wages for households began to stagnate and have continued to flatline to the present day. Whereas one salary used to be sufficient to support a family, now mothers must return to work out of financial necessity, and with no support from the government. Yet we still allocate a disproportionate amount of our attention and energy to the “issue” of women’s unequal participation in the labor force - as if this is the most important indicator of a successful, gender-equitable society. The Economist has been pushing an article to the top of my Instagram feed titled, “Where is the ‘motherhood penalty’ greatest?” By “penalty” they mean that far fewer women participate in the labor force compared with men (52% versus 95% worldwide) and - wait for the shocker - up to 80% of the difference can be explained by mothers leaving work after the birth of their first child. The article goes on to discuss the economic benefits for countries and employers of reducing this gendered employment gap, in terms of GDP. Nowhere in the article is there any discussion of choice and support for women whether they chose to return to work or stay home. This is the state of modern feminism: force mothers back into the labor force before they are ready, out of dire economic necessity, offer them zero support, and then cheer when the macroeconomic indicators show an uptick in female labor force participation and GDP.
What I am trying to say, in so many words, is that while we have certainly improved the odds of survival for mothers and babies, we have not improved the quality of life. We have lost the right to rest, to care for our bodies, the right to support, to time spent in close contact with our babies, to time spent relaxing with friends - all things that were a normal part of daily life for our Paleolithic ancestors (studies have repeatedly shown than regardless of gender or the age of their children, parents in these societies spend 30-40% of their daytime hours just chilling out - more on this to come).
Our mental and physical health is suffering, and it is costing lives. Why are so few of us challenging this model? I believe part of it has to do with the staunch American faith in progress, and the erroneous belief that, across all indicators, no matter how hard it is, it must be better now than it ever was. By some measures, it is. Afterall, we have cars! We have Costco! We have television and reclining chairs! We have modern medicine! My question is, what have we given up in the process, and if we knew, would we be more likely to advocate for change?