Widening the scope, targeting interventions, creating risk groups: maternal and child health in Denmark and Sweden from 1930s and onwards

Abstract

The subject of this article is the health checks for pregnant women and children in Denmark and Sweden introduced in the 1930s and 1940s. It focuses on how political goals and means have changed up until today. The questions addressed are: Which health issues did the politicians and authorities find relevant to deal with? How should they be dealt with? Who were the interventions targeted towards? It is shown that from the 1970s changes gradually took place in two respects. (1) The scope widened inasmuch as increasingly more aspects were to be included in the examinations and guidance. Not only did they come to comprise the physical, social and mental wellbeing of the children but also the life of the entire family, including efforts to improve the parents' social networks and their ability to handle their relationship with each other. (2) Interventions became increasingly targeted towards those categorised as being in need, either for medical reasons or because they were seen as less capable of caring for their children. Thus, this implied that the universal model of welfare provision was partly abandoned. The categorisations necessitated definitions of normality in more aspects and more surveillance in order to assess whether women and children lived up to the criteria of normality. These two changes were probably inter-related since the urge to target and therefore identify risk groups increased when more resources were invested as a consequence of the widening scope of the activities.

Developmental origins of exceptional health and survival: A four-generation family cohort study

“…Maternal and prenatal care in Denmark has changed considerably over the observation period included in our study. 32 Such changes may have had differential effects depending on whether a child was born into a family with lower rather than exceptional health at baseline. Overlapping birth cohorts between successive generations in our study allowed us to directly assess the intergenerational transmission of the observed survival advantages in restricted samples, without reference to the general population.…”

Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark

“…The vulnerable group can feel that their needs are recognized and therefore creating a starting point for improved communication and patient safety. However, the categorization can also negatively bias the health professional’s perception of this group and introduce stigma [22]. Link and Phelan define stigma as follows: “Stigma exists when elements of labeling, stereotyping, separation, status loss, and discrimination occur together in a power situation that allows them” [26].…”

“…The Danish ANC has been characterized as universal (all women are entitled to the same care), however, with increasing attention to identify and help women considered to be in special need [22]. Thus, introducing selective and targeted approaches and partly abolishing the universal welfare provision.…”

Is the focus on health-related behaviours a new phenomenon?

“…Pregnant women and parents were target groups for extensive health education campaigns that aimed to change their behaviours (Vallgårda, 2003(Vallgårda, , 2008. Literature that gave advice on how to care for infants in order to keep them alive and healthy, however, has had a much longer history (Løkke, 1998: chapter 9).…”

“…Since the 1920s the Danish National Board of Health has published pamphlets in which breastfeeding is a central issue, for advising mothers on how to take care of their infants (Sundhedsstyrelsen, 1921(Sundhedsstyrelsen, , 1999. Pregnant women and parents were target groups for extensive health education campaigns that aimed to change their behaviours (Vallgårda, 2003(Vallgårda, , 2008. Literature that gave advice on how to care for infants in order to keep them alive and healthy, however, has had a much longer history (Løkke, 1998: chapter 9).…”