⏐ IMAGES OF HEALTH ⏐
Nothing to Work With but Cleanliness:
The Training of African American Traditional
Midwives in the South
| Sheena M. Morrison, MPH, and Elizabeth Fee, PhD
THE PRACTICE OF MIDWIFERY
came under public scrutiny dur-
ing the 1910s when Progressive
reformers collected birth and
death statistics to agitate for
diverse ideas of health reform.
Physicians tended to attribute
high infant and maternal mortal-
ity rates in the United States to
the “unsanitary and supersti-
tious” practices of traditional
midwives. At a time when most
women gave birth at home,
medical and public health profes-
sionals argued that getting rid of
the midwives would yield notice-
able improvements in maternal
and infant care.
By the early 1920s the terms
“granny,” and “granny-midwife”
were synonymous with black
midwives in the rural South. In
Northeastern cities, midwives
were largely displaced by physi-
cians working in hospitals; many
women considered hospital
births the “modern” and “ad-
vanced” form of delivery. But
midwifery persisted in Southern
rural communities, where the
majority of African American
midwives practiced. Few physi-
cians—white or black—were will-
ing to attend births for the two
or three dollars per delivery that
midwives would accept. (Indeed,
midwives would sometimes be
given a chicken as payment
or not be paid at all.) African
American mothers also preferred
238 | Images of Health | Morrison
home births to hospital deliver-
ies because they could avoid
the prejudice and discrimination
they often experienced in White
society.
Finding they were unable to
eradicate midwifery, reformers
compromised by making tradi-
tional midwives register with
local health departments to ob-
tain a permit and attend classes
at local midwife clubs and state
training institutes. Midwife clubs
supported and also regulated A midwife
i if training
i i iinstitute
i being
i conducted iin a church. Photograph by E.S.
S
midwives. The nurse-midwife or Powell, for the South Carolina State Board of Health, circa 1940. Courtesy of the
public health nurse instructed American College of Nurse-Midwives Archives, National Library of Medicine.
her pupils to maintain the clean
and sterile standards required for
practice. Midwives were expected
to be “clean in person, home,
and equipment,”1 and to wear
a white cap and white starched
apron over a clean dress. They
were to carry properly stocked
black leather bags; these bags—as
well as the midwives’ homes—
were inspected for cleanliness.
Classes at state-sponsored mid-
wife institutes were taught pri-
marily through demonstrations,
role playing, and songs because
most traditional midwives had
little formal education.
The 1921 Sheppard–Towner
Maternity and Infancy Protection
Act provided matching funds
to state health departments for
C i women andd their
Community h i bbabies
bi attending
di a postnatall class.
l Ph
Photographh bby
midwife training programs. The E.S. Powell, for the South Carolina State Board of Health, circa 1940. Courtesy of
states established training and the American College of Nurse-Midwives Archives, National Library of Medicine.
regulatory programs in which
American Journal of Public Health | February 2010, Vol 100, No. 2

public health nurses taught mid-
wives to use sterile procedures,
register new births with the state,
use silver nitrate eye drops to
prevent gonococcal blindness,
and seek physician assistance
for difficult cases. The top
image shows a midwife training
program being conducted in a
church. State health officials may
be seen in the front pew; ranked
beside and behind them sit the
public health nurses and the mid-
wives in their white aprons.
Midwives trained under the
Sheppard–Towner Act and later
with funding from the Social
Security Act (1935) served as
February 2010, Vol 100, No. 2 | American Journal of Public Health
⏐ IMAGES OF HEALTH ⏐
educators to expectant mothers
and community residents in
African American communities
throughout the South. As com-
munity health educators, they
encouraged women to seek pre-
natal and postnatal care, accom-
panied them to clinics as needed,
and explained the nature and sig-
nificance of the visits. In the bot-
tom image, community women
and their babies attend a postna-
tal class. African American mid-
wives actively promoted health
by sponsoring child immuniza-
tion clinics in their homes, pro-
viding nutrition education, and
notifying public health nurses of
bedridden residents in their com-
munities—as well as by delivering
healthy babies. Traditional mid-
wives became a vital force in the
federal government’s efforts to
improve the health of African
Americans.
Author affiliations
Sheena M. Morrison is a PhD candidate in
the Department of Sociomedical Sciences,
Mailman School of Public Health, Colum-
bia University, NY. Elizabeth Fee is with
the Division of the History of Medicine,
National Library of Medicine, National
Institutes of Health, Bethesda, MD.
Correspondence should be sent to
Sheena M. Morrison, 3805 Kansas Ave
NW, Washington, DC 20011 (e-mail:
smm65@columbia.edu). Reprints can be
Brown and Fee | Images of Health | 239
ordered at www.ajph.org by clicking on the
“Reprints/Eprints” link.
This article was accepted September
23, 2009.
doi:10.2105/AJPH.2009.182873
Contributors
Both authors wrote the article, which
is based on an exhibition for Black
History Month curated by Sheena M.
Morrison and displayed in the History
of Medicine Division, National Library
of Medicine.
Acknowledgments
Thanks to Michael Sappol, PhD, for his
assistance.
Reference
1. Mississippi State Board of Health.
Manual for Midwives. 1948;8.
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