Author’s note
Introduction
PART ONE: Coming into the World
1. The Douglas Babies
2. Born to Fail?
3. In Sickness and in Health
PART TWO: Coming of Age
4. Staying Alive
5. Older and Wiser
6. Opening Up
PART THREE: Coming Full Circle
7. The Millennium Children
8. Bridging the Divides
Epilogue: Where are They Now?
Bibliographical Notes and Sources
Acknowledgements
Follow Penguin
To Ashby, Lynton and Edwin, my life project
This book is about the British birth cohort studies, a remarkable series of longitudinal studies that track generations of babies from birth to death. The cohorts span over seventy years of British and scientific history, have generated a vast range of books and academic articles across many disciplines, and have involved hundreds of scientists. This book gives just a flavour of that work. Much of it is based on over 150 interviews that I conducted over the course of five years with scientists, science administrators, cohort members and others connected with the studies. I have also drawn extensively on academic publications, as well as press clippings, historical archives and other research.
The identity of people in the cohort studies is confidential and fiercely guarded by scientists. I was able to talk to just a few people who had previously revealed that they were cohort members or were willing to do so for this book, and who allowed me to write about them. In some cases, their names and other details have been changed at their request. All the data on the cohort members is meticulously and securely stored, as are the biological samples they have donated, some of which are discussed in this book. The samples are kept in facilities that meet the approval of the Human Tissue Authority, a government regulatory body.
For simplicity, I have often mentioned only a cohort director or project leader in connection with a project or piece of research, even though science is almost always a group endeavour and others may have played vital roles in the work. And regarding the number of people in each study, I have stated the number of children at its outset, but the figures used vary in the scientific literature and change over time as people die, drop out or join up.
The birth cohort studies in Britain and around the world comprise a huge scientific enterprise − and this is just one book. Please forgive its many omissions. I urge anyone wanting to know more to explore the rich academic literature, or to talk to the scientists – the real experts − themselves.
In 1985 a young woman set out on a road trip around Britain to answer a burning question: why is it that some people succeed in life and others struggle or fail? The idea was not a new one: scientists and academics have been trying to understand all the factors that shape our lives and place us on particular paths for centuries. But this young woman, Doria Pilling, had an extraordinarily powerful way to answer this obvious yet seemingly unresolvable question: a remarkable study that was following thousands of people and charting the multitudinous details of their lives from the moment they were born.
The study had started in 1958, when scientists had carefully recorded the birth of nearly every baby born in Britain in one March week: 17,415 babies in all. They had been carefully tracking the lives of those children ever since, recording their height, health, intelligence, school performance, social class, and later their jobs, marriages and almost everything else. And, by doing this, the scientists had already discovered something profound: the children born into the most disadvantaged circumstances – the ones with poor parents and cramped homes – tended to have difficult lives from that point on, gradually racking up behavioural problems, illness and poor results at school. So troubled were these children that scientists had given them a label of unmitigated despondency: born to fail.
But luckily, life is never quite that simple, and no generalized label will cover every eventuality. The scientists knew that not all the children who were ‘born to fail’ would, in fact, do so. It was very likely that some would beat the odds, and the scientists were eager to discover who they were and how they had managed to avoid the outcomes that had been predicted for them. What is the combination of events, decisions and circumstances that can help turn things around? By the 1980s the researchers were in a good position to find out. At that stage the children had reached their twenties, and had progressed far enough in their adult lives for a judgement to be made about their success or failure, based on their educational qualifications, income and jobs. This was the project handed to Pilling, who, at this time, was still learning the ropes of her scientific profession. It became her job to find members of the study who had grown up in the most difficult of circumstances but who were now doing well in life nevertheless.
Pilling decided on the exact criteria that identified children who were ‘born to fail’. She decided that a child would qualify only if he or she had grown up in a household that had one parent or five or more children, and whose income was low enough for the child to receive free school meals or welfare benefits, and lived in a home that did not have its own supply of hot water or that housed more than one and a half people per room. To put that final category into real terms, it meant that a family with just a kitchen, living room, two parents in one bedroom and four children sleeping in the other would not qualify as being overcrowded; a family with five children crammed in the second bedroom, however, would. Pilling found 386 such severely disadvantaged children in the study.
The majority of these children did indeed go on to struggle in some way – they achieved no educational qualifications, or they had a low income or no job. Pilling put these together into one group, the non-achievers.** But she was also able to identify ‘achievers’ − those who had escaped from this difficult start and had attained some measure of success. Either they had earned qualifications, such as a string of O-levels, that put them well above the average for the entire group, or they had secured a particularly high income, a skilful job, or done well enough to buy their own home. Out of her pool of 386, Pilling found 83 who made it into the achiever group. Her next task was to talk to both the achievers and the non-achievers, in order to find out what their lives were really like. So she began her journey around Britain – by train, bus and taxi − to meet these people whose lives had taken a dramatically different course and to discover what exactly had brought this about.
It took Pilling about a year to carry out all the interviews and, since this was the 1980s, she recorded them all on cassette tapes. When she was finished, she had not only to analyse her many hours of recordings, but also to look back through all the data collected up to that point – the stacks of questionnaires, interviews and other records relating to these young people that had been carefully squirrelled away throughout their lives. She wanted to find whatever it was that the achievers commonly did – and that the others did not.
A few key characteristics floated to the top. First, typical achievers had parents who were interested in their child’s education and who had aspirations for their child’s future. Pilling found, for example, that 56% of those who had achieved good educational qualifications had parents who had wanted them to stay on at school, whereas only 11% of the non-achievers had parents who had stated these ambitions.
But her analysis showed that there was more to success than that. As well as ambitious parents, the achievers were likely to have had an ambitious school behind them – the combination of interested, aspirational parents and schools appeared to be a powerful cocktail when it came to children getting ahead. A typical achiever was also less likely to have difficulties at home, such as a sick parent, an unemployed father or separated parents. Another important factor was location. The achievers tended to live in areas with opportunities to find employment, and the non-achievers in areas where industry had been closed down, so the parents, and later the child, often struggled to find a job. (Pilling was travelling the country during the Thatcher years, at a time when manufacturing was on the wane and the unemployment rate was soaring; it reached a peak at nearly 12% in 1984.)
Children can do nothing about these things: they can’t choose their parents, schools or circumstances at home. There was, however, one other important way in which the achievers differed from the rest – something over which they did have control – and that was motivation. A typical achiever was more likely to want to complete their schoolwork and continue in education − and they were often determined to escape into better circumstances than they had experienced as a child. One achiever was so set on finding an apprenticeship that he had worked his way through the Yellow Pages, trying every company until he found one willing to take him on. But motivation on its own was not enough. Many people in the non-achievers group were equally determined to escape, but without the combination of the other factors − the encouragement of parents and school, stability at home and the availability of jobs − they just couldn’t break away from the adverse conditions of their upbringing.
Pilling summed up her findings in a book called Escape from Disadvantage, which was published in 1990 – ‘a sort of neglected book’, she calls it now. That’s because at the time it came out, the book barely ruffled a feather. It joined the thousands of academic volumes that are published each year and then quickly go out of print. But today scientists view her study as one of the most powerful and positive findings that this remarkable study of 17,415 people has ever produced. It did nothing to negate the idea that disadvantage at birth does, on average, have a profound effect on the way that the rest of life plays out. But it did clearly show that those born into disadvantage were not necessarily destined to fail – and it identified concrete ways a child who had endured a tough childhood – or, indeed, any child at all − might prosper and thrive as an adult.
Most importantly, Pilling’s book showed that fascinating discoveries emerge when scientists do something as simple as follow people carefully through their lives. This method – called a birth cohort study – has real power to reveal truths about the world and to bring about change.
Britain has an amazing collection of birth cohort studies: scientists here are carefully following the lives of five generations of children. These studies are unique in science and unparalleled elsewhere in the world; no other country has anything like it on the same scale. Their findings fill over 6,000 published papers and forty academic books – of which Pilling’s is just one slim volume − and the results have rippled out to touch almost everyone in Britain today. They are also one of Britain’s best-kept secrets: they have woven themselves quietly into the fabric of our lives, yet hardly anyone appears to know about them beyond the scientists working desperately to keep them alive.
The first cohort study was started just a few months after the end of the Second World War, when scientists recorded the births of almost every child born in one cold week in March 1946. They have been following 5,362 of them ever since, in an extraordinary feat that has now become the longest-running study of its type in the world. These people – who turn seventy in 2016 − are some of the best-studied people on the planet. The story of this birth cohort could easily fill a book on its own. Yet this was just the start. Buoyed by their success, researchers started to follow another 17,415 children, born in one week of March 1958, exactly twelve years after the start of the first study. Then, twelve years later, they started a third, which tracked 17,415 children, born in a week of April 1970. Scientists established a fourth study in 1991, and then a fifth as the millennium turned. This means that over 70,000 people, spread across successive generations and throughout the British Isles, have been the subject of intense scientific scrutiny.
These studies have amassed mountains of information – including rooms choked with paper questionnaires, terabytes of computer data, freezers full of DNA, and cardboard boxes stuffed with fingernails, baby teeth and slices of umbilical cords all carefully preserved. There is even a storage shed containing 9,000 placentas, pickled in plastic buckets. Together, these records chart the lives of ordinary British people in painstaking detail as they lived through the tumultuous decades after the Second World War.
The findings from these studies have been both prolific and far-reaching. In the 1940s they helped to shape the fledgling National Health Service, resulting in better care for pregnant women and helping to improve outcomes in all future births. Through the 1950s, 60s and 70s, they showed that bright children from working-class backgrounds were unnecessarily falling behind at school, and they exposed the lasting impact of divorce on children. They showed that our growth and development in the womb can affect our risks of disease decades down the line – and even how long we are likely to survive.
More than anything else, however, the birth cohorts have shown that the first few years of life deeply influence all the years that follow. Children who were born into wealthier or higher-class families have been more likely to do well in school and higher education, land good jobs, stay slim, healthy and mentally sharp. Those born into disadvantage, on the other hand, have been more likely to struggle on every score. In short, our parents’ circumstances have a lasting impact on ours, and this seems to be as true for the children born in 2000 as it was for those born in 1946. At the same time, the cohort studies have revealed that some routes to escaping disadvantage do exist – as Doria Pilling’s study demonstrated. Things as simple as talking to children, reading to them and having ambitions for their future may help to ameliorate some – though not all − of the difficulties that come with a disadvantaged start. These discoveries are as relevant now as they have ever been, because disadvantage shows no signs of going away.
The foresight of scientists in starting these studies, and the results that pour out of them, have made the British birth cohort studies the envy of scientists round the world. ‘Nothing comes close in value to the mighty British longitudinal surveys that track cohorts of babies, observing everything that happens from cradle to grave,’ wrote journalist and social commentator Polly Toynbee in a 2008 report.
I first learnt about the birth cohorts in 2010, sixty-four years after the first study baby had been born. I was working as a science journalist and editor in New York, interested in human stories – and I came across the 1946 birth cohort, the first in the series, as I was googling around for ideas. I called Diana Kuh, the current leader of the study, and spoke to her for an hour on the phone. In that time, she talked me from the study’s origins as a ground-breaking survey of births just months after the end of the war right up to its present investigations, as the thousands of people in the study approached retirement age. ‘It’s the best study in the world in my view,’ she told me. I immediately saw that this was an amazing story that should be told.
But I also knew that I didn’t have time in which to write it, because I was dealing with the challenges of my own life – and my own generation. I was born in Colchester in 1973, and had followed a love of science and of writing into a career in journalism – but now I was exhausted with a more-than-full-time job on a science magazine and two young children at home. What’s more, the week after that phone call, I was due to pack up my life in New York and move back to the UK. I had to find a new house, new nursery, new school and become reacquainted with Britain, which felt very different to the country I had left eight years before. A new government had just been elected, a major austerity programme was biting, and university students were protesting about the introduction of tuition fees. I had neither the time nor the energy to research a big story about a British cohort study; taking on another commitment would be insane.
But, as I was to learn, birth cohorts cast a potent spell. So, in the end, I did decide to tell their story. I worked late nights and early mornings writing a long feature about the 1946 cohort, which came out in the first week of March 2011. I attended the sixty-fifth birthday party for that cohort, which Kuh held the same week. It was the first time most people there had met another member of the study; everyone was tipsy on wine and thrilled that the study had survived that far. These were all ordinary people leading ordinary lives, but together they added up to an extraordinary piece of science that had produced an incredible legacy, one that, I realized, deserved to be more widely known. And, with that thought, the idea for this book was conceived.
That birthday party marked the start of a five-year journey that has taken me through libraries, laboratories and living rooms. As I researched the history of the cohorts, I talked with geneticists, economists, epidemiologists and statisticians. I peered into boxes of human teeth and freezers full of urine; I thumbed through stacks of punch cards just like those on which the cohort data was once laboriously stored.
I also found myself an unwitting beneficiary of the studies. Just as I was learning about how the cohort studies had helped to usher in better maternity rights and medical care, I became pregnant and gave birth to my third son – thus experiencing some of the care and maternity leave that the scientists’ work had been instrumental in creating. When I avoided alcohol and ate fish during pregnancy, it was partly because results from the cohort studies had contributed to this essential prenatal advice. When I read to my children every day, I knew, because of the cohort studies, that this was generally an excellent thing to do; and when I worried about my precarious balance between work and children, and about never being able to afford to buy a house, I knew, because of the cohort studies, that all these concerns were typical of people born in 1970, around the same time as me. My work on the cohort studies had become an illuminating frame of reference in which to view my life.
At the same time, I discovered that, ever since their inception, these valuable studies have always teetered on the brink of extinction – either through lack of money, or through the shifting winds of scientific fashion and political support. The story of the British birth cohorts is therefore one of a struggle for survival, and the heroes of that story are the remarkable scientists who have fought for them, many of whom I have been fortunate enough to meet in the last few years. It is only because of their belief, commitment, stubbornness, charm and eccentricities that the cohorts have been able to bring their benefits to the world, though the world at large has remained unaware of the extent of their achievement – until now.
The birth cohorts are one of Britain’s
greatest national treasures – even though they are quirky, at times farcical, run
on the cheap and eternally fraying at the seams – in other words, quintessentially
British endeavours. And the credit that they deserve is long overdue.
Helen Pearson
October 2015
On 5 March 1946, at a time of day that no one can recall, a baby girl forced her way out of the body and on to the bed of Gertrude Mary Palmer. The baby, to be called Patricia, was a sturdy 9 lbs 2 oz, and that Palmer had borne four children before this one didn’t lessen the pain of the birth. It hurt that bad, I nearly died, Palmer would tell her daughter years later.
She told this to the health visitor too, the woman who arrived at her door a few weeks later to talk to her about Patricia’s birth. The health visitor might have made the mistake of going to the grand front door of 3 Wolseley Terrace, in Cheltenham, before realizing that there was no bell for the basement flat where Gertrude Palmer lived, and that she had to walk around the house to a low, heavy door that opened off a scrappy lane at the back. Once she was inside and sitting at the large kitchen table, the health visitor opened her bag and pulled out a soft pencil and several sheets of foolscap paper, filled with typewritten questions and marked STRICTLY CONFIDENTIAL. She told Palmer that thousands of mothers all over the country were being asked these questions, and that by answering as accurately as she could, her experience would greatly help the authorities to plan better maternity services for future mothers. Then she checked her watch and started to read out the questions. Palmer dutifully answered them all.
Yes, Palmer said, the baby was legitimate. No, she wasn’t working when she started this baby. She just looked after the children and the house, and helped her husband to stoke the boilers that warmed the telephone-exchange offices above the flat, which they did in return for subsidized rent. The baby was born at home, she said, and a midwife had come to help with the confinement. About two days after the baby arrived, Palmer explained in answer to the next query, she was fit enough to do a full day’s work again around the house. She knew that women who gave birth in hospital were expected to stay in bed for two weeks, but she saw no point at all in that. No, she certainly didn’t have any domestics helping her: she could do the work much better herself. Palmer had grown up in service, and although the deliveries of coal and wood for the boilers meant that dirt bled into the flat, she insisted that she kept everything just so. Who looked after your husband while you were in bed, the health visitor asked her. He jolly well had to look after himself, Palmer replied.
Next, the health visitor wanted to know about any other children, and Palmer told her that she had two alive and two dead. There was Ken, who was already sixteen, and Derek, who had been robbed of his twelve-year-old life by rheumatic fever at Easter time and whose memory still made her teary at that time of year. The third child was seven-year-old Edith, the fourth child had been stillborn, and then baby Patricia made it five. She hoped there would be no more after that. How many rooms were there in the flat, excluding the kitchen and scullery, the health visitor wanted to know. Three – two bedrooms and a large living room. The bath was in the kitchen and the lavatory was outside. And had she received her full extra ration of a pint of milk during pregnancy? Yes, she had, and she’d made very sure to get her allocation of orange juice and cod liver oil too.
Now nearing the end of the form, the health visitor asked about how much the pregnancy and birth had actually cost. How many vests, napkins, petticoats, bootees, bonnets, shawls, knickers and rubber sheets had she bought for the baby, and how much had she spent on each? Palmer had spent very little, she replied; the baby was perfectly clean and comfortable in her sister’s layette. And she had spent next to nothing on smocks, corsets, nightdresses, knickers and brassieres for herself, she said, as the health visitor carefully noted it all down. As she came to the end of the list of questions, the health visitor asked what her husband did in the way of work. Patricia told her that he was a labourer for a building company. What she didn’t say was that sometimes she had no money, because he would spend his wages at the pub and the betting office before he came home.
By this time, the two women had been talking for around half an hour. The health visitor closed the questionnaire, tucked the papers into her bag, and they exchanged a few more niceties. Then Palmer showed her to the door. Once the health visitor was gone, Palmer got back to her routine. She needed to offer the waking baby her breast, settle her, check the boiler, scrub the floors and make supper for her husband, as she always did − perhaps cold meat, chipped potatoes and, because puddings were her speciality, a lovely spotted dick.
Gertrude Palmer was not the only new mother being interviewed by a health visitor as spring breezed into Great Britain in 1946. Just a few months earlier, a group of scientists in London had decided to try to interview the mother of every baby born in England, Scotland and Wales in the same week. The scientists wanted to understand what it was like for British women to go through pregnancy and bring a child into the world at that time, ten months after the end of the Second World War.
The scientists knew that surveying a week’s worth of births would involve quite a lot of babies – around 17,000, in fact. No one, in the history of science, had ever attempted to collect such detailed information on such a large group of mothers and babies; indeed, few scientists had attempted to interview such a large group of people at all. The study would be completely unprecedented in its scale and ambition – if, that is, they could get if off the ground. That job had fallen to a man called James Douglas, a 31-year-old doctor who was working out of a small office at the London School of Economics. Douglas didn’t have much in the way of staff, apart from his loyal assistant, Griselda Rowntree. He didn’t have much money for the study either, and the cash he did have would run out in two years. He also didn’t have anything so luxurious as electronic calculators, computers or e-mails to help him out, because none of those had yet been invented. But he had plenty of energy and a firm belief that he could succeed in pulling off a colossal survey of births.
Before doing anything, there were some practical decisions to be made. Most pressingly, Douglas needed a group of people the size of a small army to go out to interview the mothers. Ideally, they would have good access to the women and their health records, and have an intimate knowledge of the ‘mothers’ problems’, as he put it, which was a euphemism for the uncomfortable and gory business that accompanies a pregnancy and birth, most of which was considered a private, vulgar topic at the time. Luckily, health visitors perfectly met all the requirements. These women, who were generally trained nurses or midwives, were already sent out to check on the health of all mothers in Britain shortly after a child was born. This meant that, conveniently for Douglas, they could do the work in the course of their duties.
Next, Douglas needed to set the date of the survey. He and his colleagues had decided to survey all the births in a single week because it would be a quick way to obtain a random sample of all births across the country. But which week of the year should he choose? He wanted to employ students to help analyse the completed questionnaires on the cheap, so he realized that it had to be early in the year, before the students left on their summer holidays. He chose the week of 3–9 March 1946. He also decided that the health visitors should wait about eight weeks after the births of the babies before they interviewed the mothers. This interval, Douglas wrote later, ‘was considered to be long enough for the mother to have returned home, purchased layette, pram, &c., received bills for the confinement, and made arrangements to take her baby to the infant welfare centre.** On the other hand, details of her expenditure and experiences during pregnancy and the lying-in period would still be fresh in her mind.’ Douglas put together a trial version of his questionnaire, and asked health visitors in Bristol, in Kensington and in rural Inverness to test them out on mothers, who seemed delighted that anyone was taking an interest in their ‘problems’. Now if he could just scale everything up, it looked like the survey might very well work.
By this point, it was February 1946 and the birth week was dangerously close, but Douglas didn’t let the pressure show. He sent out typed letters to 458 local authorities across Great Britain, addressed to the medical officers of health, who kept a register of new births and oversaw the health visitors. ‘I should be most grateful if you would inform me at your earliest convenience whether you will be able to cooperate in this study,’ he wrote in the clipped tone of his time, enclosing a stamped-addressed postcard to ensure a speedy reply. Almost all of the officers sent them back saying that they were happy to help. Douglas then dispatched packets of questionnaires and a detailed ‘Memorandum on the Procedure’, which explained exactly how health visitors should complete the survey and told them to take particular care to reach all mothers, including those who would not normally see a health visitor for the simple, terrible reason that their baby had died.
With everything now in place, all Douglas needed were a few thousand babies to turn up, and they did. When the designated week arrived, bitter winds were bearing down on the country, and the south of England was blanketed with snow. But the babies, of course, didn’t care about the state of the world on their birth days. Nor did they care that everything about their births was about to be recorded on one of Douglas’s forms, or that the form would mark the start of a life that would be more scrutinized by scientists than almost any that had gone before. And so, eight weeks later, a throng of health visitors started to fan out across Britain, knocking on the doors of the mothers – of whom Gertrude Palmer was one.
Some mothers slipped through the net. There were quite a few war brides who emigrated to America with their soldier husbands before the health visitors showed up. In some other cases, the health visitors were turned away, particularly by unmarried mothers whose babies had been adopted or who were anxious to conceal the birth. One woman said she had no time to spare because of the bomb damage to her house and the seven other children under her feet. But most of the mothers didn’t dream of saying no. They were all used to doing what they were told during the war, and they felt it was their duty to carry on doing their bit.
In the end, the health visitors interviewed a remarkable 13,687 mothers – wrapping in 91% of the babies born that week. The completed forms were handed back to the medical officers of health, who posted them back to Douglas. By the end of June, the accumulating questionnaires were starting to form papery towers on his desk and floor. ‘We have found the completion of these records most interesting,’ read a letter from the health officer in Hull that accompanied the forms. ‘The health visitors have undertaken the work most willingly, feeling that they are making a contribution to a piece of work that can be of great value.’
He had no idea how right he was. This colossal, overambitious maternity survey initiated a train of events that would touch the lives of everyone in Britain, and that would be venerated by scientists internationally over the course of time.
Douglas’s maternity survey did not emerge from a vacuum. Its origins can be traced back to a group of thinkers who met for the first time in London on 15 June 1936. It was called the Population Investigation Committee, and it had come together to discuss one of the most hotly debated scientific and political issues of the day: the lack of British babies.
Up to the mid 1800s, the average woman in Britain had some four or five children, but then the birth rate had started to fall, to the point that by the 1930s she would bear just two or three. If you plotted this on a graph, the problem became obvious when you extrapolated out the line. If the trend continued, Britain wouldn’t have enough people to sustain and rule the British Empire, which at that time encompassed about a quarter of the world’s population. This anxiety was a big topic of discussion by demographers of the 1930s, who studied human populations, and was captured in publications such as The Twilight of Parenthood (1934) and The Struggle for Population (1936). ‘Unless people decide to have larger families,’ warned one particularly hysterical commentary, ‘it will go on diminishing until there is no one left.’
While extinction of the British was one possible and rather unlikely outcome of falling fertility, another was that it would drive the country into intellectual decline. That’s because those having the most children tended to be working-class people who, according to one idea, tended to be less intelligent. The fear was that the clever middle and upper classes would gradually dwindle away, swamped by a rampant proliferation of working-class fools. This was a major concern of the eugenics movement, whose aim was to discourage those considered to be physically or mentally undesirable from having children. (These were not extreme views for the time: the British Eugenics Society was a thriving group in the 1930s, and it included many politicians and academic heavyweights.) The lack of babies had also become of interest to doctors and medical researchers, although for different reasons. Compounding the fertility problem was the alarmingly high death rate for babies born in Britain. This was heart-rending for families who lost a child, and a national embarrassment for the obstetricians and gynaecologists, whose job it was to deliver them safely.
It was as a result of these fears that the Population Investigation Committee came into being. It aimed to ‘examine the trends of population in Great Britain and the Colonies and to investigate the causes of these trends, with special reference to the fall of the birth rate’. Thanks to its close links to eugenics, the group met regularly in the genteel white-stuccoed premises of the Eugenics Society, at 69 Eccleston Square. That this committee included demographers and sociologists on one side and doctors and medical scientists on the other made it all the more interesting, because it bridged two broad categories of academic research: the social sciences (the study of human behaviour and society) and the life sciences (the study of living organisms, including us). Today, scientists would say that the Committee was interdisciplinary.
At the Committee, social and medical scientists found common ground in their concern about births. But, for all their broad expertise, it must have been tricky for this gathering to talk about fertility at a time when any discussion of sex, contraception and abortion was desperately awkward. (Nothing on these matters was included in the final maternity survey – which today seems an almost absurd omission from a survey about reproduction.) So the Committee talked about other options instead. Were women put off by ‘the unsatisfactory conditions of confinement’, they mused, such as a lack of hospital beds or the pain of labour? Or was it that the expense of having children had spiralled out of reach? ‘There are reasons for thinking that the medical and other costs associated with the birth of a baby may today be a serious deterrent to parenthood,’ the Committee wrote.
But how much of a deterrent was it? Hardly any studies had tried to add up the total cost of having a child. Before and during the war, the costs of medical care were covered through a patchwork of private, public and charity funds – which meant that, basically, people got whatever medical care they could afford, and if they couldn’t afford it they often went without. Although many pregnant women were entitled to government maternity grants of approximately £2 and a few other financial hand-outs, these were thought to be pretty paltry sums. The Committee continued to debate the fertility issue all through the war years, until, at some point, its members reached something of an epiphany. They realized that they just didn’t have the information to know what was putting parents off. They needed to go out and actually talk to mothers, both poor and rich, from across the country. They needed a national maternity survey – a major investigation of British births.
By the end of the war, the idea of such a survey had gained traction, and the Committee members had drummed up a few thousand pounds to get the study off the ground. The group had already employed a young demographer called David Glass to coordinate research for the Committee, and he soon became a major champion for the study on the social sciences side. But they still needed a good hands-on man to run the survey. A medical man would be good, because he would understand all the issues around pregnancy and birth. Ideally, he would also have experience of conducting massive scientific surveys of people. Glass knew someone – a promising doctor he had met in Oxford through mutual friends. Douglas – doctor, scientist, charmer and idealist – fit the bill perfectly.
As the son of a clergyman, Douglas had grown up attending several church services a day, and the expectation was that he would be a priest or a missionary. But he didn’t want to be either. Douglas was attracted far more by the cool, hard facts offered by science and medicine than by the untestable ideas of religion. In 1932 he joined Magdalen College in Oxford to study physiology and medicine – and there he was drawn into the invigorating company that cemented his faith in science and nurtured his social ideals. He was taught by J. Z. Young, just as the young biologist was starting his work investigating the electrical pulses on the spaghetti-thick neurons of the giant squid; he was friends with Peter Medawar, who went on to win a Nobel Prize for his studies of immunity. He mingled with left-wing thinkers; he played viola and he all too frequently broke hearts. There was something about Douglas’s rangy body, prematurely receding hairline, brains and infectious charisma that would make women fall for him at the drop of a hat. He was, in the words of one of his many female friends, ‘quite devastatingly beautiful’.
By the time Douglas had finished his medical training, however, he found that a seemingly intractable problem was attached to his chosen profession: he found some sick people to be terrible, self-obsessed bores and medical practice to be hierarchical and depressing. After qualifying, he spent a few months delivering babies in London’s East End, which was so squalid that it was once described as ‘the hell of poverty’; yet it opened his eyes to the miserable conditions into which so many babies were born and which quickly caused their deaths. He became convinced that he didn’t want to spend his life clearing up nasty messes like these. Instead, he wanted to find out what made people ill and then prevent them from ever becoming so in the first place. In practical terms, this meant moving away from applied medicine and into the world of medical research.
At Oxford, Douglas had fallen in with Solly Zuckerman, a dynamic South African zoologist who hosted dinner parties packed with intellectuals. Zuckerman carried out animal experiments to try to understand the reproductive system in mammals, and for a while Douglas joined him in his cramped laboratory, where they studied such things as the menstrual cycle of monkeys and intersex conditions in pigs. When the war broke out, Zuckerman and other prominent scientists became concerned that the military effort was not being properly guided by scientific research, which, they argued, could help build better tanks, heal wounds, improve agriculture and a host of other things. Zuckerman was given permission by the Ministry of Home Security to start a Research and Experiments Branch (later Department) in 1939 − a crack team of scientists based in Oxford and assembled to inject some scientific analysis into the issues of war. Douglas was a pacifist. He had stated his conscientious objections at a tribunal, and as a doctor he didn’t have to fight. Instead, he signed up with Zuckerman.
It was here that Douglas gained his experience of surveys, but these were of deaths rather than births. The unit undertook a vast Field Survey of Air-Raid Casualties, a truly extraordinary scientific enterprise that was designed to work out how, exactly, bombs do harm. The morning after an air-raid, the unit would dispatch teams of men to selected bomb sites across London, Birmingham and Hull, where they would tour the first-aid posts, hospitals and mortuaries, classifying and counting the deaths and injuries, and detailing their causes. It must have been awful, of course. Ghoulish humour was one way to cope: a skull might have been separated from a man’s body, but look, the men would say, Brylcreem kept his hair perfectly in place.
Douglas was mostly on the numbers side of things, collating and analysing all the data as it came in. By converting all the air-raid reports into ‘standardized killed rates’ and ‘standardized casualty rates’, the Unit shattered a commonly held myth that bombs killed people by blast waves, concluding instead that a victim was far more likely to die by being ‘violently displaced’ by collapsing roofs and walls, or by a host of other tragic means. (This accorded well with the researchers’ own experiments using explosives, rabbits and goats.) Douglas wrote all this into extensive, classified reports that he dispatched to the War Office, marked TO BE KEPT UNDER LOCK AND KEY. He hoped that the reports would help politicians to work out ways to save lives during air-raids. So he was horrified when he discovered that they were also being used to devise more devastating bomb attacks abroad. Douglas learnt that scientific data can be powerful, but that once scientists let it go, they have no control over how it is used by politicians – an observation that he would make again when he was doing surveys of a different kind. He didn’t appear to let his disillusionment show. Douglas ‘rendered brilliant service’, Zuckerman wrote of him, making it ‘certain that he will prove a success in almost any venture to which he turns his attention’.
That venture, as it turned out, was the 1946 maternity survey. With his experience, Douglas was almost uniquely qualified to lead it, and he landed the job. The survey fitted with his ideals: by helping to reduce infant mortality, he hoped to prevent the ill-health and tragedy he had seen in London’s East End and perhaps to smooth out some of the gaps between rich and poor. Douglas, the medic, worked very closely with Glass, the demographer, to devise the survey. In the end, each loved the survey in his own way. Douglas set about organizing the birth survey with all the ambition, speed and can-do attitude that he had used to survey bomb sites during the war. And a few months later, the completed maternity questionnaires started to flood in.
For Douglas, collecting the 13,687 questionnaires was just the starting point − he still had to extract the information from them and work out what it all meant. This was laborious, to say the least. First, his cheap students worked through each form by hand and converted every answer into a pre-assigned number, which they wrote on the form. Next, Douglas passed the forms to a team of women whose job was to transfer the information to punched cards: small, cardboard rectangles the size of a dollar bill in which a piece of information is represented by punching out a hole at a certain spot.** One questionnaire might fill six or more cards, and with 13,687 babies you can see that all this added up to a lot of cards. Douglas stacked them up in rows of wooden filing cabinets and then fed them into a tabulating machine, a thumping device about the size of a piano that used the holes to sort the cards into piles and then count them up.
Take social class, for example, which would turn out to be one of the most important pieces of information on those cards. Douglas worked this out based on the occupation of each mother’s husband, which was the standard way it was done.**** The wives of professional and salaried men – the doctors, lawyers, businessmen and managers – were at the top end of the scale, followed by black-coated wage-earners – those who brought home a weekly salary doing clerical work, for example. Manual workers and agricultural workers occupied the bottom rungs of the ladder. (The few unmarried mothers, who could not be assigned a social class because they had no husbands, were simply hived off and later studied as a separate phenomenon.)
Douglas worked incredibly hard, and within two years of the survey he had written a remarkable red book called Maternity in Great Britain, explaining what all the holes in the thousands of punched cards amounted to in real terms. The data he had collected allowed him to address the question that had originally brought the survey into existence: why national fertility was in decline. Except that, by 1948 − as many of you will probably have realized by now − fertility wasn’t in decline at all. It was going through the roof.
In 1945, when millions of men returned from the war to their wives and girlfriends, they instigated a surge in births now famously known as the baby boom. This surge was most dramatic in the United States, but the UK also saw a sharp increase in the birth rate − and the 1946 survey had unknowingly captured the very first members of the boom. By the time that Douglas was writing up his results, babies were spilling out so quickly that any concerns about the country’s fertility had been laid to rest. But that didn’t stop Douglas’s book from shocking the nation when it was published in November 1948. That’s because his data showed, in simple numbers, what it was really like to be born in Britain – and the picture that emerged put the nation in a far from flattering light.
Almost every result that tumbled out of Douglas’s tabulating machine showed a country divided by class. The babies in the lowest class were 70% more likely to be born dead than those in the most prosperous, and they were also far more likely to be born prematurely.** Part of the problem appeared to stem