History of the NSHD

During the 1930s and 1940s there were worries about the falling birth rate in the UK, and concerns that perhaps, in those years before the National Health Service (NHS), the cost of having children was so great that people were deterred from parenthood.

A survey was designed to look into the reasons behind the low birth rate by investigating the cost of childbirth and the availability, use and effectiveness of maternity services, and to provide information for use in the design of the NHS. That study took as its participants all the 16,695 births which occurred in England, Wales and Scotland during one week in March 1946.

Information on 13,687 babies was collected by health visitors when the babies were eight weeks old. Two different questionnaires were handed out; Questionnaire “A” asked about the use of maternity services, while Questionnaire “B” focused on the cost of pregnancy and childbirth. Survey results showed not only the high cost of having a baby, but that it was proportionally much more expensive for mothers in manual workers’ families than for those who were better off.

The study described a wide range of risks to the life and health of mothers and babies, and found these risks were much greater for poor families than for others. It also revealed that only one in five mothers had received pain relief during childbirth, and this information was used to change the law to permit midwives to give pain relief without a doctor present.