The cornerstone of unity

51 MATERNITY AND WELL-BABY CLINICS
Childbirth was a dangerous thing a hundred years ago, a time when 1 in 170 births in Finland ended in maternal 
death and 3 babies in 100 were stillborn. On top of that, 15% of children died before their first birthday. Of 9 
children born in the early 1890s into a farming family in the prosperous community of Urjala, 1 was stillborn, 3 
died in infancy, and whooping cough took another at 3 years of age. The youngest, who survived, became a 
district nurse, or ‘health sister’. 
The first maternity and well-baby clinics were opened in Paris in the 1890s with the aim of supporting 
pregnant women and i
mproving infants’ nutrition. The idea arrived in Finland with General Mannerheim’s League 
for Child Protection, a charity which, in the 1920s, invited the German-trained paediatrician Arvo Ylppö to 
become the director of its hospital. Ylppö accepted and started additional training for nurses, providing them with 

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the skills to advise mothers in infant and child care. Similar training in Swedish was arranged by another charity, 
Samfundet Folkhälsan, first in the form of an apprenticeship and from 1927 through courses. The Finnish state 
assumed responsibility for training health sisters in 1931, while the hiring of midwives was the first communal 
health care activity to receive state funding. 
The first well-baby clinic in Finland was opened in 1922 and the first maternity care clinic in 1926. Both 
activities have to this day remained part of primary care, outwith hospitals. These expanded slowly through 
charitable support until some communities started setting up clinics too; legislation in 1944 then required all local 
communities to set up free maternity and well-baby clinics. Maternal mortality had by this time decreased to 1 in 
2,500 deliveries and infant mortality was under 6%. The infant mortality rate continued its downward trend, 
falling to 2% in the 1960s. Foreign physicians who were visiting Finland at the time wondered how this was 
possible when the physician to population ratio was the third lowest in Europe, but our secrets were the health 
sisters and district midwives who ran the well-baby and maternity clinics, consulting the general practitioner as 
required. District nurses and midwives also made home visits and were thus familiar with the families’ living 
conditions. 
Maternity clinics began to provide fitness classes for pregnant women in the late 1940s to prepare them for 
the hardships of labour and delivery. Psychological training was added in the 1960s and fathers were invited to 
join antenatal classes in the 1970s. Pregnancy was monitored in many ways, the oldest guidelines being weight, 
blood pressure, oedema, haemoglobin and urinary sugar and protein. The range of diseases that can be found 
and treated had widened from syphilis and tuberculosis, with professionals now able to look for Rhesus 
antibodies, hiv, and foetal structural abnormalities. Nutritional advice and help in quitting smoking have also 
supported a favourable course of pregnancy. 
Nearly all mothers visited maternity clinics 
– partly motivated by the maternity pack (innovation no. 72) – but 
only in the late 1950s did the well-baby clinics succeed in recruiting enough health sisters to fully cover the 
demand. In addition to advising mothers and following the child’s development, well-baby clinics were also 
responsible for vaccinations; although the national vaccination programme has never been compulsory, over 
95% of Finnish children have over the years been vaccinated against all the diseases in the programme before 
they go to school. 
In 2015 the Finnish infant mortality rate was 0,17 % and lowest in the world. Maternal death occurs in less 
than 1 delivery in 20 000. Reasons for this include an overall increase in wealth and progress in health care, but 
one essential factor has certainly been the health-promoting work of maternal and well-baby clinics, free of 
charge and open to all, where trained and dedicated health sisters screen for disease and provide advice on 
child care and healthy lifestyles. The population has used these services, irrespective of where they have lived 
or what level of education they have had. 
Marjukka Mäkelä 
– Emerita Research Professor at
the National Institute for Health and Welfare