Full text of Maternity Benefit Systems in Certain Foreign Countries, Legal Series No. 3, Bureau Publication No. 57

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U. S. DEPARTMENT OF LABOR

CHILDREN’S BUREAU
J U L I A C . L A T H R O P . Chief

MATERNITY BENEFIT SYSTEMS
------------------- IN-------------------

CERTAIN FOREIGN COUNTRIES
By

HENRY J. HARRIS

L E G A L SE R IES N o. 3
Bureau Publication N o. 57

WASHINGTON
GOVERNMENT PRINTING OFFICE
1919

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CONTENTS.
Page.'
Introduction...........................................................................
Australia..................................................................................

11
. 17-20

Persons in clu d ed .............. .............................

Births in clu ded......................................................... ..

Administration.............................................................
O p eration s....................................................................

18
18

Sources of information..............................................
Austria......................................................................................

. 21-29

Industries in clu d ed ............ .......................................
Persons included................. .......................................
Benefits.....................................................................- . .

21
21
21

Sources of incom e...................................................

Financial administration................... .....................

General administration...........................

Operations......................................................................

Sources of information..........................................
Denmark..................................................................................

29
. 31-35

Sources of information...................... ] .......................
France........................................................................................

35
. 3 7 -4 7
41

Persons in cluded...........................................................
Benefits............................ ........ ..................................... .

Financial administration............ ..............................

. 4 3 -4 4

The communes......................................................

The Departments...... .................. .......................

General administration..............................................
Operations......................................................................
G erm any........... ........................................................................

44
.

. 49-65

Persons in clu ded...........................................................

Industries and occupations in clu d ed ...................
D isability provided for..............................................
Benefits..............................................................................

Sources of incom e..........................................................

50
50

Financial adm inistration..........................................

General administratio n ...............................................
Operations............................................................. ...........

53
: 55-65

T h e Leipzig fu n d .................................................

Special maternity benefits during the war
Sources of information................................................
Great B ritain............................................................................

65
67-120

Persons in clu d ed ...........................................................

Industries and employments in clu d ed ................
Benefits.....................................................J......................

70
70-82

General.....................................................................

M aternity b e n e fit.. . ............................................

Pregnancy b e n e fit ..............................................

Provision for navy and arm y..........................

80
3

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CONTENTS.

Page
82

Great. Britain— Continued.
Sources of incom e.............
Financial administration.
Reinsurance of m aternity benefit................................ ......................

83-91
90

General administration.................................................................................... .
Insurance commissioners.........................................................

92-95
92

T h e joint com m ittee............................................................... ..

Insurance com m ittees............................................................ * .............*
Approved so c ie tie s............................. .....................................................
The deposit contributors’ fu n d ............................................ ...............
Operations. ...................................................................* * ...................................
The approved societies........ - .................................. * ........ ...................
Deposit contributors................... ........ ■• ..............................................
Classes of members of approved societies............. ..
- ................
Membership in the various organizations................................
National health insurance fund, England, 1 9 1 2 -1 91 6----- . . . .
National health insurance joint committee, 1913-1918............
Actuarial data................................................. - .........................................
Comment on the system.......................................................... ; - ..........
Sources of inform ation ......................... - ........................................................
I t a ly ...............................................................................................................................
Persons and industriel? in clu d ed ..............................................................
D isability provided for............................... ..................................................
Benefits.................................................................. ..............................................
Sources of incom e......................................................... * .................................
Financial administration..............................................................................
General administration..................................................................................
Operations...............- ................................................ .........................................
Sources of information....................- .....................................; ‘ ‘ * * ' *
Rules for the enforcement of the law for the maternity fu n d . . .
Luxem burg (Grand D u c h y )........................................................... * ...................
- Operations..................... - ...................................................................................
Netherlands.................................................................................................................
Persons in clu d ed ..............................................................................................
D isability provided for....................................................- ................. *
B enefits................................................................................................................
Sources of incom e....................................................................................
Voluntary insurance..........................- ................................................ ..
General administration.......................................... .....................................
Sources of information............................................. * ............... - - - *
New Zealand...................................... .............•* .....................................................
Persons, in clu d ed ............................................................................................
Benefits..............................................................................................................
Financial administration........................................................................ ..
General administration......... ................................ ........ ............................
Operations.........................................................................................................
Sources of information................................... - .......................................
N orw ay................ .......................................* ...........................................
Persons in clu d ed ....................■*......................................................................
D isability provided for........................................................- .....................
Benefits....................................................................................
Sources of in com e....................................................... * ................................
Financial administration.......................................................................... .
General administration. . . . , .....................................................................

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94
95-119
96
.

100

101

104

105

108

.
.

110
113

.
120
121-142
..

123

124

125

126

127

133

..
133
143-144
..
143
145-147
..

145

146

,..

146

...
147
. 149-152
...

149

...
...

149
150

...

150

...'
...

150
152

. 153-163
...

156

...

156

...

156

...

158

...

158

...

159

CONTENTS.

Norway— Continued.
O p era tion s;.......................................

,g7-

Laws on the care of children............................ ...................................^

Sources of information.....................................................
Russia..................................................................

4gg

Industries in clu ded.........................
..
.
..................................................................... - .....................
Persons in clu ded..................
Disability provided for.....................
Benefits............................................................................. ......................
*

Loo
166
Igg
^g

^69
2 gg
27 Q

Sources of incom e...........................................................................................
Financial administration....................................................................
General administration..................................................................
Operations....................... ............................................................. ..........
. Sources of information............... ......................................... -,.......... ..

-,7I-

Sw eden.................................... ................. ................... J ...................... . ........ *177=181
Sources of in form ation ....... ..........................................................
Switzerland..............................................

Ig^

-,'00 10,

Industries included...................................................................................

4gg

Persons included......................................................................................
D isability provided for......................... 7 ................................................|
Benefits.................................................................................................

4g 4

’*

^gg

* *
*’ *"

, ~g

Sources of incom e.............................................................................

-^gg

General administration.......................................................................
Operations.....................................................................................................

2 gg

Sources of information............................................................
Bibliography.................................... ................................ ................................ ;

jU*

jq .

19 5

T ables.
T a b l e I . Australia. Claims for maternity benefits allowed and not
allowed, for fiscal years ended 1 913-1917........................

II.

Australia.

Maternity benefits granted and total amount

paid in benefits for fiscal years ended 1913-1917,
States.................................................................................

by
jo

III. Australia.

L ive births reported and maternity allowances
granted, b y calendar years, 1912-1916............................,

I V . Austria.

L im it of daily, w eekly, and m onthly earnings

and basic average daily earnings for standard wage
classes, used in determining dues and benefits, 1917 .........

Austria. Sickness insurance funds, average membership,
and cases receiving benefits, 1890-1913................................... ’

VI.

Austria. Receipts and expenditures of the sickness insur
ance funds for selected years, 1890-1913.................................

VII.

VIII.

Austria.

Receipts and expenditures of the sickness insur

ance funds per capita of average members for each year
1890-1913.................. ................................................................. 7
’

28.

France. Cases receiving maternity and nursing benefits
19L4-1916....................................................................... H .................|

47-

IX-. Germany.

Num ber of sickness insurance funds, member

ship, total receipts, total expenditures, ancjL amounts
paid in maternity and pregnancy benefits, b y class of
fund, 1913...................................................................
X . Germany. Amounts paid for maternity and pregnancy
benefits, b y class of fund, 1912..................................................

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CON TENTS.

Page.
T able X I

Germany. Total amount of maternity relief (maternity
and pregnancy benefits) and amount per capita of aver
age female membership, 1892-1913, b y class of fu n d . . . . . .

X I I . Germany.

Maternity benefit experience of the Leipzig

local sickness insurance fund, 1887-1905...................................

XIII» Great Britain.

A ctual and expected average w eekly ex
penditure of approved societies for sickness and mater
nity benefits, per insured married man, 1913-1915...............

X I V . Great Britain. Actual and expected average w eekly ex
penditure of approved societies for sickness and mater
n ity benefits, per insured married woman, 1913-1915. - - - -

86*

X V . United Kingdom . Number of men and women insured in
approved societies and amounts paid for sickness,
maternity, and disablement benefits, 1913-1916.............. -XVI

Great Britain. Number o f male members of approved
societies in England for whom contribution cards were
received b y the commission for the quarter ended April
13, 1913, and the number of contributions paid at each

X V II

rate, b y classes............ -*- - - ............................................................. ..
Great Britain. Num ber of female members of approved
societies in England for whom contribution cards were

102

received b y the commission for the quarter ended April
13, 1913, and the number of contributions paid at each
rate, b y classes............................................................................ .7 ' '
X V I I I . England. Membership of approved societies of specified
type in England, quarter ended A pril 1 3 ,1 9 1 3 .......................
X I X . England. Receipts of the national health insurance fund
from July 15, 1912, to January 11, 1914, and balance
January 11,1914, and receipts-from January 12 to D ecem
ber 31, 1914................................ - ........................- .......... / 7
X X . England. Balance at beginning of year and receipts of tHe
national health insurance fund, for the calendar years
XXI

103
105

105
106

1915 and 1916..................... ......................................... ; ' ; .................
England. Payments out of the national health insurance
fund from July 15, 1912, to January 11, 1914, and from
January 12 to December 31, 1914, and balances at the

end of each period....................... ...................................; .................
X X I I . England. Payments out of the national health insurance
fund and balance at end of year, for calendar years 1915
and 1916.......................................................... . " 7 7 ’ 7.7 •
X X I I I . England. Appropriations for the national health insur
ance joint committee, for fiscal years ended 1 9 1 3 -1 9 1 8 ....

107

108
109

X X I V . Great Britain. Age distribution of husbands and wives,
and of husbands and wives w ith one or more children
under 1 year of age, borough of Camberwell, England,
1911............................. - .........................................................7 7 7 ' - '
X X V . United Kingdom. Legitimate and illegitimate births in
XXW 1

the United Kingdom, 1906-1911............. - ................................ ..
United Kingdom . Estimated number of husbands and
wives in the United K ingdom distributed according to
age groups, and computed numbers of births for the year,

June 30, 1909 (000 o m itte d ).
- - - - - - ............. 7 ' ’ T7 •'
X X V I I . Great Britain. Estimated central issue rates for the U n i
ted Kingdom , 1911........................... - ■ ............* ..........................

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112

112
113

CONTENTS.

T a b l e X X V I I I . Italy.

Num ber of women wage earners, wages, and num -

122

ber of births, b y industry groups, 1 9 0 2 -3 ................................
X X IX .
XXX.

Italy.

Num ber of insured persons, as indicated b y the

127

number of contributions, 1912-1916..................................
Italy. Num ber of establishments making payments of

j 28

contributions, b y industry groups, 1913-1915.........................
X X X I.

Italy.

Num ber of insured persons as indicated b y number

of contributions in northern, central, and southern Italy
1912-1915...............

129

X X X II.
Italy. Number of maternity benefits paid, 1912-1916........
X X X I I I . Italy. Births and miscarriages to mothers receiving mater
nity benefits according to civil status of mother, 1913 and
1914 ...............................’............ ..
_
’
X X X I V . Italy.

Births and miscarriages to mothers receiving mater

130
131

nity benefits, according to age of mother, 1913....................
XXXV.
X X X V I.

Italy. Receipts of the national maternity fund, 1912-1915.
Italy. Expenditures of the national maternity fund 19121915 ............................................
’

X X X V I I . Italy. Balance of receipts and expenditures of the na
tional maternity fund, 1912-1915................................ _

131

X X X V I I I . Luxemburg. Summary of operations of the sickness insui- *
ance funds of Luxemburg, 1903-1912.............

143

X X X IX .

Luxemburg. Maternity experience of sicknes^ insurance
funds, 1903-1912.........................................

X L . New Zealand. Operations of the New Zealand national
provident fund, 1911-1915................................................
X L I . Australia and New Zealand.

150

Registered live births and

deaths under 1 year in New Zealand and infantile mor
tality rates in Australia and New Zealand, 1911-1915____

151

X L I I . Norway. Deaths during confinement per 1,000 confine
ments, 1857-1861 and 1907-1911.............................................

155

N o rw aj. Membership class and rates of sickness b e n e fit.. . '
X L 1V . Russia. Cases of sickness in funds of Prokhorov Trekhgornaia Manufacturing Co., of Moscow, June 1,1913 to Janu
ary 1, 1914..................................................... ................... ................. ;
X L V . Russia.

156

Receipts and expenditures of the fund of the

Prokhorov Trekhgornaia Manufacturing Co., of Moscow
June 1, 1913, to January 1, 1914................................
’

473

X L V I . Switzerland. Num ber and membership of sickness i n s t
ance funds, according to kind of benefits provided
December 3 1,1914, and December 3 1 ,1 9 1 5 ........................... ’

192

X L V I I . Switzerland.

Membership

sickness insurance funds*

according to class of members admitted, December 31 *
1914, and December 31, 1915............ ....................................... ’
X L V I I I . Switzerland.

according to rate of subsidy paid b y the Federal Govern
ment, 1914................................... . .................................................... _
X L I X . Switzerland.

192

Membership of sickness insurance funds and

total amount of Federal subsidy, according to rate of
subsidy paid, 1915.................................. . ............... ..
L . Switzerland. Receipts of the sickness insurance 'funds
1914 and 1 9 1 5 . . . . . . . . . ....... ..........................
’
L I . Switzerland. Expenditures of the sickness insurance
funds, 1914 and 1915................................................................

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Membership of sickness insurance funds,

1Q2
^

193

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letter of transmittal .

U. S.

D epartm ent

Labor,

Ch il d r e n ’s B u r e a u ,

Washington, May 22, 1919.

fern: 1 transmit herewith a report entitled ‘ ‘Maternity Benefit Syst^ s m G e rta m Foreign Countries,” by Henry J. Harris, Ph. D., chief
o the document division of the Library of Congress, formerly sta
tistical expert of the Bureau of Labor. The data in the report are
of information available on January 1, 1918. The section on Russia
is now of historical interest only.
Maternity benefit systems are not an experiment. Most of the
leading countries of the world had such systems even before the great
oss of soldier hfe on European battlefields began insistently to attract attention to the constant, and still greater loss of mother and
child life at home. Great Britain, France, and Italy have maternity
benefit systems, while Australia and New Zealand should be added
to the territory covered by special provisions for motherhood
Germany, Austria, and Hungary early established such systems, and
enmark, Norway, Roumama, Russia, Serbia, Sweden, and Switzerland have also provided maternity benefits.
These systems are designed to protect the health of mothers and
C jT ™ , providing adequate medical and nursing care in childbirth
and by so lessening the financial burden of childbearing that mothers
may be insured a reasonable period free from excessive labor. They
vary from systems under which every woman, regardless of her finan
cial status, receives a fixed sum on the birth of a child, to systems
under which voluntary insurance funds—membership in which is
open only to wage-eammg women in certain industries and receiving
certain minimum wages—receive subsidies from the State. In some
systems the benefit consists primarily in a money payment; in others
it consists primarily in medical and nursing services.
No such system, once undertaken, has ever been abandoned. In
stead the tendency of changes in existing legislation has always been
toward including larger and larger groups of the population, toward
increased benefits, and toward the compulsory" as contrasted with the
voluntary principle of insurance.
Meanwhile a considerable body of experience has accumulated as to
methods of administration, cost, and other details of operation of
the different systems. This experience Dr. Harris, who was especially

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■£q

L E T T E R OF T R A N S M I T T A L .

qualified for the task by his wide knowledge of European labor legis
lation, was asked to summarize in the hope that the information
might prove useful to the people of one of the few great countries
which as yet have no system of State or national assistance in materuity— the United States.
Respectfully submitted.
Hon. W. B. W ilson ,

Secretary of Labor,

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j DLIA C. L ixim or, ChieJ.

MATERNITY BENEFIT SYSTEMS IN CERTAIN FOREIGN COUNTRIES.
INTRODUCTION.
'Three ways of aiding the mother at childbirth are now in use in
e leading foreign countries. The first method is that of providing
the mother, both before and after confinement, with skilled nurses
medical attendance, and helpful advice, for which she pays if slio is
able but providing no cash benefits. This method has been developed
mos thoroughly in New Zealand by a voluntary organization and
excellent results have been secured. The second method is that of
urmshmg outright a sum of money on the birth of a child, the State
supplying the funds. The third method is that of insurance, of col
lecting money in advance from the insured persons, their employers
and in many cases from the State, so that money, aid, and medical and
institutional care are available when the birth occurs. As most of
the leading countries of the world now have in operation systems of
sickness insurance for the greater part cf the population which would
need maternity aid, the maternity systems have been combined with
the sickness insurance systems to avoid creating a second piece of
a mistrative machinery. In one country, Italy, where there was
no system of sickness insurance, an independent maternity insurance
organization was developed.
J
The list of countries having some form of cash benefit for mothers
during maternity is impressive; all of the larger and most of the
smaller countries of Europe, as well as the Commonwealth of Aus
tralia, have made provision for their women wage earners These
countries are Australia, Austria, Bosnia, Denmark, France, Germany
Great Britain, Herzegovina, Hungary, Italy, Luxemburg, Netherlands, New Zealand, Norway, Roumania, Russia, Serbia, Sweden
and Switzerland.
’
The action of these countries is not a matter of recent date; the
na ional insurance system of Germany began with the year 1884
though there was provision by the local governments before that
date; Austria m 1888 and Hungary in 1891 adopted plans similar to
the German. Other countries gradually introduced relief in this
field, until at the outbreak of the European war practically all the
leading countries had fallen into line. It is worthy of note that the
interest m maternity relief was not due to the frightful loss of life
caused by the war, though the war has directed the attention of the
11

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M A T E R N IT Y B E N E F IT SYSTEM S.

world to the subject of infant mortality and the care of mothers
during childbirth to a greater extent than ever b e te e
ln W 10
Italy instituted a national maternity insurance fund, the health
insurance laws of Great Britain and Switzerland came in 1911
Kussia and Sweden passed similar laws in 1912; while Australia m
1912 and France in 1913 provided special systems of allowances to
mothers during childbirth. The whole movement may be said to be
due to realization of the fact that the health of the^wage-earm^
population is one of the greatest responsibilities of the State, and that
the care of the woman wage earner, especially the mother working
away from her home, is peculiarly important under modern conditions
There is much variety in the industries and occupation! protected
by these laws. At the one extreme is Australia winch has ignored
industries and occupations altogether by declaring that every
woman shall receive the substantial sum of *25 on the occasion o
childbirth. The health insurance systems of Germany and Great
Britain cover the greater part of all industries and occupa ions.
Italy on the other hand, restricts membership m the national
maternity insurance fund to wage earners in manufacturing indus
tries, and women employed in rice fields. The restrictions are
usually due to the difficulty of providing administrative machinery
to meet the special conditions-for instance, in the home-worfang
industries, in the case of casual workers who change employers fre
quently, or in the case of agricultural workers who would be scattered
thinly over Wide areas. Because some countries have special legis
lation aflecting domestic service, such as requiring the employer o
provide medical care for servants living in his household, this occu
pation is frequently omitted from health and maternity benefits of
the insurance systems. In recent legislation there is a clearly marked
tendency to include all occupations and all industries m systems o
health insurance, and this is particularly true of maternity insurance
and benefit systems.
. . ,
■! „
The scope of the maternity benefits is also varied by the hunts on
the persons included. There is a general agreement on the inclusion
of wage earners; salaried employees— that is, those who are engage
in clerical work, in the minor administrative positions, etc. are
sometimes omitted because they usually have a more permanent
employment status than those doing the work involving physical
labor. As a rule there is a restriction on the class of persons insured
by excluding those earning more than a specified sum, m Grea
Britain the Emit is placed at £160 (about *800) annual earnings; m
Germany it is 2,500 m. (about $600).
... . .
Great diversity of practice-exists in the treatment. accorded
wife of the-wage earner who is not herself insured Under the British
law she is entitled to maternity benefit; under the German law it is

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IN T R O D U C T IO N .

optional with the local organization which administers the insurance
to provide the maternity benefit, although the special laws in force
during the war provide practically the same benefit as for the woman
included because she is a wage earner. The tendency in the recent
legislation is to make liberal provision for the wife of the insured
wage earner.
One of the most humane features of these maternity systems is
the treatment of the unmarried mother. In New Zealand only is she
excluded from the aid; in Great Britain she is not allowed to receive
the supplementary benefit which is granted to married women.
The benefits provided by the various countries consist of, first, a
sum of money either in one payment or in weekly payments; second,
medical and surgical service and medicine; third, a small weekly sum
paid while the mother herself nurses the child. In one country,
France, a system of instructing and advising the mother by visiting
nurses or volunteer visitors is in force.
As in most countries it is the wage-earning woman who is protected
by the insurance system, the maternity benefit is practically a partial
substitute for wages. The usual amount varies from 5Q to 75 per
cent of the wages, with a tendency in the recent laws to increase the
amount to either full wages or close to that amount.
The time during which the sick wage is paid ranges from 2 to 12
weeks. In most of the countries this period is divided, 2 to 4 weeks
coming before childbirth and the rest of the period after that date.
The British and Australian plans simply grant a specified sum to the
mother, to be paid on proof of the birth of the child. This method
simplifies the administration, but the reports of the operation of the
laws seem to indicate that it produces less satisfactory results. The
weekly sick-wage payment plan makes it possible to require the
mother to refrain from factory or other work under penalty of with
holding the benefit. In France it is used also to require the mother
to observe fundamental hygienic rules.
In the majority of the countries the mother is provided with free
medical attendance and medicine, though in some of the larger
countries, such as Great Britain, no such aid is furnished.
One of the more recent provisions is that for nursing mothers.
This is granted by Germany, Switzerland, Roumania, France, and
Austria and consists of an amount varying from half the regular
benefit in Germany to a sum of 50 centimes daily in France. While
these amounts may seem insignificant under American conditions,
they are of great importance in aiding the European mother to devote
herself to the child’s welfare during the period when breast feeding is
of the utmost importance. The benefit is paid for a period ranging
from 4 to 12 weeks.
& 5 •

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M A T E R N IT Y B E N E F IT S Y S T E M S .

In all but three countries the maternity aid is joined with the
health insurance system. The reasons are obvious; the group ol
the population to be aided is, for all practical purposes, the same as
that included in the health insurance; next, the benefits needed are
the sick wage and the medical service, the same as m the health
insurance system. The three countries which do not follow this plan
have no systems of health insurance; they are Italy, with its separate
svstem of compulsory maternity insurance for women wage earners;
France, with its maternity allowance for those dependent on their
earnings; and Australia, with its maternity allowance for its citizens.
All sorts of combinations have been made in distributing t e
expense At one extreme are Roumania and Denmark, where the
wage earner pays the entire cost, though there is a slight amount of
aid from the National Government; at tho other extreme are Aus
tralia and France, where the Government bears the entire cost, lhe
majority of the systems distribute the cost among the insured per
sons, the employer, and the State, with the wage earner bearmg the
largest share.
.
As it is difficult in a short space to give any idea of the operation
of these laws, it will not be attempted; but it is important to call
attention to the fact that practically the entire wage-earning popu
lation of Germany, Great Britain, Austria, France, and R ussia-tho
largest countries of Europe—are in receipt of some sort of aid during
the period of childbirth, while in the Commonwealth of Australia
every case of childbirth receives a substantial money grant These
countries disburse large sums on this account; thus, in 1913 14, the
Federal Government of Australia paid out $3,284,839 m maternity
allowances and this sum represents 3 per cent of the consolidated
revenue of the Government. In France the maternity allowance
calls for over $1,000,000 annually from the National Government and
another $1,000,000 from the local governments. These two instances
are mentioned as showing the extent to which Governments are willing
to assume financial burdens to relieve the distress of the wage-earning
population, and it should be mentioned that this expenditure was
begun before the outbreak of the European war. Under the abnor
mal conditions caused by the war the Government o [ (Jennany has
appropriated the sum of 5,000,000 m. (about *1,190,000 montUy to
defray the cost of the maternity benefits of the national compulsory
insurance system; at the conclusion of the war, of course, it is ex
pected that the method previously m use will be resumed.
One advantage of the provision of maternity benefits is that it
furnishes information not otherwise available as to conditions among
the wage-earning women. Thus, in Great Britain, Mr. Lloy
e°ag
stated in the House of Commons: “ Above all, the working of the act
revealed an appalling amount of sickness among married women,

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IN T R O D U C T IO N .

especially under certain conditions (i. e., childbearing), a fact which
was quite unknown before the act.”
As industrial conditions in Great Britain more closely than in any
other country resemble those in the United States, it is of interest to
note the following statement of some of the effects of maternity aid
under the British act:
The operation of maternity benefit also is gradually revealing m any facts of great
interest in connection with the general question of the relation between economic
conditions and public health. .O f other effects of maternity benefit it is as yet too
early to speak. Experience limited to some 18 months is inadequate to measure
accurately the effect which maternity benefit m ay have in improving the national
physique, in raising the general standard of health among working women, and in
reducing the rate of infantile mortality.

B u t already maternity benefit has thrown

great light on the nature of the problem presented for solution, and has revealed m any
things on which there has hitherto been only the scantiest knowledge.
I t has, for example, been made clear that the expectation of unavoidable expense
in connection with the actual confinement compelled working women to work up
to the last possible m om ent before confinement occurred, in order that there m ight
be m oney in hand to m eet those inevitable expenses.

E xpectant mothers were thus

in most cases under the necessity of running every kind of risk because they could
not afford to cease work; and this consciousness of the necessity of continuing work
seems to have led m any women to ignore dangerous symptoms during the period of
pregnancy, in an optimistic belief that i t would not really hurt them to continue work
which in any case they could not afford to drop.

B u t the assurance of receiving

the maternity benefit of 30s. at the tim e of confinement, b y enabling women to
dispense with the necessity of collecting a special reserve of money for the confinement
expenses, encourages them to seek, and makes it possible for them to obey, medical
advice during pregnancy; and thus it provides a remedy not only against poverty '
but partially also against the evils of ignorance.

I t must be remembered that, where

a woman ceases work through the occurrence of dangerous symptoms and complica
tions in the course of her pregnancy, sickness benefit m ay be available for her, if she
is herself insured.

This provision, of course, cooperates with the expectation of

maternity benefit; maternity benefit dispensing with the necessity of collecting a
reserve for confinement expenses, and sickness benefit comperr i ting to some extent
for the actual loss of wages, the current income required to meet normal expenses,
*

and insured persons themselves, particularly women,

when expressing

appreciation of maternity benefit, seldom fail to emphasize the relief which it affords
from insecurity, with its attendant strain, before and at the tim e of confinement .1

To sum up the situation: In spite of all the imperfections of these
plans for caring for the mother and child, one country after another has
gradually adopted them until all the leading industrial countries of the
world have something of the kind. There has been a tendency to give
up voluntary systems for compulsory systems. At the last inter
national congress on social insurance at Rome in 1908, the conspicuous
feature of the discussions was the favorable attitude toward compul
sion taken by the delegates from countries like France and Great
Britain, where compulsory measures had previously been opposed.
In nearly all these countries there has been an effort to improve
legislation by amendments, to meet imperfections as they are dis1Annual Report of the British Insurance System, 1913-14, p. 6.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

covered, but no country has ever given up the system after it has
once been tried. On the contrary, the amending laws most fre
quently extend the system by adding workers in new occupations or
industries— for instance, the casual workers, outworkers, etc. An
increase in the amount of the benefits has been made where the
financial conditions would permit, but as maternity benefits are
expensive this increase has necessarily been cautious. The best of
these increases in benefits has been that to assist nursing motherssmall as it usually is, this benefit is of great -value in reducing infantile
sickness and death.
Believing that it would be of value to have the facts as to the scope,
organization, and experience of these foreign systems of maternity
aid made available for American readers, the following pages have
been prepared. The account is, of course, a statement of facts with
out advocating any policy or attempting to do any more than to show
what the systems are and what they do. Some of the systems are
very much involved, notably the British, and in most of them the
care for maternity has been so closely amalgamated with sickness
care that it is practically impossible to separate the features.
An effort has been made to present the information for each
country in the following form:
1. History of present system.
2. Industries or occupations included.
3. Persons included.
4. Benefits.
5. Sources of income.
6. General and financial administration.
7. Operations.
8. Opinions of legislators, employers, wage earners, social workers,
etc., as to effect of system.
The present study includes the following countries. Australia,
Austria, Denmark, France, Germany, Great Britain, Italy, Luxem
burg, Netherlands, New Zealand, Norway, Russia, Sweden, and
Switzerland.
. Other countries having national systems -of maternity benefit are
Bosnia, Herzegovina, Hungary, Roumania, and Serbia. Since little
or no information as to the operations of their systems was available,
and since they in general follow the plans used in other countries,
they have not been included.
The largest amount of space has been devoted to the British system,
partly because industrial conditions in the United Kingdom more
closely resemble conditions in the United States than those in other
foreign countries and partly because the benefit paid on acconut of
maternity has directed attention to the needs of the wage-earning
mother at the time of childbirth in a most striking manner.

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AUSTRALIA.
Under the law of 1912 the Federal Government of Australia makes
a grant of £5 (about $25) for each case of childbirth in the Common
wealth. Australia seems to have been the first country to institute
a system of national aid to relieve the financial burdens of child
birth without requiring some direct contribution on the part of the
wage earner. The title of the law, “ Maternity allowance act, 1912/’
indicates its general nature. It came into effect in October, 1912, a
year in which there was no national crisis and no financial depression,
and was enacted solely to relieve the normal strain on the resources
of the wage earner caused by the burdens of childbearing. The
reasons for the particular form of relief which was adopted, namely,*
that of a direct payment to the mother, are of interest; the prime
minister, in presenting the bill, stated that there was no intention
of instituting an insurance system, that it was not a “ baby bonus”
scheme, and that great care had been taken to avoid any stigma of
charity or philanthropy. He characterized the act as providing
“ a maternity allowance of the protection and care of the mother,
which is tantamount to the care and protection of the unborn child.”
In defense of the proposed law, he stated: “ It is the duty of. the
community, and especially the duty of a national parliament, to
protect every possible life,” and quoted with approval a statement
of Premier Seddons, of New Zealand, that measures such as this
were justified absolutely on economic lines as “ a provision for the
safety of the State.” 1 The objections to the bill, briefly stated, were
that it would discourage thrift, in that it did not require the wage
earners themselves to pay at least part of the cost of the system;
that it did not make use of the existing organizations for the relief
of financial distress in distributing the allowance; that it granted the
allowance to every mother instead of restricting the grant to those
with small incomes; that it was a reflection on the individual States
of the Commonwealth; that there was doubt of its constitutionality;
that it was “ fly paper” to catch votes; that it made no distinction
between unmarried and married mothers; that a grant such as this
would be wasted unless its expenditure were supervised by com
petent officials. That these objections were met by the advocates
of the bill may be assumed from the fact that the bill was passed
promptly and put into force as soon as approved by the executive.
d e b a t e in Australian House of Representatives, Sept. 24, 1912.
1 13300°— 19---- - 2

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M A T E R N IT Y B E N E F IT S Y S T E M S .

PERSONS INCLUDED.

The allowance is payable to women who are inhabitants of the
Commonwealth or who intend to settle in the country, regardless of
their income status. No distinction is made between married and
unmarried mothers. Certain groups of persons are excluded:
First, natives, because they are cared for through other means, and,
second, Asiatics.
BIRTHS INCLUDED.

•

Only one allowance is paid for a confinement, regardless of whether
there are one or more children at the birth. If the child was not
born alive or dies within 12 hours after birth, the claimant must
present a medical certificate to the effect that the child was a viable
child; this provision was added to avoid payments for intentional
abortions. Reasonable provision is made for cases where medical
attendance could not be secured.
ADMINISTRATION.

The duty of administering the law is placed in the hands of a
commissioner of maternity allowances who is provided with an
assistant commissioner and such deputy commissioners as are neces
sary. The commissioner is subordinate to the minister in charge of
the treasury department.
OPERATIONS.

The extent to which the rights granted by the law claimed is
shown by Table I.
T a b l e I.__Australia. - Claims fo r maternity benefits allowed and not allowed, fo r fiscal
years ended 1918-1917.
[Source: Australia, Department of the Treasury.

Maternity Allowances, 1913-1917.]
Number of cases.

Allowance of claim.
1912-13

1913-14

1914-15

1915-16

1916-17

83,094

135,707

139,495

132,447

132,866

Claims allowed, total.....................- ................ ...........-

82,475

134,998

138,855

131,943

. 132,407

Mothers attended by doctors.................................
Mothers not attended by doctors..........................

52,101
30,374

86,003
48,995

88,367
50,488

80,611
51,332

86,565
45,812

Claims not allowed................................... - - - ..............

619

709

640

504

459

The feature which is especially conspicuous in Table I is the large
proportion of cases in which there was no attendance by a physician ,
in the first three years covered by the table this proportion was
36.8 per cent, 35.6 per cent, and 36.4 per cent.
The debates in the Parliament show that the advocates of the law
hoped that it would lead to better medical care of the mother and

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AUSTRALIA.

£9

child at confinement. Since no data are available as to the attend
ance of physicians at confinements for the years preceding 1912 no
conclusion can be drawn as to the success of the act in promoting
medical care. During the brief period covered by the preceding
table, no change in this phase of child welfare is noticeable.
The expenditure for maternity allowances as shown by Table II
is considerable.
T a b l e II.

Australia. -M aternity benefits granted and total amount paid in benefits
fo r fiscal years ended 1913-1917, by States.

fSource: Australia, Department of the Treasury. Maternity Allowances, 1913-1917.]
Number of cases.
State.
1912-13

Total....................
New South W ales.. .
Victoria..............
Queensland...............
South Australia...........
Northern Territory. . .
Western Australia.;.
Tasmania..................

1913-14

' 1914-15

1915-16

1916-17

82,475

134,998

138,855

131,943

132,407

31,045
22,746
12,130
7,546
12
5,385
3,611

51,239
36,060
19,710
12,743
23
9,190
6,033

54,486
36,279
20,205
12,570
31
9,312
5,972

51,541
34,468
19,754
11,730
28
8,752
5,670

52,806
34,678
19,124
11,741
45
8,347
5,666

Amount paid In benefits.
State.

Total...........................
New South Wales........
Victoria........................
Queensland.................
South Australia...............
Northern Territory___
Western Australia___
Tasmania...

1912-13

1913-14

1914-15

1915-16

$2,006,823

$3,284,839

$3,378,689

$3,210,503

$3,221,793

755,402
553,467
295,153
183,613
292
131,031
87,865

1,246,773
877,430
479,593
310,069
560
223,616
146,798

1,325,781
882,759
491,638
305,859
754
226,584
145,314

1,254,122
838,693
480,664
285,420
681
212,958
137,965

1,284,902
843,803
465,334
285,688
1,095
203,103
137,868

1916-17

The first year’s operations began in October, 1912, and ended
with March 31, 1913. The second year’s operations (1913-14)
brought an expenditure of $3,284,839 and constitutes the assumption
of a burden of no small dimensions. The “ consolidated revenue of
the Commonwealth” for the fiscal year 1913-14 is reported as
£21,741,775 C$105,806,348);1 when there were no extraordinary
expenditures for war purposes, 3 per cent of the Government’s ex
penditure was devoted to maternity allowances.
It is not possible to make an accurate comparison of the number
of births in the Commonwealth and the number of births receiving
allowances. With the reservation that the figures in Table III are
not entirely comparable, they are given for the purpose of showing
that practically all births are granted the allowance.
1 Official Yearbook, 1914, p. 692.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

20
T

a b l e

I I I __Australia.

L ive births reported and maternity allowances granted* bp
calendar years, 1912-1916.

[Source: Commonwealth Bureau of Census and Statistics. Monthly Summary of Australian Statistics,
1
April, 1917, pp. 5 and 41.]
Live
allowances
births. . granted, a

Year.

133,088
136,714
137,983
"134,871
131,426

aIncludes viable children.

b 16,508

135,667
139,159
132,772
131,657

6 Oct. 10 to Dec. 31,1912.

According to this source, in the four calendar years, 1913 to 1916,
there were 539,994 live births reported and 539,255 births for which
maternity allowances were paid. From Table I on page 18 it will be
noted that in the two fiscal years 1913-14 and 1915-16, the total
number of claims allowed and disallowed almost equals the number
of births reported for the calendar years 1913 and 1915, respectively.
SOURCES OF INFORMATION.

The text of the maternity allowance act, 1912, was published as
act No. 8 of 1912 (assented to Oct. 10, 1912) in the official law series
entitled “ The Acts of the Parliament of the Commonwealth of Aus
tralia passed in the Session of 1012,” pages 16-18: The text is
reprinted in the English edition of the Bulletin of the International
Labour Office, volume 8, page 393. The reports of the operation of
the act are published in the annual reports of the department of the
treasury, section on maternity allowances; a separate print of this
part of the treasury report is also published.

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AUSTRIA.
A system of compulsory sickness insurance was introduced in
Austria by the law of March 30, 1888, under which wage-earning
women received a maternity benefit for four weeks, consisting of a
cash benefit and medical attendance. These benefits have been
extended by the law of January 4, 1917.
The factory law of 1885 prohibited the employment of women for
the four weeks after childbirth—at the tune an advanced measure of
protective legislation. This law was amended on January 4, 1917,
by increasing the period of prohibited employment to six weeks.1
The compulsory insurance law remained in force until April 4, 1917,
when the new act providing much more extensive benefits came into
operation. The provisions of this act are described below, but it is
of so recent a date that no statistical information as to its workings
is available.
INDUSTRIES INCLUDED.

The 1917 law does not change the class of industries covered by
the law of 1888; these are: (1) Factories, smelting, mining, shipyards,
quarries, and, in general, all establishments using power or explo
sives; (2) building trades; . (3) all establishments subject to the
industrial code; (4) transportation by land or water. The law does
not include agriculture or the home-working industries, but permits
persons engaged in them to insure voluntarily.
PERSONS INCLUDED.

The persons included are those who receive a wage or salary; the
law names them as workmen and administrative officials, though the
latter are included only when their salary is less than 2,400 crowns
($487.20). Voluntary insurance is open to a large number of persons,
but they must themselves pay the entire cost of the insurance.
BENEFITS.

The benefits under the 1917 law are: (1) Medical benefit, (2) cash
benefit, (3) maternity benefit, (4) nursing (breast-feeding) benefit,
(5) funeral benefit.
It will be noted that the sickness insurance law also covers indus
trial accidents, and the benefits numbered (1), (2), and (5) must be
provided for the legal period as in case of ordinary sickness.
1Imperial decree of Jan. 4, 1917, in Reiehsgesetzblatt of Jan. 9, 1917; reprinted in Soziale Rundschau
Jan.-Feb., 1917, p. II. 1.
*

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M A T E R N IT Y B E N E F IT S Y S T E M S .

The extent of these benefits is as follows:
(1) Medical benefit.—This consists of free medical attendance from
the beginning of tile sickness, medical attendance and midwife service
in case of childbirth, medicines, and appliances. The medical benefit
ceases at the end. of 26 weeks; but the funds may extend this to 52

weeks
The funds may also provide trained nurses for beneficiaries who
remain at home during sickness ^for the cost of this service not more
than one-half of the cash benefit may be deducted. In place of
medical benefit, medicine, and cash benefit, the funds are authorized
to provide care and maintenance in a public hospital; if the beneficiary
has dependents, not more than one-half of the cash benefit may be
deducted for this service.
(2) Cash benefit.—After the third day of sickness, the cash benefit
is a daily amount, which is 60 per cent of the standard rate of the
wage class to which the insured person belongs (sec. 6, subds. 2
and 7). These wage classes are as given in Table IV.
The funds may increase the daily cash benefit up to 90 per cent of
the lower figure given for each wage elass, but not in any case to
exceed 5.5 crowns ($1.12) per day. The period of payment may be
increased from 26 weeks to 52 weeks.
(3) Maternity benefit.— If the mother abstains from remunerative
work during the six weeks following confinement, she is entitled to a
daily benefit equal to the cash benefit for this period. The fund is
authorized to make this benefit conditional upon six months insur
ance during the year preceding the date of delivery. The mother is
entitled to medical benefit in addition to cash benefit, and she may, if
the fund so desires, be given care and maintenance in a maternity
hospital or similar institution. The fund may also provide attendance
by home nurses. In such cases not more than one-half of the daily
cash benefit may be deducted to defray the cost.
The funds may provide the daily cash benefit to pregnant women
for a specific period, but not exceeding four weeks prior to the date
of delivery, if the member is not entitled to the regular sick benefit.
The beneficiary must abstain from remunerative work while in
reoeipt of this benefit.
(4) Nursing (breast-feeding) benefit.— To encourage breast feedmg,
the funds must provide a nursing premium of half the cash benefit
for the period up to the end of the twelfth week after the date of
delivery, providing that the mother herself nurses the child. This is
in addition to the maternity benefit or any sickness benefit that the
mother may receive. The funds are authorized to extend the
period of the nursing benefit up to 26 weeks.

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A U STR IA .

T a b l e IV. Austria. L im it o f daily, weekly, and m onthly earnings and basic averaqe
daily earnings fo r standard wage classes, used in determining dues and benefits, 1917.
[Source: Soziale Kundschau, vol. 18 (1917), pp. 11, 28.]
Earnings.
Wage class.
Daily.
1..............................

Weekly.

Monthly.

2 ..........................................

Under $0.255.........
$0.255 to $0.355.....

7.................................

2.14 to 2.74................ 8.89 to 11.42...........
0.458 to 0.558............ 2.75 t o 3 35
0.559 to 0.660............ 3.36 to 3 96
0.661 to 0.761........... 3 97 t n d 57
l-U«dUtU ly.v/O« ...k ...
0.915 to 1.117............ 5.49 to 6 70
1.118 to 1.320............ 6.71 to 7 92
1.321 to 1 .5 2 3 ........ 7.93 to 9 14

3.................................
4
...................
5.............................
8 .....................................

9 ...............................
10.................................
11................................

Basie
average
daily
earnings.
$0.20
.31
.41
' .51
.61
.71
.84
1.02
1.22
1.42
1.69

The 60 per cent of the wage for benefit purposes is computed from
the last column of the table. This daily payment must be continued
for at least 26 weeks, paid at the end of each week during the receipt
of the benefit; The benefit is paid for Sundays and holidays, though
if the first or last day of sickness comes on such a day it is not included.
The benefit may be disallowed if the sickness is due to misconduct.
(5)
Funeral benefit. This consists of 30 times the standard wage
rate of the insured person; it was formerly 20 times this rate. The
benefit, however, must be at least 60 crowns ($12.18). The funds
are authorized to increase the amount up to 45 times the standard
wage rate.
The funds are authorized to provide what the law terms “ family
insurance” to uninsured members of an insured person’s family. For
specific regions of the Empire, apparently meaning the isolated
regions or places where medical service is difficult to secure, the
ministry of the interior may make family insurance compulsory.
Family insurance may include all or part of the benefits provided,
i. e., medical care, funeral benefit, and maternity benefit. Insured
persons whose taxable income is above a certain amount may not be
included in this feature.
SOURCES OF INCOME.

The income of the funds is derived from the assessments on wages,
of which the employer pays one-third, the insured person two-thirds.
Voluntarily insured persons pay the entire cost themselves. The
employer deducts the share of the employee from his or her wages,
adds to it his own share, and transmits the full amount to the fund!
The weekly contribution for a member (the employer’s and the work
man’s share together) may not exceed four-tenths of the standard
daily wage rate (see last column of Table IV, above) in which the

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M A T E R N IT Y B E N E F IT S Y S T E M S .

insured person is classed. A scale of contributions graded b y age is
not permitted, except in the case of voluntary insurance.
A graduated scale of contributions may be used for classes of mem
bers whose sickness rate is distinctly higher than that of the other
members. The graduated scale may be based on sex, on occupation,
or on industry (sec. 26 subd. 2). Under this provision a rate of dues
for women which is higher than that for men may be adopted.
FINANCIAL ADMINISTRATION.

The money collected in the form of contributions may be used only
for the purpose of paying benefits, costs of administration, the
accumulation of a reserve, and for the support of cooperative work
conducted by a number of funds joined in a federation. The reserve
must be formed from the excess of receipts over expenses and must
be equal to at least one year’s expenses.
If at the end of the operations of any year the recèipts do not cover
the expenses, and if the reserve has not reached the minimum or has
been reduced below the minimum, then steps must be taken to reduce
expenses by stricter administration, with final resort to increase of
contributions or a reduction of benefits to the legal minimum, if
there is a surplus at the end of the year, with prospects of its continu
ance, then a special account may be created for the purposé of aiding
movements for social welfare, such as combating tuberculosis, vene
real diseases, alcoholism, etc. The benefits may also be increased by
adding features mentioned above, or the contributions may be reduced.
GENERAL ADMINISTRATION.

The 1917 law makes but few changes in the general administration
of the insurance. The minister of the interior has general charge of
the system, and under his direction the local political officials have
certain powers. The funds which serve as insurance carriers are
organizations composed of insured persons and of employers who
conduct practically all of the insurance operations. These organiza
tions or funds are of six types: (1) District funds, each covering a
carefully specified area; (2) establishment funds; (3) building trades
funds* (4) guild funds; (5) miners’ funds; (6) association funds;
and finally, a special type of fund, subsidiary to the guild funds, for
apprentices only. The latter type is only of minor importance. The
employees of the State railroads have special organizations for pro
viding their insurance.
. .
(1)
District sickness insurance funds exist for each administrative
district and include all persons subject to compulsory insurance, except those insured in other types of funds. They must have not ess
than 100 members, and if their membership falls permanently below

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A U S T R IA .

this number, the fund must be dissolved and the membership assigned
to one or more adjoining district funds.
The organization of the district fund follows the usual plan of haring
a general meeting of the members, which elects a board of directors'
one-third of whom are employers. The election for six directors
representing the insured and for three representing the employers
takes place separately. These directors conduct most of the business
, . j6 Uj. ’
ke other officers consist of a supervisory committee
which audits the accounts and in general reports on the operation of
tiie fund; it also is composed of members and employers in the
proportion of two-thirds and one-third.
(2)
Establishment funds are those created for the employees of a
single establishment, such as a factory, a steamship line, or a privately
owned railway The general organization of these funds follows
closely that of the district funds. The employer has certain special
obligations, however; he must pay the cost of administration, must
m certain cases make loans to the fund without interest, etc.
t funding trades funds are, for all practical purposes, establishen unds, and m certain cases the employer may be required to
create, such a fund.
fu? ds were authorized by special laws before the enact
ment of the sickness insurance law of 1888. Under the law of 1883
hand workers, artisans, craftsmen, etc., were required to create funds
for promoting the welfare of their craft, and one of the objects of

h0Z e F Ûds WaS t0 provide aid in case of disability. By the law of
1888 they were recognized as insurance carriers and required to pro
vide at least the minimum benefits of that law.
,(.6[ Association funds are voluntary organizations, the members of
which defray the cost of the insurance without any contributions from
the employers. They are generally referred to as the “ free” funds
because of the voluntary character of the organizations and the free
dom of action permitted the members; the employer, of course, does
not participate in the administration of the funds. The funds were
or the most part m existence at the time the law of 1888 was enacted
and were the usual type of benefit society, like the English friendly
societies and the French and German mutual aid societies. They
must provide at least the minimum benefits of the law, though they
may, instead of free medical service, provide an increase of 50 per cent
? '^ e+Caf
Their general organization is somewhat similar
to that of the district funds.
The law makes careful provision for the creation of federations of
Bick funds for common purposes, such as making contracts with
doctors, pharmacies, and hospitals, the joint purchase of appliances,
the support of special curative institutions, and the like. The créa-

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M A T E R N IT Y B E N E F IT S Y S T E M S .

tion of federations is voluntary on the part of the carriers, büt the
supervisory officials are given a large measure of control over them
in order to prevent abuses. Through such organizations it is pos
sible to secure the services of specialists, consultants, Rôntgen-ray
establishments, etc. They are also authorized to undertake move
ments for the prevention of sickness.
OPERATIONS.

The operations of the system are reported in the official journal
(Amtliche Nachrichten) of the system referred to below. The data
in the 1916 volume bring the information down to 1913. The figures
are given for all funds, but not including the apprentice funds; as
these are not of importance in the present connection, no reference is
made to them;
..
.
,
The following data refer, of course, to operations under the law of
1888; the maternity benefits of this law included medical, etc., care,
and cash benefit for four weeks.
Attention .should be called to the fact that the data on sickness also
include industrial accidents.
A general summary of the membership and of the persons receiving
benefits is given in Table Y.
T a b l e V — Austria.

AAB
[Source: Austria.

Sickness insurance fu n ds, average membership, and cases receiving
benefits, 1890-1913.

Amtliche Nachrichten betreffend die Unfall-und Krankenversicherung, 1892-1916.]
Cases receiving benefits.

Members.

Year.

Average
number of
sickness
insurance
fluids.

19130.....................................

2,660
2,781
2,805
2,843
2', 879
2,889
2,912
2,899
2,908
2,916
2,913
2,907
2,889
2,906
2,921
2,912
2,900
2,882
3,314
3,325
3,323
3,342
3,386
3,149

Total.

Male.

Female.

Sickness
(including
confine
ments).

Confine
ments.

1,548,825
1,666,790
1,741,073
1,840,043
1,940,985
2,066,435
2,188,010
*<£y 232
2,349,746
2,442,333
2,499,930
2,538,896
2,595,474
2,660,623
2,767,506
2,844,245
2,946,668
3,044,129
3,240,127
3,344,258
3,467,329
3,603,521
3,694,114
3,383,408

1,209,930
1,304,794
1,359,583
1,428,730
1,511,130
1,607,943
1,697,648
1,773,975

338,895

900,342
879,307
1,013,599

1,915,434
1,958,967
1,985,506
2,066,2o8
2,279,395
2,354,034

614,507

730,302

2,582,189
2,764,589
2,821,361
2,550,710

Preliminary figures, subject to revision.

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797,683
760 221

1,158,388
1,178,552
1,310,942
1,313,148
1,339,961
1,287,575
1,364,189
1,412,272
1,527,657
1,492,360
1,677,838
1,811,869
1,805,594
1,777,514
1,932,236
logoi’ 4il

26,780
30,757
32', 394
36,220
39,021
41,846
45,558
46,999
48,076
49,319
51,053
50,842
52,113
51,735
53,265
50,696
54,020
55,046
55, t il
55,510
56,198
55,171
56,017
52,288

A U ST R IA .
T able V .

A u s t r ia .

Sickness insurancefu n d s, average membership, and cases receivin']
benefits, 1890-1918'— Continued.

Days for which sick
benefits were paid.

Year.

1890..
1891..
1892..
1893..
1894..
1895..
1896..
1897..
1898..
1899..
1900..
1901..
1902..
1903..
1904;.
1905..
1906..
1907..
1908..
1909..
1910..
1911..
1912..
1913o.

Total
(including
confine» ments).

Confine
ments.

12,409,327
12,754,508
13,869,285
15,089,873
15,629,256
17,516,981
18,260,622
20,015,380
20,477,265
22,404,876
22,708,651
23,396,827
23,301,237
24,472,135
25,088,706
26,978,071
26,433,187
29,358,348
30,658,569
31,043,055
30,597,796
32,905,047
32,885,695
31,985,800

689,889
814,814
858,435
943,121
1,019,277
1,124,522
1,234,465
1,278,980
1,311,794
1,349,566
1,399,474
1,390,371
1,430,103
1,422,459
1,468,544
1,434,982
1,502,120
1,541,076
1,561,412
1,527,418
1,555,076
1,525,174
1,535,675
1,448,850

Average number of da - s of sick
benefit per female member.
Confinements per
100 female
members.

9
7.90
8.50
8.49
8.81
9.08
9.13
9.29
9.19
9.54
9.36
9.44
9.18
9.10
8.70
8.67
7.91
8.10
7.98
7.60
7.28
7.03
6.58
6.42
6.35

Total
Sickness
(including (excluding
confine
confine
ments).
ments).
10

10.48
10.03
10.25
10.33
10.11
10.68
10.24
10.75
11.10
11.33
11.08
10.93
10.68
10.97
10.70
10.98
10.44
11.26
10.16
10.50
10.16
10.30
10.00
10.32

H
8.44
7.88
8.00
8.04
7.74
8.23
7.72
8.25
8.50
8.77
8.49
8.42
8.18
8.58
8.31
8.74
8.19
9.03
8.21
8.49
8.21
8.48
8.22
8.58

Confine
ments.

2 51
2. 50
2 3Q
2 24
2 22
2 01
1 05
1 «2
1* 78

1.74

aPreliminary figures, subject to revision.

The number of women members has increased much more rapidly
than the number of men. This is of especial interest in connection
with the column showing the number of confinements per 100 women
members. In 1891, for instance, the confinements were 8.5 per 100
women insured, in the next seven years there was a tendency for
this ratio to increase, the highest point being reached in 1898 with
9.5 per 100 women; but after that year the tendency was to decrease,
until in 1913 it reached the lowest point in the history of the insur
ance system. The explanation usually given is that, in recent years,
young unmarried women have gone into wage-earning occupations
in increasing numbers. The number of days of sickness per woman
member due to confinement in 1912 was 1.78, while in 1913 it was
1.74. Under the requirements of furnishing four weeks of cash
benefit, the carriers had to raise money enough to supply the daily
cash benefit for less than two days per woman member annually.
It should be remembered in this connection that the insurance does
not include domestic service, agriculture, or the home-working indus
tries, in which a large number of married women are engaged.
Table VI gives a condensed statement of the receipts and expend
itures of the system.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

T a b l e V I. — A u s t r ia .

Receipts and expenditures o f the sickness insurance fu n ds
selected years, 1890-1913.

far

[Source* Austria. Amtliche Nachrichten betreffend die Unfall- und Krankenversicherung, 1916. Supple'
ment 1, p. 4.]
Receipts.
Year.

From contri
butions.-

Total.

1Q11

........................................

85,017,957
7,122,864
9,583,021
12,246,584
17,493,119
18,648,189
19,977,433
18,839,212

$4,664,940
6,677,482
8,973,412
11,447,576
16,259,285
17,454,752
18,634,385
17,496,976

Expenditures

Total.
84,604,243
6,569,283
9,256,800
11,836,524
16,284,175
17,732,050
18,959,591
18,215,393

For benefits.
$4,099,382
5,784,485
8,129,338
13,894,335
15,439,977
16,229,647
------ ;--------

While these totals are of interest as showing the extent of the
system, a clearer idea of the financial operations can be secured
from the per capita ratios given in Table VII.
T a b l e VII. — A u s t r ia . Receipts and expenditures o f the sickness insurance funds per
capita o f average members fo r each year, 1890-1913.
[Source: Austria. Amtliche Nachrichten betreffend die Unfall- und Krankenversicherung, 1892-1916.]
Receipts per member .

Expenditures per member.

Insurance benefits.
AdAll
minis- All
other Total.
Hos Fune tra- other.
Total
Medi pital,
cash Physi
re
Em
ral
cian’s
Mem ploy- ceipts.
Total. bene serv cine, treat bene tion.
bers.
etc. ment. fits.
fit.
ers.
ices.
Dues of—

Year.

$0.09 $0.23 $0.09
82.10 80.91 $0.23 $2.97 $2.65 $1.61 $0.47 $0.36 $0.12
83.24
1890
....................
.08
.15
.24
.34
.11
.47
1.51
2.55
2.90
.21
.92
2.12
. 3.25
1891
....................
.09
.16
.12
.36
.24
.49
1.56
2.66
3.01
.21
.92
2.16
3.29
1892
....................
.09
.17
.12
.24
.36
.50
1.58
2.70
3.06
.22
.94
2.17
3.33
1893
....................
.09
.17
.12
.25
.36
.50
1.54
3.02
2.66
.23
.95
2.21
3.39
1894
....................
.09
.13
.17
.25
.36
.51
1.67
'2.80
3.18
.22
.97
2.26
3.45
1895
....................
.09
.15
.18
.26
.38
.51
1.67
3.24
2.83
.26
1.02
2.28
3.56
1896
....................
.09
.15
.26
.19
.39
.52
1.78
2.97
3.38
.24
1.04
2.32
3.60
1897
....................
.09
.16
.20
.27
.39
.55
1.81
3.04
3.47
.24
1.07
2.41
3.72
1898
....................
.10
.17
.21
.28
.42
.56
1.93
3.22
3.67
.25
1.08
2.42
3.75
1899
....................
.16
.09
.21
.29
.44
.58
1.93
3.25
3.70
.24
1.11
2.48
3.83
1900
....................
.10
.15
.22
.30
.45
.59
1.96
3.32
3.77
.25
1.14
2.53
3.92
1901
....................
.17
.09
.22
.31
.44
.61
1.94
3.30
3.78
.28
1.17
2.60
1902........ 4.05
.09
.32
.16
.24
.47
2.02
.63
3.45
3.93
.26
1.21
2.65
1903........ 4.12
.17
.09
.26
.33
.47
.64
2.03
3.49
3.99
.27
1.24
2.71
1904........ 4.22
.17
.34
.10
.27
.48
.65
2.15
3.65
4.16
-.28
1.27
2.76
4.31
1905
....................
.20
.27
.09
.36
.48
.65
2.05
3.54
4.10
.29
1.30
2.81
1906........ 4.40
.19
.10
'
.38
.28
.50
.70
2.27
3.85
4.42
.30
1.37
2.94
1907...... 4.61
.23
.39
.10
.30
.50
.72
2.28
3.90
4.52
.31
1.43
2.98
4.72
1908
....................
.19
.42
.10
.31
.52
.77
2.31
4.62
4.01
.34
1.48
3.08
4.90
1909
....................
.22
.09
.44
.33
.51
.81
2.27
4.67
4.01
>36
1.52
3.16
5.04
1910
....................
.17
.11
.37
.46
.56
.86
2.39
4.29
4.92
.33
1.60
3.24
5.17
1911
....................
.25
.49
.40
.11
.57
.91
2.40
4.39
5.13
.44
1.67
3.30
5.41
1912
....................
.23
.49
.11
.43
.59
.97
2.57
4.67
5.38
.40
1.71
3.46
1913»...... 5.57
* Preliminary figures, subject to revision.

The official returns do not show the amount expended for maternity
care, as the medical attendance, cash benefits, etc., are included
with the expenditure for sickness (and industrial accidents). A

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A U S T R IA .

statement in Dr. Alfons Fischer’s pamphlet* gives the information
that the officials of the system informed him that in 1909 the esti
mated expenditure for maternity aid of all kinds was 1,480,000
crowns ($300,440); as the number of confinements in 1909 was
55,510, this would average about 27 crowns ($5.48) per case. The
expenditure per case of childbirth, therefore, was but a modest sum,
and the reforms of the 1917 law were obviously needed.
SOURCES OF INFORMATION.

The laws are published in the Reichsgesetzblatt, the official law
gazette of the Empire. Official notices, reports, and statistics of
operations are published in the official journal of the ministry of the
intenor entitled, “ Amtliche Nachrichten des k. k. Ministeriums des
Innern betreffend die Unfallversicherung und die Krankenversicherung der Arbeiter.” A full account of current events in connection
with the insurance willl always be found in the journal of the labor
statistics office entitled, “ Soziale Rundschau,” The ministry of the
interior publishes (1) a pamphlet containing a model form of con
stitution and by-laws for a district sick fund entitled, “ Musterstatut
für Bezirkskrankenkassen” ; (2) a guide for fund officials entitled
“ Gebrauchsanleitung zur Musterstatut” ; (3) a model constitution
for federations of funds entitled, “ Musterstatut für Krankenkassen
verbänden.” Thé ministry of commerce publishes r model constitu
tion (including a guide for officials) for the guild funds entitled,
Musterstatut nebst zugehöriger Anleitung für die genossenschaft
lichen Krankenkassen der gewerblichen Hilfsarbeiter.”
‘ Die Mutterschaftsversicherung in den Europäischen Ländern, p. 37.

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DENMARK.1
Under the provisions of the law of May 10, 1915, voluntary sick
ness insurance societies which provide sickness and maternity benefits
or heir members are entitled to receive from the State a subsidy
based on their expenditures for this purpose. This law has been in
orce since January 1 1916, but prior to that date a similar subsidy
was granted under a law enacted in 1892.
J
The factory law of April 11, 1901, contains the following provijons (par. 18): No female worker may, during the first four weeks
ter giving birth to a child, engage in any work defined in the first
to T J t t r ? 0' 11111688 9h® poasesses a Physician’s certificate
to the effect that she can engage m such work without injury to her

Z n 7 , he^
d’S, healthP«Wic aid she receives during this
p lod forbidding her to engage m the work mentioned is t A a v e
none of the effects of poor relief.” The law of April 6, 1906 on
wor ers in bakeries repeats the provision of the law of 1901 verbatim
(par, 11). The law of April 29, 1913, on assistance to children of
widows was translated and published by the United States Children’s
ofUchiid l T * 13,f ,ii‘dlreCt mterest here as to its aim in the protection

ord ers f l
P
u“
on °f *>* “ other or foster moth
order that this may be made possible. In a circular of the minister
ot the “ tenor to provincial governorss the minister remarks that the
S t m ,ld ed b7- th!S laW’ ranS“ g from 60 to 100 kroner ($16.08 to
*26.80) a year, is given to mothers “ for their children’s sake ”
Interest m sickness insurance in Denmark developed to the point
of havmg legislative commissions study the subject as early as 1861.

There were four of these commissions which took up the matter in
flie yearn 1861, 1866, 1875, and 1885. The 1885 clm isSon filed
its report m 1887, and its recommendations formed the basis of the
law enacted on April 12, 1892. This act continued in.force until the
passmg of the law of 1915.
fu n ^b vlh rsi1? 2 P? J ided for the “ cognition of approved sick
1 i s o q y l h St te and for SOme suPP°rt by the State. B y January
^ the ’ t 7 r re 284 Si°k iuDda
ia d been recognized, and
by the end of the same year the total number was 457 with a mem-

X16’7?8:

Tbe “ fr u ity benefits given in 1893 are

( $ n 7 7 ^ ) the S1°k benefits; the two together equaled 439,312 kroner

t-------"

2^estetetnente in tMs section are based tm materia1furnished by C. E. Stangeland P h D

3Danmark Samling af Love, 1913, Afdeling B, p. 273;'also Afdeling A, p. 395 ff.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

Section n of the law of 1892 provided that the following persons
might become members of recognized and approved sick funds:
Propertyless laborers, cotters, manual laborers and workers, and
persons whose salaries were so low as to put them, economically
speaking, in a similar category. Men and women over 15 years of
age were eligible, with some exceptions, such as persons suffering
from incurable diseases. The dues were required (Sec. I l l ) to be
sufficient in amount, so that with other sources of income they
would cover the liabilities assumed. The total subsidy to be pro
vided by the State was fixed at 500,000 kroner ($134,000) annually.
Members were entitled to demand the cost of transportation for
the doctor or midwife whose services were required up to I f Danish
miles (about 6 English). Benefits of whatever nature derived from
sick funds through the State were not to be regarded as poor relief.
The members received the following benefits, which accrued also
to members’ children (Sec. IV) :
A daily cash benefit of at least 40 ore ($0,107), but not exceeding
two-thirds of the member’s usual daily income, unless this was
already provided by the rules of the sick fund concerned; but no
sick benefit could be demanded when the member had joined the
fund less than six weeks preceding his or her illness, nor for afl illness
of less than three days’ duration.
Paragraph 21 of Section IV provided that, in a confinement case,
the sick fund could grant the female member concerned a lump sum;
but if after the eighth day she became ill she Was entitled to the
usual sick benefits. The right to such benefits could extend to at
least 13 weeks out of every 12 months, though exceptions were pro
vided for.
Under the law of 1892 the maternity benefits granted by sick
funds in 1913 and 1914 were as follows:
In 1913, for the whole country, 78,595 kroner ($21,063), of which
51,762 kroner ($13,872) was in Copenhagen; in 1914, for the whole
country, 89,528 kroner ($23,993), of which 58,309 kroner ($15,626)
was in Copenhagen.
The average benefit for a birth amounted to about 12 kroner
($3.22) in Copenhagen, 8 kroner ($2.14) in provincial cities, and 5
kroner ($1.34) in rural communities. The number of cases receiv
ing benefits in 1912 was 9,263, consisting of 4,313 in the city of Copen
hagen, and 4,950 in other parts of the country.
The total number of births in Copenhagen in 1912 was 13,108, in
the provincial cities 14,581, and in the rural districts 44,776, or a
total of 72,465. This indicates that about one-eighth of the births
were affected by the existing maternity benefits in the country as a
whole, while about one-third were affected in Copenhagen.

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DENM ARK.

As in Norway,1 Danish women took an especially active interest
in the maternity sections of the old law and in their extension. The
Society of Danish Women (Dansk Kvindesamfund) addressed the
Landsthing twice during 1914 in favor of requiring sick funds to
provide female members a specified daily cash benefit» making the
following definite proposal:
In maternity cases, sick funds should grant female members affected a benefit of 2
kroner ($0.54) a day as long as they are confined in bed up to 10 days after childbirth,
unless th ey be already entitled to maternity benefits in accordance with the factory
law of 1901. After 10 days they shall be entitled to ordinary sick benefits if there is
subsequent illness.

The society justified its proposal on the ground that 10 days is
the minimum period of rest needed for women after childbirth, and
that unless a wage-earning woman is assured a benefit for at least
this time, the physician’s advice that she take such a period of rest
will be useless, because only the aid from maternity insurance would
relieve her of the necessity to work at home or outside of it. The
request by the society that the law make maternity benefits manda
tory for the sick funds was based on the fact that in 1914 only 332
out of a total of 1,547 funds did grant such benefits. The situation
was aggravated also by the fact that 441,435 of the 843,244 members
/ of sick funds were women over 15 years of age. Since 1893 the
membership of the funds, as a whole, had increased from about 8
per cent of the population over 15 years of age to 44 per cent, and the
increase of female members had been relatively more rapid than that
of the male. If maternity benefits were made compulsory, approxi
mately one-half of the births would be affected thereby, as was the
case in Norway under the compulsory law.2
The subsidies to the sick funds from the National Government
had gradually increased from 345,127 kroner ($92,494) in 1893, to
2,936,256 kroner ($786,917) in 1914, and the reports emphasize the
importance of the financial aspect of the proposed plans for maternity
aid.
A committee of the Landsthing presented a report on the proposed
changes in the law of 1892 on March 18, 1915,8in which attention is
called to the desirability, of framing a new law and to the financial
difficulties to be faced on account of the already heavy expenditures
being made by the State in consequence of the unsettled condition
of Europe due to the war.
The committee “ recognized that the law of April 12, 1892, on
approved sick funds—which was founded on the principles of freedom
and of helping others to help themselves—had had a most salutary
1For section on Norway, see p. 153.
2Beretning af Sygekasseinspekt0ren, 1914, pp 10-12.
3 Rigsdagstidende, 67 ord. Samling, Tillag B, Betankning over Forslag til Lov om anerkendte Sygekasser.

113300°— 19----- 3

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MATERNITY BENEFIT SYSTEMS.

effect and caused a great expansion in sickness insurance for the
benefit of the poorer section of the population, which was especially
in need of aid during illness,” but it recommended only slight changes
“ out of consideration for the present financial situation,” and this
was considered as an objection to the extension of the maternity
benefit clauses, which were to be regarded favorably on principle.
The law as finally adopted on May 10, 1915, provides that only
persons 15 years of age without income-bearing property (ubemidlede
Personer) and persons economically in a similar position, such as
cotters, manual laborers, and workers generally, might become
members of recognized sick funds, but unlike the Norwegian law the
Danish law does not specify more definitely the maximum incomes
of the classes to be affected. The law does provide, however, that
instructions covering this and other points shall be communicated
by the minister of the interior to the various sick funds every five
years.
The sections of the 1915 law which relate to maternity benefits are
those numbered 19, 20, and 23.
Section 19 provides that the funds must grant free attendance by
a physician and free hospital treatment to their members and to the
latter’s children under 15 years of age. There must be a cash benefit
of not less than 40 ore ($0,107) nor more than 3 kroner ($0,804) per
day. To be entitled to these benefits, the member must have been
in good standing for at least 6 weeks and, to be entitled to maternity
benefit, the woman member must have been in good standing for at
least 10 months.
Section 23 provides that “ in a case of confinement the sick fund
is required to provide the female member with a benefit of at least
1 krone ($0.27) as long as she is bedridden, but not to exceed 10
days after the birth, unless she is already entitled to maternity
benefits under the factory law of 1913. After 10 days, and if sickness
follows, she shall be entitled to the usual sick benefits. When the
attendance of a physician is necessary at the birth this must be pro
vided by the sick fund.”
Section 15 makes provision for the transportation of a physician
or midwife when the member concerned or his or her children under
15 years of age five more than 1 kilometer from a town’s limits ii
the distance traveled does not exceed 12 kilometers each way; or
the member may, if this is necessary, have his or her transportation
for the same distance to some hospital within the district.
It will be noted that the law is far less liberal in practical effect than
the Norwegian law, though it makes a great advance in that approval
or recognition by the State (upon which the State subsidies depend)
is withheld unless maternity benefits are granted in accordance with
section 23. It will be noted also that though the maternity benefit

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DENMARK.

period is too short, this is somewhat mitigated by the possibility of
subsequent sick benefits; that is, after 10 days the mother, if ill, may
still receive benefits which in effect are maternity benefits. The law
neglected to recognize the fact that rest and freedom from ordinary
work were desirable for mothers in the period immediately preceding
as well as after confinement.
SOURCES OF INFORMATION.

The official law gazette of Denmark bears the title “ Samling af
Love, Danmark,” and the laws on recognition and subsidizing sickness
funds will be found in the volumes for the years 1892, 1901, 1906,
1913, and 1915. The debates of the Parliament are reported in the
Rigsdagstidende. The operations of the sickness insurance funds
are reported in the annual Sygekasseinspekt0rens Indberetninger.
The statistical yearbook, Statistisk Aarbog, also gives information on
operations.

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FRANCE.
Under the French law of June 17, 1913, any woman dependent on
her earnings is granted a daily allowance during a period of eight
weeks at childbirth, with an additional allowance if she nurses her
child.
Prior to the year 1913, a long list of laws had been placed on the
statute books providing aid or protection for mothers during ma
ternity. Among these may be mentioned the law of November 30,
1892, which was practically a codification of the laws regulating
midwifery. Earlier than this, the law of January 19, 1811, provided
for the care of foundlings and abandoned infants. The law of
December 24, 1874 (the law Roussel), on the care of children in their
first years of life, to which reference is frequently made in current
discussions, was one of the pieces of legislation enacted in the effort
to reduce the serious child mortality of France. It provided a careful
system of regulation of those who undertook the care of nursing
children as a business; it included à plan for licensing, bonding, and
inspection, and for reporting the sickness and deaths in their estab
lishments, it also included the registration of wet nurses, etc. On
May 6, 1900, a governmental decree was issued creating a commission
whose duty was to distribute the appropriation for subsidies to insti
tutions and organizations providing care during maternity and care
for infants in their first years of life. The law of June 24, 1904
(amended Apr. 22, 1905), provided a syste._i of temporary aid for
children of tender years in cases where the father or mother was
unable to provide, or properly care for, an infant or child, the purpose
being to aid parents who might otherwise be tempted to abandon
^such children. Mention should also be made of the act of January 15,
1893, on freer medical relief; this law provided that any French citizen
was entitled to receive medical treatment in his home or in a hospital,
if he was without means, and the act has been administered to include
women during confinement. The cost of this service was defrayed
by the municipality, Department, or National Government in
accordance with the rules controlling the legal residence of the
beneficiary. Perhaps reference should also be made to the law of
July 14, 1913, providing pensions to families dependent on their
earnings, if they have four or more children under 13 years of age.
Before 1913 the laws regulating the employment of women in
commercial and industrial establishments contained but few refer
ences to the period of maternity. Thus the decree of March 7, 1908,
required that no woman employed in an industrial establishment
37

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MATERNITY BENEFIT SYSTEMS.

should be allowed to lift, push, or drag heavy loads during the three
weeks following childbirth. The act of November 27, 1909, provided
that if a woman stopped work in an industrial establishment because
of approaching confinement, such action should not be considered a
violation of the contract of employment, and her position must
again be given her when she applied for it.
The law of June 17, 1913, on maternity allowances made provision
for wage-earning women as described below; and, in addition, pro
hibited any employer in an industrial or commercial undertaking
from employing a woman within four weeks after childbirth. This
prohibition was added as section 54 (a) of book 2 of the code on labor
and social welfare.
. .
For the employees of the National Government, provision lor
maternity is made on a fairly liberal scale. Thus, women employed
in the central service and in the active service of the State railways
receive a lump sum allowance of 15 francs ($2.90) on confinement;1
in addition to this, under the rules regarding leave of absence for
sickness, a woman employee is granted not more than 60 days’ leave
with pay, and the rule specifically states that childbirth is mcluded
as sickness.2 In the munition plants, military depots, etc., under
the regulations published in the Journal Officiel,3 a woman employee
who has been in the service six months is allowed leave of absence
during maternity, with half pay, for a period of eight weeks; for the
purpose of nursing her child she may have leave without pay for three
months; and this leave may be extended until the weanmg of the
child if she so desires and a physician so recommends. Again, a
woman employed in the national printing office, by the decree ot
September 24, 1913, receives the following benefits during confine
ment: First, a lump sum of 30 francs ($5.79) on the birth of a child,
whether it lives or not; second, a daily benefit of 2.50 francs, if she
has no other children, and of 2.80 francs if she already has a childj
third, a nursing benefit of 10 francs ($1.93) per month if she hersetk
nurses the child during the six months following birth; m addition,
mothers may bring their infants to the printing office and nurse
them during the hours of work in a special room set aside for this
purpose.4 Another instance which may be mentioned is the pro
vision for public-school teachers under the law of March 15, 1910;5
besides the regular leave of absence for sickness, a teacher in the
public schools is allowed, on confinement, two months’ leave of
absence with full pay— one-half of this time to come before and onehalf after the date of childbirth. She may not resume her position
1 Journal Officiel, 1912, vol. 4, p. 1390.
2 Journal Officiel, 1914, vol. 4, p. 822.
* Dec. 17, 1916, p.,10869.
i Journal Officiel, Doc. par., Sénat, 1917, Annexe 46, p. 130.^
• Journal Officiel, Mar. 18,1910.

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FRANCE.

until after examination by a physician and his certificate to the
effect that resumption of work would not injure her health; in the
contrary case, she is to be given such additional leave with full pay
as may be necessary, but for not more than two months. The cost of
this teachers’ maternity leave must be carried in a special clause in
the annual budget of the ministry of education.
The principal agencies, not conducted by the Government, which
provide maternity benefits for wage-earning women are the mutual
aid societies. As these organizations are in some instances subsidized
by the National or local Government, some mention should be made
of them. The membership of these voluntary organizations consists
largely of wage earners; they have for a long period rendered aid to
women members during illness, and some of the societies have in
cluded maternity relief among the benefits they provided. As a
rule, though, these organizations have been reluctant to offer mater
nity aid, first, because their principal purpose was to aid the usual
forms of sickness and accident, and, second, because of the greater
expense involved. In general, the lower wages of women members
made it necessary to have low rates of dues for them, even though
the rate of sickness for women was higher than the rate for men.
On the whole, it may be said that the maternity relief furnished by
these societies has been of slight importance, even though out of the
-total membership of approximately 2,000,000 about 300,000- were
women. Nearly all the societies limit their maternity benefits to
medical attendance and medicine. This reluctance on the part of the
societies to provide maternity aid has been a matter of concern to the
Government, and in order to encourage provision for such benefits at
least two of the Departments, Nord and Seine-et-Oise, have for some
years granted subsidies to societies which pay benefits during con
finement. While the subsidies are of comparatively small amount,
they assist in reducing the cost of the extra expense of the women’s
benefit. A development of recent years is the type of mutual aid
society solely for the provision of aid in cases of maternity, such as
the well-known Mutual Maternity Society of Paris. These mutual
organizations are partly, if not wholly, dependent on the contribu
tions of honorary members for their existence. The dues paid by the
insured women are usually small, that of Paris, for instance, being 3
francs ($0.58) per year. A special report for 1910 1 shows that in
1909 such societies were in operation in about 50 cities and that their
membership numbered about 30,000, of whom 3,835 received mater
nity benefits amounting to 163,289 francs ($31,515). The National
Government annually distributed the sum of 500,000 francs ($96,500)
as subsidies to organizations which are recognized as being 1‘ of public
utility,” and these societies are the principal ones included in that
1 Journal Officiel, Dec. 28,1910.

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MATERNITY BENEFIT SYSTEMS.

class. Under the terms of the 1913 law, these societies have been
given a prominent place in the administration of the law, especially
that part of it which provides for volunteer visitors to the mothers
during the four weeks following confinement.
The need for some restriction on the employment of women in
industrial establishments immediately after childbirth was recognized
at an early date, but the leaders of the Government steadily refused
to enact the usual prohibition of employment during this period be
cause they held that it was unfair to prevent women from working •
unless some form of benefit were provided to replace the wages they
were debarred from earning. The appeals for some action on this
subject gradually became so insistent that finally the law of June 17,
1913, was passed, by which a daily sum was granted to wage-earning
women during confinement for a period not to exceed eight weeks, on
condition that they should abstain from work.
The law of June 17,1913, was proposed in the French Parliament by
Senator Strauss in November, 1909. A proposal along similar lines
had been submitted by Senator Combes in 1900; during the following
nine years, hardly a session passed without some bill being offered in
one of the two houses for the aid of mothers in the period of childbirth.
The Strauss proposal of 1909 was reported on favorably by special
commissions in 1910 and 1911; a full discussion of the measure took
place in the Senate in March and December of 1912, and it was passed
and sent to the Chamber of Deputies on December 6, 1912. The
agreement
of both houses was reached in June, 1913, and the measure
o
was promulgated as law on June 17, 1913.
The debates in the two houses show that the principal argument
for the adoption of the measure was the possibility of reducing the
high rate of infant mortality. In the Senate, especially, frequent
reference was made to the great number of children s deaths and to the
statements of high medical authorities to the effect that most of these
deaths could be prevented. It was brought out, for instance, that
in the period 1906 to 1909, of the children who died before the Mid of
their first year, 34.66 per cent died in the first four of weeks life, and
that out of the 88,000 children undei 1 year of age who died in 1910
about 30,000 died in the first four weeks after birth. The medical
authorities were agreed in stating that most of these deaths were
preventable, and that a reasonable amount of rest for the mother and
better care of the child by the mother would be poweiful factors in
saving these lives. Attention was called to the experience of Paiis in
this direction; the mortality of all infants in Paris in 1910 was about
15 per cent; the mortality of infants whose mothers were aided and
instructed by the Mutual Maternity Society of Paris (Mutualité
Maternelle de Paris) was 10 per cent in 1892, 5.6 per cent 10 years
later, and in 1909 was 3.08 per cent. The mothers aided by the

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FRANCE.

society were principally wage earners, and its successful work formed
a striking_illustration of the possibilities of saving child life by means
oi a small allowance and prompt instruction in hygiene.
PERSONS INCLUDED.

The group of persons entitled to the benefits of the 1 9 1 3 law 's
described as those of French nationality without means (“ privée de
ressources ), who work for remuneration either in the establishment
o another or m their own home, either as wage earners, salaried em
ployees, or as domestics. The authorities have construed the words
without means” to include persons who are dependent on their
earnings. In the Senate an attempt was made to have all women
made eligible for benefits, but this was opposed by the administration;
first, because of the larger expense, and, secohd, because it would be
difficult to supervise the beneficiaries in the sense of making sure that
^
r®framed from work and thus secured for themselves and the
child the rest which it was the main purpose of the law to provide
Ihe limitation to wage earners was finally adopted, and a section was
inserted m the law requiring employers in commercial and industrial
establishments to refuse employment to women for four weeks after
childbirth and for such time prior thereto as they were unable to work
with safety The employers include both public authorities and
pnvate estabhshments, the latter comprising even professional and
charitable offices.
These groups of persons entitled to the benefits of the law are of
course, principally residents of towns or cities. The woman in the
rural districts who, as a rule, is in greater need of maternity benefits
than the city dweller, is not included. In considering the budget on
ebruary 6, 1914, it was definitely stated that the wives of day la
borers and agricultural workers and the majority of the women in
t e country districts, who usually work as a family group and do not
receive wages, are not entitled to the benefits of the law 1
The law of January 23, 1917,* provides that the benefits of the 1913
law shah be granted also to wives of men in military service who are
the seParatlon allowances specified in the law of August 5,
i914. The maternity benefits are granted whether the soldier’s
wile is a wage earner or not. Women who are refugees from invaded
areas, and m receipt of refugees’ allowances, also receive the maternity
benefits of the 1913 law.
J
BENEFITS.

There are two distinct benefits provided by the law; the first mav
bendefitCnbed ** ^

hygiene benefit>tbe second as the nursing

* J°umaI Officiel, Députés, Documents Sess. ord. 1916, Ann«™ 1753
3Journal Officiel, Jan. 24,1917, p, (395.
®Journal Officiel, Aug. 6 ,1914, p. 7127.

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MATERNITY BENEFIT SYSTEMS.

The first benefit consists of a daily allowance, of not less than 0.50
franc ($0,096) and not more than 1.50 francs ($0.29). If the mot er
complies with the requirements, the benefit is paid first for the four
weeks following confinement, and second for a period of not more than
four weeks before confinement, the date of its beginning to be fixed
by the certificate of a physician specifying when the expectant
mother should stop work. As the purpose of the benefit is to assure
rest for the mother, the benefit is paid even if the child does not live.
The second benefit, the nursing benefit, consists of an additiona
allowance of 0.50 franc per day for four weeks after confinement, i
the mother nurses the child; it is practically a bonus of 14 francs
($2.70) paid at the end of four weeks.
In order to obtain these benefits the mother must secure as muc
rest as possible; she must entirely refrain from work for which she is
paid wages, she must avoid housework as much as possible, and she
must follow the prescribed hygienic rules.
.
,,
If under other laws providing medical assistance the mother is
admitted to a maternity hospital free of charge, then the daily allow
ance is reduced one-half during her stay in the institution; but the
reduction is not made if there is in the family a child under 13 years
of age, and these restrictions, of course, do not affect the nursing
benefit. In any commune or other administrative district the rates
of benefit must be the same for all persons. The money pai
or
benefits can not be pledged and can not be seized for debt or attached
in any way whatever.
.
.. ,
. ,
The rate of the daily allowance paid in each commune is determined
by the communal council, subject to the approval of the general coun
cil of the Department; the commune may, however, decide to pay a
higher rate than the maximum of 1.50 francs per day, but in such case
the cost of the excess must be defrayed entirely by the commune
itself The official sources of information contain no reports which
would show the rates generally adopted by the communes, but the
city of Paris has adopted the rate of 1.50 francs ($0.29) per day.1
The benefits provided by the law under discussion may not be
granted if the claimant receives aid under any law for the relief o
distress caused by childbirth, and especially under the law of June 24
1904 as amended April 22, 1905; this law requires the departmental
governments to provide temporary lelief to a father or mother w o
1 unable to provide food and to care for his children This law as
stated above, aims to relieve cases of destitution which mig
to the abandonment of children. The benefits of the law of June 17
1913 may be allowed in addition to those provided by the law of
July’ 14 1913, under which an annual pension may be granted to
families’having four or more children under 13 years of age.

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FRANCE.

FINANCIAL ADMINISTRATION.

The Government’s experts estimated that claims would be sub
mitted annually by 140,000 women working in the place of business
of another person and by 66,000 persons bringing work home to do,
or a total of 206,000 wage earners. It was also estimated that
the average amount paid in each case would be 50 francs ($9.65);
this would make a total annual expenditure of 10,300,000 francs'
($1,987,900) for the daily allowance; adding to this the nursing
allowance, which was estimated to be 1,236,000 francs ($238,548),
the total for all benefits under the act would be 11,536,000 francs
($2,226,448). It is expected that the National Government will pay
one-half of this sum, the other half to be defrayed by the depart
mental and communal governments.
P^an adopted provides that the National Government shall
aid the Departments, and the Departments shall aid the communes
by means of subventions. According to the finance law of July 14,
1913 (secs. 70-73), the communes and the Departments are to cover
the expense as follows:
The communes.

The communes are to provide for the expense due to the system
of aid to mothers from—
(а) Special receipts from bequests and donations made for the
purpose of aiding women during confinement;
(б) If necessary, by the participation of the communal bureau of
charity (bureau de bienfaisance) and the communal hospital;
(c) In case these receipts are not sufficient to meet the expense,
by a, subsidy of the departmental government, to be based on thé
portion of the expenditures not covered by the receipts listed under
(a) and (b) above and to be computed in accordance with a pre
scribed schedule,1 except that the share of the commune may not
be less than 10 per cent of this portion of the expense;
id) The residue of the expense shall be covered by appropriations
from the ordinary receipts from taxes of all kinds, as authorized bv
law.
The Departments.

The Departments are to provide for the benefits granted by the
law from the following sources :
(a) Special receipts from bequests and donations made for the
purpose of aiding women during confinement;
(b) In case these receipts are not sufficient to meet the expense,
by a subsidy of the National Government, to be based on the portion
of the expenditures not covered by the receipts listed in the preceding
1See Schedule A, Tables 1,2, and 3 of the law of July 14,1913, on the relief of large fa m ily

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MATERNITY BENEFIT SYSTEMS.

paragraph, and to be computed in accordance with a prescribed
schedule,1 except that the share of the Department may not be less
than 5 per cent of this portion of the expense;
(c)
The residue of the expense shall be covered by appropriations
from the ordinary receipts from taxes of all kinds, as authorized by
law. ■
. . _
This rather complicated arrangement works out in practice m abou
the following proportions: The State pays 50 per cent, the Depart
ments pay about 16 per cent, and the communes pay about 34 per
The expenditures to be met by the communes are the cost of the
benefits just described, to be paid to persons having their lega resi
dence in the commune. The expenditures by the departmental gov
ernments are (1) for benefits to persons having their legal resi
dence in the Department (that is, for persons who have not resided
in a given commune long enough to establish a residence there);
(2) for the costs of administration and of departmental control of the
service; (3) for subventions to the communes. The expenditures of
the National Government are principally for the subsidies to the
departmental governments, but in addition they consist, firs , o
the payment of the benefits for persons who have not established a
legal residence in any Department, and, second, of the general cost
of the administration and control of the execution of the law.
As each commune establishes the rate of benefits m its area, it
is enabled to take into consideration its financial condition and to
adjust the expenditure for this purpose to its resources. It also
makes possible the fixing of a benefit rate commensurate with the
cost of living in the locality.
GENERAL ADMINISTRATION.

In the regulations for the administration of the act, two points are
emphasized: First, that the benefits are restricted to women depend
ent on their earnings; and, second, that the payment of the benefits
is made only if the mother abstains from paid work entirely, from
household work as much as possible, and observes certain hygienic
ruies
The procedure to be followed by the woman applying for the- bene
fits is as follows: She must file, in writing, an application to the
mayor of the commune, stating: That she is of French nationality;
that she customarily devotes herself to work for wages; the famdy
expenses;' the resources which would be available for the family
during the confinement, especially the mcome of the husband, the
proof of legal residence. If the expectant mother wishes to apply
for the benefits which are paid prior to the date of confinement, then

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FRANCE.

she must furnish a physician’s certificate stating that work would
chikl6 ^

her ^

glYing th® aPProximate date of birth of the

If the application for benefits is approved, then the arrangements
for advising the mother and seeing that she lives up to her part of
the agreement are put into motion. This feature of the system is
cared for by the local bureau of relief or charity (bureau d’assistance)
which makes use of the services of volunteer visitors. At the besin.nm g of each year, the bureau makes up a list of persons who are
serve m thls o p a city ; these visitors, of course, are women
and the bureaus are urged by the national authorities to make every
effort to enlist the services of women of high standing in the commumty. As soon as a claim is approved, the mayor writes a letter
to this effect to the volunteer visitor, who takes it to the home of
the applicant as evidence of the official character of the visit; with
the letter is supplied a pamphlet containing instructions to the
mother on the subject of personal hygiene for herself and the child.
he visitor must explain to the mother the importance of the rules
arid advice in the pamphlet and in subsequent visits must make sure
that the rules are followed. From reports of the visitor, the mayor
wifi decide as to the progress of each case and, on her recommendation
will suspend or discontinue the benefits in case of failure to cease
work or neglect to follow hygienic instructions. The benefits may
be paid in goods mstead of in cash, if the visitor so recommends.
The nursing benefit is paid at the end of the four weeks’ period upon
the receipt of a special report from the visitor.
Ariucle 10 of the law also permits the local authorities, with the
approval of the higher authorities, to turn over to mutual maternity
societies or similar organizations the administration of the law in
the commune or part of the commune in which the society operates.
The request for such participation by an organization must be pre
sented after a general meeting of the members has voted in favor of
tf
Ti“et,local f uthorities make a thorough investigation
of the ability of the society to perform the work, and upon their
favorable report the minister of the interior and the minister of finance
issue a joint decree appointing the organization as the legal agent of
the Government for this service. It is the hope of the Government
that the work to a very large extent will be carried on by these
agencies, because a more sympathetic and informal service can be
secured m this manner.
The same point is repeated in Circular No. 109 of July 6 1914 in
calhng attention to the importance of the work of the volunteer visitors. it must be emphasized that the social results expected from
this law in connection with the reduction of infant mortality, will in
a egree which can not be exaggerated, be greater in proportion as

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MATERNITY BENEFIT SYSTEMS.

such cooperation is methodically organized in the communes or
diminished as it is neglected.”
The work of the local bureaus and local organizations in giving
instruction on the subject of hygiene is regarded as One of the most
important features of the law; thus the circular letter of the assistant
secretary of the interior to the local officials, says: This law is just amuch a law of thrift and of social hygiene as it is a law of relief. If
everyone who takes part in the administration of the law will keep
this leading idea well in mind and direct his actions accordingly,
the present law * * * ought to have and will have the result
of bringing to every woman in France a knowledge of the essential
principles of child hygiene and domestic hygiene and will thus con
tribute in a powerful manner to the reduction of infantile mortality.
Perhaps a word should be said about the admirable pamphlet of
instructions supplied to the mother; it is a clear, simply expressed,
almost homely statement of the rules she is advised to follow. The
booklet has four sections: Before-birth hygiene, hygiene following
birth, the hygiene-of the child with special reference to breast feeding,
and general rules of health. The importance of medical examination
before confinement is carefully emphasized; the necessity of complete
rest, especially from heavy work, during this period and the prepara
tions needed in the home are set forth in the same explicit manner.
After childbirth, the mother is advised to remain in bed for 10 days
at the very least; from the tenth to the twenty-eighth day she is
urged to recline as much as possible, not to do such work as washing
or running a sewing machine, and, if she does anything at all, only
light work in a seated position. The importance of breast feeding is
put strongly: “ Every mother’s duty is to nurse her child. The child
has a right to the mother’s milk. For the mother not to fulfill this
duty and to deprive the child of this right, there should be some com
pelling reason beyond her control.” The times and amount of
feeding, the possible disturbances of digestion, the time to discontinue
breast feeding, the methods of artificial feeding, the weighing of the
child, and the value of medical examinations are set out in brief, clear
sentences. The necessity for absolute cleanliness, the risk of tuber
culosis, the dangers of alcoholic drinks are also set forth. To place
each year in thousands of homes such a stock of hygienic information,
emphasized by the fact that it comes from the National Government
and is usually presented by a woman of high standing in the com
munity, must in time be of great social value to a country. It is one
of the advantages of a system of maternity benefits that such educa
tional work is made possible.
_________
i Ministry of Interior Circular of Dec. 24,1913.

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FRANCE.

OPERATIONS.

Only incomplete information regarding the operation of the law
is available. Table V III shows the number of cases receiving
maternity and nursing benefits:
T

a b le

V III.

France.

Cases receiving maternity and nursing benefits, 1914-19i t

[aource: France. Journal Officiel, 5 juin 1917.

Doc. pari., Sénat.

Annexe No. 189, p. 308.)

Number of cases
receiving—
Year.
Maternity
benefit.

Nursing
benefit.
■

1914 a .........................

50,657

aIncludes second, third, and fourth quarters of 1914.

In discussing the operation of the law, Senator Paul Strauss stated
that the law had done all that was expected of it; because of con
ditions brought about by the war, some of the things hoped for could
not be accomplished, especially the visiting of the homes and the
instruction of the mothers. Some minor improvements were still
needed, more particularly in the administrative features. It was
too early, he stated, to attempt to make any deductions from the
statistics of infant mortality.

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GERMANY.
Maternity aid on a national scale was introduced in Germany by
the compulsory sickness insurance law of 1883, which was amended
a number of times and finally included in the imperial insurance code
of July 19, 1911, which is now in force.
The factory laws of Germany enacted soon after the formation
of the Empire (1878) prohibited the employment of women for three
weeks after confinement; in the year following the 1890 International
Congress at Berlin this law was amended to make the period four
weeks, with the requirement that employment must be refused for
two weeks longer unless a medical certificate was presented that
employment would not be injurious. In 1900 the law was amended
so as to make the six-weeks’ prohibition absolute. In 1908 the
prohibition was increased so as to consist of two weeks before and
six weeks after confinement; after the six-weeks’ period a medical
certificate of ability to work must be presented. This is the status
of the law at the present time. It represents a gradual development
from 1878 to the present and in most cases has been accompanied
by changes in the insurance laws which provided cash and other
benefits for the mother while she was prevented from working.
The German writers on labor legislation refer to this eight-weeks’
period as a minimum of protection necessary for a wage-earning
woman in the period of childbirth.
The basis of the maternity provision is contained in the com
pulsory sickness insurance law of June 15, 1883, which came into
force on December 1, 1884, and which covered temporary disability
for 13 weeks, including both sickness and accident disability. This
law was amended a number of times, and finally a general codifica
tion of all the insurance laws was made in the imperial insurance
code of July 19, 1911.1 The most interesting developments in the
field of maternity provision, however, came after 1911. As the
history and experience of the sickness insurance system prior to 1911
have been described in some detail in previous reports of the Depart
ment of Labor, this period of the subject needs only brief mention.
Under the law of 1883 the duration of the maternity benefit was
three weeks; in 1892 the period was increased to four weeks (to con
form with the factory law of 1891) ; and in 1903 it was made six weeks.
1A detailed account of the German insurance system is given in the Twenty-fourth Annual Report of
the U. S. Commissioner of Labor,- Vol. I. Washington, 1911. The full text of the imperial insurance
code (workmen's insurance code) of July 19,1911, is given in Bulletin 96 of the U. S. Bureau of Labor Sta
tistics.

113300°— 19------ 4

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MATERNITY BENEFIT SYSTEMS.

An amendment to the industrial code, dated December 28, 1908,
made the period of compulsory abstention from worik eight weefe
so the insurance code of 1911 extended the maternity benefit period
to eight weeks also,- of which six weeks must follow the date of con
finement. The 1911 law (sickness insurance section) came into
operation on January 1, 1914.
PERSONS INCLUDED.

The criterion of insurance is the fact of being employed for com
pensation; persons of an independent position, such as smaU em
ployers, shopkeepers, etc., are not included. Estabhshment officials
clerks, members of a theatrical company, orchestra, etc., are included
only if their annual earnings are less than 2,500 m. ($595).
Voluntary insurance is allowed for persons whose annual income
is less than 4,000 m. ($952), though the insurance carriers may make
membership dependent on the presentation of- a health certificate
from a physician and may also impose an age limit.
INDUSTRIES AND OCCUPATIONS INCLUDED.

The following are included in the compulsory insurance: Work
men, helpers, journeymen, apprentices, servants, establishment
officials, foremen, etc., clerks in commercial establishments and in
pharmacies, members of stage companies and of orchestras, teachers,
persons in the home-working industries, domestic servants, and
crews of German seagoing vessels and of vessels engaged m p u d
navigation; certain types of agricultural employees are also included.
DISABILITY PROVIDED FOR.

Under the laws prior to 1911 benefits were paid for what is usually
understood as sickness, when such sickness was sufficient to prevent
the insured man or woman from earning a living; under the law of
1911 the disability provided for was defined as inability to work, this
disability may have been caused either by sickness or by accident.
Maternity, and in some cases pregnancy, are also included in t e
disability for which benefits are paid. A funeral benefit is also
granted. Under certain circumstances the uninsured members ol
the family of an insured person are granted sickness benefit, maternity
benefit, and funeral benefit. The system, therefore, provides aid
in case of sickness, childbirth, and death.
BENEFITS.

The benefits of the system are: (1) Cash benefit, (2) medical bene
fit, (3) maternity benefit, (4) funeral benefit.
, .
These benefits may be assumed to be the regular benefits during
times of peace; for the period of tho war moie extensive benefits in

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Federal Reserve Bank of St. Louis

GERMANY.

case of maternity have been provided, as described later.1 The above
four benefits have been provided since the sickness insurance law
of 1883 came into force.
(1) Cash benefit: This benefit must be computed on a standard
basic wage, not to exceed 5 m. ($1.19) per working day, or on the
actual daily earnings of the insured, but not to exceed 6 m. ($1.43)
per working day. The first plan is usually followed, and most of the
insurance funds use a series of wage classes for computing the dues
and the benefits, as this plan permits those earning a small wage to
pay lower dues, though thay receive smaller benefits in consequence.
The cash benefit consists of one-half of this standard daily-wage
rate, paid from the fourth day of sickness, or if inability to perform
work begins later than the fourth day, then from the beginning of
such disability. It is payable for a period nor to exceed 26 weeks
from the beginning of the sickness, but is not paid for Sundays or
legal holidays unless the insured person works regularly on such days,
as in the case of a domestic servant. The funds which provide the
insurance are authorized to make a variety of increases of this benefit,
such as paying for a period up to a full year, making the rate threefourths of the basic wage, beginning payment on the first day of
sickness, etc., but in such cases the approval of the Supervisory
authorities must first be secured. The benefit may be refused for
misconduct.
(2) Medical benefit: In the 1911 law this benefit is called “ sickness
care” ; it begins immediately with the occurrence of the sickness.
It consists of medical attendance and the supply of appliances such
as medicines, eyeglasses, trusses, and other therapeutic aid.
In place of the above, the fund may provide treatment and main
tenance in a hospital; in certain cases the fund may supply care
and attendance by ^nurses or other attendants. Where institutional
care has been furnished, the fund must provide a benefit called
“ house money,” equal to one-half of the cash benefit, if the insured
person has a household with dependents; under certain conditions,
the fund may increase the “ house money” benefit to the full amount
of the cash benefit.
(3) Maternity benefit: Women who have been members for six
months during the year preceding the date of childbirth shall receive
a maternity benefit equal to the cash benefit for a period of eight
weeks, at least six of which must be after the date of delivery and
must be consecutive. In other words, the maternity benefit takes
the place of the cash benefit for this period. With the consent of
the woman, the fund may, instead of paying the maternity benefit,
provide medical treatment and maintenance in a maternity hospital;
or the fund may provide treatment and attendance by mirses at

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Federal Reserve Bank of St. Louis

MATERNITY BENEFIT SYSTEMS.

her home and deduct for such care not more than one-half of the
maternity benefit. If the confinement is not normal— that is, if it
is complicated by sickness of any kind— then the regular sic ness
benefits are provided.

The maternity benefit must be paid for each calendar day, instead
of for working days as in the case of the regular sickness benefit.1
If the fund so desires, it is authorized to provide, in addition to
the maternity benefit, the services of a midwife and of an obstetrician,
if they should be necessary at the confinement.
Also if the fu n d so desires, it m a y provide a pregnancy benefit
consisting of a cash p a ym en t equal to the regular cash benefit, for
a period n o t exceeding six weeks, if the w om an is in capacitated on
account of pregnancy and this benefit m a y be included in the period of
paving m a tern ity benefit prior to confinem ent; the fu n d m a y also pro
vide the services o f a m idw ife and m edical attendance, if such becom e
necessary on account o f in ability to w ork because o f pregnancy.

Another benefit which the funds are authorized to Pro™ e .ls a
nursing benefit, or premium, for a period of 12 weeks after childbirth,
the amount of this benefit not to exceed one-half of the regular cash
benefit and to be paid on proof that the mother herself has nursed
the child. In case of twins this benefit must be doubled, unless the
constitution of the fund specifically provides otherwise.2
The beneficiary is exempt from the payment of contributions
while she is in receipt of sickness, maternity, or pregnancy benefits.
The maternity benefit features may be summed up as follows:
It is obligatory on the insurance funds to furnish a cash benefit for
eio-ht weeks, but they are not required to give medical attendance;
it°is optional with the funds to provide medical or institutional
treatment, home nursing and attendance, pregnancy benefit and
nursing (breast-feeding) benefit. The publications available do not
supply any information as to the extent of the adoption of these
optional benefits.

(4)
Funeral benefit: This is 20 times the amount of the basic wage
used in computing the cash benefit for sickness. If the funds so
desire they may increase the amount to 40 times the basic wage.
On account of the high maternal mortality rate in all countries this
benefit is of importance in any system providing aid in childbirth.
SOURCES OF INCOME.

The income of the funds conducting the insurance is obtained in
the proportion of two-thirds from the wages of the insured person
and one-third from the employer. The latter is required to deduct
from wages the employee’s share, to add thereto his own share, and
to transmit the whole amount directly to the fund m which the
i Amtiinhft Nachrichten, Mar. 31,1917, p. 1917.

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Federal Reserve Bank of St. Louis

a Amt.liftTift Nachrichten, Max. 31,1917, p. 334.

GERMANY.

employee is insured. Persons who insure voluntarily must pay the
entire cost of their insurance.
The law assumes that contributions at the rate of 4.5 per cent of
the basic wage— 3 per cent from wages, 1.5 per cent from the em
ployer— will be the regular rate of contributions. A rate of contri
bution higher than 4.5 per cent may be used only for the purpose of
providing the regular benefits or on the joint agreement of the
insured persons and of the employers.
FINANCIAL ADMINISTRATION.

The effort of the framers of the various insurance laws has been
to make the financial administration as simple as possible. The
rates of contributions have been computed on the basis of meeting
each year’s expenditure out of the receipts of that year, though in
order to insure solvency in the event of an emergency, such as an epi
demic or other unexpected event, the funds are required to accumulate
a reserve equal to the minimum amount of one year’s expenditure,
computed from the average of the last three years’ operations.
The resources of the fund may be used only for the payment of
benefits, for the accumulation of the reserve, for the expenses of
administration, and for the purpose of the prevention of sickness.
The style of accounts to be kept is specified by the Federal council.
An annual balance sheet and full annual reports must be submitted
by each fund in the form prescribed by the Federal council.
GENERAL ADMINISTRATION.

At the time of the enactment of the insurance law of 1883, there
were in existence a variety of insurance organizations providing aid
in case of sickness or other disability, and in some areas membership
m these organizations was required by law. It is estimated that at
the time the law was passed there were about 2,000,000 persons
participating in these societies. As in other countries, it was found
expedient to make use of these organizations as carriers of the new form
of insurance, and many of them are in existence at the present time.
Only a few of them, however, provided benefits in case of childbirth.
Sickness insurance, to be conducted efficiently, requires a close
supervision of the insured persons, and this is best secured by having
the members themselves act as officers; it also means that the number
of members in any one organization should be relatively small—
much smaller, for instance, than for an accident or invalidity insurance
carrier. In 1913 there were over 21,000 funds of different kinds in
existence, and the average number of members to a fund was between
600 and 700. The minimum number of members regarded as afford
ing a safe basis of operation is 250. The present system, therefore,
is based on having the insured persons associated in a large number

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Federal Reserve Bank of St. Louis

MATERNITY BENEFIT SYSTEMS.

of mutual societies, administered by the employees, with representation of the employers.
. A
_
The types of funds in operation under the law prior to 1914 were
as follows: (1) The local sick funds (Ortskrankenkassen), (2) parish
or

communal

(3)

the

sickness insurance

establishment

funds

(Gemeindekrankenversicherung),

(Betriebskrankenkassen),

(4)

the

building trades funds (Baukrankenkassen), (5) the gudd fun s
(Innungskrankenkassen),
(6)
the aid funds of both classes
(Eingeschriebene Hilfskassen, Landesrechthche Hdfskassen), and
(7) the miners’ funds (Knappschaftskassen).
.
Under the code of 1911, the communal insurance has been abol
ished; arrangements have been made to force the consolidation of the
smaller mutual aid funds with other funds by the requirement that
they must have at least 1,000 members. The code makes provision
for a new type of funds, the rural sick funds (Landkrankenkassen),
which are not necessarily rural organizations but cover the same area

as the local sick fund.
,
,
The most important types of funds are the local funds and the estab
lishment funds, and these include the majority of the women insured.
By far the largest number of women are in the local sick funds,
which are of two kinds-special local funds and general local funds.
The special local sick fund is generally intended to coyer persons
engaged in one or in closely related establishments or lines of industry,
or for insured persons of one sex only. The general local sick fund is
intended to include persons residing in a specified area— a city,
for example, or a group of local governments, such as several com
munes or parishes. The local authorities are required to take meas
ures to secure the stability of the general local sick f a d , such as
keeping its membership above 250 by consolidating with it the smaller
of the special local sick funds, and by refusing permission to create
special funds if the membership of the general sick fund would be
reduced below 250.

_
The constitution of the local sick funds is usually drawn up y
local government authorities of the area covered, after a hearing o
the employers and of the insured persons. The constitution must
state the area covered by the fund, the class of persons (such as
industry, sex, etc.) eligible for membership, and must specify t e
following: (1) Name and seat of the fund, (2) nature and extent of
the benefits, (3) amount of contributions and time of payment, (4)
composition, rights, and duties of the directorate (5
and convocation of the “ committee” and method of reaching its
decisions, (6) form of preliminary budget (7) form and
red
annual balance sheet, (8) amount allowed to officers and to insured
persons for expenses and loss of time devoted tobusm essoftheunxh
(9) method of issuing public notices, (10) method of amending t
i*,onst,itution.

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Federal Reserve Bank of St. Louis

GERMANY.

The 11committee ” referred to under (5) in the preceding paragraph
is somewhat similar to a board of managers or trustees in an Amer
ican organization, while the directorate performs the functions of an
executive committee. The committee is elected by the insured
persons and the employers, each holding a separate election, and
not more than one-third of its membership may consist of employers’
representatives; the greatest number of members permitted is 90.
The representatives of the employers and of the insured persons in
the committee, holding separate elections, elect the directorate, which
also consists one-third of employers and two-thirds of insured persons.
No member of the committee may be a member of the directorate.
These two bodies select their own officers and make rules for the
transaction of business. They conduct the business of the sickness
insurance and serve as honorary officials without salary; they are
reimbursed for actual expenses, and the insured persons are allowed
payment for loss of wages while engaged on work of the fund.
After the local funds, the establishment sick funds have the largest
number of women members. These funds may be created for the
employees of an establishment by its owner, if he employs permanently
at least 150 persons, and several employers may join in the crea
tion of a common sick fund. In all cases the employees must first be
given a hearing, and the approval of the supervisory insurance
officials must be obtained. This approval is given only if the mem
bership of the general local sick fund would not thereby be reduced
below 1,000. The employees of an establishment in such cases must
join the fund. It must provide not less than the regular benefits,
and its permanent solvency must be assured; if its membership falls
below the minimum stated above, or if the employer does not provide
for the orderly conduct of its. affairs, or if its solvency is no longer
assured, an establishment fund may be closed by the supervisory
insurance authorities. The employer may ask for its dissolution if
he has first secured the consent of the committee of the fund. The
constitution of an establishment sick fund is drawn up' by the em
ployer» after his employees have had a hearing. In general, its pro
visions must be the same as the constitution of the local funds, and
on the committee and on the directorate the employer's representa
tives may form only one-third of the membership.
Of the 4,000,000 women insured in 1912 under compulsory laws,
three-fourths were insured in local and establishment funds. The
communal sickness insurance, which provided maternity benefits
only rarely, has now been discontinued. The aid funds ranked
next in the number of women insured, but as their operations are
no longer reported in the official statistical reports, and it is the
intent of the 1911 code to encourage their consolidation with the
larger funds, they need only to be referred to. The building trades
funds in 1912 had less than 500 womon members, and are a negligible

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Federal Reserve Bank of St. Louis

M ATERNITY BENEFIT SYSTEMS.

factor in providing women’s insurance. The guild funds in 1912 had
over 65,000 women members; these funds serve especially the han
dicraft industries, which are still an important feature of German
industry. Under the law, the employers, with their own consent
may pay one-half of the dues instead of one-third, as in the case of
other funds, and must then be given one-half the membership of
the committee and the directorate. In most respects these funds
operate in the same manner as the local and establishment funds.
For a time this type of fund was preferred by the apprentices and
journeymen to the other funds, because it included only a com
paratively small number of married women, and hence the dues
were slightly lower on account of having to provide maternity ben
efits in but few cases. From the table on page 58 it will be seen that
the guild funds still have a much lower rate of expenditure for this
purpose than the first three funds; but in a recent discussion on this
subject (see Platz, “ Reichsgesetzliche Mutterschafts-Versicherung,”
1912, p. 38), the statement is made that this tendency is gradually
disappearing through the realization that the young men wifi even
tually marry and their wives will probably engage in work subject
to insurance. Emphasis is also being placed on the fact that ade
quate care during pregnancy and confinement will aid in preventing
a higher sickness rate among women in later fife.
OPERATIONS.

The statistics of operations of the sick funds are published in the
annual volume on sickness insurance1 in the general statistical
series of the Empire. Summaries of current returns are published
in the statistical quarterly.2 These two sources give an extensive
account of the work of the insurance carriers; special articles on
sickness insurance appear frequently in the journal of the labor
statistics office 3 while the official gazette of the imperial insurance
office4 gives the laws, decrees, judicial decisions, etc. There are a
large number of unofficial periodicals devoted to social insurance,
in which the experience of the system is discussed in detail by students
of the subject.
.
An extensive account of the general features of the sickness insur
ance system is given in the Twenty-fourth Annual Report of the
United States Commissioner of Labor.5 While this report gives
only a brief account of the maternity features of the system, it shows
the general development of the insurance down to 1908.
The population of the Empire in 1912 was about 65,000,000; it is
estimated that not quite half— approximately 30,000,000 persons—
i Die Itrankcnversicherung.
* Vierteljahrsltefte zur Statistic des Deutschen Reichs.
*Reichsarbcitsblatt.

i Amtliche jSTachrichten des Reichs-Versicherungsamt.

» Workmen’s Insurance and Compensation Systems in Europe. Washington, 1911.

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Federal Reserve Bank of St. Louis

GERMANY.

were gainfully employed. The number of persons insured in the
regular funds (not including the miners) and the aid funds in 1912
was 13,217,705, consisting of 9,262,137 men and 3,955,568 womenin 1913 the total number had increased to 13,566,473, but the pub
lications available do not report the number of women separately.
A brief summary of the general features of the system for the
year 1913, taken from the latest available source, is given in Table IX .
T

I X —Germany. Num ber o f sickness insurance fu n ds, membership, total
receipts, total expenditures, and amounts paid
m 'maternity and pregnancy benefits,
by class o f fu n d , 1913.

a b l e

[Source: Vierteljahrshefte zur Statistik des Deutschen Reichs, vol. 24 (1915), pp. 1,69-70.]

Fund.

All funds......................
Local.......: . .
Establishment...
Building..........
Guild........ . .

Number
of funds.

Average
number of
members
(both sexes).

21,342
8,033
4,678
7,699
20
906

Total
income.

Total ex
penditines.

Amount
paid in ma
ternity and
pregnancy
benefits.

13,560,473

$98,588,587

$103,000,076

$1,803,748

1.737,752
7,739,287
3,711,012
10,294
368,128

5,882,486
58,177,462
31,717,999
95,763
2,714,877

7,063,032
60,926,090
32,138,210
102,301
2,770,443

1,410
1,284,792
503,129
167
14,250

The last two columns of the table show that the total expenditure

sTos o o n 'o ^mT 1913,
o i 0, and
a T
V *1amount
*11 tMrteen
mmionwas
Persons
was
$103,000,076
of this
$1,803,748
expended
for relief m cases of childbirth. The reports do not give the number
of persons receiving this sum, but it will be noted that the amount is
than 2 Per cent of the total expenditure
Iable X gives a summary of the distribution of the maternitv
benefit durmg the year 1912.
T able X .

Germany.

Am ounts P ^ J o r vw ternity and pregnancy benefits, by class

Average number of
members.

Amounts paid in maternity and
pregnancy benefits.

Class of fund.

Local...............
Establishment.
Building...
G u ild .,..........

Both sexes.

Females.

Total.

7,558,036
3,568,795
13,103
352,168

2,529,132
733,499
427
65,677

$1,212,967
487,271
282
13,162

Per mem
ber (both
sexes).
$0.16
.14
.02
.04

Per
female
member.
$0.48
.66
.66
.20

^
leaiure oi tne table is the expenditure per memberm the local funds, where the great majority of the women are insured’
the average expenditure per woman member in 1912 was 48 cents’
while upon the total membership of both sexes the cost was about 16
cents per annum. This feature, therefore, cost each member about
H cents per month. In the establishment funds a higher expendi
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Federal Reserve Bank of St. Louis

MATERNITY BENEFIT SYSTEMS.

ture is made for maternity aid; the amount expended per woman
member in 1912 was 66 cents, and for members of both sexes it was
13.5 cents per year. For all the members, therefore, the cost of the
maternity relief amounted to about 1.1 cents per month.
The growth of this feature of the insurance since the inauguration
of the system shows a tendency to make the provision more liberal;
the amount expended per female member in the various funds from
1892 to 1912 is shown in Table X I.
T

X I — G erm an y.
Total amount o f maternity relief {maternity and pregnancy
benefits) and am ount per capita o f average fem ale membership, 1892-1918, by class o f

a b le

fu n d.

jgoarce (except for 1913): Statistik des Deutschen Reichs, vols. 170,229, and 268.]__________ _
Establishment funds.

Building funds.

Relief
Average
per
number Amount
female
of female of relief.
member.
members.

Local funds.

Year.

1892..
1893..
1894..
1895..
1896........
1897..
1898..
1899..
1900..
1901..
1902..
1903..
1904..
1905..
1906..
1907........
1908..
1909..
1910..
1911..
1912..
1913o.

Average
number
of female
members.
641,147
717,764
748,663
. 792,656
849,946
910,438
974,187
1,038,055
1,122,810
1,179,472
1,269,104
1,377,243
1,492,061
1,603,220
1,734,141
1,872,634
1,973,404
2,080,097
.
2,228,606
2,370,448
2,529,132

Amount
of relief.

Relief
per
female
member.

$140,089
190,296
206,008
219,159
244,625
268,447
293,685
312,760
332,716
350,815
370,907
401,518
641,780
698,887
793,261
876,097
957,091
996,583
1,057,206
1,131,420
1,212,967
1,284,192

$0.22

.27
.28
.28
.29
.30
.30
.30
.30
.30
.29
.29
.43
.44
.46
.47
.49
.48
.47
.48
.48

1892..
1893..
1894..
1895..
1896..
1897..
1898..
1899..
1900..
1901..
1902
1903
1904
1905
1906
1907..
1908
1909
1910
1911..
1912..
19130..

Average
Relief
Average
number Amount
per
number Amount
of
female of relief.
female
of female of relief.
member. members.
members.
$819
3,673
997
5,829
1,179
7,939
1,228
8,681
1,619
10,861
1,884
13,134
2,063
13,964
1,697
15,133
I,
17,931
2,479
21,984
4,234
30,319
....................
6,333
37,183
___________
II,
43,572
---------------13,399
47,456
---------------9,317
39,564
___________
8,397
.. 37,343
9,170
42,306
---------------9,315
47,081
___________
10,373
50,680
___________
11,650
.. 58,239
13,162
.. 65,677
14,250
. (0 )

$0.38.
.51
.52
.50
.52
.53
.54
.53
.53
.52
.51
.50
.65
.64

.66

.67
.69
.67
.67
.66
.66

(»)

Registered mutual aid funds.

Guild funds.
Year.

377,353 $143,867
198,383
390,987
212,511
406,281
210,661
421,812
231,205
443,216
243,374
4GÜ, 325
259,495
477,765
264,124
494,374
268,936
511,012
265,120
514,536
266,251
523,877
266,778
538,168
361,415
555,170
579,172 . 371,186
396,346
604,164
416,886
627,151
437,977
638,758
440,052
654,433
455,605
683,693
466,466
703,816
487,271
733,499
503,129
(*)

$0.22

.17
.15
.14
.15
.14
.15

.11
.11
990
.11

.14
.17
.26
115
.28
.24
, .23

.21
.20
.20
.20
.20

62,206
55,306
55,613
58,541
60,757
64,024
67,291
73,827
79,298
80,873
86,321
81,065
77,104
78,809
80,465
81,522
81,894
82,480
84,979
86,048

W
M

$2,366
2,130
2,841
2,109
2,271
2,461
2,558
2,587
4,027
3,838
3,980
3,755
5,344
5,339
5,314
5,746
6,205
5,766
5,814
6,819
(f)

Relief
per
female

$0.04
.04
.05
.04
.04
.04
.04
.04
.05
.05
.05
.05
.07
.07
.07
.07
.08
.07

612
496
560
558
562
500
694
592
468
362
305
302
453
468
487
561
661
710
780
792
427

(>)

122
536
319
171
193
218
293
107
95
65
59
125
177
302
116
186
189
212
228
282
167

6 Not reüorted.

.21
.20

.28
.38

.02
.21

.28
.27
.27
.29
.66

State registered mutual aid
funds.
Average
number Amount
of female of relief.
members.
24,119
13,988
13,724
13,701
13,085
12,839
12,487
8,014
7,964
7,975
7,529
7,540
6,398
6,281
6,085
5,892
5,891
6,736
6,694
6,736

1»)

$1,676
84
71
158
297
274
364
177
189
168
146
174
168
186
145
152
141
no
126
152
(*)

aVierteljahrshefte zur Statistik des Deutschen Reichs, vol. 24 (1915), p. 70.

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Federal Reserve Bank of St. Louis

$0.15
.25
.96
.57
.30
.39
.31
.50
.23
.26

Relief
per
female

SO. 07

.01
.01
.01
.02
.02
.03

.02
.02
.02
.02
.02

.03
.03
.02
.03
.02
.02
.02
.02

GERM ANY.

Under the original law of 1883 the funds* were required to provide
the cash maternity benefit for a minimum of three weeks; they were
also authorized to increase this period up to six weeks and to grant
a similar benefit for the uninsured wives of insured men. Under the
amendments of 1892, the minimum period was increased to four
weeks, while the revised sickness insurance law of 1903, made the
minimum six weeks. It will be noted that the expenditures of the
funds in 1904 showed a marked increase over 1903. In addition to
the maternity benefit, the funds were authorized, if they so desired,
to provide pregnancy benefits up to a maximum period of six weeks
and to furnish midwives' attendance and medical attendance during
the period prior to confinement. The authority to provide benefit
for the wives of insured persons was continued.
The funds show a steady growth in the number'of women members,
due to the growing number of women employed in industry. The
expenditure per woman member has also shown a tendency to
increase; the provisions of the law of 1903 caused an increase in the
expenditure per woman member in the local funds from 29 cents in
1903 to 43 cents in 1904, an increase of 47 per cent. There was also
a large increase in the establishment and guild funds.
The official report states that in the period 1885 to 1912, inclusive
the total amount expended for pregnancy and maternity benefit was
84,008,748 m. ($21,974,124).
The Leipzig fund.

The experience of the Leipzig local fund has been compiled in an
elaborate study, published by the imperial statistical office in 1910.
The study covers the period 1885 to 1905, and the data are given for
“ persons insured one year” ; this means that the total number of
days a woman was insured were added together and the sum divided
by 365. The data are given separately for the persons compulsorily
insured and for those who insured voluntarily. The sickness rate of
the two groups shows a marked contrast. The summary for confiner
ments is given in Table X II.

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T a b l e X I I — G erm an y.

Maternity benefit experience o f the Leipzig local sickness insurance fund, 1887-1905.

[Source: Krankheits- und Sterbliehkeitsverhältnisse in der Ortskrankenkasse für Leipzig mid Umgegend ... Bearbeitet im Kaiserlichen Statistischen Amte. Berlin, 1910. Vol. 4,
*
pp. 256-257.]
COMPULSORY MEMBERS.

Number of confinements.

With sickness.

With
^sick
ness
Con Cases con
sist with sist
With
ing of sick ing of Total.
out
Total. sick
abor ness abor
ness. Total. tions (total). tion
and
or mis
mis
car
car
riage.
riages.
2

82,405
81,998
37,613
18,563
11,853
8,399
5,942
4,150

15-24.................
25-34.................
35-44.................
45-54.................

164,403
56,176
20,252
10,092

15-34.................
35-54.................

220,579
30,344

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764
1,043
4,784 3,505
2,682 1,904
855
1,238
498
716
178
261
12
25
2
3
5,827
3,920
977
28
9,747
1,005

4,269
2,759
676
14
7,028
690

Aver
age
num
ber of
days

Number of cases in
confinements with
sickness exceeding
the benefit term.

Confinements per 1,000
. insured women.

Num
ber Deaths Deaths
per
per
of
of
With sickness.
100
deaths 100
sick
conconin
bene
con- fine- finefit
fine- ments ments
Abor
per
with
ments
of
With
tions
con
Abor
sickwith
all
out
34
26
13
and
fine
tion
sick- kinds. ness. Total. sick
mis ment weeks, weeks, weeks ness.
or
Total.
ness.
car
with
mis
riages. sick
car
ness.
riage.

3,034

1,845

28.2

17.2

94,191

47,295

31.0

0.3

14.6
15.1
18.3
20.0
22.2
23.0
44.0
33.3

8,264
38,182
25,112
13,141
6,755
2,371
346
20

3,560
16,787
13,619
7,025
4,506
1,498
280
20

29.6
29.9
32.3
34.3
31.0
28.6
26.6
20.0

5
13
6
4

.5
.3

All ages
(15-54).. 250,923 alO,752 a7,718
16-19.................
20-24.................
25-29.................
3 0 -3 4 ..............
35-39.................
40-44.................
45-49 ...............
50-54.................

Number of
days of sick
benefit in
confinements
with sickness.

279
1,279
778
383
218
83
13
1
1,558
1,161
301
14
2,719
315

152
723
492
247
159
60
11
1
875
739
219
12
1,614
231

26.7
26.7
29.0
30.9
30.4
31.8
52.0
33.3
26.7
29.6
30.8
50.0
27.9
31.3

15.0
18.9
22.4
42.9
16.6
23.0

46,446
38; 253
9,126
366
84,699
9,492

20,347
20,644
6,004
300
40,991
6,304

29.8
32.9
30.3
26.1
31.2
30.1

,2
4

.3
.3
1.5

1.1
1.8
1.0
1.0
.9
4! 8

1.2
.9
2.0
1.0
l.i

Days of
sick
benefit
in con
fine
ments
with
sickness
per
1,000
insured
women.

42.9

30.8

12.1

12.7
58.3
71.3
66.7
60.4
31.1
4.2
.7

9.3
42.7
50.6
46.1
42.0
21.2

3.4
15.6
20.7
20.6
18.4
9.9
.2

35.5
69.8
48.2

26.0
49.1
33.4
1.4

9.5
20.7
14.9
1.4

5.3
13.2

1.2

283
681
451
36

31.9
22.7

12.3
10.4

7.3
7.6

384
318

2.8

44.2
33.1

2.0
.5

2.2

7.4

375
100

466
13.1
13.3
13.4
7.1
1.9

10.8

668

708
570
282
58
48

M A T E R N IT Y B E N E F IT S Y S T E M S .

Age group.

Num
ber of
women
insured
one year.

Per cent of
total confine
ments.

VOLUNTARY MEMBERS.

Number of confinements.

Age group.

Num
ber of
women
insured
one year

Per cent of
total confine
ments.

With sickness.
Con
With
sist
out
ing
of
Total.
sick
abor
ness. Total. tions
and
mis
car
riages.

Cases
with
sick
ness
(total)

Number of
days of sick
benefit in
confinements
with sickness.

With
sick
ness
con
sist
ing of Total.
abor
tion
or mis
car
riage.

Abor
tions
and
mis
car
riages.

Number of cases in
confinements with
Aver
sickness exceeding
age
the benefit term.
num
ber of
days
of
sick
bene
fit
per
con
13
26
34
fine
ment weeks. weeks weeks
with
sick
ness.

25,749

9,562

1,456

15-19................
20-24................
25-29................
30-34................
35-39................
40-44......... .
45-49................
50-54.............

2,497
5,408
4,669
3,376
2,976
2,678
2,425
1,720

875
739
4,972 4,388
3,i29 2,754
1,227 1,035
574
466
226
171
15

136
584
375
192
108
55

15-24.
25-34.
35-44.
45-54.

7,905
8,045
5,654
4,145

5,847 5,127
4,356 3,789
800
637
15 I
9

720
567
163
6

123
78

15,950
9,799

10,203 8,916
815 I 646

1,287
169

15-34............
35-54............

11,018

289

13.2

2.6
1.1

Num
ber Deaths Deaths
of
per
per
deaths 100
100
With sickness,
in
con
con
con fine fine
fine ments ments
ments
of
with
With
with
all
sick
Abor
sick kinds. ness. Total. out
sick
tion
ness.
ness. Total. ■ or
mis
car
riage.
14

56,536

9; 683

38.8

0.2

15.6
18.8
24.3
40.0

1.5
2.3
4.1
7.7
15.0
13.3

5,029
21,353
14,966
8,268
4,394
2,341
185

360
2,135
2,176
1,960
1,685
1,284
83

37.0
36.6
39.9
43.1
40.7
42.6
30.8

.2
.1
.3

12.3
13.0
20.4
40.0

1.5
2.8
9.8
13.3

26,382
23,234
6,735
185

2,495
4,136
2,969
83

36.6
41.0
41.3
30.8

209
80

12.6
20.7

2.0

49,616
6,920

6,631
3,052

38.6
40.9

15.5
11.7
12.0

9.8

1.0
.9

1.5

1.2
2.1
1.0

5.6
3.6

Days of
sick
benefit
in con
fine
ments
with
sickness
per
1,000
insured
women.

427.9

371.4

56.6

11.2

2,196

350.4
919.4
670.2
363.5
192.9
84.4

296.0
811.4
589.9
306.6
156.6
63.9
3.7

54.5
108.0
80.3
56.9
36.3
20.5
2.5

4.0
14.1
15.6
14.8
14.8
12.7

2.014
3,948
3,205
2,449
1,476
874
76

6.2

1.3
4.9

739.7
541.5
141.4
3.6

648.6
471.0
112.7

2.2

91.1
70.5
28.8
1.5

10.9
15.3
13.8
.5

3,337

1.0
.2

1.5
4.7

639.7
83.2

559.0
65.9

80.7
17.3

13.1

3,111
706

1.0

1.8

8.2

GERM ANY.

10
All ages
(15-54).

Confinements per 1,000
insured women.

2,888

1,191
45

« Excluding 2 confinements each in the age groups undpr 15 and 55-59.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

The striking feature of the rates is the very high number of cases
among the voluntary members; this is explained as due to the cus
tom among wage-earning women of stopping work some time before
confinement and having themselves enrolled as voluntary menibers,
as the law permits them to do. The result of this custom is that
the number of confinements for compulsory members was 42.9 per
1 000, while for voluntary members it was 427.9 per 1,000, or 10
times as great as for the compulsory members. All of the rates for
voluntary members must be interpreted with this custom in vie ; .
One noteworthy feature is the high rate of miscarriages among
the ^compulsory members as compared with the voluntary members ,
column 7 shows that the rate of confinements with complications for
compulsory members was 17.2 per cent, while for the voluntary
members (including a large number who stopped work because of
approaching confinement) the rate was 2.6 per cent, or about oneeighth as high.
The largest number of confinements occurred m the age group
25-29.
Special maternity benefits during the war.

On the outbreak of the European war stringent measures were
taken to reduce the expenditures of the sick funds to a minimum.
The dislocation of industry and the withdrawal of all the young and
healthy men from industries meant that the receipts would be de
creased and the expenditure p€5r member increased. It was found
later, however, that the funds were financially able to stand the
strain and the Imperial Government on December 3, 1914, issued
the first of a series of decrees on maternity benefits which show the
importance attached to this subject by the Government.
The law of August 4, 1914/ assuring the solvency of the sickness
insurance funds, required them for the duration of the war to reduce
their benefits to the minimum prescribed by the 1911 code. This
meant that in maternity cases maternity cash benefit only was to
be paid, and that the authority to provide benefits for pregnancy,
services’ of midwives and medical attendance, and benefits to wives
of members, etc., was withdrawn.
In a short time the importance of these benefits was placed before
the federal council, and the, following decrees were enacted providing
special maternity benefits for the duration of the war:
December 3, 1914 (Reichs-Gesetzblatt, p. 492);
January 28, 1915 (Reichs-Gesetzblatt, p. 49.);
' April 23, 1915 (Reichs-Gesetzblatt, p. 257);
November 16, 1916 (Reichs-Gesetzblatt, p. 1279);
March 1, 1917 (Reichs-Gesetzblatt, p. 201);
_________ _
i Reichs-Gesetzblatt, p. 337. ,

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GERMANY.

June 6, 1917 (Reichs-Gesetzblatt, p. 477);
July 6, 1917 (Reichs-Gesetzblatt, p. 591);
The benefits provided under this series of laws are as follows:
1. A lump sum payment o| 25 m. ($5.95) for defraying the ex
penses arising at the time of confinement.
2. A cash benefit 1 m. ($0,238) per day, including Sundays and
holidays, for eight weeks, of which at least six must come after the
day of delivery. After June 6, 1917, this benefit was made 1.5 m.
($0,357) per day.
3. A grant of not to exceed 10 m. ($2.38) for the services of mid
wife and medical attendance during pregnancy, if sick aid becomes
necessary. If, however, the beneficiary, because of her insurance, is
already entitled to midwife service and medical attendance, then
these must be provided instead of the cash.
4. A nursing benefit, so long as the mother herself nurses the child,
0.5 m. daily, including Sundays and holidays, up to the end of the
twelfth week after the day of delivery, that is, for 84 days; the
maximum amount would therefore be 42 m. ($10).
Prior to June, 1917, the highest amount a mother could receive
was 133 m. ($31.65) consisting of 25 m. plus 56 m. plus 10 m. plus
42 m. After that date the maximum would be 161 m. ($38.32).
The persons entitled to these benefits do not receive them all in
the same degree or from the same agency; in fact, the distribution
is so varied that one diligent writer in-1915 compiled a schedule of 18
different groups of beneficiaries,1 and the number of groups has
been increased since then. In general, there are two mam groups
of .persons entitled to the benefits: First, the women who were either
insured themselves or who had some claim on an insurance fund ;
and, second, those who had no connection with the insurance system.
The first decree, that of December 3, 1914, was based on the
assumption that the women in need of benefits would be those in
cluded in the sickness insurance system, or whose husbands were
included. The decree granted benefits to women1whose husbands
were in some form of military service (army, navy, sanitary, etc.),
or whose husbands in such service had been killed, injured, disabled
by sickness, or captured, and who previous to entering service had a
claim on the sickness insurance system. Thèse persons are grouped
into three classes:
/
1. Uninsured wives of insured men in war service.
2. Insured wives of insured men in war service.
«.
3. Insured wives regardless of the husband’s war service.
Immediately after this decree was issued, attention was called to
the fact that a certain number of persons were exempted from
insurance because they were provided for during sickness under other
1R eichs-Arbeitsb latt, June, 1915, p. 49? «

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Federal Reserve Bank of St. Louis

M ATERN ITY BENEFIT SYSTEMS.

laws; these classes included seamen, farm employees, and domestic
servants. The decree of January 28, 1915, therefore, added the next
group:
4. Women whose husbands would h|ve been insured had they not
been exempted by some special law, provided that the husbands
usual annual earnings were less than 2,500 m. ($595).
The next step was taken by the decree of April 23, 1917, which
added groups of persons designated as of “ lesser means” (minderbemittelt), a term used in order to avoid any stigma of chartiable relief.
These groups were:
. .
5. Women who were entitled to war relief under existing laws;
this included unmarried women whose children men in war service
were legally required to support.
6. Women whose income (including the husband’s) did not exceed
2,500 mi before the date of the husband’s entry into war service, or
whose income after the husband’s entry did not exceed 1,500 m.,
with 250 m. ($59.50) added for each child under 15 years of age.
On December 5, 1916, a law on national service1 was enacted under
which all males of 18 to 60 years of age, not already in the armed
service, were'made subject to service in State offices, munitions
establishments, agriculture, forestry, the care of the sick, or m any
establishment for the prosecution of the war or the furnishing of
supplies necessary for the population. Under the decree of July 6,
1917, persons engaged in such service were made eligible for maternity
benefit in the following groups:
7. Women whose-husbands have been engaged in national service
for at least six months, if the financial status of the husband has been
worsened by such service and if there is need for the maternity
benefits. An unmarried woman is included if the responsibility of the
father has been legally determined.
8. Women who have themselves engaged in such national service,
if the conditions named above apply (six-months’ service, lessened
income, and need).
The entire list of benefits on page 63 above is payable to the groups
just named, except that where the cash maternity benefit for eight
weeks due to an insured woman from her fund is the higher, she is
entitled to the latter.
*
The medium for paying over the benefits to the mother may be (a)
a sickness insurance fund, (6) an employer, or (c) the provisioning
-agency” (Lieferungsverband). In so far as an insurance fund or an
employer is required under the sickness insurance law to provide
maternity benefits, they must continue to do so at the regular rates;
if the war maternity benefits just described are higher than the
i Gesetz über den vaterländischen Hilfsdienst

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Federal Reserve Bank of St. Louis

GERMANY.

regular rates, then the excess will be repaid to them by the pro
visioning agency, which is-reimbursed from the imperial treasury.
The provisioning agency” was originally an office required to be
established by the States of the Empire in their local governments
for the supply of meat, fodder, etc., for the army supply depot; at a
later time this office was given the duty of caring for the needs of
the famihes of men summoned to the colors, such as paying separation
allowances, etc. Under the decree of April 23, 1915, it was made the
office for the distribution of the war maternity benefits for persons
not connected directly or indirectly with an insurance fund.
The cost of these war maternity benefits is defrayed by the
Empire; it is estimated that the expenditure will be 5,000,000 m.
($1,190,000) per month,1 and with the increase in the number of men
called into war service the amount will be larger in the future.
SOURCES OF INFORMATION.

The laws, decrees, etc., of the German Empire are published in
the official law gazette, Reichs-Gesetzblatt. The decisions of the
insurance courts, etc., will be found in the official journal of the
Imperial Insurance Office, the Amtliche Nachrichten des ReichsVersicherungsamts, published monthly. The annual statistics of
operations are published in one of the issues of the general statistical
series, Die Statistik des Deutschen Reichs, the latest issue available
being volume 256. Current information is also given in the journal
of the labor statistics office, Reichs-Arbeitsblatt.
1Reichs-Arbeitsblatt of June, 1915, p. 490.
113300°— 19------5

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GREAT BRITAIN.
A national compulsory system of health insurance was introduced
in Great Britain by the law of December 16, 1911, which came into
operation on July 15, 1912. This law included provision for mater
nity in the form of a lump-sum payment of 30s. ($7.20) without
medical attendance. The author of the bill, Mr. Lloyd George, in
speaking of this feature, said:
W e have a provision for maternity, an allowance of 30s., which I thinir is 0ne of
the most valuable provisions in the bill, and we are going to see that the m oney is
spent for the purpose for which it is designed, in spite of one or two protests we have
had from friendly societies.

The m oney is meant for the mother, to help her in dis

charging the sacred function of motherhood b y proper treatment, fair play, so as to
put an end to the disgraceful infantile mortality of this country .1

This sentence sums up the purpose of maternity aid in all countries,
namely, proper treatment for the mother, both on her own account
and for the sake of the child.
While the law of August 5, 1891 (still in force), prohibited the
employment of women for four weeks after childbirth, no provision
was made to aiford the mother aid during tins enforced period of
unemployment. The act of 1911 finally remedied this defect by
requiring that certain of the beneficiaries must abstain from remun
erative employment for four weeks in order, to be entitled to the
maternity benefit.
At the time the plan for a national system of insurance was taken
up, Great Britain was covered by a network of friendly societies,
provident funds, trade-union benefit systems, and similar organiza
tions which had gradually developed to supply the need for financial
and other assistance in time of sickness, accident, and other distress.
Some of these organizations had furnished their members a benefit
on the birth of a child and one of them, the Hearts of Oak friendly
society, had for many years paid a maternity benefit of 30s. It was
decided to make use of this large number of voluntary organizations
as carriers of the insurance, and the health insurance bill as finally
enacted was arranged in a form to meet the needs of these societies.
The great majority of members of the societies were men, though
some of them admitted women and a few of them were composed of
women exclusively. Out of this fact developed later the result that
the insurance system proved to be on a sound financial basis as far
as the insured men were concerned, but quite otherwise for the
insured women.
George, Lloyd: The People’s Insurance. London, 1912, p. 183.
67

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Federal Reserve Bank of St. Louis

MATERNITY BENEFIT SYSTEMS.

These numerous organizations, almost regardless of their size, were j
made agencies of the insurance by applying to the State adminis- |
trative officials for approval, which is given if the latter are satisfied that the society is in a position to carry out the purposes of the law.
Arrangements had to be made of course to have the very small
societies cooperate for the purpose of caring for certain liabilities.
These long-established societies had developed what was called “ the
friendly society spirit,” and it was hoped that this atmosphere would
continue to prevail in the work of carrying out the new plan; a system
of compulsory insurance, in which the insured persons themselves
controlled the operations under a uniform plan, would, it was ex
pected, prove a thoroughly democratic institution and as popular as
the friendly societies had proved.
To describe the British system and to analyze the experience under
it is an extremely difficult task; no other system of social insurance
now in existence is so involved and contains so many features per
plexing to the uninitiated. A recent volume, containing merely the
text of the laws and regulations of the insurance, consists of about
700 closely printed quarto pages. Furthermore, the statistical
information published in the reports on the operation of the system
is so scanty that one receives little additional light from that source.
The statements in the following pages have been prepared with as
much care as possible, but it is probably too much to hope that they
are entirely free from error. In many cases, sentences from reports,
etc., have been copied verbatim (without using quotation marks) in
order to make sure that the many qualifications and reservations
connected with the features of the system are properly included.
Throughout this section the references made apply principally to
English conditions; for instance, where the practice in Ireland differs,
as it does in so many features, no reference is made to the fact.
The national insurance act ,of 1911 is divided into three parts:
Part I relates to health insurance, Part II to unemployment insur
ance, while Part III covers certain matters common to both of these
fields. In the following pages the references are to Part I of the law.
PERSONS INCLUDED.

In describing the persons included under the law, the fundamental
rule is that every person, male or female, who is engaged in manual
employment in the United Kingdom under any contract of service or
apprenticeship, or in nonmanual employment, and earning less than
£160 ($778.64) annually, is included within the terms ©f the insur
ance act as a compulsory member. There are, of course, certain
limitations on this rule.
In the great majority of cases a person included in the scope of
the law would become a member of one of the “ approved” societies
which provide the insurance. The official Handbook of Approved

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GREAT BRITAIN.

Societies (August, 1915) thus describes the persons eligible for mem
bership and, hence, for the benefits of the law (p. 26):
1. Persons in employment by way of manual labor.
2. Persons in any employment at a rate of remuneration not
exceeding in value £160 ($778.64).
3. Persons engaged in some regular occupation and wholly or
mainly dependent for their livelihood on the earnings derived from
that occupation and whose total income, including earnings, does
not exceed £160 ($778.64) per year.
4. One who has been an insured person for five years or upward
5. Une who has been an employed contributor, and being of the
age of 60 or upward, who shows to the satisfaction of the insurance
commissioners that he or she has ceased to be insurable as an employed
The laws contain provisions for voluntary insurance, but as these
are somewhat complicated it is only necessary to refer to the status
oi married women in the present connection.
While married women may become employed contributors, and
are, of course, required to insure as such, they cannot become volun-:
tary contributors, or if they were voluntary contributors before marnage, they can not continue as such after marriage. The status of
women after marriage is described on page 75.
The preceding statement of the groups of persons included in the
insurance has been restricted to the larger groups; it should be
stated that there are a number of additional groups, each having
special rates of dues and of benefits. In the accounting work of the
insurance system, the classes of members are designated by letters
o the alphabet and these letters are printed conspicuously on the
cards of membership which each insured person must have The
following list gives a summary statement of the classes of members:
1. Em ployed contributors:
British s u b j e c t s - ........... ..............................

Men. Women.

A liens aged 17 or upward at entry into State insurance.*..*. . ’ *.’. ! ! * A 2
Mercantile marine (employed on foreign-going British ships)—
British subjects..................................
A 4
A liens (residents in U nited Kingdom ) aged 17 or upward at
entry into State insurance..............
A 5
2. N avy and arm y.........
B
3. Voluntary contributors:
British subjects under 45 at entry into State insurance................
C l
Aliens under 45 at entry.............................
* * C2
British subjects over 45 at entry................
D 1
A liens over 45 at entry.......... ...........................
.................... ^
Married women (British su bjects)..................... * . ! . * ( ]
Married women (aliens).............................

................

E 2
E

E 5

FI
F 2

61
G 2
H 1
H 2

The law of 1913 abolished the classes A 3, A 6, E 3, and E 6 men
and women (British and aliens) over 65 years of age at entry into

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MATERNITY BENEFIT SYSTEMS.

State insurance, who were originally differentiated from the ordi
nary insured persons. Married women as voluntary contributors
(H 1 and H 2) were discontinued by the act of 1918.
INDUSTRIES AND EMPLOYMENTS INCLUDED.

The general rule is that all employments are included under the
compulsory insurance where there is a contract of service or appren
ticeship. There is a long list of exceptions to this rule, but they
refer, generally speaking, to employments or establishments in which
some other provision- for health insurance has been made, though
the excluded employments also include agricultural occupations for
which no wage is paid, casual work not connected with the employ
er’s business, etc. Work which is not manual and which is com
pensated at a rate higher than £160 ($778.64) is also excluded. The
greater part of these employments, however, qualify the person
engaged in them for voluntary insurance.
BENEFITS.
General.

The benefits of the health insurance system as listed in section 8
of the 1911 act are: (1) Medical benefit, (2) sanatorium benefit, (3)
sickness benefit, (4) disablement benefit, (5) maternity benefit, and
(6) additional benefits.
It will be noted that no funeral benefit is provided.
In connection with the problem of maternity care, the benefits of
interest are the medical, the sickness, the maternity, and the addi
tional benefits. Prior to the date of confinement, the frequent dis
abilities of pregnancy, and after confinement, the effects of child
birth often demand medical care and financial provision for the
periods of disability. As some mention should be made of all the
benefits to give an idea of the entire system, the following brief
statement of the benefits shows the plan adopted for conserving the
health of the men and women wage earners included in the system.
(1) The medical benefit consists of medical treatment and attend
ance, including the provision of medicines and appliances. The
law makes no mention of any restrictions on medical treatment—
it is to be “ adequate” and the regulations issued by the boards of
commissioners in charge of the system have construed this term in
a liberal sense. The provision of medicines and appliances has also
been construed liberally. The law specifically provides, however,
that the medical benefit does not include any right to medical attend
ance or treatment in respect of a confinement.
(2) Treatment in sanatoria or other institutions, or otherwise,
when suffering from tuberculosis or such other diseases as the local
government board may designate, comprises the sanatorium benefit.

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GREAT BRITAIN.

(3)
The sickness benefit consists of a periodical payment while
rendered incapable of work by some specific disease or by bodily or
mental disablement, of which notice has been given, commencing on
the fourth day of such incapacity and continuing for a period of not
exceeding 26 weeks. This benefit is payable only if 26 weeks have
elapsed since the claimant entered the insurance and only if 26 weekly
contributions have been paid.
The rates of sickness benefit were fixed by the 1911 act as follows:
For men, 10s. ($2.40) weekly; for women, 7s. 6d. ($1.80) weekly, for
the whole period of 26 Weeks. In case of unmarried persons under
21 years of age, these benefits are reduced.
Under the act of 1918, which came into force on July 1 , 1918, the
sickness benefit for persons entering the insurance after that date
is as follows:
Until 104 weeks have elapsed since the entry into insurance and
at least 104 weekly contributions have been paid by or in respect of
the insured person, the rate for men is 6s. ($1.44) weekly, and for
women 5s. ($1.20) weekly.
The act of 1911 (sec. 9, subd. 2) provided that where the rate of
sickness or disablement benefit exceeded two-thirds of the usual rate
of wages of the.insured person, the rate of benefit might be reduced;
the adt of 1918, however, repealed this provision.
The dues of the system have been calculated to provide the sick
ness benefit just described on the assumption that the insured person
enters the insurance at the age of 16 (or at the date the law came into
force). If a person enters the insurance at an age later than 16, he is
entitled to reduced benefits only. This class of insured person is
generally referred to as a “ late entrant.”
(4) In case the disease or disablement continues for more than 26
weeks, a disablement benefit of 5s. ($1.20) per week is paid “ so long
as so rendered incapable of work by the disease or disablement.”
Neither sickness nor disablement benefit may be paid in respect of
a confinement for a period of four weeks after the day of childbirth,
unless the disability is due to some cause not connected, either
directly or indirectly, with the confinement.
(5) The maternity benefit will be described later.
(6) Under certain conditions, principally relating to the financial
status of the society, a number of benefits in addition to those already
mentioned may be provided by the societies. The law designates
these as “ additional benefits” ; those specified in the law which are of
interest in the present connection are: (a) Medical treatment and
attendance for any person dependent upon the labor of a member;
(b) the payment of the whole or any part of the cost .of dental treat
ment; (c) an increase of sickness benefit or disablement benefit in the
case either of all members of the society or such of them as have any

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MATERNITY BENEFIT SYSTEMS.

children or any specified number of children wholly or in part de
pendent upon them; (d) an increase of maternity benefit.
Maternity benefit.

Prior to July 1, 1918, the maternity benefit became available after
a waiting period of 26 weeks; the law of 1918 made the waiting
period 42 weeks.1 The benefit may be said to he derived from two
sources: First, the dues paid by the husband; and, second, the dues
paid by the wife. An insured man is entitled, on the confinement of
his wife, to receive from his society a lump,sum maternity benefit of
30s. ($7.20), the benefit being the wife’s property. If the wife is also
insured, she is entitled to receive from her society a second benefit
of 30s. ($7.20), making in all 60s. ($14.40). Husband and wife may
of course belong to the same society.
If the insured woman is not married, she is entitled to the 30s.
maternity benefit from her society only. On the other hand, an
insured married woman whose husband is not insured is entitled to
the double maternity benefit of 60s. ($14.40) from her society.
There are thus two rates of benefits p-aid to two groups of bene
ficiaries ; the first group, receiving the double maternity benefit of 60s.,
consists of the married woman who is herself an employed contributor,
regardless of whether her husband is insured; the second, receiving
the 30s. benefit, consists of (a) the wife of an insured man who is her
self not insured, and (b) the unmarried woman who is an insured
employed person; under circumstances described below, a single
woman not employed, but who has become a voluntary contributor,
is also entitled to the 30s. benefit.
The law carefully excludes the payment of the sickness or disable
ment benefit of the insurance system for a period of four weeks
following confinement, unless there is a disease or disablement not
connected directly or indirectly with the confinement; after the
four weeks, sickness or disability caused by confinement is entitled
to the regular benefits.
The second 30s. benefit, paid to insured married women, carries
with it the obligation to abstain from remunerative work for a
period of four weeks after the date of childbirth, with the penalty of
a fine for infraction of this rule. Every approved society and insur
ance committee is required to establish rules on this subject, and these
rules must be ratified by the insurance commissioners.
The second maternity benefit is not subject to the conditions
attached to the payment of the sickness benefit; that is, it may be
payable even though the woman, has been suspended from sickness
benefit on account of arrears of dues or has already exhausted the
i The Further Report of the departmental committee on approved society finance and administration
(Cd. 8396 of 1916) recommended that the waiting period be made 52 weeks for both men and women (see par.
408). Parliament finally decided on 42 weeks.

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GREAT BRITAIN.

full 26 weeks for which sickness benefit is payable. Similarly the
payment of the second maternity benefit will not count as the pay
ment of four weeks’ sickness benefit for the purpose of determining
when the right to 26 weeks’ sickness benefit is exhausted. In the
same manner, if the father dies before the child is bom, his insurance
is regarded as having continued up to the date of confinement and
the fact that his dues have not been paid after his death is disregarded.
As the insured married woman receives one of her maternity
benefits from her husband’s society, it was necessary to make pro
vision that the maternity benefit should be paid regardless of whether
the husband was in arrears or for other reasons not fully qualified
to receive full benefits; otherwise the wife would be in a less favorable
position than if her husband was not insured at all. In case the
husband is in arrears or otherwise not qualified, the wife’s society
must pay the entire 60s.
To show the relation of the husband’s society and the wife’s
society in regard to the payment of the'maternity benefit, the official
Handbook for Approved Societies gives the following schedule:
Schedule o f obligations o f approved societies o f Great Britain fo r benefits under national
insurance acts, in respect o f insured married members.
[Source: Great Britain, National Insurance Acts. Handbook for the Use of Approved Societies English
edition, London, 1915, pp. Ill, 112.]
"
6
PART I.

FOR USE B Y HUSBAND'S SOCIETY.

A. nusband insured, and qualified for benefit.......... Husband’s society pays 30s. ($7.30) if husband is a
British subject, or if -wife was before marriage a
British subject. £1, 3s. 4d. ($5.68) if he is an

^
, ,
alien and his wife was before marriage an alien
B. Husband insured, but not qualified for benefit...... Husband’s society pays nothing.
PA RT II. FOR USE B Y W IFE ’S SOCIETY.

A . Wife an employed contributor, but not qualified Wife’s society pays nothing.
for benefit.
B. Wife an employed contributor and qualified for
benefit.
Then if—
(1) Husband is also insured, and qualified....... Wife’s society pays 30s. ($7.30), or 18s.. ($4.38) if
husband is an alien andwife was an alien before
marriage.
(2) Husband is also insured, but not qualified. Wife’s society pays 60s. ($14.60), or 36s. ($8.76) if
husband is an alien and wife was an alien before
marriage.
(3) Husband is hot an insured person.
Wife’s society pays 60s. ($14.60), or 36s. ($8.76) if
husband is an alien and wife was an alien before
marriage.
( 4) Husband is a deposit contributor, but the Wife’s society pays—
amount standing to his credit is not
If the husband is a British subject, or if the
enough to provide full benefit; ie .. 30s.
wife was before marriage a British subject, 30s.
($7.30) or £1, 3s. 4d.' ($5.68), as above.
($7.30) at once, and, when they know the sum
available from the husband’s credit so much
more as will, together -with that sum, make up
a further 30s. ($7.30).
If the husband is an alien, and the wife was
before marriage an alien, 18s. ($4.38) at once,
and, when they know the sum available from
the husbamPs credit, so much more (if any) as
is required, together with that sum, to make up
a further 18s. ($4.38.)

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MATERNITY BENEFIT SYSTEMS.

While the maternity benefit does not include medical treatment,
section 14 (1) of the 1913 law provides that the society shall pay
the benefit “ in cash or otherwise.” Under this authority, the model
rules recommended for societies contain the following clause:
A woman in respect of whom this benefit is payable must be attended in her
confinement b y a d u ly qualified medical practitioner or b y a midwife possessing the
prescribed qualifications.

If the society prefers, the benefit may, therefore, be paid partly
in cash and partly in kind by placing at the disposal of members the
services of qualified midwives and physicians. The mother must,
however, have perfect freedom of choice of the doctor or midwife by
whom she is attended (sec. 18 of 1911 law). However, this rule does
not authorize a society to refuse the payment of the benefit when
there was a valid reason for the nonattendance by doctor or midwife.
If the mother is in a medical or similar institution during confine
ment, the benefit may not be paid until she leaves; if she has no
dependents and has received treatment in an approved sanatorium
or in a medical institution with which the society has a contract, then
the cost of treatment is deducted from the benefit. If the mother
has dependents, these must first be provided for out of the benefit.
To obtain thè maternity benefit in respect of the husband’s insur
ance, proof of marriage in the form of a marriage certificate must
be produced, and in the same way the wife’s society must have
similar proof before paying the second benefit. One benefit may be
paid by the wife’s society without the certificate, since she is entitled
to the benefit even if not married. These certificates are supplied
by the registrar at a cost of Is. ($0.24).
Under the terms of the 1911 law the maternity benefit was desig
nated as the husband’s benefit. Because of the numerous complaints
which arose as to the misapplication— and even waste of the bene
fit, the 1913 law carefully provided that the maternity benefit paid
in 'respect of either the husband’s insurance or the wife’s insurance
m u s t in every case be the benefit of the mother.
The societies are
required under the rules to secure the receipt of the mother on the
payment of the cash; the wife may, however, authorize the husband
to receive the benefit in her behalf, in which case the husband’s
receipt is sufficient. The husband must of course pay the money to
his wife, regardless of whether the wife is an insured person.
What might be regarded as a supplementary benefit is the provi
sion of section 10 (4) b of the act of 1911, under which no account
will be taken of arrears of contributions accruing during the two
weeks before and four weeks after a confinement in the case of a
married woman who is herself insured; such a woman is, therefore,
exempt from the payment of duep for a period of six weeks.

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GREAT BRITAIN.

One of the most complicated features of the British system is the
plan adopted to provide for the insured woman who ceases to be
employed when she marries. Health insurance in a. compulsory
system is of course practically dependent upon employment- in the
case of men, insurance may be assumed to continue throughout their
working life, because employment will probably be continuous In
the case of women, employment will for the majority cease upon
marriage— at least there will probably be a break of considerable
duration at that time.
Ordinarily the stopping of the employment of a woman would
mean the stopping of the insurance, but the payment of the woman’s
dues under the British system has enabled her society to accumulate
for her credit a certain reserve, to a part of which she is entitled
when she severs her connection with the insurance at marriage. If a
single woman who has been an employed contributor for five years
gives up her employment (without marrying), she is entitled to
become a voluntary contributor with the right to full benefits even
including the maternity benefit of 30s., by paying the entire amount
of the weekly dues of 6d. ($0.12), of which her employer had pre
viously paid half. A married woman, however, is not allowed to
become a voluntary contributor, but is placed in a special class, with
special rights. The plan provided in the 1911 act was rather involved
and proved so cumbersome that it was changed by the 1918 act.
For the sake of completeness it is necessary to describe briefly the
features of section 44 of the 1911 act, no longer in force. Under this
act, when an employed woman married she had to choose one of two
courses; she could elect to continue as a “ special voluntary con
tributor” or she could cease paying contributions entirely If she
elected to become a “ special voluntary contributor” she paid a re
duced rate of 3d. ($0.06) per week and received the following lower
rate of benefits: (1) Medical benefit; (2) sickness benefit of 5s. ($1 20) '
per week for 13 weeks and then 3s. ($0.72) per week for the following
13 weeks; (3) disablement benefit of 3s. ($0.72) per week, provided
that a waiting period of 104 weeks, with contributions, had been
credited to her.
,
other hand, if she elected to stop paying contributions
then she became entitled to the following benefits with the limitation
specified: (1) Maternity benefit of 5s. ($1.20) per week on confine
ment, but for not more than four weeks on any one occasion; (2) such
, P a r e n t s as may have been determined by the society, subject to
regulations issued by the insurance commissioners, during any period
of sickness or distress. Benefits (1) and (2) were paid until they
amounted to two-thirds of the transfer value of her account, less a
certain amount written off the reserve value. As soon as she had

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M A T E R N IT Y B E N E F IT S Y S T E M S .

received benefits up to the value of this amount she ceased to have
any further claim on her society.
'
>
As already stated, it was decided to simplify these provisions, and
after July 1 , 1918, an employed woman who gives up employment
on marriage, becomes entitled to the following:' (1) Sickness benefit
of 5s. ($1.20) per week for not more than six weeks in the period of
12 months commencing next after the date of giving up employment,
(2) maternity benefit of 30s. ($7.20) in respect,of her first confine
ment after the date of giving up employment and within two years
of the date of her marriage; (3) medical and sanatorium benefits for
one year from the date of giving up employment. She is to be con
sidered as an insured person for the two years following the date of
her marriage.
.
If a woman, after becoming entitled to the benefits just mentioned,
again takes up employment, she is then treated as if she had become
insured for the first time, though she may not be deprived of any
benefits to which she was otherwise entitled.
The act of 1918 abolishes the right to become a special voluntary
contributor and provides that in lieu of any rights she may have had
under the act of 1911, such married women contributors shall receive
on July 1, 1918, a commutation of 40s. ($9.60). If the married
woman elects the second alternative of the 1911 act, under which she
stopped paying contributions and became entitled to benefits not to
exceed the transfer value of her account, she receives a cash payment
on January 1, 1919, of the amount still unexpended.
An insured woman is required to give formal notice to her society
of her marriage within eight weeks of the date thereof; if the society
has not been so notified and pays her benefits to which she was not
entitled, it may deduct the amount so paid in excess from the amount
of any benefits subsequently payable to her.
To sum up, the maternity benefit consists of a lump sum payment
of either 30s. or 60s. paid for each case of childbirth. It might be
mentioned that the benefit does not include medical attendance, nor
is any provision made for instructing the mother in child hygiene,
such as the French law includes. While medicines, etc., may be supplied, the reports contain no reference to the supply of such aid.
Under section 12 of the act of 1911, authority is given to the com
missioners to make arrangements for the treatment of patients in
hospitals. As far as the maternity benefit is concerned, the most
complete arrangements seem to have been made in Scotland. The
Scottish commissioners in March, 1915, arranged a conference with
the representatives of the hospitals and on the basis of the discussions
at that meeting issued a circular on July 1, 1915, to the societies,
pointing out the importance of securing competent assistance to
mothers at childbirth in cases entitled to a maternity benefit and
the value of the maternity hospital, both as an institution providing

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GREAT BRITAIN.

skilled assistance and as a training school for doctors and midwives.
As a result of the work of the commissioners, all of the maternity
hospitals in Scotland have agreed to a uniform scale of charges on
the basis of not more than 10s. ($2.40) for intern cases, and 7s. 6d.
($1.80) for extern cases. The hospital representatives drew up a
model form of agreement which was approved by the commissioners
for adoption by the societies; this agreement included a specific
statement that no woman should be compelled to accept treatment
by the hospital, thus preserving her free choice of doctor or midwife.
The agreement was published as a circular1 by the Scottish commis
sioners with a recommendation to the societies that it be given serious
consideration. The 1914-1917 report (Cd. 8890, p. 118) states that
59 societies and 35 branches of 9 other societies, representing in all an
insured membership of about 400,000 in the districts surrounding the
hospitals, have reported that they have decided to enter into agree
ment with a maternity hospital dr hospitals.
Pregnancy benefit.

The payment of sickness benefit for disability due to pregnancy
was for a few years a matter of dispute and for a time caused much
unfavorable criticism of the act. The 1911 and 1913 acts make no
- specific mention of such disability and it is freely charged that in
preparing the insurance bill the parliamentary committee in charge
simply forgot about the matter. The two acts define the sickness
benefit as a periodical payment granted while the insured person is
rendered incapable of work by a specific disease, or bodily or mental
disablement, commencing on the fourth day of such incapacity and
continuing for not more than 26 weeks. There is, therefore, nothing
in the terms of the acts to prevent the payment of benefit for inability
to work on account of approaching confinement, and equally the acts
may be construed as it was by many societies— as not requiring
such payment. The departmental committee on sickness claims in
its 1914 report (Cd. 7687, p. 48) states positively that the premiums
charged and the benefits promised were not fixed with reference to
the possibility of paying sickness benefit during pregnancy. The
1913-14 report (Cd. 7496) of the insurance commissioners states that
during the first two years’ operations most of the societies were
guided by what had been their practice prior to the enactment of the
insurance law, which was, of course, to decline to make such pay
ments; even the friendly societies composed exclusively of women
had usually refused to pay benefit on account of pregnancy.2 The
1913 edition of the official Handbook to the Administration of Sick
ness and Maternity Benefits by Approved Societies makes no memtion of this type of disability. The 1915 edition, however, shows
1Circular No. 661, Aug. 8,1916.

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»New Statesman, Mar. 14,1914, Supplement, p. 16.

M A T E R N IT Y B E N E F IT S Y S T E M S .

that the commissioners had finally reached a conclusion on the sub
ject, for paragraphs 339 -and 494 contain the following:
fPar

339

)

I n considering claim s lor sickness b e n e fit n o d istin c tio n sh ou ld b e
f t e p a y m e n t of b e n e fit b e tw e e n in c a p a c ity d u e to p regnancy an d
« « w .

T h is , h o w e ve r, is su b je c t to th e exp ress p rovision

of th e a c t b y w h ich m arried w o m e n , sp ec ial v o lu n ta r y contributors (class H ) , are
debarred from rece iv in g sickn ess or d isa b le m e n t b e n e fit for tw o w ee k s before ¡m d
f im ^ w e e k s a ft e r 6con fin em en t, e x c e p t in resp ect of a disease or d isa b le m e n t n e ith e r
d ire c tly nor in d ire c tly co n n ecte d w ith c h ild b irth .

In discussing the action to be taken by a society in the case of an
insured woman who marries, the Handbook (1915 edition) states.
(P ar 494 ) N o q u e stio n of a person ceasing to b e in su red as an e m p lo y e d c o n tn b u t o f c a n arise in a n y case w here th e cause of th e m e m b e r h a v in g ceased w ork was
th a t she w as n o t in a fit state of h e a lth to w ork.
If
in e m p lo y m e n t after m arriage w h ile i n h e r n orm a l state of h e a lth

sneietv th a t th e o n ly reason for h e r le a v in g h e r w ork is h e r state of h e a lth (w h eth er
d u e to pregn an cy or n o t), she sh ou ld b e considered to h a v e b e c o m e o n ly tem p orarily
unem pW

and th e q u e stio n of her ceasing to b e e n title d to co n tin u e m insurance

as an e m p lo y e d contributor shou ld n o t b e raised u n til she ceases w ork for som e reason
other th a n th e state of her h e a lth .

T h u s, if a w om a n in su red before m arriage is m a -

ried in January and con tin u es to w ork u n til th e follow in g A u g u st, w h e n eh e ceases
b y reason of her approaching co n fin em en t, she sh ou ld n o t e ™ 8P®n ®
h as recovered from th e effects of h e r co n fin em en t and is again in a fit state of h ea t
iT w m k
w ork
Ito

T h o w e v e r , she h as ceased w ork w h ile t o fa c t t o a fit »to te o f h e a lth to

th e n

apart from sp e c ia l circu m stan ces, she w o u ld b e su sp en d ed as from th e

on w to c h she ceased to w ork , e v e n th o u gh th e so c iety does n ot k n ow of th e

cessation u n til n o tic e of h e r approaching co n fin em en t is re ce iv ed .

These statements are clear enough and show that by the middle of
1915 the supervisory authorities had realized the importance of the
subject sufficiently to give positive recommendations to the societies.
There are thus two periods in the history of the treatment of disa
bility due to pregnancy; prior to 1915 there was at least a tacit
approval of the action of the societies in refusing to pay benefits lor
this disability. ' It is stated that in many societies the unexpected
high rate of sickness among married women led the society officials to
endeavor to conserve their resources b y denying claims of this class
The most frequent ground for the refusal was the usual reasoning that
pregnancy was not a disease, but merely a normalfunction, and as
such not the basis of a claim for sickness benefit. Tins conclusion, of
course, ignored the fact that benefits were to be paid not for disease
but for inability to work. Another reason given for the refusal of
the benefit was based on the interpretation of the words incapable
of work.” Many physicians advised their patients to do some light
work such as housework, as being actually beneficial to a woman s
health at this period. Some of the society officials, howeveT, insisted
that “ incapable of work” meant incapable of any kind of work what
ever and refused benefit unless the woman member absolutely refrained from every kind of work, including light housework or sewmg.

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This action was, in effect, a discrimination against the women mem
bers, for it had become almost the standard friendly society practice
to pay benefits to the men when they were unable to follow their
regular occupation; a man might perhaps be disabled by sickness,
though still able to perform some light work, such, for instance, as
that of gatekeeper, but nevertheless it had been the practice to pay
benefits until he was*able “ to retum ,, to work. The same practice
applied to women disabled by the weakness due to pregnancy would
permit them, by remaining at home, to avoid the exhaustion of
standing long hours before a machine, to the injury of both the
mother and the unborn child. In the long run it might even be to
the financial interest of the insurance system to pay benefits during
pregnancy, because it would be a precaution against later having to
pay disablement benefit to the women who injured themselves by
excessive work at this period.
As>early as in the year 1914 the wide divergence of action on the
subject of pregnancy benefit had caused so much criticism that the
departmental committee on sickness benefit was forced to say that
the situation had placed the societies, the doctors, and the insured
persons in an impossible position.1 The committee took the logical
step of recommending a change in the law by the provision of an
entirely new benefit; the committee advised “ that a new benefit
should be created payable to a pregnant woman in respect of the last
four weeks of pregnancy, whether she is incapacitated or not, and that
payment should be made to a pregnant woman who is incapacitated
from following her occupation in the month previous to the last
month, whether she is incapacitated by pregnancy alone or by preg
nancy accompanied by some other condition. This benefit can not
be expected to produce the advantages hoped for unless the woman
is required to abstain from remunerative work or other work likely
to be prejudicial to her health during this period of four weeks
.* * * .” The committee urged strongly that pregnancy is ipso
facto a condition of incapacity for work; that pregnant women,
though technically “ capable of w ork /’ would by working at their
ordinary occupation “ expose to serious risk both themselves and
their unborn children.”
The report for the years 1914-1917 (Cd. 8890), ordered printed in
January, 1918, reviews the situation for these years and, in addition
to the facts above mentioned, calls attention to the loss of income
sustained by the societies because no contributions are payable in
respect of weeks during which an insured person is in receipt of sick
ness benefit. The varying practice of the societies also led to many
inequalities in the treatment of pregnant women. Some of the soci
eties, for instance, would permit the payment of sickness benefit
1 Report of committee, 1914, Cd. 7687, p. 69.

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when the certificate of the doctor stated that the pregnancy was
accompanied by some other disabling cause. This policy often
induced the doctors to find some cause of incapacity other than preg
nancy and sometimes led them—in the hope of aiding a woman so
incapacitated— to make out a certificate without mentioning the
fact of pregnancy and ascribe the disability entirely to some other
cause.
•'
•
.
Representations were made to the Government on the subject, and
in the financial estimates submitted to Parliament in July, 1914, the
following appropriation was recommended:
F or grants tow ard th e cost of sickness b e n e fit, in c lu d in g loss of con tribu tion s incurred
sin ce th e c o m m e n ce m e n t of th e ac t, b y a p p ro ved societies h a v in g w om e n m em b ers,
on a basis c a lc u la te d w ith reference to th e re la tiv e in c id e n c e of in c a p a c ity d u n n g

pregnancy

am ong such m e m b e rs— £ 5 0 0 ,0 0 0 ($ 2 ,4 3 3 ,2 5 0 ).

In the appropriations for 1915—16 the amount was £150,000
($729,975); in 1916-17 it was £100 ($486.65), a nominal sum to keep
the item in the appropriation acts; in 1917-18 it was £10,000
($48,665).1
The 1914-1917 report (p. 80) explains that the liability had been
overestimated and the £150,000 granted for 1915-16 was returned to
the treasury. The whole subject has finally been settled by having
the national treasury assume the cost of benefits for pregnancy, as
explained on page 90. As yet, no statement has been published as
to the method to be followed in distributing the money provided for
the women’s equalization fund. Information is not yet available
to show the number of-cases claiming benefit on the ground of
pregnancy.
.
.
The position of the unmarried mother, as far as sickness benefit is
concerned, is definitely stated in the 1918 act, in section 12 (3),
which specifies “ notwithstanding any provision to the contrary in
any rule of an approved society or branch of such society, an insured
unmarried woman who is pregnant shall not, on the ground that her
pregnancy was due to misconduct, be deprived of any sickness or
disablement benefit to which she would but for that provision have
been entitled.”
Provision for Navy and Army.

The act of 1911 and subsequent amendments make provision for
the continuance of the insurance of insured persons .who enter the
service of the navy or army.2 If the man was not insured prior to
1See annual volume entitled: “ Estimates for Civil Services for the Year Ending Mar. 31, —

Ch. VII,

item L, “ sickness benefit, women.”
2 The principal laws on this subject are contained in sec. 46 of the act of 1911; the act of 1913 changed the
regulations in some particulars, while further amendments were introduced by the acts of Sept. 18,1914;
Nov. 27 1914; Mar. 16,1915; and Feb. 6,1918. The rather lengthy regulations for the navy and army in
surance’funds will be found in “ Statutes, Regulations, and Orders Relating to National Health Insurance
(1916) ” p. 458ff. The 1914-1917 Report (p. 20 ff) also states the experience of the fund.

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GREAT B R IT A IN .

his enlistment, he is made a member of the navy and army insurance
fund, which takes the place of an approved society for such persons.
Insurance is, therefore, compulsory for all enlisted men in the navy
and army, beginning with the date of enlistment.
The navy and army members receive, however, only maternity
benefit, other benefits for sickness, etc., being provided by the naval
and military establishments. The maternity benefit is paid, even if
both husband and wife are abroad at the date of the confinement.
This benefit is paid in exactly the same amount and under the same
conditions as if the insured man were the usual employed contributor.
The cost of the benefit and of maintaining the reserve value of the
insured man is defrayed by having the navy or army authorities
deduct from his pay the sum of l id. weekly, to which is added a
like amount by the authorities, making a total of 3d. per week paid
to each man’s account. As a matter of convenience, the contribu
tions are paid to the insurance commissioners, who hold these amounts
during the member’s service, and then the society claims them at the
time of his discharge or death.
In the case of the naval service, the admiralty office secures the
particulars of the man’s insurance and keeps a record for each society
showing the amount due them in respect of the contributions. In
the case of the military service, the plan of having cards stamped
was found to be burdensome, and in 1915 a system of paying contri
butions in bulk was introduced.1 A post-card certificate is sent to
the society (a) on a man’s enlistment, (b) on his discharge, (c) on his
death, the last two cards certifying the period of service and that
the contributions have been paid. These post-card certificates
enable the societies to keep a record of their serving members and
enable them to claim the contributions on discharge or death. The
bulk sums are paid over to the commissioners by the military authori
ties and are divided among the four national commissions on the
basis of the number of soldiers estimated to be drawn from each
country. Credit is given to the societies provisionally every halfyear, with a final settlement for each man on discharge or death.
On discharge from naval or military service the insured man must
resume membership in an approved society, on which he receives
credit for the reserve value added to his membership during his
period of service and again becomes entitled to all benefits as before
in the usual manner. If he has become disabled through injury or
disease to such an extent that he can not secure admittance to an
approved society, then he is eligible for continued membership in
the navy and army insurance fund, which provides maternity
and other benefits in a manner similar to the approved societies.
»1914-1917 Report, p. 23.

113300°— 19------ 6

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M A T E R N IT Y B E N E F IT S Y S T E M S .

The act of 1914, in order to simplify the procedure, provides that if
the naval or military authorities certify a man as unfit his name is
automatically placed on the roll of the navy and army insurance
fund, though this provision is limited to the duration of the present
war. The act also provides that if in any case the commissioners
consider that the state of health of the man on discharge is not such
as to disqualify him for admission to an approved society they may
give him notice that his membership of the fund will cease at the
end of a stated period (which must be not less than three months
from the date of notice nor more than six months from the date of
discharge), unless he can satisfy them that he has been unable,
because of his impaired health, to obtain admission to an approved
society. In the interim between discharge and the date of joining a
society (or becoming a deposit contributor) a discharged enlisted
man continues to be entitled to maternity benefit out of the navy
and army insurance fund (sec. 36 of 1916 Regulations).
The amounts paid for maternity benefit by the Navy and Army
Fund were:
Year.
1913........................ - ................
1914............................. ..............

Pounds.

Dollars.

6,477
6,888

1,520
33,520

Year.
1915...........................................

Pounds.
7,361
18,986

Dollars.
35,822
92,395

SOURCES OF INCOME.

The means from which benefits and the cost of administration are
paid are derived from the contributions of insured persons, supple
mented by contributions of employers and of the National Govern
ment. In England, Scotland, and Wales the so-called “ employed
rate” (the total weekly amount paid in respect of any one person)
is 7d. ($0.14) a week for men, and 6d. ($0.12) a week for women.
This weekly rate is paid by the insured person and the employer in
the following proportions: 4d. ($0.08) by the man, 3d. ($0.06) by
the woman, and 3d. ($0.06) by the employer, regardless of sex of
employee. The rates in Ireland are somewhat lower than these
because of special provisions, which need not be described here.
These rates of dues are those paid by the great majority of insured
persons; they are, however, modified for the following groups:
(1) low-wage earners; (2) persons engaged in seasonal trades; (3) those
engaged in casual or intermittent employment; (4) persons in em
ployments where the remuneration fluctuates within certain limits;
(5) persons in the mercantile marine; (6) persons in the navy and
army; (7) persons in employments in which the employer is required
to pay wages during sickness;1 (8) exempt employed contributors;
(9) a married woman special voluntary contributor, who becomes
employed, but who holds a certificate of exemption.1
____
i This group was discontinued by tbe act of Feb. 6,1918.

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GREAT BRITAIN".

These groups illustrate in part the complexity of the British sys
tem; they also show an effort to adjust the system to the varying
needs of the wage-earning population. A large part of the so-called
low-wage earners and seasonal-trade employees are women. A
low-wage earner is a person 21 years of age or more, whose wage
does not exceed 2s. 6d. ($0.60) a day for men, and 2s. ($0.48) a day
for women. The persons in receipt of these wages pay the follow
ing dues:
Group I (those whose wage does not exceed Is. 6d. per working
day): The employer pays.6d. for men, 5d. for women, and Parliament
provides Id. in each case. The employed pays nothing.
Group II (those whose remuneration is over Is. 6d. but does not
exceed 2s. per working day): The employer pays 5d. for men and
4d. for women, the employed pays Id. in each case, and Parliament
provides Id. in each case.
Group III (those whose remuneration is over 2s. but does not ex
ceed 2s. 6d. per working day): The employer pays 4d. for men, 3d.
for women, while the employed pays 3d. in each case. For the
women these rates are the same as the ordinary employed rate.
In all of the three groups a special rate is in force for Ireland.
For the seasonal trades, the insurance commissioners may issue
regulations decreasing the rates for specified periods and increasing
the rates for other periods. Modifications may also be introduced
on account of casual and intermittent employment, and employments
where the rate of pay fluctuates. In all of these cases a large number
of the employees affected are women, and many of these are married
women who supplement the family income by such w ork1
For voluntary contributors, the rates of contributions are now the
same as for employed contributors.2 Under the 1911 act this rate
was in force; under the 1913 act a complicated schedule of contribu
tions varying according to age was used, but after July 1, 1918, the
rate is again to be the same as for the ordinary employed contributor.
FINANCIAL ADMINISTRATION.

The weekly dues of 4d. for men and 3d. for women are paid by
deductions from their wages; the employer adds to each of these
weekly amounts the sum of 3d. and affixes special stamps of the
proper value to the card of each employee at the time when wages
are paid. The stamps are purchased from the post office, which
deposits all moneys from this source in a special account, the national
health insurance fund. There is thus deposited weekly 7d. for each
insured man and 6d. for each insured woman, regardless of their ages.
From this fund the societies draw the money with which to pay
1Cd. 8396, pars. 74 and 106.

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* Acts of 1918, sec. 7 (2).

M A T E R N IT Y B E N E F IT S Y S T E M S .

sickness, maternity, and disablement benefits and costs of adminis
tration, in the same manner as from a bank account.
When the insurance system was planned it was decided to use a
level rate of premium for all ages of insured persons from the very
beginning, i. e., in 1912. To overcome the cost of the higher sickness
rate of persons of advanced age it was necessary to provide a method
of accumulating a fund which could be used for this purpose. The
contributions above mentioned are estimated to be sufficient to pro
vide the benefits of the system for a person who entered at the age
of 16, because the amount saved in the earlier years of his or her
insurance (when the sickness rate is low) will be sufficient to meet
the claims in later years, when the sickness rate will be higher. But
if a person entered the insurance at the age of 17 or later the contribu
tions will not be sufficient to provide the benefits of the act. The
system adopted provides for a gradual cancellation of the liability
assumed by the sytem in providing for all ages the full benefits
already described. This liability at the start is stated to have been
about £87,000,000 ($423,385,500), of which seven-ninths for the men
and three-fourths for the women have to be borne by the contributions
of the insured; in order to provide the reserve needed to cover so
much of this liability as falls on contributions, book credits are created.
For each insured person who was over 16 at the date of his entry into
insurance, the amount required to relieve him from the burden which
must otherwise have been imposed on him of paying additional con
tributions without increased benefits is credited to his society. The
British system designates the amounts so credited as 1reserve values.
These theoretical book credits are converted into actual cash by
means of an annual charge deducted from the contributions paid in;
for the first year of the insurance this annual charge amounted to
about £4,250,000 ($20,682,625). The insurance commissioners ob
tained this sum under the 1911 act by retaining from the 7d. ($0.14)
contribution of the men the sum of 4fd., and from the 6d. ($0.12)
contribution of the women the sum of l^d. As stated elsewhere,
these deductions were later made smaller in order to provide a larger
income for current use.
The sums derived from these deductions are used in the first place
to provide interest on the “ reserve values,” and the amount not
needed for this purpose is used to write them off;—in other words, is
used to replace the theoretical credit by actual cash. When the
initial book credits have been completely canceled the proportion of
the contributions retained up to that time for that purpose will be
available for providing additional benefits. Under the provisions of
the 1911 act the period necessary to extinguish the credits was esti
mated at about 18 years; under the 1918 act it is believed that a
period of over 30 years will be necessary.

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The contributions of the insured persons are paid into the national
fund, and to provide the benefits the approved societies draw on this
fund in the same manner as on a bank account. Of the money drawn
out to pay benefits, the national treasury pays two-ninths in the case
of men and one-fourth in the case of women. Thus the maternity
benefit of 60s. is paid for by the contributions to the extent of 45s.
and the National Government pays 15s. These payments of the
National Government are made at regular intervals under regulations
prepared by the treasury department.
The cost of administration of each society is defrayed by drawing
on the society’s credit in the national insurance fund and these ex
penditures share in the parliamentary grant in the same proportion
of two-ninths for men and one-fourth for women in like manner as
expenditures for sickness, maternity, etc., benefits. The maximum
amount expended for administration, however, may not exceed 4 Id.
(S0.82) per member for each year (with a lower rate for certain
classes of members). When a deficiency occurs in the administration
account, an assessment on the members must be made.
The results achieved under the scheme of dues and benefits adopted
m 1911 and 1913 have been in part favorable and in part unfavorable;
in general, it may be said that the receipts and expenses for the in
sured men have been approximately as estimated by the actuaries;
while, on the other hand, the expenses for women have been distinctly
in excess of the estimates.
The disablement benefit did not come into operation until July,
1914, this date being so recent that information on the actuarial
result of this benefit is not available. A special report states that
the 18 months’ operation has been approximately as anticipated by
the actuaries, though the warning is given that this benefit may
eventually create a heavier charge than was expected in the case of
women, and particularly married women. Information, however, is
available as to the sickness and maternity benefits, as shown'in
Table X III.
T

X I I I . G r e a t B r ita in . Actual and expected average weekly expenditure of
approved societies fo r sickness and maternity benefits, per insured married man, 1913-

a b le

Year.

Average weekly expendi
ture per insured mar
ried man.
Actual.

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Expected.

M A T E R N IT Y B E N E F IT S Y S T E M S .

Of the three years’ experience for men, two years have a surplus
while one year shows a deficit. The provision for the men has, there
fore, been sufficient.
Table X IV gives a similar statement of the experience ior women.
Actual and expected average weekly expenditure o f
approved societies far sickness and maternity benefits, per insured married woman,

T ahte X I Y __ G r e a t B r ita in .

1913-1915.
rSource- Great Britain. National health insurance. Interim Report of the Departmental Committee
[bource. w ® py oyed society Finance and Administration. London, 1916. Cd. 8251, p. 7.1
Average weekly expendi
ture per insured mar
ried woman.
Year.
Actual.
10.050
.052
.040

Expected.
SO. 026
.037
.037

In 1913 and 1914 the claims of the insured women were distinctly
in excess of the provision made for them; the deficit for the year
1915 is less than for the two preceding years, but this probably is due
to the abnormal conditions caused by the European war.
In seeking for the explanation of this excess of claims from the
insured women the first question which arose was whether it was
due to a greater rate of sickness among the women in the higher age
groups. It was the opinion of those familiar with the situation that
sufficient allowance had been made for the age factor and that the
real cause was the existence among the women of all ages of a much
higher rate of sickness than had been anticipated by the actuaries
who planned the rates for the insurance system.
There has been, therefore, a general excess of sickness claims from
the women members and this excess is particularly marked in the
case of married women. To prepare plans for meeting the deficit
caused by these unexpected claims, the treasury department on
January 27, 1916, appointed a special committee which published
three reports on this subject; the first proposed a revision of certain
of the financial provisions of the insurance acts.1 The proposals of
this committee were the basis on which the act of February 6, 1918,
was framed and a brief statement of their recommendations, with
the reasons given for the need of the changes, is necessary in order
to understand the new arrangements provided by the 1918 act.
The most radical change recommended— which was adopted
finally— was to take part of the money intended for the sinking fund
for current needs. This proposal brought forth a variety of comi Interim Report of

the Departmental Committee on Approved Society Finance and Administration.

London. 1916. Cd. 8251.

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G R E A T B R ITA IN ".

ment, ranging from “ a sensible measure” to “ looting the baby’s
bank.” To use the income originally planned to go to the sinking
fund would postpone the date when the sinking fund would be large
enough to permit an increase in the benefits. The proposal made
by the committee provided that out of the l£d. set aside for the
sinking fund from the weekly contributions of the women, threefourths of a penny should be released; and out of the lfd . set aside
from the weekly contributions of the men, five-ninths of a penny
should be released for immediate use of the societies. The com
mittee estimated that these deductions would make available about
£1,800,000 ($8.,759,700) annually.
The purposes to which the moneys from these deductions should
be applied were stated by the committee to be as follows:
(1) An immediate increase in the income -available to the socie
ties for the payment of benefits to women generally.
(2) Further special provision for the claims falling upon the
societies in respect to married women by the institution
of a national women’s equalization fund.
(3) A men’s special reserve fund to meet the indirect but possibly
prolonged effect of war service on the insured male popu
lation.
(4) A contingencies fund, in order to place at the disposal of any
society additional resources to meet contingent liabilities
caused by excess of sickness, disablement, or maternity
claims.
(5) A special risks fund, to provide for deficiencies caused by the
inclusion in certain societies of a large proportion of mem
bers who are below standard in health as a result of hazard
ous occupations, unhealthy environment, or an excep
tionally low standard of living.
In the opinion of the committee the funds available for women’s
benefits (of all kinds) were inadequate and an immediate increase in
income was necessary. Out of the three-fourths penny per weekly
contribution proposed to be released, they recommended that onethird penny should be devoted to increasing the current income of
the societies for women’s benefits. The one-third penny reservation
would total £280,000 ($1,362,620) annually; the .committee pro
posed that of this total £145,000 ($705,642.50) should be credited
directly to the societies, while the remaining £135,000 ($656,977.50)
should be placed in the national women’s equalization fund. To
this latter amount would be added the sum of £135,000 ($656,977.50)
which Parliament appropriated in the budget for 1914-15 and which
the committee assumed would be voted each year in the future for
the purpose of meeting sickness claims on account of pregnancy.
Under the procedure followed heretofore, for each 6d. paid in in

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M A T E R N IT Y B E N E F IT S Y S T E M S .

respect of an insured woman (3d. from wages and 3d. from the em
ployer) Parliament has added 2 d , or one-third. If one-third is
added to each of these sums of £135,000 by grants from the treasury
this will make each of them £180,000 ($875,970), or a total of
£360,000 ($1,751,940).
h
_
T.
In the opinion of the committee, the distribution of the equaliza
tion fund among the societies must be governed by two factors; m
the first place, it must be varied in accordance with the number ol
married women in their membership. The information available
shows that the insured married women have an average of one week
of sickness per annum in excess of the unmarried women; while this
excess includes the claims for benefits during pregnancy, it is not
entirelv due to this cause. In the second place, m addition to the
sickness benefits, the committee expressed doubts whether the present
rates of dues were sufficient to defray the cost of the maternity bene
fits, so that the distribution of the fund of the societies must also be
based on the amounts expended for maternity benefits.
The distribution of the women’s equalization fund should be in
such a manner as to provide for the special risks of women wherever
they arise, and the fund, therefore, should be available for all parts of
the United Kingdom. This would avoid the creation of separate
funds for Scotland, Ireland, England, or Wales, because it is probable
that there is considerable variation of women’s risks m these parts of
the Kingdom and still more variation in sections of these parts.
In the act of 1918, these plans were revised somewhat, lh e new
act provides for three special funds: First, the women’s equalization
fund, to care for the particular costs due to women’s sickness espe
cially that due to pregnancy; second, the contingencies fund; an ,
third, the central fund. The last two funds are to provide for the
needs of the insurance carriers not met by the women s equalization
fund, and for which the departmental committee made the recommendations just outlined.
In accordance with the 1918 act, after July 1, 1918, the amounts
retained by the insurance commissioners shall in part be &PP1; « 1 <>
the creation of the contingencies fund and the central fund.
e e
two funds may be described as special reserves formed for the purpose
of meeting deficiencies in the operations of the approved societies
The contingencies fund and the central fund are to receive the
following amounts:
The contingencies fund, seven-eighths of a sum representing, in the case of men,
four ninths, and, in the case of women, three-ninths of a penny for each w eekly contribution paid in respect of a member of a society.
. y
T h e central fund, one-eighth of a sum representing, in the case of m en, four-m nt ,
a n d ^ tn ^ th eca se oi women, three-ninths of a penny for each w eekly contribution
paid in respect of a member of a society.

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G R E A T B R IT A IN -.

The insurance commissioners are to apportion among the societies
the sum directed by the 1918 act to be carried to the contingencies I
fund in the case of men in proportion to the number of contributions
credited in respect of the members of those societies who are men, and
likewise the sums to be carried to this fund in the case of women in
proportion to the number of contributions credited in respect of the
members of those societies who are women; the sums so apportioned
to any society, together with the proper proportion of accumulations
of interest, form the contingencies fund of that society, which is to be
available for making good any deficiency of that society. However,
no part of any surplus of any society which appears on making an ac
tuarial valuation may be used for making good any deficiency in any
other society. If the actuarial valuation of the society discloses that
there is no deficiency, or if the contingencies fund of the society is
more than sufficient to cover the deficiency, then the sum stands
to the credit of the society, though the sum so credited may not be
used for the purpose of providing “ additional” benefits, as described
on page 71.
The central fund was established by the 1918 law and is under the
control of the joint committee; beginning with the year 1917 this
fund is to receive from grants by Parliament the sum of £150,000
($729,975) annually; it shall also receive the sums mentioned on page
88 above, and all accumulations of interest on the sums standing to
the credit of the fund. The purpose of the central fund is as follows:
If on making the actuarial valuation of a society, or any branch of a
society, a deficiency is found, and sums in any contingencies funds
available to make good that deficiency are not sufficient, then the
joint committee may, out of the central fund, make good either the
whole or any part of the deficiency not covered by the contingencies
funds. The act specifies, for the guidance of the committee, that it
must be satisfied that the deficiency is due in whole or in part to an
abnormal rate of sickness among the members of the society attrib
utable to the nature of their employment or environment, or their
physical condition, or any epidemic disease, or is due to the rate of
sickness being abnormal by reasion of the small membership of the
society, or due to any other special cause beyond the control of the
society. A special, independent investigating body, if the society
requests, may be appointed to report on the causes of the deficiency.
Ihese two funds are of importance because they may be used to
defray the excess of cost of sickness benefits of women, including
benefits for pregnancy, if the amounts provided by Parliament for
the women’s equalization fund are not sufficient for that purpose.
The higher rate of sickness among women, especially sickness due
to pregnancy, has always been a serious problem to the societies, /
and the 1918 act finally settled the difficulty. Under this act the!

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M A T E R N IT Y B E N E F IT S Y S T E M S .

National Government practically assumes the cost of the sickness
benefit for women during pregnancy by the establishment of the
so-called women’s equalization fund. The purpose of this fund is
stated to be for f 1assisting approved societies in meeting their liabili
ties in respect of the sickness claims of women” (sec. 2).
Under this provision the joint committee, with the approval of the
treasury department, is to draw up a plan for distributing among the
approved societies a sum not exceeding 8s. ($1.92) for each of the
married women who are members of societies and employed con
tributors. The national treasury is to provide all of this amount,
which is increased by the proviso that the sums disbursed are to be
regarded as derived from the contributions of the members; this
automatically adds to this amount one-fourth, since Parliament adds
that sum to benefits paid by the societies. For the years 1913 to
1916 the cost is to be defrayed from the balance of the sums previ
ously appropriated for this purpose by Parliament and not expended,
which at the close of 1917 amounted to £510,000 ($2,481,91s).1 For
the future the Government has pledged an annual sum not to exceed
£250,000 ($1,216,625).
Reinsurance of maternity benefit.

Under section 20 of the act of 1911, the insurance commissioners
were given authority to provide for the reinsurance of the maternity
benefit under a system to be provided by them. The commissioners
referred the matter to the actuaries, who, in the annual report for
1912-13 (p. 563 if.), advised that such a step appeared to them
unnecessary. The purpose of such a plan would be to secure the
societies against losses arising from claims for maternity benefit
being in excess of what was expected. Deviations from the expected
costs, the actuaries state, will be of two kinds: (1) Temporary fluc
tuations due to the small number of persons involved in a particular
society; (2) permanent deviations due to the character and circum
stances of the membership in question. As to the first of these
deviations, which the actuaries call “ accidental,” there will be but
slight risk, even to the smaller societies. Thus a small society, say
of 200 male members, might be expected to have, 'on the average,
about 18 claims for maternity benefit annually, or about 90 claims
for every five-year period. The average fluctuation from this number
would not be greater than 10 per cent above or 10 per cent below,
and spread over five years this variation would not be of sufficient
importance to warrant the adding of a complicated system of
reinsurance.
The other variation from the normal— that due to actual and
permanent difference in the birth rate in different sections of the
i Report 1914-1917, Cd. 8890, p. 80.

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G REAT B R IT A IN .

population or in different types of societies, such as those composed
t
•^?un^er men composed of women:—is a more important matter.
In the large societies, with a wide distribution of membership such
a ‘ systematic” variation in the birth rate will be unlikely to cause
any difficulty. In regard to societies restricted to certain occupaions or to certain districts, there are practically no data available
as to the difference in birth rate of the various occupational groups.
* In the different localities of England, while there is a marked varia
tion m the birth rates, those below the average and those above the
average comprise a comparatively small proportion of the total
number of persons insured. As far as geographical considerations
are involved, it is probable that the average rate provided for will
be sufficient to cover the costs of the maternity benefit, and if the
recent, tendency to a decreasing birth rate is continued, there is a
possibility that the average figure used in computing the costs will
become a maximum.
In regard to women’s societies, or women’s branches of the large
societies, the actuaries point out that the maternity benefit is likely
to form a smaller proportion of expenditures for benefits than in the
case of men’s societies. The reason for this lower proportion is that
the majority of women are suspended from benefit on marriage- the
actuaries estimate that only one-seventh of the employed women
who marry continue in employment after marriage. Furthermore
in certain localities or occupations where a large proportion of women
continue in employment after marriage, it is found that there is a
rapid decrease in this proportion as the ages advance; this is prob
ably due to the fact that the married woman’s employment is of a
temporary character it is likely to cease as the cares of the house
hold become more exacting. For women who were married and in
employment at the time the insurance law came into operation the
financial provision is more than sufficient; for women who were
unmarried at that time and in employment, there will be a number of
localities where the maternity benefit claims will be in excess of the
financial provision. Until a series of actuarial studies, covering
several years of operation of the insurance system, have been made
it will be impossible to calculate the effects of the tendencies just
mentioned; since, however, the profits of the societies on this account
^will come in at once, while the losses will develop only gradually
there is no present need for reinsurance of maternity benefits in the
women’s societies or women’s branches of the larger societies.
.
gen^ a l conclusion of the committee of actuaries is that there
is no proved necessity for reinsurance of maternity benefit claims
while there are a number of definite objections against such action!
Up to September, 1916, the insurance commissioners had published
no regulations or orders on this subject.

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‘92

M A T E R N IT Y B E N E F IT S Y S T E M S .

GENERAL ADMINISTRATION.

The general administration of the insurance system may be said
to be arranged as follows: Parliament and the treasury department
are at the apex of the scheme. For each of the four countries,
England, Scotland, Ireland, and Wales, there is a board of insurance
commissioners, which are semi-independent bodies; over these four
bodies is a federated body called the National Health Insurance
Joint Committee, whose principal function is to secure uniformity of
administration of the act. In each of the four countries and subject
to the jurisdiction of the insurance commissioners for that country
there are two sets of bodies to administer the benefits, first, for each
county (or county borough) there is an insurance committee whose
principal function is to administer the medical and sanatorium bene
fits; second, in each county there are a large number of voluntary
societies (“ approved societies” ) which administer the other benefits.
This abbreviated statement of the scheme of organization omits
some important details, but it serves to give the general outline of
the plan.
Insurance commissioners.

The legal title of these bodies is “ insurance commissioners,” there
being one board each for England, Scotland,- W^ales, and Ireland.
Each board is a legal entity, with powers specified by law and with
the duty of supervising the administration of the health insurance
acts and advising the agencies which provide the insurance. The
commissioners have control and management of the fund into which
the contributions of employers and insured persons are paid and
from which payments are made to the societies and the insurance
committees. One of their important duties is to “ approve” the
societies which conduct insurance under the act, and most of the rules
of these societies require the approval of the commissioners to secure
validity. As stated below, the insurance commissioners also have
charge of the deposit contributors fund.
The joint committee.

The joint committee of the four boards of insurance commissioners
consists of the chairman of each of the four boards ex officio, of such
other members of each of the four boards as the treasury may ap
point. The joint committee is incorporated and may sue and be
sued. It has power to make financial adjustments between the
several funds under the control of the four boards of commissioners;
it may exercise such powers and perform such duties of each of the
four boards (either alone or jointly with any of them) as may be
provided by regulations. In particular, it has power to make regu
lations as to the actuarial valuation of societies which operate under
the insurance acts and as to matters in which uniformity of action

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G R E A T B R ITA IN ".

throughout the United Kingdom is desirable. The approval of
societies which operate in more than one of the four countries is
vested in the committee. Aiding the joint committee is an advisory
committee of about 150 persons, composed of representatives of
employers, insured persons, physicians, -etc., including not less than
two women. The general duty of the advisory committee is to make
recommendations concerning the rules for collection and payment of
contributions, the accounting methods of societies, payment of bene
fits, etc.
Under this plan the insurance in each of the four countries, Eng
land, Scotland, Ireland, and Wales, may be said to have a semi
independent organization, with a federated board over t.hpm to assure
uniformity of administration.
Insurance committees.

For each County and County Borough there is an insurance com
mittee whose principal function is the administration of the sana
torium and medical benefit of all the insured persons in their dis
tricts, and also to administer the sickness, disablement, and ma
ternity benefits of the deposit contributors. They must make reports
on the health of the insured population of their districts, make sta
tistical reports, and furnish suggestions to the commissioners. They
must be composed of not less than 40 nor more than 80 members,
representing the insured persons (three-fifths -of the total membership), the council of the County, the medical profession ,etc. In
1913 there were 124 of these insurance committees in England and
their total membership included about 100 women.1
Approved societies.

The principal carriers of the insurance are the so-called approved
societies. As stated elsewhere, the whole basis of the insurance sys
tem is the network of friendly societies and organizations with a
similar purpose, which had existed in the country for a long time
previous to the enactment of the law and which the system utilizes
as administrative agencies. In April, 1913, these organizations were
classed as: Friendly societies, with branches; centralized friendly
societies; trade-unions; industrial assurance companies; collecting
societies; employers’ provident funds and works societies.
To become “ approved societies” these organizations are required
to submit their statutes to the insurance commissioners and must
register their rules. In general, it may be said that the societies
become independent organizations when they once receive approval,
though, of course, subject to the control of the insurance commis
sioners as far as the provisions of the act are affected. There are
approximately 2,000 of these approved societies in England, ranging
Annual Report 1912-13, p. 92

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M A T E R N IT Y B E N E F IT S Y S T E M S .

from the great friendly societies with several hundred thousand mem
bers down to the small local clubs in villages with a membership of
less than a hundred. The character of the membership also varies;
some of the large societies have an even distribution of risks because
of the variety in their membership, while others, such as the tradeunions, have a distinct type of membership, because restricted to
particular trades; again, some societies admit men only or women
only. Some of the difficulties in the administration of the act have
developed from this segregation of risks of a distinct type, such as
men engaged in certain hazardous trades, women in occupations with
high sickness rates, etc.
These societies had for many years provided systems of benefits
for their members and had incurred a wide variety of liabilities
which it was not desired to change or disturb. As the national in
surance act provided for a system of money grants by Parliament, it
was necessary to have the financial operations under the act clearly
separated from any other work which the societies wish to conduct.
Most of the societies have, therefore, arranged a separate department
within their organization for the conduct of their work under the
act, which is generally referred to as the “ State side,” in distinction
to the “ private side.” The result of this arrangement is that many
societies conduct two systems of insurance for their members, one
providing the benefits under the national system, and one providing
benefits which are now regarded as supplementing the other benefits.
The law provides that these societies shall administer for their
members the sickness benefit, the maternity benefit, and the “ addi
tional” benefits, unless the latter consist of medical benefit. All
medical and sanatorium benefits are administered by the insurance
committees.
The particular benefit under discussion— the maternity benfit—is
thus administered by the approved societies under such general rules
as the act and the authorities named by the act provide.
The deposit contributors’ fund.

Under the system of insurance carried on by the voluntary societies,
it was not feasible to compel the societies to accept a person for mem
bership against their will, though the law does not permit them to
refuse an applicant on the ground of age alone. There will be, there
fore, a certain number of persons who are compelled to insure who
either can not or prefer not to become members of societies. For
this group of persons, a special organization in the post office was
created and is now called the deposit contributors fund (originally
called the post-office fund). Those affiliated with this fund may be
persons who are compelled to insure or who have voluntarily decided
to insure. It was originally expected that the group of “ deposit con-

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GEE A T B R IT A IN .

tnbutors” would be persons who would be subject to compulsory
insurance but who could not gain admission to societies because of
impaired health; it was also expected that their number would reach
800 000 or 900,000/ though later developments showed The n“
to be only about one-third of the estimate. The fact that the ap
proved societies generally waived any medical test of applicants for
membership permitted a person not in good health to join them and
e result has been that the deposit contributors differ in no im
portant respect from the great body of the insured persons. This
class of insured persons was originally intended to be discontinued
on January 1, 1915, but on account of the war the date has been
extended.
The msurance of the deposit contributor is dependent entirely
on is own payments, increased by the usual grants from the national
treasury. Whenever a deposit contributor files a claim for sioknets
or maternity benefit, such claim is allowed to the extent of the pay
ments he or she has made; after the amount to his individual credit has
been exhausted, no further benefits can be allowed until his payments
builds up a new credit to his account. These accounts are keptat
the central office of the insurance commissioners and the payment
of his benefits is made by the insurance committee of the county in
which he resides.
J
The claims for maternity benefit by the deposit contributors have
been only 25 to 30 per cent of the expected,2 a fact which leads the
authorities to believe that there is a large proportion of unmarried
persons m this class. The total number of deposit contributors in
England on December 31, 1916, was 228,355, of whom 125,413 were
men and 102,942 were women. The number of maternity benefits
paid to this group in the year 1916 was 3,519 for men and 737 for
women; the men’s benefit averaged 27s. ($6.48) and the women’s 23s.
($5.5 ) per case. Relatively the deposit contributors are a group of
minor importance, and one which the framers of the law intended to
eliminate as soon as possible.
OPERATIONS.

fRT!fii0peratl0nS °f the British system are not easy to describe, but
he following pages give the available information as to the number
of persons insured, the financial returns, etc. The commissions for
the four countries, being semi-independent bodies, make separate
statements of their operations, which are not consolidated in the
annual reports of the system. In a number of cases, the data for
England only are given in the following pages, as they show the
details of operation and are sufficient for present purposes.
1 Report for 1912-13, p. 158.

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* Annual Report, 1913-14, p. 56.

M A T E R N IT Y B E N E F IT S Y S T E M S .

The «approved societies.

The only way to state the number of persons insured under the
British system is to give the number of contribution cards surrendered
each quarter by members in order to have their payments counted.
This number is, of course, a fairly accurate statement of the persons
who have paid dues and are entitled to benefits each quarter. On.
this basis, the number of men insured in the societies in 1913 was
9,394,961, while in 1914 it was 9,625,562. The number of women
members of the societies in 1913 was 4,053,108, and in 1914 was
4,131,825. The number for 1915 would probably show a greater
increase because of employment in establishments where men had
been replaced by women on account of war service.
The number of uninsured wives of insured men entitled to receive
maternity benefit because of their husband’s insurance was estimated
in 1914 as being about 5,000,000? the number of married women in
the United Kingdom whose annual income is below the limit specified
in the law (£160), but whose husbands are not insured and who are
not themselves insured, was estimated in 1914 to be 456,000. To
sum up, the number of women who were entitled to maternity benefit
in 1914 was 4,131,825 insured in societies, about 100,000 women de
posit contributors, and about 5,000,000 wives of insured men, or a
total of over 9,200,000 women, while against this 9,200,000 there
were 456,000 married women not entitled to maternity benefit because
the law did not include them, though they belonged to the same
group of the population as the insured persons.
The official reports state that these is considerable divergence in
the four countries of the United Kingdom as regards the proportion
of married women among the insured women. Of the three and onethird million insured women in England in 1914, it is estimated that
about 16 per cent were married, making about 533,800 women en
titled to the double maternity benefit of 60s. ($14.40). In Ireland
the number is estimated at about 10 per cent, in Scotland about 7
per cent, and in Wales about 6 per cent.2 In planning the system
the actuaries estimated that about one-seventh of the women who
married remained in employment after marriage.
The statistics of operations of the British system are given in rather
brief form in the three annual reports published to date; the special
study of the departmental committee on approval society finance
and administration contains some information not given in the annual
reports.3 For reasons connected with the war, no statement as to
the number of persons insured is given for 1915 or 1916.
1 Official Report, Parliamentary Debates, House of Commons, Aug. 4,1914, p. 1913. ^
2Interim Report of Departmental Committee on Approved Society Finance and Administration, 1916,
Cd. 8251, p. 38.
* Interim Report of 1916, Cd. 8251.

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GREAT B R IT A IN .

The membership of the approved societies and their expenditures
for benefits in 1913 to 1916 are shown in Table X V.
Number o f mm and women insured in approved
societies and amounts paid fo r sickness, maternity, and disablemmt bm efits, 1913-1916.

T a b l e X V .— U n it e d K in g d o m .

[Source: Great Britain. Report of the Administration of National Health Insurance. 1914-1917
1917. Cd. 8S90, pp. 11,116, and 238.]

London

Amount paid for—
Number
of
members.

Country.

All benefits.

Sickness
benefits.

Maternity
benefits.

1913. MEN.
United Kingdom...........................................

9,394,961

$27,304,759

$21,354,748

$5,950,011

England.................................................................

7,359,866

21,178,468

4,568,850

'457,’ 227
551,219

l\452^446
1,949,111

16,609,618
2,056,408
1,119,874
1,568,848

Ireland...............................................................

332,572
380,263

1913. WOMEN.
United Kingdom.........................................

4,063,108

$10,752,454

$10,643,638

• $208,816

England.................................................................
Scotland...............................................................
Ireland........................ ................................. .

3,290,807
431,404
221,432
109,465

8,704,246
1,002,981
732,160
313,067

8,548,543
'968,764
720,948
305,383

155,703
34,217
11,212
7,684

1914. MEN.
United Kingdom........... . .............................

9,625,562

$31,581,118

$24,740,001

$6,128,574

England..................................................................
Scotland..................................................................
Ireland..............................................................

7,637,794
1,033,276
474,544
579,948

24,414,939
3,255,615
1,607,478
2,303,086

19,193,792
2,468,449
1,235,162
1,842,598

4,656,837
702,280
355,931
413,526

4,131,825

$11,598,869

$10,349,761

$1,026,408

3,336,285
446,337
231,291
117,912

9,447,477
1,145,122
655,838
350,432

8,409,818
1,025,586
685,639
328,718

861,385
86,565
64,472
13,986

1914. WOMEN.
United Kingdom.......................... ................

1915. MEN.
United Kingdom...........................................

(“ )

$31,019,490

$22,618,368

$5,530,267

England...................................................................
Scotland.............................................................
Ireland................................................................

(“ )
(»)
(<*)
(“ )

24,104,826
3,300,991
1,496,848
2,116,825

17,671,347
2,326,542
1,071,569
1,548,910

4,207,620
634,193
319,812
368,642

1915. WOMEN.
United Kingdom...........................................

è)

$10,172,946

$8,059,766

$888,151

England...................................................................
Scotland.......... ................................ .................... .

(«)

8,218,428
1,071,506
567,400
315,612

6,501,614
830,979
466,041
261,132

750,989
71,630
51,653
13,879

TO
(<*)
(«)

aNot reported
1 13300°— 19—

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M A T E R N IT Y B E N E F IT S Y ST E M S .

Number o f mm and women insured inappromd^
societies and amounts paidfo r sicknessf maternity, and disdblemmt bmefits, 1913 1916

T a b l e X V .— 'U n ite d K in g d o m .
Continued.

Amount paid for
Number
of
members.

Country.

.,, x.
All benefits.

Maternity
benefits.

Sickness
]>enefits.

1916. MEN.
United Kingdom...........................................

T., 1 A

Scotian —

(“ )

$30,295,661

$21,248,058

$5,300,289

(o)
(“ )

23,487,865
3,266,823
1,514,689
2,026,284

16,594,347
2,197,088
1,037,976
1,418,647

4,033,618
624,688

(“ )

$9,604,713

$6,942,266

$832,803

(a)
(»)
(“ )
(a)

7,735,379
987,904
584,291
297,138

5,585,049
eyr, &53
437,084
225,280

717,000
61,678

M
(“ )

1916. WOMEN.
United Kingdom...........................................

Average amount paid per week for—
Country.

Number
of
members.

Disable
ment
benefits.

Disable
Sickness Maternity ment
All
benefits. benefits. benefits; benefits.^

1913. MEN.
United Kingdom.........................

$0,012

9,394,961

$0.0552

$0.0432

7,359,866
1,026,649
457,227
551,219

.0546
.0504
.0602
.0670

.0428
.0380
.0464
.0540

.0118
.0124
.0138
.0130

4,053,108

$0.0501

$0.0492

$0.0010

3,290,807
431,404
221,432
109,465

.0500
.0442
.0636
.0540

.0492
.0426
.0600
.0526

.0080
.0016
.0010
.0014

1913. WOMEN.
United Kingdom.........................
England.............................................
Ireland...................................................

1914. MEN.
United Kingdom.........................

9,625,562

$712,543

$0.0620

$0.0486

$0.0120

$0.0014

Scotland..............- ................................

7,537,794
1,033,276
474 644
579’ 948

564,310
84,886
16,385
46,962

. 0612
.0596
.0640
.0846

.0482
.0452
.0492
.0676

.0116
.0136
.0142
.0152

.0014
.0016
.0060
.0018

1914. WOMEN.
United Kingdom........................

aNot reported.

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4,131,825

$222,700

$0.0530

$0.0474

$0.0046

$0.0010

3,336,285'
446,337
231,291
117,912

176,274
32,971
5.727
7.728

.0536
.0484
.0534
.0560

.0478
.0434
.0478
.0526

.0048
.0036
.0052
.0022

.0010
.0014
.0040
.0012

6 Disablement benefit payments began in July, 1914.

GREAT BRITAIN.

T able 3CV.—•United Kingdom.

Number o f men and women insured in approved
societies and amounts paid fo r sickness, m aternity, and. disablement benefits, 1913-1916 —
C o n tin u e d .

Average amount paid per week for—
Country.

Number
of
members.

Disable
ment
benefits.!»

All
benefits.

Sickness Maternity Disable
ment
benefits. benefits.
benefits.»

1915. MEN.
United Kingdom.........................
England..........................................
Scotland..........................................
Ireland......................................... .
Wales...............................................

<«)

$2,870,855

$0.0608

$0.0444

$0.0108

$0.0056

M
(“ )
(*)

2,225,859
340,256
105,467
199,273

.0604
.0604
.0596
.0778

.0442
.0426
.0426
.0568

.0106
.0116
.0128
.0136

.0058
.0082
.0042
.0074

$1,225,029

$0.0464

$0.0368

$0.0040

$0.0056

965,825
168,897
49,706
40,601

.0464
.0454
.0464
.0506

.0368
.0352
.0382
.0418

.0042
.0030
.0042
.0022

.0054
.0072
.0010
.0066

1915. WOMEN.
United Kingdom.........................
England..........................................
Scotland...............................................
Ireland.................................................
Wales....................................................

(a)
O)

(a)
(a)
(a)

1916. MEN.
United Kingdom.........................

(«)

$3,747,312

$0.0586

$0.0412

$0.0012

$0.0072

England..........................................
Scotland..........................................
Ireland...................................................
Wales..................................................

m
M

2,859,901
445,047
185,783
256,581

.0612

.0412

.0116

.0084

(a)
W

1916. WOMEN.
United Kingdom.........................
England.............................................
Scotland.............................................
Ireland.........................................
Wales......................... ....... .......
° Not reported.

(O)

$1,829,643

$0.0432

$0.0312

$0.0038

$0.0082

O)
(«)
(<>)
(<*)

1,433,330
231,372
106,543
58,398

.0422

.0296

.0026

.0098

bDisablement benefit payments began in July, 1914.

None of the reports contains information which would show how
many women received the maternity benefit in any of the years for
which other data are available.
As the insured persons are required to have been members and to
have paid contributions for 26 weeks before they became entitled to
benefits for sickness and maternity, no payments of these benefits
were made until January, 1913, since the 1911 act came into force on
July 15, 1912.
The act of 1913 made a number of changes in the maternity benefit,
and these changes came into effect as follows:
Section 14 (1): Maternity benefit to be the “ mother's benefit/’
on January 12, 1914.

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100

MATERNITY BENEFIT SYSTEMS.

Section 14 (2): Maternity benefit not affected by deficiencies in
husband’s insurance, on October 13, 1913.
Section 14 (3): Second maternity benefit of 30s. in lieu of sick
ness benefit for four weeks, on January 12, 1914.
The effect of the last-named section was to shift a large expenditure
from the sickness benefit account to the maternity benefit column,
and caused a marked increase in the expenditures for this item in the
year 1913.
Table X V shows that the societies, for all three benefits, expended
over $38,000,000 in 1913, over $43,000,000 in 1914, over $41,000,000
in 1915, and about $40,000,000 in 1916. The societies’ total expendi
ture for maternity benefit was $6,158,825 in 1913, $7,154,982 in 1914,
$6,418,417 in 1915, and $6,133,092 in 1916. The greater part of these
amounts was of course paid to the men on behalf of their wives, the
men’s maternity benefits amounted to $5,950,011 in 1913, $6,128,574
in 1914, $5,530,267 in 1915, and $5,300,289 in 1916. The women
members of the societies were paid maternity benefits amounting
to $208,814 in 1913, $1,026,408 in 1914, $888,151 in 1915, and
$832,803 in 1916. The larger amount paid in 1914 was due princi
pally to the changes introduced by the law of 1913. The marked
decrease since 1914 is due to conditions caused by the war.
Assuming the expenditures of the societies for benefits to be
$40,000,000 annually, the $6,000,000 expended for maternity benefit
makes 15 per cent of this amount. There is also a large amount
expended for sickness benefit, for disability connected with childbirth.
The last four columns of the table, giving the average expenditure
per week for each insured member, are of especial interest. The total
expenditures for the three benefits by the societies have averaged
close to 6 cents per week for the men and have ranged from 4.32 cents
to 5.3 cents for the women. The maternity benefit in respect of the
men’s insurance caused an expenditure of 1.2 cents in 1913 and 1914,
and in 1915 it was 1.08 cents, and in 1916 it was 0.12 cents per week
per man. The expenditure for maternity benefit in respect of the
women’s insurance in 1913 was 0.1 cent, in 1914 it was 0.46 cent, in
1915 it was 0.4 cent, and in 1916 it was 0.38 cent per week per woman
member of the societies.
Deposit contributors.

The expenditures for benefits by the deposit contributors’ fund are
not included in the preceding table; in comparison with the amounts
paid out by the approved societies they are almost insignificant. In
England in 1916 the amount expended for maternity benefits by this
fund was £4,758 ($23,155) for men and £850 ($4,136.52) for women,
or a total of £5,608 ($27,281) for all insured persons. The total num
ber of deposit contributors in England on December 31, 1916, was

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GREAT BRITAIN.

101

228,355, consisting of 125,413 men and 102,942 women. The average
amount of maternity benefit paid to the women members in 1916 was
23s. Id. ($5.59), while the men received an average of 27s. ($6.56).
The number of maternity benefits paid in England in 1916 was 3 519
for the men and 737 for the women; about 75 per cent of the men and
47 per cent of the women received the full benefit. The women
deposit contributors were able, therefore, to secure the entire amount
ot the benefit in less than one-half the cases.
The year 1916 shows an improvement over the earlier years both
m the number of claims presented and in the average amount of the
benefit payment available. The special investigation of the deposit
contributors’ insurance, published in the 1913-14 report, page 495
states that the number of maternity claims presented up to that date
was only 29.2 per cent of the expected in the case of men, and in the
case of women the number of claims presented was too small to
compute a ratio. The explanation of this situation of the deposit
contributors is that the cost of their benefits is defrayed from the
weekly dues which they have paid in during the age period from 16
to 70; the amounts which they pay are small weekly sums, which
of course, accumulate very slowly. The need for the maternity bene
fit comes principally in the earlier years of life when there is obviously
little on which to draw. In the case of the women deposit contrib
utors there can practically never be anything to draw on for maternity
benefit.
j
Classes of members

approved societies.

The classes of members and the rates of dues paid by them are
shown in the following table, which gives a typical quarter’s payment
or England. The table is of especial interest as showing the variety
°b classes of the insurable population and the varying rates of dues
which these classes may pay. The division of the statement into
separate tables for men and for women— Tables X V I and X V II—
permits special consideration of the data for the insured women
Footnote « to each table shows the official titles of the different classes
of members.

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a b le

X V I — G r e a t B r it a in
Number o f male members o f approved societies in England for whom ^ t r ^ t i ^ m rd sw ré received by the commis
'
^ non fo r the quarter ended April 13, 1913, and the number o f contributions paid at each rate, by classes.
[Source: Great Britain. National Health Insurance Joint Committee, Report for 1913-14.

Total.

Under
At low- sec. 47
wage of 1911
rates.
act fi

Total.

Full rate,
7d. ($0.14).

Mercantile ma
rine. ^
LowIrish
Low
wage
resi
Low
wage, dents,
resi Sec. 47, Irish
Army,
wage, dents,
resi sec. 47, sec. 47, 3d. ($0.06).
5d.
6d.
4d.
($0.10). dents,
2d.
5|d.
Sid
6d.
($0.12). ($0.11).
4£d. ($0.08). ($007).
($0.12). ($0.04).
($0.09).
11

24,583

73,677

89,382,831

86,303,891

254,027

6,871

911,704

296

A l..................... - 6,992,617 23,307
32,206
65
A2.......................
1,211
70,552
A3....................
57,903
A4.......................
2,506
A5.......................
180
A6.......................
105,921
B .........................
14,931
C l.......................
2,538
D l.......................
9
C2.......................
2
D2.......................

73,134
162
381

85,964,206 84,813,886 238,332
553
¿ /I ,555
374,026
15,142
817,724
837,913
108,057
599,043
3,490
34,271
528
2,389
1,351,446
Ì88,*65Ì"
188,651
30,753
. 107
26

6,722
134

904,948
1,784
4,972

221

1
All classes. 7,279,368

Aver-

1,351,446

479,660

43,953

451,072
26,758
1,830

39,899
4,023
31

"i,35i,446

::::::::::

aClass A l.—British subjects under w> years oi age at e u u j m w w «

A2.—Aliens between 17 and 65 years of age at entry into State insurance.
A3.—Persons (British subjects and aliens) over 65 years of age on J ^ y lo, 1912.
A4, A5, and A6.—Mercantile marine members, subdivided similarly to classes A l, A2, and A3.

ciT I^ rtm tery contributors (British subjects) under 45 years of age at entry into State insurance.
D i._Voluntary contributors (British subjects) over 45 years of age at entry into State insurance.
02."—Voluntary contributors (aliens as defined) between 17 and 45 years of age at entry into State insurance.
D o _Voluntarv contributors (aliens as defined) over 45 years of age.
.
... __
bSection 47 of the 19lf act contains the special provisions where the employer is liable to pay wages dunng sickness,
cln the mercantile marine classes the contribution card covers the penod of a voyage and: not 13 weeks only.

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num
ber of
contributions
per
contrite
utor.
15
12.3

Number of ar
rears paid em
ployed con
tributors.

Full Sec. 47,
rate,
5d.
7d.
($0.10).
($0.14).
16
142,530

17
266

12.3 139,861
731
11.6
4
1,707
11.9
231
10.3
13.7
13.3
12.8
12.6
12.1
11.9
........
13.0

M A T E R N IT Y B E N E F IT S Y S T E M S .

Class.“

Cd. 7496, pp. 500, 501.]

Number of contributions paid at specified rate.

Number of contributors.

102

Number o f fem ale members o f approved societies in England fo r whom contribution cards were received by the com
mission fo r the quarter ended A pril 18, 1918, and the number o f contributions paid at each rate, by classes.

T a b l e X V I I .— G r e a t B r ita in .

[Source: Great Britain. National Health Insurance Joint Committee, Report for 1913-14. Cd. 7496, pp. 500, 501.]
Number of contributors.

Class.®

Total.

At lowwage
rates.

Under
sec. 47
of 1911
act.*»

Total.

Irish
Full rate, Low wage, residents
and
sec.
6d. ($0.12). 5d. ($0.10). 47, 4£
d.
($0.09).
5

Number of arrears
paid employed
Average
contributors.
number
Mercantile marine.«
Low-wage
of
Irish
contri
residents Special
butions
and low voluntary
per
Full rate, See. 47,
wage, rate, 3d.
5d.
2d.
contrib
4Jd.
($0.06).
6d.
sec. 47,
($0.10).
($0.04).
utor.
($0.09).
($0.12).
3*d.
($0.07).
9

3,253,852

233,502

18,672

38,850,930

36,361,364

2,215,069

224,403

2,885

3,225,913
8,882
10,947
669

231,333 ' 18,611
28
246
1,923
33

38,514,763
106,703
130,212
7,284

36,096,805
103,880
108,636
757

2,191,450
2,509
21,110

223,642
314
447

2,866

51,260
<*7,784
26
<130
32,855
13

51,260

4,086
706
2
3
2,643
1

32,868

10
5,965

5,965

562

11.9

69,124

562

11.9
12.0
11.9
10.9

68,898
86
140

26
32,855
13

12.5
11.0
13.0
10.0
12.4
13.0

14
195

103

<*Class E l.—British subjects under 65 years of age at entry into State insurance.
E2.—Aliens between 17 and 65 years of age at entry into State insurance.
E3.—Persons (British subjects and aliens) over 65 years of age on July 15.1912.
E4, E5, and E6.—Mercantile marine members, subdivided similarly to classes A l, A2, and A3.
El.—Voluntary contributors (British subjects) under 45 years of age at entry into State insurance.
Gl.—Voluntary contributors (British subjects) over 45 years of age at entry into state insurance.
F2.—Voluntary contributors (aliens as defined) between 17 and 45 years of age at entry into State insurance.
G2.—Voluntary contributors (aliens as defined) over 45 years of age.
HI.—Voluntary contributors (British subjects), married women.
H2.—Voluntary contributors (aliens as defined), married women,
t Section 47 of the 1911 act contains the special provisions where the employer is liable to pay wages during sickness,
cln the mercanti e marine classes the contribution card covers the period of a voyage and not 13 weeks only.
dNo detail given in original table.

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GREAT B R ITAIN -.

E l ................................
E2..............................
E3...............
E4......................
£ 5 ..........
E6............
F I ..............................
G l.............................
F2...................
G2........................
H I................................
H2................................

Number of contributions paid at specified rate.

104

MATERNITY BENEFIT SYSTEMS.

There were 11 classes of membership for the men insured in approved societies under the 1911 act, though 96 per cent of the men
belonged to the class A - l (compulsorily insured British subjects under
65 years of age at entry into State insurance). The so-called lowwage group has already been described on page 83. The persons
insured under section 47 of the 1911 act are those in employments
where it is the custom for the employer to pay full wages during
sickness.
Of the 7,279,368 men contributors, 6,992,617, or 96 per cent, were
regular contributors under 65 years of age when the insurance began
and who paid at the full rate; the number of contributions they paid
formed a similar proportion of the total. The regular sickness,
maternity, and disablement benefits are available for this 96 per cent
of the men.
The total number of women contributors in England in this quarter
was 3,253,852, and the total number of contributions which they paid
was 38,850,930. While the law provides for 12 classes of members, it
is seen that the first class of members—E - l women, British subjects—
who were under 65 years of age at time of insurance, formed by far
the greater part of the insured women. The large number of classes
of members, so confusing to the foreign student, is in practice much
reduced by the fact that the members are principally in one class.
By far the greater number of women’s contributions was paid at the
full rate, only 2,191,450 out of the more than 38,000,000 contributions
being low-wage contributions. Out of the 13 possible contributions
payable in this quarter year, the average number was 11.939.
The women over 65 years of age (class E-3) numbered 10,947, of
whom 1,923 received the low-wage rate of payment for their work.
Out of the possible 13 contributions, they averaged 11.895, indicating
fairly continuous employment in the quarter year. The groups of
insured persons over 65 years of age have been consolidated with the
rest of the insured population under the terms of the 1913 act.
The women voluntary contributors (class F - l ) numbered 4,086, all
of whom were required to pay the full rate of dues under the law.
The number of payments of contributions averaged 12.545 per
member.
The number of British married women voluntary contributors
(class H - l) was 2,643, and they paid an average of 12.431 contribu
tions for the 13 weeks of the quarter. As stated on page 76, this
group was abolished by the act of 1918.
Membership in the various organizations.

The relative importance of the different types of organization which
act as carriers of the insurance is shown by the following statement
for England for 1913 (Table X V III), which is given as being fairly
representative under normal conditions:

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GREAT BRITAIN.
T able X V III.

105

Membership o f approved societies o f specified type in Enaland, quarter ended A pril IS, 1913.

E n g la n d .

[Source: Great Britain. National Health Insurance Jpint Committee, Report for 1913-14. Cd. 7496, p. 498.]
Number of members of societies formed bySex.

Total
number of
members.»

Friendly
societies.
with
branches.

Other
friendly
societies.

Tradeunions.

Collecting
societies.

Industrial Employers’
assurance provident
companies.
funds.

Total..........

10,533,220

2,387,939

2,468,645

1,154,484

663,659

3,759,396

Men......................
Women___ ____

99,097

7,279,368
3,253,852

1,877,051
510,888

1,816,266
652,379

948,885
205,599

396,105
267,554

2,162,396
1,597,000

78,665
20,432

» me uumoer oi members ■
<
commission in time for use in making up its report.

At the date given, the organizations to which most of the 3,253,852
insured women in England belong are the societies conducted by the
industrial insurance companies, 1,597,000, or 49 per cent, of the
women bemg connected with them; next to these come the wellknown friendly societies with 1,163,267, or 35 per cent, of the women
m the two classes of these societies. The trade-union group includes
205,599, or 6 per cent, of the women. These three types of societies
therefore include 90 per cent of the women in England insured in
approved societies. In addition to the above, on Julf 5, 1914, there
were 86,216 women who were members of the English deposit con
tributors’ fund.
National health insurance fund, England, 191 2 -1 91 6.

The sums paid by the insured persons, their employers, and the
grants of Parliament from the national treasury are turned into the
national health insurance funds of the four countries. As the fund
for England is being used to show the operation of the system, the
following tables show the receipts to the close of the calendar year
1916. The receipts for 1915 and 1916 were presented in a form dif
ferent from that of the previous year, making it necessary to present
the data separately in Tables X I X and X X .
Tj 797?
19U

t0 ^Un

o ? f* h ^ eceiPtsof the national health insurance fu n d from July 15,
^ ances ^anand receipts from Jan. 12 to Dec. SI,

of C Paper 38 oO M 7“ £ 2 J^

Insurance Joint Committee, Report for 1913-14. Cd.7496 d 503
InSuranee Fu* d Accounts for the’ Period Jan. 12 to Dee 31,19i?/ H.’

Receipts.
Source.

Total receipts and balance........

July 15,1912,
Jan. 12 to
to
Jan. 11,1914. Dec. 31,1914.
8129,748,768

Balance total (Jan. 11,1914)

$89,085,967
981,482

Bank...................
3)937
Receipts...................

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129,748,768

88,104,485

MATERNITY BENEFIT SYSTEMS.

106

Receipts o f the national health insurancefund from July 15,
i9 U ~ toJ a n . u fl9 1 4 , balances Jan. 11, 1914, and receipts from Jan. 12 to Dec. 31,
1914— C o n tin u e d .

T a b l e X I X — E n g la n d .

Receipts.
July 15,1912, Jan. 12 to
to
Dec. 31,1914.
Jan. 11,1914.

From sale of health insurance stamps:
Post offices..................................................... ................. ................ ...
Board of trade labor exchanges............................................................
Army council.................................................*- *......................... .
Army (India)............................ — .....................- ...............................
Other Government departments... — . . . . ..••
......................
Employer depositors, quarterly and weekly stampmg......................
Employers’ sales of high value stamps................................................
Sundry persons by insurance commissioners.......................- .............
Admiralty contributions on behalf of sailors and marmes........................
Mercantile marine exempt persons.............................................................
InterestUon investments purchased on behalf of aP F 0V^ ^
"¿V
Capital sums paid by late entrants mto insurance [sec. 9 (4) of 1911 act].
Miscellaneous receipts (suspense account)................................................
All other.

L C U llw ^ v vA

Ä T A h d « bfM

ceeding under sec. 70 of 1911 act,
vestment, $2,251.

$60,529,527
516,465
356,220
593,049
355,902
4,991,001
27,531
15,987
457,451
74,504
20,157,008
18,367
5,446
1,050
o4,977

273,970
655,077
383,472
320,644
560,115
,894,624
18,823
9,015
486,650
71,449
22,073,360
452
40
1,077

; sums recovereu from employers for credit of societies in proS 731
™ of ,investments
rS
for sale
on behalf of approved societies for rem-

Balance at beginning o f year and receipts o f the national health
insurance fund, fo r the calendar years 1915 and 1916.

T a b l e X X .— E n g la n d .

[Source: Great Britain. Report ol fh . A t e M s m t t o

N .t t a ll Health Insurance during the 1 »

Receipts.
Source
1915

Total receipts and balance.
Beginning of year.
Total receipts.......
From sale of health insurance stamps:
Post offices.................... - ................ ......................................... ............ ”
Board of trade labor exchanges..................................-........... - ..............
Army council.......................................................... - .................... .........
Army (India)......................................... *.............. ...................... .........
Other Government departments............------ — : ...........................
Employer depositors, half-yearly and weekly stamping.......................
Employers’ bulk sales.......................................................................... ..
Snndrv Dersons by insurance commissioners.
..... ..............- ........
Postmaster general: Postage stamps affixed to health insurance cards.. . .
Board of Trade: Unemployment stamps affixed to health insurance cards...
Contributions on behalf of seamen, marmes, and soldiers................................
Mercantile marine exempt persons, etc.............................................................

S S g t f S i b u t io n cards to 'instance' co'mmis^n; etc.'/refunded by'
InSrtstqoifinvestm ents'inOT^^
sioners on behalf of societies (including income tax refunded).................... .
pivnital sums naid bv late entrants mto insurance••••••............**.*......... j *■
s X s reco^ red from employers for credit of societies m proceedings under
sec 70 of national health insurance act, 1911.......... ..
- - -- ----Stationery office: Refund to societies in part payment of cost of printing....
War office: Sanatorium benefit provided to soldiers prior to discharge from
O th efd ov ern m en t' departments:' Refunds of benefit's paid as advances to
seamen, marines, and soldiers under sec.l (2) of the national insurance act

Transfer from national "health insurance fund (Ireland).
Miscellaneous receipts.............................. - .
.
4.
For sale of investments on behalf of societies for reinvestment.

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9,462,156

$92,545,208

1,140,468
98,321,688

1,354,917
91,190,291

64,235,027
337,489
811,463
221,436
460,018
4,580,804
60,153
17,916
2,855
3,974
3,787,657
92,655
23,626,635

59,184,457
298,865
446,554
4,507,832
65,483
25,471
3,176
3,821
8,159,013
111,269
18,220,207

373

239

57,484
14,248

86,282
14,318

8,147

7
640
23,828

3,076
"'278

3,812
26,600
670
7,747

107

GREAT BRITAIN.

The total receipts of this fund reached their highest in 1915, when
they were over $99,000,000; in 1916 they were just over $90,000,000.
The largest item of receipts was that for the contributions on account
of the insured persons, which has made up about two-thirds of the
total receipts in each of the periods. The payments of the National
Government toward the benefits has made up from 20 to 25 per cent
of the total. Taking the latter and adding to it the 65 per cent
from the dues of the insured, we have about 85 to 90 per cent of the
receipts from the insured, their employers, and the National Govern
ment. The item of interest on investments is steadily increasing,
but has not yet reached an amount to be of importance in the total!
The payments out of the national health insurance fund of Eng
land for the period ended December 31, 1916, are given in Tables
X X I and X X II. The 1914—1917 report gave the items in a revised
form, making it necessary to present the expenditures in two separate
tables.
T

X X I — E n g la n d . Payments out o f the national health insurance fund from
July 15, 1912 to Jan. 11, 1914, and from Jan. 12 to Dec. SI, 1914, and balances at
the end o f each penod.a

a b le

National Health Insurance Joint Committee, Report for 1913-14
h

oaf a r ^ e i s f o f m t S l J

Cd 749fi n ini

Insurance Fund Accounts for tke

Expenditures.
Object of expenditure.

Total expenditures and cash balance............
.................
Issues to:
Approved societies for sickness, maternity, etc., benefits and for admin
istration expenses..................
Approved societies for investment.............
Insurance committees for sanatorium and medical benefits and for admin
istration expenses.......................
deposit contributors for sickness and maternity benefits.
■e j avZ arLd a™ y insurance fund for sickness and maternity benefits.
Iwfnirs trade: Hea th lnsurance stamps affixed to unemployment insurance
Employer depositors: Quarterly and weekly stamping—deposits repaid
E xchequer Repayment of grant overdrawn......... .
'’“
Refunds on account of health insurance stamps returned to commissioners
£,°r purchase of postal orders less paid to deposit contributors.
£ ? r purchase of investments on behalf of approved societies.........
Miscellaneous payments (suspense account)..........
Balance in hands of national debt commissioners..
Renino of maternity benefits paid by other Government departments...
tee) Utl°nS t0 approved societies (officers) guarantee fund (joint commit-

July 15,1912,
Jan. 12 to
to Jan. ll,
Dec. 31,1914.
1914.
$129,748,768

$89,085,968

128,771,223

87,945,500

42,703,093
4,236,381

40,302,064
969,542

22,499,227
76,534
12,491

26,169,417
127,173
21,513

4,380
75,518
17,945
23,906
62,542
3,900
169,628
1,028
58,884,650

1,531

26,302
748,039
1,087
19,466,000
50,339
52,815

Approved societies for losses by malversation or misappropriation made good
out of approved societies (officers) guarantee fund (England)............1
Allother......................
■
Balance at Bank of England___

----------- --------1------------1------------- 1__________ 1_______

1,294
8,378
977,545

1,140,468

a Includes Stationery office (printing), $3,222, and refund of contributions paid in error, $5,156.

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yQ g

MATERNITY BENEFIT SYSTEMS.

T a b i _ X X I X __ E n g la n d .

T able X X X I.

» I «

«W W

Payments out o f the national health insurance fu n d and
fo r m lm dar year, 1915 and 1911.

Brttoin. Repor. . .

“

“
Expenditures.

Object oi expenditure.

1916

1915
599,462,156

$92,545,208

98,107,238

91,888,479

Societies: Benefits and expenses of administration (including postal drafts

37,089,277

34,183,870

co S ttS sf
and sanatorium teneflts'and expenses of adInsurance committees:
ministration........... - - - - .................................................... "i .........................
Deposit contributors: Benefits, etc. . . . . . . - ......................

21,906,668
110,371
49,789
7,326

24,213,415
110,547
112,509
24,409

33,944
39,645
171

32,577
96.219
278

Total expenditures and cash balance............................. ......................
Total expenditures................................ - .......................... *........................

S £ B

^ ^ no £ S t o priBto? 0» W i t * " * — ■ * * » ”

**'

1,903

East'Anglto pr^cription'pricing office:' Eipmh'es' bfcertaininsurance comRefunds^n accoxint"of health ^ '¿ ¿ ¿ ¿ 's t a m p s ret'urned to comnussl° n^ :
Army
nv council and India office..................................................... ” ...........
Sundry persons............- - - - —
..........

E x !ffie ? u £ T ^
Ctmtributions"to"p r o v e d ' ¿

23,246
1,504

' fund (joixit com

. - ....... ..b—f ¿¿fel'ÿtiom
V
, mâdë
"
VÂn
i aoui'of
„ Ì n i «rn
n rov ed societies
S mo ittee).
Ä : ' '¿¿¿¿es'
g'Jod
approved
societies (offi(offi
cërs) guarantee fund (England)
Miscellaneous payments,
Societies: Investments:
....................

P ur^^e^finv^tm ents on behalf of"societies

..........................

496.219
12,084
1,237
2,472

«“ *
¿

650
5,760

23,899

7,890

66,637

63,318

5,911
82

961
82

6,772,034
997,044
30,977,787

4,801,712
1,752,192
25,889,781

11,347,732
7,186

656,713
16

80,297
(officers) guarantee fund (England)..................................
Balance at end of year:
......................... ..............
Cash and postal orders................................ ...............................................

The amount paid out for sickness, maternity, ^ . . benefits md
administration was $40,000,000 in 1914 and decreased to $34,000,000
in 1916. The payments for medical benefit and sanatorium benefit
rank next to these.
National health insurance joint committee, 1913-1918.

The appropriations made by Parliament for the support p f the
national ^health insurance joint committee are given in the followup
statement (Table X X III). As this committee administers ‘ be spe
cial grants from the national treasury for the insurance system, thes
sums are included in the committee’s statement.

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GREAT BRITAIN-,

109

T able X X II I.— England.

Appropriations fo r the national health insurance jm n t
committee, fo r fiscal years ended 1913-1918.
J

[Source: Great Britain, Treasury. Estimates for civil services, 1914-1918.]
Amounts appropriated.
Object of appropriation.
1912-13

1913-14

1914-15

£207,227 ($1,008,470)

I£1,218,964 ($5,932,038)

CENTRAL ADMINISTRATION.

Total.........................

£37,570 ($182,834)

A. Salaries and allowances...........
B. Speeialinquiriesandservices..
C. Traveling and incidental ex
penses..................................
D. Insurance stamps, cost of
manufacture and paper,
benefits, etc.........................
E. Special drug fund (Great
Britain) (grant in aid)........
F. Mileage grants (Great Britain,
excluding the. Highlands
and islands of Scotland)__
G. Administration of medical
benefit, etc. (grant in aid )..
H. Medical research fund (grant
in aid)................ . ...............
I. Expenses of members of in
surance committee (3 and 4
Geo. 5, C. 37, S. 31).............
K. Arrears o f contributions
(grant in aid)......................
L. Sickness benefit (women). ___
Medical reference consultants,
etc. (including traveling ex
penses of insured persons)
(Great Britain)....................
Supplementary medical serv
ices, Great Britain...............
Nursing grants.........................
M. Sanatorium benefit (special
grant)........................... .......
Insurance committees(special
grant) (United Kingdom)...
Medical attendance, etc., of
aged and disabled members
of societies (1913) (grant in
aid)............ ...................

24,020 (116,893)
2,500 (12,166)

14,127
500

(68,749)
(2,433)

16,964
1,250

(82,555)
(6,083)

(6,083)

750

(3,650)

2,550

(12,410)

1,250

8,500

(41,365)

6,000

(29,199)

5,000

(24,333)

30,000

(145,995)

30,000

(145,995)

50,000

(243,325)

54,000

(262,791)

82,700

(402,460)

116,500

(566,947)

56,500

(274,957)

30,000

(145,995)

80,,000 (389,320)
500,000 (2,433,250)

22,650

50,000

(243,325)

50,000
100,000

(243,325)
(486,650)

100,000

(486,650)

28,000

(136,262)

(110,226)

Amounts appropriated.
Object of appropriation.
1915-16

^916-17

£618,275 ($3,008,835)

£208,709 ($1,015,682)

1917-18

CENTRAL ADMINISTRATION.

A. Salaries and allowances........
15,575
B. Speeialinquiriesandservices
750
C. Traveling and incidental ex
penses................................
1,000
D. Insurance stamps, cost of
manufacture and paper,
benefits, e t c .....................
5,600
E. Special drug fund (Great’
Britain) (grant in aid).......
30,000
F. Mileage grants (Great Brit
ain, excluding the High
lands and islands of Scot
land).................................
13,500
G. Administration of medical
benefit, etc. (grant in aid).
40,350
a Total original net estimate, 1914-15
Add supplementary estimate..........

£269,746 ($1,312,720)

(75,795)
(3,650)

13,059
750

(63,552)
(3,650)

12,846
750

(62,515)
(3,650)

(4,867)

1,000

(4,867)

750

(3,650)

(27,252)

5,600

(27,252)

5,900

(28,712)

(145,995)

100

(486)

(267,658)

(65,698)

37,000

(180,061)

55,000

(196,363)

59,000

(287,124)

95,000

(462,318)
£275,864 ($1,342,492)
943,100 (4,589,596)
1,218,964 (5,932,088)

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110

M A T E R N IT Y B E N E F IT S Y S T E M S .

Appropriations fo r the national health insurance join t
committee, fo r fiscal years ended 1913-1918— Continued.

T a b l e X X I I I . __ England.

Amounts appropriated.
Object of appropriation.
1915--16

1917-18

1916-17

CENTRAL ADMINISTRATION.

H. Medical research fund (grant
in aid)...............................
I. Expenses of members of in
suranee committee (3 and
4 Geo. 5, C. 37, S. 31).......
K. Arrears of contributions
(grant in aid)....................
L. Sickness benefit (women)..
Medical reference consult
ants, etc. (including trav
eling expenses of insured
persons) (Great Britain). »
Ices, Great Britain.
Nursing grants..........
M.

grant).

5 6 ,5 0 0

( 274, 957)

50 ,5 0 0

( 245, 758)

5 0 ,0 0 0

( 243, 325)

3 0 ,0 0 0

( 145, 995)

6 ,5 0 0

(31, 632)

4 ,4 0 0

( 21, 413)

100 ,000
150 ,000

( 486, 650)
( 729, 975)

100
100

( 486)
( 486)

100
10 ,0 0 0

(486)
( 48, 665)

3 5 ,0 0 0

( 170, 328)

3 5 ,0 0 0

( 170, 328)

dO, 000

2 5 ,0 0 0
50 .0 0 0

( 121, 663)
(243. 325)

50 .0 0 0

( 243. 325)

The total appropriations made for the work under the charge of
the joint committee in the last two years have amounted to about
$1,000,000 each year. In 1914 and 1915 special grants were made
under item L to assist the societies in the payment of sickness benefit
due to pregnancy. Under the act of 1918 further large grants for
this purpose were made. The administration of the medical benefit
and the work of the medical research committee together take up
over one-half of the total appropriations of the joint committee.
Actuarial data.

The actuarial basis of the plan for the maternity benefit is de
scribed in a special report.1 The estimates of cost given in this report'
were based on the original draft of the bill, which it will be remem
bered was modified while under discussion in Parliament by the
addition of certain features which increased the cost. To provide
a maternity of 30s. ($7.20) for the wife of an insured man and a
like benefit for an insured woman, as the first bill specified, would,
the actuaries estimated, cost annually for the age of 16, about £0.130
($0.63) for each insured man and £0.04 ($0,195) for each insured
woman. If the State’s contribution of two-ninths for men and onefourth for women be deducted the net amount to be paid annually
per insured man would be £0. 101 ($0.49), and per insured woman
£0.03 ($0.39). These estimates were computed on the assumption
that contributions would not be paid during sickness or unemploy
ment. The interesting fact for American readers is, assuming that
birth rates and other factors are approximately the same in the
i Report of the Actuaries in Relation to the Scheme of Insurance against Sickness, Disablement, etc.,
embodied in the national insurance bill, 1911. London, 1911, Cd. 5681.

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GREAT BRITAIN.

I ll

United States as in Great Britain, that a maternity benefit of about
$7.50 can be provided for 63 cents a year, or about 5 cents per month
for men and 20 cents a year, or less than 2 cents per month for women
wage earners, without a State subsidy.
The above estimates of cost were based on birth rates, or “ issue”
rates based on English data, and as soon as the tabulation of the
British census of 1911 had progressed to the point of making avail
able such information, a special study of a selected area in England
was undertaken for this purpose. The results of this study were
published in 1912-13 report of the insurance system (Cd. 6907).
The area selected was the metropolitan borough of Camberwell;
the number of husbands present with wives and of wives present
with husbands, together with the number of children under 1 year
of age in this district in 1911, is shown in Table X X IV .
® r e a t . B r ita in . Age distribution o f husbands and wives, and o f
husbands and wives with one or more children under 1 year o f age, borough o j Camberxvsltj Jinglana, 1911,
[Source: Great Britain. Report for 1912-13 on the Administration of the National Insurance Act
1913. Cd. 6907, p. 695.]
Husbands present with
wives.

Age groups.
Total.

Total o.
15-20.
20-25.
25-30.
30-35.
35-40.
40-45.
45-50.
50-55.
55-60.
60-65.
65-70..
70-75..
75-80..
80-85..
85-90..
90-95..

With one
or more
children
under 1
year.

44,155

5,252

,345
,223
945
,878
090
205
325
110
284
466
816
328
106
17
7

468
1,406
1,469
1,033
564
217
76
15
10
2

London
’

Wives present with
husbands.

Total.

With one
or more
children
under 1
year.

44,151

5,251

91
2,583
6,328
7,486
6,898
5,897
4,837
3,725
2,680
1,775
1,041
557
196
47

32
840
1,600
1,450
897
389
41
2

a n d ^ v f"areX c^
w ? T f berS ^ s b a n d s and wives, and between the children of husbands
ana wives, are due to the fact that m a few cases there was no statement of age in the census schedme.

In Table X X IV twin births are counted as single births. The
slight discrepancies between the number of husbands and wives,
and between the children of husbands and wives, are due to the
fact that in a few cases there was no statement of age in the census
schedule.
The actual number of births in the United Kingdom for the years
1906 to 1911 is given in Table X X V .

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112

M A T E R N IT Y B E N E F IT S Y S T E M S .

Legitimate and illegitimate births in the United
Kingdom, 1906—1911.

T a b l e X X V . — U n it e d K in g d o m .

(Source: Great Britain. Report for 1912-13 on the Administration of the national insurance act. London,
1
1913. Cd. 6907, p. 597.]
Births.
Year.

Illegiti
mate.

Total.

Legitimate.

1,170,622
1,148,624
1,173,784
1,145,900
1,122,984
1,104,810

49,387
47,544
49,232
49,641
48,517
47,464

1,121,235
1,101,080
1,124,552
1,096,259
1,074,467
1,057,346

1,144,454
1,124,565

48,631
48,541

1,095,823
1,076,024

Of interest to the financial basis of the maternity benefit system
is the tendency to a lower birth rate, so that any estimates based on
the experience prior to 1911 would have this tendency as a margin
of safety. The number of illegitimate births is less than 5 per cent
of the average for the six-year period.
From the above figures the actuaries computed a formula to give
the probability of birth at each age. Certain adjustments were
necessary in making up the formula, but on this basis the distribu
tion of births in the United Kingdom, as of June 30, 1909, is shown
in Table X X V I,
Estimated number o f husbands and wives in the
United Kingdom distributed according to age groups, and computed numbers o f births
fo r the year, June 30, 1909. (000 omitted.)

T a b l e X X V I — U n it e d K in g d o m .

[Source: Great Britain. Report for 1912-13 on the Administration of the national insurance act. London,
1913.

IXL o9U/, p. oyo.j

Age group.

15-20..................... - .............................................. *...........
20-25.............................. - ....................................... - ...........
25-30...................................................................................
30-35........................................ ............................................
35-40....................................................................................
40-45........................................... - .......................................
45-50.................... ................ ; ----- *......................................
50-55................................... - ------ ---------------------------- " "
55-60.....................................................................................
60-65.... .................................................. ...................*........
65-70.................................................................... ................
70-75.....................................................................................
75-80.....................................................................................
80-85......................................................................- .............
85-90................................................. .................... .
.......

Hus
bands.

Births.

Wives.

7,807.1

1,160.4

7,907.2

1,182.6

6.1
298.1
883.0
1,162.6
1.164.8
1.050.9
906.2
747.2
585.9
428.9
282.7
164.1
80.0
33.1
13.5

4.8
151.7
302.4
305.4
215.9
112.4
46.1
15.7
4.6
1.2

37.0
531.5
1,111.0
1,264.6
1,191.3
1,036.2
854.3
672.7
497.8
336.1
205.4
109.7
45.7
12.4
1.5

25.0
242.5
345.9
296.4
192.6
72.7
7.5

...........

Births.

This estimate of the births shows (in the total line) a greater num
ber for the wives than for the husbands. The explanation adopted
by the actuaries is that a number of husbands were out of the country

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113

GREAT B R IT A IN .

at the date of the census, and it is also believed that these absent
husbands were for the most part younger men.
From the data thus collected a general Table X X V II was con
structed giving the “ issue rates” for the population, showing the
probability that a married man or woman will have issue during
the year.
&
T a b l e X X V II.

Great Britain.

Estim ated central issue rates for the United K in a -

dom, 1911.
[Source: Great Britain. National Health Insurance Joint Committee. Report for 1912-13 on the Adminlstration of the national insurance act. London, 1913. Cd. 6907, p. 684.]
Central issue rates.

Age.

16............................
17.......................
18............................
19.....................

Aver
age
Marriec
man. taken
over.

20.....................
22..
23.. .
24 _

35.........
36................
37..................
38................
39..................

.2180
.2016

'.1515

40.........
41. .....................
42...........
43......................
44................

.1353
.1198
.1052
.0916
.0791

45...................
46...................
47...............
48................
49..................

.0578
.0491
.0415
.0349

50...................

.0292
...................1

—

.1046
.1260

0.531
.473
.412
.366

.1791
.1848

.3327
.3105
.2916
.2753

.317
.306
.296
.286

.335
.311
.293
- .280
.269

0.458
.409
.355
.310
.274

.1882
.1860
.1815
.1747

.2474
.2344
.2213
.2080

.267
.257
.246
.234

.259
.249
.238
.226
.213.

.247
.226
.210
.197
.186

0.374
.327
.283
.244
.211

.1558
1444
.1323
.1200

.1788
.1622
.1444
.1256

.204
.186
.166
.144

.199
.184
.168
.150
.131.

.175
.163
.149
.133
.115

.183
.160
.140
.122
.105

0.290
.224
.176
.141
.114

.097
.073
.052
.035

.111
.090
.070
.051
.035

.097
.080
.064
.049
.U35

.089
.074
.060
.047
.034

.093
.076
.060
.045
.033

0.191
.144
.101
.065
.038

.022
.012
.006
.002
.001

.022
.01»
.006
.002
.001

.021
.011
.006
.002
.001

.000

.0271
.0533

.2920

.513
.455
.408
.372
.347

.6800
.6250

30........
31................
32................
33..... .........
31................

.6030
.5336
.4759
.4291
.3909

0.0015
.0089

.3958

0.654
.579

0.6600
.6900

25........
26.............
27.. .
28.............
29_______

Married woman whose ago « at marriage was—

0.4000
•IaiDO
.6900
.6700

.........
..........

Marrie<I
woman
irre
spec
tive of
age at
mar
riage.

•OOaZ

■i/W
»«

•0215

*..........

..........

............

° The ages at the head of these columns are exact.

Comment on the system.

An insurance system of such great scope as the British has naturally
been the subject of much discussion, with comment favorable and
unfavorable. Much of the unfavorable criticism has been directed
1 13300°— 19------ 8

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114

M A T E R N IT Y B E N E F IT S Y S T E M S .

at the very involved methods of administration in use, and a large
part of this criticism was based on the treatment of women during
kickness, especially sickness connected with childbirth. There is,
however, a general acknowledgment of the value of the maternity
benefit, though the many cases of waste of the benefit during the first
two years of operation of the system produced a deluge of complaints
which were well justified. The amendments of 1913 seem to have
remedied these objectionable features; at least they are not mentioned in the recent discussions.
, .
The two special investigations of the system were conducted m a
thorough, impartial manner, and from the testimony of the witnesses
appearing before the committees and the reports of the committees
it is possible to secure a good impression of the working of the ma
ternity benefit. The reports of the officials in charge of administra
tion afford much general information, though it is a matter of regiet
that the statistics on the operation of the matenuty benefit are
presented in such scanty form. As it is sometimes charged that the
statements of the paid officials who administer such systems are
probably too optimistic as to the results obtained, we are fortunate
in having available the following frankly hostile criticism of the
British system made in 1914 by the Fabian (socialist) Society s com
mittee on national health insurance, of which Mr. Sidney Webb was
chairman:
B u t Mr L loyd George elected, w ith almost universal consent— the Fabian'Society,
^

tV if q t w S .t e generally standing almost alone in their warning d isa p p ro v a l-to

fit the country w ith a scheme embracing, w ith dramatic suddenness from the outset,
e ig h t-n in th s^ all its households, in c itin g a vast multitude who were already providi g

what was requisite fo r

themselves.1

In this study of the workings of the insurance acts, the New Statesman says:
T h e maternity beneSt is, w e believe, especially since the coming into force o the
amending act ol 1913, both the most popular and the t a u t
b£ .
insurance scheme * * * . W e do not ourselves consider that the m aternity ben
e S ^ S g ta to crim in a tely , without inquiry as to its application, at th e b e £ of
evervinBured mother, unconnected w ith any provision for prenatal care not m itsel
s e c S n g adequate attendance at childbirth and carrying w ith it neither
^ m m r o v i s i o n for the in fa n t-a ffo rd s in itself an adequate or a satisfactory national
provision for the great service of childbirth, the arranpm ente for w hich ran not
properly be disassociated from the w ort of the local health authority
•
„
P B u t this dies not m ean that the specific beginning of an endowment of maternity,
w M ch Mj-3 L loyd George has effected to the extent of £1,0 0 0,0 0 0 a year distributed
in s u L of 30s. or

£3 to some 4,500 households on every working day of the year, is not

already proving an enormous boon.

The second report of the operation of the system—tha or
e
year 1913-14-states that it is too early to measure accurately the
effect of the maternity benefit in improving the national physique,
i The New Statesman, Supplement, Mar. 14,1914, pp. 23, 24,28, London.

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GREAT B R IT A IN .

115

in raising the general standard of health among wage-earning women
and of reducing the rate of infant mortality; but certain results of
importance have already come to light which are clearly defined.
The first thmg is that in general the maternity benefit has worked
satisfactorily, in spite of many improvements which might be made.
Dr. Barbara Sutherland, assistant to the medical officer of health of
Glasgow, in a paper read before the English-speaking conference on
mfant mortality in 1913 stated: “ The working of the maternity
benefit has been, on the whole, very satisfactory.” 1
Nearly all of the British writers on this subject emphasize the fact
that one of the great advantages of the maternity benefit has come
from the removal of the anxiety which the need for money at the
period of childbirth always caused. This need often compelled the
expectant mother to work up to the last possible moment before con
finement m order to have on hand the money for the necessary ex
penses. In many cases all sorts of risks were incurred because the
woman could not afford to stop work, and many women are known
to have ignored dangerous symptoms in the hope that no harm would
result from gomg on with work which they could not afford to drop
even when in good health. Now that they know positively that a
definite sum of money will be available, they no longer hesitate to
seek medical advice prior to confinement and find it possible to
follow this advice and to abstain from work at a period when rest is
imperative, both on t^e mother’s and the child’s account.
One of the important results of the institution of the system is the
revelation of the existence among the insured women of a rate of
sickness much greater than had been anticipated. Thus the report
of the committee on sickness benefit claims of 1914 (Cd. 7687) states’
Secretaries of societies have expressed themselves as astounded b y their realization
for the first tim e, on the coming into operation of the act, of the kind of work done b v
women in certain occupations, and the amount of sickness entailed b y the conditions
under which they live

*•

More especially w ith regard to women this view of

the question is emphasized b y those witnesses who have appeared before us and have
given evidence from a standpoint other than that of those engaged in the administra
tion of the act.

B y these witnesses it is contended that there is in fact more sickness

than was expected when the act came into operation * * *, and that the excessive
sickness among m a m e d women is a common experience due to illness connected
with and consequent upon childbirth

The evidence of m edical prac

titioners is overwhelmingly in support of the view that the effect of the act has been
to disclose, especially among industrial women, an enormous amount of unsuspected
pickness and disease, and to afford treatment to m any who have hitherto been without
medical attendance during sickness.

The charges of the physicians and midwives in connection with
confinement cases have been the cause of some discussion. There is
evidence that the fees demanded for attendance were increased after
1 Proceedings, p. 402.

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1911. Dr. Barbara Sutherland, for instance, states that, in the
Glasgow district, midwives’ fees were raised usually from the former
rate of 10s. to 12.5s.1
The Fabian Society study makes the same statement concerning
midwives’ fees and also states that physicians’ fees have been simi
larly advanced; where formerly 1 guinea ($5.04) was the fee for a
wage-earning family, this charge has been raised to 30s. ($7.20) and
to 2 guineas ($10.08).2 The report of the chief medical officer of
health of the city of Birmingham for 1916 states: “ An increasingly
large number of doctors are giving up attendance on midwifery cases
as a result of the exacting conditions of the insurance act.” 3 This
statement, it will be noted, applies to midwifery cases only.
Two statements in the form of criticism of the maternity benefit
have been published which deserve special mention because of the
high standing of the persons making them. Miss Mary R. Macarthur
and Mr. Benjamin Broadbent both believe this benefit is inadequate.
Both of them, however, state that the benefit is of value; the point
they emphasize is that the benefit does not go far enough.
The woman’s point of view as to the operation of the insurance
laws is perhaps best represented by the statement of Miss Mary R.
Macarthur, secretary of the Women’s Trade Union League, appended
to the 1914 report of the departmental committee on sickness claims
(Cd. 7687). Miss Macarthur states that the insurance act of 1911
has done great service in bringing to fight “ a mass of suffering and a
number of social evils, as to which the nation as a whole was ill
informed or indifferent. It will now be substantially easier than in
1911, both on account of the new knowledge available and of the
state of public opinion, to make adequate provision to advance the
health of the community.” The following is a summary of Miss
Macarthur’s views.
The insurance act was, as far as women are concerned, a leap in
the dark, and on the basis of the accurate information now in hand
she claims that fundamental changes are necessary. The evidence
collected by the committee shows that the excess of sickness over esti
mates is to be found almost entirely among women; Miss Macarthur
dissents from the opinion of the majority of the committee who said
that the women’s excess was partly due to ignorance of the principles
of insurance, to the close approximation of benefits to wages, to the
difficulty of supervising behavior during sickness, to the defects in
the management of societies, and to the carelessness in medical
certification. While these causes are, without doubt, of influence in
producing a higher rate of sickness costs among the women, they are
counterbalanced by the fact that many claims of women are denied,
1Proceedings, p. 406.

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2New Statesman, Mar. 14,1914 p. 24.

8Report, appendix 5.

GREAT BRITAIU".

117

often improperly. The main cause, however, is fundamental and
can not be remedied by improvements in administration. The extra
sickness among women is due to their greater poverty and to the
character of their employment. Long hours, long standing, lack of
fresh air, long intervals without food, are clearly detrimental to
health especially so in the case of anemic young girls— and the low
wages which attach to most women's work involve insufficient and
often improper food.
Another result of the low wages of women is that the insurance dues
fall much more heavily on their wages than on the men’s. But the
main fact is that under the treble strain of childbearing, wage earn
ing, and household drudgery women break down. There is over
whelming evidence that unsuitable occupations during pregnancy,
especially late pregnancy, are a prime cause of sickness among
women, not only at the time of childbirth but later in life. Miss
Macarthur sums up what in her opinion are the causes of excessive
sickness among women: “ In the first place, poverty with all its
concomitants; in the second place, want of care and rest during
illness, of medical treatment in the past, of adequate medical treat
ment in the present, particularly during pregnancy, at confinement,
after confinement, and, indeed, in all cases of women’s diseases.” To
remedy these conditions, Miss Macarthur urges the appointment of a
royal commission on maternity, whose study should include all
matters relatmg to the care, treatment, and provision before, during,
and after confinement, including the cause and extent of miscar
riages, stillbirths, diseases of women, and infantile mortality. In
the meantime she calls attention to certain needs which can be pro
vided for by changes in the insurance laws or insurance regulations.
Among these are included the payment of pregnancy benefits as part
of the sickness benefit; attention is also directed to the fact that ap
proved societies are not the best agencies to administer such benefits.
The sick visitors,” limited in number, are practically the only
officials available for such work; they are often untrained, inexpe
rienced, and inefficient, and in cases brought out in the evidence
taken by the committee, offensively and indelicately inquisitorial in
the methods they employ; often working with so little coordination
that on occasion as many of them may visit a street as there are
houses on it. Such machinery, she claims, is certainly not adapted
for the visitation and care of expectant mothers.
Miss Macarthur suggests that there be inaugurated a supplemen
tary service of State doctors, appointed and paid by the insurance
commissioners, whose special fmiction should be that of consultation
accessible to the panel doctors, the societies, and the insured persons^
and who should be supplied with adequate premises and equipment.
The need for better hospital provision is also pointed out; these

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118

hospitals should contain equipment for maternity cases, women’s
diseases, etc.
.
. .
The fundamental weaknesses of the present organization of the
insurance is, in Miss Macarthur’s opinion, the administration of the
insurance by the independent societies; theoretically this would give
self-government by insured persons of insured persons. As a matter
of fact, the old friendly society spirit, which it was hoped would bring
this about, has almost entirely disappeared. The regulations neces
sary for the conduct of the insurance have centralized the adminis
tration to such an extent that the members have but little to do with
the management of the insurance, and in practice the members take
but little interest in the “ State side” of the societies work. Fur
thermore, the societies affiliated with the industrial insurance com
panies—which include over a third of the insured persons and half
of the women— are practically controlled by these companies. Miss
Macarthur proposes, therefore, the creation of a State insurance
society to operate in competition with the existing approved societies;
this society would be organized by the insurance commissioners, have
branches covering the same area as the local insurance authorities,
and be regulated by the commissioners. Membership in the society
would be open to any person not otherwise insured and to anyone
desiring to transfer from any other society.
One of the statements as to scope and operation of the maternity
benefit calling for special mention is that made by Mr. Benjamin
Broadbent, vice chairman of the National Association for the Preven
tion of Infant Mortality. At- a conference devoted to the subject of
establishing a national ministry of public health Mr. Broadbent, in
speaking on “ The Better Preservation of Infant Life,” said:1
*

One more point I would ask permission to dwell upon in some little detail,

because I believe it to b e an obstacle to the unification we desire.

That is the mater

nity benefit provided b y the national health insurance act and administered through
the approved societies.

I wish to point out the total inadequacy of the provision for

securing the minim um— safe birth and efficient care in early infancy; I also venture
to say that it is not only inadequate bu t that it is peculiarly liable to misdirection.
I regard the maternity benefit under the national health insurance act as little better
than a soporific for the public conscience, which is soothed into inaction b y the mere
repetition of the pleasant sounding words “ maternity benefit, ” as if the whole duty
of the State toward motherhood were thereby discharged.

First, as to its inadequacy,

there are fairly trustworthy figures for the year 1914, and there has not been any mate
rial alteration since then. In that year there were approximately 4,500,000 married
women of childbearing age in E ngland and W ales; of these there were— again approximately— as m any as 1,250,000 who were not entitled to maternity benefit at all, being
neither themselves insured nor through their husbands.

I t is not possible to estimate

what proportion of this 1,250,000 of uninsured women are too well off to need assistance
at childbirth, bu t I fear that i t is too clear that some hundreds of thousands of the
most needy mothers in the land are left outside the range of maternity benefit alto
gether.

________ _______________________ ____
i National Health, vol. 9, No. 93 (June, 1917), p. 257 ft.

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119

Surely it is a delusion to regard this as a basis for the State provision for m atern ity i
why should any woman be excluded? W h y should inclusion or exclusion depend!
upon the accident, as I may. term it, of their being insured or uninsured? B u t e v e n !
for the mothers who are entitled to the benefit there are limitations which render i t '
totally inadequate.

There is no medical attendance secured, no midwifery attend-

ance no nursmg attendance, no helpful supervision, no skilled advice: the benefit is
merely 30s. in cash. On the basis of mere cash the benefit is inadequate: a confinement in an ordinary working-class household means an outlay of at least £ 5

and

where there are a number of other children and home help is required £ 7 10s is not
too much.

True, there are a comparatively small number of mothers entitled to the

double maternity benefit— for her own insurance and for her husband’s— about 400 000
?.
bU\ T n this m0st favored class has no medical or other attendance at child
birth though they are entitled to this in ordinary sickness. The m aternity benefit is
therefore, doubly inadequate because there are left out of it hundreds of thousands
of the most needy mothers and because it Is totally insufficient for the actual needs
of those who secure it.
Another defect in the maternity benefit is that it is peculiarly liable to misdirection
and misuse. A t first, when the cash was regarded as the father’s property, the abuse
of it was a scandal, and this was partially remedied b y making the cash the property
of the mother.

B u t the risk of misuse remains: it is notorious that the mistaken

unselfishness of mothers leads them to feed and care for themselves last of all: even in
the provision of meals for expectant and nursing mothers precautions have to be taken
lest the mothers should secrete and take away for the children at home the food that
is provided exclusively for themselves.

I t is so with the 30s.— the mothers too often

T n i T SP« T d i ° ni hemselves;
* not a maternity benefit; it becomes just a house
hold benefit. Besides, it is well known that in careless households the 30s is often
mortgaged sometimes two or three tim es o v e r -f o r back rent or some debt lightlv
incurred because the 30s. would pay for it. Speaking for m yself only, I would ven
ture to

that the 30s. should be left severely alone and treated as nonexistent in

the work of the public health ministry. I t is not on the lines of the insurance mater
nity benefit that we wish the new ministry to go, in taking proper care for motherhood
and infancy. Its sphere is different and its objects infinitely larger.

h Jw6re i t 8Ure! l T “ ^ cati° n ° f the correct imes to take given b y the contrast
between the methods in New Zealand and in Australia; in New Zealand no maternitv
grant is made m cash, bu t the most helpful and experienced advice and supervision
are available, and, as we know, the death rate of infancy in New Zealand is the lowest

m the world, thanks for this to L ad y Plunket, whose support we have to-day

Australia there is a m aternity grant of £ 5 over which there is no supervision. ' The
comparative death rates of the tw o Dominions speak for themselves.
W e urge that the medical work of th e national health insurance commission should
be amalgamated w ith the m edical work of the local government board, and then with
that of the midwives board, and later on with all the medical powers of the other
. ate departments, so that the new ministry of public health will do all that the State
is piepared to do, as far as motherhood is concerned.
O b ^ o u s ly to provide th e m inim um suggested will require a large extension of
medical work, both domiciliary and institutional, devoted to the care of m a t e r n it y prenatal, at birth, and postnatal.
of midwifery and nursing.

W ith this there will be required the coordination

A n d all m ust be organized and directed from the new

central unified authority and carried out in suitable administrative areas b y local
bodies as at present.

W e hope that thus the new public health ministry will see to it

that there is no distinction made between one mother and another, or between one
baby and another bu t that all mothers b y virtue of their motherhood, and all infants’
for p ity of their helplessness, shall alike have the chance of equal care b y the State so'
far as such care can be supplied b y skilled attendance and experienced supervision

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M A T E R N IT Y B E N E F IT S Y S T E M S .
S O U R C E S O F I N F O R M A T IO N .

The best source of information for the text of t
h
e
’
etc., of the insurance system is the voiim e ent t M
® te S t o t j
Regulations, and Orders Relating to Nattonal H e a ^ Iusurance,
with Notes Cross-Eeferences, and an Index. Published by Au
thority London, September, 1916.” The act of 1918 is published in
the regular statute series and is numbered “ 7 and 8 Geo. 5, chapter
62Three reports on the administration of the s j r a t e m have been
issued, the L t one covering the years 1914-1917; the titles of these
with the document numbers, are given in the bibliography. T e
reports of two recent investigating committees are particu
y
valuable in giving an insight into the actual workings o
6
e ’
I h e L " committees were (1) the department^ committee on
Sickness benefit claims and (2) the departmental w n t a
annroved society finance and admmistration. The titles of the
reports are given in the bibliography. The official Handbook or
tbe°Use of Approved Societies, English edition, 1915 is
.f ”
the use of the officers of these societies and gives the details needed
t o the administration of these societies. Cmrent mformation as
to changes, etc., in the laws will be found in the Labour Gazette of
the ministry of labor.

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ITALY.
Under the law of July 17, 1910, Italy established the first national
compulsory maternity insurance system, by which wage-earning
~

i f T 6 a bef fit ° f 40 Hre (S7*72) on the occasion of childlr i ’ j * 16 faw applies only to women whose employment for four
weeks after childbirth is prohibited by the factory legislation.
ih e development of maternity insurance in Italy has been de
scribed at some length in three papers by Henri Scodnik presented to
i nnolnte3
m at11?nf 1 C?ngress Gn Social Insurance in 1900, 1902, and
1908 and published in the proceedings of these sessions. A compre
hensive statement of the progress to the year 1910 is given in the
Twenty-fourth Annual Report of the United States Commissioner of
.Labor, volume 2, page 1851 ff.
The actual beginnings of maternity insurance in Italy were made
y a number of private organizations which provided benefits at the
TilUS tlle maternity insurance fund in Turin was
established in 1898, while in 1905 such funds were started in Milan
Rome, Florence, and Brescia, and in 1906 in Bergamo. These funds
charged dues ranging from 1.20 to 9.60 lire ($0.23 to $1.85) per year
and provided maternity benefits of about 1.50 lire ($0.29) per day for
a varymg period, usually about 30~days. The dues, of course, were
not sufficient to defray the cost of the insurance, and the gifts of
honorary members were necessary to keep the organization in
existence.
The enactment of the law of June 19, 1902, on the regulations of
the employment of women and children, renewed discussion on
the question of maternity benefits, because this act prohibited the
employment of mothers for a period of four weeks after childbirth.
The law also required factory owners to provide a special room in
the factory in which mothers might nurse their children; no deductmn of wages for absence from work on this account was permitted,
and if the factory employed more than 50 women a special room
outside the workrooms must be provided for nursing mothers
To make the mother’s rights more specific, the act was amended
m 1907 by requiring that the mother, in addition to the rest periods
prescribed for all women employees, must also have at least one
hours leave each day for nursing if the child was kept out of the
factory rooms and at least one-half hour each day if the child was
brought to the factory nursing room. The agitation for these laws
kept the question of the care of the wage-earning mother before the
12 1

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M A T E R N IT Y B E N E F IT S Y S T E M S .

Parliament, and when the Italian labor office was created in 1903,
the first investigation made by it was a technical study of the cost
of a system of maternity benefits for women wage earners.
This report, “ Basi techniche di una cassa di maternity,” was pub
lished in 1904. The study was restricted to women subject to the
law- of 1902 and covered the 12 months- ended November 30, 1903.
A brief summary of the essential data in this somewhat elaborate
survey is given in Table X X V III.
T a b l e X X V I I I . — I t a ly .

Number o f women wage earners, wages, and number o f births,
by industry groups, 1902-8.

[Source: Italy. Ufficio del Lavoro. Basi Techniche di una Cassa di Maternità, 1904.]

—

Industry group.

All industries....................
Mines, metallurgy, mechanical

Number
of es
tablish
ments.

Number
of
Number
women
of
wage
women
earners
wage
of 300
earners.
days.

Number Average
Average
daily
of births
daily
Number per 1,000 earnings
earnings
300-day
of
of
of
women women
births.
employ employ mothers.
ees.
ees.

2,654

172,365

153,695

6,893

$0.23

$0.26

244
90
1,643
677

7,029
1,595
134,770
28,971

5,834
1,085
120,778
25,998

271
42
4,683
1,897

46
39
39
73

.23
.25
.22
.30

.26
.26

The ages of the women included in the table are from 15 to 54 years,
and since all of them did not work for the full year, the number is
reduced to the basis of employees working a full year. The com
puted number of such employees was 153,695 and the number of
births was 6,893, or about 45 births to each 1,000 women. The
average daily wage of the women who had borne children during the
year was $0.26; if a benefit of half pay for 30 days was given, this
would be $3.90. For 45 births annually the total benefits would be
$175.50 for each 1,000 members. The annual (300 days’ ) earnings
of 1,000 women at $0.23 per day would be $0.23X300X1,000, or
$69,000. To provide the 45 benefits necessary would mean assessing
$175.50 against $69,000 or about 0.254 per cent; rounding off this
figure would make the proportion about three-tenths of 1 per cent.
If instead of half pay, the benefits were three-fourths pay, the assess
ment would have to be increased one-half and would be 0.45 per cent
of the wages, while full pay would require 0.6 per cent of the wages.
The small number of births per 1,000 women employees is explained
by the fact that a large proportion of the women in factories are un
married.
On the basis of this study, the minister of agriculture, industry, and
commerce introduced a bill in the Parliament in the year 1905. The
bill did not pass and a revised bill was introduced in 1907, which also
failed of enactment.' A third bill was introduced in 1909, which was

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finally enacted into the law of July 17, 1910, and came into operation
on April 6, 1912. This law was modified by the decree of February
17, 1917.
J
P E R S O N S A N D I N D U S T R I E S IN C L U D E D .

The law includes in the compulsory insurance the women subject
to the factory law of November 10, 1907. This law provides the'
usual regulations as to women employed in factories and other in
dustries, the scope of which can readily be seen from the list óf in
dustries cited in the statistics of operations on page 128. The act does
not mclude women employed in establishments of the National or
local Governments, if such employees, by other laws or regulations,
are already entitled to benefits at least equal to those of the 1910 law!
The decree of February 17, 1917, however, extended the law to in
clude women employed by private telephone companies. No dis
tinction is made between married and unmarried mothers.
Foreigners employed in Italy are entitled to the same benefits as
Italian citizens.
D IS A B IL IT Y P R O V ID E D F O R .

The benefits of the law are granted in case of childbirth or miscar
riage; intentional abortions are carefully excluded. A miscarriage
is defined by the regulations of 1911, section 41, as one which occurs
after the third month of pregnancy, while a delivery which occurs
after the sixth month is to be designated as premature birth and is to
be entered in the returns as a normal confinement.
B E N E F IT S .

The benefit provided by the law consists of a lump-sum payment of
40 lire ($7.72); one-half of this sum, 20 lire ($3.86), may be paid
withm one week after the date of childbirth, the other half within one
week after the mother has returned to work. The law and the regula
tions contam no requirement as to the length of time the mother
must refrain from work, but, as the law regulating the employment
of women prohibits their return to work earlier than four weeks after
childbirth, the second half of the benefit can not be paid until four
weeks have elapsed.
To secure the payment of the first half of the benefit within the
week following childbirth the following papers must be presented
withm two days: First, a certificate showing the mother’s full name
the names of her parents, the name of commune, and the location of
the house where she lives or the institution in which she is stayingsecond, a certificate from the civil authorities establishing the fact of
the birth and that the applicant is the mother of thè child, or a cer
tificate to this effect from a physician or a midwife in the service of
the public relief bureau, countersigned by the mayor; third, the ap-

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M A T E R N IT Y B E N E F IT S Y S T E M S .

plicant’s pass book. Similar proofs must be submitted in case of a
miscarriage.
While the regulations authorize the directors of the fund to appoint
local committees to provide instruction in hygiene, etc., to mothers,
the annual reports of the fund make no mention of activities in this
field. The benefit is paid, therefore, without any of the restrictions
such as the French law imposes.
The benefit is to be paid to the person designated by the mother;
if she dies and the child survives, it is paid to the person who takes
charge of the child; while if both die, it is paid to the persons with
whom the mother was living at the time and who cared for the mother
and child. In case of miscarriage followed by the death of the mother
the same rules are followed. If the confinement takes place in a
foreign country the above rules also apply, and insured foreigners
confined abroad are entitled to the same treatment. No benefit,
however, is paid for a miscarriage occurring in a foreign country.
The benefit can not be seized or attached in any way, nor may the
beneficiary transfer it or pledge it in any manner. All claims for
benefits must be presented within one year from the date of birth.
S O U R C E S O F IN C O M E .

The law of 1910 required the employee and the owner of the
establishment each to pay half of the following annual rates: For
each employee from 15 to 19 years of age, 1 lira ($0.193); for each
employee from 20 to 50 years of age, 2 lire ($0.386>. That is, women
employees under this plan paid each year the sum of 10 or 19 cents
according to their age. As explained later, these dues were found
to be inadequate, and in 1917 the rates were changed so that for
each woman employed the sum of 2.25 lire ($0.43) is to be paid,
thus abolishing the distinction between those under 20 and those
over 20 years of age. Of this amount, 2.25 lire ($0.43), the employee
pays 1 lira ($0,193) and the owner of the establishment pays 1.25
lire ($0.24). For the employee, the new rate is double the old rate
for those under 20, but makes no change for those 20 years or over,
while the employer must now pay 1.25 lire ($0.24) for those under 20
instead of the 0.50 lira, and 1.25 lire instead of 1 lira for those 20
years of age or over.
The contributions of the employee and the owner of the establish
ment were estimated, when the law was enacted, to be sufficient to
provide the sum of 30 lire ($5.79) for each birth; as it was deemed
advisable to make this sum larger, it was provided that the National
Government should add the sum of 10 lire ($1.93) to the 30 lire
($5.79), making the benefit 40 lire ($7.72). Under the provisions
of the decree of February 17, 1917, the Government’s portion was
increased to 12 lire ($2.32), but no change was made in the amount

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of the benefit. The fund pays the benefit of the insured person and
later collects from the State the latter’s subsidy to each benefit.
The dues to be paid by the employer, both his own share and that
of his employees, must be paid within the period specified; if not
paid they are collectible by the fund in the same manner as delinquent
taxes. Any employer who fails or neglects to make the payment
of dues is punishable by a fine of from 50 to 500 lire ($9.65 to $96.50),
and in addition he must pay to the fund 10 times the amount of the
contributions not paid, besides the full amount of the arrears.
The miscellaneous receipts of the fund consist (1) of fines paid by
the employer for violations of the maternity insurance law and (2)
of gifts, bequests, etc., to the fund. The receipts from these two
sources, as will oe seen from the data on page 131, have always been
an insignificant part of the total.
F IN A N C IA L A D M IN IS T R A T IO N .

The 1910 law provided that the employee’s share should be deducted
from her wages by the employer, who turned this amount together
with his own share over to the treasury of the fund. These deductions
were made in advance in two installments, on April 1 and October 1
of each year. The employee retained her right to membership during
the period for which dues were paid, regardless of whether she con
tinued to be employed during the whole six months. If the woman
gave up her position or was dismissed during the last two months
of pregnancy, she retained her right to benefit even if these two
months fell in the six-months’ period following that for which her
contribution was paid. If an employee begins work in the course of
a six-months’ period, the dues for that period must be paid in full.
The decree of February 17, 1917, however, provided for one annual
payment of dues, principally because the expense of administration
would be greatly^ reduced if only one payment each year had to be
entered in the accounts, though the system of half-yearly payments
also frequently caused loss of benefit to employees in seasonal in
dustries, in employments pot continuous, and in cases where illness
due to pregnancy caused absence of several months. The date on
which the annual payment is to be made will be specified in regula
tions to be issued later.
The 1910 law provided for a different rate of contribution for the
two age groups, this distinction being based on the actuarial data of
the investigation made by the labor office in 1903. In actual prac
tice it w~as found that this plan of two rates caused no end of petty
mistakes, disputes, etc., which required correction in the bookkeeping.
According to the statement in the parliamentary report of 1917 the
effort to recognize the different rate of expense of the two age groups
was on the whole nut of harmony with the fundamental idea of

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126

M A T E R N IT Y B E N E F IT S Y S T E M S .

social insurance, which is to provide benefits to a whole group of
the population, and for this group to make the rates of dues and of
benefits as uniform as possible. The report states that the existing
system of maternity insurance departed from this idea by taking
into account the variation of cost due to age, while the system fol
lowed it by ignoring the variation due to marriage. It was recom
mended, therefore, especially since the dues were of small amount
in any case, that they be made uniform for all ages, and this recom
mendation was adopted by applying the higher rate to all msured
persons.
,
r
Under the plan of having the State provide a subsidy of 10 lire
out of the 40-lire benefit, the share of the State amounted to 25 per
cent of the benefit; under the new plan the State will provide 30
per cent of the benefit.
.
,
The cost of administration is defrayed from the contributions of
the employers and insured persons.
GENERAL ADMINISTRATION.

The maternity insurance fund is a self-governing section of the
national invalidity and old age fund, which is subject to the juris
diction of the ministry of agriculture, industry, and commerce. The
management of the maternity fund is intrusted to a board of nine
members consisting of the president of the invalidity and old age
fund; two members appointed by the council of the latter fund from
their own number; three representatives of employers and three
representatives of insured persons appointed by the minister of agri
culture, industry, and commerce. These representatives are se
lected from six names proposed by employers of women and six
names proposed by the insured'persons, submitted by these groups
to the minister, and all of whom must be members of the local indus
trial boards called councils of prud’hommes. Any vacancy occur:ring among the employer and workmen members must be filled by
selecting a successor from the names submitted at the time the. origi
nal appointee was selected. The representatives nominated by the
insured persons may be women, and during the first three years of
operation of the fund these representatives consisted of one man and
two women. Two vice presidents must be selected, one an em
ployer and one a representative of the insured persons. The repre
sentative members are paid for expenses and loss of wages for attend
ance at board meetings. They hold office for three-year terms.
The general duties of the board are: To supervise the administra
tion of the fund; to make regulations for the fund; to decide on
questions arising under the law and the regulations; to provide for
the accumulation of a reserve; to pass on the budget for the coming
year; to prepare a financial statement; to arrange for local maternity

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127

IT A L Y .

funds, offices, or committees and, when advisable, to intrust these
local committees with the duty of seeing that the mother obtains
rest and that instruction in hygiene is given; to direct the office force.
Each year the board must present a report to the minister of agri
culture, industry, and commerce, and to the minister of finances,
with full information as to financial, actuarial, and other operations.
The director of the old age and invalidity fund also acts as director
of the maternity fund.
The mail of the maternity insurance fund is entitled to the frank-,
privilege. All documents, certificates, etc., are exempt from
stamp taxes, registration fees, etc.
The owner of each establishment must keep on file a list of the
women employees subject to the compulsory maternity insurance.
These are, it will be recalled, the persons subject to the law regu
lating the employment of women and children, and this list must
be in the form prescribed by the Government; it must show the date
of admission to the service, of leaving, etc. Each woman subject
to the law must be provided with a pass book, in which is entered
her name, the date and place of birth, the establishments in which
she has been employed, the date and amount of contributions she
has paid to the maternity insurance fund, etc.
O P E R A T IO N S .

The operations of the maternity fund are reported in rather brief
form in the annual reports made by its officers. The facts contained
in these reports are supplemented by the special report presented to
Parliament in connection with the amendment of 1917.
The number of women insured is indicated by the number of con
tributions paid; according to the following table the smallest num
ber of persons insured was 436,801 in 1912, and the largest number
was 505,741 in 1915.
Table X X I X shows the variation there has been in membership.
T able X X I X .

I t a ly .

Number o f insured persons, as indicated by the number o f
contributions, 1912-1916.
J

[Source: Italy. Atti Parliamentary Camera dei Deputati, Legislatura X X IV , Sessione 1914-1917, Document No. 757, p 3.J
9
Number of contribu
tors of—

Half-year period.

Total.
$0.10

First half year, 1912..................
Second half year, 1912......
First half year, 1913................
Second haif year, 1913..................
First half year, 1914...........
Second half year, 1914......
First half year, 1915...............
Second half year. 1915........
First half year, 1916................

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....................
................................
....................
...................
.................
.........................
...............

436,801
465,978
487,177
480,713
491,629
463,866
505,741
447,702
447,570

* 173,989
198,842
188,128
201,289
188,677
190,629
190.743
177.744
176,046

$0.19
262,812
267,136
299,049
279,424
302,952
273,237
314,998
269,958
301,524

128

M A T E R N IT Y B E N E F IT S Y S T E M S .

The fluctuation in the number of insured persons since 1914 reflects
general industrial conditions; the outbreak of the war first caused a
reduction of industrial activity, then the calling of large numbers of
men to the colors in 1915 led to the employment of women in their
positions, while the smaller number of persons since 1915 is probably
due to the lessened industrial activity under war .conditions.
The industries in which the insured persons are employed are
shown in Table X X X , which gives the number of establishments
making payments of contributions.
T a b l e X X X — I t a ly .

Number o f establishments making payments o f contributions,
by industry groups, 1913-1915. -

[Source: Italy. Cassa Nazionale di Maternità. Rendiconto dell’ esercizio, 1913-1915.]
Number of establishments contributing.
Industry.

All industries.
1.
2.
3.
4.
5.

Agriculture................................ ...........................................
Mining and metallurgical industries.....................*..............
Metal working, machine building, etc...................................
Woodworking, straw working, etc........................................
Chemical industries............................... - ...............................

6. Paper and printing.................................................... - ................

7. Textiles:
(a) Silk..............................................................................
(b) Cotton........................................ - ................................
(c) Wool..............................................................................
(d) Flax, jute, hemp, asbestos..........................................
(e) Elastic fabrics of hair, elastic wire covering, etc.........
m Lace, embroidery, etc...................................................
(g) Not reported.................................................................
8. Animal products, clothing, etc.:
(a) Tailoring, dressmaking, etc.........................................
(b) Corsets and white goods.............................................
(c) Cleaning, laundering, pressing....... ...........................
(d) Furs, footwear, coral, felt hats, umbrellas, fans, etc.
(e) Not reported................................... .............................
9. Food products................................................... - ........... ■
10. Miscellaneous............................ ...........................................
11. Seasonal industries.................................................................

Apr. 1 to
Sept. 30,
1913.

Oct. 1, Apr. 1 to
1913, to
30,
Mar. 31, Sept.
1914.
1914.

Oct. 1,
1914, to
Mar. 31,
1915.

11,229

9,680

11,406

9,341

292
772
63ft
494
410
1,238

144
524
559
436
375
1,091

267
818
711
432
432
1,219

126
454
559
373
364
1,070

1,509
508
323
149
23
280
575

1,365
490
312
145
22
246
536

1,472
544
293
152
12
329
574

1,208
509
298
134
12
273
547

967
250
283
1,089
99
807
415
116

815
225
226
1,006
92
647
345
79

954
258
347
1,068
118
776
508
122

783
200
277
931
102
627
420
74

In general, it may be said that the number of establishments is an
indication of the industries in which the insured persons are engaged;
on this assumption the industries employing the largest number of
insured persons are the textile, the animal productions and clothing,
and the paper and printing trades. The arrangement of the statis
tical tables in the original reports is such that the total number of
persons in each industry class can not readily be stated.
The geographical distribution of the insured persons is shown in
Table X X X I .

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129

IT A L Y .

T able X X X I . — Ita ly .

Num ber o f insured persons as indicated by number o f contri
butions m northern, central, and southern Italy , 1912-1915.

[Source: Italy, Cassa Nazionale di Maternità. Rendiconto dell’ esercizio, 1913-1915.]
Number of contributions.
District.

1912-13
($0.10)

Total.................................
Northern Italv.....................
Central Italy....... •.........
Southern and insular Italy ...

($0.19)

1913-14
($0.10)

Amount
for 3
years.

1914-15

($0.19)

($0.10)

($0.19)

348,200 ' 503,267

379,925

571,722

377,847

574,751

$425,126

293,526
40,001
14,673

313,592
45,495
18,838

468,635
79,268
23,819

314,910
43,357
19,580

470,615
78,503
25,633

351,227
55,776
18,123

418,564
66,800
17,903

Out of the total amount of contributions paid in during the three
years 1912 to 1915, the sum of $351,227, or 83 per cent of the total,
was paid in Northern Italy where, of course, the greater part of the
industrial establishments of the country are located.
The regulations of 1911 provide that the financial year of the fund
shall be from January 1 to December 31; for this reason the data as
to receipts, expenditures, etc., are given for calendar years.
The number of benefits paid since the law came into force is shown
in Table X X X II.
T able X X X I I . — Ita ly .

Num ber o f maternity benefits paid , 1912-1916.

[Source: Italy. Atti Parliamentari, Camera dei Deputati, Legislatura X X IV , Sessione 1914-1917 Docu.
ment No. 757, p. 3.]

Year.

Total
number of
maternity
benefits.

Number of benefits
paid to mothers
of specified age.
15-19
years.

19 12................

4,961
27,468

1916 (first half year)..................

10,733

132
673
778
(«)

20-50
years.
4,829
26,795
28,974
27,278
(*)

OAge distribution for first half year 1916 not available.

During 1912 benefits were payable for the last three months of
the year only, which accounts for the small number of benefits
paid. The largest number of benefits was paid in 1914, which is
generally assumed to be a year of normal operation of the fund;
the births, etc., of this year were 29,752, which when compared with
the membership given on page 127 above, gives an average of about
6,200 births, etc., per 100,000 insured persons.
Table X X X I I I gives the civil status of the mothers to whom
benefits were paid in the two years 1913 and 1914.
113300°—19---- 9

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130

M A T E R N IT Y B E N E F IT S Y S T E M S .

,»*. <*» m

JL S setiJsseeJS ^ ^ ^ .p- -

1914

1913
Qivil status of mother.
Total.

Civil status not known.............................. .

B0“ ,m° 461

Miscar
riages.

Births.»

Miscar
riages.

Births.®

Total.

27,468

26,462

1,006

29,752

28,674

1,078

25,820
121
1,527

24,919
121
1,422

901

28,139

27,098

1,041

ÌÓ5

1,613

1,576

i Includes stillbirths.

The mothers not married or mothers whose civil status was not
known formed in 1913 about 6 per cent and in 1914 about 5.4 per
cent of the total number receiving benefits.
The ages of the mothers and the number of births aM miscar
riages for each age in the year 1913 are shown in Table X X X IV .
T a b l e X X X I V .__Italy.

Births and miscarriages to mothers receiving maternity benefits,
according to age o j .mother, 1913.

[Source: Italy. Cassa Nazionale di Maternità. Rendiconto dell’ esercizio, 1913, pp. 20, 21.]
Miscarriages.
Births.®

Aga of mother.

26,462
15..
16.. ..................

...........................

Fourth
month.

1,006

473

2
9
34
43
71
71
76
79
76
58
54
60
46
43
40
28
28
39
29
19
20
11
22
14
14
10
4

Fifth
month.
359

Sixth
month.
174

.......... ..........

4 ....... 4----67
167
404
853
1,555
2,323
2,549
2,696
2,455
2,159
1,876
1,550
1,274
1,115
952
845
668
596
504
445
436
276
184
161
136
82
60
36
12
5
1
1
1

• Includes stillbirths.

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Total.

............2*

Zi)

..............

......... .........

3
1
7
7
14
. 16
14
15
12
14
5
15
8
6
5
4
6
4
2
2
5
3
1
2
i

131

IT A L Y .

The regulations of the fund do not permit benefits to be paid for
miscarriages occurring during the first three months of pregnancy,
so that these cases do not appear in the returns; in addition, mis
carriages occurring after the sixth month are required to be reported
as births. In the year 1913 the total number of benefits granted
for births and miscarriages together was 27,468; of this number
26,462 cases were under the above rules reported as births and 1,006
as miscarriages; that is, 3.7 per cent of the cases receiving benefit
in this year were classed as miscarriages.
The receipts, expenditures, and balances of the fund, 1912 to 1915
are given in Tables X X X V , X X X V I, and X X X V II.
T able X X X V .

Ita ly .

Receipts o f the national maternity fu n d , 1912-1915.

[Source: Italy. Atti Parliamentary CM^

D ^ u ^ ^ L e g is la ta ra X X IV , Session of Mar. 8, 1917.

Receipts from—
Total
receipts.

Year.

1912........................

Contribu
tions of
employers
and •wageearning
women.
' $98,534
146,411
148,724

----------------------------------_J
T able X X X V I .— I t a ly .

Miscella
neous
sources.

Subsidy of
State.

$784
1,793
2, 434
2,514

$9,575
53,013
57,421
53,843

Expenditures o f the national maternity fu n d , 1912-1915.

[Source: Italy. Atti Parliamentary Camera dei Deputati, Legislatura X X IV , Session of Mar 8 1917
Document No. 757, p. 3.]
’
*

Expenditures for—
Total
expendi
tures.

Year.

1912..................................

T able X X X V I I .

Ita ly .

Adminis
tration.
$6,665
11,142
12,646
13, Q2ß

Benefits.

$38,299
212,053
229,685
215,372

Balance o f receipts and expenditures o f the national maternity
fu n d , 1912-1915.

[Source: Italy. Atti Parliamentary Camera dei Deputati, Legislature X X IV , Session of Mar 8 1917

Document No. 757, p. 3.]

Year.
1912...................... ..............
1913...................................
1914......................................
1915........................................

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Federal Reserve Bank of St. Louis

................................
........................:■ "*
................................

Receipts.

Expendi
tures.

$108,893
201,217
208,579
211,806

$44,964
223,195
242,331
229,297

Surplus.

Deficit.

$63,929
$21,978
33,752
17,491

132

M A T E R N IT Y B E N E F IT S Y S T E M S .

The receipts are principally the contributions of the employers and
insured persons 5 thus, in the year 1913, the receipts from dues were
approximately 73 per cent, from the State subsidy 26 per cent, and
from miscellaneous sources (fines of employers, gifts, etc.) less than
1 per cent.
The expenditures during the three years given in the table add up.
to $510,490; the cost of administration for the period was $30,453, or
approximately 6 per cent of the total expenditure.
The balance sheet of the fund shows that the original estimates on
which the dues were calculated were inaccurate. The law of July 17,
1910 (art. 14), provided that the system should come into operation
three months after the publication of the regulations; the latter bore
the date November 26, 1911, and were published in the Gazzetta
Ufficiale of January 5, 1912, so that the act really oame into opera
tion on April 6 , 1912. Contributions were collected immediately,
but as no person is eligible for benefits until she has been insured
for six months, benefits were not payable until October 1. For this
reason the year 1912 showed a considerable surplus, amounting to
$63,929. The three years 1913 to 1915 showed a defi i each year,
and at the end of the year 1915 the sum of the deficits was $73,221,
which had exhausted the surplus of 1912. The 1914 report of the
directors of the fund called attention to the financial needs of the
system and recommended an increase in the contributions and in the
State subsidy, with the amount of the benefit to remain unchanged.
Under the plan adopted in the decree of February 17, 1917, the
State subsidy is increased from 10 lire to 12 lire, leaving 28 lire out
of the benefit of 40 lire to be provided by the contributions. The
computation of the Government estimates that there will be 6,215
births per 100,000 members; to provide 28 lire for each of these
births would call for 174,020 lire. The cost of administration, taken
roughly at 10 per cent of this amount, would require approximately
18,000 lire. Changing the system of contributions from semiannual
to annual payments would admit an additional number of women
to benefits, the cost of which is estimated at 18,000 lire. These
amounts would add up as follows:
Lire.

6 ,2 1 5 ben efits of 28 l i r e .................. . ............- ............................ ..— * ........................................
A d m in istr a tio n .......................................................................................... - ...........................................

1 ^ 4 ,0 2 0
^

A d d itio n a l b e n e fits.....................................................* ................ .......................................................
T otal.

210,020

With the new rate of contributions at 2.25 lire per insured persons
the receipts from this source would be, for 100,000 members, 225,000
lire; as the estimate of cost just given was 210,000 lire, there would
be a margin of 15,000 lire in excess of the expenditures.

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IT A L Y .

133

SOURCES OF INFORMATION.

All laws, decrees, regulations, and tlie like of tlie Italian Govern
ment are published in the Gazzetta Ufficiale; thus the law of July 17,
1910, appeared in number 181 of the year 1910, the decree of Novem
ber 26, 1911, appeared in the issue of January 5 , 1912, and the decree
of February 17, 1917, in the issue of March 7 , 1917. The Bollettino
della Cassa Nazionale di Previdenza also reprints the laws and de
crees relating to the maternity fund and gives advance summaries
of the annual reports and other-data relating to operations. The
title of the annual reports of the fund is, “ Cassa hiazionale di Matermtà, Kendiconto dell’ Esercizio 1912,” and following years. The
bulletin of the labor office (Bollettino delF Ufficio del Lavoro) gives
statements as to laws, decrees, operations, eto. The English edition
of the bulletin of the international labor office gives translations of
laws and decrees and is perhaps the most accessible to American
readers of any of these sources. The Monthly Review of the United
States Bureau of Labor Statistics frequently gives digests of reports,
summaries of. legislation, etc., relating to the fund.
RULES FOR THE ENFORCEMENT JDF^THE JLAW FOR THE MATERNITY
T itle 1*

Constitution

and

A dministration

of the

F und.

A rticle 1. T h e fu n d created b y th e la w of th e 1 7th of J u ly , 1910, N o . 520

autonom ous sectio n of th e N a tio n a l P ro v id e n t F u n d for I n v a lid it y a n d O ld A g e of
W o rk m e n has th e tit le of N a tio n al M a te rn ity F u n d , w it h headquarters in R o m e
. ; * 18 forb ld d en for a n y oth er in s titu tio n to assum e th e n am e of N a tio n a l F und *
infringers w ill b e p u n ish e d as p ro vid ed in artic le 30, c o m p le te t e x t , M a y 3 0

1907*

N o . 376, on t h e N a tio n a l P ro v id e n t F u n d for I n v a lid it y an d O ld A g e o f W o rk m e n

A rt. 2

T h e N a tio n a l M a te rn ity F u n d is ad m in iste re d b y th e co u n cil of a d m in is

tration of th e N a tio n a l P ro v id e n t F u n d for In v a lid it y an d O ld A g e of W o rk m e n b v
m ean s of a sp ecial a d m in istra tiv e co m m itte e .
«
*

A rt. 3. T h e a d m in istra tiv e c o m m itte e is com posed of n in e m em b ers, as follow sO f th e p re sid e n t of t h e N a tio n a l P ro v id e n t F u n d ;

Of two members chosen from the board of administrative council of the National
Provident Fund;
O f six m e m b e rs chosen b y th e m in ister of in d u stry , co m m erce, an d labor, three
from represen tatives of th e e m p loyers an d th ree from representatives of th e w om en
op eratives.
W o m e n also shall b e a d m itte d as m e m b e rs of th e ad m in istra tiv e co m m itte e.
r t

4. T h e p erm an e n t co m m itte e of labor shall co m p ile a lis t of ind ustries or of

groups of related in d u stries w h ich e m p lo y w om e n h an d w orkers, and from th ese shall
Belect those w ho represent th e em p lo yers and w ho represent t h e w om en op eratives
in th e a d m in istra tiv e c o in m itte e of th e N a tio n a l M a te rn ity F u n d .

T h e list m a y b e

m o d ifie d b y th e ab o v e -n a m e d p erm an e n t co m m itte e of labor, p ro vid ed th a t th e
necessary p roportion is re ta in e d .

A rt. 5. The three representatives of the employers and the three representatives
of the women operatives on the administrative committee of the National Maternity

* reb- " • 1“ 1’ M°-

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Federal Reserve Bank of St. Louis

0a“ tto

134

MATERNITY BENEFIT SYSTEMS.

Fund shall be chosen b y the minister of industry, commerce, and labor, from the
industries or. groups of industries indicated on the list mentioned in the preceding
article and, respectively, from those designated from the industries, members of the
college of probiviri of the industry which employs women operatives and shall be
selected b y the working members of the college itself.
Those elected m ust be members of th e college.
The rules for such designation shall be determined b y ministerial decree.

A rt . 6. The members shall serve three years and are eligible for reelection.
In case of a vacancy among the members, nomination thereto is reserved either to
the choice of the administrative council of the National Provident Fund for Invalid
ity and Old Age of Workmen or to the substitution authorized to the council above
named.
In case of vacancy among the councilors representing the employers and the coun
cilors representing the women operatives, the minister of industry, commerce, and
labor shall select from the unelected candidates of the industry or groups of industries,
respectively. In default of candidatea unelected, a new designation shall be made.
Members of the council, nominated in substitution of others who have retired from
office before the usual three-year term, shall remain in office for the rest of the term of
the members for whom they are substituted.
A rt . 7. The administrative committee is presided over b y the president of the
National Provident Fund for In validity and Old A ge of W orkmen and shall elect two
vice presidents, of whom one shall be selected from the representatives of the women
operatives and the other from the representatives of the employers.
A rt . 8. The administrative committee shall carry on the business of the fund and
shall deliberate:
First, on the formation of the internal regulations.
Second, on thè gradual establishing of a reserve fund, using for this the annual sur
plus until it shall have amounted to a sum corresponding at least to half the average
sum paid out annually in subsidies for the preceding three years.
Third, on the working balance and on the annual statement.
Fourth, on the choice of the local m aternity funds, and, in general, of those commit
tees, institutions, or persons to whom it is believed advisable to place the supervision
of the resting of the mother and of hygienic assistance to her and of other functions
which the National M aternity Fund m ay undertake to develop in each locality,
excepting those respecting the receipt of contributions and the payment of subsidies
and on the tasks to be” entrusted to these funds, committees, institutions, or persons.
Fifth, on the eventual disposition regarding contributions or subsidies.
Sixth, on the service of the fund.
The committee shall express opinions on questions which m ay arise regarding the
application of the rules and of the present regulations, and subm it them to the m in
istry of industry, commerce, and laber.
A rt . 9. The National Maternity Fund shall present each year to the minister of
industry, commerce, and labor both a statement of the treasury and a statement of
the operations of the fund.

In this statement w ill be inserted the statistics of the

subsidies paid b y the fund, distinguishing them , first, according to births or m is
carriages and, second, the age of the mother.
A rt . 10. The president of the administrative committee is the legal representative
of the fund; in writing, he m ay assign the representation to the director general.
In case of the absence or disability of the president, the office of representing the
fund shall be assumed b y one of the two vice presidents or one of the members of the
council designated therefor b y the administrative committee.
A rt . 11. T h e services of members of the administrative
gratuitous.

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IT A L Y .

135

Members not resident in R om e shall be reimbursed their traveling expenses, and
shall be given a compensation of 20 lire ($3.86) for each day they remain in Rom e
during the sessions of the administrative committee including those days taken up
in going and coming.
T h ey shall be considered as residents of R om e if, during the sessions of the com
mittee, they are, b y reason of other p u blic offices, already in Rom e.
Those workmen members resident in Rom e w ill be granted a compensation of 10
lire ($1.93) for each day on which th ey are present at the sessions of the committee.

A rt . 12. Members of the administrative committee, who have not given notice
to the president of a good reason therefor, who are absent for two consecutive meetings,
shall cease to hold office.
Of this separation from office which shall be announced to the committee and
attested with appropriate statements in the minutes, the president shall give im m edi
ate notice to the ministry of industry, commerce, and labor.

A rt . 13. The director general of the National Maternity Fund, or whoever takes
his place, shall attend the meetings of the administrative committee and shall par
ticipate b u t have no vote.

A rt . 14. The balance sheets, the reports and the proceedings of the meetings of
the administrative committee of the National M aternity Fund m ust be communi
cated to the administrative council of the National Provident Fund for Invalid ity
and Old Age of Workmen.

A rt . 15. The financial year of the National Maternity Fund shall commence with
the first of January and end w ith the. thirty-first of December.
A rt . 16. The internal regulations of the National Maternity F und, when approved
b y ministerial decree, shall, among other things, determine:
The requirements for validity of the meetings and of the deliberations of the ad
ministrative committee;
The rules and the tim e limits for the compilation of the annual reports;
The constitution of a committee to revise the accounts with the indication of their
powers;
The form of compilation of the reports and of the annual accounts, and also the
date f<5r the presentation to the minister of industry, commerce, and labor of the
reports and of the accounts above nam ed;
The form for the compilation of the minutes of the meetings of the administrative
committee.

A rt. 17. The director general of the National M aternity Fund shall be the director
general of the National Provident Fund for In validity and Old Age of Workmen
A rt . 18. The employees of the National Maternity Fund shall form a roll identical
with that of the National Provident Fund for In valid ity and Old Age of W orkmen and
shall depend exclusively upon the latter.

A rt. 19. The investment of funds of the National M aternity Fund shall be decided
upon b y the administrative council of the National Provident Fund for Workmen.
The administrative committee of the National Maternity Fund shall provide for
the- enforcement of these deliberations according to the rules established for the in
vestment of the funds of the National Provident Fund.

A rt . 20. The service of the collection of contributions and of the paym ent of sub
sidies shall be made through the secondary offices of the National Provident Fund
through post offices and the postal savings fund.
The operations, in the interest of the aforesaid service, entrusted to the post office
and to the postal savings fund shall be performed without expense to the National
Maternity Fund, to the employers or to the women operatives.
The collection of the contributions can, b y special provision, be entrusted to the
communal collectors of taxes.

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136

The correspondence of the National Maternity Fund, of the districts of inspection of
industry and labor, of the other public offices and of the maternity food and of the
local committees between themselves and with the employers and with the women
operatives, regarding the application of the laws and the regulations, shall be exem pt
from postal charges.

T itle I I .— R egister

and

B ooks

of the

W omen Operatives .

A rt 21 In the register prescribed b y article 33 of the regulation of August 6,1916»
No. 1136, for the execution of the law on the labor of women and children as well as
children of both sexes and women under age, the adult women must also be inscribed.
Registry of all women without distinction m ust be made in the chronological order
of their admission to service.
. . j
.
.
The register must conform to the model form compiled b y the minister of industry,
commerce, and labor, and must contain, besides the information prescribed b y article
33 of the aforesaid regulation, the number of order of inscription, the date of admis
sion into service, the date of dismissal or of ending of service in the factory or estab
lishment, and the other particulars which m ay be required in the above-named mode
f° T h e employers subject to the law (complete text) on accidents to workmen while at
work m ay free themselves of the keeping of this register when the book of registration
provided b y article 25 of the regulations of March 1 3 ,1 9 0 4 , N o. 141, for the execution
of that law, if it is kept regularly according to the provisions of the regulation, but
with the two sexes distinguished in such a manner that m one book are inscribed
only all the male workers (boys and adults) and in another all the female workers
(girls young persons, and adults).

I n this manner the book of registry of women

operatives will be carried on continuously, notwithstanding any change of insurance
institution.

The attest prescribed b y article 26 of the before-mentioned regulation

concerning work accidents shall on demand be placed on the book of registry open to
inspection as above, b y the other institution.
. . . .
, ,
Both the registers and, where it is desired, the books of matriculation must be pre
served b y the employers for five years after the last registration, and, throughout that
period, must be deposited with the National Maternity F und.
.
A rt 22 The register described in the preceding article shall be provided at the
expense of the employers b y the National Maternity Fund and b y the secondary offic^
of the National Provident Fund and should be composed of numbered sheets certi
fied b y the above fund.

I t must be arranged without any space in the margin and

must be written with ink or with other indelible material.

N o erasures m ay be made

and where any cancellation is necessary it should be effected in such a way that the
erased word remains legible.

The inscription in the register, with the indication of

the date of admission into service, must be made when the woman operative com
mences work.
. . . . ..
The date of dismissal must be entered on the register on the same day on which the
woman operative ceases to belong to the establishment; in every case, even m t e
case of temporary absence of the woman through sickness, suspension, or reduction
of work or other cause, the cessation of service must be entered on the registex at a
date not later than the fifteenth day from that of actual work of the woman operative
at the establishment, notwithstanding any contrary provision of the internal rules
or of local custom.
.
,
,
.
, . .
The undertakers or employers who neglect to keep the register or book of matricu
lation according to the preceding article, or who have neglected to inscribe i n t e r n
each woman operative and the date of admission and end of service of every one of
them, together with the required information and within the dates :fixed h e re in
in the preceding article, shall be punishable b y a fine extending from 3 lire ($0,579)
for each woman operative and for each day of failure to inscribe or to insert the afore-

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IT A L Y .

137

eaid information, up to the m axim um of 1,000 lire ($193), independently of the fine
imposed b y the regulation for the execution of the law on the labor of women and
children and of the law on accidents.
The infraction of the provision of the last paragraph of the preceding article, relative
to the obligation of preserving and depositing the registers and books of matriculation,
is punishable b y a fine of 200 to 1,000 lire ($38.60 to $193), independently of the larger
penalties established b y other laws and regulations.
A r t . 23. A ll women 15 to 50 years of age occupied in establishments subject to
the laws on the labor of women and children must be provided with a book conforming
to the model approved b y royal decree, as proposed b y the minister of industry, com
merce, and labor.

For women between the ages of 15 and 21 years such books must

correspond to those required b y the law on the labor of women and children and the
regulations relating thereto and must also be valid under the law and regulations.
In the book there must be stated b y the commune of the residence of the woman
operative, the name and surname of the woman for whom it is made out; the name
of the father and the name and surname of the mother; the place and date of birth;
the commune of residence. In addition to the data prescribed b y the law and the
regulation on the labor of women and children, in the book of women from 15 to 21
years there must be stated the name, surname, and domicile of the person who exercises
the parental authority over the woman for whom the book is taken out; and, further
more, in the books of all women 15 to 50 years there must be set down the date of the
making out of the book itself.

On the part of each employer b y whom the woman

has been successively employed there must be entered in the book: The date of
admission and of the end of service with the establishment and the number of the
inscription in the register or in the book of matriculation as required b y article 21.
The date of admission and that of the end of service must be noted in the book in
conformity with the provision of article 22 for such registration in the book of the
woman operative or in the book of matriculation prescribed b y article 21.
A r t . 24. The books mentioned in the preceding article shall be furnished to the
communes at the expense of the National Maternity Fund, and they shall be given
out without cost to every woman operative within eight days after she makes request
therefor b y the syndic of the commune where she has her usual place of residence.
The syndics must see that each book is filled out b y the communal officials according
to the provisions contained in the preceding article, and that it is given to the applicant
only when all the signatures of the civil officials and the seal have been affixed.
In the register prescribed b y article 8 of the regulation for the execution of the
law on the labor of women and children, there must be noted the books given out in
conformity with the present regulation for all women operatives between the ages 15
and 50 years.
A rt . 25. A duplicate of the book m ay be given out in the commune where it was
originally taken out only in case of loss or of deterioration from prolonged use. On
giving out a duplicate the instructions contained in articles 23 and 24 must be observed;
it must be stated in the new book that it is a duplicate.
A r t . 26. The syndics and the communal officials m ay be punished b y a fine of 5
to 50 lire for every book which has not been given out in due form and containing the
facts and the dates required b y the three preceding articles, and b y a fine of from 50
to 200 lire ($9.65 to $38.60) for the failure or irregular keeping of the register mentioned
in article 24.
A r t . 27. The books shall remain deposited with the undertaker of the establish
m ent in which the women are employed, and will be arranged in the progressive
order of their respective numbers of inscription on the register or on the matriculation
record.

I t is permissible, however, to hold in place of the book the declaration of

withdrawal when this is given out b y the signature of the authority intrusted with
the carrying out of the regulations of it.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

138

In case the holder of the book ceases to belong to the establishment, the employer
or undertaker must return the book, and he shall not for any reason whatever be
permitted to retain it.

I f the woman operative, after the m aximum period of a month

of absence, without justifiable reasons, does not return to the establishment, the
management will forward the book to the commune of residence of the woman opera
tive. The establishment will be punished b y a fine of 5 to 100 lire ($0,965 to $19.30)
for every book which m ay be overlooked or delayed in being forwarded according to
the rules of the present article.
A rt. 28. The women operatives shall have the right of inspecting their books each
year.

The undertakers, managers, or directors who, within five days of the request

of the woman operative, neglect to agree thereto without good reason shall be pun
ished b y a fine* of 10 lire ($1.93) for every book in respect of which they refuse inspec
tion b y the holder.
A rt . 29. In addition to the penalty imposed b y the law, complete text, on the labor
of women and children for infringement of the above-mentioned law, the under
takers, managers, and directors are subject to—
(1) A fine of 10 to 50 lire ($1.93 to $9.65) for every woman of 15 to 50 years admitted
to or kept at work who is deprived of her book according to article 23, save in the
exception stated in the first part of article 27.
(2) A fine of 5 to 50 lire ($1.93 to $9.65) for each woman admitted to or kept at
work with a book in which the date of beginning or ceasing work is lacking or if the
dates stated in article 23 are not registered.
(3) A fine up to 25 lire ($4,825) for each woman admitted to or kept at work with a
book not conforming to the other requirements of article 23, or lacking in the regis
trations of entering or leaving the establishment in which the woman operative has
been previously employed.
A r t . 30. The undertakers, managers, and directors who b y omitting to enter in the
book the data prescribed b y the present regulation or b y making untruthful entries
shall give occasion to the payment of subsidies which it transpires are not due, shall
be responsible for reimbursing the National Maternity Fund the amount of the sub
sidies improperly paid, without prejudice to the fines set forth in the preceding arti
cles and to the penalties imposed b y the penal code.
A rt . 31. The r a s t e r or the book of matriculation mentioned in article 21 and the
books of the women operatives must be kept in the place in which the work is carried
on and must be presented without delay on every request to the Government in
spectors and to the officials of the National Maternity Fund.
Failure to com ply with such requests is punishable with a fine of 50 to 500 lire
($9.65 to $96.50).

T itle I I I .— Conditions

and

M ethods

Payment

Contributions .

A r t . 32. The contribution of 2.25 lire ($0,434) of which 1.25 lire ($0.24) is on the
account of the employer or undertaker and 1 lira ($0,193) on the account of the woman
operative, is compulsory for all women operatives between 15 and 50 years employed
in establishments subject to the laws on the labor of women and children and for all
female persons of 15 to 50 years of age in the telephone service of private establish
ments.
A r t . 33. The contribution shall be paid as a rule during the month of March of
each year for all the women operatives mentioned in the preceding article who are
employed in that month.

In case an operative is dismissed in the period between

January 1 and the day of payment of the contribution, the employer or undertaker
will arrange for the payment of the contribution in respect of the dismissed employee
before the return of her book of employment.

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139

IT A L Y .

For women operatives who begin work after the annual payment of contributions
is made and for whom there has not yet been made the contribution and who reach
their fifteenth year of age in the course of the year, the obligation for the payment of
the contribution begins at the tim e of the new employment or the day on which the
fifteenth year of age is completed and the paym ent of the contribution must be made
not later than the seventh day.

A rt . 34. The paym ent of the contribution must be made through the post offices
or the secondary offices of the National Provident Fund or the other offices which
can be charged with the collections of the National M aternity Fund.
The office which receives the payment shall provide, on application, stamps to bê
affixed to the book of employment of the woman operative; the stamps affixed to the
books shall be canceled with a dating stamp b y the office receiving the payment.
The stamps shall be furnished b y and at the expense of the National Maternity
Fund at the post offices and at the other offices charged with the receipt of contribu
tions.
The employer or the undertaker on the occasion of any paym ent shall present to
the office above named in which the paym ent is made a declaration in duplicate
conforming to the model established b y the National Maternity Fund in whick
declaration must be indicated the name, the seat and the object of the firm, the num
ber of the women operatives for whom the paym ent is made, and the amount of the
contributions paid in.

The office which receives the payment affixes a seal with a

date and the visé on the declarations indicated, one of which must be sent at once to
the ministry of post offices, directory general of savings and money orders (savings
service), together with the m oney order, forwarding the receipt belonging thereto to
the employer or undertaker together with the second copy of the declaration mentioned.
The ministry of post offices, as it receives the m oney order and the accompanying
lists of payment, transmits one statement confirming it to the employer or undertaker
who must keep the same after having ascertained that it corresponds exactly to the
amount of the payment made.

The same ministry, after making an appropriate

record, sends back the money order and the papers which belong with it to the National
Maternity Fund.
Complaints of confirmatory receipts being irregular and that they are not received
b y the employer or undertaker within 30 days from the date of the paym ent made,
have the effect of extending the tax, and they must be repeated every 15 days untii
a reply has been obtained.

T itle IY .— Conditions

and

M ethods

Payin g Subsidies .

A rt . 35. W om en from 15 to 50 years have a right to a subsidy of 40 lire ($7.72) in
case of birth or miscarriage, according to the provisions of the following articles, on
condition that at the date of birth or miscarriage;
First. A t least six months must have elapsed in the case of a birth and at least
three months in the case of a miscarriage from the date of their admission to the
establishment subject to the laws on the labor of women and children.
Second. The entire number of days on which they are employed in this establish
ment as computed from the notations of the dates of the entrance and of discharge in
¡each respective book must not be less than 45 in the period of the 360 days preceding
that of the birth or miscarriage.
There is no right to the aforesaid subsidy if the date of the last discharge from the
establishment referred to is more than nine months.

A rt. 36. The miscarriage is considered as such for the purposes of this law and for
the right to the subsidy when it occurs after the third month of pregnancy.
The birth which occurs after the sixth month of pregnancy is considered a prema
ture birth and is, for all purposes of the law, equal to a full-tim e birth.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

A r t . 37. The woman operative inscribed in the National Maternity Fund, who gives
birth in a foreign country, has the right to th e subsidy provided that she presents the
documents indicated in numbers 1 and 3 of article 41, and produces the certificate
of birth resulting from the maternity of the child.
Foreign women inscribed in the National Maternity Fund who give birth in a
foreign country have the right to the subsidy under the same conditions as an Italian
woman.

A miscarriage confers no right to the subsidy when it occurs in a foreign

country.
A r t . 38. The subsidy is paid to the woman herself or to a person designated b y her.
In case of the death of the woman and the survival of the child the subsidy is paid
entirely to the person who takes care of the child.
In case of the death of both the woman and the child tlje subsidy is paid to the
persons who prove they have taken care of her or of the child.
In case of miscarriage followed b y the death of the woman the subsidy is paid
according to the rule of the preceding sentence.
A r t . 39. W h en the woman is accused b y the doctor or judicial authority of causing
a miscarriage, payment of the subsidy shall be suspended until the settlement of the
penal proceedings.
The loss of subsidy in case of intentional miscarriage shall occur only in consequence
of a verdict of guilty.
A r t . 40. A t the end of each three months the National Maternity Fund shall com
municate to the ministry of industry, commerce and labor the number of subsidies
paid in that three months.
On the basis of this communication, the ministry aforesaid, after verifying the
statements accurately b y its own deputy, shall arrange for the reimbursing of its share
of 12 lire per subsidy on the account of the State for each birth or miscarriage sub
sidized.
A r t . 41. To obtain the paym ent of the first half of the subsidy of 20 lire ($3.86)
within the period of seven days after birth according to article 3 of the law, it is neces
sary that w ithin two days after the day of birth there m ust be forwarded to the
National Maternity Fund b y registered letter for which a receipt is given, the follow
ing documents:
1. A request for subsidy giving exactly the name and surname and the father of
the woman, the commune and the house where she resides or the institution where
she is lodged.
*2. A docum ent furnished b y the office of civil status proving the birth and the
maternity of the b aby or a certificate furnished b y a doctor or a midwife and counter
signed b y a syndic, certifying the birth and the maternity.
3. The em ploym ent book of the woman; if not possible to present the book, the
establishment at which the book m ay be found m ust be indicated.
If the documents are presented or sent too late, the period of seven days w ill expire
from the day of receiving the documents above named.
The second half of the subsidy w ill be paid within five days of the expiration of
the period of rest.
A r t . 42. To have a right to the subsidy in case of a miscarriage, there m ust be
forwarded to the fund the documents indicated b y numbers 1 to 3 of the preceding
article and a certificate furnished b y a doctor or a midwife countersigned b y the
syndic attesting the miscarriage, the day on which it occurred, and the approximate
age of the embryo.
The tim e allowed for the forwarding of the documents enumerated in the preceding
paragraph is 15 days from the date of the miscarriage or of the date of the discharge
of the woman from the hospital or institution where she has recovered.

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IT A L Y .

141

A rt . 43. Besides the penalty imposed b y the law on the work of women and chil
dren, the undertakers, managers, or directors who allow the women to work during
the rest period required b y article 6 of the aforesaid law, m ust reimburse the National
Maternity Fund that part of the subsidy belonging to the woman from the tim e of
her admission to work.
I f the woman resumes work not subject to the law of the em ploym ent of women
and childrenl before the minim um period of rest of three weeks after the birth has
elapsed, she loses the right to the subsidy or to that part not yet paid at the tim e of
resuming work.
A r t . 44 The National M aternity Fund m ay arrange with individual employers
and undertakers as to the method whereby the head or the manager of the industry
or establishment m ay pay in advance to the woman, who is still connected w ith the
actory, the first half of the subsidy or the entire subsidy when there are presented
trom the woman interested the documents mentioned in articles 41 and 42 regularly
countersigned.
’
6
*

T itle V .

I nspections

and

M edical Certificates .

A r t . 45. T h e inspections intended to ascertain the observance of the laws and of
the present regulation, in addition to that of the officials of the judiciary police shall
be earned out b y the inspectors of industry and labor and b y the mining engineers
in the case of quarries, mines, and open-pit work and in the case of the establishments
included in the list authorized in article 33 of,the regulation of April 2 7,1 9 13 No. 421
for the application of the law of December 12, 1912, No. 1361, which instituted a
corps of inspectors of industry and labor.
i T v 6 ,° ® ciai8. t0 wh?m the National M aternity Fund have intrusted the discharge
of the duty of inspection shall have b y decree of the minister of industry, commerce
and labor, always revocable, the status of adjutant inspectors of industry and labor
and shall act under the direction of the chief of the district of inspection.
A r t . 46. The officials intrusted with the supervision b y the rules of the first and
second paragraphs of the preceding article, are privileged to visit any place whatever
in which they think that women are occupied in industries subject to the laws on the
work of women and children and have, in performing the duties of the office, all the
other powers granted b y the laws and regulations on the work of women and children
and on industrial accidents.
These pemons m ust also, in making the inspections, observe in so far as they are
applicable the provisions contained in the laws and the aforesaid regulations.
The employers, heads of industries and of factories, who refuse to answer the inquiries
of the inspectors and to furnish them the information and documents requested are
punishable b y a fine of not more than 100 lire ($19.30) for each refusal or failure to
com piy without prejudice, to the penalties imposed b y other laws or regulations.
A rT ; , 47, ,^ he ^ n m c ip a l doctors and the m unicipal m idwives shall serve without
pay either from the National M aternity Fund or the insured women or the establishme,n oior, J e n work 111 connection w ith the certificates furnished under articles 41
and 42 of the present regulation.

T itle V I . — T ransitory D ispositions .
A r t . 48 T h e provisions of the present regulation concerning the paym ent of sub
sidies shall have effect as from July 1, 1917, formally revoking for the births or mis
carriages which are verified thereafter, the provisions of the regulation approved b y
royal decree of November 26, 1911, No. 1382.
*
!
r . “
1n l he Pr? ° ? i0n established b y Neutenantal decree of February
1 7 ,1 9 1 7 , No. 322, shall be applied as in force for the year 1917; and for that year shall

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142

M A T E R N IT Y B E N E F IT S Y S T E M S .

be paid in the month of August rather than in the month of March, as provided b y
article 33 of the present regulation; the provisions of articles 33 and 34 shall remain
^ h r S U t e ^ n 'c ^ r l S Î K

Ï Ï S

12 lire ($2.32) established b y the lieu-

tenanted decree cited above, for all births or miscarriages subsidized from January 1,
1917.
S. A . R . the Lieutenant General of H is M ajesty the K ing:
V iséd b y order of

T he

M inister

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I ndustry , Commerce ,

and

L a bo r : D e N a v a .

LUXEMBURG (GRAND DUCHY).
Under the law of July 31, 1901, a system of compulsory sickness
insurance, providing maternity benefits, was introduced and has
been in effect since December 1, 1902. The system resembles closely
that in use in Germany.
The persons covered by the insurance include wage earners and
salaried employees, the latter in so far as the salary does not exceed
10 francs ($1.93) per day. The insured persons are required to be
members of the district funds if they are not members of an establish
ment fund or a recognized mutual aid fund. The benefits provided
by the funds are: ( 1 ) Sickness benefit, consisting of a cash benefit
(half the daily earnings) for a period of 13 weeks, medical attendance
and medicines; (2 ) maternity benefit, consisting of the cash benefit
as before, for a period of 4 weeks after the date of birth; if complica
tions at the birth ensue, then the usual sickness benefits are provided;
(3) funeral benefit, consisting of 20 times the average daily wages.
The income of the funds is derived from contributions of the
insured persons (two-thirds) and of the employers (one-third). The
total contribution may not exceed 4.5 per cent of the wages.
O P E R A T IO N S .

The number of persons insured, the cases of sickness, and the
financial operations may be summarized as in Table X X X V III.
Summary o f operations o f the sickness insurance
funds o f Luxemburg, 1903-1912.

T able X X X V I I I . — L u x e m b u r g .

ISource: Departement für Ackerbau, Industrie, und Händel. Die Krankenversicherung Im Gross
herzogtum Luxemburg, 1913.]
Number of members.
Year.

Num
ber of
funds.

Cases of sickness.
Per 100 members.

Total.

Male.

Fe
male.

Num
ber.
Total.

1903....
1905___
1907___
1909___
1911___
1912___

73 29,516 27,613
73 33,580 31,544
66 36,888 34,621
61 35,301 32,857
63 40,454 37,682
61 42,216 39,288

1,903
2,036
2,267
2,444
2,772
2,928

34,002 115.23
45,113 134.34
53,243 144.34
56,367 159.67
71,012 175.29
95,953 179.87

Amount
Total
paid in
Total
confine
receipts. expendi
tures.
ment
benefits.

Male. Female.
116.73
135.43
145.08
161.60
178.35
183.34

93.32
117.44
132.95
133.84
137.30
132.55

$255,033
299,341
379,922
347,280
448,432
480,054

$232,630
294,011
356,413
320,738
410,527
458,449

$160
273
409
452
404
222

There has been a steady increase in the number of women members,
though the number is relatively slight; as will be seen from the last
column of the table, the expenditures for maternity benefit are
extremely small.
143

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144

The maternity experience of the funds is shown in Table X X X I X .
Table

X X X IX

—Luxemburg.

Maternity experience of sickness insurance funds,

1903-1912.
[Source: Departement für Ackerbau, Industrie, und Händel. Die Krankenversicherung im GrossHerzogtum Luxemburg, 1913.]
Days of sick benefit in
confinement cases.

Confinements.

Year.

1912..............................................

Per 100
Per 100 cases of
female
Number. female
members. sick
ness.
46
59
74
66
53
58

2.42
2.90
3.26
2.70
1.92
1.98

2.58
2.47
3.45
2.02
1.39
1.49

Total.

1,022
1,416
1,729
1,682
1,225
1,802

Average
Per 100 benefit
Average total days per case.
duration of sick
per case. benefit for
females.
22.22
24.00
23.36
23.97
23.11
22.45

7.63
6.88
10.01
8.22
5-64
6.43

$3.56
4.63
5.53
6.86
7.62
3.83

The number of confinements is so small that the ratios oomputed
in the preceding table are of doubtful value. It is interesting to
note that the expenditure per case has varied from $3.56 in 1903 to
$7.26 in 1911.

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NETHERLANDS.
Maternity insurance in the Netherlands is provided by the general
compulsory sickness insurance law which was passed on June 5 , 1913,
but which had not been put into effect because of conditions arising
out of the war on January 1 , 1918.
PERSONS INCLUDED.

The compulsory insurance includes all men and women regularly
employed in the service of any enterprise, provided that their wage
or salary does not exceed a specified amount (to be fixed later by
certain administrative officials); a few groups are exempt, such as
persons receiving a very small wage, those protected by other laws,
etc. The compulsory insurance applies equally to men and women,
though the labor councils which administer the law may, at the time
the law is put into force, temporarily exempt women who are pregnant
or persons who are disabled.
DISABILITY PROVIDED FOR.

The disability provided for is (1) that due to sickness lasting longer
.than three days or (2) th&t due to pregnancy and childbirth, as long
as inability to resume work continues.
BENEFITS.

The benefits in case of sickness consist of sick money equal to 70 per
cent of the average wage of the wage class to which the insured
belongs, beginning with the third day of disability, but continuing
for not more than six months, Sundays excluded; in case of pregnancy
the sick money of 70 per cent begins with the first day of inability to
continue work until the day of childbirth, after which it is raised to
100 per cent of the average wage and is continued for the entire period
of the disability caused by the childbirth. By royal decree certain
increases or decreases in the sick money may be introduced. The
labor council is authorized to issue rules providing that the sick
money may be refused in cases in which the pregnancy disability or
the childbirth occurs within six months of the date when the insurance
or membership in the insurance system begins, or if the insured does
not belong to a recognized sick fund, or refuses to make use of the
services of a physician, or prolongs the disability by refusing to follow
the orders of the physician. The payment of the benefits is guaran
teed by the State.
113300°— 19------10

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146

M A T E R N IT Y B E N E F IT S Y S T E M S .

The law makes no distinction between legitimate and illegitimate
children. The important feature of medical benefit is handled in a
manner somewhat different from the British and German systems.
The officials administering the law a re.charged with the duty of
establishing sick funds whose only function is to provide physicians,
nurses, midwives, medicine, etc. Membership in these funds is
required, though the insured person has the right to select the fund
which he wishes to join. Each of these funds must prescribe the rates
of their dues and the extent of the service provided, although the
benefits provided must conform to a minimum standard to be specified
by Government decrees. There must be at least two physicians and
two apothecaries in the service of each fund, and the members are
allowed to choose their physician from those on the panel of the
society.
SOURCES OF INCOME.

The dues are fixed by the State and must be revised every five
years. They must be uniform in each district. One-half must be
paid by the employer and one-half by the insured person; the employer
must make the payment of the dues, deducting the employee’s share
from the wages. The law provides the following schedule of dues!
Wage
class.

Daily wage.

Average wage.
0.50 florin ($0.20).
0.80 florin ($0.32). ’
1.20 florins ($0.48).
1.60 florins ($0.64).
2.20 florins ($0.88).
3.00 florins ($1.21).
4.00 florins ($1.61).

In case these dues are not sufficient to defray the cost of the
insurance, including the accumulation of a reserve and repayment
of any advances to the system, the labor council may recommend
the increase of the dues, or the reduction of the benefits, or both;
in the absence of such recommendation, the State may take such
measures as it deems necessary.
VOLUNTARY INSURANCE.

Provision is made for the voluntary insurance of persons not
included in the compulsory insurance and those who desire to con
tinue their insurance when they cease to be covered by. the law.
Persons insuring voluntarily must pay their own dues.
GENERAL ADMINISTRATION.

The country is to be divided into districts, in each of which is to
be created a labor council (Radon van Arbeid). Each council must

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NE TH E R LA N D S.

147

establish a sick fund, which collects the dues, pays the benefits, and
generally administers the act. In addition to these sick funds,
recognized sickness societies are allowed to provide insurance under
the general supervision of the labor council. The labor councils
must consist of a chairman and o f at least eight members, composed
of employers and insured persons, in equal number. They must be
residents of the district, must be 25 years of age, and are elected
by the groups which they represent. The chairman and his alternate
are appointed by the Crown for a term of six years. Generally
speaking, it is the duty of the labor council to enforce the laws and
decrees relating to the insurance. Provision is made for the creation
of “ insurance councils/' which are to consist of ( 1) two representa
tives each of employers and insured persons,.who serve without pay,
and (2 ) not more than three salaried members, who are appointed
by the Crown. These insurance councils have jurisdiction over a
number of labor councils and supervise their work, as well as that
of the special funds providing medical benefits.
SOURCES OF INFORMATION.

Laws are published in the Staatsblad van het Koninkrijk der
Nederlanden ¿the law gazette), the two acts regulating the sickness
insurance syifem being numbered 203 and 204, of June 5 ,' 1916.
Decrees, orders, etc., are published in the Staatscourant. A summary
of the sickness insurance laws of 1913 is given in the Bulletin of
the International Labor Office.1
1 English edition, Vol. IX , pp. cxii-cxiii.

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NEW ZEALAND.
A voluntary system of old-age and invalidity insurance, including
a maternity benefit, was provided by tbe act of November 2 1 , 1910,
instituting the New Zealand National Provident Fund, which began
operations on March 1 , 1911. The main purpose of this law is to
provide a Government office through which wage earners may
secure annuities for invalidity and old age, but in addition to these
pensions, the system also includes a benefit of not more than £6
(about $30) for medical attendance when a child is born to a con
tributor. The maternity benefit is thus a secondary feature of the
insurance, but it is paid without extra charge and is a recognition
of the fact that childbirth is often a serious drain on the resources
of the average family and that this drain should not be permitted
to discourage the thrift shown by a person making provision for
old age.
PERSONS INCLUDED.

Section 9 of the law specifies that any person, resident in New
Zealand, over 16 and under 45 years of age whose income does not
exceed £ 2 0 0 (about $ 1 ,0 0 0 ), may become a contributor to the national
provident fund. The maternity benefit is paid in respect of the wifa
of a contributor, or if the contributor is a married woman then di
rectly to her. Unmarried mothers are excluded. The membership
must have been in force for at least one year before the birth occurs,
and during this year the combined income of husband and wife must
not have exceeded £200 ($973.30).
BENEFITS.

The exact amount of the maternity benefit is determined by the
board which administers the fund; the normal amount is not more
than £ 6 ($29.20), but the board may reduce this sum to the amount
of the expenses actually incurred by the contributor in respect of
medical attendance. The law defines medical attendance to mean
the services of a registered medical practitioner, or of a registered
midwife, and of a nurse at the time of the birth of a child and at any
subsequent time within a period of three weeks after the date of birth.
The benefits are guaranteed by the State.
The principal benefits, of course, are: (a) Those for old age, (6)
pensions for children under 14 in case of death or incapacity for
work of the contributor, and (c) a widowed mother’s pension.
149

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M A T E R N IT Y B E N E F IT S Y S T E M S.
F IN A N C IA L A D M IN IS T R A T IO N .

The cost of the system is defrayed by contributions of the insured
persons and by an annual subsidy from the State, the latter being
one-fourth of the annual amount paid by the contributors. The
cost of the maternity benefit is paid from annual grants by the
Parliament.
The rates of dues are graduated according to the age of the con
tributors; thus for the 10s. ($2.43) pension beginning at the age of
60, the contributor pays 9d. ($0.18) weekly if he enters at the age
of 17, etc. For the year 1913, the average amount paid in per
member was £3 18s. 6 d. ($19.11).
The resources of the fund are deposited with the public trustee,
a Government official with functions similar to those of the ordinary
trust company in the United States. The funds must be invested
in the manner required by law for orphans’ estates, etc.
G E N E R A L A D M IN IS T R A T IO N .

The fund is administered by a board called the national provident
fund board, which consists of the minister of finance, together with
four other persons appointed by the governor, who hold office during
his pleasure. This board has general charge of the administrative
details and makes up the rules, regulations, etc., for the enforcement
of the law. The governor, by order in council, is authorized to
make certain regulations for the purpose of assuring the safety of
the fund.
O P E R A T IO N S .

The number of contributors in the fund, etc., is shown in Table X L .
T a ble X L .— N e w Z e a la n d .

O perations o f the N ew Zealand national providen t fu n d ,

1911-1915.
[Source: The New Zealand Official Yearbook, 1916, p. 540.]
Cases
Number Receipts Amount
of funds receiving Amount
of con
from
mater paid in
at close
tributors contribu
nity
benefit.
of calen
at close
tions. der
year. benefit.
of year.

Year.

Dftf* St* 1912...................................................................
D pp 31* 1913 .....................................................................................
D pp 3 Î ’ 1914 ............................................................ ..
D ap 3 Ï 'l 9 Ï R
................................................................................

550
2,660
5,791
6,858
8,101

a $15» 437

57,070
110,562
129,060
150,253

$8,887
48,850
142,720
261,419
403,920

$832.17
3i
119 3,098.74
306 8,838.00
472 13.655.00

aFor the period Mar. 1 to Dec. 31,1911.

The data show the usual experience of voluntary funds in the field
of social insurance. The census of 1911 showed that there were
231,653 males and 64,264 females or a total of 295,917 persons in the
Dominion of New Zealand designated as wage earners;1 the 8,101
i Official Yearbook, 1914, p. 128.

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NEW

151

ZEALAND.

persons who were enrolled as members of the fund, may be assumed
to compose about 2 per cent of the wage-earning population. The
total number of births reported in 1915 was 27,850, and in compari
son with this number the 472 cases receiving maternity benefit in
that year form an extremely small proportion of all the cases. The
total amount paid in 1915, namely, £2,806 ($13,655), makes an
average of slightly less than £6 per case of childbirth. This amount
is much less than was expected by the Government; thus in the
debates on the bill, the prime minister, Sir J. G. Ward, in giving the
estimates as to the expense of the bill, stated, “ In the case of the
assistance to mothers it runs from £14,000 to £17,000 a year.” 1
The moderate degree of success attained by this fund gives, how
ever, an imperfect impression of the work and the widespread
interest m the field of infant welfare on the part of the people of New
Zealand. Perhaps in no country in the world has the subject of the
reduction of the number of deaths of infants been so extensively and
so successfully attacked. At the present time New Zealand has the
lowest mfant death rate of any country in the world. The report
of the United States Census Office on Birth Statistics, 1915 page 18
shows that of 29 countries for which data are obtainable/ the New
Zealand rate of 50.05 in 1915 was far lower than that of any other
country. Table X L I shows the infant death rates for New Zealand
and Australia, the latter state having the rate next to that of New
Zealand.

'ss*
[Source: New Zealand Official Yearbook, 1916, pp. 112,113.]

Year.

1911
1912
1913
1914
1915

...........
.......
...........
.......
.

Infantile mortality rate.
Regis
Deaths
tered
under
1
live
year
Austra
births
New
(New
New
lian
Queens
(New
South- Victoria. South
Zealand). Zealand). Zealand. Common land.
Australia.
Wales.
wealth.
26,354
27,508
27,935
28,338
27,850

Average, 1911-1915...

1,484
1,409
1,653
1,456
1,394

56.31
51.22
59.17
51.38
50.05

68.49
71.74
72.21
71.47
67.52

65.36
71.73
63.35
63.87
63.97

69.46
71.00
77.78
69.72
68.13

68.70
• 74.48
70.53
78.29
68.84

60.60
61.68
69.83
76.02
67.30

53.63

70.29

65.66

71.22

72.17

67.09

In part, this favorable infant death rate may be due to the general
innnnn0nS ° f the.7 countrJ. The area of the Dominion is about
100,000 square miles ; the population in 1916 was about 1,100 0 0 0 .
here are only four cities with populations of from 50,000 to 100 000
while no other city had a larger population than 2 0 ,0 0 0 . The racial
composition of the population is distinctly homogeneous, about 98 per

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152

M A T E R N IT Y B E N E F IT S Y S T E M S .

cent being British. The people are principally engaged in agricul
tural and pastoral pursuits. In 1911 the number of persons employed
in manufacturing establishments having more than two employees
was about 56,000. What is especially important in its influence on
the favorable infant death rate is the fact that the general standard
of living in the country is generally recognized as being high.
Besides these economic conditions, the attitude both of the public
and of the governing bodies of the Dominion toward the question of
infant welfare has been one of deep interest. In the field of official
action, the first law on this subject may be said to be the nurses
registration act of 1901. The midwives’ act of 1904 provided that
only those mid wives who were duly qualified and registered might
practice on their own account. The next action was the establish
ment of a series of maternity hospitals by the State. These are now
five in number, one at each large center of population. These hospi
tals are, however, intended to be for the most part self-supporting
and are not charitable institutions.
Unofficial action has, however, had much greater influence in
securing this remarkably small infant death rate than governmental
activity. The lead in this work has been taken by the New Zealand
Society for the Health of Women and Children, founded in 1907.
As the work of this society has already been described in a previous
publication of the Children’s Bureau,1 it is only necessary to refer to
this admirable organization in the present connection.
S O U R C E S O F IN F O R M A T IO N .

The text of the law of November 2 1 , 1910, will be found in the
1910 issue of the official law series of New Zealand, entitled “ Statutes
of the Dominion of New Zealand, ” printed by the government printer,
Wellington. A digest of the law and a summary of operations under
it will be found in each issue of the New Zealand Official Yearbook,
published by the Government statistician at Wellington.
i Tew Zealand Society for the Health of Women and Children: An example of methods of baby-saying

work in small towns and rural districts. 1914. Bureau publication No. 8.

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NORWAY.1
'

Under the laws of 1909 and 1915 maternity benefits are provided
for wage-earning women as part of the compulsory sickness insurance
system. In addition to these provisions, the State requires special
care for children born out of wedlock, the provisions of which are
contained in a series of acts known as the children’s rights laws.2
The protection of women wage earners at the time of maternity
began with the factory law of 1892, which prohibited the employment
of women in industrial establishments for six weeks after confine
ment; if the mother presented a physician’s certificate to the effect
that employment would not be injurious, then work might be re
sumed at the end of four weeks. In the sickness insurance law of
1909, the six weeks’ prohibition was made absolute and a cash
benefit paid for this length of time.
Throughout all of the Norwegian legislation, special care is taken
to protect the rights of the child and of the mother. Probably no
country in the world has such admirable provisions for the care of
the helpless child born out of wedlock.
The six weeks prohibition was continued in the law of September
18, 1915, on the protection of labor in industrial establishments.
This law also provided that women must not be denied the right to
leave their positions for a period .of four weeks prior to childbirth if
they present a certificate from a physician or midwife stating that the
confinement is expected at that time. At the end of the six-weeks’
period after confinement, her former position must be given her if
she applies for it.
In the period following 1892 a special novement for the improve
ment of the political and economic status of women had a marked
effect on the social legislation. The recent enactment of the laws on
the welfare of children born out of wedlock, already referred to, is
one of the results of this movement.
The first law for the provision of maternity aid was the sickness
insurance law of September 18, 1909. The act provided that a
benefit, 60 per cent of the daily earnings of the mother, should be
paid for each working day for a period of six weeks after confine
ment; medical attendance was also provided. Membership in one of
the sick funds for a period of 10 months was required. All wage
earners and salaried employees were included, except those whose
1The statements in this section are based on material furnished by C. E. Stangeland, Ph. D.
«Magnusson, Leifur: Norwegian Laws Concerning Illegitimate Children. U. S. Children's Bureau
Publication No. 31, Legal Series No. 1. Washington, 1918.

153

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M A T E R N IT Y B E N E F IT S Y S T E M S .

earnings were in excess of 1,400 kroner ($375) in cities, and 1,200
kroner ($321) in the rural districts. The insured person paid sixteriths of the contributions, the employer one-tenth, the local govern
ment one-tenth, and the National Government two-tenths. A
special provision authorized the district funds to require the benefits
to be used for the care of the child in certain cases j this requirement
was meant to apply in cases where the infant was deserted, neglected,
or left in the care of third persons.
^
Besides these benefits, the funds were required to provide medical
attendance and medicine, but not cash benefit to the members of the
family of an insured person. This feature made it possible to secure
medical attendance for the wife of an insured man at childbirth.
A special law of 1909 on the care of unmarried women during
childbirth provided that the communes or other local governments
should provide the following benefits: Cash benefit for not more than
three months before confinement and for not more than six weeks
after confinement. If the mother kept the child with her and
nursed it herself, then the benefit must be extended up to nme months.
This provision was an attempt to reduce the great mortality of
ex-nuptial children, which was declared to be due to the unfavorable
living conditions of the mother before and after confinement.
The law of 1909 came into operation on July 1, 1911. Great
interest was taken in its administration and within two years two
proposals were submitted to the National Parliament for its extension,
and improvement. The first of these was made by the National
Council of Norwegian Women, and the second by the governmental
department of social affairs.
At a convention held on July 3, 1913, the National Council of
Norwegian Women submitted the following recommendation to the
National Government:
1. The National Council of Norwegian W om en urgently recommends that the
Government should present its resolutions concerning aid b y midwives (included in
its proposals for sick insurance) to female members of sick funds and the wives of
insured men, in confinement, promptly in order that these m ay be considered in con
nection with maternity insurance.

Free attendance b y m id wives forms an absolutely

necessary complement to maternity insurance and should therefore, as resolved by
our organization, be included in such insurance.
2. The council’ s annual meeting recommends at the same tim e that the Government
consider the conditions affecting the training and income of m idw ives in order that
their activities may be extended and their economic conditions improved.
3. In connection with the Government's proposal for maternity insurance the
council recommends that an appropriation be made to enable some properly fitted
woman to study the “ birth h om es” of cities or of sickness funds— especially in D en
mark and in Germany— in order to be able to report on their equipm ent, expenses,
and relations to sickness funds and the aid of m idw ives.

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NORW AY.

fo llow iPlanati0n ° f itS recommendation the council states in parts as
..

ani COnfinement mean aB a

the greatest part of the Ü1 health which

Ï a W° m - n I 6®0"*8 and Struggle for the fam üy- ^ t free medical
S? ™ c e * y ^ d w a v e s is in a large measure for a wife and mother.

d d T t t t

S u c h fZ
m oth erh o od ^T t

therefore he one ° f the first aids given b y provisions for insuring

dm W t
fi
1
+’ ° f ? . Ur86’ a great advantage to be able to obtain financial aid
g confinement, and it is most desirable, but unless the mother herself is given
proper care at this juncture only a part of what should be done for her is done
Good
and competent help at the right tim e w ill prevent m uch disease and w lk n e s s and
tend to preserve the mother’s working power. In the working classes or in other
S v
a n T ii r C0J e’ ChÛdhÿ f rePresents a ir io n s addition to the activities of the
that I W
t eaï
^ a Perl? d m° f difficultt° g o through. A s a result it is stated
large proportion of births take place without the attendance of a midwife or
other properly qualified h elp .1
or

Some improvement in the care of women during childbirth is noted
at the present time as compared with the previous generation; the
number of deaths of women during childbirth in two periods is given
m labié X L II.
&
T

a b l e

X L I I .— N o r w a y .

Deaths

Ver 1,000 confinements, 1857-1861

[Source: Stortings forhandlinger, pt. 3,1914; Odelstings propositionen, No. 1, pp. 10,11.
--------—----1 * 1 *J
Year.
1857.
1858.
1859.
1860.
1861.

Death
rate.
4.7
6.6
8.4
7.0
7.2

Year.
1907..........
1908..............
1909...........
1910..............
1911..............

Death
rate.

................................
.................................
.................................

2,5

Attention is also called to the fact that in 1911, out of 61,989 cases
of confinement, there were 8,456 cases in which there was no attend
ance by midwives and presumably no attendance by doctors- this
number made H per cent of the total. These cases were, of course
m families with small mcomes or families residing in isolated districts!
he department of social affairs submitted a report which is pub
lished m the parliamentary papers. Among other things the report
quoted with approval a statement submitted by Prof. Brandt of the
Maternity Hospital of Christiania:
A woman’s capacity for work always declines during pregnancy, and particularly
dim ng the last month. B u t diminished capacity means lower income, and this is aU
e more important m the case of the pregnant woman, inasmuch as her condition
calls for more rest, more food, and more comfort in general. As e v e ry U knows
there are many women who can not provide themselves with these desiderata

but

Sm ce society needs a healthy race it must in its own interest provide c o S d i t a of a
suitable l a n d - m other words, provide care for the pregnant woman as well as for the
woman who has already ^ v e n birth to a child, during the period in which her w o r t
ng capacity is diminished.

Support at such times means the prevention of impaired .

‘ St0rtings iorhandlinger, pt. 3,1914; Odelstings propositionen, No. 1, pp. 6-8.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

health, and the prospects of healthy offspring are made better thereby.
be spared m any later expenses b y such a precaution.

Society will

T h e suggestion that the insured

and pregnant woman receive aid for the 14 days preceding her confinement is a step
in the right direction, but it is maintained that these 14 days should b e extended
to a month.

The report apparently expected that opposition to proposals for
maternity benefits would be based on the cost of such a system.
W hile it is generally acknowledged that the proposed reforms (maternity insurance
and free service b y midwives) will be of the greatest importance for the home, the
mother, the children, and so for the people as a whole, and while it is recognized that
the arrangement will form a natural link in the sickness insurance, the manner in
which and the extent to which these reforms m ay be carried out depends on the
economic sacrifices which society and those most im m ediately concerned are willing
to make for this purpose.

The debates in the Parliament, as reported in the Forhandlinger
for 1913 and 1914, show that there was some opposition on this
ground— in fact, the opposition was almost entirely based on the
question of cost— and the measure was finally enacted with some
what smaller benefits than its advocates had hoped for. The law
was-finally passed on August 6 , 1915, and went into effect on January
3 ’ 1916‘

P E R S O N S IN C L U D E D .

The law covers practically the entire wage-earning population in
the compulsory insurance. All wage earners and salaried employees
either in public or in private employ, over 15 years of age, must be
insured. If, however, the annual earnings of a person in a rural dis
trict exceed 1,600 kroner ($482) they are exempt. A few other excep
tions, such as sailors on long voyages or persons supported by their
local government, are also made. Voluntary insurance is permissible
for persons who come within the above income groups.
D IS A B IL IT Y P R O V ID E D F O R .

The funds must pay benefits in case of sickness, childbirth, indus
trial accident, and death.
B E N E F IT S .

In computing the benefits of the system five classes of membership
are used; this plan makes the contributions smaller for those whose
earnings are small. The earnings and rates of benefit in these groups
are given in Table X L III.
T a b l e X L I I I .— N .orw ay.

Membership class.

Membership class and rates o f sickness benefit.

Annual earnings.

Under $80.66...................................
$80.66 to $161.05...............................
$161.06 to'$241.45.............................
$241.46 to $321.85.............................
$321.86 to $428.80 or $482.40............

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Assumed Rate of
daily daily cash
earnings. benefit.
$0.27
.40
.67
.94
1.2 1

$0 .1 6

.24
.40
•56
.7 3

NORW AY.

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The regular benefits are: (1 ) Cash benefit; (2 ) medical benefit;
(3) maternity, including pregnancy, benefit; (4) funeral benefit;
(5) family benefits.
(1 ) Cash benefit: This is paid for each day, except Sundays,
beginning with the fourth day of disability and continuing for 26
weeks, counting from the first day of receipt of cash benefit. The
amount of the benefit is 60 per cent of the average daily wage listed
above. For this cash benefit may be substituted treatment and
maintenance in a medical institution (hospitals, etc.); if the bene
ficiary has dependents, then up to 50 per cent of the cash benefit
must be allotted to their support, according to the number of depend
ents in the household.
(2) Medical benefit: This consists of free treatment by the fund
physician, free medicines, and appliances; it also includes partial
dental treatment.
(3) Maternity benefit: During confinement a woman member
must be given (a) free midwife service (but not including cost of
transportation of midwife); (b) cash benefit for six weeks, counting
from and including the day of delivery; '(c) prior to confinement,
cash benefit for two weeks. The daily cash benefit must be not less
than 1 krone ($0,268), regardless of the income groups mentioned
above.
If the childbirth is complicated by sickness, then the woman
member is entitled to the regular sickness benefit, which includes
free medical attendance, medicine, appliances, etc., and the cash
benefit described above, but in no case less than 1 krone ($0,268) per
day during the eight-weeks’ period.
The payment of these maternity benefits is Conditional on a mem
bership of 10 months prior to confinement, though short interruptions
are permitted.
If during the 13 weeks preceding the date of childbirth an insured
woman has become unable to work because of disability due to
pregnancy, the fund must continue her membership in good standing
and she retains the right to all benefits without the payment of any
contributions.
Instead of providing the cash benefit, the district sick funds are
authorized to furnish medical care and maintenance in a maternity
home (fodselshjem); if such institutional care is refused by the woman
without valid reasons, then the fund may decline to pay any other
benefit whatever. If the woman has dependents, then up to 50 per
cent of the cash benefit must be paid for their support, depending on
the circumstances of the household.
The midwife in the service of a fund must be in attendance at the
birth of the child and keep the mother under observation during the
six-weeks’ period of benefit. Where possible she must also visit the

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mother prior to the time of birth. Each sick fund must draw up a
set of regulations defining the duties of the midwife, which must bo
approved by the State insurance office. The compensation of the
midwife, if an annual salary basis is not used, must be according to
a published schedule of fees drawn up by the directors of the funds.
In case of a failure to come to an agreement with the midwives, the
head of the local government shall act as arbitrator.
Members are not required to pay contributions while in the receipt
of sickness or maternity benefit or while performing military service.
The maternity benefit, as a rule, must be paid to the- mother
personally; the fund may, however,- pay it to a third person, to be
used for the best interest of the mother and child. It may be paid
in one sum or in partial payments, as the fund decides; if a lump-sum
payment has been made and the mother dies before the expiration of
the period for which payment has been made, then the balance need
not be returned.
*
None of the benefits, especially sickness and maternity, may be
pledged or seized or attached in any manner.
(4) Funeral benefit: The funeral benefit consists of a payment of
50 kroner ($13.40).
(5) Family benefits: For the spouse (husband or wife) of a member
and for the children under 15 years of age, free medical attendance
and medicines, but not appliances.
The uninsured wife of an insured man must be provided at child
birth with free midwife service and a lump-sum maternity benefit of
30 kroner ($8.04). This benefit is conditional upon the husband’s
having been insured for at least 10 months.
SOURCES OF INCOME.

The income of the fund is derived from four sources, paid in the
following proportions:
Persons insured under compulsory features of law pay: (1) The
insured, 60 per cent; (2) the employer, 10 per cent; (3) the local
government, 10 per cent; and (4) the National Government, 20
per cent.
Persons insuring voluntarily pay: (1) The insured, 70 per cent;
(2) the local government, 10 per cent; and (3) the National Govern
ment, 20 per cent.
FINANCIAL ADMINISTRATION.

The dues of the system are to be computed on a basis sufficient to
defray the cost of benefits and other prescribed expenses of the funds.
There must be a standard schedule of contributions based on the
income groups given above, and the schedule must be approved by
the State insurance office.

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The employer must deduct from wages the amount to be paid by
the insured person, add that to be paid by himself, and forward this
amount to the fund on the first Monday of each month. The share of
the National Government shall be paid as prescribed by decree. The
share of the local government shall be paid in advance, semiannually,
and adjusted at the close of the semiannual periods.
Out of the contributions received by the funds the State insurance
office shall deduct a percentage not to exceed 10 per cent annually,
to be used in forming a central reserve.
The funds must use the surplus of receipts over expenditures to
form a reserve. As soon as this reserve reaches the amount of onehalf of the annual income the contributions may be decreased.
If at any time the reserve becomes exhausted and there is still a
deficit, application shall be made for a loan or a gift from the central
reserve. Under such circumstances the rates of contributions must
be increased immediately.
GENERAL ADMINISTRATION.

The law requires the creation of a sickness insurance fund in each
commune of the Kingdom; under certain circumstances several
funds may be established for one commune.
Over these district or local funds is the State insurance office,
which has general supervision of the insurance. Its administration
expenses are defrayed by the National Government. It administers
, the central reserve, which serves as a guarantee fund for the several
insurance carriers. It also acts as a court in the settlement of con
troversies. The State insurance office has general control of the
administration of the sickness insurance and publishes the statis
tical returns of operations. It also conducts the accident insurance
and the invalidity insurance systems of the Kingdom.
The sick funds have the usual organization of mutual insurance
carriers in this field. The board of directors is, however, selected
by the officials of the local governments; it must, as a rule, consist
of nine persons, of whom five are insured persons, two are employers,
and two persons selected at will. Each director must have an alter
nate elected at the same time and to serve in case of the disability
of his principal. A person elected as director of a fund is compelled
to accept the office, though in case, he is already f ill in g another
honorary office he may be excused. A person in the employ of the
fund, such as a physician, a dentist, or a midwife, or an employee in
the office of the fund, is not eligible for the directorate. This board
conducts the local business of the fund, such as making contracts
with physicians, dentists, midwives, apothecaries, etc., manages the
accounting, directs the office force, etc. It must call a general meet
ing of the insured persons and employers at least once a year, and at

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this meeting the directorate must submit proposed changes in the
constitution for discussion, must give a hearing to persons having a
complaint, must submit the contracts with physicians, midwives,
etc., for discussion. In voting, the insured persons must have twothirds and the employers one-third of the votes cast.
Establishment funds and other private or communal sickness insur
ance funds may be granted the status of “ recognized sick funds
and as such are entitled to conduct the insurance under the present
law for their members. They must have at least 200 members,
except in the case of establishment funds and communal funds, which
must have at least 100 members. In general their members must re
ceive not less favorable treatment than the members of the district
funds. They are also under the supervision of the State insurance
office, which prescribes the financial conditions with which they must
comply. They are also entitled, under certain conditions, to receive
the following grants: From the National Government, two-sixths of
the average contribution of their members; from the local govern
ment, one-sixth; and from the employer, one-sixth. These grants
must not exceed 4 kroner from the State, 2 kroner from the local
government, and 2 kroner from the employér per annum, and must
not exceed the average grant per member made in the case of the
district fund of that area. These fractional amounts are paid on the
proposal of the State insurance office whenever the annual contribu
tions of the insured persons exceed 12 kroner ($3.216).
OPERATIONS.

As the present law has been in effect only since the beginning of
the year 1916 no statistics relating to its operation are available.
It is worth noting, however, that at the end of 1915 there were in
existence 703 district sick funds and 70 recognized funds, all of
which, according to the new law are to provide maternity benefits
in the manner above outlined. The number of persons directly or
indirectly insured against sickness, including confinement, was esti
mated as follows by the insurance office for the year 1914:1
Through members (wives or husbands)................... ................... - * - ................. ******

Through members (ch ild ren )................................................................................................ 275) 000
T otal............. .......................................- ............... - ................. * ............... * ................. .. . 760’ 000

This total should be somewhat larger at the present time, due to a
normal increase in population and to the impetus given by the new law.
The number actually insured equals about double the number nomi
nally insured, and the total indicates that approximately one-third
of the country’s population is directly interested in this insurance.
i A arsberetning ira R iksiersekringsanstalten, 1915, B ilag. p . 2.

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The number of women insured in 1914 was 142,862, or over one-third
of the total membership. The total expenditures for sick insurance
the same year were 8,324,589 kroner ($2,230,936), while the maternity
benefits paid them (under the law of 1909 as revised in 1911) were
only 58,125 kroner ($15,577.50). Mr. Castberg explains this small
benefit total by the fact that most of the beneficiaries were unmarried
women, as the old law did not include the wives of members in
maternity cases.1 It is anticipated, he says, that the new law will
be applied to from 25,000 to 30,000 births annually. The total
number of births in Norway has been somewhat over 60,000 a year.
This would indicate that nearly half of the births in the country will
be aided by the present maternity provisions, and the aid will also
presumably cover the large number of illegitimate births; the latter
are about 7 per cent of the total (about 4,300 in 1914). Wives will
be benefited without any increase in the husbands’ contributions.
The law’s intention is to promote the establishing of municipal
maternity homes, according to Mr. Castberg, by diverting the amount
due to the mother to such homes when she is given care in them.
There is a strong movement among Norwegian women for the estab
lishing of such institutions.
‘ ‘ Incidentally,” says Mr. Castberg, “ the miserable condition of the
midwives and their social position will also be improved by the
maternity insurance. They wifi be better paid and wifi be more able
to rely upon obtaining the money due to them. There will be a
greater demand for the services of midwives on account of the
maternity insurance. It is significant of the present conditions that
according to the report of the president of the national health board,
between eight and ten thousand births take place annually (out of a
total of 62,000) in Norway without any assistance by a midwife.
The mothers can not afford to pay for them and fetch them from
long distances.” 2
LAWS ON THE CARE OF CHILDREN.

Supplementing the new sickness insurance law is the law on the
care of (neglected) children, to which reference has already been
made, and which was adopted April 10, 1915, and went into effect
January 1, 1916.3
The primary purpose of this law is to protect especially the mothers
of illegitimate children, or in the language of the Norwegian law
children whose parents are not married to one another.” As was
pointed out above, 1 out of every 1 5 births involves th is problem.
1Journal of the Society for Comparative Legislation, July, 1916, p 297
:Ibid., p. 298.
•Magnusson, Leifur: Norwegian Laws Concerning Illegitimate Children, p. 30 ft. U. S. Children’s
Bureau Publication No. 31, Legal Series'No. 1. Washington, 1918.
1 13 3 00 °— 19-------11

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Sections 1 and 2 of the law are as follows:
S ection 1. (1) Any unmarried woman w ith child who is a Norwegian citizen and
who is unable to care for her offspring m ay apply for benefits from the communal
treasury of her place of bodily residence (opholdssted) to continue for a period of
six weeks preceding confinement.
(2) A married woman m ay apply for benefits provided her husband is dead or has
deserted her or b y reason of his improper conduct is the cause of their not cohabiting.
S e c . 2. (1) A n y mother in such destitute circumstances as to be compelled to
place her child w ith another, unless she shall receive benefits, m ay apply for benefits
from the communal treasury of her bodily residence.
(2) T h e amount of the benefits shall be such that she can keep the child with her
for the first three months of its life so that she m ay nurse it at the breast if she is able
to do so.

The aid to be given such a woman is determined by the provincial
governor (amtmand) within certain limits. For the six weeks im
mediately preceding confinement the aid shall be between 25 and 45
kroner ($6,968 and $12.06), and for the month after childbirth from
20 to 35 kroner ($5.36 to $9.38), but these amounts may be increased
or decreased by one-third on the recommendation of a committee of
the local board of health. On similar recommendation the aid period
may be extended, but not for more than three additional months.
The aid period may then cover a total period of as much as seven
and a half months, including the six weeks before confinement.
The board of health is responsible for the proper expenditure of
the financial help given and may decide to give it to the midwife
attending in the event of her being willing to use it for the mother’s
and child’s best interests. The committee of the board of health
may require the woman concerned, when she demands aid, to go to
some maternity home; but it can not require her to be separated
from the child which needs her. If she receives benefits from any sick
fund, the corresponding amount is to be deducted from the aid other
wise to be given her. If the mother’s residence at the time of the
birth is not her home, thè commune or district which has her in its
care receives reimbursement from the mother’s home (or actual and
legal) residence, while the father is obliged, according to another of the
children’s laws, to contribute to her child’s support and to reimburse
the mother’s home community accordingly. If the mother is without
any recognized or known home residence, the responsibility for reim
bursement falls on the natural father’s home residence and on the father.
Aid given according to the provisions of this law is not to be
considered charity, and no disability attached tò paupers as such is
incurred by demanding and accepting such aid; but if the father does
not reimburse the community as required his failure to do so has the
effect of pauperizing him.1
i Wiesener, G.: Baraelovene av 10, Apr., 1915; Stortings Fidende, Jan.-Mar., 1915; Norsk Lovtidning,
1915; and Stortings Forhandlinger, 1915, Ot. prp. nr. 5, Ot. prp. nr. 35, Indst. O. Ill; Stortings Fordhandlinger, 1909, Indst. 0 . I X and X L

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SOURCES OF INFORMATION.

The official law gazet/te of Norway is Norsk Lovtidende: Samling
av Love, Résolutioner, m. m. ; it is published at Christiania. The
laws on sickness insurance will be found in the volumes for 1909,
1911, 1912, and 1915. Current developments in legislation and
administration are reported in the journal of the department of
commerce and labor (Sociale saker bandel, industri og fiskeri, Chris
tiania). A German translation of the law is given in Bulletin des
Internationalen Arbeitsamtes, volume 15 (1916), pages 195-217.
The children s rights laws have been translated and published by
the United States Children’s Bureau r with complete references to
the original sources. The annual report on operations will be found
in Aarsberetning fra Riksforsikringsanstalten, in the appendix (bilag).
Thç statistical yearbook of the kingdom, Statistiske Aarbok, also
contains information on this subject.
1Norwegian Laws Concerning Illigitimate Children, Introduction and Translation by Leifur Magnusson.
Ü. S. Children’s Bureau Publication No. 31, Legal Series No. 1. Washington. 1918.

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RUSSIA. 1
Maternity benefits in Russia are provided for by tbe law of June 23
(July 6), 1912, which, instituted a system of compulsory sickness and
accident insurance for wage earners in specified industries. Apparently itr required over a year to issue the necessary decrees, circulars,
etc., giving official sanction to the holding of elections for the choice
of representatives to the meetings which organized the local sickness*
funds, and similar matters. In fact, it was not until November 26,
1913, that a decree was issued giving notice of the appropriation of
46,000 rubles ($23,690) for carrying the law into effect. Prior to this
date a long series of decrees, circulars, etc., had been issued authorizing the preliminary steps in connection with the work of organiza
tion, such as the adoption of the model constitution and by-laws of
the funds (decree of Mar. 15,1913), the date of handing in applications
for the creation o f establishment sick funds (Apr. 18, 1913), etc.
The unofficial reports show that some of the funds were in operation
on June 1, 1913, and by October 1, 1913, about 1,600 funds, with
over 1,100,000 members, had taken some or all steps necessary to
* carry out the law.
The number of women employed in factories in Russia is rapidly
increasing. Thus at the date of the enactment of the sickness in
surance law, there were at least 2,000,000 wage earners subject to the
insurance and at least one-third of this number were women. A re
cent press statement2 quotes an official report to the effect that in
1900 women formed 25 per cent of the total number of factory work
ers; in 1908, they composed 31 per cent of the total, and in 1912, 45
per cent. It is also stated that in the Moscow district in 1915, women
composed 49.8 per cent of the factory employees.
At the date of the enactment of the sickness insurance law, pro
vision for medical aid and sickness benefits had been instituted by
1,982 manufacturing establishments, employing 586,480 wage earners
of both sexes.3 These establishments spent, according to the esti
mates of one writer, about 4,000,000 rubles ($2,060,000) on their em
ployees, all of whom are now subject to the sickness insurance law;
about three-fourths of this sum was contributed by the employers.4
1 The statements in this section are based on material furnished by J. G. Ohsoi, Ph. D. The information
relates to conditions as of Jan. 1, 1917; obviously the changes in Russia since this date have made this
section of historical interest only.
0
2 New York Call, Nov. 12,1916.
8Vestnik Yevropy, February, 1914, p. 361.
‘ See article by B. Soloviev, in Strakhovanie Rabotchikh, vol. 1 ,1813.
165

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It is probable that an equal number of wage earners were members
of private voluntary mutual aid associations having sick and death
benefit features.
The industrial code regulating employment in industrial estab
lishments prohibited the employment of women for a period of four
weeks after childbirth.
INDUSTRIES INCLUDED.

The sickness insurance act applies to all wage earners, men and
women, employed in factories, shops, mines, iron works, -railway
shops, inland navigation, tramways employing regularly not less than
20 persons and in which mechanical or animal power is used, or in
which not less than 30 employees are regularly engaged. Establish
ments belonging to a county (zemstvo) or municipality are also in
cluded. Establishments of the central government and railways
which are common carriers are not included, as special provision is
made for their employees under other laws. Agriculture and home
working industries are also excluded.
PERSONS INCLUDED.

All persons, men and women, employed in the industries subject
to the law who are regularly employed or who have a contract of
service in these industries, are subject to the insurance. Casual em
ployees who are engaged for less than one week are not included.
The wife of a member of a fund, who is herself not a member, may,
in the discretion of the fund, be given benefits for illness, for mater
nity, and a funeral benefit. Sickness and funeral benefit may be pro
vided for other dependents of a member. * The status of the mother
who is not legally married came before the workmen’s insurance office
of Petrograd soon after the law came into operation. The sick benefit
fund of the Petrograd Metal Works at its meeting of December 1,
1913, provided that the wife of a member, whether legally married or
not, should receive maternity benefit. The office, however, annulled
this provision on the ground that article 43 of the law referred to
legally married wives only.
DISABILITY PROVIDED FOR.

The law prescribes that benefits shall be paid for illness causing
inability to work, for illness caused by pregnancy, for maternity, and
for death. Illness caused intentionally or by misconduct is excluded.
If an insured person is ill but not prevented from working* medical
treatment is provided.
BENEFITS.

The benefits consist of (1) medical treatment; (2) sick wage; (3)
maternity benefit, including pregnancy; (4) funeral benefit; (6) bene
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fits to dependents of members. Persons must be members for three
months before they become entitled to benefits.
1 (1) Medical benefit: This consists of first aid in case of sudden
illness or accident, treatment at a dispensary (ambulatory treat
ment), services of a midwife, and hospital treatment. It also in
cludes free medicines, bandages, and other therapeutic supplies. If
the member is not prevented from working, the treatment, etc.,
must be continued as long as the illness lasts ; if he is prevented from
working, the treatment (including hospital treatment when necessary)
must be continued until recovery, but for not more than four months.
This treatment is at the cost of the owner of the establishment if
the sick fund has been created for his undertaking.
The owner of the establishment must provide a hospital, or must
enter into arrangements with other manufacturers for a joint hospital,
or must make a contract for hospital service with hospitals conducted
by local governments or other bodies. If the owner of the establish
ment fails to make such arrangements^ the members are then entitled
to go to municipal or similar hospitals at the regular charges for the
local residents, and the employer is required to pay these charges.
In any establishment having 100 or more women employees the
owner must have in his employ a midwife to aid those employees
residing within a reasonable distance of the factory. If the hospital
maintained by the owner has a confinement ward, then th ia ward
must be separated from the rest of the hospital, and all the nurses
and servants must be women. There must be an adequate supply
of obstetrical instruments. The supervision of factory hospitals
is in charge of the factory inspectors. A sick fund which has under
taken on its own account to provide hospital treatment for its mem
bers is authorized to make contracts with hospitals of local govern
ments; if it fails to make such contracts, then the members have
the right to enter such hospitals at the regular charges, and the fund
must pay these charges.
(2) Sick wage, or pecuniary, benefit: This may vary from onehalf to two-thirds of the wages of the insured persons if he or she
has dependents, such as wife, children, brothers, or sisters under
15 years of age who are orphans, or relatives in the ascending line.
If the member has no such dependents, the sick wage shall be from
one-quarter to one-half of his or her wages. It must be paid from
the fourth day of disability until recovery, but for not more than
26 weeks; if there is more than one period of illness, the benefit
payments must not cover more than 30 weeks in any one year. The
general meeting of the fund must fix in advance the rate of the sick
wage for each year.
(3) Maternity benefit: The regulations concerning the medical
benefit apply to maternity cases. The owi*ar of the establishment

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must provide hospital treatment for confinement cases just the same
as for other cases needing hospital or institutional care, and in the
same way, if the fund has arranged for thé hospital care, the member *
must be given treatment either in a general hospital or in a mater
nity hospital.
The industrial code prohibits the employment of women for four
weeks after confinement. During this period the member is entitled
to a pecuniary benefit of one-half to full wages and in addition she is
entitled to this benefit for two weeks prior to confinement, making
a period of six weeks in all. If, however, the member engages in
remunerative work during this time the money benefit may be with
held.
While the law requires a membership of three months before a
woman becomes entitled to maternity benefit, this provision does not
seem to have been followed strictly. Many of the women wage earners
are employed in seasonal industries, in which comparatively long
periods of unemployment occur regularly. This is especially true of
the married women, and to enforce this rule strictly would entail
considerable hardship. The national customs connected with the
observation of the Christmas and Easter holidays also practically
force the woman who is housekeeper to stay at home at these sea
sons, an absence from work which would also deprive her of the
maternity benefit. The industrial employees in the Moscow dis
trict petitioned the Council of Workmen’s Insuranoe at Petrograd
for permission to disregard all temporary unemployment of women,
and the council finally issued a rule permitting women to retain their
right to maternity benefit if the unemployment did not exceed one
month in any year.1 The wives of members may, if the fund so
decides, be given free hospital treatment and a money benefit; the
expenditures necessary for these benefits must be placed in the
budget for discussion at the annual meeting of the fund. The model
by-laws for these funds prescribed that the money benefit for wives
(not insured themselves) must not exceed one-half the rate paid to
women members, and the stay in the hospital must not exceed two
months (sec. 28 of the model by-laws).
(4) Funeral benefit: In case of death, a benefit of 20 to 80 times
the daily wage of the member is paid. This benefit is intended to
cover burial expenses and is paid to the one who defrays the cost of
the funeral.
(5) The funds are permitted to grant benefits to the children, the
wife, and other dependents in the family of a member. These benefits
include medical aid of all kinds, cash benefit, funeral benefit, and, as
stated above, maternity benefit. The rates of these benefits to
1Rabotnitsa, vol. 1, No. 0 (May 24,1914), p. 8.

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members must be stated in the by-laws, but the total amount ex
pended annually for this purpose may not exceed one-third of the
total annual receipts from contributions and from subsidies of the
employer (article 43 of the law).
SOURCES OF INCOME.

The income of the sick funds is derived from (1) contributions of
members and subsidies of owners of establishment; (2) income from
such invested capital as the fund may possess; (3) bequests and dona
tions; (4) fines imposed on members for infractions of rules and fines
imposed on employers for failure to comply with the law as to pay
ments to be made from wages and on his own account; (5) miscel
laneous receipts.
(1) The contributions of the insured persons are fixed by the general
meeting of the members of the fund and may range from 1 to 2 per
cent of the wages; in funds with less than 400 members the dues may
be increased up to 3 per cent of the wage. If the daily wage exceeds 5
rubles (normally $2.55), or the annual salary exceeds 1,500 rubles
($765), the contribution is assessed at the rate of 5 rubles per day only.
The funds have the right to establish wage classes, with the dues at a
fixed percentage of each class. No dues are collected from a member
while she is in receipt of sick or maternity benefit or while she is
incapacitated for work. The contribution of the employer is twothirds of the amount paid by his employees.
(2) A certain part of the annual receipts of a fund must be put into
a reserve, and the interest from the reserve may be added to the
current receipts.
(3) The funds are authorized to receive bequests and donations; if
the donor expresses a.wish that they be devoted to a specified purpose,
such wish must be followed, otherwise such receipts must be added to
the reserve.
(4) and (5) Receipts from fines of all kinds must be added to the
reserve.
FINANCIAL ADMINISTRATION.

The contributions of the insured persons must be deducted from
their wages by the employer at each time of paying wages; the.employer must add his portion to the total and place the whole amount
to the credit of the fund. The income is divided into two parts—the
current income and the reserve.
The current income consists of the contributions of the members
and of the employers, less the percentage required for the reserve, the
income from the property of the fund and the miscellaneous receipts.
The reserve consists of a regular deduction from the contributions,
which must be fixed by the general meeting of the fund and which
may range from 5 to 10 per cent of the contributions. Receipts from

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fines and from bequests and donations without special designation
must be added to the reserve, while any surplus at the end of the year
must also be placed in this account.
As soon as the reserve equals the sum of the expenditures of the two
preceding years, the 5 to 10 per cent deductions from contributions
may cease, and the fund may reduce the per cent rate of the members
proportionately. If the income is not'sufficient tô meet the expendi
tures of any year, then the reserve must be drawn upon to cover the
deficit, and later arrangements must be made to build up the reserve
again. If the annual receipts prove insufficient to meet the expendi
tures of the fund, then the fund is authorized to increase the con
tributions above the legal maximum already referred to, but with
certain restrictions on the amount to be paid by the employer.
The safe keeping of the money and securities belonging to an estab
lishment fund is intrusted to the owner of the establishment. If the
fund includes the employees of more than one establishment, the
owners must select one of their number as the custodian of the fund’s
aSS6tS‘

GENERAL ADMINISTRATION.

If the employees of an establishment exceed 200 in number, a fund
for that establishment is to be created, but the owners of several
establishments may join in the creation of a common fund. If the
number of employees in an establishment is less than 200, then a
joint fund must be created or the establishment must affiliate with
an existing fund. A number of existing funds may consolidate at
any time if the approval of the workman’s insurance office of the
district is secured. The funds are authorized, either singly or in
cooperation with other funds, to establish and maintain ambulances,
hospitals, and maternity hospitals. The business of the fund is
transacted by the general meeting and by a board of directors.
The general meeting consists of delegates of the members and of
representatives of the employer. The representatives of the em
ployer shall have votes equal to two-thirds of the votes of the dele
gates. The employer or his representative shall preside over the
meeting. The board of directors is elected by the general meeting
anclmust consist of an uneven number of persons; the representatives
of the insured persons shall have one more vote than the repre
sentatives appointed by the employer. The business transacted by
the general committee and by the board are the usual subjects
intrusted to organizations of this Kind. Both the sickness insurance
and the accident insurance are under the immediate supervision of
a local workmen’s insurance office; this body is organized in each
province under the chairmanship of the governor, or in some places
under the mayor of a city or the chief of police of a city. Its mem-?
bers consist of the vice governor, the chief of the local internal

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R U SSIA .

revenue office, the district attorney or his deputy, the chief factory
„ ^ P ^ t o r , the medical inspector, a member appointed by the minister
of the interior, a factory inspector appointed by the minister of
commerce and industry, two representatives of the county council
(zemstvo), a representative of the city council, two representatives
of the employers, and two representatives of the insured persons.
Over these local insurance offices is the workmen’s insurance
council, attached to the ministry of commerce and industry. The
council is composed of the associate ministers of commerce and
industry, the director of mines, the chief of the division of industries,
the chief of the division of commerce, two members of the council
of commerce and industry, two representatives of the ministry of
the interior, one representative each from the ministries of finance,
justice, communications, and agriculture, one member of the medical
council, one representative of the Petrograd provincial council
(zemstvo), one representative of the Petrograd city council, five
representatives of the employers, and five representatives of the
insured persons. Both of these bodies are so large that their ex
perience up to the beginning of the war showed that they were too
large for efficient administration.
OPERATIONS.

The information available concerning the operations of the sickness
insurance system consists of fragmentary items appearing in various
unofficial publications; up to January 1 , 1917, no official report on
the administration of the law had been issued. Mme. A. Kollontaï
in her treatise quotes a statement appearing in the TorgovoPromyshlen Gazeta that on October 1 , 1914, the organization of the
insurance system had progressed to the following stage:
Status o f the sickness insurance fu n d s, Oct. 1, 1914.
Number
of funds. Membership.
130
26
2,723

79,745
30,123
1,992,179

Status.
Had elected representatives to draw up by-laws

BrtSffid K ,.pp°Sd°Sp“ ,0r

permit ,0 or*anl”

Status o f sickness fu n ds whose by-laws had received, official approval, Oct. 1, 1914.
Number
of funds. Membership.
2,540
2,396
2,207
2,106

1,901,516
1,827,217
1,699,752
1,621,975

Status.
Had elected representatives to the general meeting
Had elected boards of directors.
&
General meeting had approved schedule of benefits.
Had begun making deductions from wages and paying benefits.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

Typical instances of conditions in provinces and in certain funds
give some indication of the status of the sickness insurance system.
Thus in the Province of Novgorod in July, 1914, there were 218 fac
tories with 24,821 employees, of whom 22,945 were included within
the scope of the insurance; 19 of these factories had in their service
seven physicians, while the rest of the factories used city, county,
or private physicians. The factory hospitals were on the whole
inadequately housed, being located in places such as barns or m
attics above factory offices and not easily accessible. There were
178 cots in these hospitals. Of eleven factories employing more
than 100 women each, only four had in their employ a midwife,
though the law required each of them to provide such service.1
A typical instance of a fund connected with one establishment is the
fund of the factories of the Prokhorov Trekhgornaia Manufacturing
Co. of Moscow. In the period June 1, 1913, to January 1, 1914, the
operations were as follows:
The total number of members on January 1, 1914, was 7,770; of
these 7,437 were wage earners, consisting of 4,253 men and 3,184
women,’ while 333 were salaried employees, consisting of 277 men
and 56 women, or in all, 4,530 men and 3,240 women.
The number of cases of sickness is shown in Table XLIV.
Table X L IV .__Russia.

Cases o f sickness in funds o f Prokhorov Trekhgornaia M anu
facturing Co. o f M oscow, June 1 , 1913, to Jan. 1, 1914Days lost.

Cases of sickness.
Kind of case.
Total.

Men.

Women.

Total.

Men.

Women.

2,162

900

1,262

26,698

12,327

14,371

1,826
69
267

839
61

987
8
267

24,061
1,055
1,582

11,366
961

12,695
94
1,582

It will be noted that for the 4,530 men there were 900 cases of
sickness, or about 20 per cent of the male members; for the 3,240
women there were 1,262 cases of sickness, including confinements,
or about 40 per cent of the women members, though without the
confinements it would be 30 per cent of the women members. For
each male member there were 2.7 days of" sickness, and for each
woman member there were 4.4 days of sickness. The figures given
show that the 267 confinement cases caused a loss of time of 1,582
days, or 5.9 days per case.
In this fund the dues of the members consisted of 1 per cent of
their wages. The rates of benefits were: For sickness, one-half of
i Strakhovanie Rabotehikh, February, 1915, p. 18.

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173

daily earnings per day of disability; maternity, the same rate per
day of disability; for death, thirty days’ wages.
The receipts and disbursements of this fund for the period reported
are shown in Table X L V .
T

a b le

Receipts and expenditures o f the fund o f the Prokhorov Trtkhgomaia Manufacturing Co. o f Moscow, June 1 , 19IS, to Jan. 1 , 1914.

X L V .— R u s s ia .

Source.
Total..............................
Contributions of members:
(a) Men.........................

Object of expenditure.
Total.............................
Total expenditures..................
Sick benefits...................
Maternity benefits..................
Accident benefits................

Receipts.

Source.

$13,131

Contributions of employers .
Reimbursement by employer tor acci
dent benefits paid out by sickness fund.
Interest on funds..........

5,390
2,301

Expend
itures.
$13,131
9,305
5,126
1,639
294
792

Object of expenditure.

Receipts.
$5,128
295
17

Expend
itures.

Salaries of executive board * __
Printing expenses................
Stationery......... ..
10 per cent deduction for reserve fund.

1,282

Surplus added to reserve fund (sec. 26
of Dydaws).....................

3,826

$108
52

freaeEbyPthT^pl°oyedrminiSter * * (bookkeepers and controllers) were furnished to the sick benefit fund

In general the wage-earning population seems to have been ea<mr
to introduce the system as soon as possible and with benefits as large
as the law permitted. As a rule they asked for the organization of
large funds i. e., one fund for each city instead of funds restricted
to one establishment, because this type of organization tended to a
larger measure of self-government. They were successful in estab
lishing such funds in Kiev, Odessa, and Riga, but in the very W e
industrial centers, Petrograd, Moscow, etc., they were not so sue
cessful; in fact these localities lagged behind the others in intro
ducing the insurance.
‘
In the literature available in the United States there are frequent
references to the hostility of the police to the meetings of wage earners
! m ° r^ nlzmg funds* In Petrograd, for example, prior to September,
1913, the employees of only 7 factories were permitted to hold meet
ings and organize, while in 14 factories such meetings were prohibited 1
As insurance laws were under the control of the ministry of commerce
and industry, this body would authorize meetings and the election of
representatives to the general meeting of the fund. The ministry of
the interior, which controls the police system, refused, however to
recognize these permits. Thus the members elected to the board of
directors of the Putilof Works at Petrograd were exiled, even though
the search of their dwellings had produced no evidence of conspiracy
1Strakhovanie Rabotcbikh, September, 1013, p. 27; November-December, 1913 p. u .

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M A T E R N IT Y B E N E F IT S Y S T E M S .

or anything in the nature of illegal literature.1 These arrests and
exiles were inflicted on thousands of wage earners. The situation
caused many strikes and protest meetings of the wage earners, and
the resulting dissatisfaction was so great that the Moscow manu
facturers petitioned the ministry of the interior, through the Council
of the National Manufacturers’ Conventions, to stop these baseless
-prosecutions.2 The manufacturers protested that they and their
employees had worked otit a compromise agreement as to the carrying
out of the insurance law, and these arrests were destroying this
agreement. On August 13, 1915, an interpellation was addressed
to the minister of commerce and industry by 31 members of the
Duma, who pointed out that the first election of the 5 workmen
representatives and their 10 alternates to the council on workmen s
insurance had taken place on March 2, 1914, in accordance with the
decree of October 1, 1913, and that since that date arrests and
deportations of the workmen members had continued, so that out
of the 15 persons elected only 9 were left, even though the law pro
vided that this number should never be less than 10, and that similar
conditions prevailed in the Petrograd local insurance office. The
interpellation demanded relief from these abuses from the minister
of commerce and industry. The Duma adopted this interpellation
by a unanimous vote.3 According to information available, the
outbreak of the war seriously retarded the development of the
insurance and caused many of the existing funds to restrict their
operations. Thus in Riga, joint sick benefit fund No. 51, which
included 60 industrial establishments, on July 1, 1914, had 18,583
members; on September 1 it had 15,725 members. The benefit
fund of the Provodnik Rubber Works of Riga had 14,868 members
on July 20, 1914, while on September 1 it had only 6,956 members.
A serious decrease in wages also took place; thus in joint fund
No. 51, the average monthly earnings of the members in May, 1914,
were 33 rubles ($16.995); in September this average had decreased
to 18.39 rubles ($9.42). This decrease of earnings of course caused
a decrease in the receipts of the funds, so that in a number of them
there was a deficit; as most of the funds had assessed their members
2 per cent of wages, the maximum allowed by the law, there was
nothing to do but decrease the benefits. Thus the Provodnik Rubber
Works Fund decreased the sick pay from two-thirds of the daily wage
to one-half of that rate, while the maternity benefit was reduced
from 15 to 8 rubles ($7.73 to $4.12).
1Russkiia Vedomosti, Apr. 1,1914.
2Russkoe Bogatstyo, June, 1914, p. 266.
______.
s Fourth Duma: Fourth session. ZaiavlenieNo. 179. PrilozheniaNo. 34. IV. 4; also Duma. Stenografitcheskii otchet, 4 sozy o, seniia IV f Zasedanie V osmoe, Aug. 13,1916, p. 723.

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S O U R C E S O F IN F O R M A T IO N .

The text of the laws and decrees regulating sickness (including
maternity) benefits is found in the official journal Sobranie XJzakonenii. As this source is not readily accessible to most American
readers, a translation of the law will be found in the Bulletin of the
International Labor Office, English edition, volume 8 (1913), page
129 ff. The standard or model constitution and by-laws required
to be followed by the funds is given in the Sobranie Uzakonenii, 1913,
part 1, chapter 192. A journal devoted to social insurance, entitled
“ Strakhovanie Rabotchikh i Russii i na zapade,” published by
“ Priboi” inPetrograd since 1913, contains much current information
on the development and operations, of the insurance. The most
comprehensive study on maternity benefits and insurance which
has yet appeared in any language is the volume by Mme. A. Kollontal, Obshchestoo i Materinstvo. I. Gosudarstvennoe Strakhovanie
Materinstva.1
1 Stata Insurance of Uotharhood, Potrograd, 191#.

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SWEDEN.1
At the present time, under the law of December 6, 1912, voluntary
sickness insurance and mutual aid societies which provide maternity
benefits for their members are entitled to participate in a State
subsidy.
The law of 1891 prohibited the employment of women in industrial
establishments for a period of four weeks after childbirth; the effect
of this prohibition was seriously weakened by the provision that if
the woman presented a medical certificate stating that employment
would not be injurious to her she might resume work at an earlier
date. This law is in force at the present time.
Like other countries, there has been in operation for a long time a
number of voluntary organizations providing aid in case of sickness
or other disability, and in a few cases childbirth was given the same
aid as the usual types of sickness. Under the law of October 30,
1891, provision was made for the registration of such societies as
complied with certain minimum requirements. The amount of the
subsidy was increased by the amending law of May 27r 1898. Still
further changes were introduced by the laws of July 4, 1910, and
June 29, 1912. The two laws of 1891 and 1910 were the basic laws
under which the funds operated until January 1, 1916, when all funds
'were required to come under the 1910 law.2
The law of December 6, 1912, is entitled “ Royal decree concerning
State grants to sick funds which provide maternity benefits.” 3
The sick-fund system, like that of Denmark, is voluntary in char
acter and is based on two laws: The law on sick funds of October 30
# 1891, which went into effect on July 1, 1892, and the law on State
contributions ta sick funds of July 4, 1910, which was amended
on June 29, 1912. By the end of 1911 there were 2,216 sick funds in
Sweden, with a membership of 628,151, of which 1,969 funds with a
membership of 376,829, were based on the law of 1891, while the
remainder were based on the law of 1910. The following-year, 1912
the funds based on the old law had rapidly diminished, while the
number based on the new law had increased more than proportion
ately. After January 1, 1916, all funds are to be based on the new
law.4 The number of female members in 1912 was 172,537 out of a
total of 637,049, or 27.1 per cent, a proportion which has shown a
gradual increase since 1892.
The statements in this section are based on material furnished b y C. E. Stangeland Ph D
! Sociala Meddelanden, utgit av K . Socialstyrelsen, Stockholm, 1915, vol. 2 p. 997 ff ’
•Svensk Porfattningssamling, 1912, Stockholm, pp. 841-842.

4Sociala Meddelanden, utgit av K. Socialstyrelsen, Stockholm, 1915, vol. 2 pp 997-1002
1 13300°— 19-------12

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M A T E R N IT Y B E N E F IT S Y ST E M S .

The aid given to mothers in confinement has been strikingly small
and by isolated funds. In 1909, for example, such aid was given by
only 15 funds, affecting only 75 women, at a total expenditure of
984.03 kroner, or about $263. Eighty of the funds existing at that
time forbade giving benefits on a c c o u n t of childbirth, while 1,120
funds forbade giving sick benefit until from 3 to 12 days had elapsed
after the childbirth. The explanation is undoubtedly to be found m
the fact that in Sweden women have taken a much less active part in
sickness insurance than men, as is seen in the fact that they number
about one-fourth of the total, while in Norway and Denmark they
are about one-half of the total insured.1 Of the more than 2 000
sick funds in existence in 1909, 58 were for females only, and these
58 funds had a membership of 11,491; but more than 90 per cent o
all females belonging to sick funds belonged to such as contained
both male Rnd female members.
.
_ .
The official report on maternity insurance (p. 124) remarks that
“ the slight interest in the giving of aid to mothers during confine
ment has been due no doubt largely to ignorance concerning the
significance of the problem and the fear of overburdening the fund
by obligations, which it was believed would be the result of giving the
benefits desired * * *. People have ignored the fact that the
woman who is bedridden through childbirth is prevented from work
ing exactly as is the person who is affected by normal illness * * *.
People have even overlooked the possibility of a working woman's
health being so undermined by unavoidable hardships during and
preceding her confinement that the economy to the sick fund is
more than lost through normal sickness which may result and which
then entitles her to benefits."
#
The situation existing before 1913 caused much discussion. At
the first conference of the Swedish sick funds at Norrkoping, in 1905,
the committee on resolutions reported that “ women in confine
ment should receive sick benefits as in the case of other illness,
but the difficulties in the way seemed to the meeting to be too
great and it concluded that the question should be left to each fund
for individual action. The problem was taken up again at the
Stockholm conference in 1907, and at Gothenburg in 1910. The
last-named conference adopted a resolution to the effect that its
board of directors should give special attention to the problem of
maternity insurance and report thereon for the benefit of the members.
The following year (1911) in March, at a meeting of the society
for poor relief, resolutions were adopted urging that poor mothers
i See Betiinkande ang&ende inforande af Moderskapsforsakring, afgifvet den 19. Tee., 1911, BUiang till
Riksdagens Protokoll, 1912,2. Sami., 2. Aid., 5. Bandet, pp. 122-123. This is a report by experts for the
Swedish Government and is by far the most complete and varied study of the subject that has appeared
in Scandinavian countries. A summary of this report, by M. Marcus, one of the three experts engaged,
will be found in Annalen fur Soziale Politik und Gesetzgebung, 1912, pp. 562-567. See also Bulletin des
Assurances Sociales, 1914,1, pp. 148-149.

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179

be given aid in such a way that they be not separated from their
infants; that this purpose be attained through State maternity
insurance, and that bureaus to care for neglected children be estab
lished.
As a result of this growing agitation the question was made the
subject of considerable debate in the Riksdag, in 1911 and 1912,
and the report on the subject, to which reference has been made,
was the result of this agitation. The actual result was the law
which went into effect on January 1 , 1913, but concerning whose
operation nodetailed information was available on January 1,1917.
The Swedish report calls attention to the relief furnished to mothers
by free maternity homes and hospitals, free milk distributing
agencies and crèches. It calls attention to the general level of daily
wages prevailing for women from 15 to 49 years of age, the average
being 1.95 kroner ($0.52) for married and 1.79 kroner ($0.469) for
unmarried workers. This wage level is low and naturally suggests
what the minimum maternity benefit might or should be. Con
sideration was given to the rate of illegitimate as well as of legitimate
births among working women, and to the proper protecting of
illegitimates by protecting the mothers. Inasmuch as the illegiti
macy rate is higher in Sweden than in Norway or Denmark (it Was
15.46 per cent of total in 1912) and unmarried mothers are usually
of the poorer classes, the problem is really of considerable impor
tance from the point of view of maternity insurance and aid.1 The
report concludes with a discussion of compulsory and voluntary
maternity benefits and the special financial and other problems
involved, such as the effect on birth rates connected with the two
possibilities. As far as the financial aspect of the problem is con
cerned, the report undertakes by means of tablés to illustrate the
varying and increasing premiums as the birth rate varies or increases.2
Students of maternity insurance will find many valuable suggestions
in this excellent Swedish report, whose scope has been barely
indicated here, and also in the bills or laws proposed by the com
mittee responsible for the report and which are appended to it.
The decree of December 6, 1912, provides that a sum of 25,000
kroner ($6,700) be appropriated for division among the sick funds
registered under the law of July 4, 1910, which make provision for
maternity benefits to the extent of at least 90 ore ($0.24) a day for a
period of at least 14 days following childbirth to female members of
the sick funds, or for care of such members at maternity homes.
The amount of this subsidy has since been increased to 50,000 kroner
($13,400). The decree specifies that such benefits must be given
1Cf. Sverige Statistisk Ârsbok, 1916, p. 34.
2Cf. Sverige Arbetsstatistik, Meddelanden, 1912, vol. 1, pp. 108-116; also Kungl. Maj:tsnad. Proposition
Nr. 240, Apr. 26,1912, in Bihang till Riksdagens Protokoll, 1912,1. Samlingen, 9. Bandet.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

only to female members who were continuously insured for at least
270 days preceding the birth. From the sum providéd by the
State, 60 ore (about $0.16) is to be given to the sick fund for each
day during which maternity benefits are paid by the fund to its
female members, but such aid must not be granted by the fund in
addition to sick benefits, nor for more than 42 days all told for
each birth, nor for a longer period than the member remains away
from her employment. Contributions will not be made by the State
for female members who receive more than 4 kroner ($1.07) a day
as sick or maternity benefits from a fund, and contributions granted
must be used only in connection with maternity benefits qf the fund.
Applications for State contributions are to be made in connection
with application for contributions as provided in the sickness insur
ance law of July 4, 1910, supplemented by the decree of December
23, 1910.
The law as it stands provides an incentive of a psychological
rather than of a financial nature, since it is obvious that the small
sum to be distributed by the State can not cover a large number of
oases; the fact that such a law exists, however, calls continual atten
tion to the matter and has led to considerable extension of benefits
to' working women at childbirth. Data as to operation^ are not
available for the period since the decree was issued and a considera
tion of the actual effect is therefore impossible.
The commission prepared a bill for an independent compulsory
maternity insurance system which it recommended for adoption.
Though this bill was not enacted mto law, the proposal is of interest.
Under the plan recommended, all women prohibited by the industrial
code from employment after childbirth, who were from 15 to 51
years of age, should be included. The report suggested that at a
later time this group could be extended as experience showed the need
for increasing the scope of the insurance. The contributions of the
insured persons should be 2.16 kroner ($0.58) per year, to which the
emplover should add 50 per cent. The benefits should consist of (<z) a
cash benefit of 2 kroner ($0.54) per day for six weeks ; (b) a nursing
premium of 15 kroner ($4.02) for the mother who had herself nursed
the child. The total amount for a case of childbirth would thus be
87 kroner ($23.32). The bill also included a provision changing the
industrial code so that two weeks of the six weeks of prohibited em
ployment should come before the date of the birth. The State
would provide one-fourth of the cost of the cash benefit, the cost of
the nursing premium, and the costs of administrât1on. To be eligible
for the benefit, the mother must have been insured for 180 days
before the date of birth. The insurance carriers were to be the sick
funds, but in localities where no such fund existed the local govern
ment could administer the insurance. The sick funds were to re
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181

ceive from the State an annual fee of 0.5 kroner ($0,134) per insured
woman for conducting the insurance. As stated above, the bill was
not enacted.
S O U R C E S O F IN F O R M A T IO N .

The official law gazette of Sweden is entitled “ Svensk F o r f a t t W
sam mg, and contains the text of the laws and decrees mentioned
above. Current information on the operation of the insurance will
e ound m the official journal of the labor department, Sociala MedAelanden, and m the annual statistical yearbook, Statistik Arsbok.
The title of the report of the parliamentary commission on maternity
insurance was given above.

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SWITZERLAND.
Maternity benefits in Switzerland are provided under the Federal
law of June 13, 1911, granting subsidies to voluntary sickness insur
ance organizations. Operations under this law began on Januarv 1
1914.
J ’
By its law of 1877, Switzerland prohibited the employment of
women in industrial establishments during the period of childbirth, the
prohibited period consisting of eight weeks, two of which might come
before confinement. This act was the first national law of its kind
and has served as the model in many countries in this phase of factory
legislation.
The adoption of systems of compulsory sickness insurance by the
adjoining countries of Germany and Austria in the eighties exerted
considerable influence in Switzerland, and in order to open the way
for such legislation the national council proposed an amendment to
the Federal constitution, authorizing the enactment of an obligatory
system of sickness and accident insurance. The vote was taken on
October 12, 1890, and the amendment was adopted by a large
majority. Prior to this date, however, an effort was made to intro
duce a system of national medical service by which the Federal
Government should provide medical treatment and medicines to
needy persons in all parts of the Republic. This measure failed of
adoption in the Federal legislature, and the advocates of the plan
then devoted their attention to plans for compulsory sickness in
surance. After the acceptance of the Federal amendment, it was
not until 1898 that the advocates of an insurance system secured
agreement on a plan, and this was finally adopted by the legislature
in 1899. The act provided for a system of public local funds which
would compete with the existing private funds and included practi
cally all. wage earners. A referendum was called for by a sufficient
number of signatures, and when the vote was taken ifi 1900, the
measure was rejected by a large majority. Apparently the advo
cates of the act had not made sufficient allowance for the attachment
felt by many members for their mutual aid societies, some of which
had been in operation for a long time. In order to meet the wishes
of these members, it was decided to make the voluntary societies the
principal agencies for the administration of the insurance, and, as the
first step in this direction, to secure full information as to their ability
to do this work. An investigation of the scope and operations of the
existing organizations providing sickness insurance was made in 1903.
The report of this study by the Federal department of industry
183

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M A T E R N IT Y B E N E F IT S Y S T E M ».

showed that the mutual societies providing aid in sickness had had
th e fo llo w in g d e v e lo p m e n t:

Year.

Number of
societies.
632
1,085
2,006

Membersbip.
96,000
209,920
505,947

The great majority of these funds, 1,812 with a membership of
422,000 persons, provided relief for sickness; 190 provided other bene
fits such as burial expense, invalidity benefits, aid to widows and
orphans, etc. Of the membership, 359,000, or 76 per cent, were men;
90,000, or 21 per cent, were women; while about 2.5 per cent were
children. Most of the funds were located in the cities; only a few
existed in the rural districts, while there were practically none m the
mountainous regions, where the need was greatest. It was shown
that in the mountain districts it was always difficult and sometimes
impossible to secure a physician, especially in winter. In some of
these regions the fee for a physician’s visit was 20, 40, and even 50
francs. It was also shown that in the Canton Wallis, for instance,
about half of those who died were without medical attendance, while
in one community, 39 out of 42 deaths in a specified period occurred
without any physician being available. It is a reasonable inference
that the number of confinements without medical aid must also have
been large. The report also calls attention to the small proportion
of the women employed in factories who were insured in these funds.
In. 1901 there were 92,331 women employed in factories, or about
38 per cent of the factory employees; according to the 1903 study,
only about 7 per cent of the adult women in factories were members
of funds. The study showed that out of 100 funds, 57 refused to
admit women as members, 39 admitted both men and women, ^ hile
4 consisted of women only. The report stated that there was strong
opposition to the admission of women in a large number of these
funds In part, this hostility was due to the fact that women often
competed with men for the same jobs; in part, it was due to the fact
that the men did not like to have women present at their club meet
ings, but the most general objection offered was that women had a
higher sickness rate than men. In many cases it developed that the
lower earnings of the women made it impossible for them to pay the
dues of the societies. In 1903 but a very small number of the societies
paid benefits for childbirth; the general objection was that this benefit
caused a heavy expenditure. With these facts as a basis, the advo
cates of a system of State insurance prepared a bill which was intro
duced in December, 1906. It endeavored to meet the wishes ol the
members of the existing insurance organizations by providmg lor a

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S W IT Z E R L A N D .

185

system of sudsidies to the mutual aid societies, thus making insurance
voluntary; but it also provided that any Canton or any municipality
(commune) might make insurance compulsory either for all wage
earners, dr for certain occupations only, or for certain classes of wage
earners— such as those receiving low wages. It did require, however,
that Women must be admitted to the societies on terms of equality
v ith men, and to meet the objection that women had a higher sickness
rate it provided a higher Federal subsidy for women members.
Special subsidies were provided to secure medical service in the
sparsely populated districts. The maternity benefit and the benefit
for mothers who nursed their infants in the first 10 weeks, as stated
by the chairman of the committee in charge of the bill, were regarded
by them as one of the achievements of the measure. The bill was
finally passed by the legislature in 1911, but owing largely to the fact
that a system of compulsory accident insurance was also included in
the bill, some opposition to it developed and a referendum was called
for. The vote took place in February, 1912, when it was accepted
by a small majority. The act came into force on January 1 , 1914.
Up to the end of the year 1916, the following Cantons had enacted;
laws providing or authorizing some degree of compulsory sickness'
insurance, including maternity benefits: Zurich, law of December 10,
1916; Lucerne, law of March 2, 1915; Uri, law of April 7, 1914;
Zug, law of October 26, 1916; Solothurn, law of March 31, 1916;
Basel Zown, law of March 12, 1914'; Appenzell on the Rhine, law of
April 30, 1916; St. Gall, law of July 6, 1914; Graubiinden, amended
constitution of October 2, 1892, and November, 1907. A law of the
Canton Waadt of August 31, 1916, created a special sickness insurance
fund for school children, with benefits the same as those specified for
children in the Federal law. In four of the above-named Cantons—
Basel, Appenzell, St. Gall, and Zug— the laws provide for a cantonal
system, while in the others the laws authorize the communal govern
ments to provide a system for their inhabitants.
IN D U S T R IE S IN C L U D E D .

The funds which provide the insurance may include and, in fact,
are supposed to cover all varieties of industries and occupations.
Any particular fund, however, may restrict its membership to one
occupation or one establishment; if a member changes her residence
or leaves an occupation or an employer and'can not find a new fund
for which she is eligible, then the fund of which she is a member must,
permit her to continue in membership so long as she resides in Switz
erland. Such a fund has the right to call on any fund in the new
place of residence to take charge of the collection of her dues, pay
ment of benefits, etc., for which any expenses incurred must be
reimbursed.

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Ig g ;

M A T E R N IT Y B E N E F IT S Y S T E M S .
P E R S O N S IN C L U D E D .

Every Swiss citizen, man or woman, has the right to become a
member of a fund, if he complies with the conditions of membership.
If the fund has restricted its membership to persons of a particular
religious denomination, or of a particular political party, this restric
tion may not be used to exclude a person who otherwise qualifies for
membership but who is not eligible for membership m any other
fund in that locality. In all funds, both sexes shall be granted equal
benefits unless there is a corresponding variation in the dues. Any
fund may, however, restrict its membership to persons of one sex
and may make admission dependent on the state of health of the
applicant. One of the questions brought up in the year 1915 related
to the matter of equality of sex prescribed by article 6 of the law.
A women’s fund objected to receiving a man as a member; the in
surance office ruled that since men’s funds were required to receive
women as members if the latter could not find a fund to which they
were eligible in that locality, then the women’s funds must likewise
receive men as members under these circumstances. As the question
was a matter of law, an appeal was taken to the Federal Council,.
which sustained the ruling.1 Since membership in the funds is vol
untary, the wife of a wage earner may be admitted into the funds on
the same terms as a wage earning woman and thus receive maternity
and other benefits. Children under 14 years of age may be included
as members of the funds, and the Federal Government evidently de
sired to encourage their insurance since it made the subsidy for chil
dren the same as that for an adult.
These funds (caisses scolaires) are most numerous in the Cantons
of Freibourg and Lausanne. Most of them, however, paid only a
cash benefit in case of sickness, against which strong opposition was
expressed in the legislature, so the subsidy was carefully restricted
to such funds as provided medical treatment and medicine in order
that there might be no possibility of pecuniary gain from the chil
dren’s sickness. The funds must see to it that none of their members
is insured in more than two sickness insurance funds and also that
the sick benefits do not become a source of profit to their members.
However, if a person held membership in more than two funds on
January 1,1911, the limitation of membership to two funds is waived.
D IS A B IL IT Y P R O V ID E D F O R .

: The health insurance section of the law provides benefits for sick
ness causing inability to perform labor. Childbirth is specifically in
eluded as sickness, and a mother who nurses her child is entitled to a
nursing benefit.
_________ ____________
i Report for 1915, p. 423.

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B E N E F IT S .

The benefits provided include (1) pecuniary benefit, (2) medical
attendance and medicines, (3) maternity benefit, (4) nursing benefit.
(1) The pecuniary benefit must be not less than 1 franc ($0,193)
per day; it must begin not later than the third day after the begin
ning of the sickness. In a period of 360 consecutive days, benefits
must be payable for at least 180 days; in other words, in any one
year, a member must be entitled to money benefit for half the time.
These amounts of course are the minimum benefits required of the
funds in order to be eligible to the Federal subsidies.
(2) Medical attendance and medicines must be provided from the
beginning of the sickness, and for at least 180 days out of each consec
utive 360 days. If, however, these benefits are provided for by a fund
for at least 270 of the 360 consecutive days, then the fund is not
required to pay more than 75 per cent of the cost of the medical
attendance and medicines. Free choice of physician is permitted.
fund may make a contract with physicians or with associations of
physicians for the treatment of members at fixed rates; in such case,
the members must select their physician from the panel made up of
these contract physicians. Any physician who has practiced in the
districtfor at least one year is entitled to participate in these contracts.
In the mountainous regions where communication is difficult
and the population sparse, if the public and compulsory funds have
made a contract with certain physicians, assuring to them a definite
annual payment, then other physicians may be excluded from thepanel.
A fund may call in a consulting physician, either on its own initia
tive or on the request of the attending physician or of the family of
the insured person.
The supply of medicines and drugs is regulated in a manner similar
to that of medical attendance. The insured person may select the
pharmacy from which he secures his medicines, but the funds have
the right to make contracts with pharmacists or associations of
pharmacists to supply medicines, etc., at fixed rates, and in such
case, the member must use one of the contract pharmacies. Any
registered pharmacist in the district of the fund may participate in
these contracts.
The funds may also delegate to a hospital the duty of supplying
the medicines.
In no case can the fund be required to pay unreasonable physician’s
fees or to pay for medicines or drugs not prescribed by the authorized
physician.
(3)
Maternity benefit: The funds must consider childbirth as sick
ness if at the time of confinement the insured person has been a
member of the fund for at least nine months without an interruption

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M A T E R N IT Y B E N E F IT S Y S T E M S .

in excess of three months. If she complies with these conditions,
then the pecuniary benefit, medical attendance, and medicine must be
provided her for at least six weeks. The law makes no mention of
inability to work during the period prior to confinement, and the
Federal official reports contain no information as to the practice of
the funds in this respect, but apparently members are entitled to the
regular sickness benefits at this time.
According to the official guide for the funds 1 these six weeks may
not be included in counting the maximum period for which benefits
are to be paid.
.
An effort is made to induce the mother to take a complete rest by
providing that if she returns to work before the end of the period dur
ing which she receives maternity benefit, the amount of her earnings
may be deducted from her benefits.
•
•'
(4)
Nursing benefit: The pecuniary benefit must be paid for at
least six weeks after the date of childbirth; if at the end of four weeks
after the pecuniary benefit has stopped, that is, at the end of a mbfi"
mum period of 10 weeks, the mother can prove that she has herself
nursed the child, a lump sum nursing benefit of at least 20 francs
($3.86) must be paid to her.
S O U R C E S O F IN C O M E .

As the system of insurance is based on the plan of subsidizing
voluntary organizations, the sources of income consist, for all practical
purposes, of the dues of the members and the subsidy of the Federal
Government. The Federal subsidy consists of the following annual
payments:
J
^
^
1. For each insured child, up to and including the fourteenth year
of age, 3.5 francs ($0,675).
2. (a) If the fund provides either medical care and medicme or a
cash benefit .of not less than 1 franc ($0,193) per day, 3.5 francs
($0,675) for each male member and 4 francs ($0,772) for each female
member. (6) If the fund provides both medical care and medicme
and a cash benefit of not less than 1 franc ($0,193) per day, 5 francs
($0,965) per member. If the fund provides benefits for at least
360 days out of any consecutive 540 days— that is, for a .full year out
of any year and a half— then all of the above subsidies are increased
by 0.5 franc ($0,097) per member annually.
The subsidy for each case of confinement consists of 20 francs
($3.86) per case; an additional 20 francs ($3.86) is paid for the
nursing benefit. In other words, the Federal Government pays the
entire cost of the minimum pursing benefit; if the fund provides the
minimum maternity benefit of 1 franc per day for six weeks, or 42
i Wegleitung, p. 43.

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S W IT Z E R L A N D .

189

francs, the Federal subsidy of 20 francs defrays nearly half of the
cost.
The total amount of the annual subsidies paid by the Federal
Government on account of these- benefits may not exceed one-half of
the receipts from members’ dues and donations to current expenses.
If a member is insured in more than one fund, the subsidy shall be
paid only once, and to that fund in which he has held membership
for the longest time.
^
In the mountainous districts, already referred to, where communi
cation is difficult and the population sparse, the Federal Government
pays an additional subsidy of 7 francs ($1.35) per annum for each
insured man, woman, or child. Furthermore, in these districts the
Federal Government pays an additional subsidy to the canton for its
own use, or to be turned over to its communes, on behalf of hospitals
or other institutions which provide treatment and care for cases of
sickness and for cases of maternity. These institutional subsidies,
however, must not exceed the total amount received by the institu
tion from the canton, the commune, and from third persons, nor may
the subsidies exceed 3 francs ($0,579) per capita of the population of
the district m which the institution operates. Th* Federal Govern
ment may also make the payment of the institutional subsidy con
tingent upon the creation of an insurance fund in the commune.
Where a canton or a commune declares insurance compulsory,
either for all occupations or for specified groups, and if the canton
or commune assumes the responsibility for the payment of the dues
of indigent persons under such insurance, then the Federal Govern
ment will reimburse payments on this account to the extent of onethird of such expenditure.
G E N E R A L A D M IN IS T R A T IO N .

The law provides that in general the sickness insurance funds may
organize in any manner they may desire, subject to certain requirements. The funds must have their headquarters in Switzerland,
Swiss citizens must not be less favorably treated than other persons,
and in particular they must operate as mutual organizations not con
ducted for profit. They may conduct other forms of insurance
besides sickness. They may restrict membership to persons of a
particular political party or religious faith, or to .the employees of a
particular establishment, or to a specified occupation, or to one sex.
However, any Swiss citizen who complies with the conditions of
membership must be admitted. If a Swiss citizen can not secure
admission to a fund in his place of residence, then conditions of
entrance based on political party or religious faith may not be used
to exclude him, provided that he is otherwise eligible.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

To become a “ recognized” sickness insurance society— that is, a
society entitled to the subsidies of the Federal Governm ent-the funds
must submit their constitution and by-laws to the Federal Council;
all modifications must be similarly submitted. If approved, then the
fund becomes entitle 1 to the subsidies, and by presenting its annual
statement of receipts, expenses, membership, etc., receives the sums
specified in the law.
,
The work of supervising the operations of the funds and of repre
senting the Federal Government is handled by the social insurance
office of the department of public economy (Office Fédéral des
Assurance Sociales du Département de l’Economie Publique
This
office was created by the decree of December 19, 1912, and began
operations on February 1, 1913. After orgamzation its first work
was the examination of the by-laws of the different sickness insurance
funds submitted by them as the first step in securing the approva
necessary to make them eligible for Federal subsidies. Themterpretation of the Federal law is also intrusted to the office, subject to
review by the department of pubhc economy and ultimately by the
Federal Council, if the matter at issue is a question of law. In gen
eral, the office grants recognition to funds, supervisés then* opera
tions, and must approve their accounts before the subsidy is allowed.
It also passes on violations of the law by the funds. The functions
of the office are prescribed by the decree of November 17, 1914.
O P E R A T IO N S .

The data relating to the operations of the recognized sickness
insurance are contained in the annual reports of the department of
public economy. The funds began operations under the law on
January 1, 1914, and the information available relates to the years
ended December 31, 1916. The number of recognized funds on
December 31, 1914, was 453; the report for 1916 shows that the
number had increased to 535 in 1915, and that this number included
funds with branches, so that the total number of funds at the close
of 1915 was 2,167. (See Table X L V L)

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T a b l e X LV I —Switzerland.

Number and membership o f sichness insurance funds.
according to kind o f benefits provided, Dec. 31, 1914, and Dec. 31, 1915.
[Source: Switzerland.

Bundesamt fiir Sozialversicherung.

Bericht. 1916, p. 7.]

Persons insured.
Kind of insurance.

Total..................... ........................

Year.

Number
of funds.
Total.

Men.

Women. Children.

1914
1915

453
535

361,621
428,879

243,030
281,296

93,772
115,259

Sickness only...........................

24,819
32'324

1914
1915

137
141

175,194
168,273

. 92,872
85,930

59,407
56,332

22,915
26,011

Sickness and death... .........................

1914
1915

302
357

179,363
242,026

143,675
181,714

33,791
54,680

1,897
5,632

Sickness, death, and old age...............

1914
1915

3
3

711
628

425
443

286
185

Sickness, death, old age, and invalidity.

1914
1915

4
10

2,215
6,885

2,183
. 6,038

25
836

Sickness, death, old age, and invalidity (wid
ows’ and orphans’).

1914
1915

252

225

Sickness, death, and old age (widows’ and or
phans’).

1914
1915

280

sickness, death, and invalidity (widows’ and
orphans’).

1914
1915

1,321

1,252

^ment8’ deattl’ invalidity, and unemploy-

1914
1915

883
890

Sickness, death, and invalidity................. .

1914
1915

5
14

3,134
4,588

2,938
3,409

1915

212

1914
1915

1
5

121
3,524

54
903

7
u

196
1,003

176

67
2,127

494

Sickness and deaths (widows’ and orphans’).. 1914
Sickness and invalidity..................... .

The greater part of the funds provide only sickness or sickness and
funeral benefit.
One of the interesting results of the law of 1911 is the inclusion of a
larger number of women among the insured persons. According to
the data collected in 1903 by the Federal department of industry, 57
per cent of the funds did not admit women to membership at that
time. The number of persons of each sex and of children insured at
the end of each year, classified according to the membership restric
tions, is given in Table X L V II.

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M A T E R N IT Y B E N E F IT S Y S T E M S .

Membership o f sickness insurance funds, according to
class o f members admitted, Dec. 81, 1914, and Dec. 81, 1915.

T able X L Y I I . — Sw itzerland.

[Source: Switzerland. Bundesamt für Sozialversicherung. Bericht, 1916, p. 8.]
Persons insured.
Persons admitted.

Year.

of funds.

Total.

Children.

1914
1915

453
535

361,621
428,879

24,819
32,324

1914
1915

5
7

2,200
2,931

1914
1915

73
87

147,986
169,885

22,619
28,989
404

1915

566

1914
1915

319
366

192,401
222,040

1914

1,534
1,269

1914
1915

50
70

17,500
32,188

Men.

Women.

243,030
281,296

93,772
115,259

75,722
81,008

49,645
59,8SS

149,808
168,100

42,593
53,940

102

1,534
1,209
17,500
32,188

Membership o f sickness insurance funds, according to
rate o f subsidy paid by the Federal Government, 1914-

T able X L V I I I .— Sw itzerland.

[Source: Switzerland. Bundesamt für Sozialversicherung.

Bericht, 1915, p. 8.]
Insured persons.

Rate of subsidy.

Number
of funds.

Total.

Men.

Women. Children.

Total............... .....................................................

453

361,621

243,030

93,772

24,819

3.50 francs ($0.675) or 4 francs ($0.771............... ..........
4 francs ($0.77) or 4.50 francs ($0.856)...........................

158
78
119
28
70

101,798
131,111
30,185
10,078
88,449

80,339
72,045
21,270
8,101
61,275

20,250
38,904
8,856
1,977
23,785

1,209
20,162
59

5.50 francs ($1.06)..........................................................
Varying according to membership....... .............. ........

3,389

Membership o f sickness insurance funds and total
amount o f Federal subsidy, according to rate o f subsidy paid, 1915.

T a b l e X L I X .— Sw itzerland.

[Source: Switzerland. Bundesamt für Sozialversicherung. Bericht. 1916, p. 13.]
Insured persons.
Rate of subsidy.

5.50 francs ($1.06)..........................................................

Total.

Men.

364,056

231,649

87,952
125,798
46,628
•52,835
50,843

84,348
70,522
35,743
41,036

Women.
102,288
28,761
46,628
17,092
9,807

Amount
of
Federal
Children. subsidy.
30,119

$301,980

3,604
26,515

59,411
97,116
40,498
50,985
53,970

The funds open to women included all except 55 out of the total of
435, or 88 per cent, in 1914; in 1915 it was 85.6 per cent. In 1903,
women formed 21 per cent; in 1914 they formed 26 per cent; and in
1915, *27 per cent of the total membership. In the same period the

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S W IT Z E R L A N D .

193

proportion of children increased from 2 per cent to 7 per cent in
1914 and in 1915.
The subsidies paid by the Federal Government vary according
to the kind and the duration of the benefits (see article 35 of the
law). Tables X L V III and X L IX show the number of insured
persons classified according to the rate of annual subsidy paid by
the Federal Government per member in 1914 and 1915.
The report for 1916 gives the 1915 data in slightly different form;
the number of funds in each group, for instance, is not reported.
These tables can be best understood by noting the rates of sub
sidies listed on page 188. In 1914, out of the 93,772 women insured,
20,250 were members of funds entitled to receive an annual subsidy
of 3.5 or 4 francs per member; that is, there were 20,250 women
insured in 158 funds providing either medical attendance and medi
cine or a cash benefit of at least 1 franc per day. The second line
of the 1914 table shows that 38,904 women were members of funds
receiving an annual subsidy of 4 or 4.5 francs per member, which
means that they were members of 78 funds providing benefits for
at least 360 days in a period of 540 consecutive days.
The receipts and expenditures of the funds in the years 1914-1915
are given in Tables L and LI.
T able L .

Receipts o f the sickness insurance funds, 1914 and 1915 .

S w itz e r la n d .

[Source: Switzerland. Bundesamt fiir Sozialversicherung. Bericht, 1916, p. 16.]
Receipts.
Source.

Total..................................
Dues of active members............
Dues oi other members./.___
Subsidies of cantons........ .............
Subsidies of communes..........
Subsidies of employers:
(a) Regular. ; ......................
(6) Special...........................

T able L I .

S w itz e r la n d .

1914

1915

$1,519,671

$1,772,748

1,413,102
2,344
13,655
1,103

1,587,444
2,527
69,452
3,326

82,049
7,418

95,913
14,086

Expenditures o f the sickness insurancefunds, 1914 and 19 15 .

[Source: Switzerland. Bundesamt für Sozialversicherung. Bericht, 1916, p. 16.]
Expenditures.
Object of expenditure.
1914
Total......................... $1,448,135
Benefits for loss of tim e....
Physician’s services..........
Medicines...........................
Other curative means.......
Hospital treatment............

Expenditures.
Object of expenditure.

1,029,826
231,628
74,376
7; 903
70,713

• 113300°— 19------ 13

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Federal Reserve Bank of St. Louis

1915
$2,131,751
1,330,577
327,159
106,811
13'689
140,777

1914
Aid to convalescents___
-Funeral benefit..................
Aid to indigent members
Prophylactic measures. . . .
Cost of administration

a Not reported.

1915

$2,211
3,091
21,075

$3,207
8,091
26,615

5,902
1,410
(a)

4,573
2,046
169,205

194

M A T E R N IT Y B E N E F IT S Y S T E M S .

The amount of Federal subsidy claimed by the sick funds in 1915
for maternity benefits was 83,040 francs ($16,026.72) and for nursing
benefit 31,860 francs ($6,148.98). As the Federal subsidy is 20 francs
($3.86) for each maternity case, this means that 4,152 births were
granted benefits and that the nursing benefit was paid to 1,593
mothers in 1915.
The expenditures for maternity cases are included in the amounts
given for the items of the regular sickness benefits. The nursing
benefit oaused an expenditure of $3,091, but no statement is given as
to the number of cases receiving this amount. The total amount of
subsidies paid by the Federal Government was 1,424,094.50 francs
($274,850) in 1914 and 1,564,661.50 francs ($301,980) in 1915. One
of the principal purposes of the law was to encourage provision for
medical attendance and medicine for the wage earners of the country.
Apparently this feature is developing but slowly, for at the end of
1915, out of a total number of 535 funds, 214, or 40 per cent, provided
only a cash benefit for loss of time. There were 30 funds, or 6 per cent
of the total, which provided only medical attendance and medicines.
The rest of the funds made a practice of providing medical care and
medicine to certain classes of members, but replacing this with a cash
benefit to other members. The 1915 report mentions some complaints
from the funds in this connection, based on claims that the contracts
made with physicians were not working out satisfactorily.
SOURCES OF INFORMATION.

The laws and decrees of the Federal Government are found in the
official periodical Recueil Officiel des Lois et Ordonnances de la
Confédération Suisse, published at Berne. The circulars of instruc
tion and similar notifications are published in the official gazette,
Feuille Fédérale de la Confédération Suisse, also published at Berne.
The annual reports of the working of the insurance are given in the
Rapport du Conseil Fédéral à l ’Assemblée Fédérale sur sa Gestion;
this volume is a collection of the reports of all the departments and
the Report of the Federal Office of Social Insurance is included in
that of the department of public economy (prior to 1915 called the
department of commerce, industry, and agriculture). An English
translation of the law of June 13, 1911, is given in the bulletin of the
United States Bureau of Labor, No. 103, August 1, 1912. Some of
the more important decrees are also given in the English edition of
the bulletin of the international labor office.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

B IB L IO G R A P H Y .

GENERAL SOURCES.
OFFICIAL.
Annuaire de la législation du travail, publié par l ’ Office du travail de la Belgique
1897 [to date]. Bruxelles, 1898 [to date].
Gives text (in French) of laws on labor of all countries.

U S . Bureau o f Labor.

W orkmen’s Insurance and Compensation Systems in Europe.

IU 24th AnnUal Report of the Commissioner of Labor, 1909.

1911

W ashington,

Contents.—Vol. 1. Austria, Belgium, Denmark, France, Germany. Vol. 3. Great Britain, Italy
Norway, Russia, Spam, and Sweden.
»
X»

TJ. 8 . Children’s Bureau.
Governmental Provisions in the United States and Foreign Countries for M em
bers of the Military Forces and Their Dependents.
tion of Capt. S. Herbert W olfe, Q . M ., U . S. R .
Washington, 1917.

Prepared under the direc
Miscellaneous series N o. 11

References are interspersed.
Laws Relating to Mothers’ Pensions in the United States, Denmark, and New
Zealand.
Dependent, defective, and delinquent classes series No. 1.
ington, 1914.

W ash

Contains list of references on mothers’ pensions, pp. 98-102.
Maternal Mortality from A ll Conditions Connected with Childbirth in the United
States and Certain Other Countries, b y Grace L . Meigs, M . D .
series, No. 6. Washington, 1917.

TJ. 8 . Public Health Service.

Miscellaneous

Health Insurance: Its relation to the public health.

Prepared under the direction of the Surgeon General, b y Benjam in S. W arren and
Edgar Sydenstricker. Public H ealth B ulletin No. 76.
Appendix I. British and German health insurance systems, pp. 71-73.

W ashington, 1916.

UNOFFICIAL.
Fischer, Alfons. D ie Mutterschaftsversicherung in den europäischen Ländern
2
Völlig umgearb. und erheblich erweiterte Aufl. Hrsg, in Verbindung m it dem
Institut für internationalen Austausch fortschrittlicher Erfahrungen
b. Leipzig, F . Dietrich, 1911. 69 p p ., including tables.

Gautzsch

“ Literatur und quellenangaben,” pp. 67-69.
Gibbon, loan G w ilym . Medical Benefit, a Study of the Experience of Germany and
Denmark. London, P. S. K in g & Son, 1912. 296 p p ., including tables
Kollontaï,

Aleksandra.

Obshchestvo i materinstvo.

Gosudarstvennoe strak-

hovame materinstva. Petrograd, 1916. [Society and motherhood.
surance of motherhood in different countries.]

I . State in

Maingie, Louis. L ’ assurance maternelle [aspect actuariel]. In Actes du viii congrès
international des assurances sociales. R om e, 1908. Vol. 2, pp. 437-453.
Manes, Alfred, editor.

Versicherungslexikon; ein Nachschlagewerk für alle Wissens

gebiete der Privat- und der Sozial-Versicherung insbesondere in Deutschland,
195

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

M A T E R N IT Y B E N E F IT S Y S T E M S .

196

Oesterreich und der Schweiz; unter Mitarbeiterschaft von Präsident Professor Dr.
v , d. Borght, Justizrat Direktor Dr. D om izlaff, [u. a.].
Mohr (P . Siebeck), 1909.
M ayet, Paul. Mutterschaftsversicherung.

Tübingen. - J. C. B .

*
In Actes du v in congrès Internationa

des assurances sociales. Rom e, 1908. Y o l. 2, pp. 391-436.
.
Rubinow, Isaac M ax. Social Insurance with Special Reference to American Condi
tions. New York. H . H o lt & Co., 1913.
______ Standards of H ealth Insurance. New York.
Chapter 7.

H . H o lt & Co., 1916.

Maternity benefits. Excellent résumé oí subject.

von Borosini, Victor.

W h at European Nations Are Doing in Matettiity Insurance.

In The Survey, 1914, p . 774.
Villard,

.
„ o
W orkm en’s Compensation and Insurance in France,

Harold Garrison.

H olland, and Switzerland.

A series of letters.

New Y ork , 1913.

AUSTRALIA.
OFFICIAL.
Bureau o f census and statistics.
M onthly Summary of Australian Statistics. Melbourne, 1912 [to date].
Gives current information on operations of the maternity allowance act.
Official Y e ar Book of the Commonwealth of Australia.
Contains section on the maternity allowance act.

Parliament o f the Commonwealth.

Melbourne, 1908 [to date].

Committee concerning causes o f death and invalidity

in the Commonwealth.
Report on Infantile Mortality.

Melbourne, 1917.

Report on Maternal M ortality in Childbirth.

40 pp.

Melbourne, 1917.

18 p p.

AUSTRIA.
OFFICIAL.
Am tliche Nachrichten des K . K . Ministeriums des Innern, betreffend die Unfall
versicherung und die Krankenversicherung der Arbeiter. W ien , KaiserlichKönigliche H o f- und Staatsdruckerei. 1889 [to date]. M onthly.
.
Soziale Rundschau. Hrsg, vom Arbeitsstatistischen A m te im K . K . Handelsmin
isterium. W ien , A . Hölder, 1900 [to date]. M onthly.
Official journal of the labor statistics office of Austria. Contains information on operation of insur
ance laws.

U. S. Bureau o f Labor.
W orkm en’ s Insurance and Compensation Systems in Europe.
fourth Annual Report of the Commissioner of Labor, 1909.
Contents.—Vol. 1.

_
2 vols. ^ In I w entyWashington, 1911.

Austria, Belgium, Denmark, France, Germany.

W orkmen’s Insurance in Austria, b y H enry J. Harris.
pp. 29-435, including tables.

Introductory matter and

[Reprinted from Twenty-fourth Annual Report

of the U . S. Commissioner of Labor, 1909.]

Washington, 1911.

Bibliography, pp. 434-435.

U. S. Bureau o f Labor Statistics..
Am endm ent of the Austrian Sickness Insurance Law.

In M onthly R eview , Sep-

tember, 1917, pp. 139-144.

UNOFFICIAL.
Manes, Alfred, editor.

Versicherungslexikon; ein Nachschlagewerk für alle Wissens

gebiete der Privat- und der Sozial-versicherung insbesondere in Deutschland, Oes
terreich und der Schweiz; unter Mitarbeiterschaft von Präsident Professor D r. v . d .

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

S
SS

1,“
:

” 1^

° tto-

D l- D “

[“ • M .

Tübingen, J. C. B . Mohr (P . Sie-

<^e8etze und Verordnungen fiber die Arbeiteryersicherung.

Cmv« d* a handbook „A m a to tews< regteatto,,

Vienna,

losw

BELGIUM.
OFFICIAL.
a -.-. ^

-Annuaire de la législation du travail, publié Dar
1897 [to date}. Bruxelles, 1898 [to date].

,
*a ® e* ^ u e-

Gives text (in French) of laws on labor of all countries.

Washington, 1911.

:° ff the
ftt cComm*sioner
peraation Sy9tems
»
of Labor,

1909.

Contents.—Vol. 1. Austria, Belgium, Denmark, France, Germany.

DENMARK.
OFFICIAL.
Sygekasseinspekt^rens indberetning til indenriesministorio*
n
v
date], [Annua! report of the i n a p e o t o r - g e n e ^ ^ i ^ ^

W ashington, 1911.

5898 [t°

â° f the Com™
s
f
System s “
o n e r of Labor, 1909.

Contents- V oI. 1. Austria, Belgium, Denmark,,France, Germany.

U u r a A . Thom p e o t S L nD
Æ

Prepared *

Contains a hst of references on mothers’ pensions, pp. 98-102.
u n o f f ic ia l .

Denmark*0

£S £ p“" ^

' 2 »

^ '

FRANCE.
OFFICIAL.

d e n a r i., m r Le
ports avec la puerpéralité
(N o. 35), p p. 2 7 ^ 9

p p. 285-287.

Tn R n iw i

/» B u l l e t m dee u r n e . de guerre, Jan. 1 ,1 9 1 7 (N o. 86),

Conseil supérieur du travail.

Allaitem ent mntprTtoi Q

port de M . A b e l Oaiesac, an non, “

enquête et documente.

q . 8 de m u m tions dans ses rap™ “ » de f » « ™ . Deo. 25, 1916

U letm “ “

" o

Parte, Imprimerie nationale!

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1816

t f
Proc^ ™ rbl» * .

M A T E R N IT Y B E N E F IT S Y S T E M S .

198
Laws, statutes, etc»

Assistance aux femmes en couches.

m
_
«
Loi du 17 juin 1 9 1 3 .-L o i de finances du 30

juillet 1913 (extraits).— Circulaire ministérielle du 9 août 1913.

Circulaire

ministérielle relative au repos obligatoire des femmes en couches travaillant
chez autrui (officiel du 15 août 1913), etc.

N ancy and Paris, Berger-Levrault,

Proposition de loi tendant à établir l ’ assistance maternelle obligatoire et à fixer
les indemnités et les primes de natalité et d ’ allaitement aux mères qui élèvent
elles-mêmes leurs enfants, présentée par M M . Ghesquière, Albert-Poulain,
A lbert Thomas, A ld y , Paul A ubriot, etc., députés.

Paris, Im pr. de la Chambre

des députés, 1912.
Renvoyée à la Commission d’assurance et de prévoyance sociales.

Ministère de l’intérieur, Direction de l’ assistance et de l’ hygiène publique.

Circulaire
relative aux instructions d ’hygiène qui doivent être remises aux bénéficiaires de la
loi instituant l ’ assistance aux femmes en couches.
1914.

Paris, 1914.

No. 109.

Pans, le 6 juillet,,

5 pp.

Ministère du travail et de la prévoyance sociale.

Bulletin.

Paris, 1895 [to date].

Monthly.
Gives current information on labor questions, including laws, decrees, etc., on maternity aid.

U 8 Bureau o f Labor. W orkm en’ s Insurance and Compensation Systems in Europe.
2 vols. In Twenty-fourth Annual Report of the Commissioner of Labor, 1909.
Washington, 1911.
Contents.—Vol. 1. Austria, Belgium, Denmark, France, Germany.

UNOFFICIAL.
Congrès international des assurances sociales,

comité permanent.

Bulletin

des

assurances sociales. Paris, 1889 [to date].
Contains studies by prominent writers on various aspects of social insurance, including maternity
insurance.
Gaym e, Louis.
die.

Travail et prévoyance; étude de l ’ assurance ouvrière contre la malar

Paris, F . A lcan, 1904.

Godart J.

D eu x lois sociales nouvelles (Loi du 17 juin, 1913, sur le repos des femmes

en couches ; loi du 14 juillet sur l ’ assistance aux familles nombreuses). In Questions
pratiques de législation ouvrière et d’ économie sociale (R evue mensuelle, Paris),
January-February, 1914, pp. 14-18.
M élin, Maurice.

L ’ assurance maternelle.

.
Paris, L . Larose & L . Tenin, 1911.

452 pp.

“ Bibliographie,” pp. 439-449.
Strauss Paul.
France).
1908.

V ol. 2.

V allin, A .

L ’ assurance maternelle (L ’ assistance et la mutualité maternelles en

In Actes du viii congrès international des assurances sociales.

Rom e,

pp. 455-467.

La femme salariée et la maternité.

Paris, A . Rousseau, 1911.

202 pp.

“ Bibliographie,” PP- vii-viii.
Villard, Harold Garrison.
H olland, and Switzerland.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

W orkm en’ s Compensation and Insurance in France,
A series of letters.

N ew Y ork , 1913.

B IB L IO G R A P H Y .

. 199

GERMANY.
OFFICIAL.
Great Britain Local Government Board, Intelligence Departm ent. Infant Welfare in
Germany during the W ar. London, H . M . Stationery Office, 1918.
Includes discussion of the special maternity benefits provided during the war.
H a m s , H enry J

The W orkm en’s Insurance Code (Reichs-versicherungsordnung)

1
A t r a c t i o n . Washington, 1911.
Bulletin 96 of the United States Bureau of Labor, pp. 501-774.]

[Reprinted from

W orkm en’s Insurance in Germany. Washington, M i l . [Reprinted from
Twenty-fourth Annual Report of U nited States Commissioner of Labor, dd 9751493, including tables.]
*5;
Bibliography, pp. 1491-1493.
Law s, statutes, etc.
Ausführungsbestimmungen zur Reichsversicherungsordnung vom 19. juli 1911
fur das R eich und die sämtlichen Bundesstaaten, zusammengestellt von Ernst
Funke und W alther Nernst. 2 vols. Berlin, F . V ah len ,1913.
Reichsversicherungsordnung vom 19. ju li, 1911. Berlin, Reichsdruckerei
pp. 509-860. (Reichsgesetzblatt, 1911. No. 42.)
Contents .—Reichsversicherungsordnung.

1911

Einführungsgesetz zur Reichsversicherungsordnung.

National Health Insurance Joint Committee (Great Britain).

Medical Benefit

u ^ e r the German Sickness Insurance Legislation. London, H . M.
Office, Darling & Son, L td ., printers, 1913. 42 pp. [Cd. 6581.]

Stationery

Reichsversicherungsamt.
Am tliche Nachrichten.

Berlin, 1885 [to date].

M onthly.

m S S S S S T 1' R u p o r i a l insurance offlw give, i ™ , decree,, etc., butuo et.tl.tire „ M e t Monatsblätter für Arbeiterversicheraug.
Hrsg, von Mitgliedern der ReichsVersicherungsamts. Berlin, 1907 [to date].
benefit?*13 ^

arÜCleS ““

WOrMng of tlle various features of the system, including maternity

Statistisches A m t.
Abteilung fü r ArbeiterStatistik.
Krankheits- und Sterblichkeits-Verhältnisse in der Ortskrankenkasse für
Leipzig und Umgegend. Berlin, 4 vo ls., folio.
to ^ aborJ e sJ^dy of toe sickness rates of the membership of the Leipzig Local Sick fund, 1887
to 1905. The data on maternity cases are given in vol. 1, pp. 198-201, and in vol. 4, pp. 256-278.
Reichs-arbeitsblatt, hrsg.
M onthly.

Berlin, C. Heym anns verlag, 1904 [to date!
J"

Statistik des Deutschen Reichs.
D ie Krankenversicherung.
U S . Bureau o f Labor.

1885 [to date].

Berlin.

W orkm en’s Insurance and Compensation Systems in Europe

2 vols. In Twenty-fourth Annual Report of the Commissioner of Labor 1909*
Washington, 1911.
’
Contents.—Vol. 1. Austria, Belgium, Denmark, Prance, Germany.

U . S . Public Health Service

H ealth Insurance: Its relation to the public health.

Prepared under the direction of the Surgeon General, b y Benjam in S. Warren and
Edgar Sydenstncker. Public Health Bulletin No. 76. Washington, 1916.
A ppen dix I.

British and German health insurance systems, pp. 71-73.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

200

M A T E R N IT Y B E N E F IT S Y S T E M S .

UNOFFICIAL.
Buckeley, August.

Zur Frage der Mutterschaftsversicherung.

Regensburg, G. J.

M anz, 1908.
‘•Literatur,” pp. 78-79.
Social Insurance in Germany, 1883-1911; its history,

Dawson, W illiam Harbutt.

operation, results, and a comparison with the National Insurance A ct, 1911. 10
illustrations. New Y ork, C. Scribner’s Sons, 1912. 283 pp. including tables, front.,
plates.
Fischer, Alfons.

Die Mutterschaftsversicherung in den europäischen Ländern.

Völlig umgearb. und erheblich erweiterte Aufl. Hrsg, in Verbindung m it dem
Institut für internationalen Austausch fortschrittlicher Erfahrungen. Gautzsch b .
Leipzig, F . Dietrich, 1911.

69 p p ., including tables.

“ Literatur- und quellen-angaben,” pp. 67-69.
_______ Fortschritte der sozialen H ygiene und sozialen M edizin.
soziale Politik und Gesetzgebung.

Berlin, 1911.

Fürth, Frau Henriette (Katzenstein).

In Annalen für

Band I , pp. 304-324.

D ie Mutterschaftsversicherung.

Jena, G.

Fischer, 1911. 220 pp.
“ Literaturverzeichnis,” pp. 215-220.
Gibbon, loan G w ilym .
' Denmark.

Medical Benefit, a study of the experience of Germany and

London, P. S. K in g & Son, 1912.

Manes, Alfred, editor.

296 p p ., including tables.

Versicherungslexikon; ein Nachschlagewerk für alle W is

sensgebiete der Privat- und der Sozial-versicherung insbesondere in Deutschland,
Oesterreich und der Schweiz;-unter Mitarbeiterschaft von Präsident Professor Dr.
v . d. Borght.

Justizrat Direktor Dr. Domizlaff, [u. a.].

Tübingen, J. C. B . Mohr

(P . Siebeck), 1909.
M ayet, Paul.

Mutterschaftsversicherung.

des assurances sociales.
M üller, Georg.

R om e, 1908.

In Actes du viii Congrès international

V ol. 2, pp. 391—436.

Die Anwendung des sogenannten Genter Systems auf die Mutter

schaftsversicherung.
Platz, W ilh elm .

In Soziale Praxis, Berlin, Jan. 16, 1913, p p. 449—453.

D ie reichsgesetzliche Mutterschafts-Versicherung.

T übingen, J. C.

B . Mohr (P . Siebeck), 1912. 119 pp.
“ Literaturverzeichnis,” pp. vii-viii.
Salomon, A lice. Mutterschutz und MutterschaftsversicheruAg- Leipzig, Duncker
& H u m blot, 1908. 99 pp. (Schriften des deutschen Vereins für Armenpflege und
W ohltätigkeit.

84. hft.)

Schreiber, A dele.

Mutterschaft; ein Sammelwerk für die Probleme des W eib es als

Mutter, hrsg. in Verbindung m it zweiundfünfzig M itarbeitern; Einleitung von
L ily Braun.

M it 371 Abbildungen, darunter 17 meistens farbigen Tafeln.

chen, A . Langen, 1912.

M ün

822 p p ., including illu s., plates, col. front., plates (part

col.).

GREAT BRITAIN.
OFFICIAL.
Local Government Board.
Maternity and Child W elfare.

Report'on the provision made b y public health

authorities and voluntary agencies in England and W ales.
Stationery Office, J. Truscott & Son, ltd ., printers, 1917»

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

London, H . M .

201

B IB L IO G R A P H Y .
National Health Insurance Com m ission {England).

Em ployed Married W om en Regulations, 1914, dated M ay 28,1914. [H . 0 .2 6 3 ,1 9 1 4 . ]
Handbook to the Administration of Sickness and Maternity Benefits b y Approved
Societies. Provisional Issue, Jan. 13 to July 14, 1913.
Married W om en ’s Special Benefits Regulations, 1912, dated Sept. 19, 1912 (pro
visional). [H . C. 309, 1912.] Draft dated Sept. 20, 1912.
Married W om en ’s Transfer V alue Regulations, 1914, dated M ay 22, 1914
2 61 ,1 9 1 4 .]
\

TH C

National Insurance Acts. Handbook for the use of approved societies (English
e d .). (Provisional issue rev. to August, 1915.) Edinburgh, H . M. Stationery
Office, N eill & Co., ltd ., printers, 1915. 324 p p ., including tables.
National Health Insurance Joint Committee.
Report on the Administration of the National Insurance A ct, Part I (Health
Insurance). London, H . M. Stationery Office, 1913 [to date].
6907; 1913-14, Cd. 7496; 1914-17, Cd. 8890.

1912-13, Cd -

Reprint from the Parliamentary Debates of A ll Questions and Answers in the
House of Commons Relating to the National Insurance A ct, 1911
Aug. 7, 1912.

Feb

14 to

Reprint from the Parliamentary Debates of A ll Questions and Answers in the
House of Commons Relating to National H ealth Insurance.
Mar. 7, 1913.

Oct

1912

The Statutes, Regulations, and Orders relating to National H ealth Insurance,
with notes, cross references, and an index. London, H . M. Stationery Office,
Sir J. Causton & Sons, ltd ., printers, 1916.
cluding tables.

Introductory and 679 p p ., in

Committee on Sickness Benefit Claims under National Insurance A ct.

National

Health Insurance. Report of the departmental committee on sickness benefit
claims under the national insurance act. London, H . M . Stationery Office,
Eyre & Spottiswoode,.ltd., printers, 1914. (5 v . in 3.)
The Appendix (4 v. in 2) includes minutes of evidence from Oct. 15, 1913, to May 22 1914
with index.
* *
’
Departmental Committee on Approved Society Finance and Adm inistration.
Interim Report [Cd. 8251].
Further Report [Cd. 8396].
Final Report [Cd. 8451].

JJ. S . Bureau o f Labor.
British National Insurance A ct, 1911.
series, No. 2. Washington, 1912.

W orkm en’ s insurance and compensation

W orkmen’s Insurance and Compensation Systems in Europe.

2 vols.

In T w enty-

fourth Annual Report of the Commissioner of Labor, 1909. Washington, 1911.
Contents.— Vol. 2. Great Britain, Italy, Norway, Russia, Spain, and Sweden.
U. S . Public Health Servicer Health Insurance: Its relation to the public health.
Prepared under the direction of the Surgeon General, b y Benjamin S. Warren and
Edgar Sydenstricker. Public Health Bulletin No. 76. Washington, 1916.
A ppendix I. —British and German health insurance systems, pp. 71-73.

UNOFFICIAL.
Broadbent, Benjamin. The Maternity Benefit.
June 20, 1914, pp. 336-337.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

In The New Statesman (London)
’

MATERNITY BENEFIT SYSTEMS.

202

Fabian Research Department.
ance A ct.

plement.
Harben, H . D .

Endowm ent of Motherhood.

23 pp.
Lloyd-George, David.
Exchequer.

Committee of Inquiry on the Working of the Insur

In The New Statesman (London), Mar. 14,1 9 14 .

Report.

Fabian tract No. 149.

London, 1910.

The People’ s Insurance, explained b y the Chancellor of the

3d ed., containing the text of the National insurance

together with explanations of the insurance commissioners.
York.

Special sup

Hodder and Stoughton, 1912.

act (1911),

London and New

303 pp.

Third National Conference on Infantile Mortality, London, Aug. 4 and 5 ,1 9 1 3 .
R e
port of the proceedings. London, National Association for the Prevention of Infant
Mortality and for the Welfare of Infancy, 1913.
W om en’ s Cooperative Guild.

Preface b y the R ight H on. Herbert Samuel.
211 p p ., ine. facsims.

456 pp. illus.

M aternity; letters from working women.

Collected.

London, G .-B ell and Sons, ltd ., 1915.

front., plates.

ITALY.
OFFICIAL.
Casa nazionale di 'previdenza.

Bollettino. Roma. 1910 [to date].
Bimonthly bulletin; includes information on the operations of the maternity insurance fund.

Casa nazionale di maternità.
per gli operai.

Sezione.autonoma della Cassa nazionale di previdenza

Rendiconto.

Esercizio 1912 [to date].

Parliament, Chamber of Deputies.
islatura X X I Y .

A tti Parlamentari.

Sessione 1914-1917.

Roma, 1913 [to date].
Camera dei deputati.

Documenti no. 757.

Leg

Conversione in legge

del decreto luogotenenziale 17 febbraio 1917, no. 322, concernente modificazioni
alla legge 17 luglio 1910, n. 520, per la istituzione di una Cassa di maternità.

Seduta

dell’ 8 marzo 1917.

[Roma, 1917. 10 pp.]
U S. Bureau o f Labor. W o rk m e n ’ s Insurance and Compensation Systems in Europe.
2 vols.

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Washington, 1911.
< , , ' * * *
Contents.—Voi. 2. Great Britain, Italy, Norway, Russia, Spam, and Sweden.
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Lavoro e maternità, studio etnico clinico e sociale; malattie pro

fessionali e gravidanza, relazione al X V I I Congresso della Società italiana di ostetricia
e ginecologia, Napoli, novembre 1912.

Roma, Stamperia reale, D . Ripamonti, 1914.

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UNOFFICIAL.
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du viii Congrès international des assurances sociales. Rom e, 1908. Voi. 2, pp.
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LUXEMBURG (GRAND DUCHY).
OFFICIAL.
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NETHERLANDS.
UNOFFICIAL.
v Villard,

Harold garrison.

H olland, and Switzerland.

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Federal Reserve Bank of St. Louis

W orkmen’ s Compensation and
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NORWAY.
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ton, 1918.

UNOFFICIAL.
Castberg, J.

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materinstvo.

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UNOFFICIAL.
M ay, John.

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Rom e, 1908, vol. 2, pp. 489-492.

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W egleitung

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August 1, 1912.

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UNOFFICIAL.
Manes, Alfred, editor.

Versicherungslexikon; ein Nachschlagewerk fü r alle Wissens

gebiete der Privat- und der Sozial-versicherung insbesondere in Deutschland,
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In

Some Problems of Sickness Insurance for W om en, b y M ary van K leeck .
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cities are doing to prevent infant mortality. WTashington, 1914.
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exam ple of methods of baby-saving work in small towns and rural districts.
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births in one calendar year, b y Em m a Duke. Washington, 1915.
No. 4. Infant Mortality, Montclair, N . J.: A study of infant mortality in a
suburban community. Washington, 1915.
No. 5. A Tabular Statement of Infant-W elfare W ork b y Public and Private
Agencies in the United States, b y Etta R . Goodwin.

Washington, 1915.

No. 6. Infant Mortality: Results of a field study in Manchester, N . H .,
based on births in one year, b y Beatrice Sheets Duncan and
Washington, 1917.
No. 7. Infant Mortality: Results of a field study in W aterbury,
based on births in one year, b y Estelle B . Hunter.

Duke!
Conn.,

Washington, 1918

No. 8. Infant Mortality: Results-of a field study in Brockton, Mass., based
on births in one year, b y Mary V . Dempsey. Washington, 1918.
No. 9. Infant Mortality: Results of a field study in Saginaw, M ich,
Nila F. Allen. Washington, 1919.
Rural Child Welfare Series.

No. 1. Maternity and Infant Care in a Rural County in Kansas, b y Elizabeth
Moore. Washington, 1917.
No. 2. Rural Children in Selected Counties of North Carolina, b y Frances
Sage Bradley, M. D ., and Margaretta A . W illiamson.

Washington

1918

No. 3. Maternity Care and the Welfare of Young Children in a Homesteading
County in Montana, b y Viola I . Paradise. Washington, 1919.
No. 4. Maternity and Infant Care in Two Rural Counties in Wisconsin
b y Florence Brown Sherbon and Elizabeth Moore.

Washington, 1919.

Miscellaneous Series.
No. 6. Maternal Mortality from All Conditions Connected with Childbirth
in the United States and Certain Other Countries, b y Grace L . Meigs
M. D . Washington, 1917.
5 ’

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

MATERNITY BENEFIT SYSTEMS.

206

U. S. Children?s Bureau — Continued.
Miscellaneous Series— Continued.
No. 10. Care of Dependents of Enlisted Men in Canada, b y S. Herbert Wolfe.
Washington, 1917.
No. 11. Governmental Provisions in the United States and Foreign Countries
for Members of the Military Forces and Their Dependents.

Prepared

under the direction of Capt. S. Herbert Wolfe,, Q. M ., U . S. R . Washington,
1917. 236 pp. including tables and diagrams. 6 pp. references inter
spersed.

U. S. Public Health Service.
Health Insurance: Its relation to the public health, b y B . S- Warren, surgeon,
and Edgar Sydenstricker, public health statistician. 2d ed. Prepared b y
direction of the surgeon general.

Public Health Bulletin, No. 76.

W ash-

ington, 1916.
Appendix i. British and German health-insurance systems, pp. 71-73.
Annendix n. Tvpical sick-benefit funds in the United States, pp. 74-76. ^
. _.
Appendix m. Health-insurance standards. Recommended by the committee on social insur
ance American Association for Labor Legislation, p. 77.
, TT ., .
Appendix rv. Recommendations as to health insurance. From the staff report to the Lrnted
States Commission on Industrial Relations, pp. 78-79.
Sickness insurance: Its relation to public health and the common welfare, b y
B . S. Warren, surgeon. [Reprint No. 250 from the public health reports, vol.
30, No. 2, Jan. 8, 1915.]

Washington, 1915.

UNOFFICIAL.
Am erican Association for Labor Legislation.
The American Labor Legislation R eview .

Quarterly.

New Y ork City.

1910'

^Contains many discussions on health insurance, including plans for maternity benefit. Also
numerous bibliographies. Gives texts and arguments for the bill drafted by the association on a
system of health insurance, for the United States.
■
Health insurance: Standards and tentative draft of an act. New Y ork, 1916.
32 pp.
Explanation of the provisions of the association’s bill.
_
Proceedings, First American Conference on Social Insurance, Chicago,^ 111.,
June 6 and 7, 1913. In American Labor Legislation R eview , vol. 3, No. . 2;

also in American Association for Labor Legislation, Publication 21, June, 1913,
pp. 145-292, which contains select bilbliography on social insurance, pp.
285—292.
Frankel, Lee K .

Maternity Insurance.

In New York Medical Journal, Dec. 18,

1 91 5 Also p rin ted separately b y Metropolitan Life Insurance Co., New York, 1916. 24 pp.

Lathrop, Julia C.

Public Protection of Maternity.

In American Labor Legislation

R eview , vol. 7, No. 1.
Rubinow Isaac M a x .- Social Insurance, with special reference to American condi
tions. New Y ork, H. H olt and Company, 1913. Introductory and 525 pp.
_______ Standards of Health Insurance. New Y ork, H . H olt and Company, 1916.
Introductory and 322 pp.
Chapter 7, Maternity benefit.

Seager Henry Rogers.

Excellent r&umfi of subject.

Social Insurance, a program of social reform. • The Kennedy

lectures for 1910, in the School of Philanthropy, conducted b y the Chanty Organ
ization Society of the City of New Y ork.

American social progress series.

New

Y ork, The Macmillan Company, 1910. Introductory and 175 pp.
Contents.— The common welfare.—Industrial accidents, illness, and premature death: preven
tion -Industrial accidents, illness, and premature death: compensation.-Unemployment: causes
and’rem edies.-P rovision s for old a g e .-N e x t steps in social advance.

von Borosini, Victor.

In The Survey, 1914, p. 774.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

W h at European Nations are Doing in Maternity Insurance.

Full text of Maternity Benefit Systems in Certain Foreign Countries, Legal Series No. 3, Bureau Publication No. 57

FRASER