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Enfermería Global

On-line version ISSN 1695-6141

Enferm. glob. vol.17 n.49 Murcia Jan. 2018  Epub Jan 01, 2018

http://dx.doi.org/10.6018/eglobal.17.1.263381 

Originales

Nursing and social control: the health and welfare activities of the Women’s Section of the Falange in the city of Valencia (1940-1977)

José Manuel Maceiras-Chans1  , María Eugenia Galiana-Sánchez2  , Josep Bernabéu-Mestre2 

1Enfermero. Alumno del Programa de Doctorado de la Universidad Jaime I de Castellón. España.

2Grupo Balmis de Investigación en Salud Comunitaria e Historia de la Ciencia. Universidad de Alicante. España.

ABSTRACT:

Objective

To analyse the health and welfare activities carried out by social health visitors and rural health advisors of the Women’s Section (in Spanish: Sección Femenina, S.F.) in the city of Valencia.

Materials and method

This study combined a qualitative and quantitative approach. A literature search was conducted to identify studies related to the history of nursing and the activities of the Women’s Section during the first stage of the Franco regime. The main source of information consulted was the collection of files deposited in the Archives of the Kingdom of Valencia (Spanish initials: A.R.V), the Inventory of the Women’s Section (Spanish initials: S.F.I.) (1940-1977), concerning the activities carried out by this organisation in the city of Valencia, as well as the reports submitted by nurses to their local directors and by these to the national director.

Results

The activities carried out had ideological and political nuances and were related to four areas of action: health, society, health education and religion. Particular importance was given to the fight against infant mortality, within the context of the pro-birth policies of the first stage of the Franco regime. However, these activities declined over the period studied due to a lack of professional resources and incentives, together with the Women’s Section’s loss of political influence.

Conclusions

The findings underscore the complexity of the functions assigned to social health visitors and health advisors within the Women’s Section, and also demonstrate the influence exerted by the socio-political and ideological context on the performance of these same functions.

Keywords: Nursing; social control; Women’s Section of the Falange; first stage of the Franco regim; Valencia (Spain) 1940-1977

INTRODUCTION

Spanish nursing was not immune to the social and political decline ushered in with the inauguration of the Franco dictatorship after the end of the Spanish Civil War1)(2. Against this backdrop, a major reversal occurred with respect to the progress that had been achieved in institutionalising nursing in the first decades of the twentieth century and particularly during the Second Republic3)(4)(5. The post-war period and the early Franco years were characterised by a proliferation of official bodies involved in nursing, leading to marked professional dispersal. Among the major developments at the time was the emergence of the Women’s Section of the Falange and its attempt to monopolise nursing, one of the fields in which women had attained most professional recognition6) but which was also considered a key area for achieving the social and political control of the population7)(8)(9.

In a monograph published in 1941, the National Delegation of the Women’s Section of Falange, the only official and fascist party (also know as FET y de las JONS or simply Falange)10 described the formation of the “Nursing Corps of the FET y de las JONS”, and indicated that as with hospital nurses, the “creation of the social aid scheme, with its canteens, nursery schools, crèches, dietary kitchens, etc.” would entail training community nurses as social health visitors and child care nurses in order to cope with the demand generated by the new services and agencies.

Social health visitors were assigned home care activities “for the purposes of aid and assistance, education or inspection, to locate the source of infection or main focus of an epidemic and the living conditions of a family”. They also had an obligation to identify the “economic, nutritional, occupational and living needs” of families from medical and welfare records, and determine how these could be met by social aid resources. Meanwhile, child care nurses were fundamentally assigned an “educational and instructional” mission in nursery schools, homes and schools. These two categories of social nurse were subsequently joined by a third, the rural health advisor. Of major importance among the tasks assigned to the three categories of community nurse was their role in fighting infant mortality “through suitable instruction and education in the fundamental principles of child care”, as promoted by the Franco regime’s population policies aimed at increasing the birth rate and reducing infant mortality rates11.

As indicated in the closing ceremony of the IV National Council of the Women’s Section, held in Toledo in January 1940: “Franco has entrusted you with an important task in relation to health and moral policy: to care for Spain’s mothers and children. Ultimately, a nation’s most powerful tool is its population policy”.

Community nurses played an important role not only in specific actions such as the “Week against Infant Mortality”, which was held on October 1st to coincide with the “Day of the Caudillo” (Title by which Franco was known, meaning military and political leader), but also in more long-term activities such as the monthly child care radio broadcasts aimed at “providing mothers with essential knowledge on caring for their children correctly”. In line with international guidelines on public health and child care nursing12, community nurses were required to supplement these campaigns against infant mortality by “visiting every Spanish household with an infant, to persuade mothers, through appropriate explanations, that they should take their children to a child care clinic so that their diet and growth can be monitored”.

Within the international context, one of the features of nursing under the Franco regime was its gradual distancing from the guidelines issued by international organisations such as the League of Nations and the WHO, and its increasing isolation from the outside world. Although these guidelines were observed to some extent in the early stages of Francoism -partly due to the efforts made in this area during the Republican period, which continued to influence institutions and professionals- they were increasingly disregarded in later years13.

Social nurses working in the cities served “under the orders of doctors involved in the tuberculosis campaign, child care, social aid, health centres or housing inspection” and “all other places where their services are needed”. They were required to visit houses “assigned to districts and services”, and submit a “family register” to their superiors at the Women’s Section, giving details on the “economic, health and moral situation of each family, and stating the needs remedied”. Another of their assigned tasks was to administer the treatment prescribed by doctors and manage the necessary resources and medicines. The idea was that their work would provide “complete figures on tuberculosis, infant mortality, homes without sanitation and unemployed workers, containing whatever data were of interest to the different centres”. In addition, they were required to undertake “vaccination and disinfection campaigns, under the orders of the health authorities” and to “give households the moral support of the Falange”.

To conduct a historiographical evaluation of these questions, we consulted studies that have examined the philosophy, ideology and purpose of the Women’s Section of the FET y de las JONS14)(15)(16) as well as case studies of the activities the Women’s Section carried out in different parts of Spain through its programmes and departments17)(18)(19)(20)(21.

As regards the health and welfare activities of the Women’s Section, and in particular the work of Falange nurses, various studies have explored the socialisation of these22)(23) but there remains a need to conduct an in-depth analysis of the tasks they performed and the context in which they did so.

The aim of the present study was thus to overcome this historiographical lacuna by investigating the role played by health visitors and educators affiliated to the Women’s Section in the city of Valencia. Our goal was to determine the extent to which the objectives of the scheme summarised above were achieved and to analyse the health and welfare activities carried out.

MATERIAL AND METHODS

This study combined a qualitative and quantitative approach. We conducted a literature search to identify studies related to the history of nursing in the contemporary period and to the activities of the Women’s Section, in order to contextualise the research and the results obtained.

The main source of information consulted was the Inventory of the Women’s Section (1940-1977), a collection of files deposited in the Archives of the Kingdom of Valencia. This collection basically contains the reports drawn up by the “Women’s Section Governing Body” based on the information submitted by social health visitors and rural health advisors. We also consulted correspondence (letters and official communications) between the national director and the provincial delegate of the Women’s Section in Valencia responsible for the Department of Health and Welfare. Based on the information obtained from these sources, the results have been grouped into three periods: 1950-1958, 1960-1964 and 1965-1976.

RESULTS AND DISCUSSION

The sources consulted shed light on the work carried out in the city of Valencia by social health visitors and rural health advisors in four areas: health care, welfare, health education and religion.

From an organisational point of view, a report on the health and welfare work carried out by the Women’s Section in the city of Valencia indicated that such tasks were coordinated by the Department of Dissemination, and that social health visitors and rural health advisors were distributed among the ten districts into which the city of Valencia was divided (Patriarca, Catedral, Gran Vía, Ruzafa, Devesa, Jesús, Botánico, Zaidía, Exposición and Marítimo):

“In the strictest sense, health care and assistance for the needy is run by the Department of Dissemination. This department has two target populations: an internal one, the organisation’s affiliates, and an external one, those social classes most in need or which, for various reasons, have found no support from any of the many welfare agencies. The Women’s Section has 104 nurses in the capital. Care in the capital is dispensed by district: requests for assistance are presented in each district and social health visitors are responsible for reporting on the veracity of the case and the needs of the applicants”24.

In the first of the periods considered (1950-1958) (see Table 1), the sources consulted provided data on the activities of the Women’s Section staff, including social health visitors and rural health advisor. Of these, some twenty-four people per year were listed as colleagues, without specifying qualifications or tasks performed. The mean number of social health visitors was nine per year and that of rural health advisor was two in 195325) and one in 195526. The term “colleagues” probably referred to the educators.

Table 1 Health and welfare activities carried out by the Women’s Section in the city of Valencia from 1950-1958. 

Year 1950 1951a 1952 1953 1954 1955 1956 1957 1958
Home visits 4819 959 7762 10993 9856 9283 8655 9481 8962
Vaccines 1316 32 695 748 386 1910 524 229 352
Treatment and injections 8412 1358 2106 9506 10393 9808 8547 6606 5685
Inspection 251 624 2183 2845 2433 2559 2338 16557 4429
People helped 1040 450 1982 4330 2787 5920 3621 12868 6261

Source: by the authors based on health visitors’ and educators’ reports on activities carried out, submitted to the local director of the Women’s Section.a Only data referring to December were available for 1951.

As can be seen in Table 1, activities during this first period were grouped into four main areas: home visits, treatments administered (distinguishing between vaccines and injections), actions classified as inspection and the assistance provided. This latter included food, medicine, clothing and other items such as layettes, which contained “a navel dressing, a vest, a jacket, slippers, trousers, a dress, nappies, a sweater and a scarf”. These were given to any new mother who requested one through her contact or advisor, although in accordance with the social and religious control that advisors and social health visitors were obliged to exercise, she was required to “present a certificate of marriage by the Church”.

Another concept included in assistance was “those specific medicines not provided by health insurance and which must therefore be purchased by the sick”, highlighting the exceptional problems surrounding the purchase of antibiotics such as streptomycin and the high prices they commanded during this first period 27.

Several documents contained complaints about the lack of resources necessary to carry out the tasks assigned to advisors and social health visitors. More financial resources were requested, and their lack was blamed for preventing admission of people with pulmonary tuberculosis to sanatoria and short clothes for babies and medicines. A report from 1953 summarised the basic deficiencies encountered while also revealing the dual health and moral principles that underpinned many of their actions. Specifically, the following was requested 28:

“Affordable housing to separate the high number of people who live in crowded conditions, with serious consequences for morality; and mattresses and sheets to separate people living together due to lack of inexpensive housing, to avoid the increasing problem of overcrowding among families who sublet in order to pay high rents, but which sometimes leads to terrible cases of immorality”.

Among the sections included in the reports were tasks related to family care, and more specifically to moral and religious activities. Previous research has explored the influence of religion on nursing under the Franco regime as regards the activities, training and very definition of the discipline29. Among other factors, religion contributed to the retreat from professionalisation, since nursing was viewed as an act of charity, distancing it from professional precepts and promoting values ​​such as subordination and dependence. In addition, control and intrusion into the lives of families, in this case through nursing interventions, demonstrates an interventionist nature and the pressure the population was subjected to. For instance, the interventions mentioned in the 1950 report included nine baptisms, instruction for five first communions and the legalisation of twelve marriages. An example of the control nurses were required exercise is given in the 1953 report, which described the actions taken to persuade a couple to agree to marry30:

“Several months ago, a social health visitor found that the parents of one of the families she visited were not married, and on telling them that they should remedy this situation, she received an outright refusal to marry. However, she was not discouraged by this and began to visit the home ever more frequently, caring for them affectionately through their various family misfortunes and taking advantage of these opportunities to keep talking to them about marriage. Finally, she obtained their consent and the necessary bureaucratic procedures were initiated with the parish priests. After overcoming many difficulties and solving everything, the wedding will take place within a few days. This case was initially attended by Catholic Action (AC) but then abandoned due to the difficulties it presented and the husband’s opposition to receiving assistance from AC”.

In relation to the annual variations indicated by the data, it should be noted that the results reflect the number of social health visitors and rural health advisors who practised their profession each year. However, despite these limitations, the results help assess the activities carried out and trends in the volume of these.

The documents for the period 1950-1958 contained information on the fight against infant mortality. This included educational talks given by advisors and social health visitor (courses to instruct mothers on parenting, lessons on breastfeeding and motherhood, disease prevention, domestic hygiene, personal hygiene and preventive measures such as isolating patients with pulmonary tuberculosis and disinfecting their clothes and belongings), the publication of an article on the subject by the Provincial Director of Press and Propaganda of the Women’s Section and the use of radio, specifically the broadcast of “some notes by Dr. Giménez on child care”31. Health campaigns employed the radio as a means to “awaken public interest in health matters”32, and as mentioned in the introduction, this was one of the strategies used by the Women’s Section to disseminate its discourse and influence people.

The sources consulted revealed the reluctance shown by many mothers to participate in vaccination campaigns involving rural health advisors and social health visitors, probably due to fear of a technology that clashed with the explanatory models of health/illness with which the population was familiar33. Nevertheless, they also recorded “an increased interest in children; the mothers who did not heed the advice they were previously given, now ask for it themselves [...] in the capital, social health visitors advise all mothers who attend the Child Care School or antenatal clinic from the outset and then continue attending accompanied by the child, declining to assist those who refuse to do so, and in many cases they accompany them themselves”(3,4).

The documents consulted for this first period also reflect the multiple limitations that confronted rural health advisors and social health visitors, similar to those faced by the Spanish post-war population as a whole: “Considerable difficulties exist in all districts as regards admission to hospitals and charitable centres, and there is a need for mattresses, clothes for adults, milk for the sick and financial aid”35. As Marset (2015) has indicated36, the population of post-war Spain faced a desperate situation of hunger, extreme need and lack of resources.

In relation to the period 1960-1964 (see Table 2), the information contained in the reports was grouped into the following categories: health (which included home visits, treatment, hospital admissions, referrals to clinics and drug prescriptions), social aid (basically help with food and clothing, admission to social aid homes and social security affiliation) and cultural activities (e.g. literacy and schooling). There were also separate categories with data relating to the infant nutrition campaign, health care, medical examination of Women’s Section members, health centre activities and other campaigns such as those related to blood donation or care for the elderly and disabled with medical and social rehabilitation.

Table 2 Health and welfare activities carried out by the Women’s Section in the city of Valencia from 1960-1964. 

Year 1960 1961 1962 1963 1964
Health 13074 17064 12090
Social aid 29693 2867 1091
Cultural activities 84 126 50
Infant nutrition 2796 6218 4546 67968 149091
Child care 922 1826 675 11242 23567
Medical examination of Women’s Section members 6072 6325 1151 16964 19390
Health care 4510 13321 5437 32998 53518
Other campaigns 0 538 290 4962 15691

Source: by the authors based on social health visitors’ and rural health advisors’ reports on activities carried out, submitted to the local director of the Women’s Section.

The evident changes in the report sections with respect to the first period reflect the transformation that Spanish society was undergoing, and more specifically the importance that the health model based on compulsory health insurance was beginning to assume, although many activities continued that were designed to cover major deficiencies that still persisted in many sectors of the population37. The section devoted to the infant nutrition campaign contained a variety of information: from the total number of beneficiaries (distinguishing between babies and preschool children) to the quantities of food (flour, baby food and milk), medicines, cribs and layettes supplied and the number of mothers who attended child care courses or clinics.

The documents referring to the third period considered, 1965-1976, detailed the number of rural health advisors, with an average of five per year, and social health visitors, also with an average of five per year.

The activities carried out (see Table 3) were grouped into the following categories: health care (treatment, hospital admissions, referrals to clinics and drug prescriptions) and home visits, social aid and educational and cultural activities (these latter included literacy and schooling). Some of the data referring solely to the period 1965-1979 concerned religious/moral activities such as baptisms (with a total of 103 cases), preparation for first communion (43 cases) and legalisation of marriages (31 cases). Other activities included the supply in 1971 of 226 layettes, 201 cribs and 11 donations.

Table 3 Health and welfare activities carried out by the Women’s Section in the city of Valencia from 1965-1976. 

Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976
Health care and home visits 25939 28261 12001 7754 8440 8602 9108 5174 3597 2403 5087 1563
Social aid 254 374 138 823 462 904 1088 349 582 1197 2517 554
Educational and cultural activities 4 28 24 16 16 9 3 0 0 0 0 12

Source: by the authors based on social health visitors’ and rural health advisors’ reports on activities carried out, submitted to the local director of the Women’s Section.

Changes with respect to the previous two periods include the emergence of a specific section devoted to social aid. The annual report of 1971 indicated that “staff at the Provincial Directorate for Dissemination include an administrative assistant and a colleague who temporarily held the position of social worker”38, while the reports for 1972 highlighted the social aid carried out through the preparation of reports on assistance in illness and old age requested by the Provincial Welfare Board. In contrast to the previous periods, such social aid was now considered separate from nursing interventions. This represented a key issue in community nursing, since this separation denoted an important shift in nursing focus.

Another change indicated by the information collected for this third period concerned the problems facing people with disabilities and the lack of an institutional response. A 1971 report stated: “The most difficult cases to solve are those concerning the admission of ‘subnormal people’[sic] to special centres; this province has few such centres and these cannot provide for the number of subnormal people [sic] in precarious situations who cannot afford the expenses entailed in residence”.

An analysis of the data from this third period shows that the health and welfare work of the Women’s Section declined over the years, as did the number of social health visitors and rural health advisors involved in its activities. By 1971, they still participated in child care, hygiene, food and nutrition, first aid, vaccination, blood donation and nutrition campaigns, care of the elderly and the fight against diabetes, trachoma and cancer, but in many cases their activity was symbolic or vestigial. Documents referring to participation in nutrition campaigns complained that “no food had been received for a long time” from “American social support”. Similarly, documents concerning blood donation explained that although there was “a small register of donors”, no official activity had been carried out.

CONCLUSIONS

On balance, one could say that despite the limitations of the sources consulted, the results reveal the complexity of the tasks assigned to social health visitors and rural health advisors affiliated to the Women’s Section, while also demonstrating the influence exerted by the socio-political and ideological context on the performance of these tasks.

For a quantitative assessment of the activities undertaken, it would be necessary to have more accurate figures on the number of social health visitors and rural health advisors actually involved. Although the records indicate that there were 104 Women’s Section nurses in the city of Valencia in 1950, it has not been possible to determine how many of these were social health visitors nor how many carried out the health, welfare, health education or religious activities listed in the reports. The wide variations in the number of social health visitors and advisors allocated each year and the occasional use of imprecise terms such as “colleagues” probably reflect the difficulties the Women’s Section encountered in retaining staff, a phenomenon observed in a parallel study on the health and welfare activities of rural advisors affiliated to the Women’s Section of the Falange in the Valencian region of Ribera in 1940-1958, and in other studies on the subject in other geographical areas39)(40.

To assess the real impact of the health and welfare activities of the Women’s Section, it would also be necessary to know the total volume of similar interventions carried out through other avenues such as the national health system, compulsory health insurance or charitable institutions. As explained in the document on the health care activities of the Women’s Section published in 1941, their social health visitors and rural health advisors were expected to act “under the orders of doctors involved in the tuberculosis campaign, child care, social assistance, health centres or housing inspection”. Consequently, their activities could erroneously be viewed as independent when in fact they were carried out in conjunction with other institutions, for example in the case of vaccination, disinfection and disinfestation campaigns, which they “undertook under the orders of the health authorities”41.

Despite these limitations, the nature of the activities described not only demonstrates the ideological and political use made of social health visitors and rural health advisors42, but also reflects the health, welfare and community dimensions that characterised their work.

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Received: July 12, 2016; Accepted: September 09, 2016

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