The history of public health policy and practice in the modern Caribbean region is a narrative fraught with complex struggles between diverse competing groups—colonial administrators and formerly enslaved peoples, blacks and white, women and men, elite and working classes, Western medical professionals and local lay practitioners. It is also an imperial history of the new specialization of tropical medicine, which was itself inextricably tied to the European “civilizing mission” to remake unhygienic colonized “others” into modern, sanitary “subject-citizens.” And as Juanita Se Barros shows in her study Reproducing the British Caribbean, public health policy and practice were closely tied to wider demographic and socioeconomic concerns, largely on how to successfully produce a sustainable, self-reproducing civilized labor force to satisfy labor demands. Colonial societies were as much systems of sex and reproductive control as they were systems of economic exploitation.

Throughout the post-emancipation English-speaking Caribbean, colonial authorities strove to transform former slave societies into modern free economies. Achieving this ambition rested on securing sustainable economic growth; this in turn depended on the availability of a steady supply of labor. Initial hopes that the formerly enslaved would remain on the plantations as waged laborers went unrealized, as freed peoples in Jamaica and Guyana hastily ruptured their ties to the estates, the scenes of their former subjection. Many emigrated, while others settled in free villages that were soon established. On the smaller island of Barbados, population density and land scarcity restricted mobility, forcing many to remain as waged laborers on their former estates, providing the planters a ready source of experienced labor. Jamaican and Guyanese authorities found partial resolution to the labor shortages by indenturing laborers from India, China, and elsewhere. But reproduction of the labor force by natural increase represented the surest prospects for securing a sustainable labor force. Reproduction became a matter for state intervention, and the period witnessed the inauguration of pro-natalist initiatives as reproductive control became central to colonial health policy. Women's reproductive bodies, always subject to the exigencies of colonialism, were harnessed as new public health agendas. The problem of population growth would continue to exercise colonial administrators into the 1930s—though now the problem had become a matter of limiting the fertility of black and poor white populations.

De Barros underlines how debates about population growth were framed by racialized discourses of the innate filthiness of blacks; these discourses shifted blame for the unsanitary conditions that gave rise to epidemic diseases such as cholera onto the shoulders of black peoples rather than onto the colonial regime's failure to implement effective public health systems. Traditional health practices were widely denigrated by whites as irrational and unhygienic, and where reproduction was concerned, as downright dangerous. Traditional midwives, herbalists, and Obeah practitioners (sometimes one and the same) were identified as major contributory factors to high infant and maternal death rates. They were to be replaced by modern state-driven interventions. Philanthropic, educated elite and middle-class white—and some colored—women, led these volunteer “maternalist” projects, organizing education classes in hygienic child care and domestic management. By the late nineteenth century, women in Barbados, Jamaica, and Guyana could access a range of reproductive health and child support services, including child health clinics, breastfeeding support, and childcare provision. The medicalization of childbirth—evidenced by the emergent supporting infrastructure and personnel, lying-in maternity wards staffed by trained midwives and health visitors—speaks to the extent of colonial anxieties about population growth. That officials underestimated the rationality and agency of women is evident: as De Barros argues, both trained midwives and pregnant, laboring women and mothers contested the terms of their engagement with medical health and reproductive professionals, though for different reasons.

Reproductive health policy was inflected by racialized discourses of blacks as inherently dirty and lacking parental care and skills. Fathers were deemed errant and mothers neglectful—factors that impeded healthy population and economic growth. Christian marriage and legitimate childbearing were promoted as crucial to the successful reproduction of the population. But for diverse reasons, black women and men rejected European nuclear marital patterns, giving rise to racially varnished discourses surrounding illegitimacy. Children born outside of wedlock, so prevailing wisdom ran, were less healthy and had shorter life expectancy. Should they survive childhood, they were destined for lives of ignorance, criminality, and poverty, burdens upon already strained state resources. The seeming logical outcome of this Darwinian scenario was that unmarried parents—particularly mothers—were guilty of criminal negligence, illegitimacy being likened to a form of infanticide. Illegitimacy represented a moral affront to white sensibilities, but perhaps more potently represented an economic crime at a moment when reproduction constituted an imperial duty. Public reproductive health initiatives were thus vital in educating black mothers in hygienic, nurturing mother craft; these measures predicted a reduction in the high infant mortality rates.

For perhaps the first time in the region's colonial history, the health and welfare of black women and children became the object of systematic state attention—every infant death represented the loss of future generations of laborers. Indeed, this period represented an important stage in the remaking of black motherhood; of equal significance, however, is the reconfiguration of Caribbean children as deserving beneficiaries of state care and protection. De Barros does not explicitly explore these changing meanings of childhood—it is not within the scope of the study to do so—but I do feel that it is not possible to extricate discourses of new ideals of motherhood without also exploring the extent to which they had an impact on and reconfigured understandings of what it meant to be a child.

De Barros takes a broad comparative historical reach and scope, tracing the intertwining of colonial health policy with race, class, and gender across the post-emancipation landscapes of Barbados, Jamaica, and Guyana over a century. It may be clichéd, but it is still worth repeating that until recently, Caribbean historians rarely paid attention to the specificity of women's lives, either white or black. While the labor history of post-slavery Caribbean continues to enthrall historians, women's reproductive labor, recognized by authorities as a crucial component to economic prosperity, has held far less allure. De Barros's masterly study underscores the limitations of single-issue scholarship: one cannot truly appreciate the unfolding of labor history in the region without being attentive to the role of reproductive labor politics in shaping the contours of that history.

De Barros argues that colonial public health systems gave rise to new medical and educational spaces: sites of unusually intimate and diverse encounters between men and women of diverse ethnic backgrounds. Yet elite white males supported by philanthropic elite and middle-class white women are represented as the primary agents of modernity. The relative absence of black men and poor white men—and to a lesser extent white women—within this narrative is striking. How did black men, critiqued by authorities as sexually irresponsible, errant, and absentee fathers, respond to these discussions? These silences may be a function of the relative scarcity of archival resources, but I do think that closer exploration of how black and poor white males were positioned in and responded to the racialized and classed politics of reproduction are warranted.

Drawing on a wealth of local and metropolitan archival sources, De Barros has constructed an authoritative, detailed, and closely argued narrative that represents a worthy addition to the emergent scholarship on the gender, race, and class dynamics of colonial public health policy and practice. Her clear, accessible language will appeal to students of all levels and to advanced scholars interested in the histories of tropical medicine, public health, reproductive politics, gender, race, and class in the colonial Caribbean, as well as to those with a more general interest in Caribbean history.