Maternal Health Care at a Japanese American Relocation Camp, 1942–1945: A Historical Study
Abstract
Background:
From late summer of 1942 until the fall of 1945, approximately 120,000 ethnic Japanese were confined behind barbed wire within 10 relocation camps in the United States. Although histories have been written about the relocation camps, little data are available about women's lives. This study explored women's lives and experiences with pregnancy, childbirth, and child care in a Japanese-American relocation camp.
Methods:
Twenty women who were ages 18 to 31 years at the time of internment at Heart Mountain, Wyoming Japanese American Relocation Camp, and one caucasian nurse who worked in the obstetric unit of the camp's hospital were interviewed. Archival, demographic, and historical data, including some prenatal records, provided information about maternity and public health care for pregnant women and new mothers.
Results:
Obstetric hospital practices were typical of the 1940s in the United States. Community public health services for new mothers included formula kitchens and well-baby clinics. Infant mortality statistics from 1942 to 1945 at Heart Mountain were comparatively better for the same time period than for the state of Wyoming or the United States. These outcomes may have reflected the camp's extensive social and family support, adequate housing and food, and universal access to maternity services.
Conclusions:
The Heart Mountain internment provides a story about how women's lives are impacted by war. Since World War II, civilians, especially women and children, have increasingly been targeted during wars with profound impact upon the health of mothers and babies. (BIRTH 24:3, September 1997)
A compelling and largely untold story in United States maternal-child health history is that of young women who became pregnant, gave birth, and were mothers of infants and young children in Japanese American assembly centers and relocation camps during the World War II years from 1942 to 1945. This monumental event occurred as an outgrowth of long-standing West Coast racial animosity toward the Japanese people, and was fueled by war hysteria after the Japanese bombing of Pearl Harbor in December 1941. The internment of 120,000 ethnic Japanese is an example of war's effects on the lives of women and children. Although these concentration camps were not “death camps” such as those of the Holocaust and the South Pacific, nevertheless they resulted in profound physical and emotional stress as well as disregard for constitutional and human rights of Japanese Americans.
Although several Japanese American women's histories (1–4) and political analyses of the United States internment of ethnic Japanese have been published, these included only rarely the experiences of pregnant women and mothers of young children. This article, part of a larger study of young women's lives at one of these camps, describes maternal and child health care of women who lived at Heart Mountain, Wyoming, located between the cities of Cody and Powell and close to Yellowstone National Park.
Background of United States Ethnic Japanese Women
A few Japanese women began arriving on the West Coast of the United States between 1868 and 1908 during the initial Japanese immigration. In the first two decades of the 1900s, Japanese women came in larger numbers, as many as 20,000 (3), and were often “picture brides” whereby marriage occurred by proxy. This practice ceased when the United States Immigration Act of 1924 ended Japanese immigration until after World War II.
Issei were natives of Japan. Their children, the second generation, were born in the United States, most between 1910 and 1945, and were called Nisei. It was this group of young Nisei women who, during the United States internment of ethnic Japanese, were most likely to have given birth.
Methods
This study combines ethnographic data with archival, bibliographic, and autobiographic resources. Twenty women (1 Issei who immigrated from Japan at age 4 and 19 Nisei), who were from 18 to 31 years of age during relocation, were interviewed by the author. Two women were age 18 years when they arrived at Heart Mountain, and both worked as nurses' aides in the obstetrics unit and later married and gave birth outside the camp. The remaining 18 women gave birth during internment. At the time of the interviews, women's ages ranged from 70 to 84 years. Women were located for this study through the help of a historian, women contacting other women they had known in camp, a notice placed in a Japanese-American newspaper, and introductions at a Heart Mountain reunion. In addition, a caucasian nurse was interviewed who worked in the obstetrics unit during all but six months of the hospital's operation.
Interviews used an open-ended format, with an emphasis upon the recounting of women's daily lives as well as their experiences during pregnancy, childbirth, and with child care. Sixteen of the interviews were with individual participants but, at women's requests, one interview was with a group of four women. Average interview length was 1 1/2 to 2 hours. Interviews were tape recorded and transcribed with analysis of the content. All but one woman gave permission for their names to be used in reporting study findings. Participants are identified by their own or a designated name.
Archival research was conducted at the United States National Archives in Washington, D.C., where original War Relocation Authority (WRA) records were obtained; and at the University of Wyoming library, which contained the complete volumes of the Heart Mountain camp newspaper. Statistical data were obtained from the Wyoming Department of Health, original interview data from the Wyoming State Museum, photographs from the Buffalo Bill Historical Museum in Cody, Wyoming, and demographic data from the Bancroft Library at the University of California at Berkeley. Historical and biographic works were also used.
Results
Women's Memories
The accuracy of memories 50 years after internment is an important issue, especially in light of the almost total silence by Japanese Americans about this event. Yamauchi (5) attributed the silence of the Issei to being broken hearted, exhausted, and not wanting to explain themselves. Furthermore, the Nissei, “… wanted their chance. Who had time to reflect on the past? On the camps? Who wanted to? It was too painful. An embarrassment. An anomalous experience that everyone wished to put behind them” (5, p 2).
For study participants accuracy of recall of events was probably less an issue, as validated by the consistency of women's stories when analyzed collectively, than was forgetting or selective recall. Several women mentioned the difficulties they had in remembering their lives at camp. Descriptive detail varied due to changing cognitive capacities, the 50-year time span, intervening events, and the long period when most former internees avoided talking about camp life. Interestingly, the group interview triggered recall of memories as women quickly moved from subject to subject asking each other, “Do you remember…^.?”
Velma Kessel, a caucasian registered nurse, kept a diary during her two and one-half years as a nurse at Heart Mountain, and this information provided accurate data about obstetric practices at the Heart Mountain hospital (6). The interview data and her diary writings were consistent with WRA records, such as minutes from nurses' meetings, and obstetric records.
Relocation and the Effects on Young Women's Lives
In spring 1942, ethnic Japanese on the West Coast and in southern Arizona were suddenly and traumatically relocated from their homes to one of 16 assembly centers (to Pomona or Santa Anita Assembly Centers in California for the women in this study). These served as temporary sites until permanent camps could be constructed. Women remembered with clarity what they were doing when they heard the news of Pearl Harbor and the rapid changes in their lives. Career and educational plans were abruptly curtailed for many women because they were required to remain within a five-mile radius of their homes. Animosity toward ethnic Japanese made it unpleasant to leave their communities. Often women married before relocation to avoid separation from their fiancés, who might be assigned to different assembly centers. Other women, pregnant or already mothers, were faced with responsibilities for organizing supplies for their babies. They were only allowed to take what they could carry, and did not know the final relocation destination. Many needed to plan for diapers, baby clothing, and formula or canned milk. Ada, however, in an act of resistance, defied WRA regulations on limiting belongings and took formula, a baby bathtub, and a baby bed.
In late summer and early fall, evacuation from the assembly centers to relocation camps occurred. For pregnant women and those with young children the long train ride to Heart Mountain was especially miserable. They were given Pullman sleepers, whereas husbands rode in another part of the train. Shades were drawn, kerosene lamps lighted the train, the train was hot, and babies were fretful. One newly pregnant woman had “pregnancy sickness,” which she found difficult to bear. Another woman reflected on how hard it was to care for two little children—alone, with no milk, and a crying baby.
On arrival, families were assigned to uninsulated barrack housing, each block having a common latrine combined with a laundry room. The entire camp was surrounded by barbed wire with guard towers at each corner with armed guards. Meals were taken at mess halls, disrupting family eating habits and family cohesiveness. Young couples often were assigned to an end barrack, which was small but offered some privacy, whereas larger families lived in the central rooms of the barracks. Minimal furniture was provided so that crates served as chairs, wooden planks were fashioned into shelves, bedspreads provided partitions in the room, and curtains were either ordered from catalogs or sewn. Cribs, ever in short supply, were initially constructed by the WRA, since the Japanese internees were not allowed to possess tools. Wind, tumbleweeds, and dust in the hot summers and ice and blowing snow in the winters contributed to the uncomfortable conditions.
A group of mothers and babies at Heart Mountain in 1943 is pictured in Figure 1. Extended families often lived in the same block, providing family support. After the camp was open for a while, men sometimes left to engage in agricultural or factory work in Wyoming or neighboring states. Thus the availability of grandparents for child care and companionship was important for many young mothers, who spent the bulk of their days taking care of their babies and doing laundry, washing diapers, clothing, and bed linens in buckets with plungers. In the winter months diapers froze to the clotheslines, which actually hastened drying. However, diapers and other washing were usually hung on lines within the barracks where a coal stove provided warmth.
. A group of mothers and babies at Heart Mountain, 1943.
Women varied in their responses to being at camp, with some recalling how difficult it was and others viewing camp life as allowing more time to spend with their babies. Whereas Hiroko summarized her camp experience as, “It was terrible … a terrible time in my life,” and Iwako recalled life as “hard,” Atsuko in contrast said, “After everything got organized, it was a real nice place … We were all Orientals, the doctors were all Orientals … you felt safe.” Mimi recalled, “Taking care of the baby, we had all the time in the world. What a perfect place to have a baby. You didn't have to work, the baby doesn't care if it is a cabin or barracks … and my mother-in-law was close by and she helped wash the baby.”
Ada had a less prosaic viewpoint as she recalled when her son Victor had bedbugs and other unpleasant aspects of camp life:
They bit Victor like crazy. He cried, he would have welts all over his body, and I would have welts too. And that was a horrible experience. And … washing the diapers for two babies was no fun, every day, every day…^. Emptying the honey bucket was no fun either, especially if it was blowing hard, I had to be careful I didn't spill it. So I had to carry that back and forth from the latrine, and every time we went to the latrine we had to be sure we took soap and toilet paper with us. You didn't want to go to the latrine too often because it was so cold, and when you went washing, it was cold by the time you got to the barrack … the clothes began to freeze.
Some women took sewing or craft classes, went on picnics, and to varying degrees, participated in social events. Four women, reminiscing together, talked about a woman breastfeeding at a baseball game:
Woman 1: I always remembered this one lady, she would stay and watch the ball game, and she would bring out her breast and feed the baby. I'll bet she wasn't a Nisei.
Woman 2: Oh yeah, she was a Nisei.
Interviewer: Was that unusual to breastfeed in public?
Group: Yeah, we never did that. Sometimes the first generation, the older generation … would think it was just a natural process of feeding your baby, but we were the second generation. We would never think about bringing out our breast and feeding.
Interviewer: Oh, you wouldn't?
Group: … but this one lady didn't mind. Oh gosh, I used to think, oh gosh.
Woman 3: Didn't she put a hanky over it?
Woman 1: No, she didn't.
Interviewer: And you were surprised?
Woman 1: I was surprised because I would never do that.
Maternal Health Care
Hospitals were quickly established for evacuees. At Santa Anita Assembly Center a former saddling shed for horse races was converted into a crude hospital (7). Caucasian administrators and physician and nurse supervisors were in charge of hospitals with Japanese physicians, nurses, midwives, and nurse aides providing most direct patient services. Aiko, a nurse aide, assisted with her first birth at Pomona Assembly Center and remembered that there was “always a caucasian over us.”
A total of 504 live births were reported to have occurred at the assembly centers (7), where two study participants gave birth. At Heart Mountain, when the first evacuees arrived, the hospital was not yet ready, and temporary facilities were located in a recreation hall. Aiko was immediately put to work cleaning up the new hospital and organizing supplies before admitting the first patients on August 28, 1942. During the three years that the Heart Mountain Hospital obstetric unit was open, 548 births were recorded (8).
The Heart Mountain Hospital (Fig. 2) provided complete services for antenatal, intrapartal, and postpartal care. Prenatal and well baby clinic programs were established, with the prenatal clinic held in the hospital and the well baby clinics in rotating sites in recreation halls. The clinics were under the supervision of the director of public health and the chief nurse.
. The Heart Mountain Hospital.
Although study participants had vague recall of prenatal care, several remembered they were given extra milk, vitamins, and calcium tablets. Some described prenatal visits—at first monthly and more frequently in late pregnancy. Although she could not remember her prenatal care, prenatal records provided by Yoritsune showed monthly visits that changed to bimonthly and weekly visits as pregnancy progressed to term. Women often commented that doctors were “very good” and professional. Some women thought Japanese physicians were overworked and poorly paid, an observation confirmed by WRA reports. One mother said that paying a doctor “on the side” helped in obtaining better care.
The 150-bed hospital was built according to Army specifications with a long central corridor from which various wards and wings branched off. Headlines of an early issue of The Heart Mountain Sentinel, the camp newspaper, announced, “Camp Hospital Expands, Among State's Best” (9). The article said, “Under spreading Wyoming skies, in the northeast corner of the center, stands the $1,000,000 hospital within whose walls a trained staff of men and women is constantly working to alleviate pain and suffering and to safeguard the health of almost 10,000 evacuees. It is now one of the largest and best equipped hospitals in the entire state of Wyoming.” A later issue of the Sentinel carried this story: “During 1942, 389 babies were born at Heart Mountain. Despite the common belief that more boy babies are born during war years, girls outnumbered boys last year 21 to 18” (10). A year later the paper announced that “Doctor Stork with his bundle of happiness made 199 trips to this center,” but this time stated, “in keeping with war-time tradition, Heart Mountain males took a slight lead with 101 to 98 females” (11).
Ward 4 was the obstetrics ward, and the first baby was born on September 9, 1942. The ward had two labor rooms, a delivery room, nursery, and postpartum ward. An early obstetric emergency requiring a cesarean delivery mandated transfer to a Cody, Wyoming, hospital. Specialty referrals had not yet been established with “town” hospitals, and tension was present because of hostile public attitudes toward the relocation project.
Initially eight Japanese physicians delivered babies. Velma Kessel, the nurse who worked at Heart Mountain Hospital, recalled her first delivery with Dr. Suski, a popular physician who was known among some women as “old fashioned” in his obstetric practices—one reason being because he put the baby on the mother's abdomen after birth. He was apparently opposed to circumcision. Kessel described the delivery as follows: “Very little sedation was given to the mother, and drip ether was usually given just before the birth of the baby and during the suturing of an episiotomy … [it was] administered by putting a safety pin through the top of an ether can and letting the liquid drip out over the pin and onto the mask over the patient's face” (6).
Other common procedures reflected obstetric practices of the 1940s, a few of which continue as “routines” in the 1990s. Kessel described perineal shaves and enemas, rectal examinations, minimal emotional support during labor, use of morphine and scopolamine just before delivery, routine episiotomies, high stirrups, and leather straps; forceps were occasionally used. Kessel stated that women were encouraged to move and be up during labor, although only one woman recalled walking. Three women reported being told to “hold it back in” (not to push), and one related that she “cussed the doctor out” for not giving her anything for pain. Another woman reported a baby's head being held back because the doctor was not there.
As can be expected with a group of women, birth experiences varied widely. Whereas Ada remembered “all my labors were bad,” Hiroko said she had her son Eric the old-fashioned “natural” way—no shots, nothing. Susie did not need or want ether. Although she recalled good care, she recounted, “I think the doctor was kind of new at delivering babies. He had a hard time. I think he had a harder time than I did.” Several study participants recounted unsafe practices—one woman recalling that she was in stirrups for hours, and another that she had gauze packing after delivery and it was forgotten until her husband said, “My God, it stinks in here!” In general women viewed their care as good.
Babies were taken immediately to the nursery after delivery with four-hour feeding schedules, and mothers' postpartal stays averaged 14 days, the latter being an obstetric regulation (12). Nurses' minutes from WRA record files discussed routine practices of the 1940s, such as the use of sterile sponges and towels for postpartal breast care, abdominal and breast binders for new mothers, and binders for newborn babies. Although visitors to the maternity unit were initially banned, the staff meeting minutes in July 1943 stated: “… the husbands of maternity patients have been permitted the privilege of visiting them in the evenings only” (13).
Most study participants breastfed their babies. Several women remembered a Japanese nurse who encouraged breastfeeding. Atsuko, who breastfed for two years, remembered her well:
She was a real old timer. She was telling us how we had to breastfeed the baby, how we had to pump our breast … after the childbirth when your breast was so sensitive and it would hurt, but she would grab that [sic] and she would just pump it … so that we would have milk.
Iwako remembered this same nurse as “a skinny old lady, and her finger was so long and skinny, and she would press my breast, and I almost went out of my skin it hurt so much.”
For formula-fed infants, a community-wide formula and milk distribution system was established. Originally located in the hospital during the first winter, it was decentralized before the summer of 1943 because of concern for the oncoming fly season. No refrigeration was available, so formula had to be constantly prepared and baby bottles washed and returned by the mothers.
Infant Mortality
In an attempt to obtain accurate infant mortality data, WRA monthly and final reports and State of Wyoming vital statistics were examined. Infant mortality statistics could not be accurately obtained from the WRA reports because of variations in monthly reporting procedures related to stillborns and infant deaths. State of Wyoming statistics did not specifically count infant mortality for Heart Mountain, Wyoming, but included the camp within the larger statistics for Park County. However, ethnic group categories were included in state vital statistics for the time period. Notably, in 1941 and 1946 before and after internment, infant deaths of Japanese were zero. However, from 1942 to 1945, Japanese infant deaths totaled 19. Although it is possible that these deaths occurred outside the camps, it is unlikely.
Using official WRA figures of 548 births for the period the camp was open and assuming all Wyoming ethnic Japanese infant deaths occurred in the camp, the infant mortality rate during the period births occurred at Heart Mountain from September 1942 to November 1945 was 34.67 per 1000 live births. This compares to rates ranging from a high of 45.8 (1942) to a low of 37.5 (1943) for the same time period in the State of Wyoming and United States rates ranging from a high of 40.4 (1942–1943) and a low of 38.3 (1945) for the same time period. One can deduce, acknowledging some statistical uncertainties, that infant mortality at Heart Mountain was probably better than both state and national rates for this same time period. In contrast to today's United States provisional infant mortality rate for 1995 of 7.5 (14), however, these are five times higher, indicating the substantial progress that has occurred in maternal-infant health care.
Wilcox, Skjaerven, and Irgens (15) examined the hypothesis that unfavorable social conditions affect perinatal mortality. Their study focused on occupied (by Nazi Germany) Norway during World War II. They found that perinatal mortality declined during the period, and only a slight effect occurred on postneonatal deaths. They concluded that their “inability to detect wartime effects underscores how little we understand the ways in which social factors act on perinatal mortality” (15, p 1467).
Discussion
For women at Heart Mountain, surrounded by extended family and, often, friends from their home communities, social support may have influenced infant outcomes. Furthermore, for ethnic Japanese women of poorer economic means before camp life, adequate public health services and universal access to care may have improved their health status. Examples from both Heart Mountain and Norway during World War II give an appreciation of factors that may contribute to comparatively good outcomes despite situations of high stress.
During World War II and earlier wars, civilians comprised far fewer war casualties, despite the large number of deaths in situations such as the Nazi and South Pacific concentration camps, the fire bombings of Dresden and Tokyo, and the atomic bombings of Hiroshima and Nagasaki. More than 50 years later, however, mothers and babies are far more profoundly affected by wars, most of which are intrastate wars fueled by ethnic and political conflicts. As many as 90 percent of the victims of today's wars are civilians (16,17), most of whom are women and children. At least 85 percent of refugees are women and children, and the negative effects on reproduction are extreme (17).
Antenatal and birth care may be unavailable because primary health care facilities are devastated by direct targeting and services are prioritized for the military. Armed conflict creates major public health effects on girls and young women, who suffer from inadequate food, water, and nutrition to support pregnancy, safe childbirth, and breastfeeding, thus increasing maternal, infant, and child mortality. These are global issues that should deeply concern and inspire activism by maternal and infant health professionals.
