IELTS Academic Reading Practice Test 406

Throughout the eighteenth century, childbirth remained one of the most dangerous moments in a European woman's life. In towns and cities most babies were delivered at home by midwives who had served an apprenticeship and held a licence, but the countryside was very different: a village midwife was often an older woman who had learned her work from her own experience of giving birth. When a labour went badly wrong a surgeon might be summoned, but surgeons were few, expensive and often a day's ride away. The loss of mothers and newborn infants concerned the state as well as individual families, because a healthy population was increasingly seen as a source of national strength. No reliable national records of maternal deaths were kept, and historians still disagree about how common such deaths were, but contemporaries took it for granted that childbirth was a risk no family could escape.

Angélique Marguerite Le Boursier du Coudray was born in Clermont-Ferrand in 1712. She trained as a midwife in Paris, where the Hôtel-Dieu offered one of the few systematic courses of instruction in the country, and she was licensed to practise in the capital. By the 1750s she had established a reputation as a skilled practitioner, and she had begun to teach. Her experience in Paris convinced her that many of the deaths she had witnessed were preventable, and that the remedy lay in knowledge rather than in instruments.

In 1759 she began teaching in the provinces, and the French crown soon gave her a task that no woman had been handed before. A royal warrant of 1767 from Louis XV commissioned her to travel through the kingdom teaching midwifery to the women who attended births, and granted her an annual pension in recognition of the work. The choice of a woman was deliberate. Male surgeons were eager to take over difficult deliveries and advertised their forceps as the answer to an obstructed labour, yet they were rarely available in remote districts and charged fees that peasant families could not pay. If the deaths of mothers and babies were to fall, the crown concluded, the surest route was better-trained village midwives.

Her most important invention was a teaching aid she called her machine. It was a life-sized model of a woman's lower body, built around a realistic pelvis and made from cloth, leather and stuffing, with a doll standing in for the baby. Cruder models already existed, but they were expensive and inflexible. Du Coudray's was light enough to carry between towns and detailed enough for a student to practise the manoeuvres needed when a child lay in the wrong position, including the operation of turning the baby inside the womb. Only one of her machines is known to survive, in a museum in Rouen.

Her method was practical rather than literary. Most of the women she taught could not read, so she relied on demonstration, repetition and plain language, asking each student to perform a delivery on the machine until she could do it without hesitation. She also understood that a single visit would change little. Where a town wished to continue the training, she supplied it with a machine of its own, so that local women could keep practising after she had gone, and she encouraged her ablest students to pass on what they had learned.

Not everyone welcomed her. Surgeons and physicians who regarded childbirth as their own territory resented a woman travelling with royal approval, and she was attacked in pamphlets that mocked her teaching and questioned her authority. Some doctors argued that complicated cases belonged in the hands of men with instruments. Du Coudray replied, in print as well as in person, that most deaths in childbirth arose from neglect and ignorance, and that a trained midwife who knew when to call for help was worth more than a surgeon who arrived too late.

For more than twenty-five years she travelled France by coach, on muleback and on foot, visiting cities such as Bordeaux and small towns now remembered chiefly through her own accounts. She is known to have taught in dozens of towns and to have trained several thousand women, and some men. Historians dispute the exact figures, which have been counted from her own reports and from town records. Nobody questions the size of the undertaking: in her seventies she was still on the road, teaching in places more than a week's journey from Paris.

She also produced a short textbook, the Abrégé de l'art des accouchements, which first appeared in 1759 and was reprinted and translated into several languages over the following decades. Illustrated with plates showing the position of the child and the hands of the midwife, it was intended to be used alongside the machine rather than instead of it, and it remains the clearest record of what she taught.

In her final years she settled in Bordeaux. The letters and reports she sent to royal officials, preserved in provincial archives, have supplied historians with much of what is known about her. She died there in 1794, aged eighty-one, in a country transformed by revolution. The pension the crown had awarded her had by then vanished along with the monarchy itself.

Her influence outlived her. Mannequins modelled on hers were copied and used in other European countries, and the principle that midwives should be systematically trained and examined spread steadily through the nineteenth century. Modern obstetric teaching still depends on simulation, a method whose case she argued more forcefully, and for longer, than anyone before her.

Human milk is often described as the first food, but it is better understood as a living tissue. It contains fat, sugar and protein, as any food must, yet alongside them are antibodies, enzymes, hormones, growth factors and whole cells, some of them alive and capable of moving. Even the fat is unusual: it is packaged in membranes that carry enzymes and other proteins, so that the droplets themselves are not inert. Its composition is not fixed: the thick yellow milk produced in the first days after birth, called colostrum, differs markedly from the mature milk that follows, and the milk of a mother of a premature baby differs from that of a mother who delivers at term. Nothing in a laboratory has yet reproduced the mixture completely.

The best-studied of the protective components is an antibody called secretory immunoglobulin A, or IgA. Antibodies are proteins produced by the immune system that attach to particular microbes and mark them for destruction. Secretory IgA is made by cells that have migrated to the breast and is secreted into milk in large quantities. Unlike most antibodies, it survives the journey through a baby's stomach, because its structure resists the acids and enzymes that break down other proteins. It does not enter the infant's bloodstream. Instead it works in the intestine, where it sticks to the surface of bacteria and viruses and prevents them from crossing the lining into the body.

Other proteins act in different ways. Lactoferrin, which is especially abundant in colostrum, binds tightly to iron; because most bacteria need iron in order to multiply, lactoferrin in effect withholds an essential nutrient from them. Lysozyme, an enzyme also found in tears and saliva, attacks the cell walls of bacteria directly. Milk also contains living white blood cells, including macrophages that engulf microbes, and it is not sterile: a complex community of bacteria passes from mother to baby along with the antibodies, helping to establish the infant's own gut population.

Perhaps the most surprising ingredients are the sugars. Human milk contains more than a hundred and fifty different oligosaccharides, complex carbohydrates built from simple sugars. The infant cannot digest them; they pass through the small intestine almost unchanged. That is the point. They feed particular bacteria, especially species of Bifidobacterium, which thrive in the guts of breastfed babies and crowd out organisms that cause disease. The oligosaccharides also act as decoys. Many pathogens recognise and attach to specific sugar structures, and if they meet the free sugars of milk first, they bind to those instead of to the cells of the intestinal wall, and are carried out of the body.

Milk is also responsive. The antibodies it contains reflect the infections the mother has encountered, so a woman nursing a baby while she herself is ill will begin to produce antibodies against the organism responsible. Immunologists explain this through what is called the entero-mammary pathway: cells in the mother's intestine that have met a microbe travel through her blood to the breast, where they produce antibodies against it. The result is a supply of protection tailored, imperfectly but continuously, to the threats in the family's immediate surroundings.

The health benefits that can be measured most reliably are the short-term ones. Breastfed babies have fewer infections of the digestive tract and fewer ear infections, and the protection is strongest in the first months of life. The most striking evidence concerns premature infants: feeding them human milk, from their own mother where possible or from a milk bank, substantially reduces the risk of a severe bowel condition called necrotising enterocolitis, one of the leading causes of death among very small babies.

Beyond infancy the picture becomes murky. Breastfeeding has been linked to lower rates of asthma, allergy and obesity, and to slightly higher scores on intelligence tests, but these associations are hard to separate from everything else that distinguishes families who breastfeed. Mothers who breastfeed are, on average, older, better educated and wealthier than those who do not, and such advantages affect children's health and schooling whatever they are fed. Studies that compare children raised in the same family have generally found much smaller differences than studies that compare families, which suggests that some of the long-term benefit has been overstated.

The science is changing how infant formula is made, though slowly. A few oligosaccharides, including one of the most abundant in human milk, can now be manufactured and are added to some formulas, and manufacturers have begun to include other components. Whether these additions reproduce the effects of the whole system is unknown; a nutrient added on its own does not necessarily behave as it does in milk. Research is also turning to the milk microbiome, to the proteins that help the immature intestine to seal itself, and to the ways in which the composition of milk varies between mothers and across the months of breastfeeding.

What three decades of research has established is that milk cannot be reduced to a list of ingredients. Its protection arises from the interaction of antibodies, sugars, cells and bacteria, delivered in a fluid that changes daily. Whether that system can be copied is the question that now occupies the field.

Parental leave has expanded quietly but enormously over the past half-century. In the 1970s a handful of countries offered a short period of paid maternity leave; today most high-income countries guarantee several months, and a few offer more than a year. The debate about whether to extend it further is usually conducted in the language of economics, the cost to employers and the effect on women's careers, but a growing part of the case is medical. Infancy is the period in which the foundations of health are laid, and the argument runs that if a longer period at home with a parent improves those foundations, then leave is a health policy as much as a labour-market one.

The strongest evidence concerns breastfeeding. The World Health Organization advises that babies should be fed only on breast milk for the first six months and should continue to be breastfed alongside other foods until the age of two. Employment is one of the most consistent obstacles to this: women who return to work early are more likely to stop breastfeeding sooner. Several studies of leave reforms in Europe and North America have reported that a longer paid entitlement lengthens the time for which mothers breastfeed, and the effect appears largest among women on lower incomes.

Whether these changes translate into better health later is a more difficult question. Studies of leave expansions have reported modest improvements in some measures of infant health, and a smaller number have examined outcomes in childhood, such as hospital admissions or behaviour. The results are not consistent and depend heavily on the country studied and on how long and how well paid the leave is. Reviewers who have surveyed this literature tend to reach a cautious conclusion: the short-term benefits for mothers and babies are reasonably well established, while the long-term ones are plausible but unproven.

For mothers the case is stronger. Pregnancy and birth are physically demanding, and the weeks after delivery involve recovery, interrupted sleep and an abrupt hormonal transition. Recovery from a caesarean section, which is major abdominal surgery, takes considerably longer than recovery from an uncomplicated birth, and a policy that ignores this difference leaves some mothers with little choice but to return early. Research on maternal mental health has found that paid leave, particularly when it is reasonably generous, is associated with fewer symptoms of depression in the months after birth, whereas unpaid leave offers much less protection. The effect is not only about rest; it also reflects the cost of arranging childcare in the first weeks.

The design of leave matters because it decides who takes it. Where part of the entitlement can be used only by the father and is lost if he does not take it, his take-up rises sharply. Norway introduced such a quota in 1993 and saw the proportion of fathers using leave jump within a year; Iceland's reforms of 2000 had a similar effect. The decisive factor appears to be whether the leave is reserved, rather than how much money is offered. There is also some evidence that fathers who take leave remain more involved in childcare years afterwards.

Against all this must be set the evidence that long leave can harm the people it is meant to help. The OECD has warned that entitlements of two years or more are associated with lower employment rates among women, and that long absences make it harder to return to the same kind of job. The concern is not that leave is bad, but that a very long leave, taken almost always by mothers, can reinforce the assumption that caring is women's work. Business organisations have made a different objection: the cost of covering absent staff and of administering the entitlement falls most heavily on small firms.

Both objections deserve weight, and neither is answered by insisting that health must come first. In the long run a mother's earnings and her attachment to employment are themselves determinants of health, for her and for her children. Poverty is one of the most powerful influences on child health, and a policy that improves infancy at the price of a permanent loss of income may do more harm than good. A short, unpaid or poorly paid entitlement, on the other hand, protects almost nobody.

International bodies have converged on a compromise that reflects this. The International Labour Organization's maternity protection convention of 2000 sets a minimum of fourteen weeks of maternity leave, with cash benefits of at least two-thirds of previous earnings. The European Union's directive on work-life balance, adopted in 2019, goes further, requiring at least four months of parental leave for each working parent, two of them non-transferable, alongside paid paternity leave. These are floors rather than targets, but they reflect a broad consensus about what a reasonable minimum looks like.

My own view is that the health evidence does justify longer leave than many countries currently provide, but not leave of indefinite length, and not leave designed as though only mothers exist. What the research supports is a moderate entitlement, somewhere between six months and a year, paid at a rate that makes it usable by families on low incomes, with a substantial portion reserved for fathers and a right to return to the same job. That combination would capture most of the health benefits while limiting the damage that very long absences can do to women's working lives. The case for leave is a health case, but it is also, inescapably, a case about equality, and a policy that ignores the second will eventually lose the first.