Public health activism has saved millions of lives globally and fundamentally changed the type of world we live in. While we continue to take on the many remaining public health challenges – obesity, increasing income inequality, climate change among others – it is important to take time to acknowledge and celebrate the achievements of those who paved the way. The following piece by Hilda Bastian is a powerful and personal tribute to one of Australia’s public health heroes, Judith Lumley. It also highlights the critical role of relationships and mentoring in ensuring that the voice of public health remains powerful into the future. It originally appeared in Bastian’s Absolutely Maybe blog on the Scientific American website and is reproduced here in full with permission of the author. She writes:
It began, as life changes often do, when I bought a book. It was in Sydney and I wrote the year in it: 1982.
You know when it feels as though something could have been written just for you? That. I was 21, pregnant and more than a bit scared. The book, Birth Rites, Birth Rights, was a revelation to me. And it reveals a lot about its authors. The lead author was Judith Lumley.
This is a picture of my copy. Lumley is in her 70s now, so she was around 40 when it was published not long before I bought mine. She was born in Wales, and came to Australia in her 20s. She’d gained a degree at Cambridge, and then got her medical degree in Melbourne.
A PhD in fetal physiology, research with teaching in both pediatrics and obstetrics, and three children later, this book arrived. The author descriptions tell us she was then lecturing in obstetrics, was medical editor of Australian Family Physician and on the staff of the Social Biology Resources Centre. Her co-author, Jill Astbury, was then a clinical psychologist with two children.
The book discussed research, with actual data in it. That was a big reason it helped me put my fears into perspective. The authors spoke to their readers with respect, feminist sensibility and in the context of history. They clarified societal influence and worked their way through taboos. You can see for yourself in this excerpt published in a newspaper in their hometown, Melbourne. Thirty years ago, you couldn’t take any of this for granted.
There was something else powerful about this book. And it reflects the course of Lumley’s extraordinarily diverse academic collaborations and public work, too. There were lots of women’s voices in it. Those voices often spoke of things about which women were usually silent.
He looked like a little frog. There were tubes everywhere. I said to the doctor, “That’s not mine.” (Page 230)
(Breastfeeding) I wasn’t at all enthusiastic initially, but that prejudice has been overcome. I thought it was primitive and animal-like. (Page 204)
What did my fingers do before they held him?
What did my heart do with its love?
I have never seen a thing so dear.
His lids are like the lilac-flower
And soft as a moth, his breath.
I shall not let go.
(Page 157: quote from Sylvia Plath’s Three Women)
In her academic work, too, her voice melds science and personal experience, sometimes blending in her own. As here in a 2008 editorial accompanying research on women’s expectations of pain in labor. But mostly, within and alongside her distinguished academic work and her public health advocacy, it has been other women’s voices that she has amplified. One of those voices is mine.
Before we get to the personal side of this tale, though, I’ll try to give you an idea of Lumley’s academic excellence, success and strength. Each of those, and their combination in one generous and happy woman, were of great significance to many other women.
Lumley’s body of research includes perinatal epidemiology, physiology, qualitative studies, randomized trials, systematic reviews and meta-analyses. And she had a long-term commitment to working on social, cultural and medical issues facing migrant and indigenous women.
She established and directed the Victorian Perinatal Data Collection – around the time I was pregnant and discovering Birth Rites, Birth Rights. In the 1980s, she led a major government review of maternity services that we all called the Lumley Review, and it included a survey of women’s views. She co-edited the Australian Journal of Public Health for most of the decade, while also being a Professor at La Trobe University in Melbourne and director of a research center.
In the 1990s, she was director of the National Perinatal Epidemiology Unit at Oxford University for a couple of years. In the 2000s, she was awarded the Sidney Sax Public Health Medal and made a member of the Order of Australia, recognizing her extensive contributions to Australian public health and maternity services.
A few weeks ago, the multi-disciplinary public health research center she founded was renamed the Judith Lumley Centre. The Centre’s fields are maternal and infant health, the early years of parenthood, sexual and reproductive health, and reducing violence against women and children – the areas that Lumley’s own work did so much to advance.
After Judith retired in 2008, one of her colleagues, Professor Rhonda Small took over the Centre’s leadership. Small and her team describe Judith as a “wonderful mentor.” Which brings me to my mentoring tale.
Back in 1982 when I bought that book, I was grappling with my fears of hospital and childbirth. I decided to give birth at home – and I became a maternity consumer and women’s health activist. I thought I was heading towards a life of community organizations, or an eventual career in journalism or politics. Instead, my career veered towards science – because of Judith.
When I met her, I was starstruck, and shy at first about talking to her. It wasn’t just that Judith had written a book that had meant so much to me. It was how much she knew, and her epidemiologist’s way of considering evidence.
Data from Lumley et al’s meta-analysis of folate to prevent neural tube defects
I went to a workshop she gave at a childbirth education conference on how to critically appraise medical research. One of my most vivid memories of that time is of Judith that day. I must have communicated my eagerness and readiness somehow, because she gave me so much attention. She was in a mode that I would see again often – very engaged, with answers ready to bubble out, but holding herself back to make sure I would reach understanding under more of my own steam. What a gift.
In those early days, she would look at me seeing the limits of my knowledge and, I was sure, accurately assessing the social background I was silent about then. But her expression never made me feel vulnerable or looked down on. I felt both “seen” and valued.
Years later I would be quoted in a newspaper interview saying “being middle class is an act I’ve got down pat.” But when Judith and I first met, I was very rough around the edges, working class and on the radical side. I was committed to being the kind of organic or movement intellectual described by Freire and Habermas, rooted in activism and my social class, not academia.
Judith encouraged me to not let my lack of any degree stop me from being a practicing scientist. She introduced me to, and paved my way with, the director of the National Perinatal Statistics Unit in Sydney, so that I could do my own epidemiological work rigorously alongside my activism. She nudged me into my first professional society, the multi-disciplinary Perinatal Society. We co-authored an article about ethics and randomized trials.
We would talk about poverty and family violence in a way I was still reluctant to do publicly then. Personal revelation was tricky terrain for me. Sometimes she would ask me when a research finding in disadvantaged people was unexpected to her: why would they make that decision? But mostly it would be me turning to her with questions and for back-up.
Being a woman in science was tricky terrain as well – even if you weren’t an interloper like me, and even worse than it is now. When I was digging through bits and pieces for this post, I found the newspaper article I mentioned earlier. I’d been interviewed, along with the Chair of Australia’s National Health and Medical Research Council (NHMRC), Sir Richard Smallwood. Those times rushed vividly back when I read this bit – the quote is from me:
Over the years, many doctors have resisted her appointment to various committees, and some even threatened to resign when she joined the NHMRC working party on deaths of women during childbirth. “One of them even said to me at one time that ‘you can’t represent consumers – you are not dead’.”
That national review of every maternal death in pregnancy, childbirth and the first year afterwards had been done every three years since 1964. Only powerful male obstetricians had been members for the first few decades. After we lobbied the NHMRC to accept consumer representation for the first time – it was a rather epic battle! – they brought in Judith too. We were a very effective double act. But even so, a lot of the first day was very tough-going, as we wrestled through how to address the abortion landmark (the first three years that no Australian woman had died because of an abortion), suicide, violence against women and deaths of Aboriginal women.
Years later, the maternal death review would be done by a majority of women, including an Aboriginal woman (although the chairperson was still a man). It’s a different world in many respects. But now as then, when you’re isolated out “in the trenches,” facing a climb tilted more uphill by your gender too, even one role model like Judith can make all the difference.
Hearing Judith talk about her own and others’ struggles as pioneering women in obstetrics and pediatrics was important as well. The combination of inter-generational support and sharing stories meant a lot to me. We had extremely different styles. But she still had my back, even though my actions would not always have been those she would have chosen.
When I’d tell her about something outrageous that I’d done – and there was always something, especially when it came to the bastions of male obstetric power then in Australia – she’d take a rather wicked delight. Her giggling about a somewhat spectacular one of these incidents is one of my fondest memories of some tough times.
Watching Judith in action taught me a lot about the power of building a reputation and making your protests count in an environment where women’s voices are easily discounted. Normally rather quiet-spoken with some still-British reserve, I remember her ripping into the scientific weaknesses of an international Professor’s keynote address on preterm labor. He in essence had pinned causality in large part to women’s behavior (like heavy-lifting – basically the weight of shopping or a small child). Her voice vibrated with anger. It was all the more fearsome for being so rarely unleashed – like Thor’s hammer coming down, and the hall reverberated with the power of it.
That combination of respected authority, strength and always-reliable taking a stand for women strengthened other women, too. Our paths would diverge when I was in my 30s and left maternity activism – but the epidemiology stuck.
Women’s activism in the Wikipedia: international WikiWomen meeting in 2012 (I’m row 2, 4th from left)
The women’s activism changed form, but it stuck too. Addressing the weakness of women’s health in the Wikipedia – and women’s participation and history – is the focus there for me these days. This blog post, and starting a Judith Lumley Wikipedia page, are my (very belated) contributions to the 2013 Ada Lovelace Day effort to get more biographies of women in STEM into the Wikipedia.
This photo is a gathering in Washington DC of WikiWomen. It looks very much like the childbirth educators’ meeting where I first encountered Judith in Australia, actually. I haven’t seen Judith, though, for many years. The last time we were in touch was when I left Australia nearly 10 years ago.
I had a rather large collection of old books of advice for women about childbirth and mothering, and it was time to let go of them. Judith accepted them for her research center. We shared a voracious appetite for reading and love of books. With hindsight it seems to me that the passing on of books was a fitting coda. A relationship that began with one book, ended with a pile of them.
In 2008, Judith retired because of illness. Alzheimer’s disease was encroaching on her brilliant brain. She won’t be reading this. But we will continue to read her work. And like many others, my voice is stronger because of hers.
A few months ago, I met one of Judith’s sons, Thomas Lumley, when we started following each other on Twitter to keep up with each others’ blogs. (I blog about clinical epidemiology at Statistically Funny.) He’s a Professor of Biostatistics at the University of Auckland: his wonderful blogs are Stats Chat and Biased and Inefficient on tumblr and he’s @tslumley on Twitter. I’m deeply grateful to him for his help. My thanks, too, to Rhonda Small, the current director of the Judith Lumley Center for fact-checking on the Wikipedia page.
The photo of Judith Lumley is from Wikimedia Commons.
The newspaper article referred to in this post is a “Saturday Portrait” by Melissa Sweet, called “A voice for the people.” In the Sydney Morning Herald, 10 September 1994, page 34.
* The thoughts Hilda Bastian expresses here at Absolutely Maybe are personal, and do not necessarily reflect the views of the National Institutes of Health or the U.S. Department of Health and Human Services.
About the Author: Hilda Bastian likes thinking about bias, uncertainty and how we come to know all sorts of thing. Her day job is making clinical effectiveness research accessible. And she explores the limitless comedic potential of clinical epidemiology at her cartoon blog, Statistically Funny. Follow on Twitter @hildabast.