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I guess that during the Middle Ages and the emergence of the European nobility, they became conscious of the dangers of Rh-negative women being pregnant with Rh+ children. Since every pregnancy was a serious health risk for women, with about 1 in 10 women dying during or short after childbirth and only about 1 in 5 children attaining puberty, everything had to be done not only to keep the possessions and the titles within the families but also to have a steady supply of healthy offspring. Especially since medieval politics wasn’t exactly peaceful and the death toll of warfare could be very hard on the male segment of the noble class. E.g. During the Hundred Years-war, the mortality rate of English noblemen was at certain moments extremely high which caused a skewed male-female ratio in the knightly and noble families. In such times every woman possessed a high genetic value, even if they did not yet know about genetics.
The difference in the “value” of women in medieval noble families can also be discerned if you look at the status of the wedding partners of natural daughters in comparison to natural sons. Natural sons having titles and possessions of their own often married women of lesser descent or remained unmarried (abbots/bishops/…), while daughters often married within the same segment of nobility as their father.
This feeling of something being “special” about the women in the families could also partly explain the intermarrying of cousins within these families. E.g. the intermarrying of the different branches of the French Valois and their closely related kinsmen during the fifteenth century or the excessive intermarrying of the Spanish and Austrian Habsburgs with all genetic disasters as a result.
It is of course difficult to talk about the genetics and the blood types of men and women that lived centuries ago and of whom the remains are almost always lost or untested, but a closer look to the noble portraits of the late Middle Ages and the Early Modern Period clearly (or descriptions of their appearance in contemporary sources) provide us with dead giveaways that at least a high number of them could have been Rh-, especially since many of their present descendants also are Rh-.
E.g. Charles the Bold (Duke of Burgundy) had black curly hair, a light complexion, light green eyes (the chronicler calls them “angelically bright”) and a reddish brown beard. His father, Philip the Good, had dark hair and steel grey eyes, and John I of Cleves (a cousin of Philip the Good) had also black hair and light coloured eyes. Charles the Bold’s daughter married Maximilian of Habsburg, is the grandmother of Emperor Charles V, and became as such the “mother” of the present noble families.