Birth on the Threshold. Cecilia Van Hollen
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and child health care in the postcolonial era. This chapter also describes the maternal and child health care services available to women for childbirth in my particular field sites in Tamil Nadu in 1995. Chapter Three looks at the value placed on consumption as a central marker of modernity in the contemporary global order. In India this has become particularly apparent in the context of post-1991 liberalization policies. Increasing consumer orientation has intensified and transformed pregnancy rituals in Tamil Nadu in such a way that these rituals publicized the auspiciousness of women’s fertility while simultaneously becoming an important context and conduit for the exchange of consumer goods from a pregnant woman’s kin to her in-laws, resulting in the construction of poor pregnant women as, what I call, “auspicious burdens.” Chapter Four examines the use of modern technologies which alter the nature of pain during delivery. Most of the women whom I met in Tamil Nadu wanted to have their labors medically induced with oxytocin drugs and were unaware of the possibility of using anesthesia and wary of this notion when presented with it for the first time. The particular use of pain medication among poor women in Tamil Nadu both draws on and transforms cultural constructions of women’s reproductive bodies, and of female power, or sakti, and is influenced by political-economic constraints of public maternity wards in Tamil Nadu. Chapter Five takes on the theme of population-control programs in the modern era, particularly as these programs have been implemented in the context of postcolonial international development projects. The internationally driven family-planning agenda has long overshadowed all other aspects of maternal and child health care in India, and Tamil Nadu has been touted as a model state in this regard. In this chapter, I show how this impacted poor women’s experiences during childbirth. Chapter Six addresses the transnational discourse of “development,” in its myriad forms, as a central element in the postcolonial modernizing process. I examine the postpartum period as a key site within which such discourses of development were maneuvered in Tamil Nadu. In particular I discuss the ways in which discourses of development constructed non-allopathic practices and systems of knowledge surrounding the mother’s and baby’s postpartum diets and baths as “unscientific” and therefore not only dangerous but immoral.
The issue of how poor women in Tamil Nadu made decisions about what kind of care to seek during childbirth is filtered throughout the various chapters of this book. This issue of “choice” is the central theme of the conclusion. By focusing on Kaanathur-Reddikuppam as a community in transition, this chapter examines how new constructions of maternity which emerged in the context of the modernization of childbirth in Tamil Nadu simultaneously compelled women to seek and repelled them from seeking childbirth-related care in allopathic institutions. Although some women were “choosing” to remain home for deliveries, they usually claimed to do so to avoid specific class-based forms of discrimination in hospitals, rather than to rebuke allopathic obstetrics itself. Some women said they were choosing to remain home only because new allopathic procedures were being introduced into the home-birth context. This is a specific form of resistance to a specific form of biomedicalization. This response does not necessarily reflect greater reproductive choices for these mothers. In fact, it could, potentially, have negative consequences for their health and the health of their babies.
With improvements in quality and monitoring, however, home-birth care could provide a model for women of all socio-economic classes in rural and urban India. Such a movement should not, however, be pursued at the expense of redressing the serious problems of discrimination within the public maternity hospitals.
CHAPTER 1
The Professionalization of Obstetrics in Colonial India
The “Problem” of Childbirth in Colonial Discourse
In the late nineteenth and early twentieth centuries, the management of childbirth emerged as a key issue in colonial and nationalist discourses in India, as it did in other colonial settings around the globe from Jamaica to the Sudan to Malaya and the Pacific Islands.1 The concern with childbirth in the colonies, particularly as it related to maternal and infant mortality, echoed anxieties arising around these issues in the European metropoles. Both in the metropole and on the periphery this heightened interest in childbirth arose due to growing awareness and pronatalist fears of depopulation trends. Depopulation, particularly among proletarians, was thought to threaten capitalist interests by shrinking the labor pool. In both the metropoles and their colonial outposts the provision of maternal and child health care was thus increasingly viewed as critical to the economic interests of the state since it held the promise of arresting depopulation.
In India colonial sympathizers and nationalists alike depicted the conditions of childbirth as deplorable and used these images to legitimize their own political and economic goals in the name of protecting the “vulnerable” members of society, i.e., women and children. Differences lay in where each placed the blame for the sorry state of the birthing woman. The colonists tended to blame Indian “custom” and “tradition,” while nationalists blamed the colonial government’s extractive economic policies and unequal distribution of health services. Some Hindu nationalists used ancient Sanskrit texts as evidence that there had previously been an advanced tradition of obstetrics in India that had been lost through historical incursions from outsiders, namely Muslims and the British.2 Just as Lata Mani has argued that in colonial and nationalist debates on sati “women are neither subjects nor objects, but rather the grounds of the discourse on sati,”3 the status of women’s health can also be viewed as the “grounds” rather than the subject of the discourse on the care of Indian women during childbirth in the colonial era.
In general, colonists and nationalists both considered the professionalization of obstetrics to be an antidote to the problem. Debates in the late nineteenth and early twentieth centuries revolved around the question of how and to what extent childbirth could be brought within the ambit of the emerging allopathic medical establishment in India. The focus of these debates can be viewed as part of a larger trend away from an earlier approach that emphasized coexistence and collaboration between allopathic and indigenous systems of medicine toward the late-nineteenth-century approach, which asserted the dominance of allopathy and attempted to repress indigenous medicine throughout the colonized world.4 This shift was due in part to new scientific discoveries which rendered allopathy increasingly distinct from indigenous medicine. It was also precipitated by the growing popularity of the eugenics movement in Europe and the United States insofar as the exclusive use of Western-style medicine was deemed critical to asserting racial superiority. Furthermore, the “whiteness” of the initial allopathic doctors who served colonial administrative personnel ensured the physical separation of the “races” to a degree which was not considered necessary in the earlier phase of colonialism.5
This chapter examines debates regarding how to bring childbirth within the domain of the allopathic medical professions in colonial India. This is not intended as a full history of the biomedicalization of childbirth in India. Other scholars have begun to write pieces of such a history, and I draw a great deal from their findings as well as from materials I gathered in the Tamil Nadu State Archives in Madras.6 Here I focus on how the context of colonialism as well as local cultural constructions of gender and caste combined in such a way that the professionalization of childbirth in India took on a different form than it did in the United States and Europe, and differed also from the situation in other colonial contexts. Two factors of note which differentiate the situation in the United States and Europe from that in India are, first, that from the inception of obstetrics as a profession in India, it has been largely a women’s profession; and, second, hospitalized births did not become and still are not the norm in India, despite the government’s conviction of the supremacy of allopathic hospital obstetric care. Combined, these factors lead us to ponder the extent to which the kinds of power relationships described by feminist scholars writing about the history of childbirth in the West are and are not replicated in the Indian situation.
Madras played a prominent role in the professionalization of obstetrics in British India. The first “lying-in” allopathic maternity hospital in British India—and in Asia as a whole—was established in Madras in 1844. The Government Hospital for Women and Children in Egmore is still one of the preeminent maternity hospitals in India. The first training school for