Birth on the Threshold. Cecilia Van Hollen
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their communities than do those in parts of rural Uttar Pradesh, where Jeffery et al. conducted their study, or in contemporary Bangladesh, where Santi Rozario did her research.20 Is this difference due to precolonial cultural differences between the north and south, or is it more restricted to the historical role of the midwife in fishing communities in Tamil Nadu? These issues need to be pursued further for a deeper understanding of the politics of gender in precolonial, colonial, and postcolonial South Asia.
Due to the establishment of government “dai-training” programs, in Tamil Nadu the term “maruttuvacci” has come to be associated with those who have not been officially “trained” and thus to connote a lack of scientific knowledge and state recognition. Women who go through dai-training programs, whether they are hereditary maruttuvaccis or not, tend to prefer the label “dai” to “maruttuvacci,” since they feel this gives them greater legitimacy in relation to the communities they serve and, more important, to government and nongovernmental health workers. I try, therefore, to maintain distinctions between such terms as “maruttuvacci” and “dai” in order to highlight the meanings that various terms come to have for people in different contexts. When speaking of India as a whole, I use the term “dai” because that is how most people refer to midwives, even, or perhaps particularly, when they are speaking English.
In colonial discourses the practices of the dai were repeatedly decried as “barbaric,” and the dai herself was represented as the primary cause of high rates of infant and maternal mortality and as an obstacle to “progress,” which the colonial government was promising. Once again, concerns about mortality rates were tied to anxieties about depopulation of the labor force. Two tactics were taken to rectify the situation and to bring Western medical care to Indian women during childbirth. On the one hand, efforts were made to increase the number of Western-trained doctors, nurses, and nurse-midwives who provided services to Indian women primarily in institutional settings. This effort was initiated throughout India under the Countess of Dufferin Fund in 1885. On the other hand, the Victoria Memorial Scholarship Fund was initiated in 1903 to provide training to the hereditary dais already working in communities throughout India.
THE COUNTESS OF DUFFERIN FUND
The first woman doctor trained in biomedicine to work in India was an American missionary named Clara Swain who arrived in India in 1869.21 For some time following her arrival, missionary women made up the bulk of the women doctors in India. It appears that the first woman doctor to be employed by the government was Elizabeth Beilby, who began working in Lahore in 1885. It was in this year that the Countess of Dufferin Fund (known in full as the National Association for Supplying Female Medical Aid to the Women of India but generally referred to as the Dufferin Fund) was established, setting the stage for a nation-wide, nonsectarian project to employ women in the medical services. Queen Victoria herself issued a plea for the formation of this fund.22
The Dufferin Fund and the Victoria Memorial Scholarship Fund were initiated by then-vicereine of India, Lady Curzon. Both funds, as well as subsequent funds for women’s medical care in India such as those initiated by Lady Chelmsford in 1920 and by Lady Reading in 1924, received support from the colonial government, but they were independent of the government in terms of administration and policy and had to raise much of their money from individual philanthropists. This lack of full government funding demonstrates that ultimately the government did not consider maternal health to be an issue of the state, and without full government support it was difficult for these funds to survive.
The stated purpose of the Dufferin Fund was “to bring medical knowledge and medical relief to the women of India.”23 Maneesha Lal writes that this goal was to be achieved through the provision of:
(1) medical tuition, including the teaching and training of women as physicians, hospital assistants, nurses, and midwives, the education to be supplied first by England and America but then by India; (2) medical relief, which included establishing, under female superintendence, dispensaries and cottage hospitals for the treatment of women and children, opening female wards under female supervision in existing hospitals and dispensaries, providing female medical officers and attendants for existing female wards, and founding hospitals for women where funds were forthcoming; and (3) provision of trained female nurses and midwives to care for women and children in hospitals and private houses.24
It is important to note that the Dufferin Fund, unlike the Victoria Memorial Scholarship Fund, was intent on training a new cadre of midwives who were not hereditary dais. In fact, as discussed below, most of the midwives initially trained and employed through the Dufferin Fund were of European descent.
Historians writing on the Dufferin Fund have highlighted two key interrelated issues which influenced the motivation for and structure of the fund: purdah (seclusion of women) and caste.25 The main reason given for the need to train medical women in India was that cultural practices of purdah prevented Indian women from going to see male doctors. Indeed, cross-cultural studies in many parts of the world suggest that women prefer to be attended by women doctors during childbirth due to cultural notions of modesty, regardless of whether or not women are secluded for religious purposes such as in purdah.26 The emphasis placed on purdah as a cultural practice in the colonial discourse may have served to legitimize the dominance of male obstetricians in Europe and the United States, where purdah is not prevalent. In colonial discourse not only was purdah represented as problematic insofar as it barred women from medical care, but the practice of purdah in and of itself was viewed as dangerous to women’s health because it kept women away from sunlight and fresh air, and it was blamed for excessive female morbidity and mortality. In an official memorandum on maternity and child welfare relief, the director of public health for Madras Presidency (a British colonial province that included most of the contemporary state of Tamil Nadu and portions of the three states that border Tamil Nadu) in 1923 articulated all these anxieties about the effects of purdah on maternal health. In a discussion on maternal mortality he wrote:
Amongst purdah women conditions are even worse, tuberculosis being particularly common. Under this system, the women are prevented from availing themselves of skilled medical advice in the absence of properly qualified medical women, and are also prohibited from taking advantage of the maternity hospitals. Even among the better educated classes the woman in travail is shut up in a dark dirty room where neither light nor fresh air can gain admittance, and she is usually surrounded by a crowd of female relations all prepared to resist to the utmost the introduction of any new-fangled notions of sanitation and hygiene. It is not surprising that the mother, weak and unhealthy to start with, very often succumbs in giving birth to a puny child.27
Indeed, purdah was an important Orientalist trope in constructing the colonized “other” society as repressive toward women, thereby legitimizing colonial authority.
Since in India purdah was primarily practiced by upper-caste Muslims and Hindus, the unstated implication was that the Dufferin Fund was intended to serve upper-caste women so as to make allopathic maternity care respectable and, ultimately, hegemonic. In fact, when female-supervised maternity wards in large hospitals did begin to open up, those women who tended to come at first were Hindu women from the lower castes and classes as well as some less-affluent European and Anglo-Indians.28
In order to lure high-caste Hindus and Muslims, therefore, hospitals began to establish separate wards for these communities. For example, in 1890 the Victoria Hospital for Caste and Gosha Women was established in Madras. Today the official name of this hospital is the Kasthurba Gandhi Hospital, though it is still colloquially referred to as Gosha Hospital. Gosha refers to the practice of veiling among Muslim women. Much of the ethnographic material in this book refers to this hospital. In 1904 a report put out by the Victoria Hospital for Caste and Gosha Women stated:
We have much pleasure in noting the increasing popularity of the hospital. No pressure or inducement is now needed; patients come of their own free will, asking admission into the hospital. In fact during certain seasons of the year, it becomes necessary, from want of accommodation, to refuse admission to patients and they are advised to go to other