Birth on the Threshold. Cecilia Van Hollen
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patients is high as usual…. It is very satisfactory to find that there is a steady increase in the maternity every year. We are also pleased to state that several of the better class come into the hospital for their confinements. We have had no less than 33 Brahmin and respectable Hindu cases. There is no doubt that the new delivery ward, the gift of Lady Bashyam Iyengar,30 will prove a special attraction as the accommodation and sanitary conditions are far superior to those of the old delivery ward.31
Lal points out the contradiction which this created in British policy. Colonial discourse represented purdah as a sign of India’s barbarism and something to be reformed, yet the Dufferin Fund was structured to accommodate the practice.32 By the same token, in the interest of attracting an elite clientele, hospitals supported by the Dufferin Fund were structured along caste lines at the same time that caste was rhetorically touted by the colonial regime as inimical to civilized society. Maternity hospitals were established in other colonies at the same time with the same intent of luring elite women, for example the Victoria Jubilee Hospital which opened in Jamaica in 1894. Victoria Jubilee, however, was staffed with male physicians, following the model established in maternity hospitals in Britain.33
Despite some reports that more high-caste women were using these maternity wards established under the Dufferin Fund, attendance remained low up through World War I. Within India, the Madras Presidency was known to be making greater strides in the provision of Western medical care for women than governments in most other provinces of the colony. Nevertheless, David Arnold reports that even by 1913, less than one-fifth of all registered births in the city of Madras took place in hospitals, and in rural areas of the Madras Presidency maternity hospitals were scarce.34
Despite the official rhetoric which emphasized purdah as the reason for the need to employ female medical practitioners in India, Lal makes the important point that there was also an imperialistic logic to this demand, which has often been ignored by historians. Lal argues that the rhetoric of purdah was used as justification for the establishment of the Dufferin Fund, but the fund initially provided employment and educational opportunities almost exclusively to women from Great Britain. Women interested in breaking into the medical establishment in Great Britain at the time faced fierce competition from male medical professionals. The “need” for women medical professionals in India, therefore, provided an alternative for British women who could not successfully compete with their male counterparts at home.35 As Arnold writes, “Western medicine in India was a colonial science and not simply an extension or transference of Western science to a colonial outpost.”36 In reality, Lal and others suggest, most Indian women were prevented from accessing male medical practitioners primarily due to cost and patriarchal structures which rendered women’s health care secondary to men’s.37 Furthermore, Meredith Borthwick’s study of high-caste Bengali bhadramahilas suggests that even high-caste women were in fact willing to see male doctors, and that male doctors even entered zenanas to provide their services to women.38
Due to the colonial context, race was central to how the Dufferin Fund was executed. Initially, women doctors working in India all originated from and were trained in the West and then sent to India. Women began entering medical colleges in India in 1875 at Madras Medical College, but still these were mostly British and American or Anglo-Indian women. The Indian women who did enter the medical profession at the time came primarily from Christian communities. Hindu and Muslim women, particularly from the upper castes, tended to stay out of the women’s medical professions just as they had stayed away from maternity wards as patients. The reason given for the lack of representation from these communities was that work associated with childbirth was culturally considered “polluting.”39 But racist attitudes in the recruiting policies of medical colleges must also be held responsible for this imbalance that existed up until the 1930s.40
One of the ways that women of European descent attempted to hold onto their privileged positions in nursing and midwifery was by arguing that better quality of care could be guaranteed only by providing training (and stipends for training) in the English language, as opposed to vernacular languages. In Madras Presidency this issue was, however, hotly debated in the 1930s, and the Madras government began to establish stipends and training programs in vernacular languages with the intent of spreading allopathic care to a wider population.41
By 1939 the Madras government explicitly stated that preference for candidates in midwifery would be given to “natives of the Province.” Key restrictions for such candidates, however, were applied. First, candidates had to be between the ages of eighteen and thirty-five. And, in addition to the preference given to candidates who had received higher education, unmarried candidates were also preferred. Candidates who were pregnant or nursing would not be considered. And a student who married during the course of training would be considered to have resigned her training and would be penalized.42 The combination of family and professional work was clearly viewed as inimical for women in the colonies, as it was for women in Britain. But such restrictions for candidates may have been particularly problematic in the Indian context, where marriage and maternity were expected at a younger age for most Indian women than for European women. Such restrictions may therefore have favored single European women seeking work in the colonies.
Proponents of the Dufferin Fund felt that part of their mission was to rid childbirth and medical care at birth of what they perceived to be a dominant cultural association of childbirth with “pollution,” and therefore with untouchability in India. The profession of obstetrics thus had to be presented as both sanitary and noble. The success of the Dufferin Fund relied in many ways on the vilification of the dai as unsanitary and on the representation of home birth as inherently dangerous. Over time, however, it became eminently clear that due to the economic condition of colonial India it was not realistic to expect that all birthing women could be served by medical professionals in the short term. It was felt that intermediary measures had to be taken to improve the practices of the dais. It was to this end that the Victoria Memorial Scholarship Fund was established in 1903.
VICTORIA MEMORIAL SCHOLARSHIP FUND
Although individual civil surgeons and missionaries had provided training to dais as early as the 1860s,43 the Victoria Memorial Scholarship Fund (hereafter called the Victoria Fund) represented the first systematic effort to train dais throughout India. Like the Dufferin Fund, the Victoria Fund was run by a voluntary organization consisting primarily of the wives of colonial administrators and headed by Lady Dufferin. Although it had government support, it was not a government program.
In 1918 a major report on the Victoria Fund, entitled Improvement of the Condition of Childbirth in India, reviewed the goals of the fund and assessed the extent to which these goals had been achieved. Civil surgeons, inspectors general of civil hospitals, and medical officers from several provinces, as well as “medical women” and “qualified midwives” all contributed papers to the report. Almost all contributors were men and women of British descent. An analysis of this report reveals the extent to which this project was conceived of as part of the civilizing process and was riddled with the contradictions regarding the question of whether this process would occur voluntarily or by force. These contradictions were played out in the representation of the dai, who was simultaneously depicted as a victim of “custom” and caste and as a criminal agent acting with free will. The question, therefore, was whether the dai could be enlightened and reformed, or whether she represented a threat to civility and should therefore be forbidden from engaging in her work assisting births.
The report states that the primary objective of the Victoria Fund was “to train midwives in the female wards of hospitals and female training schools in such a manner as will enable them to carry on their hereditary calling in harmony with the religious feelings of the people, and gradually to improve their traditional methods in light of modern sanitation and medical knowledge.”44 The emphasis on the gradual pace at which this transformation should take place was further underscored by Colonel C. Mactaggart, the inspector general of civil hospitals in the United Provinces, who wrote:
I am strongly of the opinion that in all sanitary and medical matters in this country progress can only be made by