Birth on the Threshold. Cecilia Van Hollen
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in Srinagar, wrote, “In England women can and do manage their own affairs and those of other people too, intelligently, efficiently, and well. Without them where would be our educational system, our hospitals, our orphanages and a thousand other activities essential to the welfare of a great nation. Out here not only are the women not educated, but they have no power to reform things.”60
Although the “Indian mother” in this report is generally constructed as ignorant but malleable and potentially reformable, the construction of the dai which emerges in this report is much more ambiguous. On the one hand, dais are represented as ignorant products of the “traditional” society within which they must live and work. On the other hand, they are depicted as self-serving criminal agents who are rigid in their opinions and are thus obstructing progress. Most of the dais at the time were at least forty years old, and their age was viewed as a marker of their conservatism. Some distinctions were made between rural and urban dais. Urban dais, it was felt, were more malleable, whereas rural dais were rigid in their ways and a force to be reckoned with.61 But generally the report refers to dais as a homogenous category—sometimes calling them a “caste,” an “institution,” a “class,” or a “race.” Whichever label was used, they were always viewed as the lower rung of the social order, without access to education. Their low status itself was thought to preclude the possibility of their adopting Western knowledge and practices.
The dai was always depicted as dirty. In introducing two dais to the reader, Dr. Vaughan writes, “Their clothes filthy, their hands begrimed with dirt, their heads alive with vermin, they explain that they are midwives, that the patient has been in labour for three days and they cannot get the child out. They are rubbing their hands on the floor previous to making another effort.”62
In fact, dais were constructed as being inherently dirty due to their low caste position. Thus, while most colonial reformers claimed that caste was an obstacle to building a civil society, they employed their view of the logic of caste to condemn the practice of the dais. In addition to being dirty, the dais were often referred to as “evil” and construed as being “meddlesome,” echoing the condemnation of midwives in Europe and America by the church as well as the state and the medical profession.
In 1923, the director of public health for Madras Presidency even suggested that it was safer to deliver with no assistance at all than to be attended on by a dai. As he wrote:
Excluding the few fortunate women who are delivered without any assistance or intervention, there still remains some 10 lakhs [one lakh is 100,000] of labor cases which are managed by barber midwives or dhais [sic]. Their ignorance of hygiene, or even of cleanliness, is stupendous, as may be recognized when it is stated that the duties of physician, midwife, and scavenger are all performed by them. Their methods, the instruments used by them, and the medicaments given to both mother and child are so revolting that no language sufficiently strong can be used to condemn them. It cannot therefore be a matter of great surprise that maternal deaths amount to the colossal figure of 25,000 annually.63
The introduction to the Victoria Fund report acknowledges that the dai-training schemes had not been wholly successful and attributes the lack of success to the active resistance of the dais:
Many of the women were forty, fifty, sixty, or even seventy years of age: some were deaf, some were blind: none had any previous education or had ever exercised their mental faculties: they were very prejudiced and jealous of their reputation and in addition honestly convinced that no one could teach them anything as regards normal labour. They believed that doctors were required in abnormal cases, but they also believed that they themselves were the proper judges as to when a doctor should be called in. This was and is the general opinion of their patients and it is the attitude of the people of India at the present day. They are only very slowly beginning to realise that the great mass of the abnormal cases are due to neglect and ignorance in the treatment of normal labour.64
In the end, this report reflects extreme ambivalence about the value of working with hereditary dais through the Victoria Fund. Nevertheless, throughout the report there is a sense that despite the innumerable obstacles faced in training hereditary dais and in reforming “the Indian woman,” the continuation of the work of the Victoria Fund remained essential to the stated goals of reducing infant and maternal mortality in India. The dai-training programs were viewed as necessary stopgap measures, while the long-term goals lay in the development of a cadre of professionally trained women doctors, nurses, and even midwives who would oversee deliveries in hospitals.
The director of public health for the Madras Presidency in 1923, quoted above, was less willing to concede that short-term government support of hereditary dais should be continued. He sought to prevent dais from practicing in the presidency and proposed to do so through the passage of a government act modeled after the Midwives Act of 1902 in England, which required all midwives to be licensed and penalized all midwives practicing without licenses. Through such an act, he felt that all dais would be replaced by certified midwives who would not be drawn from the pool of hereditary dais.65
In 1926 the government of Madras Presidency passed the Madras Nurses and Midwives Act requiring certification and registration of all nurses, midwives, health visitors, auxiliary nurse midwives, and dais.66 Under this act, anyone working without a certificate of registration could be fined, as could anyone issuing false certificates or anyone falsely using such titles as “registered nurse” or “registered dai.” Applicants who wished to be put on the register had to pass standardized exams and had to provide testimonials of both their professional competency from medical personnel and their “good moral character” from persons of “good social standing.” The council deciding who could and could not be on the register included representatives from all the above categories of practitioners except dais. Obviously, the administrative difficulty of officially training all dais and penalizing all those dais practicing without certification was insurmountable. Additionally, it would be interesting to know, although impossible to ascertain, how councils voted on the “moral” qualifications of dais given the construction of dais as inherently immoral. Clearly this legislation was more symbolic than pragmatic. Many dais then, just as today, of course continued to practice without any government training or licensing. Nevertheless, this act did represent the government’s ongoing efforts to publicly condemn the traditional practices of the dais while simultaneously demonstrating a commitment to officially recognize and sanction the work of those dais who went through dai-training programs.
Throughout the Victoria Fund report, and in the numerous other government reports on maternal and child health at the time, the high rates of infant and maternal mortality are attributed to the general ignorance of the Indian population and specifically to the evils of the untrained dai in her (mis)management of birth. The report does not consider how maternal health during pregnancy results in high rates of infant and maternal mortality as well as miscarriages and stillbirths. A 1928 study of maternal mortality in India reported that 31 percent of “abnormal” obstetric cases and 54 percent of maternal deaths were caused by “diseases of pregnancy,” whereas in Britain only 7 percent of “abnormal” obstetric cases and 35 percent of maternal deaths were caused by “diseases of pregnancy.”67 Poor maternal health during pregnancy is, of course, directly related to poverty and thus to broader structures of political economy.
The Victoria Fund report does not, however, consider how the political-economic structures under colonialism might have negatively impacted women’s health. For example, colonial systems of labor and wage structures rendered women increasingly economically dependent on men, thereby diminishing their ability to take advantage of whatever medical services might be available.68 Furthermore, colonialism was directly implicated in the spread of deadly epidemics of smallpox, cholera, and the plague, and was responsible for famines which devastated communities throughout the subcontinent. In the face of these man-made disasters, it was the health of women and children which suffered the most.
In sum,