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 midwives in India opened in Madras. Madras was the first city to admit women into its medical schools, and the first city with a medical school offering a post-graduate diploma in obstetrics and gynecology. It was, therefore, no surprise that in 1936 the first All India Obstetrics and Gynaecological Congress gathered in the Museum Theatre in Egmore, Madras, just down the road from the Egmore maternity hospital. Ida Scudder, an obstetrician and gynecologist—born into a missionary family in South India—who helped to found the world-renowned Christian Medical School and associated hospital in nearby Vellore, was elected the first president of this congress. In her welcoming address, the chair of the congress, Dr. A. Lakshmanaswami Mudaliar, proudly stated:
Madras may not stand comparison in many respects with the Gateway of India or with the City of Palaces—the second largest city in the British Empire. But Madras is proud[,] and justly so, of the place it occupies in the Obstetric world of today and it is in no spirit of narrow provincialism that I venture to maintain that no other city in India could have claimed this honour with greater confidence and dignity.7
Prior to the 1844 opening of the Government Hospital for Women and Children, women in India had all been delivering their babies at home, usually in either their natal home or their husband’s family’s home. There were medical institutions for indigenous medical traditions (such as Ayurveda, Unani, and Siddha), and these traditions did have well-developed theories of reproduction and birth.8 However, these indigenous medical institutions and practitioners were not involved in providing services to women during the actual birth. Some have suggested that this is largely due to the fact the practitioners were almost all men and it was inappropriate for a man to be present at a birth.9
Many of the home deliveries were overseen by senior female members of the extended family who had experience in assisting births. Other deliveries were attended by lay midwives who were called from outside the family. In South Asia these midwives are often referred to collectively as dais by people writing about the region as a whole. This term is most widely used in the northern regions of South Asia and is thought to be of Arabic origin.10 Some scholars have chosen to use the term “traditional birth attendant,” or “TBA,” which is taken from the international development discourse, because the term “dai” is deemed condescending in the communities they are studying.11 Indeed, in much of the literature on midwifery in India the primary role of the dai is thought to be the removal of ritual “pollution” associated with childbirth. In particular, writers mention that the cutting of the umbilical cord and the disposal of the placenta and blood are the primary tasks performed by dais and that these tasks are deemed defiling. In general, specialized dais belong to low-caste Hindu or poor Muslim communities. Many dais are members of the “barber” castes, which participated in an extensive network of patron-client, or jajmani, relationships in the precolonial era.12 The work of the dai is often hereditary, passed on from mother-in-law to daughter-in-law.
Unfortunately, discussions about the deprecating connotations of the term “dai” have not looked carefully into the history of the dai’s role in South Asian societies and the extent to which colonial representations of the dai and the very process of the professionalization of obstetrics in South Asia may have significantly transformed these women’s status. Patricia Jeffery et al. refer briefly to the possibility of a historically shifting status of dais when they write:
The few historical sources that feature dais and women’s experiences of childbearing are often written by doctors patently biased against their competitors. Thus we cannot be sure about how dais’ skills and status might have changed, especially in the wake of the major secular changes since the mid-60s. Possibly in the face of what are probably more restricted employment opportunities for women in the poorest classes, proportionately more women are being pauperized and more women with families without traditions of dai practice may be resorting to an occupation that is becoming increasingly de-skilled. Further, as urban medical facilities have expanded, any ante-natal, abortion, and infertility work of dais may have declined, and dais may have become more restricted to delivery work.13
Yet Jeffery et al. do not pursue this line of thinking further. Such historical contextualization is critical for a more complete understanding of the dai’s role in India and the role of the so-called TBAs in any society. This chapter will emphasize colonial representations of dais and of local childbirth practices in the contexts of attempts to professionalize obstetrics in India and of the
