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 hospitals. The influx of mofussil29 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
