184

CHAPTER VII.

Maternity.

       A general review of the maternity service in India reveals the vast
magnitude of the problem. It is doubtful if it is generally realised that
even now the great majority of confinements in India are conducted by
indigenous dais or midwives. For ages the dai had been the genius
presiding over childbirth and her sway until recent years was undisputed.
The profession is hereditary; it passes from mother to daughter.
These women are, generally speaking, low in the social scale, e.g.,
in Madras and Bombay they belong to the "barber" caste while
in North India Mohammedan women of the lower classes practise
the art. They have no scientific knowledge of the mechanism of labour
or of the elementary principles asepsis. In any difficulty their only
remedy is force, with what disastrous consequences may be imagined.
Under these conditions is it any wonder the maternal deaths in India
arising out of pregnancy in. 1936 numbered over 160,000?

       2. The tragedy is that probably 80 per cent. of those deaths were
preventable. During the recent inquiry into maternal mortality in
Calcutta, Dr. Neal laid down lower standards and, as judged by them,
the proportion of preventable cases in her series of 430 cases was as high
as 96.3 per cent.

       3. It must also be stressed that along with this wastage of life a very
serious wastage of health takes place. In the annual report of the
Public Health Commissioner with the Government of India for 1935 it
was stated that "the percentage of women disabled as a result of preg-
nancy and labour may perhaps be taken as not less than 30 per cent. and
in a country where nearly ten million births are registered annually, the
percentage of women temporarily or permanently incapacitated must be
very large". On this estimate about 3 million women are disabled tem-
porarily or permanently every year. To the physical disabilities must also
be added the loss of happiness in the home life which must result from
this heavy mortality and morbidity.

       4. There is a great difference between the conditions existing in
Western countries and in India and it is only in large cities like Madras,
Bombay, Delhi and Calcutta that serious efforts have been made to
establish a connected chain of agencies concerned in maternal and infant
welfare. In small towns and in a large proportion of villages, the old
order still prevails.

       5. Owing to lack of education in the public it is also clear the
maximum benefit from the services in existence is not derived. Further
the best midwifery schemes devised will be ineffective until there is a
general improvement in the general health and resistance of the people.
Little improvement in the mortality rate can be hoped for until the public
are better educated, the economic conditions of the people are improved
and the untrained and meddlesome indigenous dai is replaced by the

       This Chapter is based on notes supplied by Dr. C. L. Houlton, Chief Medical Officer,
Women's Medical Service.