MATERNAL MORTALITY IN INDIA
[To the Editor• of the SvEc-rATon.] Sin, The interesting letter by G. B. C. in your issue of March 7th, may possibly convey to readers an unintended impression that the baby-welfare centres and dispensaries described cover all the ground, or at least that further hard Work on the same unpretentious lines is all that is needed to combat the immense evil of maternal mortality in India. The following facts may perhaps help to dispel any false optimism on this score :- First, as to the extent of the evil. Computations as to the rate of maternal mortality vary greatly according to district and are all admittedly imperfect. Thus the Director of Public Health for Madras (one of the best organized districts) considers twenty maternal deaths per thousand births to he a " most conservative estimate." Dr. Adesheshan's field- study of seventy thousand confinements over a wide area showed 17.89 deaths per thousand births. Taking the lower estimate of fifteen per thousand, one may reckon that there are at least one hundred and twenty-six thousand maternal deaths in British India per annum. (The corresponding European death-rate varies from 2.35 in Denmark to 6.64 in France). This terrible mortality is attributed partly to bad midwifery and unhygienic conditions of confinement, but partly to child marriage. The Report of the Committee on Age of Consent—a weighty Government Committee composed mainly of Indian doctors, lawyers, &c.— reported in 1929 that nearly fifty per cent. of Indian girls were married under the age of fifteen ; that the rate of improvement was exceedingly slow ; and that the resulting early maternity was " an evil of great magnitude " which " contributes very largely to maternal and infantile mortality, in many cases wrecks the physical system of the girl and generally leads to degeneracy in the physique of the race." They went on to compare the evil of early maternity to that of suttee, pointing out that while the suttees of the past had been few and rare, and affected only individuals, the evil of early maternity was so extensive as to affect the whole framework of society. After going through the ordeal, if a woman survives to the age of thirty, she is in many cases an old Woman, almost a shadow of her former self. Her life is a long lingering misery and she is a sacrifice on the altar of custom."
As to the personnel of health workers engaged in combating these evils, the most recent figures I have been able to obtain show that there are in British India about four hundred medical women with registrable qualifications ; about six hundred and thirty-six women medical students ; about two hundred and fifty health visitors ; and less than fifty students in the various health schools. I could find no estimate of the number of trained nurses and midwives. Schemes for training these and for giving brief courses to indigenous dais seem. to be spotted over India fairly thickly in a few cities, so sparsely over rural India as to seem almost negligible. The 1928 Report of the League of Nations on Health Organization describes the problem of supplying trained midwifery to the villages (in which about two hundred and twenty-one million out of about two hundred and forty. seven million of the population reside) ." is one of which the solution has scarcely beep attempted." I do not give these figures in order to disparage the wholly admirable work of the Lady Chelmsford League, but merely to indicate the futility of relying wholly on individual philanthropy, aided by such exiguous Government grants as have hitherto been- available, to combat evils so enormous. What is •needed to quicken the pace ?
India is now at the beginning of a new era. Its administra- tion, especially of internal affairs such as health, education, marriage laws, &c., will pass more and more completely into Indian hands. What security have we that•the..needs. of the most inarticulate and helpless section of its population will receive adequate consideration ? I suggest that the best security would be the inclusion in the new Constitution of provisions for ensuring that Indian ,women themselves will take their full share in the work of shaping and administering the law. The early period will be the formative period, while the life of India is running into new channels and shaping new moulds. The emergence of women in the national struggle, their zeal and devotion, have attracted all observers. Now is the time to turn the women's movement, which the Simon Commission described as " the key of progress," to constructive ends. During the sittings of the Round Table Conference a small group of men and women, mostly them- selves of long Indian experience, and in consultation with members of the Conference, gave much thought to the problem of how the future 'participation of women could be secured. The following steps were agreed on as the most practicable :- I. A wide extension of the franchise qualification for women, which at present admits only a negligible fraction, on the lines recommended by the Simon Commission.
2. Reservation of seats (say to the extent of 5 per cent. as recom- mended by the Central Indian CoMmittee of the Simon Commission) for women in the provincial Legislatures ; these to be filled by co-option by the Councils themselves, through the method of proportional representation. This arrangement to last only for three general elections, to meet the difficulty that women are at first unlikely to be successful in ordinary contested elections. 3. Corresponding steps to secure adequate representation of women in the Central Legislature. 4. The inclusion of the words " or sex " in the proposed con- stitutional safeguards against discrimination in the matter of civil and social rights on the ground of race, religion or caste. 5. The establishment of Bureaux of Education and Health in connexion with the Central Legislature.
I would recommend all those who desire to study the full facts in relation to the above problem to read The Key of Progress, a survey by various writers of the status and con- ditions of women in India, published recently by the Oxford 50 Romney Street, Westminster, S.W. 1.
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