MATERNAL MORTALITY IN INDIA
. [To the Editor of the SPECTATOR.]
Sin,—Maternal mortality in India is a subject which has been - treated from various points of view by different observers. It is a pleasure to contemplate the practical and most useful results achieved by the unobtrusive action taken by Lady Chelmsford some years ago to set on foot centres for baby welfare and pre-natal treatment among Indian women all over the country. The framers of this scheme and those who had to put it into execution knew all the gruesome details which Miss Mayo has outlined in her book, but they tackled these evils silently and practically and in the short time their centres have been running they have made steady and increasing progress.
The method of working is _simple and direct. Briefly a few Indian and European ladies are got together in a place where operations are to be started. The local hospital or dispensary is made use of as a starting point in many cases. An Indian lady doctor, paid from ten to twenty pounds a month, and a midwife are provided. The _qualifications of these lady doctors vary from full qualification to that of a female assistant surgeon, the latter being by far the most common. The central fund provides about half the income required and private subscriptions or municipal assistance make up the balance. If it so happens that there is a separate female dispensary in the municipal area the work is much facilitated. In many cases municipalities and District Boards (urban district councils) will gladly open female dispensaries if the Chelmsford Fund female assistant surgeon will run them. _
To see how these dispensaries are patronized is both gratifying and rather disconcerting as the question at once arises, where did all these poor people go before for treatment and advice? The answer to this is all too obvious, they had to go without.
Where one sees these packed dispensaries one naturally expects that a ward for in-patients if provided would be equally sought after. This, however, is not the case. All Indians dislike going into hospital. There is the trouble about preparing food. There is the horror of dying in hospital away from the family ; though in this connexion it is very often permitted to the relatives to take away a patient to spend the last few days of life in the family circle, in hopeless cases.
Besides the above reasons which make it difficult to Persuade patients to enter hospital wards, there is possibly another, especially in the case of women patients, a legacy from the bad old days when hospitals in the bigger military stations had a lock hospital attached. All that sort of thing, including the examination of women, is a thing entirely of the past, but although many years have elapsed since those days the memory of such things may linger a tong time.
But whilst it is true that the education of the people in health work, including the .necessity of making use of the hospitals and dispensaries which exist, has made less progress than one would have wished to see, there has always been a system by which women in labour could obtain the assist- ance of professional dais (midwives).
Quite enough is known about the qualifications, or rather disqualifications, of these terrible old women without retouching the unpleasant picture here. But it must be remembered that the indigenous dai does stand for some- thing—she stands for an established system and that means a lot, if my political friends will allow me to say so. It means something to build on. Now the Lady Chelmsford Association have taken the system as they found it, arranged courses of lectures and demonstrations for the midwives, together, of course, with a small payment for each attendance at a lecture, and so are slowly bringing these women into line with modern ideas. One or two local governments, notably that of the United Provinces of Agra and Oudh, have, after watching the experiment, even gone to the length of introducing legislation to enable local bodies to take powers by means of by-laws to control these dais.
It is very disappointing to realize, as one must if one moves much among the people, especially off, the beaten track, how terribly ignorant they almost all are on this subject of health. Such a lot remains to be done in the most rudimentary questions affecting health before one can even start popularizing measures for reducing maternal mortality and protecting the lives of young infants.
It is hard working and hard thinking that are required, and there is nothing showy in it. It does not appeal like politics and it has too few advocates at present, but perhaps in time, if only the political situation could be got on to a more satisfactory footing, men and women might have energy left to tackle this huge and very vital problem in the way it deserves.—I am, Sir, &c., G. B. C.
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