Modernizing Childbirth in Colonial Bengal: A History of Institutionalization and Professionalization of Midwifery, c.1860-1947

<p>In colonial India, medicalization of childbirth has been historically perceived as an attempt to ‘sanitise’ the zenana (secluded quarters of a respectable household inhabited by women) as the chief site of birthing practices and to replace the dhais (traditional birth attendants ) with trained midwives and qualified female doctors. This thesis has taken a broader view of the subject but in doing so, focusses on Bengal as the geographical area of study. It has argued that medicalization of childbirth in Bengal was preceded by the reconstitution of midwifery as an academic subject and a medical discipline at the Calcutta Medical College. The consequence was the gradual ascendancy of professionalized obstetrics that prioritised research, surgical intervention and ‘surveillance’ over women’s bodies. The thesis also shows how the medicalization of childbirth was supported by the reformist and nationalist discourses of the middle-class Bengalis in the late nineteenth and early twentieth centuries. The thesis begins from the 1860s when the earliest scientific essays on childbirth and pregnancy began to appear in Bengali women’s magazines such as Bamabodhini Patrika. It ends in the 1940s, when nationalism profoundly influenced the professionalization of obstetrics - midwifery being perceived as the keystone in a nation’s progress. Bengal being the earliest seat of British power in India it was also the first to experience contact with the western civilization, culture and thought. It also had the most elaborate medical establishment along western medical lines since the foundation of the Calcutta Medical College in 1835. It is argued in the extant literature that unlike the West where professionalized obstetrics was characterised as essentially a male domain, the evolving professional domain of obstetrics in Bengal was dominated by female doctors alone. Questioning that argument, the thesis demonstrates that the domain of obstetrics in Bengal was since the 1880s shared by both female and male doctors, although the role of the latter was more pedagogic and ideological than being directly interventionist. Together they contributed to the evolution of a new medical discourse on childbirth in colonial Bengal. The thesis shows how the late nineteenth century initiatives to reform birthing practices were essentially a modernist response of the western educated colonized middle class to the colonial critique of Indian socio-cultural codes that also included an explicit reference to the ‘low’ status of Bengali women. Reforming midwifery constituted one of the ways of modernizing the middle class women as mothers. In the twentieth century, the argument for medicalization was further driven by nationalist recognition of family and health as important elements of the nation building process. It also drew sustenance from international movements, such as the global eugenic discourse on the centrality of ‘racial regeneration’ in national development, and the maternal and infant welfare movement in England and elsewhere in the inter-war years. The thesis provides a historical analysis of how institutionalization of midwifery was shaped by the debates on women’s question, nationalism and colonial public health policies, all intersecting with each other in Bengal in the inter-war years. The thesis has drawn upon a number of Bengali women’s magazines, popular health magazines, and professional medical journals in English and Bengali that represent both nationalist and official viewpoints on the medicalization of childbirth and maternal and infant health. It has also used annual reports of the medical institutions to chart the history of institutionalization of midwifery and draws upon archival sources - the medical and educational proceedings in particular - in the West Bengal State Archives and the National Archives of India.</p>

Modernizing Childbirth in Colonial Bengal: A History of Institutionalization and Professionalization of Midwifery, c.1860-1947

<p>In colonial India, medicalization of childbirth has been historically perceived as an attempt to ‘sanitise’ the zenana (secluded quarters of a respectable household inhabited by women) as the chief site of birthing practices and to replace the dhais (traditional birth attendants ) with trained midwives and qualified female doctors. This thesis has taken a broader view of the subject but in doing so, focusses on Bengal as the geographical area of study. It has argued that medicalization of childbirth in Bengal was preceded by the reconstitution of midwifery as an academic subject and a medical discipline at the Calcutta Medical College. The consequence was the gradual ascendancy of professionalized obstetrics that prioritised research, surgical intervention and ‘surveillance’ over women’s bodies. The thesis also shows how the medicalization of childbirth was supported by the reformist and nationalist discourses of the middle-class Bengalis in the late nineteenth and early twentieth centuries. The thesis begins from the 1860s when the earliest scientific essays on childbirth and pregnancy began to appear in Bengali women’s magazines such as Bamabodhini Patrika. It ends in the 1940s, when nationalism profoundly influenced the professionalization of obstetrics - midwifery being perceived as the keystone in a nation’s progress. Bengal being the earliest seat of British power in India it was also the first to experience contact with the western civilization, culture and thought. It also had the most elaborate medical establishment along western medical lines since the foundation of the Calcutta Medical College in 1835. It is argued in the extant literature that unlike the West where professionalized obstetrics was characterised as essentially a male domain, the evolving professional domain of obstetrics in Bengal was dominated by female doctors alone. Questioning that argument, the thesis demonstrates that the domain of obstetrics in Bengal was since the 1880s shared by both female and male doctors, although the role of the latter was more pedagogic and ideological than being directly interventionist. Together they contributed to the evolution of a new medical discourse on childbirth in colonial Bengal. The thesis shows how the late nineteenth century initiatives to reform birthing practices were essentially a modernist response of the western educated colonized middle class to the colonial critique of Indian socio-cultural codes that also included an explicit reference to the ‘low’ status of Bengali women. Reforming midwifery constituted one of the ways of modernizing the middle class women as mothers. In the twentieth century, the argument for medicalization was further driven by nationalist recognition of family and health as important elements of the nation building process. It also drew sustenance from international movements, such as the global eugenic discourse on the centrality of ‘racial regeneration’ in national development, and the maternal and infant welfare movement in England and elsewhere in the inter-war years. The thesis provides a historical analysis of how institutionalization of midwifery was shaped by the debates on women’s question, nationalism and colonial public health policies, all intersecting with each other in Bengal in the inter-war years. The thesis has drawn upon a number of Bengali women’s magazines, popular health magazines, and professional medical journals in English and Bengali that represent both nationalist and official viewpoints on the medicalization of childbirth and maternal and infant health. It has also used annual reports of the medical institutions to chart the history of institutionalization of midwifery and draws upon archival sources - the medical and educational proceedings in particular - in the West Bengal State Archives and the National Archives of India.</p>

“An Inside Thing to Live by”: Refusal, Conjure, and Black Feminist Imaginaries among Granny Midwives

“Granny midwives” often based their authority to practice midwifery on the spiritual traditions of rootwork or conjure passed down by the foremothers who trained them. However, granny midwives were compelled to give up their conjure-infused methods of birthing if they wanted to become licensed (that is, to get a “permit”) or be authorized by the state to continue their practice of midwifery. In response, some granny midwives refused to recognize the authority of the state in the birthing realm, willfully retaining rootwork in their birthing practices. In this article, I contrast the response of granny midwives, a politics of refusal, with another major tradition in African American thought, a politics of recognition, such as gaining citizenship and rights, permits, and licenses from the state. Due to the political stakes of the granny midwife's conflict with the state, I argue that black feminists often endow the figure of the granny midwife (or more broadly, the conjure woman) with the political significance of refusal in our emancipatory imaginaries. To demonstrate this, I will analyze the interventions in black liberation politics that two black feminist writers make through their invocation of granny midwives: Zora Neale Hurston's essay, “High John de Conquer,” and Toni Morrison's novel, Paradise.

A Local Midwife or a Doctor? Two Systems of Knowledge in Birthing Practices of Russian Old Believers

The article explores complex relationships between traditional midwifery and medical institutions as two legitimate knowledge systems in the communities of Russian Old Believers in the Republic of Moldova and in Romania. It is aimed at discussing beliefs and practices around giving birth with the help of a local midwife from the same community, their transformation caused by the access to maternity hospitals as well as distribution of roles between a traditional birth attendant and a doctor. The article is based on oral narratives of Old Believers who used to be local midwives or gave birth to children with the help of such a specialist. The narratives were recorded by the author in 2008–2018.

The Making of Viequenses

This article delves into the history of medical institutions, birthing practices, and reproductive rights in Vieques. The exploration exposes contradictions at the heart of Puerto Rico’s colonial modernity. Around the middle of the twentieth century, Puerto Ricans were encouraged to depend on the colonial state and medical establishment for guarantee of life, health, and general well-being. This encouragement clashed with the militarized colonialism imposed on Viequenses. The 1940s expropriations—through which the U.S. Navy gained control over three-fourths of Vieques—devastated the community. And the interventions by the colonial state and medical establishment proved at times meek, complicit, and ineffective. In 2003, unruly colonial citizens evicted the Navy. Their actions were part of a struggle for the survival and well-being of the Viequense island community. In this article, the author argues that la lucha viequense has been fundamentally shaped by the concerns and actions of women who placed reproductive rights at the center of the struggle.

Why women chose unassisted home birth in Malaysia: A qualitative study

Background: Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions. Methods: Twelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.Results: Women in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and steadfast despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs.Conclusions: Women may choose unassisted home birth to express their personal views and values, at the expense of the health risks. Apart from increasing mothers' awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values.

Why women chose unassisted home birth in Malaysia: A qualitative study

Background: Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions. Methods: Twelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literatures. The interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Results: Women in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and strong despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs. Conclusions: Women may choose unassisted home birth to express their personal beliefs and values, at the expense of the health risks. Apart from increasing mothers’ awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values.

Determinants of Clean Birthing Practices in Low- and Middle-Income Countries: a Scoping Review

Background Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare workers or mothers during the perinatal period in LMIC. Methods We reviewed literature published between January 2000 and February 2018 providing information on behaviour change interventions, behaviours or behavioural determinants during the perinatal period in LMIC. Following a multi-stage screening process, we extracted key data manually from studies. We mapped identified determinants according to the COM-B behavioural framework, which posits that behaviour is shaped by three categories of determinants – capability, opportunity and motivation. Results 78 studies were included: 47 observational studies and 31 studies evaluating an intervention. 51% had a household or community focus, 28% had a healthcare facility focus and 21% focused on both. We identified 31 determinants of clean birthing practices. Determinants related to clean birthing practices as a generalised set of behaviours featured in 50 studies; determinants related specifically to one or more of six predefined behaviours – commonly referred to as “the six cleans” – featured in 31 studies. Determinants of hand hygiene (n=13) and clean cord care (n=11) were most commonly reported. Reported determinants across all studies clustered around psychological capability (knowledge) and physical opportunity (access to resources). However, greater heterogeneity in reported behavioural determinants was found across studies investigating specific clean birthing practices compared to those studying clean birthing as a generalised set of behaviours. Conclusions Efforts to combine clean birthing practices into a single suite of behaviours – such as the “six cleans”– may simplify policy and advocacy efforts. However, each clean practice has a unique set of determinants and understanding what drives or hinders the adoption of these individual practices is critical to designing more effective interventions to improve hygiene behaviours and neonatal and maternal health outcomes in LMIC. Current understanding in this regard remains limited. More theory-grounded formative research is required to understand motivators and social influences across different contexts.