Red Medicine: Socialized Health in Soviet Russia
THE benefits given to women workers before and after confinement in the shape of full wages during absence from work and the money allowances to mothers while nursing their infants are enumerated on page 192. These special benefits come from insurance funds. The free attendance at infant consultations and the care given to children in creches constitute important additional benefits ; and the most important benefit of all is the care of the mother in pregnancy and during her confinement in the hospital. These lastnamed benefits are not limited to the insured.
Russia has always had a high birth rate (see page 202), probably higher than that of any other European country. Of these births some 80 per cent at least occur in its scattered rural districts, a fact which makes it additionally impressive that under the Soviet regime a very high proportion of these births occur in institutions. In London probably not more than one tenth of all births occur in institutions;(1) in rural Soviet Russia wherever we went this proportion is attained or exceeded. We were officially informed that the proportion of institutional births in villages is about 20 per cent as against 7 per cent before the Revolution, while in cities it is approximating loo per cent.
At Kazan, the capital of the Tartar Republic, the 100 per cent rate is reached in the case of workers. At Samara and Saratov we found similar conditions. In Stalingrad nearly all city confinements are in hospitals. In Rostov in the North Caucasus, in Tiflis, and in other Georgian towns we were informed that the vast majority of confinements are in hospitals, the proportion of hospital confinements in rural districts being unknown.
The vast increase in the institutional care of the parturient mother is in the main a development of Soviet administration. It forms an essential part of general policy. As already stated, the care of motherhood and childhood is regarded as a first charge on Soviet funds. But under the new regime the rapid industrialization of Russia is also regarded as of primary importance, even of urgency; and maternity must not, therefore, be allowed to diminish, more than is inevitable, the working capacity of women. According to the Economic Review of the Soviet Union (June 15, 1932) the number of women industrial workers in the U.S.S.R. in 1932 was expected to be six and one half millions, an increase of 25 per cent during the year.
The needs of industry as a motive for maternity hospital provision are reinforced by the deficiencies of housing accommodation. It was always inadequate, but the inadequacy has been increased by the flocking of people into the towns. However, as we previously said, the housing conditions even in the crowded cities are not as bad as they were before the Revolution.
To reduce the industrial loss of working power, and as part of general policy, the three lines of action taken are
1. The insurance provisions for mothers and their infants already indicated;
2. Hospital provision on a liberal scale, and free for all workers, during the prenatal period and at confinement, and;
3. The care of children in factory and other public nurseries.
The proportion of children thus cared for in factory and other public nurseries is variously stated (see, for instance, pages 161 and 165) ; but it is rapidly extending and is being introduced into collective farms.
The maternity hospitals seen by us were of a high type, the arrangements for preventing crossinfection being excellent. (See, for instance, page 240.)
The Leningrad centre illustrates well the unification of all the related provisions for mothers and their infants (see page 27). In a single institution there are prenatal clinics, clinics at which contraceive advice is given, and clinics for the various periods of infancy and childhood, all these being coordinated with arrangements for domiciliary medical care as needed. Here also advice as to abortion can be obtained, a subject on which more is written in the next chapter. A remarkable fact is that nearly every pregnant woman comes under medical supervision at an early stage, often with a view to possible abortion, from which she is dissuaded if medical opinion is against it in the particular case. Wassermann tests are always made, and if the patient does not attend regularly she is visited by a nurse at home. The same applies to children; and the nurses appear to be acquainted with every mother and child in their respective subdistricts.
On attending a prenatal centre the expectant mother receives a card which entitles her to: (a) the right of precedence in tramcars and a sheltered place in them (see also page 14) ; (b) service in shops without waiting in a queue; (c) a supplementary food ration; (d) lighter work in the office or shop in which she is employed; and (e), as already stated, two months' rest without loss of wages.
Mrs. Field (in her book already cited) states that, of every hundred pregnant women who come to the Moscow clinics, from 17 to 20 ask for abortion. Leaving aside the provisions for abortion, our observations on Soviet arrangements for the medical and hygienic care of mothers and their children have filled us with admiration and with wonder that such good work, scientific and advanced work, should be undertaken and successfully accomplished in a period when the finances of the country are at a low ebb. The maternity and child welfare institutions and arrangements seen by us gave us the impression that they were nowhere being stinted or restricted because of financial stress.
Dr. Genss (see page 21) informed us that prophylactic care has been developed, especially prenatal. In every city there are stated to be special consultation centres for pregnant women, and we found this to be so in all the cities visited by us.
The duty has been imposed on the doctor at the consultation centre of fixing the date when the mother should cease industrial work (two months before confinement), a difficult task. Much investigation has been carried out in Dr. Genss's department to secure an accurate test for diagnosing (through the urine) very early pregnancy.
During last year each prenatal centre in Moscow has been linked up with a gynecological clinic to avoid overlap of work.
When the woman is first interviewed she receives a complete medical card, thus avoiding unnecessary subsequent examinations. Dr. Genss informed us that in villages about 20 per cent of pregnant women are cared for in institutions, and that in cities the number has approached Ioo per cent. However, recently the strain of work with an inadequate staff has reduced the lastnamed percentage. Now approximately 90 per cent of confinements take place in hospitals.
Obstetric care at home is given when needed, and midwives are employed. These are required to undertake a threeyear course of training, and unqualified practice is forbidden. Notwithstanding this, women in villages are still commonly attended by their neighbors. Recently, in view of the urgent need of midwives, the experiment has been begun of training them for a year only.
After a patient is confined in the hospital a postal card is sent from the hospital to the centre for infant consultation, and another to the mother's clinic, giving the necessary medical information.
At Kazan, the capital of the Tartar Republic, we found that in each ambulatorium there are two beds for confinements, and that all confinements of workers in the city are in hospitals, in which also 6o per cent of other confinements take place. On State and collective farms in this republic hospital provision is rapidly increasing. In the rural parts fewer confinements are in hospitals; it may be as low as 30 per cent. Midwives and partially educated medical workers ("feldschers") attend half the home cases. Trained nurses are increasing; and as a rule, in this republic, every doctor undertakes a postgraduate course usually of three months every third year. The child welfare centres are supplemented by kindergartens; and nearly every factory has its special nursery.
Questioning Russian authorities regarding infant diet, they admitted that in some places the children suffer somewhat from deficiency of fatty foods.
(1) These figures should not be misinterpreted as unfavorable to London. The superiority of English working class homes must be remembered. Even so, however, many more confinements of English mothers would be freer from complications if they occurred in firstrate maternity hospitals.