Fighting for Life

by S. Josephine Baker

  These free abortion clinics were a tremendous storm center of controversy in the bourgeois world three or four years ago. They told me in Russia that, in the absence of effective birth-control equipment, free abortion was the only solution for the problem of reconciling motherhood with the free status of Communist women. If the state had not performed abortions, they would have been performed privately by Heaven knows who, as they had been before the revolution, with disastrous results. I took the figures they gave me, as to results, with a grain of salt. But after visiting ward after ward of abortion patients with no sign of illness among them all, I was forced to believe in spite of myself.

  I admired the Russians’ willingness to meet that situation frankly and openly. All doctors know of the deplorable conditions existing in this country. Underground, bootleg abortion is almost always disastrous. And so, I felt a corresponding amount of disappointment when I learned, as the whole world now knows, that the Soviet government has reversed that policy and now prohibits abortion except in the exceptional instances covered by conventional medical reasons. They are in a good strategic position for I can believe there are no doctors in Russia who would dare to perform an abortion. In this country we leave it to the quacks and midwives, and thousands of women die because of this policy. I have heard that one reason for the change in the policy of the Soviet government is that too-frequent abortions are undermining the health of Russian womanhood. That is medically acceptable as a reason. But I suspect that the Soviet drive for more and more population, to offset the German threat on the west and the Japanese threat on the east, has a good deal to do with it. It may be additionally a part of the whole tendency to return to bourgeois principles, to the family, differentiated scales of pay and non-progressive education, all of which have been so evident of late in the Soviet Union. Since the practice of medicine is a state function in the Soviet Union, the government may well be able to suppress private abortion, but I shall be surprised if, with human nature as it is, abortion can be efficiently stopped anywhere else.

  Anyway, it was a joy to my professional soul to see institutions like the Prophylactarium in Leningrad—at least that part of it which was a large-scale baby clinic. One of their schemes here struck me as particularly clever and I have seen nothing like it in this country. There was no main entrance, or at least no such thing in a conspicuous position. Instead there was a long array of doors along the front of the building, each door leading into a glass-walled cubicle. When a mother and her child entered the cubicle, a doctor appeared from another door leading from the clinic proper, and thus isolated, the child was examined for the possibility of any infectious disease before it was allowed to cross the actual threshold of the building. If any suspicious symptoms were found, isolation was immediately enforced. This calls for hordes of doctors of course. But there are hordes of doctors in the Soviet Union. Moreover, the doctors are distributed throughout the country so that no one need ever be without medical care of some sort.

  I wish I might have been equally impressed with the quality and amount of medical supplies in the Soviet Union. When we were there—the same situation must still hold to a considerable extent—drugs and chemicals that medical practice elsewhere considers absolutely essential were available only in pathetically limited amounts. That, of course, is why anaesthetics are used only in major operations and then sparingly. In a provincial Torgsin (foreign currency) store, I remember seeing some digitalis on display for sale in the forlorn drug case. Its label was in English and bore the name of a Russian doctor’s laboratory in St. Petersburg, which, since that name was changed to Petrograd in 1918, meant that the drug was almost twenty years old. Digitalis at that age is about as much use in the treatment of a patient with any abnormal condition of the heart as a drum with a hole in it would be in an orchestra. When, at the end of our trip, both Miss Wylie and I were victims of various complaints due to the fact that we were not Russian and so not immune to bad food and multitudinous insect bites, I wanted to supplement my supply of bicarbonate of soda, surely an innocent drug. To obtain some, I had to persuade a very special doctor to write me a prescription, and even then all I could get was about one teaspoonful. Later, when Ida Wylie was really ill, her doctor and I had to combine our small stocks of drugs to get the ones that were essential. Notwithstanding my admiration for the state medical system, I could not face with any equanimity the thought of a Russian hospital, so after many conferences with the staff at the American Embassy, I finally found a German doctor in Moscow who was independent and confined his practice to the embassies.

  He, and my store of castor oil, saved the situation. For, though I appreciate that to a Russian any doctor is better than no doctor, I doubted if the patient’s effete bourgeois constitution could have survived the methods of the local talent.

  And yet, the doctors whom we met were delightful people. They were wonderfully cordial and eager to show you all they were doing and all they had with a naïve insistence that, whether it was an X-ray machine or a hypodermic syringe, there was nothing like it anywhere else in the world. I often found it difficult to sit quietly through their long-winded explanations because few of them spoke English and the guides were not often qualified to interpret and give a detailed explanation of fifteen solid minutes of a lecture on some fine point of procedure. Once, in that fine cottage-hospital in Rostov, which I think is the most modern and probably the best hospital that I saw, I was hysterically reminded of the “he said yes” business in the old vaudeville acts I used to see at Proctor’s 23rd Street Theatre in my student days. I was consulting with the director and his closest associates. They spoke no English and all the Russian I knew consisted of isolated words—a hundred or so, few of which were to the purpose. We bowed to one another and then sat solemnly waiting for something to happen. My guide whispered to me:

  “They are waiting for you to ask them a question.”

  All I could think of at the moment was the old standard question, the fundamental inquiry in all infant care:

  “What is the baby death rate in Rostov?”

  That started the flood of words. My guide rose and made a long speech lasting some ten minutes. Goodness knows what she said, but it was eloquent and pithy and delivered with the oratorical flair of a born stump-speaker. When she had finished, the director arose and proceeded to show us how a speech should be made. The guide had been a clever amateur but this was a masterpiece; portentous, grave, lightened with flashes of wit, enlivened with homely philosophy and profoundly stimulating. I could sense all that by the close attention, the laughter and the solemn faces of the listeners. Then he bowed and sat down. I turned to the guide:

  “What did you ask him?”

  “I asked what was the baby death rate.”

  “And what did he say?”

  “He says it is one hundred and thirty-five.”

  When we were able to travel, we started for Leningrad with Elizabeth Embler and Rachel Barrett who had joined us in the latter part of our travels. For a long time neither I nor the embassies’ doctor was at all sure that Miss Wylie would ever travel anywhere again, but in some way we did get on that train for Leningrad and there, for a final touch, occurred one of the interesting sidelights on the Communist regime. At the hotel we were given two small rooms over the kitchen, dark, smelly and most uninviting. With my last burst of American surety, I went to the office:

  “Surely, you have better rooms than these,” I said.

  “Nothing better,” the clerk replied with finality.

  “What about a suite I happened to see on the second floor? You know we are in the first-class category.”

  Strangely enough he succumbed at once. Producing a key he ushered us into a suite which I am sure must have been reserved for the elite of the land. Seven rooms all remarkably and elegantly furnished with furniture which I am sure came from places of grandeur. It was as Jimmy Durante has said, “colossal, magnificent, almost mediocre!” At any rate, our last days were spent in a burst
of glory.

  I have never had such a feeling of “Thank God, that’s over,” as when our train passed over the bridge that marks the Finnish border. Just across a tiny brook from the Soviet Union, it was a different world. With its cleanliness, cheap hotel rates, green forests and glistening lakes, Finland seemed to me to be the loveliest place in the world. I want to go back some day and see if it is really as altogether lovely and cheerful as it seemed to me then, or if it was just the effect of the Soviet Union.

  For I came out of Russia in an extremely curious state of mind. Did I, or did I not, believe in state medicine? Did I know whether to ascribe to the Russian race the strange quirks in temperament I had witnessed or were they to be thought of as part of the Communistic state of mind? As someone who had carved an adequate and personally satisfactory career out of state medicine—for in the last analysis, child welfare in public agencies is merely the most obvious branch of state preventive medicine—I could not help feeling deeply gratified at the spectacle of a great nation really trying, for the first time in history, to make health the privilege of every citizen.

  State medicine is to my mind an ideal, and the sooner it changes from an ideal to a practical reality, the better off the human race will be. The mere fact that in Russia every pregnant woman is given ample time off from her work both before and after her confinement and that she not only receives full pay for this time but also has the best care available during her entire pregnancy and confinement, all without cost, means an untold amount to the veteran welfare-worker. I have, perhaps unwittingly, done my share to bring state medicine into existence. I am reasonably certain that the next generation will see it immeasurably advanced in the United States and, unlike so many of my colleagues, I am on the whole pleased with the prospect. It may come about through some form of co-operative plan; it may be the form of “panel system” that seems to work with success in England, or it may be in some other still unthought-of form. It is already on its way and it is now too late for any backward step.

  I can quite appreciate the position of organized medicine in its abhorrence toward anything that may interfere with the present isolated integrity of the medical profession. Yet the practice of medicine holds its present status only by virtue of state control. No one can deny that the really poor and, above all, the small salaried class are now facing insurmountable difficulties in obtaining adequate medical care at a price at all within their power to pay. The present cost of medical care is far beyond the capacity of the majority of the citizens of this country. On the other hand, doctors must and should be able to earn a livelihood. State medicine will provide for both sides.

  There will have to be safeguards and concessions to our democratic ideals. For instance, when I am ill I want to be free to choose my own doctor. I do not want a doctor arbitrarily forced upon me by the State. But I am convinced that intelligent legislation can meet this difficulty. As far as Russia is concerned I am equally convinced that there was no choice in the matter. It was state medicine or a continuance of the chaotic neglect of the vast majority of the people left over from the old regime. The failures in the Russian experiment need not discourage us. They are the result of the Russian temperament and the Russian history. They are not an inherent feature of the experiment itself. In any case a civilization which insists upon compulsory education must logically insist upon compulsory health of the children it educates.

  In general I left Russia feeling that however interesting and exciting the country’s social adventures might be, it offered neither an example nor a warning to our more advanced civilization. In fact, at the time of my visit, I could not see that it was an example of any sort. I went to Russia expecting to find a Communistic country; instead I found a form of state socialism almost verging on state capitalism. I went expecting to see equal pay and equal methods of life and living; instead I found as great a hiatus between the rich and the poor as may be found in any capitalistic state. In Russia the poor are still poor and working for inadequate wages; the well-to-do and powerful are, in relative terms, as well fed and housed and as strong in their might as in any other country. And yet, among the masses of the people there was a genuine joy in the thought that they were building a new world on a new basis.

  So that my feeling about Russia still remains in a state of something approaching confusion, which recent news from the Soviet Union has done nothing to dispel. The Russians I met were courteous, friendly and charming. They were frightened, it is true; there is fear stalking everywhere in Russia. But I left with an astonishingly friendly attitude toward the place and its aspirations. This sounds fantastic. Even with all the bad mixed with the good, it is so. A book might be written about it all but I am still on the negative side about that. By now, I can say only that it was an inspiring three months—one of the most interesting experiences of a most interesting life.

  CHAPTER XIII

  IN WRITING AN AUTOBIOGRAPHY, ONE HAS THE great advantage of occupying the center of the stage. It is much the same feeling that came over me during those long years when I taught. I knew then that sitting on the right side of the table made an immense difference. It seemed to me to be the real secret of effectiveness in teaching or lecturing. For that brief moment you are there to be listened to, and in a sense, your word is law. When you step down from the platform or out of the classroom, you become a mere mortal again. But meanwhile the advantage is all on your side and the only defense your audience can have is not to listen. So now, I assume the right to give my reactions to my life as I have lived it, and, if they seem pontifical, they can very easily be skipped.

  Why do we give birth to and raise children? That question came up very naturally in the course of a career devoted to child hygiene. Frankly, as the years went by, I grew more and more confused about it. Years ago, when the work for saving babies started, there was little or no doubt in my mind that it was a great humanitarian project and that no effort, no matter how great, could be counted wasted if it accomplished this purpose. Not that I was ever even mildly sentimental about working for and with children. There were many times when it seemed quite clear to me that I might as well have been of any business that involved mass production. It brought into play all of the administrative and executive functions that might be applied to any large business. Once in a while, it seemed actually necessary for me to make trips throughout the city and to visit the baby health stations and the schools so that the necessary human touch would come back to me. On the whole, my work was strangely impersonal; simply an intriguing proposition that had enough difficulties to make it worth doing. I never gave a great deal of thought to its ultimate purpose. Here was a great waste: my problem was how to prevent it.

  Since my ideas and my work have now passed over to many other minds and hands, there has been time for reflection as to its value. I know that any mother and father will think this question has only one answer; they would be shocked even to think that there could be a suspicion that the lives and welfare of their children are not the most important thing in the world. There has never been a doubt in my mind either that, from the family point of view, the safety and well-being of that family’s children is of the first importance. Of course it is. The human race is the only species, so far as I know, that has an abiding faith in mother-love—a valuable part of our heritage which we could not efface even if we would. With its protective and holding instinct, it is unique, and although there are many individual tragedies connected with it when it is too much prolonged, its earlier manifestation is one of the finest aspects of family life. In the earliest years of human life, I could ask for even more, and not less, “mothering.” It may mean the difference between life and death for a baby. But all this is after the babies come. It does not necessarily play a part in the question as to whether they are worth having or not.

  Whatever the answer or the reason, fewer babies are being born. Several years ago, when I was writing a monthly article on baby and child care for The Ladies’ Home Journal, the
continued trend toward a lower birth rate was becoming manifest not only in this country but throughout the civilized world. I decided to write an article about it for that magazine. In collecting my facts, I wrote to a large number of the leading obstetricians throughout the country and asked them if fewer babies were being born in their neighborhoods and their practices, and if so, what in their opinion was the cause of this trend toward smaller families.

  I called the article, “The High Cost of Babies,” but that did not cover the entire problem. The replies to my questions were very interesting and informative. In the cities, among the middle classes, most young married couples either had no children at all or limited themselves to one. The reasons they gave were based upon their economic status. Small living-quarters in apartment hotels or equally small apartments afforded no room for additions to the family. Children invariably meant additional rent and that was a factor of importance. Then our modern high-geared life seemed to require the ownership of an automobile. Only too often the choice was between a motor car and a baby—the initial cost and the upkeep were about the same—and the toss frequently went to the immediate motor car rather than to the future baby. In the less privileged classes the same sort of consideration was creeping in. During my lifetime the immigrant family of from six to eight children had shrunk to an average of three or four. Restricted immigration meant no more replenishments of the type of European which accepted fecundity as a normal condition. Difficult economic conditions, meaning fewer jobs, made children a liability instead of an asset. The second and third generations were coming to accept the American standard.