Red Medicine: Socialized Health in Soviet Russia

Care of Children and Youths

CARE of maternity is considered in the next chapter, but it requires a note here, because this care is the most important element in ensuring the infant's welfare. In Russian towns nearly all confinements occur in hospitals, and this enormously enhances the infant's prospect of future health. During the week or fortnight in which the mother is cared for institutionally, the infant secures a good start, whichespecially in the home circumstances of Russiawould otherwise be lacking.

The arrangements for infant consultations in Moscow, Leningrad, Rostov, and Kharkov, are described in Chapter 19.

As already indicated, the care of children has been transferred in large measure from parents to public nurseries, to open air and other schools, and to summer camps. For children and still more for youths of both sexes, club life has become fairly general. This is a novel and profoundly interesting feature in proletarian life. It may be compared with the more limited provision of boarding schools for the middle and upper class children in England, but it is vaster in its scope both as to age and numbers.

As early as the first Congress of the International, Marx insisted on state protection of mothers and children. And factory nurseries or creches were a very early development of the Soviet Government.

In capitalistic countries the death rate among illegitimate infants usually is about double that of infants born in matrimony. Under the Soviet regime marriage has become a civil partnership which becomes void as soon as either partner wishes this and registers his or her intention; while living together without civil marriage has become equivalent to marriage, and to this extent the Soviet Revolution can be said to have "liquidated" the problems of illegitimacy.

The centres for infant consultation which are found in every city are closely linked up with other medical arrangements, and home visits are made to infants not able to be brought to the centre. Often the Infant Consultation and General Medical Centre are on the same premises as the creche. Attendance at these centres may be one of the conditions attaching to the mother's maternity benefits, and this in most instances ensures attendance. Mrs. Alice W. Field states that in 1931 there were thirty-five child welfare centres in Moscow, each of which had its own milk kitchen. Each centre dealt with 7,000 children in the year, and its health visitors made some 40,000 home visits.

Work similar to that done in these centres and in the creches described in the following paragraphs is being done in other countries; but a feature which cannot fail to impress the visitor is the intensive and continuous publicity given to this work in Russia. At every club and factory, in the trade union meetings, frequently in cinemas and theatres, and by means of posters, mothers are invited to bring their children to these centres and creches, and their work thus is universally known and emphasized as of profound national importance.

Public Nurseries or Creches

Public nurseries or creches are indispensable in view of the almost universal industrial life of women. They are not yet adequate to the requirements of all the industrially employed women, but are intended to become so, and their number is increasing with amazing rapidity on collective and State farms, as well as in the cities and towns.

Creches are of two kinds, permanent and seasonal. The following figures' show the rapid progress made:

(in thousands)
1927-28 1931(1) 1932(2)
In town creches 34 129 263
In village creches:
(a) Permanent 2.5 103 329
(b) Seasonal 101 1,426 3,501

Children are brought to the creches at the age of one or two months and until they are three, sometimes five, years old. Each creche accommodates from fifty to one hundred children. They are arranged in three groups according to age, the management being differentiated for each group.

In the creches seen by us, and we believe generally, intelligent precautions are taken against infection. Each child is stripped when brought, and clad in special clothes. If it is verminous, the child is sent back home with its mother and is not readmitted until a health visitor has visited and inspected the home. If the infant is a suckling, the factory working mother comes twice to nurse her infant during her working hours and once during her dinner hour.

It is stated that fortnightly visits are made to the homes of the children of the creche. Creches are not merely nurseries; they are seriously regarded also as training centres for the future Soviet workers.

The training the children receive is a most valuable function of the centres. Each child is kept scrupulously clean. The infants are encouraged in appropriate exercises. Regular habits in regard to natural functions are inculcated, and instruction in the proper use of modern sanitary facilities is given as soon as the child is old enough to use them. The older children are treated on the principle that nothing must be done for them which they can do themselves. They wash themselves, help to lay tables, and put their toys away after playing. Each child has his own towel, glass, and toothbrush.

We found arrangements fulfilling in the main the above conditions in each creche visited by us.

The kindergarten takes the place of the creche for children more than three, or sometimes five, years old, until they attend school at the age of seven, at which age school attendance becomes compulsory.

The creches, kindergartens, open air and other schools and summer camps have to a very great extent taken over from parents the care of their children. Such transfer of responsibility applies even more to older children and youths of both sexes, for whom forms of club life have become fairly general. This is a new feature in proletarian life. In other countries there are boarding schools for children of the middle and upper classes, and in some countries there are meagre arrangements for very poor children to be boarded out during a part of the holidays in the country or at the seaside. The Russian arrangements of a similar kind are on a very large scale. These arrangements are highly beneficial; the quality of the provision made for the hygienic and medical care of infants bears comparison with any similar arrangements in western countries, and in quantity it is vastly greater.

The total provision for children is good evidence of the real economic equality of women with men; as are also the equal benefits of women under social insurance and the maternity benefits received by mothers. (See page 192.)

This equality carries with it a correlative obligation in Soviet policy; for work is a universal obligation without distinction of sex, and ablebodied persons living without working are deprived of electoral rights. It is not intended that women shall ordinarily be only housekeepers, although when there are dependents or when a woman cares domestically for others who are regularly employed this is permissible!

Some natural perturbation is felt by one accustomed to western life at the supersession, at least in part, of the home by the public nursery. Is it not inimical to family life? Is not much that is precious lost, which even devoted nurses in a creche cannot supply? The answer to this puzzle is that one must balance good and evil or less good on either side. In a good home in which a mother gives intelligent as well as loving care she gives more than can be obtained in full measure otherwise. The Russians claim, however, that there is no lack of affection between mother and child under their plan. On the contrary, they say, because the mother is free from all the little irritations of trying to care for a number of children, while at the same time endeavoring to carry on her household and social du- . ties, she is better able and more eager to devote herself to her children at the end of a short day's work. Similarly, they say, the children are more anxious to see their parents and are better prepared to enjoy them.

One may well ask in what proportion of families either in Britain or in the United States of America is maternal care complete and of the highest quality? Is not, for instance, the attem to control the passions and prejudices of the child commonly illinformed, careless ethically, and in the end sometimes even ruinous to his character? This is too often true, even in welltodo households, for the child is left largely to the care of an untrained nursemaid who may practice bribery and instill fear to secure a quiet nursery. In the household of the wage earnercomprising, it must not be forgotten, a very large part of the populationfurther disadvantages are added. There is inadequate space

Soviet City Nurseries

FIG. 2. Growth in the capacity of city nurseries in the Union of Soviet Socialist Republics since 1929. The figures for 1932 are estimated.

for play, and the children need frequent attention when the mother is busily engaged in cooking or cleaning; and there may be serious accidents while she is temporarily absent.

The common ignorance of child hygiene and dietetics in rich and poor households alike must also be remembered. Some of these evils are being lessened in most countries with advancing education and especially following on the domiciliary visits of health visitors (public health nurses) and the work of child welfare centres. But even so, in western countries public nurseries continue to be needed for many children; and in the present circumstances of Russia, including not only the industrial occupation of mothers, but the defective housing conditions, creches undoubtedly are doing highly beneficent work. Creches and kindergartens are training schools in health and dietetics, and through them the mothers of the children at these institutions are being trained to a better life more rapidly than would be possible without them.

On this question a highly intelligent British resident in Russia told us that he did not think maternal love is enhanced by having one's children around while working. In these circumstances half the mother's relationship may be made one of endurance. Quoting the instance of even welltodo people having an unskilled nurse, he thinks that under the Soviet regime mothers now see more of their children and in a better way.

One of the finest illustrations of inclusive child welfare work was in the Children's Village in the Park of Culture and Rest at Moscow, which we visited under the guidance of Professor Popoff, Director of Research in Health, and Professor L. Rosenstein, Director of Research in the Institute for Neuro-Psychiatric Prophylaxis. This park has been open for three years. In its children's section three hundred children at a time are cared for, and a doctor is always present.

A record is kept of each child. Exact social particulars are taken as to each child when received.

Each child after being examined by the doctor of the Children's Village receives a numbered card which is pinned to his dress by a safety pin, and a second copy of this is given to the parent. Lockers for clothes are provided, separate clothes being worn by the child while in the Village. No disciplinary measures appear to be needed.

The children in each group of twentyfive are identically clad to show the group to which they belong. Children of workers are taken to a factory creche on four days, and on the fifth day are brought here. Engineers, doctors, and other professional workers place their children here. If the mother goes to a rest home, the child goes with her and is specially provided for. Our attention was drawn to the contrast between conditions in the Children's Village and in homes of the welltodo where only an untrained nurse is available. The nurse here is a collegiate graduate and afterwards has had a special course of training for her work. Older help in entertaining younger children.

In this park there are 3,500 workers in all its departments, and for them eight doctors are employed.

At Rostov we were informed that while children under three are cared for at the special child centres, those aged from four to seven attend kindergartens, which are being provided in increasing numbers. There are no domestic servants, and these kindergartens are a partial substitute for them. In important respects the kindergarten is superior to the domestic service obtained in many western homes; for the children are under skilled care and are trained in good personal habits.

At the age of seven, compulsory school attendance begins. School life is divided into a number of grades, of which there were formerly seven, now commonly nine. If the scholar successfully passes nine grades, he can enter the university without further examination.

Dr. Genss, Assistant Director of the Institute for the Protection of Motherhood and Childhood, Moscow, elucidated from another angle some of the points already made. He laid down three chief principles and aims:

1. That the protection given is entirely by State organization;
2. That no charity whatever is involved; and
3. That a chief aim is to make it possible by means of creches, etc., for the working woman to continue her work in the factory.

Dr. Genss told us that a French visitor in reference to this second point remarked : "Thus the working woman comes, not asking, but demanding, help."

It is an essential part of the organization that workers themselves take a considerable part in its work.

None of this work existed in the pre-Revolution period, Dr. Genss informed us. There were only 14 creches before 1914. Now there are 2,000 with 1,750,000 children in them. Creches are either temporary and seasonal or permanent. None of the latter existed in villages, but with the development of collectivism, 50,000 children are now cared for in creches in villages.

In 1913: 600,000 children were in seasonal creches.
In 1931: 1,100,000 children were in seasonal creches.
In 1932: 3,000,000 children, according to estimate, were in them.

At the admirably organized Institute for the Protection of Motherhood and Childhood in Leningrad, we found a complete organization comprising every phase of maternity and child hygiene work. We were shown first the creche in which children are kept while their mothers are at work. This creche, owing to the mothers working double shifts, is open long hours, small children in one shift being kept until 1 a.m. Every arrangement is made for cleanliness and for the prevention of infection. No sick babies are taken, and there are special isolation cubicles for doubtful cases. Children are taken from the age of two months, when the obligatory period of absence from industrial work ceases. The doctors of the rest of the institute are in regular attendance. There are similar creches in all the eight districts of Leningrad.

All working mothers bring their children to the creche. Although there is no compulsion, insurance payments to mothers appear to be related to attendance at the institute. The children of mothers who are not workers also nearly all come to the creche.

There is close cooperation between home medical attendance and the work of the creche and of other departments of the institute. The district served by the institute is subdivided and each subdistrict has a special member of the medical staff to make home visits and to see patients at the institute from that district.

During the medical consultations at the institute the doctor sees only twelve patients in two hours. Children attend here at least up to the age of four. School attendance begins at the age of seven. A continuous record is kept of the history of each child and is available for reference.

Milk is supplied to those children needing it, and modified milks are prepared. The milk is derived from a collective farm and is pasteurized.

In Tiflis we visited a nursery attached to a silk factory. A part of the factory not intended for this purpose had been set aside for children, and good work is being done. At this factory there are two shifts, so the nursery is open each. day until io p.m. About eighty children are received at each shift. All the children's clothes are deposited in a special compartment in the receion room. There are separate rooms for infants, for very young children, for crawlers, and for older children. Each child is weighed fortnightly, and a doctor attends in the morning and again in the evening. The directress also has had a medical training. Each child is trained in selfhelp and selfcontrol, as regards washing and natural functions. Crossinfections do not often occur, and there has been no trouble with eye infections. All the mothers in the factory use this nursery, except a few who have some relative at home who can care for the child.

The Youth Movement

Several references have already been made to the arrangements for educating the youth of Russia and for training them in civic philosophy (see pages 94 and 97) which, Russia being a Communist State, is naturally Communism.

The entire Youth Movement is under State guidance, and altogetherapart from education in schools six or seven million youths are under its influence. The movement is for both boys and girls, no sex difference being made. It embraces all ages from seven to twentyfive. The Octobrist groups include children aged from five to eight, the Pioneers include youths aged eight to eighteen, and the Comsomols, youths and young adults from eighteen to twentyfive.

The two younger branches of the Youth Movement undertake work resembling that of British or American Boy Scouts and Girl Guides or Girl Scouts. Boy Scouts owe loyalty to the individual leader of their group and are not expected to take part in production. The Pioneers owe loyalty to the collectivist principles of Sovietism and embrace production within their activities.

In all divisions initiative is encouraged, and games and athletics, form an important branch of their activities. They also undertake parades and demonstrations. Some parades seen by us were very impressivebanners with party mottoes flying, bands playing, and much evidence of the semimilitary background of the movement. Some parades are devoted to antialcoholic propaganda. The movement against vodka is actively pushed, because vodka means ill health and inefficiency in work.

According to one of the rules of his organization the Pioneer watches over his health and cleanliness, and neither smokes nor drinks nor swears. This injunction is prefaced by an undertaking to be true to the "workers' cause and the commandments of Lenin."

The two higher divisions of the Youth Movement control the divisions below them. Over the Pioneers is the Union of Communist Youth, whose members are called Comsomols. Membership in it is conditional on renunciation of religious belief. It is really a junior division preparatory to candidature for membership in the Communist Party.

Most of the work done in all three divisions is admirable, as is also the exaltation of motives of nonacquisitiveness. But we strongly deprecate the great stress laid in each of the three sections on persistent instruction favoring continuance of the active sentiment of hatred of class enemies, and the antireligious bias. Each youth is taught that world revolution and communism are inevitable. In every unit there is military training, and military phraseology is used. There are campaigns, drives, and parades. The Youth Movement undoubtedly gives its members an important realization of their citizenship in the State and of their individual importance in relation to it.

Since the Revolution a new generation is growing up under Communist teaching and conditions of life. More than two thirds of the whole population has been born since 1905 and about one half since 1915, a circumstance having important bearing on the prospect of maintenance of the chief features of Communist organization.

At the age of eighteen, over a fourth of the Comsomols voluntarily become candidates for membership in the Communist Party, into which they are, for the most part, co-opted, after the satisfactory completion of a strictly supervised period of probation.

(1) See Soviet Culture Review, Nos. 7-9, 1932.

(2) The figures for 1931 are preliminary and those for 1932 estimated.