The world of dais

IT is a large room packed with women who have come to the Shisha village of Sanada Taluka in Gujarat, to attend a meeting of Traditional Birth Attendants (TBAs or dais), called by SEWA (Self Employed Women's Association). These women have been delivering babies for generations, and the hunar or the art they have, is usually passed down from mother-in-law to daughter-in-law. Approximately one million women are said to be working as dais in India. In the urban areas they still attend to almost 60 per cent of all births, whereas in the rural areas, the percentage goes up to almost 90 per cent. They all belong to the areas where they serve and share deep ethno-cultural ties with the women. They are mostly paid in kind because in the villages cash is hard to come by. The earnings come variously: in the shape of grain, jaggery, saris, blouse material or garden produce. The quantity depends on the economic status of the family and the gender of the baby. "If it is a boy, and the firstborn at that," says Gomat ben, "families pay the maximum. But if it is a girl and a third or a fourth one at that, then there is rona-dhona (crying and wailing) that the dai just accepts whatever she gets and leaves."

Gomat ben is a matriarch of the old school, but is open to new ideas, especially on midwifery. A mother of five sons herself, she works both on her farm and as a healthworker. She says she has gained much by being trained by the doctors from SEWA. She and her fellow birth attendants now realise how faulty and hazardous some of the old practices of delivering babies were. Maternal mortality was very high, and childbearing for women, Gomat ben says, was like a trip to narak (hell) and back. Through all this, families stood by and waited. A woman's lot they said, was such.

Diane Smith, a Canadian nurse midwife, training dais in Tamil Nadu at a health centre run by another NGO, RUWSEC (Rural Women's Socio Educational Centre) was appalled at the general indifference to maternal well-being in India, particularly in the rural areas. "There is a lack of forensic thinking in villages relating to child births. Stories told about deaths are just accepted," she wrote in a journal (International Midwife - Winter, 1998). In Rajasthan, another village healthworker told me, "If there is a death by drought related starvation, the whole government office descends on our village to find out who died and how. From Panchayat Pradhan to Collector, all are made answerable. But each year dozens of young, healthy, women die in childbirth, and not even a leaf falls. Everyone says this is the lot of a lugai (woman). Then they get the man another wife."

If, to gather knowledge is to gather pain, as the wise voice of Ecclesiastes tells us, then to talk to village dais is to gather a whole harvest of pain and neglect. This knowledge comes not as a whole, organically constructed matrix, but in pieces. It is like trying to understand a fistful of little shards and bits of paper that may once have carried precious but long lost formula perfected in some bombed out lab. Most dais today are illiterate, poor and belong to lower castes, because, as they tell you, birthing is a dirty job, full of blood, sweat and pain. They acquire an aura of holiness through their ability to assist the birth of a new life. When they come to deliver a baby, their word is treated as law, and their touch does not pollute. But although they can prescribe herbs and oils and preside over normal birthing rituals, in cases where the birth is difficult and requires surgical intervention or transfusions, they are helpless and clueless.

Jassi ben and her daughter-in-law are a good example of this. They form a team from Madhav Nagar village. She said before they were trained by the doctors from SEWA, they too knew little and subscribed to local superstitions regarding birth, such as:

* The pregnant woman must eat very little and not eat sticky food like bananas, milk and buttermilk, that "cling" to the bacchedani (uterus).

* Mother's milk was "bad" in the first three days after delivery and had to be discarded. Meanwhile, the baby is to be fed a mixture of water and gur.

* The mother was "unclean" after birth for three weeks, so she must stay in her room and not bathe. A hole was dug in a corner for defecating. The room at the end of the "unclean" period began to stink like a sty.

* The woman's body is a large sack inside which the organs float. If the labour is long, chances are, she has sucked up air and the baby is lodged in her chest and must be expelled by the dai bearing down on it.

In Maharashtra, in Gadhchiroli district, dais are trained at the Shodhgram, a health and research centre run by the NGO, SEARCH. The genial trainer Dr. Baituley says they first tried training the partially trained Auxiliary Nurse Midwives (ANMs) but their superiors resented it. They were told the ANMs were required for "family planning" (read sterilisation) and immunisation work. So eventually, they turned to the illiterate dais, the only birth attendants available to the poor living in far off villages. The same applies to workers of ARTH in far away Rajasthan, and workers of ADITI in Bihar. All these health researchers and trainers realised that though training these semi-literate dais into correct and basic birthing techniques is rife with problems, their reclamation and reinduction into the mainstream of healthcare is essential if millions of maternal lives are to be saved. Births, like deaths, do not wait for governmental policy changes or sensitisation of the healthworkers. On the other hand, our formal medical systems, by a sensitive and humane interaction with the world of the dais, may gain valuable insights into areas that can create simple and inexpensive health initiatives for women.

It is not simply the depth of the problems the dais and their clients face everyday, but the strange forbearance and compassion with which they try to make the best of a bad situation that makes you look at them with respect. Our women, especially the poor ones, refuse to compartmentalise their experience of their own and others' motherhood, into joys and sorrows to be celebrated and mourned separately. For the dais, as for millions of Indians, the mysteries of life and death are whole mysteries where spiritualism and physicality, joy and pain co-exist. Their search for well-being and relief means a stretching and deepening of one's commonsense and kindness and women's ability to stand up to pain. Despite the blood, sweat and tears when the birth of a healthy baby is announced, joy warms up the mother, the dai and all those around her:

"Mother-in-law is here, the husband's sister
Too shall come at noon, the brother's wife in the evening.
With sandalwood paste and colours
Come all, O women of my village,
- and celebrate my baby's arrival."

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