In primary school, one of our lessons was on 'people who help us'. "The baker bakes our bread, the cobbler mends our shoes, the doctor treats us when we are ill," was what we learned. But there was one person who didn't make it to the list. Indeed, urban kids did not know that she so much as existed. And yet, these were the women who brought - and still bring - life to most people in this country, literally.
The midwife. Official statistics tell us that 70 per cent of the Indian population lives in rural areas. And 98 per cent births in these areas happen at home, with help from the village midwife or dai. The fate of pregnant women in numerous villages that have neither hospital nor health centre would have been far worse if there had been no midwives.
Dais are usually between 35 and 65 years old. While some women take to midwifery because of a calling, others take it up for various reasons - financial or otherwise. However, the dedication and sincerity with which a dai performs her duty can hardly be questioned.
More often than not, the dai comes from the most deprived sections of society. She is illiterate, poorly paid (in cash or kind), and unacquainted with modern science. Says an elderly dai in Dhenkanal, Orissa, "Birth control is fine. But if everybody goes for it, how will we survive?"
The homespun knowledge midwives rely upon is ridden with superstition. As a result, despite many successful deliveries, the maternal and infant mortality rate in the areas where they operate is disquietingly high (though this is due also to poor maternal nutrition and health which leads to weak newborns, and lack of hygiene). For instance, one existing custom puts the woman in a crouching position during delivery, hands resting against a wall with an earthen pot placed for applying pressure. Inevitably, both mother and child are hurt when the pot breaks after prolonged labor.
In the districts of North and South 24 Paraganas (West Bengal), there are two types of midwives. One delivers the baby and tends to the newborn, while the other - the hanri dai - cuts the umbilical cord. In both these districts, the cord is sometimes not cut for hours together. A baby may be born in the afternoon, but if the hanri dai is on another island, the umbilical cord may be cut only the next morning.
These are only a few of the alarming facts unearthed by the Tagore Society for Rural Development (TSRD) - a Kolkata-based NGO - during its Dai Training Program under the central Ministry of Health and Family Welfare. According to Tania Das of TSRD, 1,840 dais were in the first phase (between
1998 and 1999) and 1,360 in the 2001-2002 period.
The TSRD program covered 23 blocks across the states of Bihar (now Jharkhand), Orissa and West Bengal. Its objective was to equip the dai with a basic scientific orientation which, with her own experience-based knowledge, would help in happier and healthier births. Based on a small local survey, TSRD drew up its training curriculum. Each dai was given a three-day training and a one-day refresher course after two months. Group discussions and visual aids were the main methods of instruction.
The emphasis was on challenging and changing numerous unhealthy procedures or customs. If the child didn't cry immediately after birth, dais would blow hard or whistle into the tiny ears, perhaps permanently damaging the child's hearing. In Rangabelia, an island in the Sunderbans, the child is made to cry by pouring hot water on the umbilical before it is cut. In many Jharkhand villages, the umbilical cord is cut not by a blade, but by a sliver of bamboo or the shell of a snail. "Our efforts helped to a certain extent. We insisted that in a complicated case the dai must refer the patient to the nearest health centre or hospital," says Das.
How useful has the program been for the dais? Says Das, "Actually, the dais suffered in the initial stages of the scheme. At one point of time, the government used to pay the dais, but then it stopped doing so. They (dais) had to depend on whatever their clients gave them - old or new clothes, a handful of grain or some cash. But as soon as we entered the scene, villagers thought we were helping the dais financially; they actually thought the dai kit we distributed was some form of payment. And they stopped paying the dai even the little they used to."
The dais turned to the TSRD for help but the NGO was not equipped to pay them. Instead, the TSRD team went about urging villagers not to stop paying the dais. Now efforts are on to get the government to pay the dais a basic stipend.
Can the program be termed successful? "Not entirely," admits Das. As the government is no longer funding the project, TSRD couldn't go back to the trained dais for feedback. "If we could monitor their activities for about a year, we would know what is lacking and how to plug the gaps." Despite TSRD's willingness to intensify its program and a request for financial aid, there has been no response from the central government.