Female Empowerment and the Traditional Midwives of India
by Soma Mukhopadhyay

[Editor’s note: This article first appeared in Midwifery Today, Issue 99, Autumn 2011.]
Photo provided by author

A friend in need is a friend indeed. This proverb is very much applicable to the women folk of rural India who earn their livelihood through midwifery. Usually known as dai, or dhais, they play a role of social significance and have served Indian society through the ages. Though society has never taken their profession seriously, now the time has come to reassess their role and importance.

Midwifery is one of the ancient professions of the world. The oldest epic, that of Gilgamesh (c. 2000 BCE), refers to Ishtar of Arebla, the senior midwife and wet nurse of Esarhaddon. In the writings of Hippocrates and two eminent physicians of ancient India, Charaka and Sushruta, are references to the profession of midwifery, as well as to the social status of midwives.

After extensive study of the lives and culture of midwives in West Bengal, I have reached the conclusion that most Indians have very little knowledge of traditional midwives. Most people hold the view that a dai’s only work is to cut the umbilical cord of the newborn in a barbaric way (using a sharpened bamboo stick, locally known as chanchari). Yet, the writings of Charaka and Sushruta reveal that midwives used to come from well-to-do families and were well-regarded as wet nurses, not umbilical cord cutters. Unfortunately, we don’t know how they gradually lost their social status and became accepted as untouchable by the higher castes.

My field survey of more than a decade has helped me to understand that dais are very experienced professionals who know every bit about delivery and are good practitioners of folk medicine as well. From the very beginning of pregnancy until parturition, they are the main caretakers of expectant mothers.

It was the missionaries who, due to the high rates of maternal and infant mortality, first attacked the age-old techniques of the Indian midwives, addressing them as “dangerous dai.” In the mid-19th century, the British government started a midwifery training programme for native midwives that, ultimately, failed. Most of the training required knowledge of English and regular attendance; dais were also fearful of losing their jobs, as most of their clients were satisfied with the indigenous system and would never have allowed the Western medicalization of childbirth.

Imperial policy was ultimately responsible for the failure of these training programmes, as the colonial state intended to terminate traditional practices in order to spread the Western system of childbirth. The imperial government wanted to create a group of nurses and midwives, who would, in time, supplant traditional midwives. Unfortunately, newly educated women of the period also agreed with the views of the colonial state and they wrote a good number of articles in support of replacing dais with “functional” midwives. Yet, India’s Western-educated women never thought about their poor sisters, whose only way of earning a living was as a midwife. Thus began the struggle, during a time considered an age of female empowerment, to sustain these traditional birthing communities.

Due to the loyalty of their clients, traditional midwives have sustained their livelihood, and though “trained” midwives are in great demand in hospitals to serve the urban elite, they have never replaced traditional midwives at homebirths. According to dais’ clients, it is better to call a dai rather than a “trained” midwife, since she provides most of the care, not only during labor, but also afterward during the traditional period of confinement.

After Indian independence, there was some change to the family welfare policy. New training programmes and orientation courses were given to dais in an effort to lower the maternal and infant mortality rates. In the beginning, these policies created new hope among traditional midwives and I have come across a good number of trained dais who’ve told me how they benefited from these programmes. I have seen the other side of the coin, too. Many village midwives lost interest in these medicalized training courses and say policy makers have never understood the psyche of the midwives.

Regardless, we in India cannot ignore the work of the traditional midwives. They are an asset to our country. It is interesting to note that many traditional childbirth practices, like squatting positions, perineal massage, delayed cord cutting and continuous caregiver support, have recently found scientific validity. Each day, these brave midwives face a new challenge to their existence. It is unfortunate that under the strong influence of globalization, some people oppose the indigenous delivery system. However, many doctors, social activists and researchers are doing good work to empower the traditional midwives. It is our duty to strengthen maternity services in India with serious input from dais, instead of marginalizing them as unskilled birth attendants.

Soma Mukhopadhyay, PhD (Jadavpur University), is a researcher from Calcutta, West Bengal, India, working in the government sector. She is interested in female empowerment and women’s health. She has studied the traditional midwives of India for the last 15 years and wrote a book on the subject, Baglar Dai (Midwives of Bengal).

If you enjoyed this article, you’ll enjoy Midwifery Today magazine! Subscribe now!