Only cord-cutters? Midwifery and childbirth in rural north India.

This paper discusses the negative effect midwives' traditional birth procedures have on the promise of decreasing perinatal morbidity and mortality rates in North India. Specifically, 3 aims are achieved: 1) a discussion of the status of TBAs--traditional birth attendants--in different parts of India; 2) a presentation of field work on midwives, compiled from a recent study done in Uttar Pradesh; and 3) a discussion of the training offered to midwives by the Indian government and why it has been unsuccessful. In South India it is common for a woman to give birth in the presense of relatives and friends. The woman's dai - or midwife - is called in at the last moment, and is rarely in full charge of the childbirth. Because childbirth is thought of as a dirty and shameful occurrence, the dai is also thought of as an inferior menial -- not as an expert in her job. Most dais are illiterate, poor, and pursue their jobs after a marital breakdown has occurred. In fact, most midwives have no training or experience in baby delivery prior to their first delivery. However, one important role that the dai plays is in her diagnostic ability to advise women with complications to go to a health center. This is due to the fear that the midwife has of being associated with a bad birth which could ruin her reputation. The Indian government began a program in 1977 to train 1 dai for every 500 people. Most midwives are wary of government personnel because they often encourage the midwife to take more responsibility in the actual birth as well as in more complicated births. Because the dais, their clients, and their trainers, share such low opinions of midwifery, and because secular changes are rare in such a traditional country, midwife training prospects do not look promising.