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Reorganizations of Traditional Birth Attendants

There are over 10 lakh dais or Traditional Birth Attendants (TBAs) serving rural and urban communities in the country and for centuries. The NRHM, however, made the
mistake of equating safe delivery with institutional delivery. But it is not as if hospitals or health centers have brought about a revolutionary change. On the contrary, health experts have pointed out that now the site of maternal deaths has shifted from homes to medical institutions. Though the concerns of the NRHM are justified as India has the highest maternal mortality rate in the world, yet the manner in which it has gone about solving this problem is questionable.

Ideally, the dais should have been integrated into the NRHM, as they are deeply respected in their villages. Many of them have shown leadership qualities and have got into village panachayats. This potential should have been tapped to make them service providers and health educators. Some dais has even become ASHAs, but because of their low literacy level, very few could make the grade. This has led to a direct conflict with those lucky enough to get into the system. Instead of respecting their contribution and upgrading their time-tested skills and knowledge, there is an attempt to by-pass them in many parts of the country. Worse, they are being blamed for the continuing high maternal mortality in the country, though it is a well-known fact that emergency obstetric care is not available in a large part of the country.

However, instead of aping the West, India needs to realize the ground reality and recognize the role of dais. There is a need to find a proper place for them in the NRHM as active partners with ASHAs, ANMs and Anganwadi Workers. The rich traditional support that the dais provide through counseling, massage, delivery by squatting, traditional medicines and nutrition needs to be documented and recognized. There is also a need for an accreditation council to train dais and ensure quality service.

Better Awareness

India's rural health mission is failing to deliver results, as half of the country's women still deliver babies at home and contributes 20 per cent of the world's child mortality. Under the JSY, the government pays a certain amount to a woman who gives birth to a baby in hospital. But even then, half of India's women deliver at home without any medical attention. It is one of the key reasons for maternal mortality in the country. ASHAs are also not well trained and they are over-burdened. India never lacks manpower but trained manpower is a concern here.

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Dr. Gursharan Singh Kainth started his career as Lecturer at Post Graduate Dept. of Economics, Government College, Gurdaspur, and later at Khalsa College; Amritsar, specializes in Quantitative & Development Economics. Has the distinction of serving Punjab Agricultural Univ, Ludhiana, for more than 2 decades and remained Director-Principal of Saint Soldier Management & Technical Institute, Jalandhar. Currently, heading GAD Institute of Development Studies, Amritsar, a self-financed research institute. Has been honoured with various awards, including Guru Draunacharya Samman, Vijay Rattan Award, etc.
Article posted on December 14, 2008.