Caught in the middle

She has assisted in the birth of almost the entire village population. At 65, Charki Devi, a dai, or midwife, in Beh Charan, a village in Rajasthan, is happy she has played a pivotal role in birthings. But her role and of those like her is now fading, with hospital deliveries taking over.

In this village of about 650 people in Jodhpur, dais such as Charki Devi and Imrati Devi have undergone government training so they can ensure safe motherhood to women. Both midwives are very careful about hygiene during deliveries.

"We cut our nails, wash our hands carefully, see," said Charki Devi, holding out her hands.

Charki has spent 30 years in her profession, while Imrati, who is about 50, has spent 15.

Now with most births taking place in medical institutions, either the primary healthcare centre or the nearest hospital, women such as Charki and Imrati don't play the key role they used to, but nevertheless their services are wanted.

The way it used to be

They are beckoned at all odd hours by villagers to examine pregnant women, and can tell if they require to be immediately rushed to hospital.

"We can also tell if it is going to be a boy or a girl, from the food the pregnant woman craves to eat," Imrati said.

If the delivery is done at home, then the dai, besides ensuring her own hands are clean, also ensures there is a clean cotton cloth on which the delivery is to take place, a new blade with which to cut the umbilical cord and a piece of thread — boiled and sterilised — to tie up the cut cord.

There were times some years ago when some deliveries would take place on a bed of sand or a pan of heated soil. The sand or the soil would have a cushioning effect and also soak up the blood.

"These dais are called to accompany the expectant mothers to hospital," said Smita Bajpai, programme officer of Chetna, an NGO working under the White Ribbon Alliance India for safe motherhood.

"The expectant mothers feel more at home with the dais, who are known to them in the village. The dais remain with the women in the hospital and alert the doctors and nurses when the baby is about to be born," she said.

The dais would earlier get Rs50 (Dh3) per delivery, but now they don't get anything, Imrati said.

But villagers do give the women some token gifts and food after a successful delivery. The dais are also called on the seventh day after the birth, during the naming ceremony.

Besides the dais, there are also the ANMs, or the auxilliary nurses and midwives, the ASHAs (Accredited Social Health Activists) or trained female community health activists, and the Anganwadi workers who work among the women in the rural areas of Rajasthan to spread awareness about preparing for delivery and the birth of a child.

In Rajasthan, which has among the country's highest maternal mortality rates, at 335 women for every 100,000, the midwives and trained nurses play an important role as an interface between the families and the healthcare centres.

An eye on health

Sandhya Rani Purohit, in her fifties, is an ANM with about 27 years of experience working in Beh Charan village. Trained under the National Rural Health Mission, Sandhya takes the blood pressure readings of the pregnant women, checks their weight, gives them their tetanus "tika", or shots, and also gives the women advice on family-planning methods.

"I monitor the health of all the women between the ages of 15 and 45. I check the mother and the child, and advise women to go for hospital deliveries," Purohit said.

There is also Shyam Kumari, an Anganwadi worker in the same village.

"Earlier, births in our village used to take place at home. Now all the women are sent to the hospital. We also advise them on their diet and monitor their health closely," Kumari said.

Aparajita Gogoi, country director for the Centre for Development and Population Activities, which helped form the White Ribbon Alliance India, said that the aim was to make childbirth safer. "We work at multiple levels — both at the awareness-generation level and at the community level," Gogoi said.

A select group of mediapersons visited some villages of Rajasthan's Jodhpur district to view the results of a project coordinated by SUMA-Rajasthan White Ribbon Alliance for Safe Motherhood, in partnership with White Ribbon Alliance India and GRAVIS (Gramin Vikas Vigyan Samiti).