Dais India’s Unsung Birth Keepers

Dais (Traditional Midwives)

Dais (Traditional Midwives) have always played an important part in the Indian community, especially in rural areas. Their skills and expertise have benefited many pregnant ladies. In Charaka Samhita and Sushruta Samhita Ancient Ayurveda, the role of the Traditional Birth Attendant is acknowledged. These texts have highlighted the expertise of traditional birth attendants in assisting childbirth, prenatal care, labor management, and postnatal support. Hence it is essential to document their indigenous knowledge through research and employment. This indigenous knowledge can be used in modern health care, especially in reducing C-section deliveries. Through this article, we will highlight the role of traditional midwives in India and share some policy recommendations.

Who are Dais (Traditional Midwives)

Dais or Traditional Birth Attendants (TBAs) assist mothers in childbirth using knowledge and practice passed down through generations. They did not have formal qualifications but most of their knowledge is based on oral tradition and mentorship. Their skills go beyond assisting childbirth; they also provide prenatal massages, and herbal remedies, and perform cultural rituals. According to the National Family Health Survey (NFHS-5), 11.4% of rural births are done with the help of traditional birth attendants (dais). Hence they continue to play an important role in India.

Role of Dais (Traditional Midwives in India

Dais Culture is more prevalent in South Asia, especially India, Pakistan, Nepal, and Bangladesh. In India historically they have played a central role in maternal and newborn care, especially in rural areas. They are regarded as guardians of traditional wisdom, rituals, and birth-related practices. Their primary role is to assist in Home-based deliveries. That helps to reduce anxiety and stress and promotes a smoother labor process. When Trained and experienced Traditional midwives help in-home delivery it helps to reduce overuse and unnecessary C-sections which often lead to complications such as infection, bleeding, blood clots, and injury to surrounding organs.

Beyond this, they also help in prenatal care, postnatal support, newborn care, and preparing traditional remedies for maternal health. They have the traditional knowledge of home-based remedies using natural ingredients, such as herbs, oils, and other locally available resources, As a result, they provide nutrition guidance, and herbal treatments for postpartum massages, and can handle minor complications using indigenous methods. For rural India where there is a lack of health Infrastructures, they are the primary source of maternal care.  Through our Midwifery Knowledge sharing project, we have interviewed 50+ last-generation Dais (Traditional Midwives) from Himachal Pradesh and Uttarakhand. Through our Primary research, we have seen many cases where traditional midwives have helped mothers during birth by providing prenatal massages, recommending herbal remedies, and guiding mothers on diet and lifestyle throughout pregnancy.

Policy Recommendations

Indian Law only recognises institutional-trained practitioners as midwives and has two cards first Auxiliary Nurse Midwives [ANMs] and Nurse Practitioner Midwives [NPMs]. As a result, it is necessary to give formal recognition to Dais (Traditional Midwives). We can recognize them as link workers or community health workers. The government can support them by providing education and training programs in areas like basic healthcare, sanitation, safe delivery practices, and emergency response skills. In the past, there were some policies like Dai Training Programs (1960s–1990s) and the National Maternity Benefit Scheme (NMBS) (1995). But in the last decade, the government has increasingly moved towards institutionalized health systems. Although Guidelines on Midwifery Services 2018 was a landmark step. But still, there is a need to Recognize dais as essential workers in the healthcare system.  Collecting their Indigenous knowledge and scientifically doing research will indirectly benefit in recognizing their Indigenous knowledge with scientific backing. The government can establish a national or state-level network of traditional midwives where traditional midwives can connect, share knowledge, and advocate for better working conditions.

What Future Brings

Dais (Traditional Midwives) Indigenous knowledge is very crucial for preserving our Indigenous knowledge. NGOs like the Matrika, Vatsalya Foundation, Sambhav Foundation, and Prayas play a crucial role in preserving and enhancing the existence of traditional midwives' dais in India. Although there are several challenges and opportunities there. However, the right policy and implementation can help India to Integrate traditional knowledge with Modern Healthcare Systems and can empower traditional midwives both financially and socially.