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Paper presented at the 100th meeting of the American Anthropological Association in Washington, DC, USA 2001

The ethnographic data contained in this paper is drawn from three years of research by MATRIKA, (Motherhood and Traditional Resources, Information, Knowledge and Action)—an NGO effort to document, interpret and analyze traditional midwives’ ethno-medical and religio-cultural traditions. The MATRIKA team interacted with dais (indigenous midwives) at workshops held in Rajasthan, Bihar, Punjab and slums on the outskirts of Delhi. Invaluable assistance in this research project was provided by local NGOs, particularly their health workers who were themselves from the communities and had longstanding relationships with the dais. The film excerpt from “Born at Home”, which you have seen, was shot in Rajasthan.

At first dais seemed to want to impress us with their knowledge of the modern, biomedical approach to birth. But especially after our own enactments of the loneliness and confusion of a woman laboring in a hospital, they were convinced of our critical views on modern birth and began to trust and share what they really believed and practiced. Ours was a collective effort, a group of researcher-activists interacting with a group of dais. We ate, slept, talked, sang and danced, produced drawings and plays together. Our workshop activities were a celebration of the fertile capacity of female body and dais’ cultural handling of birth. Our celebrating, however, was often under most difficult local conditions. Poverty, environmental degradation, violence and extremes of weather challenged our middle class urban sensibilities

MATRIKA data consists of voluminous workshop transcripts; interviews; documentation of role plays depicting the handling of birth and accompanying rites; ritual drawings; birth songs; and team reports and analyses. MATRIKA reversed the common TBA training model by asking groups of dais to ‘train us’ and to answer the question ‘what does a woman need during pregnancy, labour and postpartum?’ We now have a more informed view of traditional mappings of female bodily processes and the religio-cultural contexts of this body knowledge. We have also documented dais’ voices on their own experiences and perceptions: how they learned their skills; blessings and protection of deities; caste and occupation-based discrimination; living within impoverished communities; the increasing medicalization of birth; and how a degraded environment and modern agricultural methods compromise their communities’ health.

We were able to access and remain with this alien (to us) information because we decided at the outset that we must not execute the usual approach of limiting ourselves to modern categories of health and medicine. We were open to hearing about ritual practice, deities and demons, bhut-pret (ghosts and spirits), and the nazar or evil eye. In other words, we attempted to let the data speak the categories rather than the categories shape the data. MATRIKA’s findings demonstrate that dais do not observe the modern and mutually exclusive categories of religion and medicine.

Now, acting as advocates for dais, we face the epistemologically challenging task of amplifying the voices and body knowledge systems of women who relate the heartfelt realities of their lives in a ‘religious’ idiom. And this exercise is particularly perplexing when dealing with public health and biomedical establishments founded on the modernist assumptions that religion and medicine are mutually exclusive enterprises. Global Safe Motherhood and gender projects are influenced by neither pre-modern, nor postmodern ideas of body/spirit holism.

Recognition of indigenous cognitive processes has, for us, involved crossing boundaries and listening carefully—to the unspoken as well as words. We learned that although the dais use some of the language of caste Hindu (and Sikh, Muslim and Christian) orthodoxy, denoting the defiling nature of birth, older dais maintain a healthy distance and ironic disdain for attitudes which demean their work. Rukhma Dadi laughs in the film as she relates that it is said that she has ‘sinned’ by cutting so many umbilical cords. Her sardonic chuckle demonstrates an embodied confidence and ironic distance from such pejorative attitudes. Inheritors of the dai tradition see themselves primarily as servants of the life force, or jee. And the placenta is viewed as the repository of jee.

Placenta as ‘phool’ (flower), Newborn as ‘phul’ (fruit)

The placenta, the organ interfacing maternal and foetal systems, is referred to, and revered as, “another mother” to the child. One dai said “We never throw the placenta away. The child is so dear to us, so is the placenta dear to us. For nine months it has protected and supported the baby, so how can we throw it away?” Dais consider the placenta to be the flower and the baby, the fruit. As you have seen, the afterbirth is buried, in the house or courtyard, with rite and prayer for the newborn child. How the placenta is treated is believed to affect the well being of the child. Rituals honouring the placenta assume vital correlations between the human body and the earth body (microcosm-macrocosm) and allow for a system of knowledge and praxis based on radically different epistemologies and ontologies than biomedical rationalism. Similar assumptions exist in other Indian systems such as Tantra, Yoga and Ayurveda. But the dai tradition is not text-based. It is usually passed down through family based apprenticeship, mostly from mother-in-law to daughter-in-law—because a woman must have herself had the experience of childbearing before she is considered a creditable inheritor of the tradition.

Jee as Life Force or Vital Energy

The placenta is viewed as the site of jee and as the protector or that which safeguards the fetus/baby. Dais use the word ‘jee’ to describe the palpable pulsations which they are able to detect in the body generally and the female pregnant body specifically. During the third or fourth week after conception, skilled practitioners are able to feel the splitting off of this life force energy to support the emerging life of the embryo, allowing them to detect pregnancy. The word ‘jee’ is related to ‘jeevan’, the Hindi word for life. Biomedicine has no equivalent to the notion of jee. Chi or ki in Chinese and Japanese medicine; vital force in homeopathy; prana or ojas in Ayurveda all signify life energy.
Health modalities and therapeutic systems based on facilitating and augmenting jee mainly concern themselves with removing blockages to the life force and maintaining or restoring balance in the body/person.

Traditional midwives in many parts of the world have considered a birth occurring in the eighth month of pregnancy as particularly dangerous for the child. The Susruta Samhita explains this phenomenon “During the eighth month of pregnancy, there is instability in the ojas. If there is a delivery during this period, the child does not survive because of the absence of ojas in it…” This Ayurvedic knowledge is a part of indigenous midwifery, but totally absent from obstetrics. Interestingly, ‘granny’ midwives in the United States also had this belief/knowledge about the dangers of the eighth month, but it has long been considered an ‘old wives tale.’

Free flow of jee through the body maintains health. Obstructions or imbalances cause pathology. Removing blockages in the nadis, conduits for jee, is one of the functions of Indian forms of massage. Whereas western massage therapies use strokes promoting venous return (up the arms and legs, towards the heart), Indian massage techniques involve moving negative energies or blocks down the limbs and out of the body. The underlying concept of bodily functioning is radically different. Maintaining or restoring balance in the body is conceptualised as working on the following axes: hot and cold; up and down; open and closed, etc. Restoring balance of the panch mahabhuta (five elements), earth, air, fire, water and space, is also part of indigenous therapeutic work of promoting jee.

Cutting the Cord as a Great Paap (Sin)

One dai in Rajasthan informed us that the dai was considered “a ma, a vaidya, and a butcher.” The “ma” is understandable as she supports, nurtures and ‘mothers’ the mother. The “vaidya” is also comprehensible in terms of her ethno-medical role. The “butcher” is more problematic and central to the concept of the “sin” of cutting the cord. A butcher kills a live animal and cuts it up into parts, so others can eat it. A midwife also cuts flesh and divides babe from ma so that life can go on. All traditional dais wait until the placenta is delivered before tying and cutting the cord. When they speak in their idiom, they acknowledge it as a great paap, but a paap about which they never express guilt, shame (sharam) or regret.

The cord is considered alive, as possessing jeevan (life). Another Rajasthani dai said the act of cutting the cord was considered a paap equal to the killing of a hundred cows. Other dais have stated that the umbilical cord has 72 nadis or channels for life energy. Dais usually offer something to the gods in connection with cutting the cord. From one perspective the paap of cord-cutting seems to be related to high caste attitudes towards the ‘down and dirty’ birth work of dais.

On the other hand, terming the cutting of the bond between mother and child ‘paap’ also expresses the value of the mother-child bond and reverence for fleshy female blood ties. It appears that something alive, which possesses jeevan, is being violated by being severed. Perhaps this paap of cord cutting reflects an attitude similar to ahimsa or non-violence. Practitioners of folk and women’s ethnomedical traditions respect bodily integrity and utilize non-invasive therapeutics. Dais’ varied and gentle techniques negotiate the inner body without violating the integrity of the skin/body/life force. Their holistic health modalities utilize touch (massage, pressure, manipulation) and natural resources (mud, baths and fomentation, herbs) and application of ‘hot and cold’ (in food and drink, fomentation etc.) and isolation and protection (from domestic, maternal and sexual obligations).

Not cutting the umbilical cord until the placenta is delivered is the common tradition throughout India, although dais are now being trained to cut it immediately according to the obstetrical model. Traditional women consider the infant-cord-placenta as an integral package. Baby and placenta have been together for nine months with this organ functioning to nurture the foetus. Why should they be severed too quickly? Midwives throughout the country use the placenta to resuscitate the baby if it is not breathing. The placenta is heated, sometimes by placing it on the tava, and jee flows from the phool to the phul, reviving it. One dai said “In the city doctors have injections, machines and all, to take care of such babies, but we only have the placenta, so we use it.”

Recognition of Dais’ Indigenous Cognitive Processes

Yoga, tantra, Ayurveda, and meditation are globally recognised as being sophisticated mind-body interfaces which have emerged from the Indian subcontinent, but when it comes to knowledge of the female body, indigenous midwives are usually depicted as ignorant, superstitious, dirty and unskilled. As in other developing countries inheritors of indigenous midwifery traditions are considered fit only for training, and increasingly not even that. However, our data contains evidence of the scientific nature of midwifery, insofar as it is a knowledge system, learned via apprenticeship, and does not comprise just a few wise women popping up out of nowhere. We are also fortunate that in India we can benchmark the principles of dais knowledge/practice with Ayurvedic concepts.

The health status of poor and rural women and their babies cannot be improved without linkages, conceptual and practical, between biomedicine and ethno-medicine. Building on the culturally appropriate knowledge and skills of women is an important form of empowerment which avoids a common ‘development’ trap of seeing women only in terms of violence, victimisation and vulnerability. Initiatives to reduce maternal mortality must be based on respectful exchanges between all service providers. Such dialogues are only possible if dais are recognized as decision-makers in their own domains and health professionals begin to speak the language of placenta, life force and sin.

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