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Mapping the Terrain: Birth Voices, Knowledges and Work

Janet Chawla
This paper was the introductory essay to Birth and Birthgivers: the Power behind the Shame edited by Janet Chawla and published by Har-Anand Publishers Pvt Ltd.

It is said that the personal is political. That is not true, of course…Personal and political are interdependent but not one and the same thing. The realm of imagination is a bridge between them, constantly refashioning one in terms of the other.
Azar Nafisi 1

To describe the context within which this book is situated is not an easy task. Many scholarly books are introduced with a review of existing writings in the field along with relevant history and politics. Birth, however, expands like over-leavened bread dough, spilling out of containers, colonising one’s kitchen with its generative force. Babies quicken in mothers’ wombs and mothers in all societies experience birth both bodily, and within their socio-cultural context. Birth is both imaged and corporeal. Individual women and groups of women make sense of their positions within dynamic and fluid environments. It is a challenge to do a review of these macro-level, holistic and fluid environments. Complicating the issue, in this kitchen ‘traditionally’ within the Indian subcontinent, the womb and the cooking pot partake of the same meaning as sites of transformation. And these cultural signifiers, along with so many others, are images that have been transmuted through the hegemonic violence of the colonist’s language. As Sara Suleri writes,

To state the case at its most naked, the Indian subcontinent is not merely a geographical space upon which colonial rapacities have been enacted, but is furthermore that imaginative construction through which rapaciousness can worship its own misdeeds, thus making the subcontinent a tropological repository from which colonial and post colonial imaginations have drawn—and continue to draw…. 2

The problem then becomes how to step out of the box in order to name and celebrate what I have learned about subcontinental cultural constructions of birth.

This collection of essays attempts to recognize, document and amplify voices (and silences which enigmatically ‘speak’) that are not usually heard. I seek to balance what I consider to be an inordinately dark and shadowy pessimism. It does seem that women’s and feminist scholarly writings on the body within India are often more focused on oppression and atrocities than pleasure and celebration; on what doesn’t please them, rather than what does. I have found much that awes and delights me, and satisfies my female soul within traditional Indian birth cultures. Here I present material which may be useful in skilful reclamation of tradition to be brought forward in the contemporary world.

Academic and development literature is replete with descriptions and analyses of how patriarchy exploits women’s sexual and reproductive power. International, government and NGO initiatives to ‘empower’ women and right these gendered wrongs abound—and they are much needed. However precious little exists in praise of indigenous gender constructs generally, 3 or specifically, as they pertain to birth. Entire legacies of female culture, which has existed alongside and within patriarchy, are threatened with extinction: identities, socialities, knowledges. This book seeks to fill that lacuna by an exploration of the world of ‘tradition’— problematic as that term may be.

In this context I shift from the ‘reproductive health’ and ‘empowerment’ jargon of ‘women’s health’ and ‘development’ analyses. Foregrounding a problematic terrain I ask questions of a past which segues into the modern and even postmodern; where syntocin injections used to stimulate labour become the ritual of choice, replacing birth rites invoking the goddess Bemata. This book explores indigenous Indian (or more precisely South Asian) cultural constructions of birth, thus the title Birth and Birthgivers: The Power Behind the Shame. After all, childbirth, traditionally, is sharam ki baat, or a matter of shame/shyness/embarrassment. It is women’s business, not men’s. It is an emotional, bloody, life-and-death affair—to be exposed neither to the male gaze, nor public presence, eye or ear; jealousy, chaya and nazar lurk threateningly.

In this introductory essay I problematize the translation of the word sharam into shame. Shame, in English—according to the New Shorter Oxford English Dictionary—means “the feeling of humiliation or distress arising from the consciousness of something dishonourable or ridiculous in one’s own or another’s behaviour or circumstances, or from a situation offensive to one’s own or another’s sense of propriety or decency.” Conversely, shameless means “lacking a sense of shame, devoid of feelings of modesty…impudent, brazen; suffering no shame, free from disgrace, uninhibitedness.” I propose that sharam, read as shame, obscures multivalent and powerful cultural imagings of femaleness. Accessing these imagings, as the reader will see below, opens up entire cultural worlds—many of which are sites of women’s expression, creativity, and agency.

How this Work was Conceived and its Methodology

Some fifteen years ago I became frustrated with teaching ‘natural childbirth’ classes to middle and upper class women and couples in Delhi—preparing them for birth without the medical interventions of pharmaceuticals and surgery. Even then, too many women ended up having caesareans despite their decision to have a normal birth. As an American who had lived and worked in India for many years, I had come to know about dais (indigenous midwives) from friends who were women’s health activists and working in NGOs with slum and rural women. Being well versed in western notions of natural childbirth, I was very curious about its Indian version. I did my first research in collaboration with Action India and Jagori Women’s Documentation Centre when we collected experiences of childbearing from women of many classes and communities. Each woman interviewed a woman whom she already knew, and, whom she felt would have something meaningful to share about her pregnancy and birth experiences. first research in collaboration with Action India and Jagori Women’s Documentation Centre when we collected experiences of childbearing from women of many classes and communities. Each woman interviewed a woman whom she already knew, and, whom she felt would have something meaningful to share about her pregnancy and birth experiences.

This was a collective effort, Action India, Jagori and myself as consulting researcher. We grounded ourselves with methodologies drawn from psychological counselling techniques of active listening and positive reinforcement. Active listening involves an empathetic rephrasing of what a woman had spoken, allowing her to go deeper into her own self, memories and emotions. This was a turn away from the probing and quantitative orientation of the standard ‘questionnaire’ methods more commonly used. Positive reinforcement meant articulating an appreciation of what the interviewer considered to be behaviour which was woman-centred caretaking—either of herself, of other women, girl children, or female infants.

We were not dispassionate collectors of data; we were personally engaged with topics of menstruation, pregnancy, birth and postpartum. Profoundly dissatisfied with our own biomedical encounters, we were willing to use our imaginations and capacity for empathy in order to learn from (not ‘teach’ and ‘uplift’) poor women. By far the most intriguing interviews were those of the basti women who still related their experiences in what I have come to call, a religio-cultural idiom.

Anthropologist, Kalpana Ram, presents the problems feminist scholars face in understanding women who ground their experience within a religious identity.
To the extent that feminism itself views the splitting of the self as an index of the fundamental crippling of women in patriarchy, and implicitly posits a unified and continuous self as the aspiration of a feminist sense of subjecthood, we stand the risk which is acute in a country such as India of ceasing to be able to apprehend the voices of women who situate their experience within a religious framework. 4

And it is precisely this problem which we faced as researchers.

In 1995, with the intellectual and practical support of my colleague and friend Deepti Priya Mehrotra (who has contributed an essay to this volume, chapter 5), I initiated MATRIKA, 5 a broader research initiative to further document and analyze birth traditions with a specific focus on dais, the indigenous birth specialists of India. Here we were on a slippery slope in terms of nomenclature. One reason modern institutions have not been able to incorporate or liase with these women in policy and programs is the fluidity of the category. As Sarah Pinto unpacks in her sociological essay on birth work and workers in Sitapur district of Uttar Pradesh, a division exists in birth work roles between that of baby-delivering and that of cord-cutting, cleanup and postpartum care, which is always performed by the lowest caste in the areas (chapter 6 in this volume). Pinto indicates that it is not only individual religious orientation that acts as a barrier to modern understanding of women’s birth work, but also the complexities of caste-based social organization.

Nevertheless in the four geographical areas where MATRIKA held a series of workshops in collaboration with local NGOs 6 we met women who were called dais no matter how loosely they were defined. We interacted with dais who had attended thousands of deliveries, and those who had attended only ten. Most of our dais did cut the cord, although some didn’t. We came to realize that that act of severing the anatomical bond between mother and child was of utmost significance. Our team asked the question “what does a woman need during pregnancy, birth, postpartum?” At first, in keeping with the code of sharam, mentioned above (and perhaps being protective of their trade secrets), they did not openly discuss their knowledge and practice—rather they told us what they thought we wanted to hear. They spoke of using clean razor blades to cut the umbilical cord, referring women to doctors (even though there were often no facilities or doctors in the area), washing their hands, etc.

MATRIKA’s methodology thus involved reversing the common Traditional Birth Attendant (TBA) training model by asking groups of dais to ‘train us’ in their methods. And we persisted in attempting to create the space for their expression, as well as our own capacities to hear and understand them. Role playing, ritual drawings, singing of birth songs, sharing of birth experiences (ours and theirs) as well as dais’ life narratives were our workshop activities. We were able to access, and remain with, this different kind of information because we decided not to limit ourselves to the modern and mutually exclusive categories of ‘medicine’ and ‘religion’. Rather we chose to be receptive to diverse ways of facilitating birth, diagnosing and healing—to rituals, deities and demons, bhut-pret (ghosts and spirits) and the nazar or evil eye. We attempted to let the data which emerged from groups of dais speak the categories, rather than have the categories shape the data.

NGO health workers provided invaluable assistance to us in the task of deciphering meanings, allowing us to deepen our understandings in subsequent workshops. They, themselves, were from the local communities and often had longstanding relationships with the dais. Health workers, who are not a part of a professional cadre, nor the NGO establishment, often have a ‘feel’ for the language and life situations of traditionally oriented women. When given permission from the higher-ups they can be an invaluable human resource in orienting researchers and organizations toward a respectful understanding of the ‘client’ communities. Unfortunately, being keenly aware of the power and attitudes of their superiors, they usually remain quiet.

During the gestation of the ideas in this work, I was being ‘massaged’, so to speak, by Delhi feminists both activists and intellectuals. I would occasionally be invited to gatherings at Delhi School of Economics, Department of Sociology or Teen Murti Library or Jawahar Lal Nehru University to seminars on some aspect of women’s lives or feminist scholarship. Often I would cringe as so-called experts from the west would expound on a topic and the Delhi scholars would politely listen, question, and then, slowly, it would emerge that their presentations had been ethnocentric and patronizing. The Indian feminist scholars too, who were the crème de la crème of intellectuals, would dazzle with their erudition. Neo-colonialism, re-enacted. However when I would try to raise questions of dais and wombs and childbirth, I was seen both by western and Indian feminist scholars to be romanticizing tradition and/or being an essentialist. There was simply no anthropological/sociological, nor even activist slot for my kind of work. 7 Anthropological literature, with the sole exception of Dr. Tulsi Patel at the Sociology Department of Delhi School of Economics, 8 has focussed on service castes such as dhobins, nains, and their roles as matchmakers and ritual participants at the time of births and weddings. But dais and cord-cutters, and the caste-based nature of their work do not find their way into such scholarly writings. What accounts for this neglect? First and foremost is the postcolonial assumption held by the general public and researchers alike that dais are not fit subjects for research, being superstitious, ignorant and unhygienic. Rather, poor women need to be ‘rescued’ from these ‘backward’ women. Secondly is the fraught nature of ‘family’ in independent India. ‘Family welfare’ for the Government of India has come to mean limiting births and not providing quality healthcare. Third is that birth work and workers have been ‘sharam ki baat.’ A researcher can walk into a village and see the dhobin washing clothes, but birth and cord-cutting remain shrouded behind the purdah. 9

Once I submitted a manuscript to a feminist press only to be told (granted, among other critiques) that my writing was “constructing motherhood biologically.” I was disturbed and puzzled, and lacked the intellectual bravado (like a ‘good woman’, I was afflicted with ‘ sharam’) to persist. But went home perplexed (wasn’t growing a baby in your tummy and pushing it out and nursing it, biological?) and continued to follow the direction of my own curiosity.

In retrospect, however, I consider it quite ironic that I was accused of ‘constructing motherhood biologically.’ I have myself been a single mother, a mother in a nuclear family, a mother in a joint family. I have been a mother in the United States as well as in India. I have three children. With this background I, of all people, should be aware of the fact that motherhood is socially constructed! Indian feminists too perhaps have somewhat avoided the topic of motherhood. The challenge of evolving an Indian feminist perspective on motherhood may be due to the fact that being a mother is privileged and valorized, often even compulsory in the Indian familial context—as well as a site for patriarchal and familial oppression and exploitation. Experiences such as these led me to a more nuanced reclamation, along with a healthy feminist scepticism.

Some 15 years ago I was lecturing at Hampshire College in Massachusetts and a scholar whom I have since come to respect immensely, Frederique Marglin, began questioning me. Frederique, who has worked extensively in/on India, is a trained classical Indian dancer and loves India. I watched my own reflexive awareness of a shift of my voice in this exhchange, from that of advocate for custom, to that of feminist critic of ‘tradition’. I live in India, walk down the street, read the daily papers, hear the gup-shup (gossip), continually experience fallout from a gender code which enforces male privilege. No, I am not naïvely reclaiming the past—one cannot simply go from oppressive constructions of the “other” to projecting one’s hopes, dreams and ideals onto them. 10

Also problematic is the fact that woman-as-mother has been valorized at all levels, in all traditions via a gendered and seemingly paradoxical metaphysics. The Mother Goddess, historically, is a central image in Hindu rite, icon, text and devotion. 11 Magico-religious properties have always been attributed to the body, especially the female body. Nai and dhobin traditionally handled hair, fingernails, and clothes carefully, lest they fall into the wrong hands and be used to perform black magic. As many papers in this collection attest, the placenta is handled with care, postpartum, especially with the boy infant, to avoid its misuse by women unable to conceive.

Likewise images central to Hinduism (the garbha grihya of temple architecture, the hiranya garbha of the Rig Veda, the garbha dancing during the Navratra in Gujarat; the sacrality of the pot as transformative vessel ( kumha mela) all speak obliquely of the awesome aspects of female physiology—the womb and its capacity to hold and transform. This signification code allows for human communication in ritual, speech and craft/art but at the same time protects the mysteries of the signified (woman-Devi) from a scorching public gaze as surely as images in mandirs throughout India are covered with veils, and darshan is only given selectively by the pundits. Sharam, in this sense, might be the other face of the sacred.

The modernist bias of the feminist movement further complicates contemporary discourses on gender. In a seminar on “Masculinities” held at Delhi School of Economics, Delhi University a few years ago, I was struck by the differences between the way groups of men spoke of sexuality and the way groups of women did. I was quite unnerved as men immediately started talking about semen, wet dreams, and erections—very physical and very visceral—even showing a film on male fantasy. I thought ‘hey—that’s not fair!’ When women intellectuals talked of sex, they spoke of ‘the control of female sexuality’ not female desire and pleasure, clitoral and vaginal orgasms! When they discussed motherhood, it was in terms of exploitation, not what it felt like to have a baby emerge from between one’s legs, or have milk dripping from one’s breasts. It seemed to me the men got to talk about the physicality of it all, without being accused of being essentialist.

Perhaps this is one reason I love the dais: besharam, embodied and caring and spiritual. Interestingly, when I first came to India 26 years ago, I began my ‘research’ career by interviewing holy women. As we had no such tradition, of which I was aware, within my Roman Catholic upbringing, I was curious about this phenomenon. And I interviewed Mataji Shri Nirmala Devi, Chidvalasananda (now known as Gurumai) and Vimala Thakur—questioning whether spiritual experience was different for men and women. And was there any such thing as ‘women’s spirituality’? This orientation was just emerging in scholarly and popular writing in the United States. I learned a bit about kundalini, Kashmiri Shaivism and meditation but not much about women. Wise and holy, perhaps, but they didn’t speak to the issues which concerned me as wife, mother, woman: menstruation, sex, childbirth, nursing, and being embedded in familial relationships and expectations. It took dais to teach me about these aspects of women’s lives and from a very real, embodied ‘spiritual’ perspective.

When I was naïve enough to believe that I might find mention of the dai in epic or classical texts, I asked the Sanskritist and Marxist historian, Sukumari Bhattacharji, for help. She wrote:
The dai is a substitute priest working between two worlds: the sacred and the mundane as well as the pre-natal (foetal) and the post-natal. And like the priest, or more like the shaman, she discharges her function through control of the spirit world. There are demons which seek to delay, prevent or muck up the birth (the defective or stillborn babe; childhood diseases; the death of the mother)….

The dai’s unique position is equivalent to that of a shamaness; she pre-empts, makes interventions in a literal rite of passage. She was allowed this privilege, possibly, because the whole process is ‘dirty’. Remember the Asvins, divine physicians, were deprived of the soma drink in the later Vedic-Epic literature because as physicians they had to touch the uncleanness connected with disease. Later Indian literature states that doctors may not be ritual guests.

The birth rite is the only wholly female rite where male presence is precluded. It is solemn, awesome, throbbing with tension because it uniquely empowers the female assistant and it is the only rite where a new life enters our world. The dai (derived from ‘ dhatri’) is symbolic of mother earth; whereas the earth gives birth unaided, in a human birth she splits herself into two—the mother and the dai. Note the foetus devouring demons in the Atharva Veda, and in the description of Shiva’s spirit entourage in the Anusasana Parvan (Book XIII of the Mahabharata). 12

The religio-cultural world of traditional birth enchants me precisely because it does not fragment the female self into Cartesian dualisms of body/spirit, reason/emotion, human beings/gods, religion/medicine—and even male/female, because, after all, both male and female are born from the womb! 13

‘Birth and Birthgivers’

This book is a forthrightly besharam celebration of indigenous traditions relating to birth and their practitioners, birthgivers. Birth is a uniquely female capacity. Men do not bear babies in their wombs, nor push them out from between their legs, nor feed them from their breasts—at least not yet. New Reproductive Technologies, test tube babies, and cloning may be eclipsing our power, however this female biological power still abides. And, perhaps, nowhere in the world has it been more extensively celebrated than in the religio-cultural forms of the Indian subcontinent. 14

The birth and birthgivers of the title are not hospital births conducted by obstetricians, but those which take place in jhuggis and huts attended by dais or other traditionally oriented women. Often, we of the modern middle-class, discount these practices and practitioners as sites of information relevant to our own health and wellbeing. However, I have learned much which could enrich our own body-knowledge. Birthgivers are not only the mothers giving their gift of a child to the family and community, but they also include the dais or family and neighbourhood women who attend them. Dais often refer to their work as ‘ sewa ka kaam’ or work of service. “God is the doer, the hands are mine” one Punjabi dai said. Yet it is precisely these women, who in popular, historical and medical literature, are often accused of being responsible for the deaths of mothers and infants. It is these women who catch the babies of the poor women of the subcontinent, those who have been excluded from the modernist enterprise of ‘development’. And although older, experienced dais speak against the practice, increasingly in villages throughout India, the poor are turning to injections rather than rites to the goddess to facilitate labour. As D. D. Kosambi noted years ago, women around Pune propitiated Sitaladevi, the goddess of childhood diseases, particularly fever and pox, after their children were vaccinated. He concluded that to these women “vaccination is just a new-fangled blood-rite.” 15

Birth and birthgivers—because birth is a site, real and imagined, where life meets death, society recreates itself, and, women, as mothers, meet themselves in an elemental bodily way. Birth is where women gather together to help a new being slither out from between her mother’s legs, where social constructionism meets essentialism. Where women’s knowledge and creative expression are writ large: in songs, stories, rituals, magic and medicine. Birth is where spirits of magnificent grandeur lurk, where the neighbors’ or relation’s nazar can fall (evil eye be cast), where songs of sophisticated sociological complexity are sung. Where herbs are plucked and boiled and drunk. And the mother’s body, more specifically her nether regions, yoni or birth canal are the bindu, the focus and locus of all this activity.

The Power: Shakti and Satta

Deepti Priya Mehrotra points out that the word ‘power’ translates into Hindi in two senses: satta and shakti.
Whereas ‘ satta’ looks upon power as a primarily political phenomenon, ‘ shakti’ looks upon power as energy, personal or impersonal. The former is used in the context of the state, and of various strata—racial, class, caste, gender. ‘ Pittrisatta’, for example, or ‘ purush-satta’, are the Hindi terms used for ‘patriarchy’; ‘ raj-satta’, for state power. ‘ Shakti’, on the other hand, is used in a wide range of cultural contexts to denote the energy or strength that flows through all—through women, men, trees, flowers, goddesses and gods. The entire cosmos is connected to ‘ shakti’ by ‘ shakti’. ‘ Satta’ deals with areas of domination and oppression, of one group versus another. ‘ Shakti’, on the other hand, is a principle of movement, growth, action, flowing and flowering. 16

I consider the distinction Mehrotra has noted between the satta and shakti aspects of power germane to the enterprise of this collection of essays. Concepts of women’s ‘empowerment’ and ‘agency’ are bandied about these days like hotcakes (or chappaties?). I have been interacting with birthing women, obstetricians, midwives and childbirth educators for over 30 years in the US and in India. The experienced, older dais whom I have had the privilege of interacting with, are the most embodied, empowered, and empowering of the lot.

Many urban, English-educated women, will talk in syrupy-sweet and condescending voices about how poor, illiterate women must be educated and uplifted. These same young women, becoming mothers, will submit willingly to having their bellies sliced open and their baby lifted out of its mother-nature given cocoon into the glare of hospital lights, the clanging of metallic instruments, antiseptic smells and the brusque and unloving hands of strangers. This procedure, caesarean section, can be a life-saving intervention. However, when used (mistakenly) to avoid the pain of labour; to have the baby on a convenient date and time (for doctor, mother, family); to be seen as modern, well-off, or trendy, or, when the labouring woman’s human needs for encouragement, guidance, physical, emotional and spiritual support are not met, then caesarean cutting is a horrific mutilation of the female body. And, increasingly, globally, this mutilation is becoming the norm.
Disciplinary technologies are not primarily repressive mechanism. In other words, they do not operate primarily through violence against or seizure of women’s bodies or bodily processes, but rather by producing new objects and subjects of knowledge, by inciting and channelling desires, generating and focusing individual and group energies, and establishing bodily norms and techniques for observing, monitoring and controlling bodily movements, processes, and capacities. Disciplinary technologies control the body through techniques that simultaneously render it more useful, more powerful and more docile. 17

A woman-centred critique of caesareans 18 and reclamation of sharam would be naïve and grossly misplaced if we were not to acknowledge ruptures and discontinuities in any single line of reasoning. This book valorizes much of what has taken place behind the veil of purdah, in women’s special spaces, and attempts to document and analyze the ‘voices’ raised within these texts. But this should in no way be construed as a failure to recognize the multiple violations of women, female victimization and enforced silence, which has occurred in the name of honour and sharam. Ritu Menon and Kamla Bhasin write of the socio-sexual code of sharam as it functioned during partition.
Neither absolute nor monolithic (obviously, not all men agreed that killing kinswomen was acceptable) this consensus is, nevertheless, at once deep and wide-ranging and encompasses most forms of violence…. It has two critical and distinguishing features: it sanctions the violent “resolution” (so to speak) of the troublesome question of women’s sexuality and sexual status—chaste, polluted, impure—and simultaneously insists on women’s silence regarding it through the attachment of shame and stigma to this very profound violation of self. Thus, the woman raped, the woman who may be raped, the raped child, the young widow whose sexuality can no longer be channelised, the wife raped by kinsmen or others, the women who must be killed so that their sexuality is not misappropriated, the wives, daughters and sisters who must be recovered so that sexual transgression is reversed—are all compelled into acquiescing. 19

Sharam—A Peek Behind the Purdah

Sharam as shame needs to be deconstructed and viewed from within, not dismissed with the simplistic and judgemental assertion such as the below, found in a popular work on birth in India.
Women are still ashamed of their sexuality, and regard themselves as polluting to others when they menstruate or give birth. Common shame is a poor basis for common action. 20

Sharam is usually translated as shame, but the meaning of the word is much more complex and nuanced. Implicit in the modernist tendency to accept sharam (the word and the concept) as connoting shame, in its uniformly pejorative sense, is a radical distortion of female cultural domains.
One of the main features of imperial oppression is control over language…Language becomes the medium through which a hierarchical structure of power is perpetuated and the medium through which conceptions of ‘truth’, ‘order’, and ‘reality’ become established. Such power is rejected in the emergence of an effective post-colonial voice. 21

Sharam can be viewed as an agreed upon social code which offers both protection and the ability to negotiate within a gendered world as well as delimiting female behaviour and domains. By only focusing on the negative aspects of this code we neglect the shaktic aspect of female physiological processes. I use ‘ shaktic’ here to refer to the cultural entwining of the sexual/menstrual/birthing energies of the female body and the heterodox Hindu streams which valorize woman as embodiment of the divine and understand her female physiological processes as signs of divine manifestation.
Actually, shame is a mistranslation, or terribly incomplete one, for the Hindustani word of Urdu origin, ‘ sharam.’ Menstruation and childbirth on the subcontinent have traditionally been matters of ‘ shame’ or ‘ sharam ki baat.’ In our MATRIKA workshops researching birth with groups of slum and rural dais, we enforced a ‘women-only’ exclusionist policy because of sharam. Traditionally oriented women will not discuss these matters when men are present. If we had admitted men, no matter how gender-sensitive they were, the dais would have remained proper and tight-lipped. Their culturally appropriate behaviour norms dictated that these were female-body centred matters which had no place ‘in the male gaze.’ How could we investigate the handling of pregnancy, birth and postpartum if we violated one of the basic tenets of indigenous cultural discourse?

Conversely in a national meeting on women’s health “Many Voices: One Agenda,” one NGO presented on their work with adolescent women. The speaker related their work on menstrual hygiene saying that they encouraged young women to hang their menstrual cloths out in the sun to dry them, rather than tucking them under the mattress as they sometimes did. She went on to narrate, very indignantly, that one (obviously considered ignorant) mother actually “beat” her daughter for putting her washed menstrual cloth outside. No one, except me, spoke up against an intervention by the NGO which led to such a vehement reaction from a mother, obviously based on an understanding of the significance of menstrual blood which differed radically from that of the NGO. After the meeting several people came up to me (observing the rules of sharam—not speaking out honestly in the face of authority figures) and shared privately that they were happy that someone had spoken out. Modernist and simplistic NGO and medical programs continually function in total ignorance of the complexities of indigenous body culture. The challenge before us is to create a balance between modern health knowledge and facilities and that of indigenous health practices and practitioners, such as dais, Ayurvedic practitioners and ritual healers.

Such mistranslations, oversimplifications and ignorance of the very existence of other systems of body knowledge, by scholars as well as NGOs, manufacture an unmitigatedly bleak picture of the birth scenario in India.

Alongside the jachcha’s weakness, vulnerability and capacity to contaminate others is another aspect of maternity: sharam. The jachcha’s condition is a sharam-ki-baat; her physiological processes are embarrassing, distasteful and striking evidence of her sexuality. 22

In much of the current public health, maternal-child health and ‘reproductive health’ literature and interventions, the indigenous culture of childbirth is not only filthy but also oppressive and victimizing of women. This stream of thought has a long and hoary past. ( Mother India by Katherine Mayo, The Countess of Dufferin’s Fund, 23 etc.) Edward W. Said’s critiques of colonialism foreground the cultural imperialism pervading current attitudes towards indigenous birth practices and practitioners.
…But we must also focus on the intellectual and cultural argument within the nationalist resistance that once independence was gained, new and imaginative re-conceptions of society and culture were required in order to avoid the old orthodoxies and injustices…The women’s movement is central here.” 24
Much feminist writing has considered the female body as a political battleground, 25 from the colonizers to the nationalists, from the government to the Hindutva brigade.

Even fictional versions of ‘new and imaginative re-conceptions’ rework of this cultural idiom of shame. Salman Rushdie wrote a novel entitled Shame—and the book shows a keen sensitivity to female cultural forms. In Midnight’s Children, his first novel, he analogises the writing of the novel with the making of achar—a quite positive rendering of women’s domestic activity. However, in Shame, we find another cultural trope, the collective mothers, depicted in the register of the grotesque, the horrific. Collective mothers (sometimes called Saptamatrika) are to be found in the Rig Veda, voluptuous sculptural renderings, literary and ritualistic manifestation. Referred to as Mother Goddesses or Shaktis, they link Brahmanical with non-Brahmanical traditions. Rushdie, however, fictionalises these female activities (sex and baby-making and childrearing) subverting the fecundity of maternal enterprise in service of polemics.

Similarly, avoiding the complex and fantastical world of Rushdie, Taslima Nasrin titled her political document Lajja. A word which carries much the same meaning as sharam, here it seems to be used for its cultural currency—and yet in a totally unequivocal sense—that of the shame/guilt of those responsible for the mindless bloodthirstiness of fundamentalism. Lajja novelised the horrors that took place in Bangladesh after the destruction of Babri-Masjid and showed the vulnerability of women to all manner of exploitation. Towards the end of the novel even Suranjan, the activist Hindu protagonist, resorts to the rape of a Muslim prostitute in his anguish over his sister’s abduction and his imaginings of the sexual violence she is experiencing. The novel graphically dramatizes the violent intersection of gender and religion.

On the other hand, in her work, Reading Lolita in Tehran, Azar Nafisi writes of the aesthetics of the veil and its absence in those who don it for political reasons.
There is something peculiar about the way they wear their chadors… For there is, in them, in their gestures and movements, none of the shy withdrawal of my grandmother, whose every gesture begged and commanded the beholder to ignore her, to bypass her and leave her alone. All through my childhood and early youth, my grandmother’s chador had a special meaning to me. It was a shelter, a world apart from the rest of the world. I remember the way she wrapped her chador around her body and the way she walked around her yard when the pomegranates were in bloom. Now the chador was forever marred by the political significance it had gained. It had become cold and menacing, worn by women like Miss Hatef and Miss Ruhi with defiance. (p. 192) 26
What is this femininity, this female bodily presence that simultaneously begs and commands, that is cloaked by the veil? Keep in mind that these descriptions are written by a woman who was fired because she refused to wear the chador to the Tehran University.
There are different forms of seduction, and the kind I have witnessed in Persian dancers is so unique, such a mixture of subtlety and brazenness, I cannot find a Western equivalent to compare it to. I have seen women of vastly different backgrounds take on that same expression: a hazy, lazy, flirtatious look in their eyes. I found Sanaz’s look…as she suddenly began to dance to music with stretches of naz and eshveh and kereshmeh, all words whose substitutes in English—coquettishness, teasing, flirtatiousness—seem just not poor but irrelevant. 27

Within the Indian subcontinent gender-culture relationships are also formatted by these kinds of cultural nuances. In the Nava Rasa system, the elaboration of emotional states underpinning classical Indian aesthetics, sharam is subsumed under the category of shringar, the erotic. A complex palette of possibilities are involved. Displaying coyness (knowing and aware), shyness (of a very young girl, at the beginning of a padam) or embarrassment (if her pallu falls off or buttons come undone). 28
Similarly the ethnographic fieldwork of Raheja and Gold, in Uttar Pradesh and Rajasthan, alert us to the fact that “the gestures constituting purdah, or female seclusion, were recognized as poses, enforced by behavioural codes…They did not appear in the least to be fundamentally ashamed of female bodily processes.”  29 And one of the major arguments of their book is that “the performances associated with Hindu festivals and the many rituals surrounding birth, children, and weddings are both expressions of and sources for women’s positive self-images.”  30 Raheja and Gold’s work stepped out of the box and presented ample data to question the cultural image portrayed in some academic work of Hindu women as, “ambivalently construed and inherently split” having internalised patriarchal norms. According to Raheja and Gold, Sudhir Kakar, psychoanalyst; Wendy Donniger O’Flaherty, Sanskritist and historian of religion; and Lynn Bennett, anthropologist, all assert profound disjunctions between sexuality and fertility. They claim that the “split-image approach to South Asian women derives largely from the male point of view” and point out that none of these authors claim to give women’s view of women. Their own documentation of women’s songs displayed maternal-erotic holisms beyond the scope of Cosmopolitan magazine or the Kama Sutra. Indeed, we have much to learn from the songs of our rural sisters.

Problem of Voice: Representation and Re-presentation

We face a particularly acute problem of re-presentation in the domain of ‘religion’ and ritual. For ten years or so the American academe has been prolific in generating research on the goddesses of India, folk religion, and women’s ritual practice—in history of religion, anthropology and women’s studies disciplines. It is my impression that academic research and publications tend to generate a biased view of what constitutes women’s spirituality. The insiders, who know the context, because they live, work and grew up here write either analytical, polemical or devotional tracts, and the outsiders, grounded in theory and ‘literature in the field’, come and do dissertation research for a few years, contributing further to that literature, but little to ongoing Indian or ‘development’ discourses.

In considering scholarly writing on childbirth, I have encountered this situation with two authors: Rajeshwari Sunder Rajan and Cecilia Von Hollen. Sunder Rajan discusses the pain of childbirth, and the ‘naturalization’ of female pain in her essay on sati. She makes the point that “An initial dichotomy of body and spirit is the basis for postulating the superiority of spirit over flesh, as in all forms of asceticism, heroism and marytyrdom. The subjectification of the sati demands, not a devalued ‘body for burning’, but a body invested with exceptional physical properties.”  31

All of our MATRIKA data supports this assertion of the female body as invested with exceptional properties. Anuradha Singh in her essay on Ayurveda states that the female body is viewed as a microcosmic workplace, the site of creation and regeneration—where macrocosmic forces are transacted in microcosmic bodily form. Problems arise when we examine that notion of the valorized female body without factoring in women’s own (behind the purdah, sharam ki baat) cultural constructions of the body. It also seems important to note that patriarchal and patrilineal constructions of the female body, whether they valorize or disparage the female physical form, do so in the service of husbanding, or controlling, both women’s sexuality and the paternity of her children.

Sunder Rajan, in examining the explanations that ‘the sati does not feel pain as you or I do’ argues that,
Ritual pain is regarded as a discipline, a yogic submission, both abject and heroic…Such attribution of separateness is facilitated also by the absolute otherness of woman as subject-of-pain through the mystique built around sexual difference. The labour of childbirth, for instance, is frequently treated as both natural for women and selflessly, even heroically, submitted to; since men can have no experience of it they are willing either to valorize women’s experience through mystification or naturalize it through acceptance of anatomical difference. 32
Von Hollen likewise invokes the tapasya of the dominant tradition in her explication of women’s discussions about the pain of childbirth. “A key concept which arose in discussions about the relationship between suffering and shakti in the context of labour pains was that of tapas….In short, tapas is the bodily experience of internal heat from self-inflicted suffering as well as the power derived from that heat.”  33 Many legends and rituals depict the heat of the earth, or that of the sages who have been practicing austerities—and the interventions, ritual or mythic—which are needed to correct the situation. But the heating of the body has other significance besides self-inflicted suffering and valorized women—that of the heat of generating new life. It is important to note here that we have abundant textual and other data on the phenomenon of tapasya, but sacred texts, orthodox Hindu myth and knowledge of yoga and other ascetic practice are androcentric source material.

Von Hollen makes the important observation that women whom she interacted with in Tamil Nadu do not turn away from the pain and want painkillers (the way westerners do) but rather choose oxytocics which intensify the pain and supposedly get the baby born. “ Piracava vali and iduppu vali refer to both the sensory experience of pain and the function which the pain serves—the contractions.”

MATRIKA research findings reflected similar attitudes about the pain of contractions—but their idiomatic expressions were more like “the pot is boiling” and heating substances were given to increase the heat in the body. This, I would argue, is in a very different register than that of tapasya—and is totally congruent with an ethno-medical understanding leading to practical therapeutics. Suffering is not chosen for purification of body or spirit, but rather as an acceptance of physical difficulties encountered in bringing new life into the world. This is an essential paradigmatic shift which might reframe the masculine, ascetic spirituality as mimetic of female biological processes. Heating in the female body is, pardon me, ‘natural’ during menses and birth. Bodily experience involving transformation in the service of bearing new life. Men have to simulate it in tapasya. 34

Vidya Rao, in her essay (chapter 2) “Singing the Female Body: An Exploration of Sohar Songs” examines women’s expressions of experience of pain not from the perspective of the valorized ascetic of the dominant traditions (the practice of tapasya), nor even that of the viraha (the woman longing for her lover), but that of the female householder, whose pain is that of childbirth.
These songs speak of pain, raw, earthy, real pain, pain not in the heart, but in back and legs, and stomach. Pain and discomfort, not heartache makes the jachcha unable to eat. Her face is pale not from love and longing, but from nausea!
And within the context of sohar, directions are given as to how this pain can be assuaged. And not by the saas, nanad or jethani, but rather her own mother, or the dai—but above all the tender ministrations of her own husband, he who has put her in this very uncomfortable situation.

Rao accesses the fluidity of imagistic renderings of the female body, through varied aesthetic traditions which are often understood as discrete: thumri, sohar, Therighata, bhakti, Natyashastra, Kalidas.* As a singer-scholar she guides us through worlds of courtesans, textual traditions, folklore, nuns and besharam female saints—giving us a helpful context for apprehending the sohar tradition.

As I was writing this introduction I heard art historian Vikas Harish narrate the following folk tale during a walk through the National Museum’s miniature painting gallery. A king wanted to learn how to sculpt so that he could make a sculpture of himself. He approached a sculptor to teach him. The sculptor said that he would teach him, but first he would have to go to a painter, and learn how to draw and paint the human form before learning three dimensional renderings. The painter also agreed to teach the king, but said that first he must go to a dancer, to learn about movement, before learning to depict the human body as static. The dancer also agreed, but said that sound preceded movement, and the king must learn music before learning to dance. 35

Similarly Rao details the ways in which women within different situations, and differently situated within those situations (jachcha, saas, nanad are differently situated at different times in their lives) apparently have found freedom within informally codified forms manage to say what they have to say. As Rao points out
When any text (and this includes a song) allows space, or when the performers create space, for multiple voices and perspectives to be heard within the performance and the text, this succeeds in disturbing the tendency to stereotype and essentialize both characters and actors.
Just as the aesthetic experience segues into a thick braid of representational forms, so too does sohar produce a seamless web of traditionally-oriented women’s experiences of familial relations, sexuality, maternity. Rao presents us with silences too, childlessness, the refusals of pregnancy, poverty. Singers are listeners and listeners are singers and the jachcha, whom all the fuss is being made about—does not sing! Finally sohars articulate women’s abilities to see bodies (the pregnant – two hearted one), persons and relationships not in a stand-alone ascetic mode, but as inclusive, of the ‘other/s’.

In Manju Kapur’s “Birth of a Baby” (chapter 3) we shift from hearing the collective and ‘traditional’ voice to that of the individual and the ‘modern’ (or is it postmodern?) woman writing personally of her own birth experiences. I have taught childbirth classes and am familiar with this voice from the American ‘natural childbirth’ genre of writing. But to my knowledge there is no Indian version of this forthright individual voice—except for perhaps tidbits in novels.

The contemporary interest in “natural childbirth” originated with the 1933 publication of Natural Childbirth (later called Childbirth without Fear) by an English obstetrician, Dr. Grantly Dick-Read. This was followed in the 1950’s by the work of Dr. Ferdinand Lamaze, a French physician. One could write a book on the history of natural childbirth, but two points are important here. First, there was nothing indigenous or traditional about it. Secondly, insofar as it was popular, it was a reaction to the over-medicalization of birth, and women’s profound dissatisfactions with their birth experiences. As Manju herself relates, her home birth was not grounded in tradition, but in her own “being individual, modern and doing my own thing.” The dai, hired to clean up the mess and wash the clothes, was present almost by accident because the doctor didn’t make it.

Choosing to have her fourth child at home horrified her family and at first she was plagued by doubts. Was she creating trouble? Being self-indulgent? A novelist who has probed family relationships in her previous works ( Difficult Daughters and A Married Woman) Kapur is frankly physical ( besharam) in her descriptions of birth both at home and hospital. Her delightful piece displays her ironic sense of humour. She is able to analyse and critique.
I had always been told that episiotomies were necessary to prevent untidy vaginal tearing, that a neat precise cut was preferable to nasty jagged edges. Now I was torn and not cut. The area had been cut and stitched three times before and was no longer supple, so a tearing was inevitable. I had the jagged tear I had been so protected against in all my previous deliveries.

And what a difference! How easy it was this time! I had no stitches poking, no bristle digging into me. No soreness while walking…The doctor’s advice was do not strain yourself…the area is so elastic it will heal itself. And it did! Then why, why had I been made to endure all that torture before? The shaving, the cutting, the stitching?
This essential physiological truth, related by Kapur, should make every woman of childbearing age take note and investigate further. She describes the biomedical rationale behind the episiotomy, that a tear is worse than a cut, but there is ample evidence to indicate otherwise. 36 In India obstetricians routinely perform an episiotomy on first-time mothers. (Some of MATRIKA’s slum women informants called episiotomy a “chhota [small] operation”—whereas a caesarean was a “burra [big] operation.”) Gradually, in the United States, this routine obstetrical practice is changing. Midwives are usually trained, either in their formal studies, or informal apprenticeships, to massage the perineum (the area between

His words reach me across a vast chasm. Is there a world where people think of doctors and make decisions about their bodies? If there is, I am not part of it. I am a mass of turmoil that involves every cell of my body.vagina and rectum), allowing it to slowly move out of the baby’s path. An obstetrical curriculum details the use of the scalpel, but not massage. Episiotomy can be a life-saving intervention when used judiciously. As a routine procedure for first time mothers it is nothing short of ritual genital mutilation.

Kapur is skilful in giving voice to the body-self:
His words reach me across a vast chasm. Is there a world where people think of doctors and make decisions about their bodies? If there is, I am not part of it. I am a mass of turmoil that involves every cell of my body.
She resists the voice of authority, and describes bodily sensations:
The door bursts open. Enter, the doctor, a nurse and the family. First thing the doctor says is “Lie down.” “No,” I respond. My body is still in charge of my position.
A few minutes later another warm wet feeling and the placenta emerges. Vaguely I realise, oh that’s why I can’t lie down, there was still the placenta to deliver.
And then, the accidental dai. Arranged by her traditionally oriented mother-in-law to bury the placenta and wash the bloody clothes, she is called in at the last minute because the doctor has said that the baby will be born in the morning and has gone home! Her household is ritualistic: observing the laws of sootak, burial of the placenta under the mango tree, being ritually attired in red saris for puja and naming ceremony—and the crowning glory, carrying cow dung on her head to be deposited in the well!

Problem of Knowing—How do we Know the Body?

Lal Ded was a Kashmiri mystic of the 14th Century claimed by Hindus and Muslims alike. One story relates that she came to call on her guru, Shrikantha, only to be told that he had undertaken chandravana, a forty-day, austere, “moon” penance of fasting and self-mortification and that he was occupied with his meditation. Lalla, as she was called, observed that he was actually thinking of his horse in the high meadows. Shrikantha overheard this remark and emerged from his supposed meditation—because that was exactly what he was thinking about.
Then it is said, she gave him a demonstration of what the penance should really be. She placed an earthen pot on her head and another under her feet; and with the waning of the moon; her body waned till, on the fifteenth night of the dark fortnight (Amavasya), nothing was left of her except a little quantity of trembling quicksilver. Then, with the waxing moon her body waxed and, on the full moon night, she was herself again. 37
Following Jungian and anthropological interpretive methodologies (but also congruent with tantric and shaktic ritual and practice), I read this narrative as referring to women’s menstrual rhythms. Lal Ded, in her vaakh, (Kashmiri sayings and songs) displays to her male mentor that a female does not need to practice austerities in the same manner as a male adept. He observes lunar rhythms by fasting and mortifications—she by directing her consciousness, to her self-body connection with cosmic forces, those moving through her monthly (lunar) rhythms. Here there is no self/body split. There is no self/cosmos split. So a female self does not need to practice austerities, but rather centre on and move with cosmic embodied forces. A spiritual praxis of embodied gnosis.

As Sunder Rajan acknowledges, “…the body/mind dichotomy is so firmly in place in theoretical discourse, religious as well as philosophical, that any invocation of the body as ground for human subjectivity inevitably appears reductive.” Lal Ded’s Vaakh is not, I would argue, reductive, it simply speaks another language, that of an aesthetic, an imagistic, knowing, where knower and known are not wrenched into orthodox dualisms of body/spirit, man/god, profane/sacred.

Another split is avoided here also, that of the valorization of woman-as-mother. I suggest that female physiology in many heterodox religious traditions signifies in the realm of energy and potential. Potential for motherhood, yes. Menstruation denotes that. But with Lal Ded, and other besharam women, Mira Bai, Akkamahadevi, who wander about sometimes naked, defying conventional gender norms, it is hardly motherhood (or even the potential for it) which is being depicted, rather, it is the female capacity for ecstatic and embodied enlightenment. So we should not be surprised to find other modes of female-gendered knowing in the domain of childbirth.

Often traditional birth knowledge and practice is understood to be ‘superstitious’ or outdated. But perhaps they are dismissed because, as Foucault noted, they are subjugated knowledges. No one can package and peddle them, thus, they are ignored.
I believe that by subjugated knowledges one should understand ….a whole set of knowledges that have been disqualified as inadequate to their task or insufficiently elaborated: naïve knowledges, located low down on the hierarchy, beneath the required level of cognition or scientificity . 38
In India we are fortunate to possess a conceptual tool, Ayurveda, which is congruent with the ‘scientificity’ of the dais and traditional birth practices. Anuradha Singh states in her essay on Ayurveda and maternity that the strong theoretical base provides a conceptual rationale and explanatory framework for specific practices which folk, local and oral traditions lack. Unfortunately the practice and teaching of Ayurvedic medicine today is commonly mixed with allopathic medicine in India, and institutions supposedly dedicated to propagating indigenous and Ayurvedic medicine are rife with internal political struggles. 39

Anuradha Singh, the author writing on Ayurveda and motherhood, (chapter 4) was a consultant with MATRIKA during our research on dais. I would have long telephone conversations with her. “Look Anuradha, they are saying that after the birth the mother will suffer from hawa-gola. How can it be both hawa (wind) and gola (ball)? What are they talking about? Gas?” And in conversing I would learn that, in dais’ parlance about the postpartum time, the gola—the roundness of the now-empty womb, the space vacated by the baby, now may be filled by the air element—and must be dealt with, in order to avoid that danger, by giving her warm food and drink, by massage, by rituals. 40 During our Dai Mela we learned about a postpartum ritual involving breaking a coconut, and the understanding was that it was not the coconut itself which was being broken—it was the space inside the coconut that was being broken. In the civilization in which the concept of zero originated; where Buddhist shunyata signifies the source of the phenomenal world; where Brahmistan, the center space of a building, should be left vacant, we should not be surprised by the active postpartum management of the empty womb. Anuradha would understand the dais’ word pictures in ways that MATRIKA researchers didn’t—and this interactive process was crucial to our ability to deepen our understandings of the dais’ language and practice.

In her paper Anuradha states that in her NGO interactions with local practitioners “It was as if the classical language of the medical texts had come alive in the narratives of these practitioners.” She sees similar underlying principles at work but at two different levels of discourse and presents the example of the textual treatment of bodily existence at three levels: the gross, the subtle and the causal or karmic. She comments that dais seem to traverse the same paths of the known; the knowable; and the unknown, simultaneously using their capacities for intuition and imagination, as well as inference and logical thinking. I remembered hearing from Dr. Mira Sadgopal, who was then practising in Hoshangabad District in Madhya Pradesh, about a birth she had been called to in a poor villager’s hut. The woman was in bad shape and the baby’s shoulder was stuck—she couldn’t do anything and so she had told the family to arrange for transport to the nearest hospital miles away. In the meantime a very elderly, blind dai was called (just the kind attacked in the colonial literature) and she managed to get the baby out alive. Everyone was amazed that this blind, wizened dai could do what the doctor could not.

Often people think of dais as ‘wise women’ and intuitive (both of which they may be). But Singh’s and Mehrotra’s papers unpack not only ‘beliefs’, as they are disparagingly called by those who feel themselves superior by virtue of ‘science’, but also the cognitive systems which they play out in their practice. These diagnostics and therapeutics rely on touch, natural resources, ritual and image, and supportive networks of women. Again, one is not advocating blind dais attending births, but only questioning the absence of appreciation of methods, and methodologies, which utilize capacities of empathy, intuition and imagination alongside the very hands-on skills of touch: massage, manipulation, repositioning of the baby’s body (a practice which is only recently coming into vogue in the west).

The subject matter of both Singh’s paper on Ayurveda, and Mehrotra’s on the nexus between birth experience, knowledge and rights, fundamentally challenge classic Western epistemological notions. The retrieval of Ayurveda involves the recognition of a classic knowledge base distinct from western epistemologies. The mega theory of Indian civilizational knowledge does not change when new findings are ‘discovered’. Einstein revolutionized physics and Newtonian theory was replaced; again quantum physics set aside some of Einstein’s propositions. This paradigm shift does not take place in Ayurveda. As it is practiced today the foundational theoretical principles remain unchanged. The building blocks of panchmahabhuta; kapha, pitta and vata; rasa are fundamentals of this indigenous system which remain the same.

A similar view of traditional healing systems’ unchanging knowledge base is presented in a recent article in the journal Social Science and Medicine. Stella R. Quah, based on her research in Singapore, explores the challenges that the ‘ethos of science’ poses to traditional Chinese medical practitioners . 41 Quah proposes that there are two sets of norms in Chinese medicine: the norm on knowledge, and the norm on practice. In considering “knowledge creation,” she identifies the same understanding underlying Ayurvedic claims—that at the conceptual level, pioneering knowledge is unnecessary because the fundamental principles of Chinese medicine were already provided in the classics of Chinese thought. Furthermore the contributions of each generation of Chinese practitioners rested on the accumulation of empirical data supporting these fundamental principles. “Thus experience is always understood in terms of basic principles learned from superior knowers.” This sounds terribly hierarchical, and it is—but we are challenged to examine these claims rationally. In fact Ayurveda and traditional Chinese medicine are effective, many times providing healing to those whom biomedical practitioners have declared incurable.

Anuradha Singh also recommends Ayurveda as a system which privileges the subjective experience of the pregnant woman and accommodates her individual perceptions, sensations, desires—all within it’s classificatory system. She states that within Ayurveda the woman/mother is both the kshetra, field (i.e. body), and the kshetrajna field-knower (the one who knows the body). This is a radical departure from the more common understanding of this image/homology embedded in the Samkhya philosophy system, but also active in the folk imagination, and even legal frameworks. Purush, the cosmic man, is the field-knower, whereas prakriti, the world of form or matter, is considered the female. Theoretically this philosophical system is not gendered, but, as many feminist writers have shown, in practice it is not only gendered, but also hierarchically gendered—with the male as knower, with entitlements and power; and the female rendered as object to be known, possessed. As anthropologist Leela Dube has shown, the rights to possession of property and to children are given to “he who has the seed,” i.e. the male.

Singh retrieves the image of the field-knower from the texts in a different register—that of the woman subject observing her own body/self processes (heat/cool, emotions, energy, pain, desires) in order to diagnose and heal, yes, but also be embodied ‘participant observer’, if you will, to the miracle of creating new life. And it is this embodied knowing of self that signifies a domain similar to that of Lal Ded, Akka and the other besharam women—only now, and especially within the conservative textual tradition, husbanded and in the service of patriliny.

Within a bio-medical framework the procreative body is known as the re-productive body. Obstetric language uses terminology drawn from an industrial model—a woman labours; the baby is delivered; contractions may be false, there may be failure to progress. The individual experience of the mother is not accommodated for within this medical view. As Jessica Mitford writes in her The American Way of Birth
The whole concept of a preordained average time for the various stages of labour, from which one deviates at one’s peril is absurd to trained midwives, who know from experience that there is no “norm,” each case presenting its own specific peculiarities of timing in which artificial deadlines have no place—are in fact, worse than meaningless . 42
Unfortunately this American way of birth has become the globalized, cosmopolitan obstetrics, which now totally dominates childbirth. Equally unfortunate is the lack of quality Ayurvedic practitioners handling birth within India. New Age guru Deepak Chopra, based in San Diego California, has franchised Ayurvedic “childbirth preparation” classes (and receives financial remuneration from franchisees). But unfortunately in the land of its origins Ayurveda, especially during pregnancy and birth, even with NGOs and ‘alternative’ practitioners, is seldom utilized. Anuradha Singh’s contribution to this volume is both nostalgic and visionary—it presents a thorough exegesis of Ayurvedic texts on the subject in both philosophical and practical dimensions.

Deepti Priya Mehrotra’s essay, on the other hand, speaks from the bottom up. Birth Rights, Experiences and Knowledge Claims (chapter 5) derives from her decades of familiarity with the realities of poor women’s lives—including their birth and body knowledge. Knowledge and practice is never de-contextualized—it is situated and the ‘knower’ has her own subjective history. Mehrotra presents five birthgivers’ narratives, ‘voices from the ground’ as they tell their stories from within their socio-cultural matrix. Rich in emotion, belief, custom, relationship, geographic and economic circumstances, we get a sense of the life situations and personalities of the women. I am tempted to write ‘informants’. But they are not primarily providers of data—almost all of the women quoted in the paper have had an abiding relationship with Deepti; as colleagues, friends, fellow activists and NGO workers. This is precisely what public health statistics about maternal mortality and morbidity cannot capture. Statistics representing maternal and infant mortality and morbidity rates objectify, literally make objects/numbers out of human persons. Unfortunately because of funders’ and government requirements, even the NGO sector (which is supposed to be innovative and humane) mostly collect their information on dais and birthgivers through questionnaires and interview schedules—because they are supposedly scientific!

Mehrotra foregrounds the importance of experience in the expression, transmission and development of traditional midwifery knowledge. Interestingly, in the public health and bio-medical literature, the dai is not regarded as a midwife, she is a TBA or traditional birth attendant. But who else beside the dai is the inheritor of the midwifery knowledge in the indigenous medical tradition? Still the status of midwife is denied to her by the powers-that-be, in part because these powers themselves do not comprehend the experience-based indigenous medical traditions. Quah, besides giving norms of knowledge (mentioned above) in her Singapore study, also presents norms of practice guiding traditional Chinese healers in what she calls the ethos of pragmatic healing. These norms are: a particularist approach; an emphasis on experiential knowledge; and the norm of empathy. Mehrotra’s narratives display these approaches in the caregivers whom she is documenting.

As Mehrotra reminds us, for the majority of women who delivered at home, birth was part and parcel of ordinary life, not an isolated medical event. Fundamental to both her data, and that of Alpana Sagar, in her essay (chapter 8), is the fact that the majority of slum women voice a strong preference for birth at home, and elaborate on the reasons for that preference. Birth at home is an extension of the domestic sphere; women have always cooked, cleaned, cared for the young, elderly, sick. As much as some women may want to be ‘liberated’ from the onerous burden of this work, we can still appreciate the value of caretaking activities. (For more on this see Subhadra Rai’s essay, chapter 7) This way of birthing and caretaking is steeped in relational ways of knowing, which are directly empirical, knowledge through the senses. Domesticity and birth were, and no longer are, high touch not high tech. Because they are embedded in relationships, dynamics and even decision-making are interactive, often collective. This is not to say that birth-at-home should be romanticized. Increasingly we are hearing from activists in the outlying slums of Delhi, where the poor are removed to make way for modernization and beautification, that birth in the jhuggis can be a horrible experience. There is no space or privacy for the labouring woman; with joint families disappearing, older women are not present to help the birthing woman.

Interestingly the research methodology, presented by Mehrotra, is mimetic of the dais methods. “It was always clear that I am not doing research on these women, rather it is with and for them—and for myself too.” Just as the elderly dais call their work ‘ sewa ka kaam’ and consider it a ‘gift’ and a ‘calling’—there is a relatedness and depth in both grounded research (catching women’s words and stories) and dais’ catching babies. Qualitative social science research methods, as refined by feminist researchers, use active listening to communicate their respect for the speaker’s flow of words, memories, experiences. Whereas staccato interview questions only reach a superficial level of human experience, an engaged and skilful listener or group listening situation adeptly facilitated, reaches deeper levels of meaning. This is particularly important on topics of body, birth and the sacred.

Deepti and I were colleagues in the MATRIKA project, and together we struggled to understand the figure of Bemata, the goddess often invoked at the time of birth. I have quoted Deepti in another volume Invoking Goddesses: Gender Politics in Indian Religion in this Shakti series:
Imaged as a playful and rather fickle old woman, Bemata is amazingly familiar and at the same time a divine persona. She is invoked at the time of childbirth being the special patron of dais and parturient women. Living underground, she creates human beings out of earth, breathing life into them and writes their fate on their foreheads shortly after birth. Bemata is immanent in all nature, grows and protects the baby in the womb, but also seems to be responsible for complications if she does not ‘exit’ the mother’s body via postpartum bleeding. She is understood to leave the birth home at the time of the chatti rite, six days after birth when she is thanked for growing and protecting the baby. However, she is also perceived as being responsible for diseases of mother and child in the postpartum period . 43
In the process of deciphering the word pictures and imagistic understandings of the dais, we drew pictures of our ideas about what they were saying, a form of visual “active listening.” Deepti sketched a crayon drawing of the Bemata figure, dividing the paper into three layers. At the bottom of the page is the underground, or ‘ narak’ where Bemata depicted gleefully pushing babies up into the realm above and likewise growing a plant. In the middle section, in the mundane world, one woman has a baby in her belly while another, postpartum, allows the lochial blood to return to the earth, as the plant grows. Finally in the top section, the sun is shining. Posters like these were returned to groups of dais to see if we had ‘got it right’.

These kinds of unconventional methods, using empathy, artistry and imagination, are crucial to the reclamation and understanding of indigenous birth knowledges and ways of knowing. “Scientific” knowledge is based on propositional knowledge, that there is one ‘truth’ that can be stated. It is not embodied and situated, it is, to coin a phrase ‘enworded’—put into words or numbers. The ‘scientific method’ involves hypothesis, analysis, thesis, verification and repeatability. By its very nature it is reductive; verification can only take place within a circumscribed framework. Childbirth, I would argue, is by its very nature ‘ jungli’ or out of bounds of convention. In a hospital a doctor might never know the concerns which plague the labouring woman (was she abused as a child? Is she afraid of bearing yet another daughter in a family which wants a son? Is she battered in her marriage?) Normal human labour is a hormonal process. The body’s hormonal system functions efficiently when it is not under stress, when the woman is being nurtured and her physical, emotional, social, spiritual and psychological needs are being met. How can this complex web of factors be handled by scientific thesis?

MATRIKA team member’s drawing of Bemata figure as described by dais.

Dais’ norms of practice are similar to the ones Quah describes in Chinese traditional practitioners. Paying attention to the particulars of the labouring woman; an emphasis on knowledge gained by experience; and the crucial importance of empathy.
The practice gives priority to the identification of the unique features of a patients’ ailment over the similarities that the case may share with others…

The norm of experiential knowledge indicates that direct knowledge of the patient’s ailment is a fundamental prerequisite. It is through palpation that a practitioner establishes whether there is local hardness or dilated vessels or raised temperatures, all of which could suggest obstruction of the Qi channels.

The third norm is empathy—the practitioner must empathize with the pain which the patient experiences and share his anxieties. He or she should be kind-hearted or benevolent—a good doctor is someone who understands.
Focus on the individuality of the woman, the particulars of her experience; respect for knowledge gained through hands-on experience; and an empathetic relationship with the labouring woman—all these mark the women who attend birth ‘traditionally’.

These women know the body through what they do, through sense experience and they are keen observers of energy. They may not be able to read books and charts, but they read the body in a myriad of ways. Unfortunately the whole enterprise of ‘development’ seems to be erasing, or corrupting these ways of knowing. Dai training programs are bio-medically based, hierarchical (where trainers who may have attended no births teach dais who often have attended hundreds), and focused on anatomical charts that have no resemblance to dais’ own mappings of the body.

I remember years ago when I started hearing about the danger of “the placenta moving up into the chest.” Of course the literal placenta cannot cross the diaphragm and go into the chest. But as a childbirth educator, I knew that at the time of pushing the baby out, women often exert energy in the chest and throat, and not in their bellies. So we have to tell them “don’t push from your chest but from your belly.” Similarly, I figured that the placenta “moving into the chest” was referring to energy not to the literal organ, the placenta. What is being signified here is that the energy, which should be moving the afterbirth down and out of the body, is stuck in the upper body. I have heard so many doctors scoff at the ignorance of women who refer to this phenomenon in this way. “Ha-ha, these dais/women are so ignorant that they don’t even know that a placenta can not move into the chest.” It’s a basic problem of miscommunication—whereas the bio-medical, literate trainers ‘know’ the body in terms of matter, organs, discrete physiological systems (circulatory, nervous, hormonal), the traditionally oriented speak in an image-laden language which represents energetic processes.

Quah concludes that the traditional Chinese medicine is incompatible with the ethos of science. She sees that the pressures to comply with official health regulations, and the inability to succeed under the ethos of science, pose an onerous challenge to practitioners. The same seems to be true, even more so with the dais—today they are being utilized (and paid) for bringing labouring women to the hospital and motivating sterilization cases. This program is the deepest form of betrayal of Indian women’s midwifery knowledge. Many dais have the trust and respect of their communities. The state, perceiving this special relationship, uses dais, human resources, to gain entry into “underserved” areas, or communities that are self reliant and resourceful in handling their own births. Again this is stated with the caveat that the state is responsible for quality back-up services for poor women, not for universalising bio-medically handled birth. So dais are being paid to erase their own tradition; to deliver poor women to substandard hospitals and clinics, often private; and serve as barefoot touts for pharmaceutical and medical profit.

Mehrotra questions this universalising of the biomedical approach to birth as if it would secure women’s rights. She suggests universal rights need to be put forward; right to food; right to choose to birth traditionally; rights to high quality medical services and access to diverse information on birthing. She also places advocacy for indigenous birth knowledge within the people’s science movement, as yet another domain of indigenous knowledge being replaced by modernity; consumerism; mass culture.

Concepts of the human body and its place in the world or cosmos are central to any culture. Likewise, care of the body, the health behaviour, which the mother, family or community inculcates into the child as a part of socialisation, are intrinsically cultural orientations. Unfortunately the powerful language of human rights used in CEDAW (Convention on the Elimination of All Forms of Discrimination Against Women) and Safe Motherhood literature/discourse seems to ignore the existence of indigenous systems of health, healing and medicine in the effort to guarantee access to modern medical facilities to women and prevent economic and gender based discrimination. Most NGO human rights initiatives have not addressed economic, social and cultural rights, in part because of the near total absence of any methodology to monitor enforcement or define violations of them.

Increasingly the language of women’s human rights to health care includes ‘accessibility’ of that care—not just physical but also social accessibility. This acknowledges the importance of an attitude on the part of health care providers compatible with women’s beliefs and respectful of her cultural practices. Women are reluctant to use health services, in part, because they perceive health care providers to be rude, patronising and insensitive to the contexts in which they live. Interactions with providers can be threatening and humiliating, and women often feel pressured to make choices that conflict with their own health and fertility goals.

Naming the human rights of women to choose, as practitioners and as users, indigenous health modalities and specialists is an important step in enumerating rights. The language of choice should not only extend to cafeteria style approaches to birth control techniques and family planning. A woman should be able to choose to squat, rather than lie down on a delivery table (or perform a ritual or be accompanied by a loved one), as she births her baby-and still avail herself of the advantages of bio-medical services or back up.

Problem of Birth Work—Impure or Pure?

As we considered in the beginning of this essay, birth is ‘ sharam ki baat’—to be kept separate from the ‘sacred’ and men, it is also ritually unclean or polluted. Strange, isn’t it, that the word ‘pollution’ signifies in such radically different discourses as the environmental waste which is poisoning our planet, and the priestly injunctions against menstruating and postpartum (bleeding) women ‘contaminating’ sacred spaces with their procreative bodies? The modern mind would think there is absolutely no relationship between these two sets of phenomena. We might view pollution, as Mary Douglas does, as “matter out of place.” However this essay proposes an analysis that probes that linkage between the violation of our mother earth and the desacralization of the maternal body in ‘genealogies’ of gender, the sacred and the cosmos. It also sets out how these ideas and pragmatic realities impact the handling of birth—and the handlers of birth. Birth is a rather messy affair, with all kinds of bodily fluids and “afterbirth” (waste) oozing. And those who literally handle the birthing body and clean up the place afterwards are never a part of the local hierarchy be it in a hospital in New York City, a safai karmchari in a nursing home in Delhi or a dhanuk, cord-cutter and postpartum worker in rural Sitapur—see Sarah Pinto’s work in this volume.

My own personal experience of many years living and travelling, attending births and interacting with dais in many parts of India is the ground of this analysis. And yes it may be seen as homogenizing and totalising—a meta-analysis, if you will, and an essentialist one. To play on words again, it is this concept of ‘fertility’ and generativity that links the maternal body with the fecund soil. In the Indian imagination, I would argue, one does not ‘symbolize’ the other. Woman is not a symbol of the earth nor does the earth ‘symbolize’ woman. The relationship is deeper than that. A power adheres within earth body and female body—one that ultimately lies outside of male control. This is the essential meaning of ‘virgin’—not chaste or untouched. But rather, not ‘husbanded’ not under patriarchal control—as a virgin forest, which is generative, but not ‘husbanded’ or possessed by any man. This is a the jungli power which underlies practices of magic and alchemy; and is being tinkered with by scientists in white coats practicing genetic engineering, cloning, and other control techniques.

So what is this bodily and earthly fertile dirt? And how did we come to be so confused about it? And how did the women who handled the ‘dirt’ of birth come to be stigmatised for that work? When I was studying theology and pollution ‘taboos’ I remember reading that the same word was used in Aramaic to describe the polluted blood of the female body and that of the alluvial soil that is so regenerative, on the banks of the river. Sanskrit scholar and brilliant radical thinker Giti Thadani pointed out the same overlap in the Sanskrit word ‘ mal’. Body dirt— mal is what Parvati rubs off her body to make Ganesh. Indian deities, especially in their Puranic appearances, are embodied; they relieve themselves, copulate, breastfeed—nonetheless menstrual blood is repeatedly linked with the demonic. And, as I have written in an exploration of the origins of the menstrual taboos in the Rig Veda , 44 in the early textual sources the demons are all referred to by matronymics rather than patronymics. That is, demons are matrilineal! We then need to deconstruct demon, the demonic and hellish within the Hindu Brahmanic context.

Should we really be surprised by that ‘co-incidence’ within staunchly patriarchal and patrilineal societies? Women’s blood, that of menstruation and postpartum, spill onto the pages of the so-called ‘legal texts’—the guidelines which have sought to regulate the lives of the Hindu high castes and Judeo-Christian-Islamic adherents. The assumption is that an orderly society demands the regulation of female sexuality and procreativity. A vital throbbing presence lurks behind the policing, however—that which we have been ‘historically’ unable to access, as Uma Chakravarty has shown in her “Whatever Happened to the Vedic Dasi?”  45 My answer to the question, which Chakravarty poses in pointing out the high caste biases of ‘historical’ writing, is that the Vedic dasi might be todays dai.

We should not dismiss these matters thinking that menstrual and childbirth ‘taboos’ are simply outdated superstitions relegated to the purview of archeologists of an ancient past. A recent conference “Pollution and Safety: Exploring the ‘Dirty’ Side of Women’s Health” addressed an increasing body of research on aspects of pollution and women’s health. 46 The organizers put forward the following rationale:
The development of modern health care and birthing practices has been associated with an emphasis upon safety and clinical cleanness along with significant changes in roles and beliefs. Yet themes of dirt recur, for instance, in research on practices within modern labour wards, around sexually transmitted diseases and in many medicalised aspects of women’s health care as well as in traditional settings.
One of the papers presented at the conference, “I’m just going to wash you down’: the ‘dirty’ vaginal examination” notes that notions of dirt are still associated with the examination of the vagina. This exam is a common procedure in labour, and is carried out by midwives and obstetricians, providing information about the opening of the cervix and the position of the fetus. Most labouring women in United Kingdom (and in hospitalized birth globally) experience two or three such exams.

Midwife and midwifery lecturer Mary Stewart’s paper presented observational data from an ethnographic study exploring the ‘ritual’ of the vaginal examination. She describes techniques used by midwives to prepare for the exam, (including the use of sterile packs, and washing of the woman’s genitalia) as well as data from discussions with midwives exploring the rationale behind these practices. She asserts
…labouring women’s vaginas are perceived as ‘dirty’ and that midwifery practice acts as a signifier of this. Midwives use the ritual of the VE (vaginal exam) as one strategy for demonstrating their considerable power over women and as a means of separating themselves, as ‘clean’, from the women, who are ‘dirty’.

Midwives need to re-examine the rituals associated with VE and to re-consider both their practice and the words and language they use when preparing women for this intimate examination . 47
Another conference paper examined a postpartum ritual which the author claimed foregrounds not the baby, nor the family, but the mother herself in a salutary manner. The use of language can be so powerful in illuminating social constructs as in this rite, the ritual of churching 48 used historically by the Christian church for purifying women after childbirth. Although regarded as an act of thanksgiving…as an opportunity for the woman to receive a celebratory blessing, that characterization, according to the writer, disguises the control that was exerted over parturient women and their midwives. Concepts of ‘uncleanness’ and ‘pollution’  49 associated with the churching of women had been in existence for hundreds of years before rapidly falling into decline in the early 20th century at the same time as modernism began to emerge.

But let us consider, for a moment, what we might call genealogies of the sacred as they pertain to birth and birthgivers. This is important because attitudes and values tend to linger. Striking similarities exist between the Judeo-Christian-Islamic and the Brahmanic textual traditions in their treatment of the handling, and by implication the handlers, of birth. The Leviticus book of the Old Testament and the Dharamshastra texts of Brahmanic Hinduism both consider birth as defiling and pronounce in a myriad of diktats that both birth and menstruation should be set apart from the sacred activities of prayer, reading sacred texts; entering temple, church or mosque; or personal practice like meditation, yoga, etc. We must note that in these orthodoxies, women are desacralized at the height of their bodily power—their miraculous potential, to bring forth new human life into this world. There is a need for us to step outside of the notions and methodologies which position priestly voices and texts at the centre of gender analyses—and reclaim, re-image the blood of women and the work of birth, ritual and practical, from another perspective. This does not mean casting aside scholarly suspicion and naively re-enacting ‘tradition’ however.

Western feminist and anthropological scholarship, however, present other, more woman-centered, interpretations of these ‘dirty’ female bodily processes . 50Blood Magic: An Anthropology of Menstruation includes an essay 51 presenting data on menstrual synchrony from the Yurok Indians of Northern California—evidence which was clearly overlooked by early scholars because it just didn’t fit into their notions of women, society and the cosmos. The women of the Yurok tribe of Native Americans always attended an inter area celebration, but were never allowed to attend if they were menstruating—suggesting a seasonal menstrual time, when women menstruated collectively. Anthropologist Chris Knight presents an encyclopedia of data to support a new understanding of the construction of menstruation in his book Blood Relations, Menstruation and the Origins of Culture. 52 Integrating perspectives of evolutionary biology, feminism and social anthropology within a Marxist framework, Knight rejects the common assumption that human culture was a modified extension of primate behaviours and argues instead that it was the product of an immense social, sexual, and political revolution initiated by women.

Similarly we must ask questions of the ‘science’ of the body that ignores vital questions of harmony, cyclicity and cosmic creative synchrony. Why do women bleed in 28-day cycles, similar to lunar cycles? Why do women who work, live, or are emotionally bonded together, menstruate together? How do their menstrual cycles come to align themselves? Did tribal groups of women, as some anthropologists have indicated, bleed collectively?

Female Blood

As mentioned above, female procreative blood and the demonic feminine have a long and hoary relationship in the Vedic and Brahmanic textual traditions. Indologist Wendy Doniger writes of the earliest textual reference to the demonic nature of female bodily fluids to be found in the Rig Veda where the blood of defloration is said to “claw and bite” the husband. In this case it is the hotr or priest who deals with the bloody sheet and removes the threat to the man and his family. This passage is referred to as “Suryaa’s Bridal”—Suryaa, being the feminine of Surya—the sun. (Today we are totally unfamiliar with the mythology of the feminine sun) This portion of the Rig Veda is the divine prototype for human, patriarchal, Hindu marriage ritual. Relevant portions (RV:10:85) read:
May happiness be fated for you here through your progeny. Watch over this house as mistress. Mingle your body with that of your husband. The purple and red appears, a magic spirit; [Griffith translates ‘fiend] the stain is imprinted…Throw away the gown, and distribute wealth to the priests. It becomes a magic spirit walking on feet, and like the wife it draws near the husband.

The body becomes ugly and sinisterly pale, if the husband with evil desire covers his sexual limb with his wife’s robe…It burns, it bites, and it has claws as dangerous a poison is to eat. Only the priest who knows the surya hymn is able to receive the bridal gown. 53
Male Indological scholars have glossed over this text, but recent women scholars have taken note, not just the blood of menstruation and childbirth, but also that of defloration—mentioned in the earliest existing sacred text—as demonic! How do these demons signify when read by foregrounding the gender politics of that time? And also when deconstructing the androcentric bias of subsequent interpreters?

Likewise, menstruation has textual associations with both pollution and the demonic feminine. The Ayurvedic text, Sushruta Samhita, in the Uttaram Tantra presents the origins, causes, symptoms and treatment of “the nine diseases of infant life” in the form of demonic females. Then the demons/deities are located as creations of the gods and goddesses constituted by the menstrual fluid (“ Rajasa essence”) of Ganga, Uma and Krittika. These demons/deities preside over the diseases of infants and “are all possessed of ethereal frames, divine effulgence and specific sex distinctions of their own.”

In Julia Leslie’s Roles and Rituals for Hindu Women, it is emphasized that traditional purity-pollution concerns were still active in the Hindu mind.

This concern for the magical powers connected with virginal blood still exists in Hindu society today. At our original workshops in 1987, several participants spontaneously adduced evidence that the blood of the first night, or of a girl’s first menstruation, continues to be given special ritual importance in a variety of Hindu communities. However, the ritual recipient of these polluting agents is now most often a woman (frequently a midwife or barber’s wife), who expects some auspicious gift in return for ‘absorbing’ the magical dangers of the virginal blood . 54

For our purposes here, in examining the constructions of birth-workers and work, it is important to note that the handler of the bloody sheet (and thus the demon) is the priest who knows the surya hymn. As one woman scholar points out, the work of removal of female blood and the energy which surrounds it needs to be performed by someone—and that someone, in the Rig Vedic context, is the hotr or priest. Within the context of the caste system, this function is performed for the blood of birth by the dai or, as Pinto explores in her paper, the dhanuk. Pinto shows, in her examination of the roles of birth workers (chapter 6), that in Sitapur district of Uttar Pradesh, anyone can be a baby deliverer, but only a woman of the lowest caste of that area can be a cord-cutter, or dhanuk. We should not be surprised by the fact that elements of postpartum ‘trash’ work extend into cosmological concerns with the women of the sweeper class, who literally handle the placenta, apply the oil to the bodies of mother and infant, wash the soiled clothes thus performing invaluable practical as well as religio-ritual roles. As Pinto points out, many emotional, linguistic and symbolic structures underpin this allocation of birth work tasks and ritual performances.

I have been asking questions about this power to pollute for many years. Not simply an academic question, it seems to underlie much of distinctively Indian or South Asian attitudes to the body, especially the female body. Twenty years ago I journeyed to Mount Abu, Rajasthan with a British psychologist who was researching how different personality types were attracted to different kinds of gurus. I was interviewing holy women at the time. We stayed near the ashram of an intellectual woman guru, Vimila Thakur. When we walked drowsily into the 5 am meditation sessions we noticed that her secretary was ‘sitting outside’ the meditation hall, looking dishevelled. Later, during an interview, my friend asked her why she was sitting at the entrance and not meditating every morning. The secretary responded by first asking us to turn off the tape recorder (menstruation being sharam ki baat) and told us that she was menstruating and, on further questioning, we learned that menstruating women are believed to emit certain ‘vibrations’ at that time, and these vibrations would interfere with others’ meditations. We packed up our interviewing paraphernalia and went down the road to a chai stall. My friend and I proceeded to argue about this ‘sitting outside’ practice. “What is this?” she said. “Vimila Thakur is a modern, English speaking, educated guru, and a woman guru. Why is she promoting this superstitious nonsense? It’s irrational and insulting to women.” My mind was working on a different track. “What is this power, this bodily capacity to disrupt meditations? And how could we understand that power in a different way—that would be more woman-friendly?” Thus began both my interrogation of the modernist understandings of ‘superstitious’ taboos and my research on the ritualization of female bodily processes and how these ritual spaces could be viewed more positively.

Female Spaces

On the Indian subcontinent, the women who handle birth invoke the realms of the ‘religious’ but are considered outcaste and polluted by the religious authorities—and their communities have been fighting this stigma of ‘untouchability’ long before India’s independence. But the basic conundrum faced here is that precisely while cordoning off spaces of menstruation and birth as polluting, the priestly sacred elites (and/or texts) left ‘private’ female spaces where women (body, spirit, sex, motherhood, creativity, ritual and aesthetics) could play. The low or outcaste woman, by and large, was the ritual practitioner (with ritual inseparable from practice and knowledge) by tradition. The creation of domains of pollution and ‘untouchability’ functioned to protect women’s bodily spaces, rituals and practice from Brahmanic incursions. All other life-cycle rituals have evolved into priestly purview, but apart from the Atharva Vedic birth mantras—there are no priestly rituals at birth. Here the Brahmin priests are ‘sitting outside’! As Anuradha Singh mentions in her essay, the Ayurvedic texts remain silent on the time of cutting the umbilical cord. Why? Because the high caste textual authors and practitioners concerned themselves with applying Ayurvedic theory to the birth moment. They were not involved in the hands-on caring for the labouring woman nor severing of that fleshy cord, nor cleaning up messy stuff. Conversely the dais and ‘other women’ who handle birth, once they get talking will not be quiet about these moments and their significance.

Although dais often use some of the language of caste Hindu as well as 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, when interviewed by Samira Jain for her film Born at Home, laughed as she related how it is said she ‘sinned’ by cutting so many umbilical cords. Her sardonic chuckle demonstrated 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. 55

I should mention here that to my knowledge, generally, dais serve the women of religious communities other than their own. Both in our early research in the slums of Delhi and during our MATRIKA research in four areas of North India, religion was not an issue of who served whom—caste was! And all religions, Hindu, Muslim, Sikh and Christian had some form of caste. And again, generally according to tradition, dais and other birth workers were from the lowest or outcaste groups. It’s almost as though this birth work, particularly handling bodily fluids and afterbirth, was transacted beneath and radar screen of religious orthodoxies and configurations.

Placenta as ‘Phool’ (Flower), Newborn as ‘Phul’ (Fruit)

The placenta, the organ interfacing maternal and fetal 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. The afterbirth, the most polluting of substances in the Dharamshastras, is buried by the dai with rite and prayer for the newborn child. How the placenta is treated is believed to affect the well being of the child. These rituals honouring the placenta assume vital correlations between the human body and the earth body. And the dai negotiates these worlds and the embodied maternal-newborn relationship.

Caste and gender intersect in an extraordinary way here. Let’s get the rules of caste straight—strictly speaking, by Dharamshastric definition, all women are shudras because they menstruate. Modernity has obscured and in many cases erased, much of female body-based ‘spirituality’, ritual and practical, by solely focusing on high caste, textual sources and not the religiosity of female spaces and the low or outcaste ritual specialists.

Within the context of modern, globalised societies, religion and medicine are entirely separate enterprises. The medical doctor usually does not pray before entering the consulting room or operation theatre. The priest usually does not heal, except for counsel about the spiritual realm. The body is the doctors’ purview. The soul, or spirit, is that of the priests. This Cartesian dualism, however, is not observed in pre-modern, or even postmodern societies. The vast number of “New Age” web sites confirms that many ‘seekers’ in the dislocated global context desire “holistic” practices and practitioners. For example the hundreds of web pages devoted to Indian or Hindu pregnancy rituals testify to the re-invention of tradition—the global diaspora desperately seeking to reconnect to the ritual practice of their elders (and the dais, nains, bais and others who helped both practically and ritually during parturition—though in cyberspace they loose the touch and the sociability of these interactions).

In their introduction to Decolonizing Knowledge: From Development to Dialogue, editors Frederique Apffel-Marglin and Stephen A. Marglin write of the divergence between the ancient Greeks and modern “scientific” cosmo-visions and ways of knowing the world.
For the Greeks, understanding the world was an ethical pursuit. Modern rationality by contrast is disengaged not only from the body and the world but from ethics as well, or rather the world for us is no longer a sacred cosmos and the laws of nature are silent as to the good and the beautiful.
They quote Albert Einstein on the issue.
“The concepts which [the scientific way of thinking] uses to build up its coherent systems do not express emotions. For the scientist, there is only ‘being’, but no wishing, no valuing, no good, no evil—in short, no goal”…
The Good that inhered in the cosmos for the Classical Greek was eventually replaced by the Good that faith in God enables one to attain. What made the new mode of knowing ultimately triumphant…is the fact that the new neutral ground created by it did not fundamentally challenge Christian doctrine, either Catholic or Protestant. The new mechanistic de-spiritualized objects of knowledge contrasted in that respect with Renaissance magic: alchemy, astrology, sorcery and witchcraft . 56

Birth (and female bodily fluids/powers) has/have always been seen as a site for witchcraft and sorcery. The knowledge and practice—and practitioners of woman-centred birth enact this belief that “good inheres in the cosmos,” not exclusively in any god or goddess; strength, guidance and blessings can be sourced from any fraction of the universe one has known and experienced. This multiplicity has been demeaned with the epithets ‘polytheism’, paganism, and superstition. Maternal bodies, as all human bodies, are not deemed to be separate from nature. As Singh points out, Ayurveda is grounded in the presupposition that the human body is composed of the same matter as that of all of nature, of the entire cosmos.

Narak as Fertile Ground

The MATRIKA team was sitting on my drawing room floor, mulling over how to translate the phrase “ nau mahene ka narak kund” or “nine month’s hellish (or demonic) pond”—used by the dais to signify the afterbirth or placenta, cord, amniotic sac. We knew we were not dealing with the Christian “fire and brimstone” hell, the abode of the damned. But even the Hindi word ‘ narak’ is translated into English as hell, also with negative associations. We were discussing what exactly a kund was, how to translate that into English and I said it was a spring-fed body of water, which had no streams running into it, but rather the water flowed up through the earth. As I moved my hand upside down, fingers pointing up to demonstrate the movement, I realized that that same gesturing had been used by my childbirth educators’ class instructor to demonstrate the functioning of the placenta! Structurally and functionally the placenta and the kund are similar, an excellent example of simultaneous structure and functioning—which I subsequently verified with my geo-technical engineering PhD husband! Then my colleague Deepti Priya pointed out that the word ‘ kundalini’, signifying the life force energy residing curled up at the base of the spine, had the same root word, kund.

As I reflect back I realize that our MATRIKA team entered the dais’ world of birth work through their word-pictures—and one of the central images was that of narak. During the first workshop in Gomia, Bihar one dai explained the meaning of narak to us in terms of menstruation and postpartum:
Girls are considered holy before puberty. The marriage of a young girl (who has not had her periods) is performed with her sitting on her father’s lap. After puberty the woman is considered unclean, and is unholy, because she bleeds, and this is narak.
Similarly she explained the postpartum ritual of chatti. Here rite and indigenous health practice (checking umbilical cord, bathing and cleaning of room) are seamlessly entwined. The isolation of the mother (confinement) provides rest for the new mother, relief from domestic responsibilities and time for bonding with the baby, as well as protection from communicable diseases carried by others.
On chhati day (after birth) the narak period ends. The Dai checks if the umbilical cord has fallen off. Then she bathes the baby and beats a thaali (plate) and gives the baby to chachi (husband’s younger brother’s wife). Chachi does puja and gives the baby to jethani (husband’s elder brother’s wife). Then the woman is bathed and she wears new clothes. The dai then cleans the room where the delivery took place and the mother was kept separately for six days.
I interpret the concept of narak as an ethno-medical concept allowing for a host of therapeutic interventions. Narak signifies the inner world of the body, invisible to the eye—particularly to the reproductive power of the female body. This concept then provides a mode of cognition through which practitioners utilize diagnostics and therapeutics that do not violate the integrity of the body. And dais’ health modalities are high-touch (massage, pressure, manipulation); use natural resources (mud, baths and fomentation, herbs); and application of ‘hot and cold’ (in food and drink, fomentation etc.); isolation and protection (from household work and maternal and sexual obligations).

Dais refer to the postpartum period as “narak ka samay” or hellish or demonic time. And narak is also spoken of as the underground and fertile realm where Bemata dwells. Dais use the term without distaste or moral judgment. The following quote from a Rajasthani dai elaborates the postpartum care that helps us appreciate how entwined the concept of narak is with an ethno-medical approach.
Till the jachcha has a bath, a name is given to the baby and puja is done—she is considered unclean ( chhutak). After bathing the new mother, the room is also cleaned. Till this day only dai was touching her and taking care of her. Nobody from the house was touching the jachcha. Dai massages the new mother and the new baby. There is a tradition to use wheat grain flour, ghee and turmeric for massage. This softens jachcha’s skin and her skin glows like that of a new bride. Her shareer is cleaned with warm water and rangjhar (a herb) water. We boil rangjhar and put ghee in this water and make the new mother sit in it. This helps in fomentation and prevents infection and is done for three-four days. If the woman gets a perineum tear then we soak cotton in ghee and turmeric and keep it on the tear for three-four days.
Whereas traditionally narak signified within the domain of sacred nature, thanks to the horrific combine of priestly purity and scientific rationality the balance between heaven and earth has been lost. Also, balance between male and female—even as we are being ‘liberated’ from ‘tradition’ we have lost our bodily spaces; the normative body is now the male body. Not the body which bleeds monthly nor grows babies in wombs nor feeds them from her breasts. All these physiological processes are now socially and ritually invisible—or as Robbie Davis Floyd has written, are medically ritualised. 57

A Modern Dilemma? – Midwifery and the Status of the Midwife

Four years ago, when I was a scholar in residence at a Massachusetts college, a group of midwives had introduced a bill to the state legislature to take certification of midwives out of the hands of the Nursing Council and create a separate “Midwifery Counsel.” The impetus for this move was to bring closer together the professional midwives, who were all nursing-trained, with the “lay” or “direct-entry” midwives—those who had acquired their skills informally, not through nursing education. I was already suspicious of such benign sounding moves, coming from Delhi where Safe Motherhood initiatives mainly aim to wipe out the dais, the sole birth practitioners available to many poor women. I questioned a woman who was proposing the legislation as to who (which groups of birth workers) would be further marginalised if this bill were to pass. She immediately recognized the motivation of the question and said they had already thought about this difficult decision. “The Native Americans, the street midwives, and the Amish.” She replied. These three groups perceive birth, birthgivers and birth workers as outside of the purview of state authority, thus they would not submit to ‘certification’ by any board, be it nursing or midwifery. Native Americans and the Amish have their own ‘culture’ of birth which is based on their own traditions—where spiritual is not separate from medical. Street midwives serve women from groups of addicts, homeless, sex workers and others who are too poor or alienated to deal with institutions at the time of birth. Certification of lay and professional midwives commonly would benefit middle and upper classes—but it would further jeopardise those who do not work within a state system that insists on legitimisation (certification) and disciplines non-compliance with harassment by state forces.

Midwife and academician Dr. Leslie Barclay writes of the shifting status of midwives within their social contexts.
I find it fascinating how the term midwife appears and disappears from view according to the status or standing of midwifery and the person who practices it i.e. whether midwifery is ‘clean’ or ‘dirty’. …some of these interesting questions are symbolic, but of significant consequence in the way midwives are seen, see themselves and act as agents of women within their own society.

It has become clearer to me recently how words can identify ‘clean and dirty’ groups and distinguish those valued groups (clean) from those being devalued (dirty). I remember when the term midwife was not used in Australia. Midwives have reclaimed the word which is now being used with pride and reappearing in titles such as Schools of Nursing and Midwifery…. The reappearance of the term in Australian language marks the reappearance of a health worker who is returning with strength and some authority. I would argue that ‘clean’ in this sense is associated with high status and ‘dirty’ is equivalent to having no language or name for work that is hidden or devalued.

Another example, from the Peoples Republic of China demonstrates this further. In China there are two terms for the word midwife. Jiseng po is a ‘grandmother’ midwife who catches the baby zucheng shi a professional midwife. In the last 10 years national policy has decreed doctors and nurses (clean) are the people who should attend birth. Even the word for professional midwife has disappeared from health worker Acts and education systems. The term professional midwife survives only in Hong Kong and Taiwan. It is as if the pre modern jiseng po and the zucheng shi have become equally dirty and are associated with pre modern or feudal health care. Some of our current work is trying to explore why this has occurred and the consequences of this. 58

Birth Work Appearance and Disappearance

Sarah Pinto, in chapter 6 of this volume, ‘disappears’ the idea of the ‘village midwife’ in both her nurturing and nostalgic appearance, and her dirty, ignorant and superstition one. Utilising Veena Das’s “ecology of care” methodology she focuses on the social relations within which the provision of health care is embedded. Her attention to local detail and the manner in which social organisation (mainly caste) refracts through the work of birth allows her to elaborate a novel perspective on birth work and workers. One which lies outside the “idea” of the dai held in policy, NGO and civil society circles. She asks us to attend to places (like the placenta) where our attention doesn’t usually fall in intervention-oriented discussions. As Pinto, herself puts it, “It encourages us to think about the nature and meaning of Dalit women’s work, and about the social and political aspects of birth-workers’ lives.”

Pinto’s approach escapes the current global public health trap of invisibilizing the politics of caste and poverty. I am amazed at the continuities perpetuated in dominant discourses on dais. One can read contemporary Safe Motherhood writings and note the sanitized (i.e. non racist and more seemingly culturally sensitive) policy line that dais, or other women who handle birth, are basically responsible for maternal mortality and recognize the same line of reasoning which existed in colonial discussions. Dai training schemes had their origins in this colonial context, as Sagar reminds us in chapter 8 of this volume. And Pinto makes it clear that attitudes towards dais reflect the hegemonic idea that they, dais, were (and are) considered backward, that policies cleaning them up are steps on a road to national progress. She claims that these ideas and images relate more to institutional efforts to create ‘modernity’ than to the shapes of tradition.

And indeed contemporary health policy advocates institutionalised birth for all women, more as a marker on the road of progress, than from a pragmatic and patient-centred service provision point of view. Never mind the abysmal quality of existing health services in Delhi, and their non-existence in many rural areas. Never mind that most doctors and other trained personnel follow the money and refuse to work in rural areas. Don’t consider the fact that many women, desiring human support, quality of care and traditional practices, (see the data of Mehrotra and Sagar) don’t want to birth in hospitals. And don’t consider the fact that women’s health status is grossly compromised before they even become pregnant.

The Ministry of Health and Family Welfare, under pressure from international NGOs, funders and United Nations bodies (Unicef, World Health Organization, United Nations Foundation for Population Activities), is now promoting the ‘solution’ to high maternal mortality rates (MMR) as ‘skilled attendance at birth’ and developing new cadres of birth workers—the SBA (skilled birth attendant) or the CBA (community birth attendant) as they are variously called. As Pinto points out
In Sitapur, it is not necessarily that the denigration of female bodily fluids or the association of body-work with trash-removal makes dais something other than midwives. Rather, the range of categorically distinct kinds of work disappears the idea of the dai into a multiplicity of actors and processes.
Attention to the distinction between the “ dhanuk” (cord-cutter—who always belongs to the lowest caste of the area) and the “baby-deliverers” (who can be anyone) asks us to consider deeply gendered notions of the sacred. Observing the dhanuk’s work, cord-cutting, burial of the placenta, cleaning, massage, bathing and ritually progressing the mother back into her mundane status in the domestic sphere—all allow us to appreciate the services which she renders from an insider’s vantage point, rather than the conventional ‘social science’ modernist “caste and gender discrimination is a terrible thing” point of view. Our MATRIKA research data, although not overtly exploring the separate roles of birth workers, corroborates Pinto’s insights on the heightened concerns with the cosmological and moral dimensions of cord-cutting, and the shifting valuations of hands-on postpartum care—at once socially at the lowest rung of caste hierarchy but at the same time of the utmost value to the woman and her family.

In sharp contrast to our Western, ‘natural childbirth’ and biomedical concerns with providing care during labour and getting the baby out, I have for many years, and in many places, noticed that danger, and woman’s needs during the postpartum time are perceived to be greatest. And indeed it is to these most outcaste of women that this care is entrusted. As Pinto puts it
…the argument that caste is above all a matter of the body. It is the reproductive female body in particular, with its mix of the auspicious and the polluting, upon which meanings and socialities can be situated, performed, and rearticulated, particularly for those deemed untouchable.
Interestingly, again according to Pinto, “Trained dais,” often post-partum workers, are encouraged by NGOs to “demand payment” from clients in the name of free enterprise, while compensation or support from the government are spurned. This is a globalized shift, from the domestic to the monetarized sphere. At an American Anthropological Association Meeting, Jane A. Szurek presented her research in Ghana, aptly titled “Teaching Women in Ghana to Pay for Childbirth: Redefining Midwifery for Economic Restructuring.”   59Commercialization of birth is not only a developing country phenomenon. In a recent publication Consuming Motherhood, the authors address the question of how motherhood and consumption, as ideologies and social action, mutually shape and constitute one another in North American and European social life. 60

The star role in postpartum concerns is played by the lowly, cast out placenta. The organ interfacing mother and fetus, is referred to within our MATRIKA data as “another mother” in it’s role of providing nutrients to the fetus, is often viewed with civilized distaste by those who live far from the daily realities of animal and human births, and deaths.

As Pinto notes, in another section of her dissertation from which this paper is drawn, deconstruction of the village midwife, for purely sociological sake is not merely an exercise. There are power hierarchies playing themselves out with ironic incongruities.
Where development and health care institutions are concerned, the performance of power via talk can indeed become a kind of pathology. Exaggerated versions of hierarchalized talk often play out in the space of institutional practice, in interactions between authorities and trainees/recipients, but not in policy discourse and institutional self-representation, where hierarchies are often denied through assertion of an explicitly ‘participatory approach’.
Pinto points out that the concept of pollution has the power to delineate birth workers’ roles. Although she correctly maintains that it is inappropriate to consider the dai a midwife by western standards, the disappearing midwife in the USA and the dirty Vaginal Exam reminds us that we moderns have not ‘disappeared’ our own ‘dirtiness’ ascribed to birth.

Dhanuks, in fact, barter and negotiate with families—they use their rather uniquely gendered agency (derived from handling the ‘untouchable’) in leveraging payment. It seems to me that what with doctors, science and the need for sterility, female bodily agencies and female spaces have shrunk.

Human bonds, quintessentially exemplified in the bond between baby and placenta, and between mother and baby, are no longer meditated upon at the moment of cord-cutting. The slow death of placenta, once the repository of life force, is no longer a marker of cosmic cyclicity and sacrality. The messy afterbirth is now merely ‘garbage’.

Female agency, however, is not just derived from handling the mess. Pinto, in her preliminary description of a birth in her fieldwork village, puts forward the concept of barhriya, an understanding of the womb and postpartum phenomena, not only at odds with western-derived anatomy and physiology, but actually attributing agency to the woman, womb, the female body. Barhiya wanders in the womb, searching for the baby—what we would call the contracting uterus. In biomedical renderings the womb, cervix are not at all sensitive, lacking in nerve fibers. The womb, in dais’ conceptualisation, in a somato-psychic holism, is depicted as active, aware and ‘searching’ for that which has been a part of the self for nine months!

Birth Work: Sewa Ka Kaam or Income Generation?

While Pinto’s deconstruction of the village midwife is sited in village Uttar Pradesh, and viewed through the lens of postmodern anthropology, Subhadra Rai’s advocacy tool of attributing monetary value to dai work was developed in Gujarat and during her research with SEWA (Self-Employed Women’s Association). Read against each other, one unpacks a caste-based agrarian social context while the other attempts to better the lot of the dai by assigning an economic value within an increasingly monetarized economic framework.

Feminist analyses and gender-sensitive data reveal the inequities of women’s work throughout the world. Rai points out that the real economic value of dais’ birth work, like that of housework, care of the young, elderly and sick, in addition to rural tasks of fetching water, cooking fuel, care of animals and seasonal agricultural work—have all been traditionally perceived by and evaluated from the patriarchal point of view—as extensions of the domestic sphere, thereby not REAL work. Rai suggests that methodologies be used to calculate the economic contribution of dais, in terms of what it would cost for an institutionalised health system to replace them with paid workers, could be used as an assessment of the financial savings to the health care budget—and the REAL cost to the exchequer if dais are phased out. She points out the extensive coverage of traditionally oriented birth practitioners, and the extent of their workload—and suggests that erasing and de-skilling these women will result in leaving the vast majority of women without any obstetric care.

During the writing of this introduction a devastating tsunami hit the south Asian region. A colleague working with United Nations Fund for Population Activities, UNFPA, told me that hundreds of women were going into premature labour as a result of their trauma. Sri Lanka has done away with the dai system. All the hospitals are full and doctors are occupied with disaster victims—now that the dais have been de-skilled, who will care for the labouring women? International agencies are concerned—and yet they are propagating the modernist solution of ‘replacing’ dais! However, the argument for a programmatic valuation of indigenous medicine and its human and cultural resource base is beginning to be heard in policy circles, especially as urban elites are turning to ‘alternative,’ ‘complementary’ and indigenous therapies.

A recent article in S ocial Science and Medicine uses the term “cultural capital” to denote traditional body knowledge and resources. Elizabeth Chacko elaborates on such complementary therapies, really local and regional herbal remedies that have been a part of ‘folk’ and Ayurvedic repertory, as they are used to treat diabetes. Chacko argues that greater attention needs to be paid to the broader systems of the environment and culture and their interconnections to understand the use of such therapies by persons with chronic illnesses. She explores respondents’ knowledge and use of herbal therapeutics (often alongside biomedical ones) as well as how they came to know of these therapies. Identified by Pierre Bordieu, the concept of cultural capital includes benefits gained from early training and the home/cultural environment that is transmitted within the household from one generation to the next. 61

Rai’s effort is more a valuation of practitioner, rather than method (not that the two can be separated). But dais (and other women who attend birth and postpartum—keeping in mind Pinto’s cautions) are indeed the inheritors of India’s midwifery legacy. Although the knowledge and practice is decentralized and certainly not ‘professionalized’, indigenous reproductive health traditions should be considered ‘cultural capital’. Rai’s advocacy method, assigning monetary value to dai work, would enhance prospects of financial agency, although this is not entirely unproblematic within traditional societies where reciprocity often binds local relationships. (See Pinto’s paper for a critique of the NGO standardized approach which neglects the contours of birth worker roles in Uttar Pradesh.) Unfortunately these political-economic approaches to ‘reproductive health’ may also function to promote the further commodification of health care.

Rai acknowledges the caring and social aspects of dais’ work in considering its gendered nature. “The non-economic frame of reference allows for better understanding of work’s social connotations where power, gender and culture intersect.” Birth work, she asserts, like other ‘women’s work,’ is complex, multi-layered and gendered. And I would suggest that no work is as gendered as birth work. Standing, or squatting, between a woman’s legs as she pushes that baby out into the world is a consummately physiological and gendered act/work.

Pointing to the social value of work Rai notes that psychological health of individuals and communities is also implicated. The deeply gendered work of caring for others, often inserted into the register of the domestic rather than that of economically productive, is implicated here and is at the heart of debates around recompense for midwifery. Although she doesn’t elaborate on this mental health perspective, the technological and pharmaceutical takeover of birth increasingly critiqued in developed countries has produced a “Humanization of Birth” movement. Within “technocratic” societies, many women have learned to fear birth: this fear is represented by the increase in caesarean section rates seen in many countries. It is posited that the ‘humanization of birth’ may reduce this fear, and yet a paradox emerges—humanization is difficult to achieve in increasingly technocratic societies. The Humanization of Birth movement maintains that safety and self-fulfilling experiences are not contradictions and that humanized birth is the safest approach . 62 Advocates of more humane birthing practices recognize that a woman needs individualized care while she is going through simultaneously a universal and, for her—a most unique, process. In talking about supporting natural or physiological birth, these humanization advocates are talking about skills, yes, but also about personal relationships.

Rai grapples with dais’ own perceptions that dai work is poonya ka kaam (good work), dharm (duty, religion), blessings, happiness, help to the poor, and reciprocity. She observes that dais live in an environment where there is a narrow margin of choices, and that they are reluctant to insist on payment for many reasons—among them the above ethical norms. However, Rai states that dai work is ‘necessary but culturally unappealing,’ whereas Pinto sees that same ‘dirty work’ as cultural leveraging available to insist on her terms of reimbursement.

The paper proceeds to evaluate the relative merits of ‘opportunity costs’ and ‘replacement costs’ as methods for arriving at financial valuation of dais’ work. Rai acknowledges the difficultly involved in measuring and tracking dais’ tasks: the lack of available statistics, problems of difficult births and referrals. Secondly, a challenge arises from the variety of ways dais themselves define their work. Thirdly, standardized notions of hourly wages are not usually found in the government’s socio-economic or health publications.

Rai critiques state policy viewing the dais as a “weak link” in the Gujarat government’s health system, as it minimizes their important contributions. Dais do conduct deliveries in both rural and urban settings. “Instead of seeing them as an essential link between poor women and the overburdened health care system, dais as a weak link hides the real reasons for dais responsibilities and involvement.” A question arises about how much can we expect the state to respond to these kinds of advocacies, agitations and demands, even though they may be completely rational and economically sound, considering Indian realities. Political will and public opinion would need to coalesce around these as priorities—and that doesn’t seem to be happening, especially when “Safe Motherhood” campaigns are dominated by those who want to mobilize opinion and resources, but don’t choose to address issues of poverty and the value and relevance of indigenous medicine and culture.

Birth Work: Whose Business is it?

Alpana Sagar displays an amazing critical reflexivity in her paper “Doctor’s Business or Women’s Business? Towards Making Childbirth Safer for Poor Women in India.” As a physician, she poses the question of how such disparate points of view came to exist between poor women, who view birth as natural and women’s business (although for serious complications they are eager to use modern medicine), and doctors who view every pregnancy as a potential risk. Sagar ambitiously sets out to answer this question, first providing the data from her research with women in the Gautam Nagar slum near Delhi’s premier medical institution—All India Medical Sciences Hospital, then tracing the history of the displacement of women, tradition and midwives from the birth arena, ideologically and practically, in both the Western, and the Indian contexts.

Sagar’s paper, appearing in this volume, speaks to the larger issue of power politics as they impinge on the ‘private’ and personal space of birth. Ideology, livelihood issues, hegemonic forces of colonial, class and state power in medieval Europe and post-Independence India emerge as crucial factors, as well as gendered notions of scientificity. Sagar provides ample data highlighting the scapegoating of women healers and midwives during the witchhunts that plagued Europe. She notes that social and political unrest was channeled against women healers and religious dissidents rather than popes and kings. Interestingly we might see a parallel in the British and post-colonial state and elites scapegoating dais rather than dealing with issues of poverty and providing quality rural referral services.

Another gross omission from modern Indian discourse and memory (especially in that of women’s health and global health agencies) is the historical linkages which Sagar sketches between the eugenics movement, early birth control enterprises, and contemporary family planning or “health and family welfare” bureaucracies. The idea that some people ‘deserve’ to reproduce, and others don’t was responsible for genocide, not only of Jews, but also Gypsies, homosexuals and the disabled in Nazi Germany. Post-war propaganda would have us believe that this was a uniquely German, or Nazi effort and ideology. However Sagar points out that such notable European and American figures as Thomas Huxley, Mathew Arnold, Havelock Ellis, H.G. Wells, Francis Crick and, of course, Adolf Hitler, were adherents of eugenic thought. Early advocates of ‘birth control’ were eugenicists such as Margaret Sanger who is today celebrated by feminists for her freethinking and the delusion that birth control’s social contribution is liberating of women from biological dictates of motherhood. It is crucial for us today to recognize the historical linkage between ‘family planning’ and eugenics because social, political and economic forces are colluding to form an ugly ideology that the poor, without money and resources, do not deserve to reproduce.

While historicizing the various players assuming the role of birth workers and decision-makers, she indicts the colonial power’s maneuver of exporting problems from England to the colonies. In this case, newly trained women doctors, who were agitating to practice medicine at home—against the gender norms of the times, were encouraged to serve, convert and civilize the natives, and then return home with status and respectability. We have elaborated above on the ideological notion of the superiority of scientific medicine and temperament that operated in both the medieval European context and that of colonial and postcolonial takeover of birth from women and midwives. Goodness, harmony and balance are no longer believed to be an integral part of the cosmos and unruly nature (and natives) are to be conquered, civilized and controlled. A part of this project is the dislocation of indigenous medicine by Western medicine (the term used at the time) that presented itself as a universally applicable and superior form of therapeutics. Both biomedicine and public health, which delivers the services of biomedicine, envision a modernist trajectory, a straight line of heroic progress against disease. Nowhere is this enterprise more misguided than in its application in childbearing. The female body, as a life-bearing body, has been viewed as defective, a site for pathology. It is in this ideological context that Sagar views the displacement of women from birth and misguided policies and programme.

How will the World be Born? Problems with Globalization

Increasingly motherhood, or ‘reproduction’ as the medical, academic and development establishments would have it, is moving from the margins of social science analysis to the centre. ‘Reproduction’ is being used more productively to analyse the complex global terrains in which contemporary identities and societies are produced. The critical importance of how we human beings, as a species, give birth to ourselves, is finally being recognized. Consideration of motherhood/reproduction is no longer a soft, ‘domestic science’, a sentimental and womanly concern. We may be able to situate birth within its socio-economic and political context, a difficult enterprise, but achievable. But how, finally, can we image birth, in the realm of the imagination? How can we grapple with the mystery, the emotion, and the elemental rawness of birth alongside the statistics on maternal mortality? We risk being labeled as sentimental, essentialist, reactionary or even cultist if we talk, as the dais do, about the ‘life force’ or ‘jee’ . 63 We have no English words for this life force that swells the belly and is tracked by the dai during labour unless we couch our terms in religious, therapeutic or ‘natural law’ kinds of discourse. Some, nevertheless, attempt to articulate this.

A recent article in the journal Social Science and Medicine, “Midwifery practice and the crisis of modernity: implications for the midwife,” deals with this dilemma by using Habermas’s notion of ‘the colonization of the lifeworld’ to interpret data drawn from in-depth interviews with Irish midwives. The authors explore the tensions within the concept of modernity—between the emancipatory potential to liberate the human subject from the manacles of tradition and the application of reason to co-ordinate and control the natural world through scientific knowledge. Again, drawing on Habermas’ theory of communicative action, they argue that the midwife’s role in facilitating the autonomous choices of women is impeded by the colonization of the lifeworld of labour and childbirth by the technocratic system of obstetrics. Labour is no longer a hormone-driven process—where the power to birth lies in a woman’s body. As Jo Murphy Lawless points out
Illogically, at a time when women in wealthy post-industrial countries have never had better general health and with it, the opportunity to control their own fertility (thus largely eliminating the threats to pregnancy and labour that once accompanied prolonged childbearing), the rates of intervention have never been so high. 64
In the Irish study inductions, caesarians and other interventions during labour were routinely class based.
Interventions were also determined by the civil status of the woman in terms of whether she was a public or a private patient. Private patients were subjected to a greater level of interventions because medical consultants were called to attend all private deliveries whether there was a problem at the time of delivery or not, whereas midwives had greater freedom to practice midwifery on public patients. 65
A similar observation on interventions during labour based on class is made in a review of data on caesarean section rates in India.
There is reason to believe that current rates are part of a rising trend. This cannot be attributed only to the rise in institutional deliveries because of the strong association between caesarean sections and private sector institutions…. In Andhra Pradesh, Bihar, Gujarat, Karnataka, Punjab and Uttar Pradesh, the risk of undergoing caesarean section in private sector institutions is four or more times that of a public sector institution. 66
Some medical and health policy journals even refer to a caesarean ‘epidemic’ in developing countries. In “Over-medicalisation of Maternal Care in Developing Countries” the author concludes “the epidemic of C. sections continues in Latin America and extends into Asia. In addition there are signs of a worldwide epidemic of other interventions. There is an urgent need to build strong strategies to promote evidence-based interventions.”  67

On one level this book indicts a bulwark of modernity (which also happen to be a site where vast numbers of marginalized poor seek to partake of the health resources more routinely available to the middle and upper classes) namely doctors, hospitals and the peripherals associated with them, particularly pharmaceuticals. One prominent south Asian physician, activist and pioneer in the production and distribution of quality generic drugs for the poor, Zafrulla Chowdry, noted that of all the irrational and harmful pharmaceutical use, the most occurred in the practice of gynecology and obstetrics. 68

However it is not the doctors, nor the medical professionals, nor the pharmaceutical businesses alone that are to be held responsible for high rates of surgical and pharmaceutical interventions. A recent sociological analysis of birth among middle class Calcutta families 69 claims that by far the majority of women prefer caesarean sections to normal vaginal births. The author, based on ethnographic fieldwork, contextualizes this preference in terms of the shift from the maternal home to the married home as site for birth and postpartum care, alongside the shift from home to hospital as place of birth. Traditionally, the daughter-in-law, in her married home is expected to perform domestic duties. The author presents an in-depth case study in which a mother reveals her preference for a caesarean in order to avoid the in-laws expectations of domestic work postpartum. The author views this decision as an exercise of agency and negotiating power. Although this paper is methodologically important, as it considers women’s ‘choice’ of surgical birth in the context of specific marital and residential patterns, nevertheless the face-value acceptance of invasive surgery to avoid familial expectations as women’s power seems misguided to me. This shift in site of the parturient women from maike to sasural, is common to many locations and communities in India, as modernity erases tradition—in this sociologist’s view accompanied by surgical rites replacing religio-cultural ones.

The crises of global capitalism, expansionist moves driven by the market economy, technocratic hyper-specialization plus a neo-liberal assault on provisions (ie. food distribution) for the underprivileged; these macro-level forces are miniaturized in birth situations. Everywhere in this country, in the most remote villages, women are being injected with oxytocics to induce or strengthen labour pains. One NGO head in Jharkand talked of needing to distribute bolts of cotton cloth for use as sanitary napkins and nappies. 70 In rural areas women now wear polyester saris and are not able to use their outworn cotton ones for these purposes. In a sense globalization recapitulates the colonial dilemma. Sustainability is touted in NGO funders proposal guidelines—supposedly leading to ‘development’ while macro-level forces collude to disembowel local communities’ sustainable lifestyles. Remember that Gandhians spun their own cloth and burnt mill-made cloth from England as a resistance tactic—the unavailability of cotton fabric for poor women’s use to sop up bodily fluids/wastes proves that the original vision of Gandhi was not just romantic non-sense.

Likewise cooptation of intellectuals, occupying their narrow areas of specializations, NGOs and consultants all serve to camouflage the ugly face of the impoverishment which accompanies this neutral-sounding globalization. Similarly cultures, indeed civilizations reflecting various understandings of the human body, particularly the reproductive female body are sites of neo-colonialism via the ideology of scientific medicine—obstetrics and gynecology. Cultural homogenization minimizes diversity, resulting in, not choice but standardization—with insistence on the observable and measurable. Pluralism is eroded and knowledge is fragmented.

Actually there is a deep irony in the fact that birth workers, dais and dhanuks, used to serve all women across caste and class hierarchies. And now they, themselves, their families and communities are literally outcastes to the benefits of both modern medical facilities and state-trained dais and ANMs (Auxiliary Nurse Midwives)—who often neglect to serve castes ‘below’ their own. Building bridges between the best of the traditional and the modern can lead to better birthing for women of all classes. Many studies document the global poor-rich differences in the utilization of delivery care 71 as well as the unscientific practice/rituals of modern medicine in maternal health care. According to a recent article in the International Journal of Gynecology and Obstetrics, gaps between evidence and practice, (the current jargon of health care analyses), exist in the areas of clinical care, implementation of effective practices and in setting research priorities—essentially stating that countries with few resources should catch up with the current ‘scientific’ evidence. Yet no one remembers the Western and modern origins of the ‘outdated’ practices. A 1996 World Health Organization document 72 (which is not being circulated too much these days because of its flagrant violation in the vast majority of the world’s hospital delivery rooms) lists these practices that so violate the bodily integrity and dignity of the labouring woman:
  • Use of enema: enema is uncomfortable, can damage the bowel, and does not shorten labour or decrease neonatal infection or perinatal wound infection.
  • Pubic shaving.
  • Restriction of foods and fluids during labor.
  • Repeated or frequent vaginal examinations.
  • Routinely moving labouring woman to a different room at onset of second stage.
  • Guided expulsive efforts/sustained bearing down efforts.
So today, women are supposed to have the ‘right’ to a safe birth, a right to health care, but not a right to the integrity of their bodies, food, or a right to employment for herself or her husband. Whose rights are being guaranteed? Those of the millions of ‘professionals’ engaged in the growth industry of poverty alleviation and development. A World Health Organization report on women’s rights to safe motherhood errs in the first paragraph.
This report considers how human rights laws can be applied to relieve the estimated 1,400 deaths worldwide that occur every day, an annual mortality rate of 515,000, that women suffer because they are pregnant. 73
Women don’t suffer and die because they are pregnant, but because they are impoverished, malnourished and overworked. As Arundhati Roy eloquently stated in her acceptance of the Sydney Peace Prize
Today, it is not merely justice itself, but the idea of justice that is under attack. The assault on vulnerable, fragile sections of society is at once so complete, so cruel and so clever—all encompassing and yet specifically targeted…that its sheer audacity has eroded our definition of justice….notions of equality, or parity have been pried loose and eased out of the equation…Almost unconsciously, we begin to think of justice for the rich and human rights for the poor. Justice for the corporate world, human rights for its victims… 74
Jo Murphy-Lawless, one of the most articulate analysts of birth, sensitive to global politics, writes of the high tech, medical solutions proposed to solve the impoverished world’s problem of maternal mortality.
Proposed solutions to problems of maternal mortality have flowed from advanced economies and global institutions like the World Health Organisation and have tended to reflect models of health care that are heavily influenced by the politico-administrative apparatus of the wealthy modern industrial/post-industrial state.…. In the World Health Organisation, whose professional core is made up of medical doctors, the issue of appropriate maternal policies and model-building for Safe Motherhood programmes, has been caught between the structures and systems in wealthy countries that produce their medical elite and the circumstances of poor countries, where maternal health and well-being are threatened by the problems of extreme poverty. 75
It is within this context, then, that this collection of papers puts forward alternative visions of birth across class and globally: singing the female body, homebirth by an upper-class woman, Ayurveda, the birth knowledge of slum residents, cord cutters in Uttar Pradesh, a call for monetary recompense for dais and tracking the takeovers of birth from women. In the best of all worlds middle and upperclass women could learn the simple and natural methods of the dais for facilitating labour and handling postpartum. Their health would be positively impacted, medical professionals and facilities would be freed as backup for dais, for use by lower class women facing emergencies. Any midwife conducting a homebirth in the USA or Europe, or anywhere in the world, wants biomedical backup—so do dais.

Murphy-Lawless points to the difficulty in transferring resource-intensive technological and pharmaceutical based models in increasingly unsecured social and economic conditions. She questions their applicability amid the increasingly extreme conditions created by the impact of globalisation on poor countries. She also asserts the violence behind the erasure of indigenous birth practices and practitioners in the Bolivian context.
More critically still for women in Bolivia, the WHO has taken a particular stance on the issue of skilled attendance in childbirth. In 1992, the WHO drew a line under indigenous midwifery, categorising it as an unsafe traditional form which must be replaced with a full modern health care system (WHO, 1992). Leaving aside this policy as a violation of indigenous rights, it was a potentially disastrous decision from a practical point of view, given the still large percentages of women in parts of the world who give birth reliant on local indigenous midwifery and who do not have access to formal health care systems…
It is my hope that the papers in this volume will alert readers to cultural resources, support networks, knowleges, and visions of how the world has been, and might be born. Perhaps we can appreciate and revitalize, selectively and critically, some of the birth and body culture, the women’s culture elaborated upon here. Veils of sharam, time, class, gender and caste have shrouded them from our gaze. These ways of birth are fast disappearing. Might the veil be lifted?

1 Reading Lolita in Tehran (New York: Random House, 2004), p. 273.
2 Sara Suleri, The Rhetoric of English India (New Delhi: Penguin Books, 2005), p. 4.
3 One exception was the conference Shaktika on the Ascent: Reframing Gender in the Context of the Culture of India organized by the Indira Gandhi National Centre for the Arts and Utkal University in Bhubaneshwar, March 20th-23rd, 2003. A small group of women scholars presented works reconfiguring and reclaiming aspects of indigenous gender forms.
4From “The Female Body of Possession,” in Mental Health from a Gender Perspective, edited by Bhargavi V. Davar (New Delhi: Sage Publications, 2001), p. 209. Possession, like parturition, is an inherently liminal and embodied phenomenon unable to be completely controlled by patriarchal injunctions. Women have utilized both these domains as times/spaces of great creativity and religio-cultural expression.
5 MATRIKA is an acronym for Motherhood and Traditional Resources, Information, Knowledge and Action, as well as signifying in image and text the concept of the group mothers, semi-divine beings. For further information about the Matrikas see Shivaji K. Panikkar’s Sapta Matrika Worship and Sculptures (Delhi: D.K. Printworld, 1997) and the entry on the Saptamatr(s) in Vettam Mani’s Puranic Encyclopaedia (Delhi: Motilal Banarsidass, 2002).
6 MATRIKA’s collaborators were Mahila Jagriti Kendra in Gomia then located in Bihar (now Jharkand); Action India, Delhi; Voluntary Health Association of Punjab, Chandigarh; and URMUL, Bikaneer, Rajasthan.
7 Thanks to friend and colleague Poonam Zutshi for general feedback on this introduction and specifically helping me to become aware of my (and dais’) liminal space vis a vis anthropology.
8 See her Fertility Behaviour: Population and Society in a Rajasthan Village (Delhi: Oxford University Press, 1994).
9 Thanks to Vidya Rao for discussing these reasons with me.
10 Frederique Apffel Marglin has produced a vast and valuable body of work on India, particularly “Rhythms of Life: Ritual Time and Historical Time,” in Practice and the Public, Aldershot Brookfield (Hong Kong, Singapore, Sidney 1991) and “Gender and the Unitary Self: Looking for the Subaltern in Costal Orissa” South Asia Research, Vol. 15, No. 1, Spring 1995 as well as “Secularism, unicity and diversity: The case of Haracandi’s grove” in Contributions to Indian Sociology 32, 2 (1998).
11 See Is the Goddess a Feminist? The Politics of South Asian Goddesses, eds. Alf Hiltebeitel and Kathleen M. Erndl (Sheffield: Sheffield Academic Press, 2000) for an investigation of female deities and how their representation functions in contemporary society.
12 Personal communication from Sukumari Bhattacharji, 8-8-93.
13 My work on birth includes: Child-bearing and Culture: Women Centered Revisioning of the Traditional Midwife, the Dai as a Ritual Practitioner (Delhi: Indian Social Institute, 1994).
“The Conflation of the Female Body and the Earth in Indian Religious Traditions: Gendered Representations of Seed, Earth and Grain,” in Gender/Bodies/Religions, ed. Sylvia Marcos (Cuernavaca: ALER Publications, 2000).
“Hawa-Gola and Mother-in-law’s Big Toe: On understanding dais’ imagery of the female body,” in Daughters of Hariti, Childbirth an female healers in South and Southeast Asia, eds. Santi Rosario and Geoffrey Samuel (London and New York: Routledge, 2002).
14 For any doubt about its antiquity, refer to the Harappan ‘birth seal’ which portrays an inverted woman from whose womb a plant sprouts. To be found in Pupul Jayakar’s The Earthen Drum, An Introduction to the Ritual Arts of Rural India (Delhi: National Museum, date unknown), p. 47. For an Indian and woman-centred perspective on its extensive nature see Kamala Ganesh’s, “Mother who is Not a Mother: In Search of the Great Indian Goddess,” in the Economic and Political Weekly, Vol. xxv, No. 42, (October 20th, 1990).
15 In Myth and Reality: Studies in the Formation of Indian Culture (Bombay: Popular Prakshan, 1983).
16 Deepti Priya Mehrotra, “Bridges Between Spirituality and the Women’s Movement in India,” Vidyajyoti Journal of Theological Reflection, Vol. 60, No. 8, (August 1996), p. 513.
17 Jana Sawicki, “Disciplining Mothers: Feminism and the New Reproductive Technologies,” in Feminist Theory and the Body, A Reader eds. Janet Price and Margrit Shildrick (Edinburgh: Edinburgh University Press, 1999), p. 193.
18 “Despite the rising critique of caesareans in urban hospitals in Tamil Nadu, most of the women I met expressed great relief that such emergency procedures were increasingly available to them in case of problems such as delayed labour.” Cecilia Van Hollen Birth on the Threshold: Childbirth and Modernity in South India Zubaan (New Delhi: 2003), p. 117.
19 Ritu Menon and Kamla Bhasin, Borders and Boundaries: Women in India’s Partition (Delhi: Kali for Women, 1998), p. 58.
20 Patricia Jeffrey, Roger Jeffrey and Andrew Lyon, Labour Pains and Labour Power, Women and Childbearing in India (London and New Jersey: Zed Books Ltd. 1989), p. 224.
21 From The Empire Writes Back, Theory and practice in post-colonial literatures, Bill Ashcroft, Gareth Griffiths and Helen Tiffin. (London and New York: Routledge, 2000), p. 7.
22 op. cit. Jeffrey, Jeffrey and Lyon, Labour Pains and Labour Power, p. 150.
23 The Fifty Years’ Retrospect, India 1885-1935 is clear in it’s imperial indictment of dais. “In 1903, Lady Curzon appealed for funds for a memorial to Queen Victoria and devoted the proceeds to the organization of a scheme for improving the indigenous dais of India, whose ignorance is responsible for so much suffering.” p. 13.
24 Edward W. Said, Culture and Imperialism (New York: Vintage Books, 1994), p. 218.
25 See my own work Janet Chawla and Sarah Pinto. 2001. “The Female Body as the Battleground of Meaning,” in Bhargavi V. Davar, ed. Mental Health from a Gender Perspective (New Delhi: Sage) which reflects a cultural view of this battleground as well as the more overtly political work of Menon and Bhasin, Urvashi Bhutalia and Kumkum Sangari.
26 op.cit. Reading Lolita, p. 192.
27 ibid.
28 Personal communication with Aditi Rao, Bharatnayam dancer. 17 March 2004.
29 Gloria Goodwin Raheja and Ann Grodzins Gold, Listen to the Heron’s Words, Reimagining Gender and Kinship in North India (Delhi: Oxford University Press, 1996), p xxix.
30 ibid. p. xxxiii.
31 Rajeshwari Sunder Rajan, Real and Imagined Women, Gender, Culture and Postcolonialism (London and New York: Routledge, 1993), p. 21.
32 ibid. p. 20.
33 Cecilia Van Hollen, Birth on the Threshold, childbirth and modernity in south India (New Delhi: Zuban, 2003), p. 119.
34 See “Menstruation and Childbirth as Ritual and Religious Experience among Native Australians,” in Unspoken Worlds: Women’s Religious Lives, eds. Nancy Auer Falk and Rita Gross (Belmont, California: Wadsworth Publishing Company, 1989) for an overt example of male ritual mimesis of female physiology as well as my “Negotiating Narak and Writing Destiny: The Theology of Bemata in Dais’ Handling of Birth,” in Invoking Goddesses: Gender Politics In Indian Religion, ed. Nilima Chitgopekar (New Delhi: Har-Anand Publications, 2002) for discussions of male ritual mimesis of female bodily processes.
*Capitalization and lack thereof reflects written as opposed to oral texts.
35 The reference provided by Vikas Harish for this story is the Vishnudarmotra Purana.
36 For further information on the misuse of episiotomy see the following: Some Women’s Experiences of Episiotomy, Sheila Kitzinger with Rhiannon Walters. 2nd ed. 1993, National Childbirth Trust (out of print).
_ _ Episiotomy and the Second stage of Labor, Sheila Kitzinger and Penny Simkin, eds, 2nd ed. Pennypress inc, available through International Childbirth Educators Association.
37 Lal Ded by Jayalal Kaul (New Delhi: Sahitya Akademi, 1973), p. 14.
38 Michel Foucault, Power/Knowledge: Selected Interviews and Other Writings, 1972-1977. Edited and translated by C. Gordon (New York: Pantheon Books, 1980), p. 82.
39 “According to sources, while the Central Council for Research in Ayurvedic Systems has been functioning without a full time Director for the past six years….Insiders allege undue interference of senior bureaucrats in the Health Ministry who are interested in retaining their stranglehold on these councils by putting off appointments of full-time heads as long as possible.” “Ayurvedic Disputes,” Hindustan Times, August 16, 2003.
40 See my essay, “Hawa, Gola and Mother-in-law’s Big Toe: On Understanding dais’ Imagery of the Female Body,” in Daughters of Hariti, Childbirth and Female Healers in South and Southeast Asia, eds Santi Rozario and Geoffrey Samuel (London: Routledge, 2002).
41 Stella R. Quah, “Traditional Healing Systems and the Ethos of Science,” in Social Science and Medicine (2003), p. 57.
42 Jessica Mitford, The American Way of Birth (New York: Penguin Books, 1993), p. 145.
43 “Negotiating Narak and Writing Destiny: The Theology of Bemata in Dais’ Handling of Birth,” in Invoking Goddesses, Gender Politics and Religion in India, ed. Nilima Chitgopekar (New Delhi: Har-Anand Publications, 2002).
44 See my article, “Mythic Origins of the Menstrual Taboo in the Rig Veda,” Economic and Political Weekly, Vol. XXIX, No. 43, October 22nd, 1994, p. 2817.
45 In Recasting Women, Essays in Colonial History, eds. Kumkum Sangari and Sudesh Vaid (New Delhi: Kali for Women, 1989).
46 “Pollution and Safety: Exploring the Dirty Side of Women’s Health,” Department of Nursing and Midwifery, University of Sheffield, June 14th, 2004.
47 Mary Stewart, Senior lecturer in midwifery and Ph. D. student, School of Maternal and Child Health, Faculty of Health and Social Care, University of the West of England, Blackberry Hill, UK.
48 The Scottish Book of Common Prayer (1929). Edinburgh. The Scottish Episcopal Church.
49 Mary Douglas. Purity and Danger (London: Routledge, 1966).
50 Today the genre is rather large, but pioneering American works were: Adrienne Rich’s Of Woman Born, Judy Grahn’s Blood, Bread, and Roses—How Menstruation Created the World, Penelope Shuttle and Peter Redgrove’s The Wise Wound, The Myths, Realities and Meanings of Menstruation. M. Ester Harding, a Jungian analyst, wrote Women’s Mysteries, Ancient and Modern in 1971 and Ina May Gaskin’s Spiritual Midwifery influenced many American women and midwives. More recently Anita Diamant’s novel The Red Tent, revolving around a menstruation and birth tent, has been a bestseller.
51 “Menstruation and the Power of Yurok Women” by Thomas Buckley in Blood Magic the Anthropology of Menstruation, eds. Thomas Buckley and Alma Gottlieb (Berkeley: University of California Press, 1988).
52 Chris Knight, Blood Relations, Menstruation and the Origins of Culture, (New Naven and London: Yale University Press, 1995).
53 The Rig Veda, An Anthology, ed. and trans. Wendy Doniger O’Flaherty (London: Penguin, 1981), p. 267.
54 In Werner F. Manski’s “Marital Expectations as Dramatized in Hindu Marriage Rituals,” in Julia Leslie, ed., Roles and Rituals for Hindu Women (Delhi: Motilal Banarsidass, 1992), p. 65.
55 I presented a talk at the American Anthropological Association’s 100th Meeting on November 29th, 2001 called “Mediating Ethnomedical and Biomedical Knowledge: Placenta, Life Force and “Sin” in Dais’ Midwifery Practice.”
56 Decolonizing Knowledge: From Development to Dialogue, eds. Frederique Apffel-Marglin and Stephen A. Marglin (Oxford: Clarendon Press, 1996), pp. 4-5.
57 See Robbie Davis-Floyd’s seminal work Birth as an American Rite of Passage (Berkeley: University of California Press, 1992) for a treatment of ritualised birth, American style.
58 Lesley Barclay – RN CM BA MEd Ph.D., Professor and Director, Centre for Family Health and Midwifery, University of Technology, Sydney. Paper presented at “Pollution and Safety Conference.”
59 American Anthropological Association’s 100th Meeting, Washington DC, November 2001. The panel on birth was entitled Science and Humanism in Midwifery and Anthropology: Global Transformations.
60 See Consuming Motherhood, eds Linda Layne, Danielle Wozniak and Janelle Taylor (New Jersey: Rutgers University Press, 2004).
61 Elizabeth Chacko, “Culture and Therapy: Complementary Strategies for the Treatment of Type-2 Diabetes in an Urban Setting in Kerala, India,” in Social Science and Medicine 56 (2003) pp. 1087-1098.
62 See L. Page, “The Humanization of Birth,” International Journal of Gynecology and Obstetrics, (2001) p. 75, which is the closing speech of the International Conference on the Humanization of Birth held in Fortaleza Brazil in 2000.
63 The dais with whom MATRIKA interacted used the word ‘jee’ to signify the palpable energy of the life force (which seems to resemble the more philosophical word shakti) which flows through the human body. Ayurveda uses the word ojas, homeopaths ‘vital force’, Chinese “chi” and Japanese “ki” to denote this energy whereas biomedicine has no concept of life force.
64 “How Will the World Be Born: The Critical Importance of Indigenous Midwifery,” Dr. Jo Murphy-Lawless, Royal College of Midwives, Midwifery Journal, Vol. 6, No. 10 (October, 2003).
65 “Midwifery practice and the crisis of modernity: implications for the role of the midwife” Abbey Hyde, Bernadette Roche-Reid, in Social Science and Medicine 58 (2004) pp. 2613-2623.
66 “Delivery-related complications and determinants of caesarean rates in India” US Mishra and Mala Ramanathan, in Health Policy and Planning 17 (1) 90-98 Oxford University Press (2002).
67 “Over-medicalisation of Maternal Care in Developing Countries” Pierre Buekens, in Studies in HSO&P, 17, 2001.
68 …In one instance the same drug (Captopril), manufactured by the same company was 10 times cheaper in Sri Lanka than in India…probably because there generic drugs compete with the branded drugs for price in the retail market, and because the State, (through SPC and STC which are parastatal organisations) run fair price shops, where good quality generic/branded generic drugs are available at a lower price….What has the Indian public gained in terms of affordable prices by a strong indigenous pharma manufacturing sector? What does it matter to a poor person who cannot afford medicines if India’s pharma stocks are doing well?
Impoverishing the Poor: Pharmaceuticals and Drug Pricing in India (Vadodara/Bilaspur: LOCOST/JSS, December 2004), p. 127.
69 Donner, Henrike, “The place of birth: childbearing and kinship in Calcutta middle-class families” Medical Anthropology, 2003 22(4).
70 Personal communication with Lindsay Barnes of Jan Chetna Manch, a community based organization comprised of 300 village women’s groups in Bokaro District, Jharkand.
71 For example “A global picture of poor-rich differences in the utilisation of delivery care” by Anton E Kunst and Tanja Houweling in Studies in HSO&P, 17, 2001.
72 Practices No Longer Recommended for Management of Labor, (WHO 1996) Care in Normal Birth: A practical Guide—Report of a Technical Working Group, WHO Geneva.
73 Advancing Safe Motherhood through Human Rights, Ref. WHO/RHR/01.5.
74 Excerpted from Arundhati Roy’s acceptance speech on receiving the Sydney Peace Prize. The Hindu, November 7th, 2004.
75 op. cit. Murphy-Lawless, Midwifery Journal.

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