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This paper was written for a conference “Exploring Pollution and Safety—The Dirty Side of Women’s Health” held at Sheffield University’s School of Nursing and Midwifery (UK) June 14–15, 2004

An Interpretation of Data from Dais in North India
By Janet Chawla


The MATRIKA Research Project

MATRIKA (Motherhood and Traditional Resources, Information, Knowledge, and Action) was a 3-year participatory action research project in collaboration with four local NGOs during the years 1998-2001. MATRIKA is named after a group of female figures, usually either seven or eight, depicted in sculpture and myth as collective and semi-divine beings—and associated with mothering. The Matrika images include voluptuous beauties—one with an infant, theriomorphic (human body with animal head) figures and a wizened crone (for more detail see Panniker, 1997).

We drew up collaboration agreements with Action India (working in the slums of Delhi); Mahila Jagriti Kendra (South Bihar); Voluntary Health Association of Punjab (Fategarh District) and URMUL (Rajasthan)—in order to generate material that would be of use to the NGO as well as our own interests. The NGO then called together dais who were considered by local women to be experienced and knowledgeable for a series of three workshops. In these workshops we posed the question ‘what does a woman need during pregnancy, birth and postpartum?’
Our initial methodology was derived from counselling—usually practiced in a one-to-one setting—which we transposed to our workshops. ‘Active listening,’ when practiced by the interviewer or facilitator, allows the person (or group) to speak in a non-directed manner—with topics emerging from the informant/s rather than using a questionnaire with a specific agenda. Active listening also involves feeding back what has been understood by the researchers in order to allow the group/person to go deeper into the subject or refine or correct misunderstandings. Secondly, positive reinforcement involves recognising and appreciating behaviour which seems to the listener to have contributed to the speaker’s own well being or the well being of those around her—particularly if gender or caste bias is involved. For example, if the family were biased towards the male children then protecting taking care of a girl infant or child would be actively appreciated.

The attitudes of our team were crucial to the success of the research work. We consciously cultivated a team ethos in which we

  • Were open to religio-cultural ways of thinking and doing ‘health’.
  • Assumed that poor, illiterate, low caste women could be skilled birth practitioners (for supporting data see Singh, 2006)
  • Used our capacities for empathy and imagination to enter another world with different ways of knowing about the female body
  • Believed that birth is a normal and natural process
  • Understood that poverty compromises women’s health apart from pregnancy and birth (for information and analysis see Murphy-Lawless, 2003)

We realized that often dais have been made scapegoats for maternal mortality and morbidity and blamed for the effects of other macro-level processes. MATRIKA’s workshop methodology reversed the common TBA training model. We asked groups of dais to ‘train us’ by seeking to understand what they thought about and did to meet women’s needs during parturition.

Our activities included role-plays, ritual drawings, body mapping, singing of birth songs, sharing of birth experiences (ours and theirs) as well as dais’ life narratives. . Group discussions, interpreting role-plays and other data, were at the heart of our activities. The lower-level NGO health workers were invaluable in helping us to understand the material we were receiving. Mostly drawn from local communities themselves, they, when given permission from those with ‘authority’ would explain and elaborate on the ‘data.’ We were able to access, and remain with, this alien (to us) information because we did not limit ourselves by separating data into mutually exclusive categories of ‘medicine’ and ‘religion’. Rather we were receptive to diverse ways of facilitating birth, diagnosing and healing—to ritual enactments, notions of deities and demons, bhut-pret (ghosts and spirits) and the nazar or evil eye. We attempted to let the data speak the categories rather than the categories shape the data.

MATRIKA Findings

At first, of course, dais seemed to want to impress us with their knowledge of the modern, biomedical approach. They spoke of the need for using a clean blade, taking the woman to the hospital if there were problems (when often there no doctors or hospitals in the area). But as our sincere desire to learn and not ‘teach’ or criticize became apparent—and especially after our own enactments of the loneliness and confusion of a woman laboring alone in a hospital—they began to trust us and share what they really believed and practiced. Ours was a collective effort: a group of researcher-activists interacting with a group of dais. We ate, slept, talked, sang and danced, produced drawings and plays together. Our workshop activities were a celebration of dais cultural handling of childbirth. We were sometimes told that no one had ever called them together to share and enjoy like this.

Body mapping session in Gomia District Bihar

Rajasthani ritual images generated in a workshop in Lunkaransar District

During body mapping sessions we would outline a woman’s body and then generate terms, often terms of abuse, for parts of women’s bodies. I repeatedly emphasized to our team that we were not generating the equivalent to a bio-medical anatomy chart—but rather we were ‘catching’ women’s stories, their words about and experiences with the body.

Motifs from rituals and ritual drawings emerged from Rajasthani dais when they were provided with felt pens and large swaths of paper. Note the swastik, or satiyas in the lower left hand corner—a symbol connoting fertility and auspiciousness. Also the sari blouse hung on a tree in the seventh month—the spirit who lives there is evoked to protect the pregnant woman.

Our key research innovations included

  • No distinction made between the categories of ‘religion’ and ‘medicine’
  • Returning to informants with our interpretive role plays, drawings, posters—for clarification and correction
A MATRIKA team member drew this poster of Bemata who dwells in narak, underground, a visual version of ‘active listening.’ Bemata grows both babies in mother’s wombs and plants from the earth. Thus the postpartum “bad” blood is shown here returning to the earth, completing the cycle. And, in fact we have heard of families in Delhi slums who put sand from the Jamuna river under the charpoy (woven rope cot) to absorb post-birth fluids. This drawing was shown to dais to make sure we had “got it right”. Notice the ‘three worlds’ ( triloka) of heaven (sky), mundane life (earthly plane) and narak (underground). In this way we were allowing categories like narak to emerge from the data; not producing data to fit into our own researchers’ categories (for elaboration on bemata and narak see Chawla, 2003).

Bemata image of the 3 worlds (tri-loka) with bemata under the ground—in narak)

Narak Quotes

The following quotes from our workshop transcripts present meanings of narak. The first series of quotes from Bihar speak explicitly, using the word ‘narak.’ In other areas the meanings are more implicit in the practices and the ‘dirtiness’ associated with times of female fertility.

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.” (Bihar)

On Chhati day the narak period ends. The Dai checks if the umbilical cord has fallen off. Then she bathes the baby and beats a thaali (plate). After this the woman is bathed and wears new clothes. The dai cleans the room where the delivery took place and the woman was kept separately for six days. The dirty clothes of mother and child are washed. After this the dai is given soap and oil for bathing. All this is on the sixth day after delivery. (Bihar)

The conflation of the female body and the earth—Reclaiming narak

It is very tempting for us modern women to stand outside of ideas of the ‘dirty’ female body and critique them as archaic and misogynist. Having listened carefully to dais’ voices, and paid attention to Indian, indeed sub-continental representation systems for almost 30 years I am now adamantly against doing so.

Although often translated as hellish or demonic place, narak can be understood as the site or energy of the unseen inner world - of the earth and of the body, particularly the fertile and bleeding female body. Narak has the connotation ‘filth’ but also signifies the fertility or fruitful potential of the earth and woman. So-called ‘pollution taboos’ are related to narak—where the idea of the sacred is radically separated from the reproductive potential of the female body. During menstruation and post-birth women are ‘unclean’. However the dai speaks with a very different voice than the pundit about this uncleanness, this narak. To her the placenta, the ultimate polluting substance in the shastra literature, is spoken of reverently. It is no coincidence that dais are mainly from low and outcaste communities. Both caste and gender are involved in concepts of narak.

Despite the pejorative connotations of the word narak, the concept has allowed for abiding female spaces and birth cultures. In the ‘male’ or ‘dominant’ view these female times are ‘filthy’ or polluted, but they are also times when masculine, social and even familial demands on women are suspended. And traditionally older women guarded these spaces from any incursions—perhaps with the help of ‘demons’ and nether forces!? Within this imagistic representation, the nature of female bodily energy is understood as ‘out of control’—women are presumed to be more emotional and have special physical needs at this time—so the usual social constraints are suspended. Of course we need to interrogate the priestly voice and de-sacralisation of menstruation and birth—but we should not throw out the baby with the bathwater. We should not ignore the traditional birth knowledge of India.

Conversely the fertility of land and woman are acknowledged and honored. Both are ‘fruitful’ and this is not simply a symbolic device. Within indigenous medical traditions such as Ayurveda, and with the dais, a totally different ontological system is at work. Woman is not a ‘symbol’ of the earth. Nor is the earth a ‘symbol’ of woman. Rather they both partake of the same nature of fecundity. Just as the wind outside my window partakes of the same essence as the breath which flows in and out of my lungs.

During narak time what is usually closed, the womb, is open, raw, vulnerable and bleeding. Narak allows for the imaging of the unseen—and the use of other senses, besides the visual, as well as the human capacities of empathy and imagination in diagnostics and therapeutics. And in fact narak is deeply implicated in the handling of postpartum care.

After delivery a woman is not given any grain or heavy food. This is called narak fasting. Grain is only given on the third day after all the dirty blood comes out. On first day, she eats biscuits with tea. She drinks warm water. Second day, heat-producing balls made out of ginger, pepper, turmeric, roasted rice, milk and jaggery (saunth laddos). On the third day, rice, dal and vegetables. " (Bihar)

It is called dirty blood because it has collected over nine months in the body. It is dark, smelly and clotted. It comes out first and then fresh clean blood comes out. With a little pressure and massage we take it out completely, and when the color of the blood becomes clear like monthly cycle we believe that it is clean." (Punjab)

"Gola is baby's home. When the house becomes empty, only dirty blood is left. When this comes out there is pain. Hot drinks (of ajwain, saunth, pipar and gur) are given. This drink cleans the belly. After the baby is born, the gola roams around. This gola has taken care of the baby, now it must leave. If the pain is intense then warm fomentation is done and gola melts away (pighal jata hai). This is dirty blood and needs cleaning up." (Delhi)

Perhaps in the dominant world religions (Judeo-Christian-Islamic and Hinduism, or more correctly Brahminism) the concept of narak or ‘hell’ overlays previous meaning systems which had more to do with the health of women than the purity of priests.

Re-entering the social world and saying goodbye to Bemata

Women are ritually progressed from their status as ‘unclean’ differently, at different times, within different religious traditions. Interestingly both the Leviticus text in the Old Testament of the Bible and the Dharamshastra writings—both of which concern themselves with ritual cleanliness in their respective traditions—specify a longer period of ‘pollution’ for woman who has given birth to a female infant than a male infant! In the Indian context birth is celebrated and women’s ‘confinement’ gradually comes to an end.

On the 13th day after birth, the new mother is allowed to enter the kitchen. (Chauka Charhana). Some do it on 7th or on 11th day. Everybody celebrates. There is singing and dancing. On this day the new mother and the baby bathe and wear new clean clothes. She comes out to get everyone's blessing. Friends and relatives are invited and eat food together. The Dai is given clothes, food and grain. (Punjab)

On the day of the birth ritual celebration (Chhatti-6th day) the woman wears everything that was taken off at the time of the birth. She put on bindi, bangles, henna and nose ring. We make ritual drawings of swastik, worship Bemata and light a lamp. We make a foot impression of the mother on the floor and then the woman enters the main house. Till the 5th day Bemata roams around in the house. After the birth celebrations Bemata leaves, she goes to another house. The dai also goes to serve others. (Rajasthan)

Image of Bemata on charpoy leg

To my knowledge there are no shrines, formal images, textual references to Bemata. She is definitely a fleeting presence, invoked by women at the time of birth and sent off to another’s home with postpartum ritual. According to the dais with whom we interacted, Bemata dwells in the realm of narak, deep within the earth. She is a Creatrix responsible for the conception, growth within the womb, and birth of human beings as well as the growth of all vegetation. In this image Bemata was drawn on a charpoy leg along with the swastik, a common post-birth ritual drawing.

Contemporary relevance of Bemata and Narak

Shakina, a Muslim dai working in a slum of Delhi talked about birth time in a swirl of Hindu and Muslim references—a testimony to the syncretism of North Indian folk culture. And we found that Sikh, Christian, Muslim as well as ‘Hindu’ dais used the concepts and often the language of narak and Bemata. Look, sister, at the time of

birth it’s only the woman’s shakti. She who gives birth, at that time, her one foot is in heaven and the other, in hell (narak).”

Shakina goes on to say

Before doing a delivery I get the woman to open all the trunks, doors and so on. I pray to the One above to open the knot quickly. I take off her sari, open her hair and take off any bangles or jewellery. I put the atta on a thali and ask the woman to divide it into two equal parts. Also I get Rs.1.25 in the name of Sayyid kept separately. But mostly I remember Bemata. Repeated I pray to Bemata “O mother! Please open the knot quickly.”

the ‘sympathetic magic’ of opening rituals. The untying of knots, opening of locks, doors and windows, loosening hair and removing bangles are common rites performed during labour throughout North India. This facilitation can be interpreted as an opening in the external word which is then mimicked or mirrored in the inner world of the maternal body. The manipulation of the external environment in this way serves as a permission and encouragement for the ‘opening of the body’. The separation of the atta from one mound into two also imitates imaginatively the separation of the pregnant maternal body into two—mother and babe. When I first encountered these birth facilitations I noticed the parallel in guided imagery used in cancer treatments, when the patient was encouraged to imagine the T-cells and the immune system dealing with tumours. If internal imagery were effective, why should not externally manifest imagery also work?

Narak allows for a holistic and non-invasive diagnostics and therapeutics—health promoting practices which do not violate the integrity of the body and facilitate the “jee” or life force. This concept then provides a mode of understanding allowing practitioners and therapeutics which can negotiate and affect the inner body without violating the integrity of the skin/body/life force. And indeed the dais’ health modalities are sophisticated in terms of emotional support and ritual practice. As well as practical utilizing touch (massage, pressure, manipulation, assisted squat, external version); natural resources (mud, baths and fomentation, herbs, gobar or cow dung); and application of ‘hot and cold’ (in food and drink, fomentation, heating placenta to revive baby, birthing body as ‘heated’ etc.); isolation and protection (from household work and maternal, familial and sexual obligations).

This interpretation of narak is congruent with some dais usage of the terms ‘opening body’ (labour), ‘open body’ (birth), and ‘closing body’ (postpartum)—for the entire process of birth time. These empirical terms stand in opposition to the factory model of birth (labour, delivery, failure to progress, false labour) implicit in many obstetrical terms. And interestingly the womb-bond between mother and newborn continues to be respected during this time—Narak ka Samay.

Implications for improving midwifery/dai training

MATRIKA findings about ‘Narak’ have great relevance to public health initiatives targeted at dais. As MATRIKA data has demonstrated above, dais say

“Bad blood must come out.”

Dai Trainers say

“Hemorrhage must stop.”

In the context of postpartum care narak relates to the ‘bad blood’ that dais think must exit the body. That energy of the maternal body associated with growing the baby is signified by the ‘black blood’—this fluid emerges signifying, not only the uterus contracting, but also that the mother’s body is transiting from holding the ‘other’ to releasing the other. Sometimes we heard that the ‘contractions’ were the womb ‘searching’ for the baby. Dai's imaging speaks a poetics of the body that attributes consciousness, activity and sensation to the uterus-- which is totally absent in the biomedical framework. The understanding and use of these concepts in dai training would significantly improve communications on controlling hemorrhage postpartum, as well as preserve the respect for indigenous meaning systems.

Furthermore, the Bemata figure encodes a process orientation towards birth and postpartum while providing a framework for diagnostics and therapeutics. In obstetrical practice the examination done immediately after birth, ‘the Apgar score’, is used to assess the well being of the newborn. It is a scale for measuring the infant’s process of adapting to extra-uterine life. But no such formal, process-oriented assessment is geared towards the bodily functioning of the mother postpartum, the time the dais call ‘the closing of the body’. Bemata seems to function as a diagnostic system assisting dais in their roles as caretakers of mothers, especially crucial in the six day post birth period.

The practice of not cutting the cord until the placenta is delivered is common in all the areas where MATRIKA conducted research. Doctors and health workers throughout the country also report it as the common practice. Dais have the utmost respect for these parts of the female body usually considered as waste products (by the bio-medical system) or highly polluting (by the Dharamshastras). It seems as though dais consider the infant-cord-placenta as a package. They have been together for nine months, cord and placenta functioning to nurture the fetus—why should they be severed too quickly?

Dais say
“Cut the cord after placenta is delivered”

If the baby is not active or does not cry then the dai rubs the cord, placing a coin or rice grain underneath it. By rubbing, heat passes to the baby. The baby often revives. Heating the placenta on a fire may also do this resuscitation. (Bihar)

After birth, if the baby does not cry or is hardly breathing, or even seems stillborn, the placenta is used by placing it on a heated surface -- pan or cow dung cakes. Life flows towards the baby most of the time. It is only after she knows that this is not needed that the cord is cut. (Delhi)

If the baby, once born, is not active, the placenta may be heated to stimulate the baby and bring it to life. (Rajasthan)

But trainers and health education messages throughout the subcontinent are teaching dais to cut the cord right away.

We modern, ‘educated’ women have come to believe that ‘pollution’ taboos are atavistic relics of a misogynist and patriarchal past—and that they should be superceded by ‘scientific’ understandings of the female body based on fact rather than superstitions. Our MATRIKA data, gathered by crossing boundaries and listening carefully, and respectfully, suggests that dais’ knowledge and practice are encoded in a language, a poetics of the body—which radically differs from that of bio-medical obstetrics, and is more congruent with other Asian medical/health/healing systems such as Yoga, Ayurveda, Tantra as well as Chinese, Tibetan and even Greek/Islamic medicine.

In order to facilitate communications in training indigenous midwives, as well as reclaim aspects of indigenous Indian midwifery for use with more privileged women
MATRIKA recommends the development of criteria for evaluation of dais and their practices drawing on Ayurveda and other indigenous systems of health maintenance and healing. Rather than using the evaluation perspective of biomedicine, indigenous tools of assessment will allow the incorporation of a human resource base which can complement existing ‘reproductive health’ facilities and practitioners.

An entire legacy of midwifery knowledge will be erased unless we begin to learn to think and speak the language of ‘narak’ (and develop dai-training materials dialoguing with that language). Or at the very least we should not cringe in disdain when we hear or observe women using these languages, or observing these practices. Finally, on the Asian subcontinent it is essential that we begin to include skilled dais in maternal child health programs at all levels. Hopefully we will all be able to cross boundaries, listen carefully and help the world to be born more humanely.

1. Shivaji K. Panikkar, Sapta Matrika Worship and Sculptures, Delhi, DK Printworld, 1997.
2. Anuradha Singh, “Her One Foot is in this World and One in the Other: Ayurveda, Dais and Maternity” in ed. Janet Chawla, Birth and BirthgiversThe power behind the shame, New Delhi, Har-Anand Publications, 2006
3. Jo Murphy Law-Lawless, 2003, “How Will the World Be Born: The Critical Importance of Indigenous Midwifery” in Royal College of Midwives’ Midwifery Journal, Vol. 6, No. 10
4. Janet Chawla, 2003, “Negotiating Narak and Writing Destiny: the Theology of Dais’ Handling of Birth” in ed Nilima Chitgopekar, Invoking Goddesses: Gender Politics in Indian Religion, New Delhi, Har-Anand Publishers


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