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Delhi workshop 1 synoptic report



Collaborating NGO: Action India

Dates: 7- 9 August, 1997

Venue: Gurudev Ashram, Chhatarpur, Delhi

Participants: 11 dais (10 from Jehangirpuri, 1 from Sunder Nagari )

10 Action India members
6 Matrika members

Activities

Sessions During Workshop:

Day 1 -- 1 7.8.97
Personal and group introductions by dais and Action India
Role-plays on childbirth (in small groups, sharing with the whole group)
Slide show on images of women.


Day 2 -- 8.8.97
Personal and group introductions by Matrika
Body mapping (in small groups and sharing with the whole group)
Massage


Day 3 -- 9.8.97
dais' questions regarding particular interventions, response from
Matrika and general discussion
Feelings and evaluations; and expectations/plans for future work.

Post-Workshop Evaluation and Planning Meeting
9.8.97  6 Matrika members
              6 Action India members



  1. Knowledge, Skills & Practices Before Birth
    1. The dai is called when the Jacha gives the signal to her family Saas, Jethani or neighbour. Whatever time of day or night it is, the dai comes to the Jacha's home.
    2. The dai may check the baby's heartbeat with her ear to the Jacha's belly.
    3. The dai will check whether the head is fixed , shareer bhar gaya hai.
    4. She notes the position of the baby, confirms that it is normal, seedha .
    5. In A.P. the dai pours castor oil on the navel, and if it is full term it will flow to the end of the womb. Also, the size of the baby is measured by placing hands on the upper and lower belly.
    6. If the contractions indicate early stage of labour, kacha dard, the dai advises the woman to keep active by walking, doing light work. She advises her to take contractions by holding onto a wall or a ledge.
    7. The dai may request that only one or two family members (or elder woman of the neighbourhood) stay in the room, so that the work of birthing can be done with concentration. No men can stay inside.
    8. She asks for water to be boiled, sterilises blade and thread.
    9. She keeps her attention on the Jacha, talking with her, joking, reassuring her, asking questions and noting the progress of labour.
    10. If progress is slow, or the woman is weak or tired, then the dai gives her a warm drink. This may be coriander warmed in jaggery; or ajwain and ghee in milk.
    11. If progress is slow, the dai may apply light pressure on the upper belly.
    12. She may place hair in the Jacha's mouth for gagging.
    13. All knots on the woman's clothing, her hair, any other knots in the room are usually untied. In Rajasthan, all the locks and windows of the house are opened, the Jacha's bangles are removed.
    14. In Rajasthan aata is kept in a thaali and cut in two before the birth. The Jacha herself is asked to cut it, with a coin. It speeds the birth, and symbolises the cutting of the umbilical cord.
    15. In Bihar, when the woman has contractions, two separate heaps of grain are kept, one is for Gau Mata, the other for hal-halo Mata. The belief is that Dharti Ma will protect the child. [Gau means cow, hal means plough, both terms associated with cultivation]

  2. Knowledge, Skills and Practices During Birth
    1. When she observes that the woman is ready to deliver, the dai asks her to squat on two bricks, or to lie down. The dai exercises her judgement here. Traditionally, squatting is preferred, but if the woman is weak or is multigravidae with a history of prolapsed uterus, it is better that she lie down for the birth.
    2. The dai massages the Jacha's perineum so that it becomes maximally flexible.
    3. The dai and other attendant support the woman through the birth. If the woman is squatting, then one attendant is at the back, providing pressure at the lower back, and the dai sits in front: the woman may lean on her during a contraction.
    4. No dai will tell a woman to push until and unless the contractions are hard (pukka dard).
    5. When she finds the woman absolutely ready to deliver, she tells her to push. Many dais relate that there are three pukka dard. During the third, the baby is delivered.
    6. During birth, dais pray to teeka . The belief is that when the time is ripe, teeka will send the baby, no sooner and no later. It is mukti (liberation) for the baby, from the nau maheene ka narak kund (nine months' hell).
    7. Among Bengalis (according to the dais present, none of whom was Bengali), it is common to receive the child from the back. The Jacha is on all fours, and somebody is there at the back to take the baby. Somebody may hold the stomach from the back. Some dais said in this position there is pressure on the chest and this helps the child to move downwards.

  3. Knowledge, Skills and Practices After Birth
    1. The dai or another attendant cleans the mouth and throat of baby, and the anal passage by inserting finger dipped in oil.
    2. The dai massages Jacha from stomach to pelvic area, to facilitate placenta delivery.
    3. She may put a hair in the mouth to make the Jacha gag to facilitate placenta delivery, or ash mixed in water is given to her to drink.
    4. The Jacha may be told to call out her mother or mother-in-law's name.
    5. After removing placenta the cord is tied and cut. Most dais do this, but some Rajasthani dais consider it a sin to cut the cord (a paap that equals the killing of a 100 cows). One elderly dai at the workshop said that though she has delivered many babies she has cut only 12 cords -- her own. She has herself had 12 children. She always makes the Jacha cut her own cord.
    6. If the dai cuts the cord, she donates something for the gods.
    7. Later, the dai buries the placenta and cord. In Bihar a boy's placenta is buried under the bamboo bushes but that of a girl is thrown in the garbage can. In Rajasthan the placenta of the first and second child is buried, but if there is a third or fourth girl the placenta is thrown in the garbage so that a girl is not born again.
    8. The dai ties the Jacha's stomach with a broad cloth.
    9. The baby is bathed and wiped, dressed and may be placed next to the mother at this point. The baby is usually given a lick of honey or jaggery, and may or may not be placed at the breast immediately. dais in Delhi are from various communities (Rajasthani, Punjabi, U.P., Bihari, Andhra etc), and so are their clients. Often, the dai is from the same community, but not always. If she is from a different community, she is sensitive to their customs and respects their practices, for instance with regard to breast-feeding. In several communities, the Nanad or another woman of the husband's family cleans the woman's breast with doob grass and warm water, after this breastfeeding may start.
    10. The Jacha passes urine in a bed-pan.
    11. Her pelvic area is pushed firmly by the dai, aidi dena, using the heel of her foot. This is done for some time every day for the next few days.
    12. A pad of cloth may be placed inside to soak blood.
    13. The Jacha is told to cross her legs. For at least two days, she should keep her legs crossed most of the time. She should not get up and walk about or else gas would form.
    14. In some communities, the mother may be given milk and ghee soon after birth. In Bihar, no food may be given, except ajwain , for 12 hours; later milk with jeera and jaggery is given. Next day she is given aata ka halwa (flour cooked in oil/ghee and sugar). No salt is given to her until Chhatii day; on that day, different kinds of food are cooked and given to her. In Rajasthan, no solid food made of grain is given for six days, but she is given dry fruits and ajwain .
    15. For several days, there are special preparations for the mother. These are different in different communities, with the objectives of providing nutrition, helping the uterus to shrink and aiding milk production. Some examples are -- chutney (fine paste of garlic, curry leaves and mustard seeds) with rice in A.P; a spoonful of ajwain daily in Rajasthan, helps food digestion ; milk with ghee, ajwain and jaggery etc.
    16. Mother and baby are massaged. There are differing massage practices. In most places, the stomach is massaged gently and with the purpose of helping the uterus move back into its original shape and place, and aid removal of blood from the womb. The navel may be pressed to help settle the uterus. Some dais massage the entire body. The legs may be massaged with force, because the woman's legs tend to become weak after childbirth. Some dais massage only the head, (.."because if there is tension in the head, there is tension in the whole body, if there is peace in the head there is peace in the whole body, if the head is cool, the whole body is cool. After massage I tell the woman to lie quiet, talk to no one for a while. I ask her what she wants to have. If she wants milk, I give her milk, if she wants rice and dal, I give her rice and dal", Ram Pyari). In A.P. the massage is with arandi oil.
    17. The mother is advised to rest as much as she can for about 40 days.
    18. In Bihar, for 40 days the mother does not enter the puja ghar, touch the gods or do any puja. She cannot touch utensils and lives in a separate room. Nor is she allowed to rest or sit under a tree. Doors and windows are closed in the evening. Such measures are to keep away any evil spirit which may otherwise harm baby and mother.
    19. Chhati is performed a few days after birth. The mother is bathed, dressed in new clothes, and taken to the water source for worship. Before Chhati she is not allowed to touch household things or cook, after Chhati she can. The Rajasthanicustom is to make her sit outside the house on a chauka (platform), and the pandit perform puja for mother and child; Nanad puts teeka on the mother, and keeps cowdung cakes in the room where childbirth took place; Saas and Nanad get new clothes. At Chhati , all mud vessels in the household are broken and new ones brought in. In A.P. on the 10th day, Chhati is celebrated. Adolescent girls are called and the woman is given green bangles, flowers and coconut. On the 40th day there is well worship, the mother and baby are taken to the well by married women and bathed. The land near the well is mopped with cow-dung and then five kinds of grain are sown there. Paan, supari, sindoor are thrown in the well, then she carries water from the well home. For 40 days she does not touch cold water. For three months she has no physical contact with her husband. In Punjab, on Chhati day the pandit is called to do puja and make the child's horoscope. In Bihar, well-worship is done by throwing sindoor into the well.

  4. Complications Before, During and After Birth
    1. Breech presentation is handled by the dai. She is able to manually change the baby's position, through massage done slowly, skilfully and very carefully, to the seedha position.
    2. A terha presentation is more difficult for her to handle. Unless it changes to seedha, most dais advise the woman to go to a doctor for the delivery.
    3. Delayed labour is handled by the various facilitation techniques already described. If delay persists beyond 12 hours, most dais say they get an injection put, or, if they are themselves trained and competent to do so, they administer the injection themselves.
    4. Most dais have handled the birth of twins and are confident about it.
    5. Some dais report birth of monster babies (tera toma ??)
    6. After birth, if the baby is synosed or hardly breathing, or even seems stillborn, the placenta is used as a resuscitation device. The dais report doing this by placing the placenta on a heated surface, a pan or fuel-cakes. They report that life flows towards the baby in the majority of such cases. It is only after this that they cut the cord.
    7. Post-partum haemorrhage is a source of great worry for the dais. They recognise that this often occurs if the woman has delivered a third/fourth/fifth girl. Most dais said they have therefore made a practice of never informing the Jacha about the sex of the child immediately after it is born, be it a boy or a girl. They are very keen on advice on handling post-partum haemorrhage. They are well aware that if the woman is taken to hospital it may already be too late.

  5. Understanding of the Body, Health and Disease
    1. Local names of body parts and physiological processes relating to childbirth were accessed, amid a lot of giggling, bantering and teasing. From the dynamics we understood a lot of sharam (shame) and taboos surround this area, but at the same time there is subtle acknowledgement of hidden pleasure. Women's body parts are invariably terms of abuse, used frequently by males.
    2. dais are specialists in this area, therefore, partake of both the sharam, the pollution, and the pleasure associated with it. Once inhibitions were crossed, the dais made sketches and clay models, and described processes in local idiom.
    3. c) While some dais acknowledge the role of the woman's egg in conception, some speak only of the male keeda (insect). In the womb is a katori (bowl) wherein the baby begins to form.
    4. Some nalis in the pelvic area are important in descriptions of pregnancy and birth. The dais describe more by doing than verbally, so while massaging they could show
    5. different parts and processes.
    6. Also, during the workshop, a pregnant woman from the ashram needed help, which the dais provided. She was approaching full term and feeling extreme discomfort and exhaustion. Usha dai examined her, and treated by vigorous kicking on the thighs and buttocks, which provided immediate relief. The treatment had helped move the baby into a more comfortable position, and helped the release of gas. Bala, the pregnant woman, experienced great relief.
    7. Speaking of breast- feeding, the eldest dai, 90 year old Chhoti Devi, said a baby should learn how to suckle and if the mother is tired, she immediately puts her, even now, to her own breast!
    8. One sub-group linked body parts closely to rituals. In Bihar the breast is cleaned by the new mother before beginning breast- feeding, with her own long hair -- analogous to Shiv Bhagwan's release of the Ganga from his hair.
      1. Another group linked the physiology of childbirth with their belief in teeka . teeka makes clay figurines, babies. First, she makes it the size of a grain, in three months it reaches the size of a fist. After three months, body parts are moulded, and in four months life is blown into the figurine.[See more in section 10 below].

  6. Formal and Informal Health Delivery and Referral Networks
    1. Except for three of the oldest dais at the workshop the rest have all taken a formal dai training course, one month to one year long. Most said they have learnt the work from traditional dais, and at the formal course the only new skill learnt was how to administer injections. One had apprenticed with a doctor for some years; another learnt from three different places. There was a consensus that "real learning has been from apprenticeship -- from observation and experience; bookish learning has not been of use."
    2. The dais are aware of the higher status and legitimacy now attached to the formal system, and try to align with it, primarily, so they retain a foothold. Injections, registering the Jacha, registering the baby. Some have extended their responsibilities to cover these areas.
    3. All dais exercise their discretion regarding complicated cases. Most advise a woman with a breech presentation to deliver at a hospital. Many dais have established some link with one or two public hospitals or private clinics/doctors. They usually undertake to take the woman there. They are sometimes able to provide her with speedy and appropriate medical attention. This is almost always due to their personal contacts with a doctor/ clinic etc. dais voiced the need for identity cards so that their professional status is recognised and they can formally obtain speedy attention for the patients they bring in.
    4. Some dais have had a great deal of exposure to the medical system, whether it be public hospitals or a private clinic/ doctor; and also the RMPs. All are unanimous in their criticism of the following practices – no one, family or dai, is allowed to accompany the Jacha during her delivery.
    5. Injection is frequently administered during kacha dard, which is extremely dangerous.
    6. The doctor makes a cut (episiotomy) which often gets infected later.
    7. Doctors simply do not have the skills of massaging and generally facilitating and guiding;
    8. Far too many Caesarean births; in the majority of cases it is totally unnecessary; often the woman retains blood clots.
    9. Too much money is charged, it is a business with no sanctity attached any more.
    10. RMPs are sometimes good, but often crooks, “neither dai nor doctor and may kill people.”
    11. The dais are keen to collaborate with Action India to start a Birthing Centre in Jehangirpuri wherein they could conduct deliveries.

  7. Identity and Status of dai
    1. The dais are almost uniformly low-caste and poor, though the extent of poverty varies, from the Rajasthanidais who break stones for a living, to the relatively well-off upwardly mobile lower-middle-class ‘trained dai’.
    2. As repositories of knowledge of the female body and being, traditional dais command respect within their communities. They are accepted as wise, and often referred to for various kinds of advice. Yet they are untouchable -- for caste reasons, reinforced by the ‘dirty’ and polluting nature of the work they do.
    3. dais are beginning to recognise intense competition from the formal medical system and the need to establish their status as professionals. They are confident of their skills but keen to upgrade their knowledge. They are keen to earn both respect and money for survival.
    4. The knowledge about birthing is not monopolised by dass. Among the Bengalis in Jehangirpuri, women of the household conduct the deliveries and there may be no specialised dai at all. In our sample at the workshop, one dai had learnt the work from her mother; another from ‘nature’ (observing animals when she took them grazing as a young girl in her village...using her intelligence...also, being the only one present, as a young woman, when a woman with whom she had gone far into the forest to collect fuelwood, went into labour.); others learnt by apprenticing with an older experienced dai in the neighbourhood.
    5. Most of the dais are illiterate, but the younger crop has usually studied up to a few classes.
    6. The newer dais seem to sometimes take on cases before they have learnt the skills thoroughly, and end up combining the traditional with the modern, not always to advantage.
    7. The dais express enthusiasm for Action India's proposal that they unionise in order to establish their status and credibility and struggle collectively for improved conditions of work. This will be a long and complex process. dais are independent women, not used to collective organising. (During initial introductions, a dai Ram Pyari misunderstood the word ‘group’, thinking it is guru-- this speaks of an underlying difference in their experiential understanding. Typically, a dai learns her work from an older dai whom she considers to be her guru.)
    8. Some dais are keen on good payment for their work, while others do not feel the need. One or two of the oldest ones refuse to take any money on grounds of the sanctity of the work ("It is not I who delivers, it is God/ teeka . I only help. God has given me this gift. How can I charge money for this? I have conducted so many deliveries but take no payment.") This being the situation, Tara, one of the dais who has brought up children solely on the income from her work as dai, notes that "women who accept less money spoil the market". However, even the most money-minded dai exercises her discretion when it comes to payment, and takes less, or nothing, from a woman who is very poor.
      1. There is unevenness as regards skills, with the older dais usually more patient and philosophical, affectionate and skilled; the younger dais we found relatively harsh, hard and lacking in skills of support and facilitation.

  8. Stories, Songs, Beliefs
    1. There is widespread belief in teeka , the "old white-haired woman who leans on her staff and lives underground and keeps making clay figurines, which she throws up and around....It is she who decides precisely when a baby will be born...." Not only that, it is teeka (or Bahimata) who writes the fate of the child on the forehead (for a boy) or back of the head (for a girl) -- a fate which nobody can change. Once, teeka wrote for her own daughter, that the girl would marry a Dom and also marry her own son. When the girl came to know, she asked her mother to change the predictions, but teeka said that even she was unable to wipe out whatever she had once written. Resentful, the girl left home. Much later, she met a man on a horse who requested her hand in marriage. She agreed, thinking of him as a Rajput. But one day, when she was living with him, he was called to make an announcement for the birth of a son born to a zamindar. It was only then that teeka 's daughter realised that she had married dom. By this time she was pregnant. She wanted to kill the child, but she could not bring herself to do so. She delivered her child, wrapped it with her chunni and left him in the river. banjaran found this child and brought him up. In this village, teeka 's daughter also happened to be working. The banjaran asked her to marry her son. And she married him. On the day of Rakhi, the banjaran told her daughter-in-law that she could open all the trunks except one. But teeka 's daughter opened the trunk she was told not to touch, and found the chunni she had used for her child. She asked her mother-in-law about it who told her the story of the child that God had sent to her in the chunni . Thus the teeka 's words came true. teeka cannot change even her own daughter's fate.
    2. If a baby smiles, it is said teeka is making her smile, if she says your mother is dead the child cries.
    3. A fifth girl child is born to a woman, the woman is worried but the baby speaks and says she will not stay for long with her. The family had a lot of debts. In the evening the money-lender came and asked them to vacate the house, then the new-born girl speaks and says that there is some money in the house, and directs where it is. So the debt is repaid and the family continues to live in the house. Then the girl runs out and climbs a pipal tree, with red clothes on. People come to her with their problems and she helps out. After a few days she just disappears.
    4. A number of songs were sung, including Sohars i.e songs specially associated with birth. The dais are extremely lively, and quick to procure a dholak (drum) and sing and dance. Even 90-year old Chhoti enjoys singing and dancing, often solo. However, the major dance was by Ram Pyari who was vigorous, with weird animal faces and movements, quick -- and this was mirrored by Janet from Matrika, which Ram Pyari enjoyed thoroughly.

  9. Socio-Economic Profile of the Area
    1. Jehangirpuri and Sunder Nagri are resettlement colonies, which were founded in the mid-'70s, with the objective of ‘cleaning up’ the main city. A number of resettlement colonies were created, in which large numbers of poorer people were provided with tiny plots of land at subsidised rates. Many plots were granted in lieu of `voluntary sterilisations'...!
    2. These are large colonies, with row upon row of tiny ramshackle houses. Characteristically different communities live huddled together in certain rows and blocks.
    3. Some communities still keep animals -- buffalos, pigs, goats etc. so these can be seen crowded up in the narrow lanes and by-ways.
    4. There is no provision for latrines with each plot, rather community latrines have been built after every few rows. These are typically in filthy condition, due to a very high number of people per latrine.
    5. The number of people in Jehangirpuri is a few lakh. It is extremely overcrowded. While some families are better off, with a salaried earner, and manage to educate children through school, most are not so lucky. Large numbers of women do small-time home-base piece-rate work -- sticking bindis, stitiching vests, etc.
    6. Hygiene and sanitary conditions are deplorable. Sewers are often full. Water is available for restricted hours, that too varies. Jehangirpuri has been created on low-lying land and in the monsoons it often gets flooded as the Jamuna waters rise.

  10. Relevant Background about the Collaborating NGO
    1. Action India has been active in four resettlement colonies for over two decades. In Jehangirpuri, Action India's interventions began soon after the establishment of the colony. A number of community-based activities to improve the health situation of the residents have been undertaken, through a small number of full-time women health workers, and a larger number of women organised under the rubric of `Sabla Sangh'.
    2. At present, Action India's health programme here is active in the area of fertility awareness, herbal medication, `Apni Rasoi' which is reinforcing the value of women's traditional knowledge regarding nutrition and herbs.Violence against women is also tackled. A small-savings scheme is doing very well.
    3. Action India has been keen to begin work with dais so the Matrika workshops would help them gain a deeper understanding of the dais' work, and strengthen linkages. In June '97 Action India had its first meeting with dais, which went off very well. It is a tribute to the organisational skills and ground-level credibility of the local Action India workers that they were able to motivate 11 dais to come away for 3 whole days, for a workshop wherein no money nor any degree were involved.
    4. In the first meeting itself, the idea of a union of dais was floated and accepted enthusiastically.
    5. By the next meeting, the idea of a small-savings scheme was described in detail, and the dais have been very enthusiastic about this.
    6. At the workshop, dais expressed liking the fact of having met each-other, which had not happened before.
    7. The idea of setting up a Birthing Centre is extremely appealing to the dais.
    8. Action India requested Matrika to provide material and assistance for the ‘Birth’ tent in their Health Melas , scheduled for September '97, and for filming the three Rajasthani dais. Both of these requests Matrika agreed to.
    9. Action India also expressed the need for information-cum-ideological training sessions for themselves, the community-level workers, on the theme of childbirth. Also, they requested training in Active Listening, to help them build up profiles of women, also of dais.
    10. dais wanted Matrika and Action India to do advocacy for their methods in their local areas -- speak at public meetings etc.

  11. Special Insights
    1. One of the aged Rajasthani midwives, Dhapo, said that traditionally nobody will cut the umbilical cord, except the Jacha herself. This is because the cutting of the cord is considered a paap (sin), since by this cutting, the source of life is severed. Dhapo and others said that the cutting of the cord is equal to the paap of killing a hundred cows. Even when the Jacha herself cuts the cord it is a sin but far less severe.
    2. Whoever cuts the umbilical cord should make an offering to the deities. If the mother has cut the cord, she must make an offering. dais always pay obeisance and make an offering before they begin handling the delivery.

     

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