Web Special | Bring the midwife back into the NRHM paradigm

New Delhi: Janakibai is from Khargone district in Madhya Pradesh. She is one of the 10 lakh dais who works as a traditional birth attendant (TBA) in the country’s rural areas and urban slums. She has over the last two decades delivered 3-4 babies every week and is compensated by being paid anything between Rs25-100, a sari, bag of rice or just a coconut, depending on how much the family can afford.

Of greater value to her is the trust and respect she has earned from the young and old alike. She has groomed herself to be a semi-health worker, providing services that go beyond childbirth. Diligently carrying out post natal visits, she informs families about polio vaccinations and booster doses, promotes family planning, counsels on HIV/AIDS and drives home the importance of health insurance. With an enhanced awareness, she can make appropriate referrals to healthcare facilities in complicated cases, saving precious lives.

Janaki, along with 100 midwives from 11 states and their civil society organizations were in the capital recently to make a representation to the government for having a more defined and concrete role in public health programmes, specifically the National Rural Health Mission (NRHM). After having been part of the public health system for generations, these TBA-dais find themselves on the periphery, marginalized and ignored as castaways. They are seen as being redundant and are blamed for the high numbers of maternal and infant mortality rates that continue to haunt rural India. The government’s emphasis on institutional delivery and on including ASHAs (female local health volunteers) within the NRHM, has been at the cost of diminishing their worth. They want the NRHM, which is three years into its seven-year lifespan, to re-examine their delegitmization and to bring them back into the mainstream public health domain.

Dr Manisha Malhotra, assistant commissioner, Ministry of Health and Family Welfare clarifies that, “The NRHM has not disowned dais. It is up to the state government to be innovative and to integrate them into the public health system. The NRHM is considering guidelines for providing them financial incentives.”