They are the traditional masseurs, the "delivery" women of Maharashtra, the dais, whose corpus of traditional health knowledge has been totally ignored by health policy makers.
These midwives, who could have been incorporated into the health system by serving in maternity wards of government hospital and health centres, still do "deliveries" at the rate of Rs 300 or Rs 400 (US$1=Rs 50) per childbirth in and around the slum areas of Nagpur. They massage the post-partum mother and the newborn for a wage of about Rs 700 to 1,000 per month, and charge about Rs 30 or 40 for an ordinary massage. Due to their association with work that involves a menstruating woman, they have traditionally been regarded as low caste and untouchable. Hindu society had regarded the process of childbirth, associated with bleeding, as unclean and traditional midwives were seen at par with sanitation workers.
There was strictly no physical contact between members of the household and the woman who had given birth as well as the one who tended to her during this period. In the midst of the rejoicing, the new mother was segregated and could not enter the kitchen or prayer room for around five weeks. The dai, who tended to the mother, also had to observe rituals of purification.
Girijabai, an elderly midwife belonging to the Matang caste, narrates how she still waits outside her own home until someone comes to give her a fresh sari and pour out some water for her bath. Dr Sita Gupta, a Nagpur-based college lecturer, describes how, at her mother's home in the village, water had to be sprinkled over the dais' footprints as ablutions before others could enter that part of the house.
For years, dais have had to clean up after the birthing process in the most unhygienic and primitive way. Girijabai narrates how the afterbirth was buried in a pit dug within the premises of the house. In the villages and slums in small towns, where there were stables for the cattle, this pit was often located inside the stable. A fire is lit over area where the placenta and other waste were buried for about 12 days as a purification process.
Sheela Chahande, who is well into her fifties, was brought into the world by a midwife - also called Girijabai - in her ancestral home which had mud-walls. According to Chahande, the midwife used to do the post-birth sanitation work for all the tenants of her paternal family. After delivery, a pit was dug into the mud floor, and the waste matter of the child and the new mother swept or poured into it. Each day, bath water, excreta and washing waste was thrown into this pit. No one was to have anything to do with the pit apart from the dai and the new mother. Also, according to traditional practice, the mother was not allowed to see sunlight for those 12 days and her only source of support and comfort during this period of isolation was the dai who attended on her.
The people of the Matang Samaj, or Mangs as they are called, practiced a few other traditional occupations, such as making brooms from palm leaves and playing music on simple instruments when the body of a dead person was taken to the pyre or "ghat". They are classified as Scheduled Castes (SC) but since many of them embraced Buddhism and followed the path of the great Indian reformer, Dr B.R. Ambedkar, they have managed to shed the caste tag. But they continue to remain socially and economically marginalised, caught between the old and the new.
Chandrakala Wankhede, a dai from the Matang Samaj, observes that because of the growing trend of women choosing to give birth in hospitals, dais have been deprived of their traditional occupation. Now they do just the post-delivery massages. She and her mother describe how they learnt their work from their own mothers. "I used to accompany my mother to houses for deliveries since I was 15," she recalls. "We learnt how to feel the pregnant woman's abdomen and estimate how many months the foetus she was carrying was, and work out when the birth would occur."
Her mother, Sakhubai Dhoke, explains how they dealt with emergencies. "If a hand emerges instead of the head, we gently squeeze it back in and turn the baby till the head is in the right position," she says, adding, "If a leg comes out first, we gently manoeuvre till the other leg emerges and we get the baby to come out legs first. We never use forceps, but try the massage and easing-out technique. If the placenta and umbilical cord remain inside, we wrap a piece of cloth on the upper part of the abdomen and push it all out."
In some states like Madhya Pradesh, the government has worked out a way by which dais are associated with hospitals as contract workers. Their expertise is thus used and they are paid per childbirth. But since the burgeoning of hospitals and maternity homes in Maharashtra, the Matang women, especially in rural areas, have been without a regular source of income. Some have almost been forced into begging. It has become a customary practice for people to give the 'Mangin', as she is called, old clothes, shoes, and leftovers. Kharebai, who now works as a peon in a school at Saoner, a tehsil town of Nagpur, describes how pauperised Matang women have to sometimes dry the stale rotis or puran polis they are given under the sun, and eat them over a few days.
Some within the community have been able to figure out ways to embrace change. Kalabai of Indora Jhopda argues that Dr Ambedkar's teachings and the possibility of conversion to Buddhism or Christianity, can be a way out for the destitute. While many of them have not experienced untouchability personally because of urbanisation and rising literacy, Kalabai still believes that her community members should educate themselves and seek jobs in other professions. Nanda, another dai in her thirties, points to the bane of early marriage which has ruined many like her. "In our community, girls are married off when they are very young," says Nanda. "I was married when I was about 13 or 14, but my husband deserted me and I had to resort to our traditional work to earn a living. Through great effort, I have managed to bring up my children. My daughter-in-law, however, is not interested in the profession," she says.
While the desire for change is great, it does not often translate into reality. According to Janardhan Borge, a lab assistant in a Nagpur school, about 25 per cent of children of the community drop out of school at the primary level and 50 per cent at the higher levels. As a child, Borge lived near Amravati and his mother used to work as a dai. But Borge ensured that his own sons received a good education, and they are presently in college with one of them training to be an engineer.
Borge's story is relatively rare in the Matang community. Most, especially the women, still live poverty-stricken lives. Which is a great pity given the fact that the skills these women possess are of great value in a public health scenario where the ratio of nurses and medical attendants to patients is extremely low and where infant and maternal mortality is a huge concern.
Shakuni Wankhade, who works in a local hospital, speaks for many when she observes, "Women in the Matang community are hardworking and loving. They provide a valuable service and need to be recognised for doing so."