Traditional birth attendants play a central role during pregnancies, childbirth in remote areas. But due to the government’s push towards institutional deliveries, younger women have stopped taking up the profession.
Panchmahal, Gujarat: Kaliben Dholbhai Baria is a resident of Moghadhra village in Panchmahal district of Gujarat. The 55 year old has been a traditional birth attendant or a dai for over three decades.
“I have never lost a child in 30 years,” she said in an interview to Sahaj, an NGO that works on women’s issues in the area.
Hoyanis, as they are called in parts of eastern Gujarat like Dahod and Panchmahal, are the only medical assistance a pregnant woman can get in the area. Almost two decades have gone by since the Indian government decided to encourage institutional deliveries under the National Rural Health Mission (NRHM) through incentive schemes. In the process, the government also stopped training and remunerating traditional birth attendants. However, in most of the villages in the districts Dahod and Panchmahal – mostly inhabited by tribals – hardly any alternative mechanisms of medical assistance have developed over the years.
Under these circumstances, villagers have come to trust the hoyanis, who have over the time transcended the role of a dai and become more of a caregiver for women and at times even for men of her village.
“Contrary to popular belief, the hoyanis of these areas act as a bridge between whatever modern medical treatment is available in the area and the villagers. They work with a woman from her early days of pregnancy till the child’s vaccination post delivery. They advise a pregnant woman on a proper diet and counsel her against local superstitions around pregnancy and patriarchal customs,” says Renu Khanna of Sahaj.
“Adequate medical assistance to facilitate institutional deliveries has not come up in these areas. Hospitals are few and far between and are poorly equipped. To add to the lack of hospitals and PHCs (primary health centres), there are issues like bad roads, inaccessible terrain and lack of doctors and nurses in PHCs that make villagers depend on hoyanis. Illiteracy and even fear of hospitals are added factors,” said Khanna.
The hoyanis are usually Dalits or women from other lower castes. In most cases, despite a prevalent practice of caste and untouchability, these women have managed to cater to women of upper castes, owing to their skills and the lack of availability of an alternative medical support.
Some hoyanis have reserved themselves to cater to women of a particular caste only. Kaliben is one of them. She mostly caters to women of the Baria caste, considered as an upper caste in the social hierarchy of the area.
“Caste plays an intrinsic role in these tribal-dominated areas. A person from an upper caste would not drink water touched by people of lower caste. But when it comes to hoyanis, they have transcended the barrier of caste in a way. Women of higher castes have to depend on hoyanis, who might be lower in caste or even considered untouchable otherwise,” said Umesh Solanki, a documentary filmmaker and writer who had directed a film on the subject a year ago.
There are examples of what Solanki says in hoyanis like Shantaben Madhubhai Baria. The 65 year old has catered to women of all castes in her 50 years of experience.
Shantaben began assisting deliveries when she was 15 and learnt the tricks of the trade by observing local hoyanis. She remembers undergoing some training at Devgadh Baria, a small town in Dahod district, but never received any equipment from any organisation. Over the years, she has become a name that people trust. People even come from neighbouring villages to pick her up for a delivery. Many a time she accompanies the woman to the PHC or private hospital for an institutional delivery and despite the presence of doctors, villagers trust her with the child.
“Many of the villages in these areas are in remote locations on top of hills and amid forests. These areas are not easily accessible due to the lack of proper roads. In such cases, an emergency helpline facility 108 ambulance would refuse to take the risk to reach the family. Hoyanis take that risk, travel through the terrain and help women in distress,” says Smita Vajpayee who is associated with CHETNA, an NGO that has been addressing the issues of women’s health and development since 1984.
“In one such case, a hoyani carried a woman in a make-shift sling through hills to the nearest PHC at Devgadh Baria just in time to save her life. Hoyanis are the only hope for women who don’t have their families by their side in an emergency. There have been many instances where hoyanis have taken these women to hospitals, cooked food, stayed with the women, cleaned and even fed them,” added Vajpayee, who was one of many activists who played a pivotal role in the forming of Dai Sangathan, an association of traditional birth attendants.
The role of hoyanis has not been limited to child delivery, many of them have volunteered to help their own people in cases of general sickness and disease outbreak.
“Many hoyanis administer medicines to tuberculosis patients in their village. They visit the patient to see that medicine is being taken regularly,” said Neeta Hardikar, an activist from ANANDI, an NGO working with hoyanis in Dahod and Panchmahal.
However, since the government propagated institutional deliveries over two decades ago, these hoyanis have stopped receiving remuneration.
“On the day of delivery, I am usually given one kilogram to two kilograms of grain and a token amount of Rs 10. Later, when I perform chokkukarvanu, a cleansing ritual, anything between Rs 150 and Rs 500 is paid along with some grains and sometimes a sari depending upon the financial capacity of the family,” says Lakhudiben Nayak from Juni Bedi village.
The money given by families is usually more if the child is a boy.
Owing to the circumstances, younger women have stopped taking up the trade.
“In about 20 years, we have not witnessed a young woman wanting to become a hoyani. Most hoyanis who are working currently in Dahod and Panchmahal are between 40 and 60 years of age. Some are above 60 years of age even. As the old generation of hoyanis retire their numbers keep reducing. In two blocks of Dahod for example, there are 80 of them working as of now,” says Pradeepa, who is associated with ANANDI.
Damayantee Dhar is a freelance reporter.