Govt urged not to edge out 'dais'

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New Delhi, May 4 (UNI) A consultation on the role of 'dais' has called for integradation of traditional birth attendants into the country's healthcare system and warned that ancient wisdom was in danger of being lost with midwives finding no space in government programmes.

''Dais have been synonymous with childbirth in rural parts of the country since time immemorial. But suddenly they are being edged out of government health programmes due to several factors and their role as caregivers and health promoters beyond childbirth is being forgotten,'' said Dr Abhijit Das, Director Health and Social Justice.

A two-day consultation on the role of traditional birth attendants in the National Rural Health Mission, which concluded on May two, focussed on redefining and expanding the role of 'dais' in the institutional framework.

Dr Das argued that the emphasis on institutional births in order to lower materal mortality rate was misplaced as ''institutional deliveries did not always translate into safe deliveries''.

''While institutional deliveries have increased, there are also increasing reports about the lack of appropriate facilities and very poor quality of care, leading to life threatening complications in women. Post natal care is also important and it has been brought to light that discharge from institutions takes place well before time leading to danger to both mother and child.

''We are not saying that births brought about by midwives at homes are safe...we only want an integration of 'dais', who are storehouses of ancient traditional wisdom, into the governmental framework as they not just help in births and provide post natal care but are also a source of socio-psychological support.

Ms Mirai Chatterjee, who works with the Ahmedabad-based SEWA, said the meet discussed how to integrate 'dais' into the NRHM and the new paradigm of health care and institutional childbirth.

''Testimonies from 11 states show that 'dais' play a key role in childbirth in not just rural but some pockets of urban areas also, they go to places where doctors are not available or on call.

They also serve as health educators in rural areas and provide information about the immunisation programmes.'' She said the midwives also played a very pro-active role in health schemes and the government should recognise their contribution and include them in the public health system.'' Dais are of the people and help in the implementation of the healthcare they not only play an important but also a complementary role along with government workers.'' The meet also called for recognising, preserving and documenting the traditional practices followed by 'dais' and said the midwives should be made active partners along with ASHAs and ANMs in the NRHM.

It wanted that an accreditation council should be set up for training 'dais' to ensure quality standards and investment in grassroots organisations for the midwives.

Dr Das said the government figures about institutional births in some states were ''not accurate''. ''Claims about very high percentage of institutional births can be debunked by the abysmal figures about trained workers in the institutions.'' The 'dais' said though the remuneration was meagre and at times no-existent, the motivation was to be part of a community service and carry on a traditional practice.

Babiben Parmar, president of Gujarat Dai Sangathan, said apart from support during childbirth, the midwives promoted immunisation and helped in the prevention of tuberculosis and HIV/AIDS.

''We also recognise the danger signals in pregnant women and refer the risky cases to hospitals and accompany them there.'' Narmadabai from Chittorgarh in Rajasthan advocated the upgradation of skills of midwives through training at the village level.'' This will ensure that the community respects our skills and the public health system recognises the role of midwives.'' On the role of midwives, the government has said the NRHM has not disowned the 'dais'. ''It is up to the state governments to be innovative and integrate the midwives. NRHM is considering guidelines for financial incentives for them,'' said Dr Manisha Malhotra, Assistant Commissioner in the Ministry of Health and Family Welfare.


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