Traditional Birth Attendant (DAI) Issues and Concern Presented by Dr. Ajay Khare

Who are They Traditional- Family based Traditional- Family based Old Women / Family Member ( Tribes) Old Women / Family Member ( Tribes) Trained for 30 days Trained for 30 days Mostly Schedule Cast, Some Tribes or Muslims Mostly Schedule Cast, Some Tribes or Muslims

Their work Care During Pregnancy Care During Pregnancy Identification of Danger Sign Identification of Danger Sign Assisting Labour Assisting Labour Care of New Born Care of New Born Post Natal Care/ Follow up Post Natal Care/ Follow up Disposing placenta Disposing placenta Massage Women / New Born Massage Women / New Born

Their Remuneration From Govt.- started from Rs 2 to From Govt.- started from Rs 2 to now Rs 50 now Rs 50 House Hold- Rs House Hold- Rs Kg Cereals Kg Cereals Sari Sari Some times Rs Some times Rs JSY- Rs / Delivery JSY- Rs / Delivery Birth Assistant – Rs 50 Birth Assistant – Rs 50

Deficiencies / Difficulties Mostly old, Illiterate, Poor Women, SC Mostly old, Illiterate, Poor Women, SC Work is considered dirty / untouchable Work is considered dirty / untouchable Training was given very old time Training was given very old time Unable t access new information/ Knowledge Unable t access new information/ Knowledge Mostly put pressure during delivery Mostly put pressure during delivery Bath New Born even premature baby Bath New Born even premature baby Retraining required Retraining required But deep rooted culturally and socially But deep rooted culturally and socially

Some Facts Available in most of the villages Available in most of the villages Villages Dais Villages without Dai 1026 Villages Dais Villages without Dai 1026 Dais Training started in 1973 Dais Training started in 1973 Training Component Training Component 1. Care of pregnant women 1. Care of pregnant women 2. Normal labour 2. Normal labour 3.Asepsis 3.Asepsis 4.Breast feeding 4.Breast feeding 5.Weighing new born 5.Weighing new born 6.Vaccination 6.Vaccination 7.Referral 7.Referral

Issues Some Dais became ASHA Some Dais became ASHA Some are Anganwadi assistant and competing with ASHA for JSY Some are Anganwadi assistant and competing with ASHA for JSY After Institutional delivery child and mother unattended After Institutional delivery child and mother unattended Deliveries on the way Deliveries on the way Villagers still have faith in Dais Villagers still have faith in Dais Some times waited dais for two days for cutting umbilical cord Some times waited dais for two days for cutting umbilical cord

Some Cases Mangaliya Bai 55Yrs- Village Markadhana Mangaliya Bai 55Yrs- Village Markadhana Illiterate, traditional dai, tribal village trained for 3 days, get only coconut or Sari, considered religious work, ASHA not available, Working as motivator for JSY Bhuriaya Bai 70 Yrs - Village Harsdiwari Bhuriaya Bai 70 Yrs - Village Harsdiwari Trained 6-7 years back, Selected as ASHA but JSY cases are taken by Anganwadi worker

Some Cases Ganiya Bai 70 Yrs - Village Bijori Ganiya Bai 70 Yrs - Village Bijori Familial work, received Rs 300, Cereals and Sari / Delivery She has conducted many difficult delivery After ASHA all income stopped Katto Bai 50 Yrs- Chhindi Katto Bai 50 Yrs- Chhindi Trained Dai, Very Popular, ASHA is not getting JSY cases

Some Cases Naziran Bee- Chhindi Naziran Bee- Chhindi Taken Fatwa for Dai work, Trained, Earlier Govt. paid 50Rs / Delivery and from family Rs 400 – 500, ASHA is not getting JSY cases Some Dais are conducting deliveries in PHC and CHC also