Where There Is No Midwife

Birth and Loss in Rural India

Sarah Pinto

• Publisher: Berghahn Books
• Year: 2008
• ISBN:
  9780857450333
• Edition: 1
• Topic: Sozialwissenschaften
• Subtopic: Genderforschung

In the Sitapurdistrict of Uttar Pradesh, an agricultural region with high rates of infant mortality, maternal health services are poor while family planning efforts are intensive. By following the daily lives of women in this setting, the author considers the women's own experiences of birth and infant death, their ways of making-do, and the hierarchies they create and contend with. This book develops an approach to the care that focuses on emotion, domestic spaces, illicit and extra-institutional biomedicine, and household and neighborly relations that these women are able to access. It shows that, as part of the concatenation of affect and access, globalized moralities about reproduction are dependent on ambiguous ideas about caste. Through the unfolding of birth and death, a new vision of "untouchability" emerges that is integral to visions of progress.

Chapter 1

WORK WHERE THERE IS NO MIDWIFE

Dais who don’t deliver

I went to Sitapur to talk to “midwives.” An interest in women I had long known to be called “dais” (something readily translatable as “Indian traditional midwives”), in their social position, the nature of their work, their uncertain role in health interventions: these are the things that carried me through graduate school and readings of historical and ethnographic accounts of birth in South Asia, through interactions with NGOs and advocates in different parts of India, finally to Sitapur, for a “study” of my own. Dais were something I thought I knew. Now, I find myself beginning stories about Sitapur with the moment at which the bottom falls out. The inevitability of this framing may come from the force of familiar ethnographic beginnings, or it may come from what the NGO director in Lucknow tells me on my first visit to his office to hear about “dai trainings”: “Dais here,” he says, “don’t do deliveries.”

The comment takes me back to my first visit to India when I was already drawn to the creative and disruptive capacity of this fantasy person—the midwife. I had wanted to talk to Tibetan women in exile about their birth experiences, and had thought about locating a “traditional midwife” to talk to. A friend and I walked into the town in Bihar where we were on a student program, into the “STD” office where patchy, expensive international calls could be made. His aunt in America had done research with Tibetan women, and she could tell me where to start. After awkwardly yelled introductions, she said, “The first thing you need to know is that there is no such thing as a ‘traditional midwife’ for Tibetans.”

Years later, in the Lucknow office of Mahila Seva Sansthan, I try to clarify what “no midwives” means with the director—an American man who has been running dai trainings for several years. He is patient, and seems himself quite taken with the situation. Faced again with “no midwives here,” I feel trailed in my obsessions by the predictable (and orientalized) cunning of “the local.” But as the clear outline of “the dai” blurs, a specificity emerges that is also about the “global,” about a dialectic of ideas about what is “local” that orients much about interventions. I visit Mahila Seva Sansthan field sites with supervisors and field coordinators, talk with women who are and are not quite “dais.” I observe complicated hierarchies of trainings with workers from other NGOs in Lucknow—aid organizations and hospitals connected like extended kin through bloodlines of funding, family names of project titles, and complicated myths of origin. I go to villages further and further from Lucknow, talking, still, to women who both are and are not quite “midwives.” I visit Varanasi, a half-day’s train journey to the east, and have more of the same kinds of conversations with NGO workers and “village women,” all in an effort to find a place in Uttar Pradesh where there is something more like “midwives.” I plan a trip to Gorakhpur that is thwarted by illness (my own), then decide that maybe it is time to stay put for a while. Dais in Varanasi and Gorakhpur, it seems, also “don’t do deliveries,” or maybe they aren’t quite “dais.” I am confused by the language politics: in foregrounding “the dai” I have demoted the women I am meeting (all of whom perform a range of tasks associated with birth, none of whom do everything) in the same way I have long felt international and Indian agencies demote “dais.” How am I to think about the advocacy work I have been moved by in Delhi and Bihar, or the shape of conversations about “traditional knowledge” I have understood to be the central theoretical dilemma of “training”?

Anthropological beginnings are often marked by the disappearance of the object of inquiry; spaces open up in the places that seem most known, to be filled in again with reckonings of newness. What Lawrence Cohen describes as the search for the missing “it”—the way we chase obsessively after the thing, following nattering old ladies down alleys like paparazzi of the abject, as Cohen so marvelously describes (1999), or the way I spend months in motion around central and eastern Uttar Pradesh in search of the “real dais.” My own loss of the cultural object feels somehow right, even as it happens in a place where ethnographic certainty feels indelible. I reread older ethnographies and colonial accounts—some half-memorized by this point—with a different eye. What did it mean that Patricia Jeffery, Roger Jeffery, and Andrew Lyon had noted in their seminal work on birth in western Uttar Pradesh that dais often consider their work to “begin after the baby is born, not before” (1989: 109), or that Doranne Jacobson mentioned that a midwife’s arrival may be delayed for hours after the baby is born, but the cord left uncut until her arrival (1989: 64)? I now read the whirl of ghosts, witches, placentas, umbilical cords, and “untouchable women” and their iron blades that populate George Briggs’s 1920 account of Chamars as banal, even scientific.

The absence leads to no clear moment of revelation, though at times it is tempting to tell the story that way. Around the time that I begin to see appearing in my notes a structurally appealing map of “birth work,” a division of “labor”—the labor of birth workers mapped onto the labor of birthing women, so nicely illustrating P. Jeffery and colleagues’ 1989 title (Labour Pains and Labour Power)—I move to a village about eighty kilometers north of Lucknow. I call the village Lalpur now, though its real name is more evocative than any I can come up with (I am stuck with the sense provoked by lal [red], metaphors of redness that drive associations with shakti, women’s power, and the stuff of birth). I live there in a room in the outer courtyard of a prominent Srivastav household. Over my room’s door, next to the cowshed and threshing machine, hangs a sign saying “Post Office,” and just beyond it the brick-paved enclosure is a gathering place of both governmental authority and domestic concern. Long days in the yard with men and in the interior angan (courtyard) with women mean long hours watching comings and goings—visitors, household and agricultural workers, children to “watch” me, and women to chat with the two women I come to call Bari Bhabhi and Choti Bhabhi—elder and younger sister-in-law.

The Bhabhis stay in the inner courtyard most of the time, though Bari Bhabhi comes out every day to milk the cow. Their “seclusion” of purdah is a busy and social one. Amma, their recently widowed mother-in-law, lives out her new social position unfettering the requirements of suhag (the auspiciousness of wifehood) by sitting for hours in the outer yard. There is a mix of relief, fatigue, and uncertainty in the air. Her husband had had a heavy hand with women of the household, and no one knows quite what will happen in his absence. Women, often elderly and low-caste, come and go through outer and inner courtyards. The busyness of the angan has an echo, I sense, in the movements in and out of the space of childbirth. During labor and birth, the sor—the room of childbirth—can be as social, I come to learn, as it is quiet and secluded during postnatal recuperation. My pretty structural map of birth work becomes inhabited. And it becomes temporalized, a matter of movements and rooms and houses and neighbors and changes over a sort of time in which what is “the body” and what is “the social world” are not so easily separated.

Women in Lalpur don’t talk much about “dais,” but when they do, it has a ring of translation to it. “The state makes you a dai,” one woman says to me by way of explaining the term. Others use it as a way of clarifying things for the benefit of someone from “outside.” Translation, where birth work is concerned, is not in the purview of the ethnographer. In other words, with this “division of labor,” as I have begun calling it, it is not the case that there is anything new (new old, or new emergent) to be “discovered,” nothing to be identified as a basic lacuna in either “local knowledge” or “knowledge about the local.” Rather, in the figure of the “dai,” certain moralities and assumptions about the world don’t so much clash with “local realities” as they flow alongside the lived exuberances, anxieties, and actions of rural birth.

I begin my stay in Lalpur by trying to hang around with the two women who do the most specialized birth work I can locate—postpartum work. These Dalit sisters-in-law are called by most “the Chamarins.” Neither is especially excited about my presence. In different ways, they present my questions and attempts at conversation with evasions, too-short replies, silence, and at times annoyance. I hear detailed, moving birth stories from Bari and Choti Bhabhi, often related on the road to somewhere else—in a bus or the back of a cycle rickshaw—or in the quiet darkness of winter nights while we cook dinner. In other homes, birth stories are harder to come by, hardly the privileged or critical genre recognizable in ethnographic accounts of reproduction, internet blogs, or birth activists’ writings in the West. Women don’t remember which detail pertains to which child’s birth, or who actually delivered which or any baby. “There were so many people there, it is hard to know,” one says. Pushpadevi, the Dalit next-door neighbor who becomes one of my most talkative interlocutors, says, “You want to hear stories? What is there to tell? It is like this: there is a lot of pain.” Others remember extraordinary cases by recounting less the body’s story than the situations surrounding it—“When my daughter-in-law had her baby there was so much rain, rain you can’t even imagine, rain coming down constantly for days…”

But with death comes language and narration. I hear death stories on a regular basis. Pushpadevi tells me about her son’s death instead of about her other children’s births. These stories are detailed and common. They require no elicitation from me and erupt (or flow) into other stories about other things. And then there are other people’s birth and death stories—often the same thing—extraordinary tales and plain ones, stories of difficult circumstances, stories circulated, but seldom on demand. A recent difficult delivery, a doctor’s failed medicine, a botched hospital delivery, a baby’s death four years ago from illness, a birth that would have come out better if one woman or another had been called. Listening to the way stories, such as they are, unfold, to the kinds of actors and actions involved, and even more so, watching the comings and goings through angans, struggling to manage women’s frequent references to someone or other in this village or that who “knows a lot” or “has good hands,” to someone or other whose daughter or son is “finished,” I begin to sense that the idea that “There are no midwives here” offers lack to a situation that is all about abundance. But “No midwives here,” or the opposite, “Let’s train the dais” (who don’t really exist as such), confound the very real lacks that make rural life one of poverty and state failures with a different imaginary of lack. That imaginary is a repository of overlapping fantasies and feelings about the boundedness of reality: “local custom,” “tradition,” “blind belief,” “rural women” “village women,” “the village,” “the dai.” Here, as I will come to see in domains beyond “birth work,” is a persistently intertwined sense of abundance and lack around the sor, the time-space of rural birth.

This story begins in a familiar place, and with familiar conversations about what might be “local” and what might come from “outside,” starting with universal categories (“the traditional midwife”) and the many arrivals and transformations that mark the birth of a child. Encompassing these themes is the figure of “the dai.”¹ Representing a person and an idea, the term is broad, perhaps even mythical, and points at the same time to the stuff of the household and the shape of institutional visions of the past and future. The term encapsulates histories of intervention, official and local visions of caste, class, and gender, and the very relationship of what we might think of as “local” to what appears at first glance to be “global.” But eclipsed by the concept’s span and givenness are certain subtleties—the sensations of the sor, the nested diacritics of caste and progress. In the question “What is a dai?” lies an inquiry about the emerging (and longstanding) political subjectivities of rural women. And so I begin this account with an attempt to dismantle the category that took me to Sitapur in the first place.

One way to begin to unpack “the dai” would be with state and transnational interventions—and especially the “dai trainings”—that seem to solidify an unstable term, putting development, as Stacey Pigg and others have argued (1997), in terms of relationships based on approved and authoritative knowledge—who has it and who needs to get it. Beyond India, the “traditional midwife” is a trope of knowledge politics across a range of discourses. A standard unit of caregiving, she is, like the dai, romanticized and vilified, symbolic of the timelessness of non-western peoples and “tradition” in general, and axiomatic of where women stand in the ascensions of development. In many public health literatures the “traditional midwife” becomes the “traditional birth attendant,” the “TBA,” and serves as either a resource for social transformation or the accumulation of all that is dangerous about certain ways of thinking and doing.

From policy documents to training manuals, much can be read about notions of “tradition” and the gendering of progress from the place the TBA holds in what Timothy Mitchell calls the “world-as-picture” of modernity (2000a: xiii). As such, like other categories of transnational feminism and health-related development, most notably the “Third World woman” or “the rural woman,” the TBA can be deconstructed for the way, as a category of modernity, it is part of how mappings of time, space, and personhood are put in the service of transnational power (Apffel-Marglin and Simon 1994; Mohanty 1991; Pigg 1997; Trinh 1989). This is especially true in postcolonial times and places in which unique “body politics” unsettle Western “theories of the maternal body” (Ram 1998a). In these sites of intervention, gendered body politics involve overlapping modes of difference that include (alongside household dynamics, patriarchy, and the symbolic frameworks of caste) the position of nations in a global frame, the relationship of states to their citizens, and the tangles of authority that make “governmentality” a “derestricted” mode of accounting and surveillance obsessed with with “population” (Foucault 1991: 99). Likewise, they involve the flows (and blockages) of commodities, ideas, and resources that have come to characterize what we think of as globalization. In such a context, forms of care illegible to international categories of intervention require we question debates pitting “local” against “global,” or “traditional” against transnational agents.

The dai is well suited to deromanticizing “the traditional midwife” given the way she is dogged by notions of “pollution” in layers of discourse difficult to parse. Indeed, ways of talking about “pollution” make up a set of moralities that has everything to do with the shape of “progress” and the stakes of its imagined recipients. In a tug of war between representations focusing on pollution and those interested in recuperating “local knowledge,” the dai has come to mean something for feminist ethnography as well. Ethnographers have long reminded us that “midwives” in India are in a unique position, of low caste status and performing stigmatized work deemed polluting by association with female bodily fluids (Jacobson 1989; Jacobson and Wadley 1977; P. Jeffery et al. 1989; Rozario 1998; Wadley 1975). Assertions that it is “inappropriate to regard the dai as a ‘midwife’ in the contemporary Western sense” (R. Jeffery and P. Jeffery 1993: 17) consider the pollutedness of the dai and the stigmatized nature of birth work a challenge to the romance of midwives and other orientalist fantasies of the other, discourses in which non-Western women serve as beacons of “naturalness” in opposition to Western ideas about the modern female self (P. Jeffery et al. 1989; R. Jeffery and P. Jeffery 1993; Ram 1998a; Rozario 1998, 2002; Unnithan-Kumar 2002). The stigma of birth work, according to some, makes South Asia a place where women’s subordination rather than their “sources of power and influence” (R. Jeffery and P. Jeffery 1993: 9) determine the way childbirth is handled.

But other accounts note that local forms of knowledge have been forced into accountability to biomedical models, often the very ones that disparage and disqualify them (Ram 1998a: 290). There are charges that the dai has been overassociated with “pollution,” that her knowledge, abilities, and religious role have been obscured in descriptions (scholarly and otherwise) emphasizing caste status and a biomedical or public health agenda (a side of the argument to which I have contributed, see Chawla and Pinto 2001). Activists, health workers, scholars, and artists have made efforts to resituate the dai as a skilled practitioner disruptive to a bundled set of institutions—medicine, science, development—as well as to the Brahmanical Hinduisms that can devalue the female body (Chawla 1994).

Where pollution battles local knowledge (to oversimplify) in ethnographic representations, in public health discussions spanning colonial and postcolonial eras, talk about dais equivocates on the matter of value—Are dais good or bad for progress? Are they good or bad representatives of “Indian tradition?” Are they a hindrance to public health or a resource? Are they better resigned to the past or brought into the future? Within debates about how to improve life in rural areas, as within debates over knowledge and stigma, the dai is mu...