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Vanderbilt University

Publication Date

Spring 2016

Program Name

India: Public Health, Policy Advocacy, and Community


The dai, once a prominent figure in Indian maternal health, now faces marginalization as the government of India adopts the goal of universal institutional delivery. Under pressure from international discourse that Skilled Birth Attendants (SBAs) were more effective at lowering Maternal Mortality Rate (MMR) than Traditional Birth Attendants (TBAs) like dais (World Health Organization), dai training was discontinued and left in the hands of NGOs, while concurrently women and ASHAs were monetarily incentivized for every institutional birth (Park, 419). Yet in rural, isolated, or hilly areas like Okhalakanda block in Uttarakhand, institutional delivery is a long way from universal—only 37% of all deliveries occur in a hospital (Aarohi Arogya Project). The harsh realities of being a woman in an isolated Kumaoni village contribute to the backward motivations of home deliveries: women often have low selfdetermination, must return to work quickly after giving birth, and are not well included into many government services (Capila). They fear the hospital for its cesarean sections and long recovery periods from stitches, feel pressure from mother-in-laws who called on dais in their day, and often do not receive effective counselling about proper ANC, PNC, and institutional delivery. Yet safe and hygienic delivery are the right of every woman—disregarding home deliveries and dais puts the onus on the woman to get to the hospital in order to receive proper services and counselling. In reality, social and logistical factors can impede a woman’s ability or desire to delivery in a hospital. While dai training can seemingly endorse home delivery, it is the only way to improve the health outcomes of the women who are left out of the government ‘universal’ institutional delivery services. The findings recommend that dai training furthermore should focus on including them and their clients in government health services and tracking, as well as filling the counselling gap that the outreach efforts of ASHAs and ANMs have been unable close.


Health Policy | Maternal and Child Health | Nursing Midwifery | Obstetrics and Gynecology | Women's Health


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