The path is uneven and slippery. Recent rains have made it difficult to negotiate the muddy track in Nichla Badho village in Jagjit Nagar, Solan district, Himachal Pradesh. But this doesn't bother Shanti Devi. The 80-year-old skips nimbly over puddles and maneuvers herself down the steep incline. After all, as a 'dai', or traditional birth attendant (TBA), this is what she has been doing for the past 57 years. Come rain or shine, night or day, if there is a distress call from a pregnant woman or if there is a baby to be delivered or even if the fears of a first-time mother-to-be need to be soothed, Shanti is sure to be there.
Her commitment as a TBA, in promoting safe motherhood and newborn care by ensuring practices such as early breastfeeding, has made her one of the most respected village elders in a state where malnutrition, a problem compounded by delayed weaning, is a major problem. As many as 81 per cent children suffer from mild to moderate malnutrition and four per cent suffer from a severe degree of malnutrition (Himachal Government Health Vision Document, 2006). It is no wonder that Shanti, who has delivered more than half the population of her village, including six of her own grandchildren, is a household name.
"I am 'dai bua' (aunt) to some and 'dai dadi' (granny) to most of the villagers. It feels nice when all the families and children I have delivered shower so much love and respect. It makes my work worthwhile and boosts my confidence in my abilities even at this age," says Shanti, her weather beaten face creasing into a smile of contentment.
But 71 years ago, when nine-year-old Shanti was married off to a man 28 years her senior, little did she think she would be able to do something so significant and meaningful.
Illiterate and unskilled, all she could do were household chores. In fact, when she became pregnant some years after her marriage, Shanti was convinced she was going to die. "No one had told me about how to handle pregnancy. I was very frightened. There was no hospital nearby. It was a 'dai' who took care of me like a mother," she remembers.
Although her own experience with the 'dai' sparked an interest in the profession, the turning point came a year later when she was able to help her sister's pregnancy pains with a hot mustard oil massage. Shanti then realized she had the temperament to nurture and care, two important characteristics of a good 'dai'. Thereafter, she began to accompany the local 'dai' on her rounds and soon picked up all the traditional techniques.
The first test came when, at 23, she conducted her first independent delivery. "I was nervous as it was my sister's daughter-in-law. I knew how to induce labor pain by giving hot herbal drinks made by boiling 'methi' (fenugreek seeds), 'ajwain' (carom seeds) and soya. I used a sickle to cut the chord and, after the birth, gave the mother two spoons of diluted brandy," recalls Shanti.
She hasn't look back since then and has now lost count of the innumerable children she has helped deliver. Though she rarely received more than Rs 10 (US$1=Rs 42) as fee and sometimes a set of clothes for these deliveries, Shanti's enthusiasm hasn't waned. This was to prove fortunate for Bimla, 35, a resident of Nichla Badho village.
When Shanti delivered her son, he was absolutely still. She tried pressing his chest and when that did not work she placed him alternately in cold and hot water. This, too, failed to resuscitate him.
So, Shanti broke an earthen pitcher and put the bottom end over a charcoal-fuelled stove or 'angeeti'. Then she placed the placenta on it and massaged the cord to transfer the heat to the child. After about 30 minutes, the baby finally showed signs of life and began to cry. Only then did Shanti heave a sigh of relief.
"We will always be in her debt. Our son, Manjit, who is 10 now, owes his life to her. She kept massaging for half an hour and that too briskly. Considering her age at that time (Shanti was 70), it was nothing short of a miracle for us," says a grateful Bimla.
Families living in villages as far as 35 kilometers away also invite Shanti to deliver children. But one of Shanti's biggest achievements has been the breaking of caste barriers.
Traditionally, upper caste women shy away from calling a 'dai' belonging to a caste lower than theirs. But such is her reputation that women from all castes, including upper caste Rajput families, welcome her. In fact, even when the delivered child has died soon after, these families have not blamed Shanti.
One of the prime reasons why Shanti is in great demand is because women living in the community are comfortable with her and are confident about her abilities contends Subhash Mendhapurkar, Director, Society for Social Uplift Through Rural Action (SUTRA). The Jagjit Nagar-based non-governmental organization, which works for women's empowerment, has conducted training programmes for 'dais'.
"Women prefer to have home deliveries by someone they know rather than an unknown doctor. Further, the hospital is some distance away, while the 'dai' is right there and readily available. Shanti's long experience has enabled her to predict when a delivery will take place on seeing a pregnant woman. Even if the baby is positioned feet first, she is able to conduct deliveries. In addition, she provides information on immunization, birth registration and nutrition. Shanti is an icon here because she has made a big difference to women's health by using her traditional skills and knowledge," says Mendhapurkar.
Her readiness to accept change, even after she had turned 60 and had conducted innumerable deliveries, has also made her services invaluable. Since 1980, she has switched from using a sickle to a blade to cut the cord and also uses the training kit given by SUTRA. The kit contains blades, scissors, thread (to tie the cord before cutting) and a weighing machine to help them record the weight of the baby after birth.
However, what has won her trust and admiration from pregnant women and health activists is her refusal to succumb to the pressure of revealing the sex of the unborn child.
Incidentally, her village is one of the few in the district that hasn't registered a single case of female feticide in the last 40 years. This is despite the fact that Solan is one of the districts in Himachal Pradesh where the child sex ratio has declined to 900 (Census 2001).
According to the White Ribbon Alliance for Safe Motherhood, one Indian woman dies every seven minutes because of pregnancy or childbirth-related complications and of the half-a-million women who die every year around the world due to maternity related complications, 70,000 are Indians. In this scenario, women like Shanti are truly indispensable. They make all the difference between life and death.