Feature Stories
Recognizing Midwives
Banke, April 2008
It was a mere coincidence. While traveling for a different purpose I had the chance to talk on the same day to an unskilled birth attendant and three auxiliary nurses midwifes from a Primary Health Center. Being raised in a country where until recently all women delivered in hospitals and even now those who decide to deliver at home do it as a conscious choice it had never occurred to me how important midwives all over the world are. The encounters during my trip were enlightening.
The traditional midwife was a woman from Tharu community in Dang and the trained midwives were from Bankathwa VDC in Banke. On the surface, there were many similarities in what they have shared with me. The Tharu lady said that people often call her when the trained midwife cannot deal with the case; not surprisingly auxiliary nurses had just opposite story to tell. The former stated with firmness that in more than 20 years of her experience she had not dealt with any difficult cases. The midwives from primary health center had several heartbreaking stories of babies lost when they were called on after the traditional attendant could not cope. The traditional midwife's testimony was simple and clear- 'I deliver everything, goats, pigs, cows; a human is an animal just like them, there is no difference whatsoever. I'm very experienced and I also train whoever requests me to.' On the other hand the auxiliary nurses talked emotionally about rewarding moments when lives of mothers and babies were saved; when they had to deal with mothers-in-law who were convinced that the amount of prenatal check-ups and 'all this fuss' about taking care of pregnant mother is overexaggeration; when they had to provide contraceptives to women in secrecy because all of the children were girls and the mother felt she could not bear another pregnancy.
The testimonies of auxiliary nurses reflected many of the socially conditioned reproductive health problems in Nepalese society. The belief that uterine prolapse happens because a woman has been with other men or that venereal infection (which in many cases causes symptoms only for women) is a reason to question her marital faith are examples of very harmful traditional beliefs. The attitude among older ladies that 'we all have gone through it so why would you need extra rest, any pills, vaccinations or check-ups' is difficult to eradicate. It is not a secret that daughters-in-law are at the very bottom of the family hierarchy and as soon as they deliver they have to go back to work. In fact what the Tharu lady told me was that in her culture 'a woman goes back to work as soon as the umbilical cord is cut'.
All this puts the role of trained midwives in Nepal in an entirely new light; they are not only health workers, but they are agents of social change. They call angry mothers-in-law and suspicious husbands for conversations, they explain that daughters are as good as sons; they negotiate with hospitals to admit women with no income free of charge and they save many lives every day in every district of Nepal without much fuss and ado. They deserve recognition.
Special thanks to Durga Bhandari, Manju Koirala and Buddhimaya Bashyal from Bankatwa PHC, Banke for sharing their experiences with
By Anna Adhikari
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