The Future of Dais: Traditional birth attendants and biomedical cultural change in Matlab, Bangladesh 公开
Jia, Jenny (2010)
Abstract
In developing countries, the traditional birth attendant (TBA) plays an important role in maternal and infant health as the most accessible resource for women. International agencies recommend investing limited resources in training skilled birth attendants (SBAs) rather than TBAs, although this recommendation is contested. The International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) has been involved with maternal health in the rural community of Matlab since 1977, and their approach supports SBAs, facility birth, and biomedical practices while excluding TBAs. In two years, facility deliveries have increased rapidly from 48 percent to 68 percent, and childbirth has moved from the traditional home to the modern hospital. Yet, TBAs, locally called dais, are still active in Matlab. The objectives of this study were to determine the current practice of Matlab dais, explore potential future roles of dais in formal healthcare, and reveal local perceptions of home and facility birth. We conducted interviews with dais, community health research workers, support persons, and ICDDR,B research investigators, all obstetrical healthcare providers. Through interviews, I observed that dais valued their practice for the skills they gained and for the respect and good treatment they received from community members rather than for material benefits. Knowledge and trainings seemed empowering to dais, and many wished for additional training, which positively influenced their reputations. The current practices of dais exhibited biomedical influences, yet ICDDR,B workers continued to view dais as problematic and egotistical, unable to change their ways, and utilizing risky practices. Residents' perceptions of home and facility birth showed that multiple considerations were involved in deciding the location of birth, and although facility birth was largely preferred over home birth, interest in each method still existed. Dais' wishes for more training, their preoccupation with their reputations--determined greatly by the outcome of deliveries they performed, and evidence that facility birth could not satisfy all the concerns of residents suggests that a medically plural system of childbirth may be appropriate. Both systems could be kept in check through healthy competition and collaboration. Beliefs and practices of dais have changed to incorporate biomedical principles. ICDDR,B should explore these changes and consider the possibility of partnerships with dais in Matlab.
Table of Contents
List of Tables and Figures
Glossary of Acronyms and Local Bangla Terms
Preface
Chapter 1: Introduction 3
i. Problem statement
ii. Purpose of study
Chapter 2: Literature Review 16
i. What is a traditional birth attendant?
ii. TBA training: The great debate
iii. TBA policies in Bangladesh
Chapter 3: Ethnographic Context 31
i. History of Bangladesh
ii. Birth in rural Bangladesh
iii. Project Site: ICDDR,B's intervention area of Matlab Thana
iv. History of ICDDR,B
v. The Maternal, Neonatal, and Child Health (MNCH) Program
Chapter 4 : Methods and Field Observations 46
i. Objectives of the study
ii. Methods
iii. Limitations of the study
iv. Field observations in Matlab
v. Field observations of the Matlab Hospital
Chapter 5: The Dai Practice in Matlab 60
i. Motivations to practice
ii. Antenatal customs
iii. Khalas: Making bacha kacha delivered
iv. Complication management in home birth
Chapter 6 : Change and Resistance in Local Birth Ideology and Practices 75
i. Signs of change
ii. Source of change
iii. Signs and sources of resistance
iv. The relationship between facility and home birth
Chapter 7 : Knowledge as Power 89
i. Sources of knowledge on childbirth
ii. Role of biomedical education in healthcare providers
iii. Dais: Courage through knowledge
Chapter 8 : Ego Reputation, and Prejudice 95
i. Colonial representations of dais and their legacy
ii. Knowledge and garima
iii. Reputation, biomedical knowledge, and skills in dais
Chapter 9 : Conclusion 104
References 111
Appendices 120
A. Interview Questionnaires
B. Timeline of MCH- and ICDDR,B-related events
C. Life Cycle Approach to Prioritization of ICDDR,B Research
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