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Wendy Marijnissen | The Dai


Birth at home in Pakistan, no matter what social class or caste, involves calling the Dai. A Dai is an unskilled midwife or traditional birth attendant (TBA), who usually learn their trade passed on from generation to generations without any formal training.
Every 30 minutes a women dies during or shortly after childbirth in Pakistan.
Heartbreakingly, most of the deaths and complications surrounding childbirth are treatable. Young women die because they have no access to sufficiently equipped medical facilities, or because the traditional midwife (dai) doesn’t refer the women in time to the hospitals when complications arise and a caesarean section is needed. In a place where poverty is rife, most families can’t afford the medicine or care they require.

The women giving birth know their Dai personally from their neighborhoods and consider her the expert in childbirth. She is respected within her community and thus an important figure.
The Dai are valued somewhat differently by hospital staff though.
The terms Dai handled is synonyms for dangerous practices.
Paradoxically, many women say they are afraid of being ‘hospital handled’.
Most think the doctors deliberately complicate cases or perform c-sections to get more money.
Increasing costs of medicines and diagnostic tests have made treatment unaffordable for most people in Pakistan with low-incomes.
More and more people simply cannot afford the care they need and medicines are beyond their budget, leaving them with no choice but to call in the help of the Dai to assist their delivery.

Slowly the Dai are educating themselves, many working part-time in government hospitals alongside skilled doctors.
The new generation of midwifes go to schools instead of learning the trade from their elders and work in more professional and hygienic environment.
At present it seems very unlikely Pakistan will achieve the Millennium Development Goals by 2015.
Affordable medical care and the availability to skilled female health workers during childbirth is crucial for reducing maternal deaths and birth complications like obstetric fistula and the Dai can help play a very important role.

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