Two hundred traditional birth attendants (TBAs) of a community development block of India were interviewed. The majority were age 45 years or above (81%), illiterate (85%), and of low caste (78%). Most (88%) had three or more children. Although 27% had inherited the profession from older female relatives, only 4% have daughters or daughters-in-law in the profession. Almost half (48%) had conducted 11 or more deliveries in last year. The TBAs charged more money to deliver a male infant than to deliver a female. The TBA workforce in India appears to be shrinking, possibly because of gradual reduction in family size. Backup support from state maternal health care services is lacking. Existing cadre of TBAs should be involved in primary health care to ensure the survival of the institution of dais (TBAs) and to ensure the availability of basic maternity services to rural women.
PIP: In Haryana State, India, during 1989-1991, a social worker interviewed 200 traditional birth attendants (TBAs) in Raipur Rani Block in Ambala District to examine their sociodemographic characteristics and practices. Their mean age was 58.5 years, and 81% were older than 45 years old, indicating few new recruits. 71% of the TBAs gained a sense of happiness and fulfillment from their profession. 30% had not yet undergone formal training. TBA-based family planning services included recruiting, motivating, and escorting women to health centers and supplying condoms or oral contraceptives (OCs). 95% of TBAs approved of contraception and small families. TBAs received more compensation for the delivery of a boy than of a girl and for a first birth than for subsequent births. Compensation consisted of money, clothes, and cereal. 70% of currently practicing TBAs joined the profession before age 45. 25% had a previous-generation relative in the profession, yet just 4% were preparing a next-generation relative to become a TBA. As more and more TBAs grow old or die without being replaced by younger TBAs, the government will soon not be able to provide comprehensive maternal-child health coverage to rural women. Based on these findings, the government should adopt steps to recognize the importance of TBAs, adequately compensate them, train them, and improve their skills. It should do so until the rural health infrastructure absorbs or replaces the TBAs. It should integrate them into family planning programs by having them be community-based distributors of condoms and OCs or as a first level contact person for recruitment, supply, and follow-up. They should undergo continuing education sessions provided through the more than 150 medical colleges in India. If they are not compensated financially, the rural health service program may fail.