Introduction

Tribe

The term tribe refers to a social group that exists outside or on the margins of modern state systems, often characterized by a shared sense of identity, common ancestry, language, customs, and traditional territory. In anthropology, a tribe is typically seen as a form of social organization that is relatively self-sufficient, with strong kinship ties and culturally distinct practices. Over 104 million tribal people live in India. Spread across 705 tribes, they account for 8.6% of the country’s population. Cognizant of the distinct socio-cultural structures and way of life in these communities, the government of India has laid down the three landmark policy expressions – The constitution of India, The Panchsheel principles and the PESA act – for the protection and development of tribal communities.  “A social group existing before the development of, or outside of, states, often united by shared dialects, cultures, and traditions.” (Barfield, 1997) “A tribe is a collection of a number of clans who have distinct nomenclature, separate language, distinct political organisation and a territory under their own possession.” (Morgan L.H, 1877)

Health

"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."  (World Health Organization’s Constitution 1948) “The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health.”  (The Indian Constitution under Article 47)

Tribal health refers to the physical, mental, and social well-being of indigenous communities who identify as members of a particular tribe or nation. These communities often have unique cultural traditions, languages, and histories that shape their health beliefs and practices. “Tribal health is a multi-dimensional concept encompassing the cultural, social, and ecological determinants of health for indigenous people, often marked by high levels of malnutrition, infectious diseases, and maternal mortality.”  (MoHFW & Ministry of Tribal Affairs, 2018)

Tribal communities in India face a range of structural, cultural, and economic problems due to their unique way of life, marginalization, and historical neglect. These problems are interrelated and often lead to poor health, education, and livelihood outcomes. “Indigenous and tribal peoples face marginalization, lack of access to justice, loss of land and natural resources, and socio-economic exclusion.” ILO (International Labour Organization) Indigenous Peoples are still excluded from decisions regarding “the very foundation of our identity, survival, and self-determination,” said Aluki kotierk, Chair of the 24th United Nations Permanent Forum on Indigenous Issues (UNPFII).

Health care practices

“The diseases are caused by one or combination of three agencies viz. natural, human and supernatural. Naturally, they have developed their own traditional medicine system. The common measures against diseases are magical extraction, administration of medicinal herbs, sacrifice and offerings and contact with magical objects like amulets and dietary restriction.” (Bhattacharya 1986) Discussed about the disease perceptions, nature and role of traditional health practioners , ethno-medicinal and ritualistic way of treatment as found among the Thakurs tribe of Maharastra. The author has discussed about the symbols (acts, words, colour, chants, and object) and its relation with health culture. (Tribhuwan 1998) Discussed about the health practices as found among the rural tribe of South India. Traditionally they are rat trappers. The paper basically deals with the treatment of diseases through two ways- magico-religious practices and herbal medicine. Magico-religious practices are categorized into five types-(1) sorcery, (2) Breach of Taboos, (3) Intrusion by spirits, (4) objects, (5) causes of evil eye. (Saheb 2006) “Due to large scale urbanization /modernization the tribal people are gradually joining mainstream. They are getting the benefits of development in education, health, income generating leading to a change in lifestyle. Thus these people are becoming susceptible to various diseases like cardio vascular diseases, diabetes, and high blood pressure.” (Kshatriya 2014) Discussed about the presence of medical Pluralism among the Garos of Nisangram. The people are adopting the modern medicinal system along with their traditional system. The Garos believe both biological as well as supernatural factors as the cause of diseases. They are well versed with the ethno medicinal plants found in their area for treatment of diseases. (Medhi et al. 2002)

Midwife Practice

Midwife practice, also referred to as midwifery, encompasses the care, knowledge systems, skills, and rituals traditionally or professionally used to support women during pregnancy, childbirth, and the postpartum period. In both institutional and indigenous contexts, midwives play a vital role in reproductive and community health. Their functions often go beyond clinical support and extend into emotional, cultural, and spiritual guidance—especially in tribal societies like the Baiga community. Midwifery is defined as “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pregnancy, pregnancy, birth, postpartum and the early weeks of life”. (WHO) The midwife is recognised as a responsible and accountable professional, who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. (ICM).

Midwife Practice among Tribal Communities

·     In tribal groups like the Baiga, midwife practice involves:

·     Use of forest-based herbs for labour pain and bleeding.

·     Belief in spiritual interference causing difficult childbirths.

·     Preference for home deliveries over institutional births.

·     Social respect given to elderly ‘dais’ as healers and protectors.

·     Lack of integration with government health systems, causing underutilization of modern services.

Objectives of study

1.   To understand the role of ‘dais’ and Mitanins in maternal and child healthcare.

2.   To examine the methods used during delivery, including tools, techniques, and rituals.

3.   To analyze the beliefs and cultural practices associated with pregnancy and childbirth.

4.   To assess the community’s perception and trust toward traditional midwives.

5.   To evaluate the changes and decline in midwifery practices due to modernization.

6.   To identify the limitations and challenges faced by ‘dais’ in present-day healthcare systems.

7.   To compare the effectiveness of traditional vs institutional deliveries.

Literature Review

The Pan American Health Organization (PAHO), with the support of the Government of Canada, has been working with over a thousand traditional midwives since 2021 to provide them with knowledge of warning signs to help prevent maternal and neonatal deaths. PAHO also helps bridge the cultural gap between traditional midwives and healthcare services to facilitate the respectful treatment of women. (PAHO) This study explains how traditional midwives (‘dais’) in Rajasthan survived policy-driven marginalization by adapting to NGO-supported healthcare models. Through “professional niche differentiation,” ‘dais’ redefined their roles as educators and care coordinators, coexisting with ASHAs and ANMs while retaining community trust. (Azher 2017) Critiques India’s development narrative by exploring how traditional midwives (‘dais’) are displaced by institutional childbirth. Using the story of Mamta Dai, a trained dai in Madhya Pradesh, the article reveals how poor infrastructure, lack of supplies like cotton, and neglect of traditional wisdom lead to the erosion of indigenous midwifery. It highlights the irony of development relying on the disappearance of a rural midwife to claim success. The article emphasizes how ‘dais’ remain culturally significant, even as policy marginalizes them. (Ghoshal. R, 2014) Conducted twelve focus-group discussions with Baiga women aged 15–49 across forest villages in Madhya Pradesh. They found that over 85% of births were assisted by traditional midwives (‘dais’), largely due to cultural beliefs, lack of transport, and distrust of modern facilities. Key barriers included late pregnancy disclosure, misconceptions about safe delivery, and logistical challenges. The study emphasizes the critical role of ‘dais’ in the Baiga community and recommends culturally sensitive integration of midwives into public health outreach to improve maternal and child health services. (Kumar et al. 2016) In-depth interviews and participant observation with tribal women, healthcare providers, and traditional healers in Odisha. They found maternal care is shaped by cultural perceptions that childbirth is natural and home-based midwives (‘dais’) are trusted, while formal health facilities remain culturally distant. Incentivized institutional delivery programs (e.g., JSY) have low uptake due to language barriers, provider disrespect, and lack of cultural accommodation. The study recommends health systems integrate ‘dais’ and adapt service delivery to fit tribal cultural frameworks—policy shifts that could improve acceptability and maternal outcomes. (Contractor et al. 2018)

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. (Singh A. 1994) Training of TBAs in 16 Indian villages improved practices such as handwashing, clean cord cutting, and immediate breastfeeding. Despite limited prior evidence, post-training outcomes were positive. The study recommends enhancing TBA training with updated, evidence-based content, integrating local knowledge, and increasing community awareness of maternal and child health to improve public health outcomes. (Saravanan et al.  2011) Post‐training surveys found TBAs expanded maternal care services, improved community acceptance, and increased referrals to emergency obstetric facilities. The study recommends durable TBA training and integration for effective reproductive health delivery. (Islam, A. 2001) This WHO report re-evaluates the role of Traditional Birth Attendants (TBAs) in reducing maternal mortality. It stresses TBAs as an interim solution, highlights their cultural value, and outlines steps for effective training programs. While TBAs alone can’t ensure maternal health, their compassionate, culturally rooted care remains essential alongside professional healthcare expansion. ‎ (UNICEF 1992) The study highlights the strengths and limitations of traditional midwives (‘dais’) in North India, who offer culturally accepted maternal care, including treatments and family planning during pre- and postnatal stages. They enjoy deep community trust, unlike auxiliary nurse midwives, who are overstretched across multiple villages. Recognizing this gap, the Indian Government has initiated training for ‘dais’ under the Rural Health Scheme to enhance their role in the healthcare system.(Kakar, D.N. 1980)

The Baiga tribe of Nemna, Sonbhadra (UP), possesses rich ethnobotanical knowledge, traditionally passed down orally. They use Mangifera indica for eye disease, Kurli bark for skin issues, Sarphonk for snakebites, Gainthi to boost immunity, and Koraya bark for malaria. Modern shifts in livelihood threaten this heritage. The study emphasizes urgent documentation and conservation of Baiga traditional medicinal practices and associated plant resources. (Srivastava, A. 2014)Conducted a quasi-experimental study with 1,178 low-risk women in four Ethiopian hospitals, comparing midwife-led continuity care (MLCC) to standard care. The MLCC group saw higher rates of spontaneous vaginal birth and significantly reduced preterm birth (adjusted risk ratio = 0.394) compared to standard care. The study demonstrates that consistent care by midwives throughout antenatal, birthing, and postnatal periods yields improved maternal and neonatal health outcomes in low-resource settings, advocating for scaling up MLCC models to enhance maternal health in similar regions. (Hailemeskel et al. 2021).

Materials and Methods

Significance of the Study

1. It highlights that traditional ‘dais’ often work without fees, driven by social duty, trust, and cultural respect rather than economic gain.

2. It foregrounds how Baiga women have been the custodians of maternal care without formal training, revealing gendered knowledge systems.

3. Advocates for training and support for traditional ‘dais’.

4. Findings show that younger women are not learning midwifery, indicating a breakdown in cultural continuity.

5. By comparing the roles of ‘dais’ and Mitanins, the research shows how traditional and institutional healthcare can complement each other.

6. Captures real-time challenges, preferences, and outcomes from women who have received both traditional and institutional delivery care.

7. Through interviews and cross-examinations, the study gives voice to tribal women’s own experiences and evaluations of care quality.

Study area and People

Study area 

Village: Taregaon jungle

Study people BAIGA

As per the legends, In early times, there was only water and no land around. One fine day, God created the Universe. Followed by which, two ascetics emerged from the depths of the earth. One was Nanga baiga and the other one was Brahmin. The Brahmin was given pen and paper for reading and writing, and to the Nanga Baiga, God gave an ax. Right after, God instructed to cultivate kutki and Kodo (Grain) to the Nanga Baiga. Since then, the Baigas have been practicing Bewar (swidden agriculture) by cutting down trees in forests. The Baiga Adivasis are the forest-dwelling indigenous tribal community of Central India. According to local mythology, they are often considered the original inhabitants of Earth. Being identified as a Dravidian tribe (Primitive), the Baiga tribe is also known for their traditionally minimalistic lifestyle. Baigas lived in intimacy with the elements of nature in the past, and even at present, their everyday lives and livelihoods continue to be closely connected with their forest ecologies. Erstwhile nomadic hunter-gatherers, who practiced shifting agriculture, the Baigas are also known to be extremely skilled with the medicinal and healing practices using the various species of plants and trees which are found in the forests of central India.The Baiga tribe is found to be endogamous. Their major sub-castes are Binjhwar, Bharatotia, Narotia (Nahar), Rambhaina, Katbhaina, Dudhbhaina, Kodwan (Kundi), Gondabhaina, Kurka Baiga, Savat Baiga, etc. The tribes are divided into various extraterrestrials "goti (gotra). Their main gotras are Marawi, Dhurve, Markam, Paratti, Tekam, Netam etc. Fauna, animals, birds, trees, creepers, etc. are the totems of their gotras. These tribes are ancestral, patriarchal, and ancestral local. That is, the girls go to the bride's father's house after marriage. Their children are called their father's descendants.

The marriage age is considered to be 14-18 years for boys and 13-16 years for girls. The marriage proposal is from the groom's side, son and daughters of maternal uncle and aunt (father's sister) get married to each other. The bridegroom is given some amount of rice, lentils, turmeric, oil, jaggery, and cash in the form of an expenditure (bride) by the bride. The marriage ceremony takes place under the supervision of the elders. Lamsena (Seva Marriage), Chori Vivah, Paithu Vivah (bribery), Guravat (exchange) have social acceptance. Remarriage (Khadoni) is also prevalent Bury the deceased when he dies. On the third day, the cleaning of the house is done Men cut beard-mustache Dashakaram is performed on the 10th day, in which the soul of the deceased is worshiped and the relatives offer a death feast. In the 2011 census, literacy among this tribe was 40.6%. Literacy was 50.4% among males and 30.8% among females.

Research methodology

Research design: This study follows a qualitative-cum-exploratory research design to examine and describe the working methods, lived experiences, and transitions in traditional midwifery practices (Traditional Birth Attendants or ‘dais’) within the Baiga tribal community of Taregaon Jungle. Exploratory research design: Exploratory research design is a flexible research approach used to investigate a problem that is not clearly defined or understood. It's often the initial step in research, aiming to gain a deeper understanding of a topic, identify key variables, and formulate hypothesis for further investigation.

Sampling: Kabirdham district of Chhattisgarh where we did field work is considered as universe and the village (taregaon jungle) where tribal community lives is considered as sample area.  A purposive sampling technique was used. The selection of the fieldwork site (Taregaon Jungle) and research topic (Traditional Midwife Practices) was carried out by the School of Studies in Anthropology, Pandit Ravishankar Shukla University, Raipur which is purposively. A particular tribe is selected for research that is baiga tribe which is also purposively selected.

Key informants –

•     4 traditional birth attendant dai’s

•     1 Community health worker ‘mitanin’

•     10 women’s of that tribe (to cross-validate the work and narratives of the ‘dais’)

Collection of data

Primary data collection: Non-participant observation was conducted among the Baiga tribe in Taregaon Jungle. Direct interaction with tribe members allowed for authentic data collection using the following tools: Interview, Structured Schedule, Non-participant observation, Case study, Audio recording, Photography.

Secondary data collection: Research papers, Journals, Articles, Books, Thesis, Census report    

Result and Discussion:

Mitanin and Midwives’ Knowledge and Experiences Regarding Traditional Delivery Practices Among the Baiga Tribe

Status of Midwifery Practice within Family Traditions

Mitanin - After conducting an interview with one Mitanin named Hina , it was found that she comes from a family background in midwifery, although she herself has no practical knowledge or training in conducting deliveries. She has been working as a certified Mitanin for the past six years, and her services are recognized and compensated by the government. Her responsibilities include maternal care, health awareness, and promotion of institutional deliveries and on every refers she got fee of rupees 200. In addition to her Mitanin duties, she also engages in agriculture as part of her livelihood.

Dai 1 - An interview was conducted with Suruchi, a traditional birth attendant (Dai), aged 40 years, who belongs to a multi-generational midwifery family. She began practicing after her marriage and has an estimated 10 years of experience. She reported learning midwifery through observing her mother-in-law during childbirth. Sita has no formal certification from any institution or organization, and hence, her work is not legally validated. Midwifery is not her primary occupation; she also works as a farmer and laborer to support her household.

Dai 2 - Another interview was conducted with Chhaya, aged 60, who also hails from a long lineage of traditional midwives. She began her practice post-marriage and estimates her experience to be around 25 years. Like others, she learned the practice by assisting and observing her mother-in-law. Chhaya is not certified by any official body, and therefore, lacks legal recognition for her services. In addition to midwifery, she is engaged in agricultural and labor work, which remains her primary source of income.

Dai 3 - The third Dai interviewed was Madhuri, aged 36, who also comes from a family of traditional midwives. She began practicing after marriage, with an estimated 5–6 years of experience. She too acquired her skills by observing deliveries conducted by her mother-in-law. She also taught this practice to her daughter-in-laws. Madhuri has not received any formal training or certification, and her work is not legally sanctioned. Like others, midwifery is not her main occupation; she sustains her livelihood through farming and daily wage labor.

Dai 4 - The fourth Dai interviewed, Chetna, aged 55, also has a hereditary background in midwifery. She began practicing post-marriage and has accumulated approximately 20 years of experience. Her learning process was similar—acquired by watching her mother-in-law conduct deliveries. Chetna is uncertified, and her work does not hold any legal or institutional recognition. Farming and labor work form the core of her economic livelihood, with midwifery being a secondary and unpaid service to the community.

Training and learning process

As previously established, the Mitanin does not engage in midwifery practice and possesses no knowledge or training related to childbirth assistance.

Dai 1 - She has a personal background of learning midwifery through traditional, observation-based methods. She reported that it took her approximately five years to learn the practice—longer than the other midwives. She regularly accompanied her mother-in-law during deliveries and gradually acquired the necessary skills. She did not undergo any formal examination or certification. Her competency was informally recognized, and she began practicing once she felt confident in her abilities.

Dai 2 - She also learned midwifery through generational observation. Her training period was around 1–2 years, during which she assisted her mother-in-law in multiple deliveries. Like the others, she has no formal training or institutional certification. Her skills were gained through practical experience and her confidence developed over time, allowing her to begin independent practice.

Dai 3 - Similar to others, she reported a learning duration of 1–2 years, achieved by observing and assisting her mother-in-law during childbirth. She did not receive any formal education or certification in midwifery. Her practice is based on experiential learning and was self-initiated once she felt adequately prepared.

Dai 4 - She followed the same traditional route of learning midwifery through family transmission, particularly by assisting her mother-in-law during childbirth. Her training also spanned about 1–2 years. She has not undergone any formal assessment or received any official certification, and her practice began after gaining sufficient confidence through direct observation and assistance.

Experience and knowledge

The Mitanin does not conduct deliveries herself but plays a significant role in maternal care.

Dai 1 - She is actively engaged in midwifery and has conducted approximately 16 deliveries, of which 15 were successful and one was unsuccessful. Reflecting on her experiences, she expressed satisfaction and pride in her role, stating that assisting in childbirth makes her feel good and valued in the community. Due to the absence of medical tools or diagnostic training, she assesses the condition of a pregnant woman through visual observation, abdominal palpation, and pulse reading. According to her, complications in pregnancy can only be identified when visible symptoms appear. She believes the ideal age for pregnancy is 18–25 years, as early pregnancies may result in weaker babies, higher risks for first-time mothers, and complications for both mother and child. Similarly, she considers late pregnancies more dangerous for maternal health. When asked about complications such as breech birth, amniotic fluid intake, or excessive bleeding, she reported no experience with such cases. She has assisted in one twin delivery, with a gap of 15–20 minutes between the births. She identified the twins as monozygotic and mentioned that twin pregnancies are only detected at the time of delivery.

Dai 2 - She previously practiced midwifery and has conducted approximately 25–30 deliveries, all of which she claimed were successful. However, cross-verification with women in her village revealed discrepancies in this claim. Reflecting on her experiences, she expressed satisfaction and pride in her role, stating that assisting in childbirth makes her feel good and valued in the community. She relies entirely on visible physical symptoms to detect complications in pregnancy and lacks the knowledge to identify conditions such as breech presentation, amniotic fluid aspiration, or nuchal cord—these are recognized only during or after delivery. According to her, the ideal age for pregnancy is between 20–25 years, as both early and late pregnancies pose risks to maternal and child health, with late pregnancies considered more dangerous. She has performed 4–5 twin deliveries, with gaps of 10–20 minutes between the births. As with the others, she noted that twin pregnancies are never detected in advance.

Dai 3 - She is currently active in her practice and has performed approximately 12–15 deliveries, all of which she considers successful. Reflecting on her experiences, she expressed satisfaction and pride in her role, stating that assisting in childbirth makes her feel good and valued in the community. Like others, she identifies complications only when physically observable symptoms are present. She is not trained to detect medical complications such as breech birth, amniotic fluid ingestion, or nuchal cord, and these are typically noticed during delivery. She emphasized that pregnancies outside the age range of 18–25 years are risky, with late pregnancies posing a greater threat. In cases of suspected complications, she prefers to refer women to hospital facilities. She has conducted two twin deliveries, with 10–20 minute gaps between births. One of these cases involved her daughter-in-law.

Dai 4 - Currently practicing midwifery, she has attended approximately 25–30 deliveries, all of which she reported as successful. Reflecting on her experiences, she expressed satisfaction and pride in her role, stating that assisting in childbirth makes her feel good and valued in the community.  She identifies pregnancy complications only when they present visibly. Based on her experience, she is able to estimate the expected date of delivery, although she cannot detect complex cases such as breech presentation, amniotic fluid aspiration, or nuchal cord until delivery begins. In such situations, she refers women to hospitals. According to her, the optimal age for pregnancy is 18–25 years, and she considers late pregnancy more hazardous than early pregnancy. She has not yet performed any twin deliveries.

Pre-natal care

Mitanin - The Mitanin regularly conducts house-to-house visits to monitor the health of pregnant women. She performs basic medical check-ups, such as malaria testing and blood pressure monitoring, using government-provided equipment. She educates women about the importance of institutional delivery and advises them to contact her immediately if they have any health concerns. In emergencies, she promptly calls for an ambulance to ensure the pregnant woman is taken to a nearby hospital for proper medical care.

Dai 1 - She provides midwifery services only when called upon by the pregnant woman or her family. Her practice is experience-based and she relies solely on traditional knowledge. She does not recommend any specific precautions or physical exercises during pregnancy. For diet, she suggests “madiya ke roti,” a local dish. She does not offer any iron tablets or supplements and claims to be emotionally detached from her clients, stating that she is only called at the time of delivery. During labor, she reassures the woman to stay calm and have faith. She performs oil massages using mustard or refined oil, considering mustard oil the most beneficial. She does not use any medical equipment or medicines, depending entirely on her hands-on experience and faith in divine intervention during complicated cases.

Dai 2 - She attends to deliveries when requested by the family and provides assistance based on her practical experience. She recommends a few dietary items to pregnant women, such as dal-bhat, kodo pej, maize-based pej, and pigeon pea (rahar dal). She also advises them to avoid outdoor or heavy labor during pregnancy. Initially, in critical cases, she would continue with delivery and leave the outcome to fate, but now she prefers to recommend institutional deliveries for high-risk cases. She does not recommend any exercise, supplements, massages, or methods for supporting the mental health of the mother. Her deliveries are conducted without any medical tools or medication.

Dai 3 - She offers her services when called by pregnant women or their families, using her experience-based knowledge. She does not advise any specific supplements, precautions, or dietary plans. However, she performs full-body oil massages, typically using mustard oil, although any available oil may be used if mustard oil is unavailable. She takes along helpers during delivery and conducts the process without any medication or modern equipment. She does not provide emotional or mental support beyond physical assistance during delivery.

Dai 4 - She attends deliveries upon request from the pregnant woman’s family, relying on traditional knowledge. She does not recommend any special precautions or massages during pregnancy. For diet, she suggests only dal-bhat and no other specific food items. She occasionally performs oil massages, preferring mustard oil. She does not provide supplements such as iron tablets. In complicated cases, she advises hospital referral. Despite lacking access to medical tools, she is able to perform deliveries independently using only traditional methods.

Post-natal care

Mitanin – She provides essential postnatal care by visiting new mothers at home. She monitors the mother's recovery, ensures newborn health, promotes breastfeeding, distributes supplements, and educates about hygiene, immunization and vaccination. In case of complications, she refers them to health centers, acting as a vital link between tribal communities and institutional healthcare services.

Dai 1 – The delivery was conducted in the room where the woman resides, as there is no specific space designated for childbirth. No traditional rituals were performed before, during, or after delivery. Following a successful delivery, the newborn is bathed by the Dai and then handed over to the mother. Earlier, the umbilical cord was cut and tied at home, and the stump was buried in the soil. However, she now takes the baby to the hospital for umbilical cord cutting, as hospitals dispose of the stump as medical waste and provide a birth certificate. She encourages exclusive breastfeeding for up to two months, believing it is essential for the baby's health. During this period, the mother stays separated from household chores, based on beliefs around postnatal impurity. She does not prescribe any medicines or supplements for either the mother or the child. In cases of insufficient breast milk, she does not offer treatment, although male Baigas sometimes administer herbal remedies, of which she has no knowledge. She also does not suggest any specific diet, exercise, or massages for the mother. If the mother shows signs of infection, she does not have any treatment options available.

Dai 2 – Deliveries are performed at the woman’s residence, and no rituals are observed before, during, or after childbirth. After delivery, the newborn is bathed and handed over to the mother. Previously, the umbilical cord was cut and the stump buried in the soil, but now she takes the baby to the hospital for the cord to be cut, where it is disposed of as medical waste. She promotes breastfeeding for 2–3 months, and during this period, the mother is given complete rest. She recommends specific postnatal diets such as gehun pej, pej bhat, and jondhari pej to promote maternal recovery and milk production. Additionally, male Baigas provide herbal medicines for enhancing lactation. She performs baby massages using mustard oil. In critical maternal situations, she refers the case to the hospital, as she does not have the ability to manage medical emergencies.

Dai 3 – This Dai performs deliveries at the mother’s home and is the only one among the four who follows a traditional ritual before childbirth. This includes offering a coconut and worshiping the Kuldevta (family deity). After a successful delivery, she bathes the newborn and hands the baby over to the mother. Earlier, the umbilical cord was cut at home and buried, but now she prefers to take the newborn to a hospital for cord cutting, as it ensures medical disposal of the stump and allows issuance of a birth certificate. She advises that breastfeeding should begin 20 minutes after birth. No medicines or supplements are provided to either mother or baby. In the case of low milk supply, she does not administer any remedy, although male Baigas sometimes provide herbal treatments.

Dai 4 – Deliveries are also performed at the woman’s house, and no formal rituals are observed. However, she offers a silent prayer to God before the delivery. After childbirth, she bathes the newborn. Previously, the umbilical cord was cut and buried, but she now takes the baby to the hospital for cord cutting, where it is disposed of as medical waste. She conducts oil massages for the newborn using mustard oil. In some cases, she has also accompanied pregnant women to hospitals, where deliveries were conducted under the supervision of medical staff, with help from the Mitanin. She recommends initiating breastfeeding 20 minutes after birth. Like others, she does not prescribe any supplements or medicines for the mother or child.

Infertility

Mitanin - The Mitanin refers couples who are unable to conceive to nearby hospitals or health centers for further medical evaluation and treatment. However, she stated that she has not yet encountered any such cases in her area and therefore has no personal experience to share regarding infertility.

Dai 1 - As a traditional birth attendant, Suruchi mentioned that she is not involved in assisting infertile couples and has never handled such cases. She considers infertility to be “God’s will” and does not associate it with any superstitions. According to her, there are no specific cultural or social beliefs regarding infertility in her community, and no discrimination is practiced against childless couples. They are treated with respect and regarded as normal individuals.

Dai 2 – Chhaya also stated that she has no role in helping infertile couples and has never been approached for such matters. Like others, she believes infertility is simply “God’s doing” and is not influenced by superstitious explanations. In her community, infertility is not culturally stigmatized, and childless couples are treated equally, without any form of social exclusion or negative perception.

Dai 3 - Madhuri confirmed that she has no involvement or experience in dealing with infertility cases. She shares the common belief that infertility is determined by divine will and does not relate it to any rituals or superstitions. Her community, according to her, holds no discriminatory views against infertile individuals or couples and treats them with normalcy and inclusion.

Dai 4 – Chetna also reported that she has not assisted any infertile couple and has no experience with such cases. She too views infertility as beyond human control, attributing it to God’s will. She stated that there are no traditional beliefs, rituals, or stigma associated with infertility in her community, and that infertile couples are treated just like any other members of society.

Role in community

Mitanin – The Mitanin plays a crucial role as a certified Community Health Worker (CHW) in her tribal village. She raises awareness about government schemes and health policies, especially among women. Her responsibilities include providing care to pregnant and lactating women, distributing iron tablets and other essential medicines, and conducting door-to-door immunization and vaccination drives. She serves as a vital link between the community and formal healthcare systems.

Dai 1 – Suruchi shared that her community respects her for her midwifery services, and she often educates pregnant women about common delivery-related issues. She clarified that there is no mythology associated with childbirth, except the burial of the umbilical cord stump, which is believed to protect the newborn from the evil eye. Unlike the Mitanin, she does not counsel women on family planning. In the past, she handled deliveries regardless of complications, but now she refers critical cases to hospitals. She noted a significant shift in childbirth preferences—people now prioritize hospital deliveries, and midwives are called mainly for support, not for the actual delivery.

Dai 2 – Chhaya affirmed that she is respected by the community for her contributions as a traditional birth attendant. Although she has not provided formal education to women on delivery complications, she emphasized that there is no mythological belief associated with childbirth, apart from burying the cord stump to protect against the evil eye. She does not provide family or child planning guidance, which she says is the Mitanin’s domain. Reflecting on changes over time, she acknowledged that modern hospital delivery is now preferred, and traditional midwives are less frequently sought for delivery assistance.

Dai 3 – According Madhuri, her role is appreciated, and she is given respect by her community for her services. Similar to other ‘dais’, she noted that no myths are linked with childbirth, and she also practices cord stump burial to ward off the evil eye. She does not engage in family planning education, a responsibility she attributes to the Mitanin. On the subject of changing practices, she observed that most families now prefer hospitals for delivery, calling midwives primarily for care and presence, rather than for conducting the delivery itself.

Dai 4 – Chetna reported that her work is valued in the community, and she is treated with respect. Like the others, she rejects mythological explanations for childbirth, performing only the symbolic burial of the cord stump for spiritual protection. She does not advise on family or birth planning, recognizing this as the Mitanin’s role. She confirmed that hospital deliveries have become the norm, and midwives are now rarely requested to perform deliveries, being called more for supportive assistance.

Tools and techniques

Mitanin – As a Community Health Worker, the Hina does not conduct deliveries and therefore does not carry any tools related to childbirth. Her role focuses on preventive healthcare, and she is equipped with malaria testing kits and a blood pressure monitor, provided by the government. These are used during routine health checks for pregnant and lactating women in the community. Her responsibilities are limited to awareness, early detection, and referrals, not actual delivery procedures.

Dai 1 – Suruchi  practices traditional midwifery, with no exposure to modern medical instruments or techniques. She conducts deliveries using her bare hands, without the assistance of any professional tools. The only tool she uses is a razor blade for cutting the umbilical cord, which she disposes of immediately after use. Earlier, she mentioned that a “hasiya” (sickle) was traditionally used for this purpose. She does not use herbal medicine during delivery, nor does she adopt any technique to relieve labor pain or manage excessive bleeding. Her practice is entirely based on experience and observation passed down from elder midwives.

Dai 2 – Chhaya  also conducts childbirth using traditional knowledge and has no familiarity with modern tools or medical practices. She relies solely on her hands during delivery. To cut the umbilical cord, she uses a razor blade, a tool she has adopted in place of the “hasiya” used in earlier generations. After cutting, the blade is discarded without sterilization. She does not use any herbal preparations, nor does she implement any strategies to ease labor pain or control bleeding. Her work reflects the longstanding customs of her community, rooted in practical, experience-based midwifery.

Dai 3 – Madhuri follows traditional childbirth methods and has no access to or training in modern medical tools. She performs deliveries manually, without using any specialized instruments. The only tool she mentioned is a disposable blade for cutting the umbilical cord, replacing the “hasiya” used by previous generations. Like the other ‘dais’, she does not reuse the blade and disposes of it after each delivery. She does not apply any herbal remedies, and lacks any means to manage pain or hemorrhaging during labor. Her practice is firmly based on the oral traditions and experiential learning within her community.

Dai 4 – Chetna also serves as a traditional birth attendant, delivering babies without any medical instruments. She performs the procedure entirely by hand, guided by the techniques learned from elder midwives. For umbilical cord cutting, she uses a razor blade, stating that in the past, a “hasiya” was used instead. The blade is discarded after one use, eliminating the need for sterilization procedures. She does not utilize herbal medicines during or after delivery, and has no methods to relieve labor pain or prevent excessive bleeding. Her work remains an example of community-trusted traditional midwifery, though hospital deliveries are now increasingly preferred.

Relation with government and health system

Mitanin – The Mitanin maintains a direct connection with the government and formal healthcare system. She has been appointed and trained by the government to serve as a Community Health Worker in her area. During her training, she was educated about basic medicines, primary health care, and how to conduct medical tests such as blood pressure and malaria screening. For her services, she receives a monthly salary of ₹2200, along with additional incentives for successfully referring pregnant women to hospitals for institutional deliveries.

Dai 1 – Suruchi When asked about her relationship with the healthcare system, Dai 1 shared that the government does not permit traditional midwives like her to conduct home deliveries. She has received no formal training and has no clinical experience. Additionally, she is not allowed to assist in hospital deliveries, and there is no remuneration or recognition from the government for her services. She is unaware of any schemes or policies that support or regulate traditional midwives. When asked how traditional midwifery and the modern medical system could coexist within the community, she responded that such integration would be possible if the government began appointing traditional midwives as Mitanins or at least did not impose restrictions on their practice. In her view, this would allow both systems to function side by side in harmony.

Dai 2 – Chhaya also stated that the health authorities do not permit home deliveries by traditional birth attendants. She has never undergone any formal training and is not permitted to conduct deliveries in hospitals either. As a result, she receives no financial support or acknowledgment from the government. She expressed that she is not informed about any schemes or official policies related to midwifery practices. She also give same answer when asked how traditional midwifery and the modern medical system could coexist within the community, she responded that such integration would be possible if the government began appointing traditional midwives as Mitanins or at least did not impose restrictions on their practice. In her view, this would allow both systems to function side by side in harmony.

Dai 3 – Similar to other respondents, Madhuri revealed that government policy prohibits traditional midwives from performing home deliveries. She has not received any institutional training and is not allowed to participate in hospital-based childbirth. Because of this restriction, she is not paid or supported by the government for her midwifery work. She is also unaware of any health programs, policies, or schemes concerning traditional midwives. Her thoughts are the same as others on the existence of midwifery and the modern medical system together.

Dai 4 – Chetna  reported that although she has not received formal training and home deliveries by ‘dais’ are not permitted under government regulations, she has, on occasion, assisted in institutional deliveries under the supervision of hospital staff. These deliveries were coordinated with the help of the Mitanin, who took the pregnant woman and the Mitanin to the hospital. Despite her involvement in such cases, she receives no official payment or recognition from the government. She is also not aware of any formal policies or schemes related to traditional midwifery. Her thoughts are same as others on existence of midwifery and modern medical system together.

Personal challenges and experiences

Mitanin – As a Community Health Worker and a woman herself, the Hina finds it easy to connect with pregnant women in the community. Being a resident of the same village, she has strong interpersonal relationships, which help her build trust and comfort with the women she supports. She reported no challenges in engaging with them during her work related to maternal care.

Dai 1 – When asked about her experience, Suruchi shared that she is content with her work and takes pride and satisfaction in assisting with childbirth. Although she experienced one unsuccessful delivery, she stated that no blame was placed on her by the family, expressing her belief that "everything is in God’s hands." Her mother-in-law inspired her to take up midwifery, and she has never considered leaving her role. However, with the rise of institutional deliveries and improved medical facilities, the demand for her services has declined significantly.

Dai 2 – Chhaya described her experience in midwifery as positive and fulfilling. She takes joy in serving her community and has not faced any unsuccessful deliveries in her practice, eliminating the possibility of blame. Like others, she was inspired by her mother-in-law, from whom she learned the practice. Although she remains committed to her role, she acknowledged that changing times and increasing reliance on hospital care have led to a decline in the number of home deliveries.

Dai 3 – Madhuri expressed satisfaction and happiness with her role as a traditional midwife. She has not encountered any failed deliveries in her experience and therefore faced no criticism from the families she served. Her entry into midwifery was also inspired by her mother-in-law, and she has always been dedicated to her work. Nonetheless, she observed that modern healthcare facilities and shifting community preferences have significantly reduced her involvement in childbirth.

Dai 4 – Chetna also shared that she feels fulfilled and respected through her work in midwifery. Having no record of unsuccessful deliveries, she has not experienced any accusations or negativity from community members. She too was influenced by her mother-in-law, who passed down the knowledge of childbirth. Although she remains connected to her work, she noted that institutional deliveries are now prioritized, leading to a natural decline in demand for traditional birth attendants.

Traditional and religious aspects

Mitanin – The Mitanin stated that she does not follow any traditional or religious rituals related to her work. Her responsibilities are part of a government-assigned role, and the system is designed such that new Mitanins are appointed over time to continue the work. Hence, her role is institutionalized and ensured for the future through government support.

Dai 1 – Suruchi shared that she does not perform any rituals during childbirth and does not use any herbal medicines herself. When medicines are required, male Baigas provide herbal treatments. The only taboo she follows is the burial of the umbilical cord stump, believed to protect the it  from the evil eye. Regarding the future of her practice, she expressed concern that with government restrictions and growing preference for institutional deliveries, the relevance of traditional midwifery is declining. She also noted that the younger generation shows no interest in learning this tradition, which may lead to the extinction of the practice in the near future.

Dai 2 – Similar to Suruchi, Chhaya stated that she does not perform any childbirth rituals and does not administer herbal medicine—those are handled by male Baigas if needed. She also adheres to the traditional practice of burying the umbilical cord stump to ward off the evil eye. She believes that the practice of traditional midwifery is gradually fading, primarily due to lack of official support and the community’s increasing reliance on hospital deliveries. According to her, younger women are uninterested in midwifery, which threatens the continuity of this knowledge system.

Dai 3 – Madhuri mentioned that she does perform a ritual before delivery, which involves offering a coconut to the Kuldevta (family deity) for blessings. However, she does not use herbal medicines; instead, these are administered by male Baigas when necessary. She also practices the burial of the umbilical cord stump as a protective custom. She feels that the future of traditional midwifery is uncertain, as government restrictions and shifting public preference toward modern healthcare have reduced its importance. Like others, she observed that the new generation lacks interest in continuing this legacy.

Dai 4 – Chetna shared that she does not observe specific rituals during delivery, but she offers prayers to God for a safe childbirth. She does not use herbal medicine, leaving such treatments to male Baigas when needed. She follows the custom of burying the cord stump to protect the child from negative energies. Reflecting on the future, she expressed that due to lack of formal recognition and increased dependence on hospitals, traditional midwifery is declining. She, too, observed that younger women in her community are not interested in learning or continuing the practice.

Cross-Examination of Midwives’ Services Through the Experiences of Women Who Received Their Care During Pregnancy -

Table 1: Basic Demographic and Pregnancy History

The sequence of serial numbers in this table is arranged according to age and the same sequence is maintained in all the tables that follow.

Table 2: Antenatal Checkup Details

From Table No. 2, it is evident that the women selected as samples for cross-examination sought antenatal checkups from both doctors and traditional midwives (‘dais’). However, the majority of the respondents showed a clear preference for consulting doctors over ‘dais’ for their antenatal care.

Table 3: Midwife Services Used

Table No. 3 Those who did contact a dai were mostly referred by their family members. Additionally, the majority of respondents reported delivering their babies in hospitals.

Table 4: Cultural Practices & Beliefs

Table No. 4 due to institutional delivery women’s can’t able to dump stump cord in soil but they believes this rituals.

Table 5: Satisfaction and Trust Level of ‘dai’

Table no. 5 highlights that the most of the women satisfied with dai services.

Table 6: Type of Support Received by ‘dai’

Table No. 6 indicates that while midwives do provide pre- and postnatal care, they do not offer emotional or mental support. Their visits are not regular only when called by the family.

Table 7: Influence on Others

Table No. 7 shows that only a few women recommended the services of ‘dais’ to others. They were more influenced by Mitanins for maternal care guidance.

The cross-examination of women who availed traditional midwifery services revealed a transitional shift from home-based deliveries to institutional care. Most women reported that they preferred consulting doctors or visiting hospitals for antenatal checkups, though a few still contacted traditional midwives ‘dais’, typically through family recommendations. The availability of ‘dais’ was limited, and they were rarely contacted directly. While ‘dais’ still provide delivery services, most respondents chose hospital deliveries due to better medical support, government schemes, and Mitanin interventions. Despite this shift, traditional customs—like burying the umbilical cord stump in the soil to ward off the evil eye—remain common. ‘dais’ provide limited prenatal and postnatal care, primarily offering physical support. Emotional or psychological support is generally absent. They only attend deliveries when called and do not possess modern tools or sterilization methods, relying instead on blades or sickles for cutting the cord. Although women respect the ‘dais’ for their traditional knowledge and past services, they now prioritize hospitals for safety and documentation like birth certificates.

Conclusion

The study confirms that traditional midwifery among the Baigas is not merely a biological act but a deeply embedded cultural process passed down through generations, mostly through observational learning. The ‘dais’, despite lacking formal training or institutional recognition, hold immense experiential knowledge and enjoy social respect. However, due to the rise of institutional deliveries, government-imposed restrictions, and generational disinterest, this age-old practice is rapidly declining.

Contrastingly, the role of the Mitanin, a state-appointed community health worker, showcases the shift toward modern public health infrastructure. Her ability to mobilize resources, conduct prenatal checks, and refer critical cases to hospitals makes her a bridge between the government and tribal society. Yet, she lacks traditional birthing knowledge, creating a knowledge and service gap that neither system fully fills.

The study also highlights the significant trust placed in spiritual beliefs, herbal traditions, and symbolic practices such as burying the umbilical stump to ward off evil. Despite this, ‘dais’ exhibit remarkable adaptability—some accompanying Mitanins to hospitals, showing a possibility of co-existence if recognized properly.

Through this research, it becomes clear that any future maternal health initiative in tribal areas must not undermine traditional wisdom. Instead, there is a pressing need to integrate ‘dais’ into formal health systems through culturally sensitive training, support, and recognition. Their emotional connect, experience-driven confidence, and community trust cannot be replaced by clinical expertise alone.

In conclusion, this study not only preserves and documents the disappearing legacy of Baiga midwifery but also raises important questions about sustainability, recognition, and inclusivity in tribal health care systems. It urges policymakers, anthropologists, and public health professionals to rethink healthcare delivery in tribal settings—not just from a clinical lens, but from a holistic and humanistic perspective.

Suggestions and recommendation

• Formal Recognition of ‘dais’

The government should formally recognize traditional midwives and include them in rural health schemes as informal healthcare providers with proper documentation and identity.

• Basic Skill-Based Training

Provide ‘dais’ with training in hygiene, emergency referrals, and safe delivery techniques—while respecting and retaining their traditional knowledge systems.

• Preservation of Indigenous Knowledge

Systematically document the ethnomedical and midwifery knowledge of Baiga ‘dais’ before it disappears with the older generation.

• Youth Engagement for Continuity

Introduce awareness and learning programs to involve young Baiga girls in traditional midwifery, supported with modern healthcare education.

• Collaborative Healthcare Model

Promote active collaboration between government-trained Mitanins and traditional ‘dais’ to ensure comprehensive and culturally sensitive maternal care.

Conflict of interest Author declares that there is no conflict of interest.

Funding information not applicable.

Ethical approval not applicable.

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