amount of resentment on the part of Chellamma, a fifty-five-year-old maruttuvacci who had been conducting home deliveries in the area for over twenty-five years. Chellamma’s home was on a small path just off the main road near the mini-health-center. Like most hereditary maruttuvaccis, Chellamma had learned how to conduct deliveries through observation and apprenticeship at home rather than through any formal dai-training program. Karpagam, who lived in a thatched house off the open road leading from Kaanathur to Reddikuppam, had undergone a dai-training course at the Kelambakkam PHC in 1990 and also conducted home deliveries on occasion. This was not a hereditary profession for her. She was, however, quite critical of the training she had received since it was very time consuming and did not adequately compensate her for loss of pay due to missed work. She was also bitter that her clients did not pay her adequately and so she found herself seeing fewer and fewer home deliveries over the years. I have met some hereditary midwives in Tamil Nadu who complained that after they had gone through the dai-training programs their clients were more hesitant to pay them than they had been prior to the training, since these clients believed that the midwives were now receiving regular payment from the government.
For both Chellamma and Karpagam, the delivery work was very much part-time. Chellamma had worked most of her life as an agricultural laborer, and Karpagam was working as a laborer on construction sites.8 Neither of these women provided prenatal care. They came only at the time of the delivery. Chellamma would also come for postpartum visits to bathe the baby and prepare postpartum medicines, but Karpagam did not provide these services.
There was one pharmacy in Kaanathur-Reddikuppam, which was located on the main road in the middle of all the shops. This pharmacy was run by a man whom most people referred to as a “doctor.” He had MPHW training and had also taken a three-year course in Siddha medicine. When people asked this pharmacist what he recommended in terms of prenatal and postpartum care for mothers, he tried to encourage them to take Siddha medicines.9 But he complained that people no longer had the patience required for Siddha medicines to really take effect, and they were increasingly demanding allopathic medicines, especially injections, for immediate results. It was because of this attitude, he said, that he was increasingly being summoned to accompany Chellamma to deliveries to give vitamin B12 injections to speed up labor. The pharmacist also occasionally gave mothers and newborns immunization shots. The pharmacist’s shop was a private enterprise, so patients paid a fee for the medicines and services he provided.
In addition to the care provided by the VHS workers, Shahida, Chellama, Karpagam, and the pharmacist, women in the area could also get some government-provided prenatal and postpartum care at the local balwadis (day-care centers), which were run by the government’s Integrated Child Development Services (ICDS). ICDS had become a national program throughout India, but it was modeled on a scheme initiated in Tamil Nadu during M. G. Ramachandran’s term as chief minister in the 1980s. In Tamil Nadu, this program was often called by its original name, the Chief Minister’s Noon Meals Scheme. This program had helped to establish balwadis in low-income communities throughout the state. The balwadis served as free day-care centers for children ages two to five and provided them with free lunches that were supposed to include rice, dal, soya flour, vegetables, and occasionally eggs. In addition, at these balwadis, packets of dried nutritious food (in Tamil referred to as cattu u
In addition to the above-mentioned MCH services for women within Kaanathur-Reddikuppam itself, services were also provided by various hospitals outside of Kaanathur-Reddikuppam. The PHC which serviced Kaanathur-Reddikuppam was located in the town of Kelambakkam. Very few women from this area chose to go to the Kelambakkam PHC just for their deliveries. This was partly due to the distance. As the crow flies, Kelambakkam was quite close. But the route there from Kaanathur-Reddikuppam was indirect and arduous. People would first take a bus going south to Kovalam and then get an auto-rickshaw or van to take them on a long dirt road riddled with potholes through the paddy fields back up to Kelambakkam, which lay on the east side of the canal. The trip by this route took about forty-five minutes. Most felt that travel to Madras was much more convenient even though it took a bit longer. Furthermore, they felt that the quality of care in the larger “government hospitals” in Madras was superior to that of the PHC. The “government hospitals” had emergency care for such things as cesareans, whereas the PHC did not. Those who did go to Kelambakkam for their deliveries only did so if they were planning to undergo sterilization following their delivery. Because the PHC in Kelambakkam was the central PHC for the entire Thirupoorur development block, there were more beds there than in most PHCs.
The other main option for women seeking care for deliveries in public hospitals was to go to the Kasthurba Gandhi Hospital in Madras. This large “government hospital” was usually referred to as “Gosha Hospital” because of its previous name as the Victoria Hospital for Caste and Gosha Women during the colonial era. The direct journey to Kasthurba Gandhi Hospital from Kaanathur-Reddikuppam by auto-rickshaw or van was approximately 20 km. and took about one hour. Many could not afford the expense of such private transportation (Rs. 150), however, and instead had to take two buses (costing a total of less than Rs. 10) to travel to Kasthurba Gandhi Hospital, thereby making the trip one-and-a-half-hours long. Some women from Kaanathur-Reddikuppam who were planning to deliver at Kasthurba Gandhi Hospital would go to the hospital in advance of their labor and, if there was room, stay in the prenatal ward until their labor began. Those who had female relatives (usually on their side of the family rather than their husband’s) living in Madras would go and stay with them prior to their due date so that they could reach the hospital immediately once labor pains began.
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