Women’s birth experiences in Pakistan – the importance of the Dai

Aim. The aim of this paper is to present findings from a research study undertaken to explore women’s life and birth experiences in Pakistan. Method. The design was ethnographic (Denzin, 1978) with an anthropological slant. Participant observation was undertaken in a maternity hospital in Pakistan and an over-50s luncheon club in the UK. Following two focus groups, in-depth interviews were undertaken with 16 women. Data were collected from observation, experience gained during nine field trips to Pakistan and the use of a reflective research diary. Findings/results. The main theme that emerged was the importance of the Dai (untrained traditional birth attendant) in women’s accounts of their experiences. This theme included her influence on the women’s birth experience and her work in the context of relatives and other health professionals. Other sub-themes not covered in this paper were boy preference, the omnipresent medical model, birth systems, the powerful symbolism of blood, purity shame and honour, and specifically from the women interviewed in the UK – coming to England and modernisation. Implications. The Dai was considered essential for the birth and currently 80% of all rural births are attended by Dai. However the medical professionals and policy-makers in Pakistan consider Dai practice to be dangerous and aim to establish systems for supervising and supporting skilled birth attendants, including the development of emergency referral services and a community midwife programme. Further research on women’s experiences of birth in the home and hospital in Pakistan are necessary to inform government policy.