The Social Rural Research Institute confirms that 60-70% of village people in India seek the health services of a rural private practitioner (RPP), 98-99% of whom are men. Dais or female midwives provide most obstetric and childbirth care and have done so for generations. They have learned the skills needed to deliver infants from their forebears. They constitute a category separate from that of RPPs in rural India. Villagers have begun to accept modern medicine, resulting in the marginalization of Dais. Consequently, Dais face social pressures, lack of professional recognition, and problems of credibility. The government of India has trained rural health workers (75% of whom are female) in preventive and promotive health care since 1977. Other community workers include Anganwadi workers, Saathins, and trained assistant nurse-midwives but they have little authority or power to make decisions. The government claims that training women for these grass root roles empowers them, but it has not granted them power to make decisions, resulting in their low social status. They do not receive wages for their work, but honorariums, while most men receive a salary. Some cases objecting to this mode of payment have become before the High Court in Jaipur. In 1990 in Padampura, Saathins protested their low wages in relation to their long work hours, large workload, and commitment. Gender, caste, and class biases further undermine the status of many of these grass roots workers (e.g., the rape case of a Saathin in Bhateri district of Rajasthan). They must work odd hours and in far away villages with no transportation or other support. The government and nongovernmental groups should support them vigorously, including promoting their professional and social legitimacy and credibility. They should institutionalize a link between the community workers, RPPs, and primary health care physicians to establish this needed legitimacy and credibility.
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