Birthing Between the "Traditional" and the "Modern": DaI Practices and Childbearing Women's Choices During COVID-19 in Pakistan

Pregnancy and birth are biological phenomena that carry heavy cultural overlays, and pregnant and birthing women need care and attention during both ordinary and extraordinary times. Most Pakistani pregnant women now go to doctors and hospitals for their perinatal care. Yet traditional community midwives, called DaI in the singular and Dayun in the plural, still attend 24% of all Pakistani births, primarily in rural areas. In this article, via data collected from 16 interviews-5 with Dayun and 11 with mothers, we explore a maternity care system in tension between the past and the present, the DaI and the doctor. We ask, what does the maternity care provided by the Dayun look like during times of normalcy, and how does it differ during COVID-19? We look at the roles the DaI has traditionally performed and how these roles have been changing, both in ordinary and in Covidian circumstances. Presenting the words of the Dayun we interviewed, all from Pakistan's Sindh Province, we demonstrate their practices and show that these have not changed during this present pandemic, as these Dayun, like many others in Sindh Province, do not believe that COVID-19 is real-or are at least suspect that it is not. To contextualize the Dayun, we also briefly present local mother's perceptions of the Dayun in their regions, which vary between extremely positive and extremely negative. Employing the theoretical frameworks of "authoritative knowledge" and of critical medical anthropology, we highlight the dominance of "modern" biomedicine over "traditional" healthcare systems and its effects on the Dayun and their roles within their communities. Positioning this article within Pakistan's national profile, we propose formally training and institutionalizing the Dayun in order to alleviate the overwhelming burdens that pandemics-present and future-place on this country's fragile maternity care system, to give mothers more-and more viable-options at all times, and to counterbalance the rising tide of biomedical hegemony over pregnancy and birth.