11.3 The Narrative
11.3.1 Pre-Pregnancy
Roshni is a 21year old married woman living in Nayatoli village in Bihar. She is in her third year of marriage and lives with her husband Bablu and his parents. Roshni and Bablu are trying for their first child. As it has been two years of their Marriage, Roshni’s pregnancy is a huge point of concern for her and her family. Many of the younger married couples nearby in their village had a child within the first year or so of marriage, so that there’s is taking a bit longer is starting to make Roshni feel examined or perhaps even talked about by her neighbors and peers.
In order to assist their efforts to have a child, they experiment with various rituals, some originating from medical advice while others are non-medical in origin. Roshni’s mother-in-law suggests she try a commonly used ayurvedic syrup called ‘Ashokarishta,’ which is readily available in their local pharmacy. Women in Bihar, and other parts of India, often consume this syrup to cure underlying issues that could be preventing her ability to conceive, such as irregular periods, premenstrual syndrome, and hormonal imbalances. While Roshni opts for drinking some of the Ashokarishta, she’s heard that other women in her village experiencing some difficulty getting pregnant drink a mixture of water and flower from the ‘Urhul’ plant to empty the stomach every morning, a treatment that has been recommended by a woman’s ‘Vaidya’ (traditional physician) or a pundit (Hindu priest).
Roshni has another opportunity during a famous festival in Bihar called ‘Chhath Puja.’ During Chhath Puja, certain women perform the Chhath rituals and are considered very holy. As a result, their blessings can make the wish of getting pregnant come true. Roshni knows this and after Chhath Puja she washes the Sari worn by the woman who performs the festival’s most critical rituals in the river and then wipes her forehead with the sari.
Roshni also lights a special lamp called the Diya. She knows that if she lights the Diya from between five to nine times in the goddess’s temple, only on Tuesday, she could get the goddess’s blessing. While Roshni hasn’t tried this yet, she is also aware of a special cure that involves swallowing a live tiny fish called a Jhinga during another festival, which can get rid of almost any ailment obstructing the pregnancy. When Roshni hears about ‘Gath Bandhan Puja’ being organized at her neighbor’s home as part of the marriage rituals, she participates to benefit from the marriage rituals’ auspiciousness for pregnancy. Roshni also avoids sour food, as these can cause difficulties in conceiving.
As with any couple trying to have a child, encountering difficulties can be a source of stress or dismay. Roshni and her husband tried remedies known to the people around them, and considered many more.
11.3.2 First Trimester
Eventually, Roshni realizes that she has missed her period and begins to wonder if these techniques have worked and she may finally be pregnant. In addition to being late on her period, Roshni has also experienced a recent loss of appetite, which she has heard from family members and other women is a possible sign of pregnancy. Like many women, in Bihar and elsewhere, the first place Roshni turns to confirm if she is pregnant is a kit, which her husband purchases for her from the local pharmacy. Other women in Roshni’s village purchase the kit themselves, preferring to keep the possibility of pregnancy as private as possible.
Interestingly, it does not really occur to Roshni to approach her ASHA for the pregnancy kit, locally known as a Nischchay kit. These government pregnancy kits are commonly used by some women, but Roshni has not established a relationship with her local ASHA yet, as she moved into her husband’s home, in a new village, when they were married. In fact, the ASHA has little to no awareness of Roshni’s possible condition or intentions at this time. In our metaphor of the perinatal journey as a stage for Roshni, as different characters come on and off the stage, the ASHA is not on her stage in this sensitive time early in pregnancy.
In cases where women in Roshni’s village have not established a relationship with their ASHAs or if the Nischchay kits are limited, their families might call the Dai or a trusted and respected elder woman in the family. These women can tell if a woman is pregnant by observing how she walks, or by inspecting her toes, legs, or stomach for visible cues.
Roshni is relieved when the kit her husband bought indeed confirms that she is finally pregnant. At this point, she and her husband share the news only with family members in the household, but will continue to keep the matter a secret from outsiders for at least for the next 3-4 months, as it would become difficult to hide the pregnancy after that. However, Roshni soon makes an exception and tells her parents and siblings about the pregnancy in a phone call. Nearly all the women in Roshni’s village do the same thing, although the amount of time that they wait to share the news varies from a few months to nearly the full term. In general, it seems to be the case that women and families are more protective of news about a pregnancy if a woman gets pregnant too early or too late after marriage. Newlyweds who get pregnant right after marriage avoid disclosing the news early to avoid gossiping and comments related to the couple’s sex lives, fueled by speculation that conception may have occurred before marriage.
Pregnancy is a risky period for many reasons. One common fear is that of evil eye or other general misfortunes. Such risks increase as news of the pregnancy spreads. If information about the pregnancy is known outside the family and the woman faces any issues or ailment, then clearly the blame for the misfortune is on the fact that the pregnancy was revealed too soon.
Another common fear is that complications with the pregnancy can occur when the fetus is so fragile and hence harsh medicines, such as vaccines, should be avoided early on. One of the ASHA’s duties is to give Roshni a Tetanus vaccine and this contributes to her hesitancy to inform her ASHA about her pregnancy. However, Roshni finally reaches out to her local ASHA in the middle of the fourth month of her pregnancy. This begins a process of ante-natal-care (ANC) and includes recommendations such as taking iron and folic acid tablets (IFA).
Roshin starts taking several precautions in light of her pregnancy and also gets advice from her MIL on what she should be doing to avoid risk. For instance, Roshni avoids climbing stairs, carrying heavy items, and strenuous household chores to alleviate additional movement and pressure on the fetus. For the same reason, Roshni’s MIL has suggested her to sleep on her side and to avoid getting up straight from the bed. Roshni likes sleeping on the terrace, but she does not do it during the pregnancy. She is afraid of the Jiloi, an evil bird called who may fly over her if she sleeps under the open sky, and this can lead to thin and weak legs and arms of her newborn child. Furthermore, Roshni is sure not to burn any ropes or strings, especially those made from dried rice plants, to lower the risk of the umbilical cord getting wrapped around the newborn during delivery.
Even though Roshni is typically very pious, she forgoes worshiping lord Shiva or the goddesses Durga, Lakshmi, and Sarasvati during the pregnancy, to prevent her newborn from being born with physical deformities that mimic those of the goddesses, such as having multiple legs and hands (like the goddesses) or a beastly face (like Shiva). However, using analogous reasoning, she continues worshiping the child avatar of Lord Vishnu so her newborn will have beautiful and sharp features. Some of the women in Roshni’s village pray to the river Ganga to bless them with children, but once they are pregnant they do not take bathes in the river Ganga until after the child is born when his or her shaved hair is offered to the river. There is good reason for avoiding the river while pregnant. If a woman bathes in the river before childbirth, the river goddess will take the child back, thus the woman would lose her child.
Another concern for Roshni and women in her village is that of the type of witchcraft known as ‘Godi sun karna.’ In this case, a woman practicing Godi sun karna is trying to conceive and perhaps struggling to get pregnant, as Roshni was, but rather than trying the methods Roshni tried they resort to this more devious technique whereby they spot a pregnant woman and secretly pull a thread from the pregnant woman’s ‘Anchal’ (a portion of the sari that covers the chest and head) and then wears the thread on their wrist. If this works, it steals the pregnant woman’s fetus from the pregnant woman and places it in the body of the woman practicing the witchcraft. Many miscarriages are attributed to this curse and it causes Roshni to head advice about avoiding markets and not roaming around.
Like most Bihari women, Roshni receives a lot of advice regarding her diet and she does add and avoid certain foods as a result. She especially takes her mother’s advice regarding diet during pregnancy. For instance, she avoids eating any hot food and even drinks her tea only after it has cooled to prevent indigestion and any damage to her fetus. Roshni is also careful to eat less than her truly desired amount of food during meals, especially early in pregnancy. According to her MIL, it is important that she not ‘get full’ or over eat because too much food may pressure the fetus and cause complications. It is common for pregnant women in her village to curb their diet throughout pregnancy to prevent the fetus from growing so big that it makes the delivery difficult. Usually, Roshni fasts every Tuesday, but she curtails it during pregnancy to reduce the risk of a weak and malnourished newborn. However, some women of her village continue fasting even during pregnancy to continue getting the gods’ blessings.
In the third month of pregnancy, Bablu takes Roshni to a private clinic for an ultrasound checkup. They go to the private clinic instead of the nearby government-run Primary Health Center (PHC). The PHC does not have the equipment for ultrasound and it is easier to get quality service at the private clinic while keeping the pregnancy secret. Some couples use ultrasound checkups for sex determination, which in some cases leads to feticide.
At the beginning of the fourth month of pregnancy, Bablu meets their local ASHA and informs her about Roshni’s pregnancy. The following day, the ASHA visits Roshni and gets her details for pregnancy registration. Roshni knows that it is essential to register the pregnancy for getting the benefits of free Antenatal Care (ANC) checkups, free ration, and delivery in the public hospital. Roshni and Bablu are also excited about the 6000 rupees they will receive in incentive payments from the government if Roshni goes for all of her recommended number of ANC checkups and delivers in a PHC. In the village, the ASHA also goes to the households to identify pregnant women, and especially to the homes with a new bride. However, the distance to the household can affect how likely it is that the ASHA is able to do such visits. Roshni also doesn’t call her Dai in the initial months of pregnancy. Dai’s role becomes prominent in the last few months of pregnancy, but mostly during delivery (for a home birth) and post-delivery. In some cases, if the pregnant woman faces any minor ailments in the early months, the Dai is called for prescribing some home remedies or to give massages.
11.3.3 The Second Trimester
In the fourth month of her pregnancy, Roshni gets invited by her ASHA to the Village Health Nutrition Day (VHND) for her first ANC checkup. A VHND is usually organized on the third Wednesday of every month at the village Anganwadi Center (AWC). Roshni gets her first TT vaccine. They also measure her weight and blood pressure and she receives the first batch of free IFA tablets and a Maternal Mother-Child Protection (MCP) Card. An MCP card helps track the recommened procedure for a mother and records some basic measurements like weight, and how many IFA tablets have been consumed10.
During this ANC checkup Roshni also meets with her Auxiliary Nurse Midwife (ANM) and ASHA. They briefly discuss the next ANC checkup and the importance of institutional delivery (as opposed to a home birth). They advise Roshni that she should eat a diverse diet and consume all of her IFA tablets. Because there are several other pregnant women at the VHND, the ANM and ASHA only spend a couple of minutes with Roshni before they have to turn to another young mother who is in a hurry to return home, but Roshni is thankful for their advice. She knows from her family and neighbors that she should listen to their advice and that the community thinks highly of them.
Immediately after this first ANC checkup, Roshni returns home and takes her first IFA tablet and records this on her MCP card. While she has every intention of taking the IFA tablets as recommended, after just a few days Roshni starts experiencing constipation and notices a strange darkening of her stool that makes her uncomfortable. When she shares her concerns with her MIL, she tells Roshni that since she is healthy and feeling fine that she doesn’t need to take the IFA tablets, as the side effects aren’t worth it. Roshni’s neighbor echos this advice saying that the IFA is not really necessary for healthy women and she adds that IFA tablets could darken her newborn’s skin. Hence, after just a few doses, Roshni stops taking the IFA tablets she got from the ASHA. Some women in the village continue to take IFA pills provided by the ASHA, as they believe that these pills will help their bodies produce more blood and treat ailments like weakness or the swelling of the arms and legs that some of them experience. Other women who live in Roshni’s village, however, do not trust the quality of the free pills provided by the government, and instead take a similar medicine prescribed by the private clinic.
In the fifth month of pregnancy, Roshni goes for her second ANC checkup at her village’s VHND. She receives her 2nd TT shot and they again record her weight and blood pressure. After the pregnancy registration, Roshni also starts receiving free food rations from the AWC under the Integrated Child Development Services (ICDS) program. She is one of the eight pregnant women selected by the Anganwadi Worker (AWW) to receive free rations, commonly consisting of pulses, cereals, oil, vegetables, and sugar. In spite of this augmenting of nutritious food, Roshni does not increase her diet and continues to worry about the possibility of a difficult labor caused by eating too much. The reasoning is simply that a larger-sized baby is more difficult to deliver than a smaller one. While the ration is appreciated, it does not really translate to an increase in the overall caloric intake or quality of her diet. Avoiding certain foods, occasional fasting, or even intentionally lowering one’s diet are all fairly common practices in Bihar.
In the first few months of pregnancy, Roshni had a reduced appetite but she finds it returning after about the forth month (or middle of second trimester). At this point she starts eating more than she has in the first trimester. Bablu is doing the grocery shopping at this time and Roshni’s MIL advises him about what to buy. She tells him to get dry fruits, coconut water, and cowmilk for Roshni, as she considers these food items highly nutritious. Moreover, she believes coconut and milk help improve the newborn’s complexion to fairer tones. Some women in the village consume protein powder during pregnancy, which would come to their attention primarily via doctor’s prescription. These additions are also dependent on the families’ financial situation, where financially better-off families spend more on the woman’s diet. For some of the families in Roshni’s village, more effort and focus are given to the first child and with each subsequent birth they pay a little less heed to the advice from ASHAs and other members of the medical system. This is in part due to the simple fact that a woman’s attention and effort become divided among her living children. However, due to a strong preference for sons in some families, the attention and focus may increase with later births if they have only had daughters so far.
Because this is Roshni’s first pregnancy, her mother calls her MIL with a request that they bring Roshni home to her parent’s home for a visit. Most of the women in rural Bihar go to their parents’ homes for their first delivery. This common tradition helps place the woman in a more familiar setting, of the home they have only left within the previous one to three years, and this in turn helps alleviate the anxiety of the first pregnancy. Likewise, some women in the village prefer to go to their parents’ place to circumvent their household duties which they are usually obligated to do at the in-laws’ home. As women get a little older, have more children, and gain experience, they also gain increased agency in their husbands’ homes. As a result most later births women stay in the homes of their husband’s family.
Roshni’s MIL gives her approval for Roshni to go back to her mother’s home for this birth. In about the sixth month of pregnancy she moves to her parents’ home for the rest of the pregnancy. Generally, if a woman is going to return to her mother’s home for the delivery, she will do so before the 8th month because it is considered very risky to move and travel so late in the pregnancy. Before leaving for her parents’ place, Roshni calls the ASHA and the AWW to inform them regarding her moving plans. The ASHA reminds her to bring her MCP card, which will help her continue receiving the government benefits at her new location. The AWW informs her that she will not receive the rations for the time she stays in her parent’s village, and she can start receiving the ration for her child once she returns after the delivery. Some women have close relations with the AWW, so they continue receiving the ration even when the pregnant woman stays in a different village. Once Roshni arrives at her parent’s place, her mother calls the ASHA of her village and shows her the MCP card. The new ASHA assures Roshni that she will be there to provide assistance with the institutional delivery and related paperwork. She also counsels Roshni to maintain a diverse diet and maintain at least two years of a gap before planning for the second child.
In the seventh month of the pregnancy, Roshni’s parents organize a celebratory event known as ‘God Bharai.’ Roshni’s family invites close relatives to attend the event, and Roshni receives new clothes, rice, fruits, among other gifts. However, it is still not common in the village to celebrate ‘God Bharai,’ and some believe it to be a modern ritual organized in cities and TV shows. There is an older ritual called ‘Sadhor,’ which is celebrated during the third trimester in some regions in Bihar, and it is related to ‘God Bharai’ in some respects. In ‘Sadhor,’ at least five varieties of fruits, sweets like ‘sonth ladoo,’ Yogurt, and new clothes are offered to the pregnant woman. These items are presented to her in copper plates. This stems from a belief that if a pregnant woman craves a certain food but is not able to eat it, this results in a newborn who drools, sucks their thumb, and throws food.
11.3.4 Third Trimester
As Roshni enters the seventh month of pregnancy, there is increasingly more discussion in her mother’s home regarding delivery and related preparations. Roshni talks to her husband and MIL about where to have the delivery. They decide to go for the second ultrasound before making any decisions. Many women of the village go to private clinics for the ultrasound in the eighth month of pregnancy. Depending on the results of the ultrasound and the private doctor’s diagnosis of fetal health or any concerns for complications, they may decide to deliver in a public or private facility. Since Roshni’s ultrasound report is normal, she and her husband decide to deliver in the nearby PHC. Most women in Bihar are now having births in hospitals, but this was not common just a decade or so ago.
After deciding where to have the delivery, Roshni calls her new ASHA and asks about the process she needs to follow in order to deliver at the PHC. The ASHA advises Roshni to go to the PHC for an antenatal checkup soon, as it should be done in the final few months of her pregnancy, to have recent documentation of her pregnancy before the delivery. The ASHA also tells her about other benefits of an ANC checkup in the third trimester, such as reduced hassle on the day of the delivery, more straightforward process to get the incentives, and issuance of birth certificate for the newborn. After a week, Roshni, accompanied by the ASHA and her mother, goes to the PHC for the ANC checkup.
Roshni’s family considers the eighth and ninth months of pregnancy to be especially high in risk. This view, which is common in her village as well, lead to extra caution for a risk-free delivery and a healthy newborn. For example, non-essential movements and travel are restricted for Roshni to reduce the risk of evil eye, witchcraft, and physical stress on the fetus. In these two months, Roshni follows all the rituals and practices elders advised at the beginning of pregnancy with utmost dedication. She wants to do everything possible to make sure her baby is safe and healthy and there are many practices intended to do just that. She avoids going to the riverbank to avoid evil spirits and witches. She avoid thickets of vegetation near the village for the same reason. The last few months of pregnancy are when women are especially vulnerable to becoming possessed or negatively affected by these evil spirits. Other precautions for warding off evil spirits that Roshni takes include wearing an iron bracelet and tying a ‘Hing’ (asafetida - a gum extracted from an herb) and nut into her Sari. Roshni also avoids working with needles or scissors, so she stops sewing or stitching clothes and cutting her nails, as these activities can cause deformities in the newborn, such as cleft palate. In order to avoid a prolonged or difficult labor, Roshni avoids opening and closing the house’s grain storage containers. Any chores that require prolonged sitting, like cooking or mopping, are also prohibited for Roshni because these can create extra pressure on the fetus, which can lead to the water breaking early or other delivery complications. While Roshni avoids these behaviors based on the advice she’s been given, some pregnant women in the village continue doing some household chores late into the third trimester because they believe the moderate movement can help the baby take its final position in the womb necessary for normal delivery.
During the last two months of pregnancy, Roshni again watches her diet by curbing the quantity of food she eats. She also takes small bites during eating because her mother told her that the child becomes a blabbermouth if a pregnant woman takes large bites. Moreover, Roshni consumes rich and oily food during the last few weeks of pregnancy, as oily and greasy food is believed to ease the delivery by lubricating the womb’s exit passage. In the Muslim families of the village, pregnant women also consume more eggs during the last few weeks of pregnancy, as they consider eggs as warm food that can help in easing the delivery with less pain.
11.3.5 Labor
As Roshni enters her 9th month of pregnancy she is both excited and nervous as she and her family make birth-related preparations around the home. Roshni’s mother invites Pammi, Roshni’s younger cousin, to come to the home and help with delivery preparations and the postpartum care required for the initial few weeks after delivery. Roshni’s mother arranges for Mustard oil, Ghee (clarified butter), Gud (jaggery, a sweet made from unrefined sugar), firewood, and some old but thoroughly cleaned clothing. Some families in the village dry and store the hard coverings from palm tree fruits (known as tarkun or palmyra fruit) as these can be used for firewood to help heat the home for the newborn. Some families also prepare cow dung cakes for heating the home and in some cases they will embed dead scorpions in the cakes and give a hot compress of its smoke to the infant, which is meant to reduce the chances of the child getting bitten by a scorpion later in life and initiates some resistance to its poison.
One day Roshni feels intense pain in her lower abdomen, and she assumes that labor pain has begun. She immediately tells her mother about the pain. As the pain is not intense, Roshni’s mother calls their Dai for help confirming if the labor has started or is just a false pain. In some villages, a Dai is not available or may be hard to reach, and older women are consulted to check if the labor has begun. Meanwhile, Roshni’s brother calls the autorickshaw driver to be ready to take Roshni and other family members to the hospital for delivery. The Dai arrives and after a short observation confirms that labor has begun.
Roshni’s brother then calls the ASHA and informs her about the situation. As their ASHA lives nearby, she accompanies Roshni’s brother to their home to go along with Roshni to the hospital. Sometimes, if the pregnant woman lives far from their ASHA’s home, the ASHA meets the woman at the hospital. While the family is waiting for the vehicle, Roshni is fed Ghee to help the delivery process by lubricating the birth passage. In some families, Porridge (Khichdi) is given to the pregnant woman because it is easier to digest. There is another belief that as Khichdi is a mix of various food items (primarily rice, pulses, etc.), it balances equates the probability of having a girl or a boy. Roshni’s cousin goes to the pundit for blessings, and the pundit provides ‘prasad’ (consecrated food) for Roshni to consume for safe and healthy delivery. Similarly, in Muslim families, ‘Maulvi’ (Muslim priest) provides consecrated oil and water. A pregnant woman drinks the water, and oil is applied to her hair. As the labor intensifies, Roshni’s hair is untied to reduce the pain and quicken delivery. Not untying the hair in this way is believed to cause a head-related deformity in the newborn known as ‘joda.’ While Roshni is taken to the PHC, her father informs Bablu (Roshni’s husband) about the situation, and Bablu immediately heads to the hospital as well.
11.3.6 Delivery and Early Postpartum
After weeks of preparation and months of anticipation, Roshni finally arrives at the PHC with her ASHA, mother, and brother in an autorickshaw. They first complete some paperwork, with a great deal of help from the ASHA, then the facility nurses admit Roshni into the labor room; Roshni’s mother and the ASHA accompany her inside. A nurse administers the required medication for Roshni to get ready for the delivery, and soon Roshni gives birth to a baby boy through normal delivery. The nurse clamps the umbilical cord and puts the child on Roshni’s chest. The nurse checks for any signs of complication in the newborn, and after getting satisfied, cuts the umbilical cord. Another nurse checks on Roshni for any postpartum complications and prepares her for breastfeeding. Meanwhile, the newborn is given BCG and Polio vaccinations, and his weight is recorded by the nurse. Roshni then breastfeeds her child colostrum (earliest yellow, thick milky fluid). In Muslim families, a maulvi or an elderly male family member recites ‘Azan’ (an Islamic prayer) in the ear of a newborn before breastfeeding to get god’s blessings. If no male member is physically present, then such recitations also happen over the phone. In some cases, such as c-section deliveries), when there are complications, or if the mother is not lactating immediately, the infant is given cow’s milk or Infant formula in the initial few days.
Roshni and her family are happy and relieved that the delivery is normal and without complications, which are common in Bihar. Roshni leaves the hospital four hours after the delivery. Before leaving the hospital, one of the staff photographs the newborn newborn as support for the incentive for institutional delivery and birth-certificate-related paperwork. As soon as Roshni leaves the hospital, her mother informs the family members at home regarding their pending arrival. The ASHA also accompanies Roshni to the village.
At home, arrangements for Roshni and the newborn’s arrival are made. A separate room is prepared for their stay in the initial few days, where Roshni and her baby will be kept in semi-isolation from others, with an iron object and thorns placed near the door for protection. New mothers and infants are believed to have impure bodies and foul smells, which are susceptible to evil spirits, and iron and thorns provide protection form such evil spirits. Cow Dung cakes with wood are burnt at the room’s entrance with certain herbs like Ajwain (carom seeds) to keep the room warm and ward off evil spirits. With Roshni’s arrival, she is immediately bathed with warm water to clean the impurities of the hospital and delivery. In some families, Dettol (a kind of mild disinfectant) or neem (a disinfectant herb) is mixed with the water. Meanwhile, Roshni’s mother wipes the baby with wet clothes for the same reason. Some families of the village also bathe the newborns to remove impurities, but there has been extensive messaging to limit this practice and it seems to be less common these days. While wiping-off the newborn, Roshni’s cousin bangs steel plates to check if the child is attentive and not deaf. Once Roshni and the newborn are cleaned, they wear clean (but old) clothes for the initial six days. On the sixth day, the important ritual called Chhathi will occur and they will receive new clothes in preparation for it. Moreover, new clothes may attract evil eye, which is especially dangerous for the first six days. In addition, jaggery and ginger are given to Roshni to eat before she holds the child after the bath, as these are considered auspicious, energy-producing, and warm.
For the next twenty days postpartum, Roshni and her newborn remain in that separate room. If Roshni had a girl child, it would be nineteen days of isolation. In the other households of the village with limited space, at least six days of isolation is warranted for the woman and child. Even if there is one room in the house, a separation is built with a curtain in the room for the mother and the newborn’s stay. Roshni’s cousin (usually one person) stays with her during the isolation period for care and support. Roshni and her newborn do not closely interact with anyone outside the family, while close relatives and friends either ask about their well being without entering the room. One reason is to avoid the risk of evil eye and witchcraft, and another reason is mother and child’s impurity. Anyone who enters the room during the isolation or touches Roshni or the child takes a bath afterwards. The Dai is called every day (morning and evening) for the first week after birth to massage Roshni and her child. The Dai’s massage to mothers during this time, is known as ‘Pet Bandhana,’ which means “wrapping the womb.” The intention of Pet Bandhana is to avoid further bleeding and remove the remaining placenta and other impurities out of the mother’s body. The Dai also washes Roshni’s and the newborn’s clothing, as the clothes they’ve been wearing are considered impure.
In the first few days after birth, Roshni follows her mother’s suggestion regarding her diet. She avoids any cereal-based foods and salt. They believe eating cereal-based food and salt can get into the mother’s milk, which can cause indigestion in the newborn. Roshni eats Halwa, a sweet specially prepared sweet porridge consisting of turmeric, ginger, cumin, fennel seeds, jaggery, cashews, dry grapes, coconut, and dates prepared in ghee or refined oil. This special Halwa is considered warm and nutritious, which can help remove body pain and make Roshni healthier to produce more milk. On the sixth day, Roshni’s family celebrates Chhathi to welcome the newborn into the living world. The child’s hair is shaved (and offered to the river) and he is bathed. Roshni also takes a bath, and both of them (Roshni and her child) wear new clothes. Furthermore, the newborn is given a formal name, which is based on the horoscope prepared by the village pundit (Hindu priest).
Chhathi is a social event with relatives and friends who meet the child for the first time. The ASHA also joins the ‘Chhathi’ celebration as a community member (ASHAs are attend Chhathi almost half the time in Project RISE’s sample of recent mothers). Various kinds of vegetables (a minimum of five different kinds), fish, meat, pulses, and rice are prepared. Roshni eats these food items with other women and family members. Roshni’s in-laws also join the celebration with gifts for Roshni and her child. In some cases, the child is born on Sataisa, which is an inauspicious day based on the horoscope and determined by the pundit. If a child is born on Sataisa the father should not see them until twenty-seven days have passed, and only after a special puja organized on that day.
Roshni receives a visit from her ASHA once during the first week after birth to check on her and her child. Her ASHA provides suggestions related to breastfeeding, mother’s nutrition, and a vaccination schedule. As Roshni and her child are in good health and without major concerns, she limits her visits afterward. In some cases an ASHA’s husband might visit the family if there are any issues related to paperwork or documentation related to incentives (which is fairly common, as ASHAs and families alike find the paperwork rather cumbersome). About six weeks after delivery, it is time for the first scheduled vaccination for the newborn. In that morning, ASHA informs Roshni about the vaccination. Roshni’s mother takes the child to VHND for the vaccination, as Roshni does not go out during the first few months after birth. She also does not visit the private clinic or PHC, as she and her child do not face any complications. A few weeks after birth, Roshni’s husband consults the pundit (priest) to decide an auspicious day for Roshni and the newborn’s arrival to his home. Based on the date chosen by the pundit, Roshni returns to her in-law’s place with her child.