Professional Niche Differentiation: Understanding Dai (Traditional Midwife) Survival in Rural Rajasthan

Sharmeen Azher studies Biology and Anthropology at Union College and is also an MBA candidate at Clarkson University’s Capital Region Campus. Passionate about disease and healthcare management in resource-poor settings, Sharmeen will start medical school in the fall. Sharmeen is immensely grateful to her alma mater for their Summer Research Grant (2015), as well as to Dr. Jeffrey Witsoe, her master-of-all-trades mentor for teaching her that good ethnography requires curiosity and adventure. Prescribing medicine, providing contraception, delivering babies – although we may turn to physicians, rural Rajasthani women turn to Barefoot Doctors out of necessity. Such care is available courtesy of the Barefoot College, a pioneering NGO that transforms the skills of the illiterate poor into local infrastructure. Barefoot Doctors are innovative because of their origins as dais (traditional midwives); once abundant across South Asia, dais are mostly extinct due to government/NGO interventions emphasizing “modernity”, like the Accredited Social Health Activist program. Why, then, have dais survived as Barefoot Doctors when they are extinct elsewhere? Ecological niche differentiation refers to when competing species successfully coexist; one species adapts to fulfill another role. Using over fifty interviews with stakeholders, I explain the persistence of Barefoot Doctors as health resources using “professional niche differentiation”. Barefoot Doctors exemplify how health infrastructure can be sustainable in resource-poor settings when created according to local needs and ideologies.