Midwifery scope of practice among staff nurses: a grounded theory study in Gujarat, India.

Sharma, B., et al., Midwifery scope of practice among staff nurses: A grounded theory study in Gujarat, India. Midwifery (2012),http://dx.doi.org/10.1016/j.midw.2012.05.008


Article history: Received 22 December 2011; Received in revised form 11 May 2012; Accepted 12 May 2012

Background: Midwifery is a part of the nursing profession in India.This current study explores and describes the midwifery scope of practice among staff nurses.


Methods: A grounded theory approach was used to develop a model. Twenty-eight service providers from the maternity sections of public health facilities, selected through purposive and theoretical sampling were interviewed in-depth. Unstructured observations in the labour wards were also used for developing the model.


Findings: The midwifery practice of staff nurses was limited in scope compared to international

Standards of midwifery.Their practice was circumstance driven, ranging from extended to marginal depending on the context. Their right to practice was not legally defined, but they were not specifically prohibited from practice. As a consequence, the staff nurses faced loss of skills, and deskilling when their practice was restricted. Their practice was perceived as risky, when the scope of practice was extended because it was not rightfully endorsed, the nurses having no officially recognized right to practice  midwifery at that level. The clinical midwifery education of nursing and midwifery students was  marginalized because the education of medical students was given priority, and the students only got exposed to the restricted practice of staff nurses.


Conclusions: Unclear definitions of the right to practice and the scope of practice have led to the un-utilized potential of staff nurses practicing midwifery. This is detrimental because India faces an acute shortage of qualified personnel to meet the need in providing human resources for maternal health.

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midwifery scope of practice

Negotiating Peace in India’s ‘Red Corridor’

By Medha Chaturvedi

Agence France-Presse/Getty Images
Pictured, Alex Paul Menon who was abducted by Maoist rebels in Chhattisgarh.

In April, Maoist rebels kidnapped Alex Paul Menon, a senior administrator in the Sukma district of Chhattisgarh state, as he met tribal villagers. Two security guards traveling with Mr. Menon were killed when he was abducted. The rebels’ demands included the release of jailed comrades in Chhattisgarh and the end of government counter-insurgency operations against their movement.

Mr. Menon was held for 12 days before being handed over unharmed to a team of four negotiators, including Brahma Dev Sharma, a former district collector and commissioner of Bastar district, and G. Hargopal, a professor from Central University of Hyderabad. Both were chosen by the Maoists as negotiators.

India Real Time spoke with Mr. Sharma about the negotiations and the Maoist insurgency. Edited excerpts:

IRT: You were handpicked by the Maoists for the negotiations, do you think the process went as planned?

Mr. Sharma: My position is very clear on this. I was asked to help and so, I was involved in the negotiations to find the best solution acceptable to both the sides. However, in my opinion, the most effective negotiations between the Maoists and the government happened in 2004 in Andhra Pradesh when all the stakeholders were involved in the process, when a team of mediators headed by former Indian Administrative Service Officer S.R. Sankaran negotiated the demands of the Maoists and the government representatives. Sankaran himself had been kidnapped by the People’s War Group some years ago and [was then] a civil society activist. Following the mediation, there was a ceasefire for six months because all the stakeholders agreed that the socio-economic aspect of the Naxalite insurgency needed to be addressed, rather than treating it as a law and order situation and combating it with only counter-insurgency offensives.

In the recent cases, however, that sharpness and involvement of all stakeholders hasn’t come about. All the organizations talk on their own line and put forward their own perceptions. There is a need for a coherent inclusive round of talks which represents all interests and arrives at a compromise acceptable to all.

IRT: Do you think that kidnapping foreign nationals, as was seen in Orissa in March, proved to be counter-productive for the Maoists?

Mr. Sharma: The government saw the issue of abduction of foreign nationals in isolation. What they failed to acknowledge was the actual reason for this kidnapping, hurting the tourism industry in the state. Tourism comes with alcohol consumption which is directly influenced by the Excise Policy that India follows which the Maoists are opposed to. In terms of a possibility of an international backlash with the abduction of foreign nationals, I feel that public memory is very short-lived. Sporadic incidents as such would not leave a lasting impact.

IRT: Do you think that the Maoists are facing factionalism as was evident in the Orissa case when the State Organising Committee led by Sabyasachi Panda, functioning under the CPI (Maoist) Central Committee, called for a ceasefire during the period of negotiations while separate factions carried out attacks including the killing of a sub-inspector in Malkangiri district?

Mr. Sharma: Factionalism is everywhere in India. As a nation, we are in the habit of not standing united and the Maoists structure is no exception to the rule.

IRT: What is the biggest reason for this insurgency to have carried on for so long?

Mr. Sharma: India was primarily an agrarian country before the British occupation. After Aurangzeb’s time, the British changed that and made it predominantly industrial and post Independence, it again became an agrarian country. In this context, these tribal areas had their own worth in terms of natural resources. After the fourth and the fifth five-year plan, the Western concepts of globalization were again encouraged in India and these again came to the fore. The problem is that the government has brought these areas to the fore, but left the people marginalized. Consequently, the people in these tribal areas were massively displaced. The government of India has an account of every brick used in the construction of what they call appropriate infrastructure, but no account of the number of people who were displaced. This is a contradiction that needs to be addressed.

What the state is now giving to the tribals in the form of aid is nothing but perversion and is treated as alms. When I was the commissioner in Chhattisgarh, my simple question to the state authorities was, “Would you knock before you enter someone’s home?” Why would you just barge into the jungle without even asking those who live there, for whom it is home? You don’t discuss the plans you want to implement in these areas with the locals and you don’t talk about their displacement so then, who are you to ask them to not support the Maoists? This is a clear case of the state abdicating its responsibility.

IRT: Is there a distinction between the Maoists and the tribals and are the Maoists actually representing local interests? What is the reason for the huge local support that the Maoists thrive on?

Mr. Sharma: As a Commissioner of undivided Bastar, back in the 80s when Maoism had just started appearing as a menace in Chhattisgarh, I asked the locals what they felt was the advantage of supporting the Maoists. They said that Maoism rid them of the three biggest problems they faced: the Patwaris (government officials who keep records regarding ownership of land), the forest guards and the police. The police force in India is a highly imperialistic structure and is seen as such by the locals.

What is happening in the tribal regions of what is called the “Red Corridor” is the worst form of exploitation by the state. The state is not willing to provide the tribals even basic dignity. The PM has said time and again that the development policies implemented in the area are for uplifting the “poor” tribals. By calling these tribals poor, you have already humiliated and undignified them. When they have all that they need for a satisfactory survival right there in their natural habitat, the jungle, how can you call them poor? Is just making roads in those areas sufficient?

When the government opens up the tribal areas, they do nothing to protect them from non-tribal settlers. This is the biggest contradiction because the government is implementing development policies in line with their own definition of development. What needs to be done is to define development in such a way that it does not humiliate the locals. Tribals are not Maoists and to put them in the same bracket is not correct. The state has a dialogue with the Maoists because they are at a conflict with them but the tribals, who are the actual stakeholders, are completely ignored.

IRT: What can the state do to contain this insurgency?

Mr. Sharma: This is a complicated problem with various layers. I feel that the first thing that needs to be done is to define land ownership in these areas. Under the principle of eminent domain, post independence, the government inherited rights to all the land under the British rule. Now, they claim that it is their land while the tribals claim it is theirs. My question is: who came there first, the state or the tribals? Independence Day was a celebration for everyone but for these tribals, it was a dark night which took away everything that belongs to them. The state is completely ignoring its own constitutional provisions as given in the Fifth Schedule (administration and control of scheduled areas and tribes). It is this capitalistic predomination which is the root cause of Naxalism and unless this is addressed, this insurgency will not end.

IRT: You have been an administrator and now you are a civil society activist. Having seen the problem from both the sides, what made you switch?

Mr. Sharma: I was happy as an administrator in doing whatever I could to ensure such injustice does not happen in my area of influence. I have always maintained that I don’t believe in the law, I am with the people, wherever they stand. As a district collector or commissioner, I had executive powers so that in my area of influence, I could stop this grave injustice. However, I resigned when I was to be the secretary to the state or at the center because that would’ve meant taking up an advisory position which, for me, was of no use in helping these people. I am happy being a part of the civil society now.

Medha Chaturvedi is a research officer with the Institute of Peace and Conflict Studies in New Delhi. Her areas of research are left wing extremism and the process of internal development in Myanmar. Before joining IPCS in 2010, she worked for five years as a journalist covering organized crime. Write to: medhachaturvedi@gmail.com or follow her on Twitter @medhachaturvedi

Rights of tribals at the core of Maoist conflict – B D Sharma

“Rights of tribals at the core of Maoist conflict”

Mohammad Ali

Social activist B.D. Sharma addressing a news conference in New Delhi on Saturday. Photo: Shiv Kumar Pushpakar.
 Social activist B.D. Sharma addressing a news conference in New Delhi on Saturday. Photo: Shiv Kumar Pushpakar.
The Hindu

States have allowed exploitation of mineral-rich regions without locals’ consent

The conflict between the government and the Maoists in the tribal areas didn’t start with the abduction of Sukma Collector Alex Paul Menon and it would not end with his release, observed B.D. Sharma, the mediator who secured Mr. Menon’s freedom after two weeks in captivity.

Addressing a press conference here on Saturday, Mr. Sharma said: “At the core of the clash between the governments and the Maoists lies the question of ownership ofjal, jangal and zameen of the tribals, who used to be the owners of the mineral-rich region, and the model of development which the governments, State as well as the Union, are thrusting upon them.”

Referring to the “understanding” reached between the Chhattisgarh government and Maoists, he hoped the temporary ceasefire in Operation Green Hunt will lead to an era of peace. However, he added: “Only astrologers can predict the longevity of the current ‘ceasefire.”

The former District Magistrate of Bastar talked about the situation prevailing in the tribal region while highlighting the government’s failure in protecting the rights of tribals.

“When I asked a local tribal in Bastar about the difference the Maoists’ presence has made to his life, he replied that the tribals don’t get troubled by the patwari and thedaroga,” Mr. Sharma said.

Talking about the “inherent contradiction” in the government’s policy on tribals, Mr. Sharma said instead of resolving core issues like rights over forests, forest produce, people’s rights over land and resources, and the trader-contractor-politician nexus, governments have signed hundreds of memoranda of understanding with foreign and domestic companies for exploitation of minerals without the consent of the local people.

“Our Prime Minister calls the tribal people poor! How can you call the community poor which historically and naturally used to own and cultivate the mineral-rich region and its resources?” he said.

Mr. Sharma regretted that the Bhuria Committee’s 1996 recommendation regarding community ownership of industry had not been adopted still. He said tribals had not been given any stake in the present model of development despite the Centre having envisaged carving out a zone to ensure the partnership of tribals in development.

He highlighted the “open violation” of the provisions of the Panchayat (Extension to Schedule Areas) Act, 1996 (PESA) — the PESA had envisaged that “every Gram Sabha shall be competent to safeguard and preserve the tradition and customs of the people, their cultural identity, community resources and the customary mode of the dispute resolution.”

NHRC plans draft legislation on rights of patients

New Delhi: The National Human Rights Commission is mulling to come out with a draft legislation that seeks to protect the rights of patients and ensure that standard treatment is made available to everyone.

The Commission has also written to the Centre and state governments with regard to the rise in the number of people inflicted by silicosis, a respiratory disease caused by breathing in silica dust, asking them to take steps to give priority to such patients in all hospitals.

PC Sharma, member, NHRC, said the trend of patients “surrendering themselves before doctors” should end and every patient should have the right to know what kind of disease he has been inflicted with and the kind of treatment needed.

“We have asked the Government for the need (for a legislation). We are trying to make a draft with the help of NGOs. We are of the opinion that at least there should be a draft. Just as you can demand the right to education and equality, one should get the right to health also,” he told reporters here.

“We want a legislation which says that the doctor should tell the patient about his disease and other details. Now the patient goes and surrenders himself before the doctor. There are instances where doctors don’t listen to patients and just give them some medicines,” he said.

On silicosis, the NHRC member said all states have been asked to take precautions under the Industries Act and make sure that employees undergo periodic health check-up.

“We have also told the states that they should instruct hospitals that such patients should be treated immediately. Many hospitals don’t treat them by giving some reasons. This should be stopped,” he said.
Sharma said urgent attention has to be given for development of infrastructure in hospitals in the country and also expressed concerned over the “widespread” racket in sub- standard medicine.

He also said the NHRC wants the Centre to come out with an Act on prevention of silicosis as the disease affects mostly the poorer sections of the society.

Notices were sent to a number of states where deaths have occurred due to the disease and only Rajasthan responded positively by giving Rs three lakh to the families of the victims of silicosis.

“Silicosis, hitherto, remains a neglected area. This is a disease which is irreversible. Victims of this disease are mostly migrants who are in search of jobs. Protection to them is granted under labour laws, but these things are not followed,” he said.

He also claimed that in some cases state government authorities refused to look into complaints of people afflicted with the diseases because they were from the unorganised sector.

“This is the most serious grievous violation of human rights,” he said.

Sharma said the NHRC is also concerned about the lack of doctors in the field of mental health and asked the MCI to add mental health as part of curriculum for MBBS students.

He also said this disease cannot be cured only medically but also needed proper care by families.

Source- NHRC Release

‘Make silicosis a notifiable disease’


Plight of the Silicosis victims and their family members at Musabani Ghatsila. The potential victims of silicosis are poor migrant workers employed in quarries, mines, gem cutting and other hazardous occupations such as construction sites, a majority of whom are likely to die for lack of specialised treatment. File photo

Plight of the Silicosis victims and their family members at Musabani Ghatsila. The potential victims of silicosis are poor migrant workers employed in quarries, mines, gem cutting and other hazardous occupations such as construction sites, a majority of whom are likely to die for lack of specialised treatment. File photo

Special Report- The  Hindu
Health facilities, adequate compensation must be provided

Taking a serious note of the increasing silicosis-related deaths in the country, the National Human Rights Commission (NHRC) has recommended that silicosis be made a notifiable disease. Once notified, all government and private health facilities will have to report confirmed as well as suspected silicosis cases to the government.

Silicosis is an incurable lung disease caused by inhaling of dust containing free crystalline silica. The potential victims of silicosis are poor migrant workers employed in quarries, mines, gem cutting and other hazardous occupations such as construction sites, a majority of whom are likely to die for lack of specialised treatment.

In a special report — a first of its kind — presented to Parliament, the NHRC has suggested that the government should ensure health facilities to all workers employed at places prone to silica and earmark adequate compensation to the families in case of death.

Talking to reporters here on Friday, P.C. Sharma, NHRC member, said the governments often adopted a strange attitude by saying that those employed in such hazardous jobs were migrant labourers and under the unorganised sector of employment, and hence not much could be done.

“This is a grievous violation of human rights because laws should be equal for organised and unorganised sector workers, keeping in mind the fact that a majority of workers in the country fall in the category of unemployed sector,” he said.

Mr. Sharma admitted that numerous laws were only on paper and poorly implemented. Preventive measures and health care facilities should be the responsibility of the employers, he said.

The Commission has also written to all States to identify the hazardous industries and mapping them for silica generation which results in silicosis. The response from the States were not adequate and they had been asked to send specific answers.

The report to Parliament also suggests regular check-up for the workers employed at places where they are exposed to silica and even linking silica treatment with the TB Control Programme.

It was based on the NHRC recommendation that Rajasthan enhanced compensation in case of silica-related death to Rs.3 lakh. It has also set up a corpus of Rs.25 crore for the purpose as instances of silica-related cases are very high in that State.

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