Traditional Maternity Carers of Malabar: Caste, Religion and Knowledge

The impact of caste, religion and the changing dynamics of medicalization on eattummas–the traditional Islamic postnatal caregivers of north Malabar.

Marva. M

“Within my family there are people who make a fuss about me doing this job. But I ask what is wrong with any job as long as it is not anything unethical to what Allah and Rasool (Prophet Muhammed) has said. Otherwise all the jobs are equally good. Even if I have to clean shit I will do it. It’s a part of my job and it’s a problem of life. Just because I do vellamveethal (വെള്ളം വീത്തൽ) [literal translation is the act of pouring water] does not mean I have become lower caste/ a lower person. People ask me why you are doing this kind of a waged job and I tell them If I have to deal with shit, I do. It’s my work, my livelihood. It is not stealing or sex work.”

– Fathima, an eattumma (ഈറ്റുമ്മ), Malappuram

The phrase Fathima uses, “vellam veethal”, is one used in regions of south Malabar, especially in Ponnani Taluk, to refer to eattummas who are informal unorganized care labourers who work solely for mothers who have newly given birth to babies. Malabar Muslims, specifically the communities of the upper strata, have a system of postnatal care which is a mix of traditional herbal medicine, regional diet, religious and spiritual elements like prayers and cultural taboos. Women who have newly given birth are taken care of by the elder women of her family and the eattumma. Eattummas are domiciliary carers who care for the new mother and baby for 40 days with homemade traditional medicines, diet supervision, oil massage and bathing and laundry. They assist the mother in adjusting with maternity. These Muslim informal labourers are from various lower caste and class backgrounds like mukkuvar/fishers, coir workers and landless farm labourers and the job is generally demeaned as dirty work. Their job is not hereditary except for a few cases of daughters following mothers as eattummas. Eattummas tend to be widows or wives of sick husbands.

I attempted to study how the social structures of gender, caste and religion formulate and figure in the everyday care labour of eattummas and how the eattummas reflexively shape their knowledge of care and body. Between July 2017 and January 2018, I interviewed about 22 postnatal carers, 10 care receivers and 7 medical practitioners to study the eattummas in Malabar. My research led to the understanding that eattummas are a recent ‘traditional’ category that evolved in the last 60-80 years.  I found out that eattummas form only one part of the shifting system of postnatal care in Malabar which currently has multiple kinds of care labourers involved in different localities of the same regionthe Ossathis, Vannatis and home nurses. While Ossathis are women of Muslim barber (Ossan) caste-like communities, Vannatis are washerwomen from the Vannan caste. Home-nursing is a more recent phenomenon of carers being recruited from bordering states or southern districts of Kerala.

Prior to its medicalization and institutionalization, primary postnatal care in the Muslim community was a domestic activity managed by the Ossathis/Otthachis along with the Vannatis. There was a system of division of labour where the Ossathis massaged and bathed the new mothers and also worked as female-barbers, and the Vannatis washed the soiled clothes, and also bathed and massaged the infants. Herbal medicines were prepared by the family members of the mother themselves. The practice continues to exist in the northern rural interiors of Malappuram.

Caste in the case of postnatal carers of Malabar can be discussed in terms of two dimensions. Firstly, how postnatal carers and historically traditional midwives of the region belong to certain caste groups which function as service castes who perform community caring including aesthetic, affective and ‘dirty’ labour. Secondly, there is the issue of how the stigma prevalent towards such labour and labourers arises out of the caste-system; of them being ‘lower’ caste or their labour being ‘lower’ jobs which entail an everyday engagement with bodily impurities (Lee: 2017).  

Among the Muslims of Malabar, the social stratification is such that the Keralite descendants of Prophet and other Arabs rank higher in social hierarchy, followed by the upper-caste converts, with the lower caste converts being at the bottom of the social ladder which includes barbers/Ossans, fishers etc. Caste consciousness prevails among the Muslims, yet it cannot be equated with the systemic and historical ways in which it has operated or continues to operate among the Hindu society (Haskerali: 2017). While theologically contrary to Islamic principles, there are forms of endogamy practiced where the Mappilas refuse to have marital relationships with Ossans. Increasingly, new generations of the Ossan community are seeking alternative professions to hairdressing. Similarly, all the Ossathis and Vannatis currently working as eattummas are above 45-50 years of age, and their younger descendants, seeking social mobility, rarely take up the same work.

The rigid division of labour between Ossathis and Vannatis, based on caste and religious grounds, has broken down. This now depends on the local availability of carers and their financial needs rather than caste. Ossathi Fatima, for instance, says:

“I began attending birth at the age of 18. After my marriage, I went to the families where my mother-in-law worked as an eattumma. Each Ossathi has her own area of service. Now, it is different, you have to wash the clothes of the mother and baby; back then, the Vannathis or Perunnathis used to do that. Now they are not that available. I don’t do that sort of work, I can’t. Maybe there are Ossathis who do that, like my cousin Ossathi Laila, but I cannot. I just bathe the mother and sometimes the baby. If the Vannatis are there they bathe and massage the baby.”

She was bothered about this decreasing differentiation of the duties of Ossathi and Vannati. Similarly, the eattumma Aasya was sad about the fact that home nurses are being hired for postnatal care in cities where eattummas are unavailable. She said, “The preference for a Muslim carer is not about the difference in work; it’s about the body. It’s not desirable that people of other religion see or touch your body. But if you have a dearth of eattummas or home nurses you have no other way, you can’t choose according to religion then.” According to verse 31 of chapter 24 of Quran Al Noor, marriageable men and non-Muslim women should not see the concealed body parts of Muslim women, although this interpretation is contested. Muslim women of older generations in particular prefer pious Ossathis and eattummas and never non-Muslim women as bodily secrecy for them is part of modesty, neither to be shamed not to be flaunted.

At a primary glance, one may conclude that it was the caste system which facilitated the dissemination of knowledge through the pedagogy of practice and apprenticeship among the Ossathis and Vannatis. But that is not the case, and in fact, it is the caste system and its division of labour which has subjugated these knowledges by rigidly confining these care practices to certain social groups and by stigmatizing those professions as ‘dirty’ to the extent that these castes are perceived as communally embodying the impurities. With the advent of colonial biomedicine and the canonization and commercialization of Ayurveda, the folk medical knowledge of the Mappila women which has been passed from generations to generations has declined (Mukharji: 2008, Ram: 2009, Van Hollen: 2003). Thus, the traditional knowledgeable bodily carer has now become relegated to a ‘dirty labourer’ who merely cooks the herbal medicines bought from the Ayurvedic shop and washes soiled clothes, bathes the women and applies oils.


  • Haskerali, E.C. Mappilamuslikalum jaathibhodhavum/മാപ്പിളമുസ്ലീംകളും ജാതിബോധവും. Vachanam Books, 2017.
  • Lee, Joel. “Who Is the True Halalkhor? Genealogy and Ethics in Dalit Muslim Oral Traditions.” Contributions to Indian Sociology 52, no. 1: 1-27, 2007 doi:10.1177/0069966717742223.
  • Mukharji, Projit B. “Pharmacology,‘indigenous knowledge’, nationalism: A few words from the epitaph of subaltern science.” In Biswamoy Pati and Mark Harrison eds., The Social History of Health and Medicine in Colonial India. Routledge, 2008.
  • Ram, Kalpana. Rural Midwives in South India: The Politics of Bodily Knowledge in Childbirth across Cultures: Ideas and Practices of Pregnancy, Childbirth and the Postpartum edited by Helaine Seline and Pamela. K.Stone, Vol.5 in the Science across Cultures: The History of Non-western Science series. Springer, 2009.
  • Van Hollen, Cecilia. Birth on the threshold: childbirth and modernity in south India. University of California Press, 2003.

(Marva M, a native of Malappuram, is currently working as a Storyteller at Book Lovers’ Program for Schools based in Chennai. She graduated with an Integrated Masters in English Studies from IIT Madras. When she is not telling stories, she is either painting, watching cinema or cycling. She can be contacted at

One comment

  1. Marva’s beautiful article gives us ways to open up questions pertaining to caste, gender, and Islam in ways that are not usually done. Her original engagement in the field allows a peek into what Muslim barber women do/say rather than what we assume they do. I think the word limit has not allowed the author to engage with the question of rupture (historically) in detail, nevertheless, she suggests important periods to rethink. But then how far into the past do we go? I strongly believe (and this is based on my own fieldwork with the Muslim barbers of Malabar) that a lot more can be made sense of if we start picking on the minute details that are available to us. For instance, (and this is based on having had the privilege to read Marva’s wonderful field notes beforehand) the very pedagogy of the eetumma’s in question, at times, don’t comply with our standard ideas of apprenticeship/training. There are instances where the female barber, with no prior experience, deliver the baby with no issues at all. What goes into these processes of deliverance and care? How does such knowledge-practices find avenues in transmission? We are left with this and many other perplexing questions.

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