Only when the boat has started sinking: A maternal death in rural north India

Abstract

This paper uses a close reading of villagers’ responses to the death in childbirth of a Muslim woman to raise questions about India’s current policy emphasis on institutional delivery as a means of reducing maternal mortality. After introducing the context and methods of our research, we describe recent policy interventions related to maternal health, including the National Rural Health Mission established in 2005. We then outline villagers’ commentaries on the specific maternal death, focusing on the costs to women’s health (and sometimes life) of high fertility; the lack of care available from rural government facilities and staff and the preference for delivering at home with the aid of local practitioners; the financial constraints that make people hesitate to seek medical treatment; and the high costs of private treatment and the poor treatment experienced in government facilities. Our core argument is that government health care provision in rural Uttar Pradesh is embedded in a moral universe characterised by widespread and long-term mistrust of state services and that encouraging institutional deliveries without addressing the perceptions of potential service users is a seriously flawed approach to reducing maternal mortality. The paper draws primarily on ethnographic research funded by the Wellcome Trust during 2002–2005, in a Muslim village in rural Bijnor district (in north-western Uttar Pradesh).

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India

“…It is similarly consistent with treatment of patients described by Jeffrey and Jeffrey, 2010, who write about “staff who embezzle government funds, extort money illegally and treat patients in distress in discriminatory, demeaning and punitive ways” (1717). Although it is beyond the scope of this study to explore the following hypothesis in detail, it is important to mention that the JSY program may actually exacerbate poor treatment at the hospital.…”

How female community health workers navigate work challenges and why there are still gaps in their performance: a look at female community health workers in maternal and child health in two Indian districts through a reciprocal determinism framework

“…There is an urgent need for promoting better interpersonal skills as a major obstacle in seeking public institutional care is lack of respect shown by health providers [52]. Lessons from ASHAs’ experiences can be one mechanism for improving patient-provider relationship [53].…”

Grief and Women: Stillbirth in the Social Context of India

“…When complications are noted, treatment delays occur because of absence of the required decision makers, economic concerns (both financial and the loss of productivity for all involved), the shame of pregnancy, facilities that are inadequately supplied or staffed, difficult access to a facility, or mistrust of government services (Gopalakrishnan & Ukil, 2009; Jeffery & Jeffery, 1996, 2010). These factors contribute to high stillbirth rates in India, yet many medical providers do not acknowledge perinatal grief (Mehta & Verma, 1990).…”