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Political contexts and maternal health policy: Insights from a comparison of south Indian states

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  • Smith, Stephanie L.

Abstract

Nearly 300,000 women die from pregnancy-related complications each year. One-fifth of these deaths occur in India. Maternal survival rose on India's national policy agenda in the mid-2000s, but responsibility for health policy and implementation in the federal system is largely devolved to the state level where priority for the issue and maternal health outcomes vary. This study investigates sources of variation in maternal health policy and implementation sub-nationally in India. The study is guided by four analytical categories drawn from policy process literature: constitutional, governing and social structures; political contexts; actors and ideas. The experiences of two south Indian states—Tamil Nadu a leader and Karnataka a relatively slow mover—are examined. Process-tracing, a case study methodology that helps to identify roles of complex historical events in causal processes, was employed to investigate the research question in each state. The study is informed by interviews with public health policy experts and service delivery professionals, observation of implementation sites and archival document analysis. Historical legacies—Tamil Nadu's non-Brahmin social movement and Karnataka's developmental disparities combined with decentralization—shape the states' political contexts, affecting variation in maternal health policy and implementation. Competition to advance consistent political priorities across regimes in Tamil Nadu offers fertile ground for policy entrepreneurship and strong public health system administration facilitates progress. Inconsistent political priorities and relatively weak public health system administration frustrate progress in Karnataka. These variations offer insights to the ways in which sub-national political and administrative contexts shape health policy and implementation.

Suggested Citation

  • Smith, Stephanie L., 2014. "Political contexts and maternal health policy: Insights from a comparison of south Indian states," Social Science & Medicine, Elsevier, vol. 100(C), pages 46-53.
    • Handle: RePEc:eee:socmed:v:100:y:2014:i:c:p:46-53
    DOI: 10.1016/j.socscimed.2013.10.029
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    References listed on IDEAS

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    1. Crook,Richard C. & Manor,James, 1998. "Democracy and Decentralisation in South Asia and West Africa," Cambridge Books, Cambridge University Press, number 9780521636476, October.
    2. Parkhurst, Justin O & Lush, Louisiana, 2004. "The political environment of HIV: lessons from a comparison of Uganda and South Africa," Social Science & Medicine, Elsevier, vol. 59(9), pages 1913-1924, November.
    3. Shireen J. Jejeebhoy & Zeba A. Sathar, 2001. "Women's Autonomy in India and Pakistan: The Influence of Religion and Region," Population and Development Review, The Population Council, Inc., vol. 27(4), pages 687-712, December.
    4. Heller, Patrick & Harilal, K.N. & Chaudhuri, Shubham, 2007. "Building Local Democracy: Evaluating the Impact of Decentralization in Kerala, India," World Development, Elsevier, vol. 35(4), pages 626-648, April.
    5. Jeremy Shiffman & Stephanie Smith, 2007. "Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality," Working Papers 129, Center for Global Development.
    6. S. Narayan, 2009. "India," Chapters, in: Peter Draper & Philip Alves & Razeen Sally (ed.), The Political Economy of Trade Reform in Emerging Markets, chapter 7, Edward Elgar Publishing.
    7. Planning Commission, India, 2011. "Faster, Sustainable and More Inclusive Growth: An Approach to the 12th Five Year Plan," Working Papers id:4452, eSocialSciences.
    8. Bossert, Thomas John & Mitchell, Andrew David, 2011. "Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan," Social Science & Medicine, Elsevier, vol. 72(1), pages 39-48, January.
    9. Reich, Michael R., 1995. "The politics of health sector reform in developing countries: three cases of pharmaceutical policy," Health Policy, Elsevier, vol. 32(1-3), pages 47-77.
    10. Crook,Richard C. & Manor,James, 1998. "Democracy and Decentralisation in South Asia and West Africa," Cambridge Books, Cambridge University Press, number 9780521631570, October.
    11. Bossert, Thomas, 1998. "Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance," Social Science & Medicine, Elsevier, vol. 47(10), pages 1513-1527, November.
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    Cited by:

    1. Bukenya, Badru & Golooba-Mutebi, Frederick, 2020. "What explains sub-national variation in maternal mortality rates within developing countries? A political economy explanation," Social Science & Medicine, Elsevier, vol. 256(C).
    2. Alice Evans, 2018. "Amplifying accountability by benchmarking results at district and national levels," Development Policy Review, Overseas Development Institute, vol. 36(2), pages 221-240, March.
    3. Smith, Stephanie L. & Hunsmann, Moritz, 2019. "Agenda setting for maternal survival in Ghana and Tanzania against the backdrop of the MDGs," Social Science & Medicine, Elsevier, vol. 226(C), pages 135-142.
    4. George, Asha & Scott, Kerry & Garimella, Surekha & Mondal, Shinjini & Ved, Rajani & Sheikh, Kabir, 2015. "Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries," Social Science & Medicine, Elsevier, vol. 133(C), pages 159-167.
    5. Tulasi Malini Maharatha & Sumirtha Gandhi & Umakant Dash, 2021. "Has the Demand and Supply-side Components of Janani Suraksha Yojana Augmented the Uptake of Maternal Health Care Services among Poor Women in India ? : An Application of Hybrid Matching Technique," BASE University Working Papers 08/2021, BASE University, Bengaluru, India.

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