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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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    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. 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.
    3. 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.
    4. 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.
    5. 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.

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