Individuals, institutions, and the global political economy
Unpacking intentionality in obstetric violence
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This chapter interrogates the utility of the term obstetric violence in the Indian context using ethnographic insights from research conducted between 2015 and 2019 in two geographically distinct areas of India, as well as the scholarship on obstetric violence, disrespect and abuse and respectful maternity care. It argues that the circumstances under which institutional births became widespread in India, the conditions under which rural Indian women give birth, the excessive focus on individual provider responsibility while ignoring the systemic and normative mechanisms that routinise disrespectful and abusive treatment, and poor health that is an outcome of exclusion due to social identities and remoteness in terms of geography, make it difficult to capture these inequities within the conceptual category of obstetric violence. It problematises the role of transnational and global health initiatives (GHIs) that have reduced maternal health to a set of technological fixes instead of using a framework that privilege the social determinants of health and/or strengthen health systems. These GHIs have not been attentive to the quality of care that women receive unless they have causative impacts on reducing infant and maternal mortality. A case study of Shaheed hospital, a worker’s hospital in Chhattisgarh, central India, is used to demonstrate that alternative institutional possibilities may exist, which keep service users at the centre of care. This analysis reveals that a different vocabulary, taxonomy, and imagination is essential for a safe and dignified childbirth experiences in low- and middle-income countries that are rooted in their contextual realities and constraints, rather than importing blueprints that work in the developed countries of the global north, as is currently the case.

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Editor: Amrita Pande

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