IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v100y2014icp46-53.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953613005777
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2013.10.029?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. Crook,Richard C. & Manor,James, 1998. "Democracy and Decentralisation in South Asia and West Africa," Cambridge Books, Cambridge University Press, number 9780521631570.
    4. 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.
    5. Crook,Richard C. & Manor,James, 1998. "Democracy and Decentralisation in South Asia and West Africa," Cambridge Books, Cambridge University Press, number 9780521636476.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. Planning Commission, India, 2011. "Faster, Sustainable and More Inclusive Growth: An Approach to the 12th Five Year Plan," Working Papers id:4452, eSocialSciences.
    11. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    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. 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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Fischer, Harry W. & Ali, Syed Shoaib, 2019. "Reshaping the public domain: Decentralization, the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), and trajectories of local democracy in rural India," World Development, Elsevier, vol. 120(C), pages 147-158.
    2. Dilip Mookherjee, 2014. "Accountability of local and state governments in India: an overview of recent research," Indian Growth and Development Review, Emerald Group Publishing Limited, vol. 7(1), pages 12-41, April.
    3. Ganesh Prasad Pandeya & Shree Krishna Shrestha, 2016. "Does Citizen Participation Improve Local Planning? An Empirical Analysis of Stakeholders’ Perceptions in Nepal," Journal of South Asian Development, , vol. 11(3), pages 276-304, December.
    4. Lankina, Tomila, 2008. "Cross-Cutting Literature Review on the Drivers of Local Council Accountability and Performance," MPRA Paper 12408, University Library of Munich, Germany.
    5. Julia Brown, 2014. "Evaluating Participatory Initiatives in South Africa," SAGE Open, , vol. 4(2), pages 21582440145, April.
    6. Frimpong Boamah, Emmanuel, 2018. "Constitutional economics of Ghana’s decentralization," World Development, Elsevier, vol. 110(C), pages 256-267.
    7. Veron, Rene & Williams, Glyn & Corbridge, Stuart & Srivastava, Manoj, 2006. "Decentralized Corruption or Corrupt Decentralization? Community Monitoring of Poverty-Alleviation Schemes in Eastern India," World Development, Elsevier, vol. 34(11), pages 1922-1941, November.
    8. Andrew Wardell, D. & Lund, Christian, 2006. "Governing Access to Forests in Northern Ghana: Micro-Politics and the Rents of Non-Enforcement," World Development, Elsevier, vol. 34(11), pages 1887-1906, November.
    9. Mogues, Tewodaj & Benin, Samuel, 2012. "Do External Grants to District Governments Discourage Own Revenue Generation? A Look at Local Public Finance Dynamics in Ghana," World Development, Elsevier, vol. 40(5), pages 1054-1067.
    10. Bidhan Kanti Das, 2019. "Denial of Rights Continues: How Legislation for ‘Democratic Decentralisation’ of Forest Governance was Subverted in the Implementation Process of the Forest Rights Act in India," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 31(4), pages 957-983, September.
    11. Christa N. Brunnschweiler & Samuel Kwabena Obeng, 2020. "Rewarding Allegiance: Political Alignment and Fiscal Outcomes in Local Government," University of East Anglia School of Economics Working Paper Series 2020-05, School of Economics, University of East Anglia, Norwich, UK..
    12. Narayana, D., 2005. "Institutional change and its impact on the poor and excluded : the Indian decentralisation experience," ILO Working Papers 993769263402676, International Labour Organization.
    13. Binswanger, Hans P., 2006. "Leonard K. Elmhirst Lecture: Empowering Rural People for Their Own Development," 2006 Annual Meeting, August 12-18, 2006, Queensland, Australia 25713, International Association of Agricultural Economists.
    14. Cook, Nathan J. & Wright, Glenn D. & Andersson, Krister P., 2017. "Local Politics of Forest Governance: Why NGO Support Can Reduce Local Government Responsiveness," World Development, Elsevier, vol. 92(C), pages 203-214.
    15. Service Opare, 2011. "Sustaining water supply through a phased community management approach: lessons from Ghana’s “oats” water supply scheme," Environment, Development and Sustainability: A Multidisciplinary Approach to the Theory and Practice of Sustainable Development, Springer, vol. 13(6), pages 1021-1042, December.
    16. Westphal, Nico, 2011. "Political Decentralisation and Local Economic Development: Findings on the pro-poor responsiveness in 5 Cambodian communes," IEE Working Papers 193, Ruhr University Bochum, Institute of Development Research and Development Policy (IEE).
    17. Holzner, B.M. & de Wit, J.W., 2003. "Supporting decentralised urban governance : training women municipal councillors in Mumbai, India," ISS Working Papers - General Series 19145, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    18. Alexander Stoecker, 2021. "Partisan Alignment and Political Corruption: Evidence from a New Democracy," Volkswirtschaftliche Diskussionsbeiträge 192-21, Universität Siegen, Fakultät Wirtschaftswissenschaften, Wirtschaftsinformatik und Wirtschaftsrecht.
    19. Edward Ampratwum & Mohammed Awal & Franklin Oduro, 2018. "Decentralisation and teacher accountability: How the political settlement shapes governance in the education sector at sub-national levels in Ghana," Global Development Institute Working Paper Series esid-102-18, GDI, The University of Manchester.
    20. Stoecker, Alexander, 2022. "Partisan alignment and political corruption: Evidence from a new democracy," World Development, Elsevier, vol. 152(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:100:y:2014:i:c:p:46-53. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.