Ten years of negotiating rights around maternal health in Uttar Pradesh, India

The findings from SAHAYOG’s experiences with poor Dalit women (formerly “untouchables” and now members of the Scheduled Castes) in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing lifesaving care. Given the accountability deficit, this analysis takes into account the complexity of the negotiating process around claims for any kind of entitlements. It interrogates the process of civil society action around maternal mortality in Uttar Pradesh to ask why the issue of maternal deaths has not become a political issue. SAHAYOG organization has been working since 2000 on maternal mortality

Ten years of negotiating rights around maternal health in Uttar Pradesh, India

The findings from SAHAYOG’s experiences with poor Dalit women (formerly “untouchables” and now members of the Scheduled Castes) in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing lifesaving care. Given the accountability deficit, this analysis takes into account the complexity of the negotiating process around claims for any kind of entitlements. It interrogates the process of civil society action around maternal mortality in Uttar Pradesh to ask why the issue of maternal deaths has not become a political issue. SAHAYOG organization has been working since 2000 on maternal mortality

“Our fear is finished,” but nothing changes: efforts of marginalized women to foment state accountability for maternal health care in a context of low state capacity

Background Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. Methods The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. Results The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG’s efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. Conclusion Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have made the task somewhat less difficult, but given the population making the rights claims and the rights they were claiming, widespread changes in demands for informal payments may require a much larger and stronger coalition

Using an intersectionality approach to transform health services for overlooked healthcare users and workers after Covid-19

Globally, government responses to the covid-19 pandemic reinforced prevailing patterns of privilege and prejudice and further entrenched the inequitable distribution of health and disease in different populations.1-3 These patterns reflect how the legacies of historical discrimination combine with existing power structures to shape, condone, and continue social disadvantage and the unequal distribution of resources. Analysis of these inequalities within health systems from the perspective of intersectionality can help us understand their drivers and find solutions to reduce them. Tackling these inequalities can also help transform health services for improved pandemic preparedness.

Does Information and Communication Technology Add Value to Citizen-Led Accountability Initiatives in Health? Experiences from India and Guatemala

Information and Communication Technology (ICT) may facilitate the collection and dissemination of citizen-generated data to enhance governmental accountability for the fulfillment of the right to health. The aim of this multiple case study research was to distill considerations related to the implementation of ICT and health accountability projects, describe the added operational value of ICT tools (as compared to similar projects that do not use ICT), and make preliminary statements regarding government responsiveness to accountability demands through ICT projects. In all three projects, the need for relationship building, continuous community engagement and technical support, and training for volunteers or service users was identified. Government responsiveness to the data varied, suggesting that political will is lacking in certain contexts. Despite these challenges, ICT initiatives provided an easy, accessible, and low-risk platform for reporting violations and demanding accountability from service providers and decision-makers. ICT-enabled citizen generated data can add significant operational value and some political value to project activities and goals, and may affect systems change when it is part of a broad-based, multi-level civil societal and governmental effort to improve health care quality.publishedVersio

Using an intersectionality approach to transform health services for overlooked healthcare users and workers after covid-19

Intersectional analysis and action are needed to prepare for future pandemics and ensure more inclusive health services, say Mamothena Mothupi and colleagues

The Emperor's New Clothes: feminist contests with global health knowledge

Introduction This paper is a reflection on fifteen years of working in Uttar Pradesh (UP), India, on the issue of maternal mortality among poor rural women, from the year 2000 to 2015. The work was done through SAHAYOG, a non-profit voluntary organisation, which I helped set up in 1992 and which I led from 2002 to 2014. SAHAYOG works with the mission of promoting gender equality and women’s health using human rights fr­­ameworks, in partnership with community-based organisations (CBOs) worki..

Les survivantes de Bhopal luttent pour une justice écologique

Introduction Certains aiment croire que l’empowerment des femmes n’est possible que lorsqu’une intervention, par exemple une formation sur les questions de genre, est menée par une agence de développement. On aime croire également que la connaissance qui intègre les questions de genre ne peut naître que d’une analyse de genre menée par un bureau d’étude spécialiste des questions de genre. Les résultats des luttes menées par les survivantes de la plus grande catastrophe industrielle au monde, ..