Faith, Trust and the Perinatal Healthcare Maze in Urban India

S. Raman


How women access and utilise health services through pregnancy, childbirth and infancy needs to be understood if we are to improve the delivery of and access to appropriate healthcare. Drawing on ethnographic observations of clinic encounters and in-depth interviews with women in Bangalore, South India, this paper reports on the complexities of negotiating healthcare throughout the perinatal continuum in urban India. Key themes identified include faith and trust in health services, confusion over right to healthcare; and the contested nature of choice for women. What is revealed is a socially restrictive framework that results in choices that seem arbitrary, irrational and self-defeating; poor women being particularly vulnerable. Given the current policy support for public-private-partnerships in reproductive healthcare delivery in India, both public and private health services need to move substantially to achieve true partnership and provide care that is respectful and valued by women and children in urban India.


Private healthcare, perinatal continuum, access, healthcare utilisation, India

Full Text:



Adam, Taghreed, Lim, Stephen S., Mehta, Sumi, Bhutta, Zulfiqar A., Fogstad, Helga, Mathai, Matthews, Zupan, J, & Darmstadt, Gary L. (2005). Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. BMJ, 331(7525), 1107.

Balabanova, Dina, Mills, Anne, Conteh, Lesong, Akkazieva, Baktygul, Banteyerga, Hailom, Dash, Umakant, . . . & McKee, Martin. (2013). Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening. The Lancet, 381, 2118–2133.

Balarajan, Y, Selvaraj, S, & Subramanian, S V (2011). India: Towards Universal Health Coverage 4: Health care and equity in India. The Lancet, 377, 505-515. doi: 10.1016/S0140-6736(10)61894-6

Barros, Aluísio J. D., Ronsmans, Carine, Axelson, Henrik, Loaiza, Edilberto, Bertoldi, Andréa D., França, Giovanny V. A., Bryce, J, Boerma, J. T, Victora, & Cesar G. (2012). Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. The Lancet, 379(9822), 1225-1233.

Baru, R. (2003). Privatization of health services: a South Asian perspective. Economic and Political Weekly, 38(42), 4433-4437.

Berman, Peter. (2001). Getting more from private health care in poor countries: a missed opportunity. International Journal for Quality in Health Care, 13(4), 279-280. doi: 10.1093/intqhc/13.4.279

Bhat, R, Huntington, D, & Maheshwari, S. (2007). Public-private partnerships: managing contracting arrangements to strengthen the Reproductive and Child Health Programme in India. Lessons and implications from three case studies.

Bhate-Deosthali, Padma, Khatri, Ritu, & Wagle, Suchitra. (2011). Poor standards of care in small, private hospitals in Maharashtra, India: implications for public–private partnerships for maternity care. Reproductive Health Matters, 19(37), 32-41. doi: 10.1016/s0968-8080(11)37560-x

Bhatia, Jagdish C., & Cleland, John. (1995). Determinants of maternal care in a region of South India Health Transition Review 5, 127 - 142.

Bhaumik, Soumyadeep. (2012). India outlines plans for National Urban Health Mission. The Lancet, 380(9841), 550.

Blanchet, T. (1984). Women, pollution and marginality: meanings and rituals of birth in rural Bangladesh: Dhaka: University Press.

Braun, Virginia, & Clarke, Victoria. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77-101.

Brugha, R, & Zwi, A. (1998). Improving the quality of private sector delivery of public health services: Challenges and strategies. Health Policy and Planning, 13(2), 107-120.

Das, Jishnu, & Hammer, Jeffrey. (2004). Strained mercy: quality of medical care in Delhi. Economic and Political Weekly, 951-961.

De Costa, Ayesha, Johansson, Eva, & Diwan, Vinod K (2008). Barriers of mistrust: Public and private health sectors' perceptions of each other in Madhya Pradesh, India. Qualitative Health Research, 18(6), 756-766.

de Zoysa, I , Bhandari, N , Akhtari, N , & Bhan, MK (1998). Careseeking for illness in young infants in an urban slum in India Social Science & Medicine, 47 2101-2111.

Deosthali, P , & Khatri, Ritu (2010). Private health sector in Maharashtra: a study of private hospitals. Mumbai: CEHAT.

Floyd, Katherine, Arora, VK, Murthy, KJR, Lonnroth, Knut, Singla, Neeta, Akbar, Y, . . . Uplekar, Mukund. (2006). Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India. Bulletin of the World Health Organization, 84(6), 437-445.

Forsey, Martin Gerard. (2010). Ethnography as participant listening. Ethnography, 11 (4), 558–572. doi: 10.1177/1466138110372587

Fotso, J. C., & Mukiira, C. (2012). Perceived quality of and access to care among poor urban women in Kenya and their utilization of delivery care: harnessing the potential of private clinics? Health Policy & Planning, 27(6), 505-515.

Gangolli, Leena V, Duggal, Ravi, & Shukla, Abhay. (2005). Review of healthcare in India. Mumbai: Centre for Enquiry into Health and Allied Themes.

Gideon, Helen. (1962). A baby is born in the Punjab. American Anthropologist, 64(6), 1220-1234.

Grbich, Carol. (2003). Qualitative Research in Health: An introduction. London: Sage Publications.

Green, Judith, & Thorogood, Nicki. (2009). Qualitative methods for health research. Second edition. London: Sage Publications.

Helen, Lambert. (2012). Medical pluralism and medical marginality: Bone doctors and the selective legitimation of therapeutic expertise in India. Social Science & Medicine, 74(7), 1029-1036. doi: 10.1016/j.socscimed.2011.12.024

HLEG. (2011). High Level Expert Group (HLEG) Report on Universal Health Coverage for India. New Delhi: Planning Commission of India.

Jallow, Isatou K., Chou, Yiing-Jenq, Liu, Tsai-Ling, & Huang, Nicole. (2012). Women's perception of antenatal care services in public and private clinics in the Gambia. International Journal for Quality in Health Care, 24(6), 595-600.

Jat, Tej Ram, Ng, Nawi, & San Sebastian, Miguel. (2011). Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. International Journal for Equity in Health, 10(1), 59.

Kakar, Sudhir. (1984). Shamans, mystics and doctors: a psychological inquiry into India and its healing traditions. London: Unwin Paperbacks.

Kesterton, Amy, Cleland, John, Sloggett, Andy, & Ronsmans, Carine. (2010). Institutional delivery in rural India: the relative importance of accessibility and economic status. BMC Pregnancy and Childbirth, 10(1), 30.

Khan, Shamshad. (2006). Systems of medicine and nationalist discourse in India: Towards “new horizons” in medical anthropology and history. Social Science & Medicine, 62(11), 2786-2797. doi:

Khare, R. S. (1996). Dava, Daktar, and Dua: Anthropology of practiced medicine in India. Social Science & Medicine, 43(5), 837-848. doi:

Langer, Ana, Horton, Richard, & Chalamilla, Guerino. (2013). A manifesto for maternal health post-2015. The Lancet, 381(9867), 601-602.

Lopez, Alan D, Mathers, Colin D, Ezzati, Majid, Jamison, Dean T, & Murray, Christopher J L. (2006). Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367, 1747-1757.

Matthews, Zoe, Ramakrishna, Jayashree, Mahendra, Shanti, Kilaru, Asha, & Ganapathy, Saraswathy. (2005). Birth rights and rituals in rural South India: care seeking in the intrpartum period. Journal of Biosocial Science, 37 (4), 385 411. doi: 10.1017/S0021932004006911

Ministry of Health and Family Welfare. (2008). 2005-2006 National Family Health Survey (NFHS-3). National Fact Sheet- India, Provisional Data. New Delhi: Retrieved from

Mohanty, Sanjay K. . (2012). Multiple deprivations and maternal care in India. International Perspectives on Sexual and Reproductive Health, 38(1), 6-14. doi: 10.1363/3800612

MOHFW. (2002). National Health Policy. New Delhi.

Narayan, Ravi. (2011). Universal health care in India: missing core determinants. The Lancet, 377(9769), 883-885. doi:

Navaneetham, K, & Dharmalingam, A. (2002). Utilisation of maternal health care services in southern India. Social Science & Medicine, 55, 1849 - 1869.

Nichter, Mark. (1980). The layperson's perception of medicine as perspective into the utilization of multiple therapy systems in the Indian context. Social Science & Medicine. Part B: Medical Anthropology, 14(4), 225-233. doi:

Pigg, Stacy Leigh. (2013). On sitting and doing: Ethnography as action in global health. Social Science & Medicine(0). doi:

Pinto, Sarah K. (2008). Where There Is No Midwife: Birth and Loss in Rural India. New York: Berghahn Books.

Radwan, Ismail. (2005). India - Private Health Services for the Poor: A Policy Note. In N. Health, and Population Family (HNP) of the World Bank’s Human Development Network, (Ed.). Washington DC: The World Bank.

Ram, Kalpana. (1994). Medical management and giving birth: Responses of coastal women in Tamil Nadu. Reproductive Health Matters, 2(4), 20-26. doi: 10.1016/0968-8080(94)90004-3

Raman, Shanti, Srinivasan, Krishnamachari, Kurpad, Anura J, Dwarkanath, Pratibha, Ritchie, Jan, & Worth, Heather. (2013). “My mother…my sisters… and my friends”: Sources of maternal support in the perinatal period in urban India. Midwifery, In press.

Rao, Krishna D, Bhatnagar, Aarushi, & Berman, Peter. (2012). So many, yet few: Human resources for health in India. Human Resources for Health 10(19). doi: doi:10.1186/1478-4491-10-19

Reddy, K. Srinath, Patel, Vikram, Jha, Prabhat, Paul, Vinod K., Kumar, A. K. Shiva, & Dandona, Lalit. (2011). Towards achievement of universal health care in India by 2020: a call to action. The Lancet, 377(9767), 760-768. doi:

Rozario, Santi. (1998). The dai and the doctor: discourses on women's reproductive health in rural Bangladesh In K. Ram & M. Jolly (Eds.), Maternities and Modernities: Colonial and Postcolonial Experiences in Asia and the Pacific (pp. 144-176). Cambridge: Cambridge University Press

Sengupta, Amit, & Prasad, Vandana. (2011). Towards a truly

universal Indian health system. The Lancet, 377(9767), 702-703. doi:

Van Hollen, Cecilia (1998). Moving Targets: Routine IUD Insertion in Maternity Wards in Tamil Nadu, India. Reproductive Health Matters, 6(11), 98-106.

Van Hollen, Cecilia (2003). Birth on the threshold: childbirth and modernity in South India. New Delhi: Zubaan.

Zaman, Shahaduz. (2004). Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh. Social Science & Medicine, 59(10), 2025-2036.



  • There are currently no refbacks.