Gendered health systems biased against maternal survival: preliminary findings from Koppal, Karnataka, India

This Institute of Development Studies working paper examines the persistently high levels of maternal mortality in India. The paper explores the context of pregnant women’s lives and the plural health systems they encounter in Koppal, the most deprived district in the state of Karnataka. Findings show that a large number of maternal deaths are preventable. However, the authors argue that addressing the high levels of maternal mortality is not merely an issue of resolving the technical and managerial capacity constraints to ensuring emergency obstetric services. The health system needs to address gender biases which result in a lack of acknowledgement of, and accountability for, pregnant women’s needs.

The authors outline how the invisibility and neglect of important women’s health issues, such as anaemia, domestic violence, safe abortion and postnatal care, need to be addressed. Women’s experiences must be acknowledged and responded to by families, health providers and managers. A network of individuals with gender and public health training needs to be nurtured to make pregnancy safer. Finally, the authors argue that the larger health system needs to be made more accountable. To do this, public concern needs to be aroused to challenge the inequitable ways that it is organised and financed. [adapted from author]