Unpacking the Myths: Inequities and maternal mortality in South Asia
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Local/Global Encounters
Unpacking the Myths: Inequities and maternal mortality in South Asia
IMRANA QADEER
ABSTRACT Imrana Qadeer examines whether the Millennium Development Goals (MDG) are different from past approaches to maternal mortality in South Asia and critically assesses how they address the underlying inequities that determine reproductive health policies. She argues that policies to reduce maternal mortality can work, but that these strategies require a long-term perspective that is based on holistic development of the people and not just a select section given that maternal mortality is largely the outcome of poor general health and socio-economic constraints. KEYWORDS integrated approach; Millennium Development Goals; The World Bank; population control; capabilities; self-determination
A brief history of maternity services in India Official concern with maternal mortality is not new. The colonial British government had used volunteerism to its own advantage by encouraging the establishment of the Lady Dufferin Fund in 1885 to provide maternity care and to attract British women doctors to the colonies. On the one hand, this resolved a crisis in 19th century Britain, where women, no matter how competent, had great difficulty in acquiring a medical education and male bureaucrats, students, and doctors opposed their entry. On the other hand, the sub-continent offered an easy way to let the women acquire schooling as well as proficiency. It was in the Indian sub-continent, and other colonies, that many of the aspiring women doctors sharpened their skills, using new techniques and instruments, before they moved back to practice in Britain. The women doctors severely criticized the traditional birth attendants (Dais).While they used their superior positions to persuade Dais to bring cases to their private practice and hospitals, they neither recognized their good practices nor encouraged them to learn and improve their wrong practices and thus contributed to the process of delegitimizing the traditional practitioners. The Dais were also used to penetrate the barriers of the ‘zenana’and induce the native women to come out and expand the private practice of the women doctors. The Dufferin Fund on the other hand provided the required resources to support a new breed of subordinates ^ the midwives who were trained by the doctors themselves (Dhingra, 2001). In this context, it is important to remember that the colonial government condemned the natives for their lack of concern for the poor health and very high maternal Development (2005) 48(4), 120–126. doi:10.1057/palgrave.development.1100188
Qadeer: Maternal Mortality in South Asia mortality among their women folk. But when, for the first time in 1913, it accepted the responsibility of subsidizing maternal care, and annually invested Rs. 150,000 in the Dufferin Fund to coordinate its maternity hospitals, the reforms largely focused on the salaries and working conditions of the women doctors, and not on the welfare of the women in need. This trend continued e
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