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Featured researches published by Aditi Iyer.


Journal of Human Development and Capabilities | 2009

A Methodology to Analyse the Intersections of Social Inequalities in Health

Gita Sen; Aditi Iyer; Chandan Mukherjee

Abstract An important issue for health policy and planning is the way in which multiple sources of disadvantage, such as class, gender, caste, race, ethnicity, and so forth, work together to influence health. Although ‘intersectionality’ is a topic for which there is growing interest and evidence, several questions as yet remain unanswered. These gaps partly reflect limitations in the quantitative methods used to study intersectionality in health, even though the techniques used to analyse health inequalities as separable processes can be sophisticated. In this paper, we discuss a method we developed to analyse the intersections between different social inequalities, including a technique to test for differences along the entire span of the social spectrum, not just between the extremes. We show how this method can be applied to the analysis of intersectionality in access to healthcare, using cross‐sectional data in Koppal, one of the poorest districts in Karnataka, India.


Global Public Health | 2008

The intersections of gender and class in health status and health care

Aditi Iyer; Gita Sen; Piroska Östlin

Abstract It is increasingly recognized that different axes of social power relations, such as gender and class, are interrelated, not as additive but as intersecting processes. This paper has reviewed existing research on the intersections between gender and class, and their impacts on health status and access to health care. The review suggests that intersecting stratification processes can significantly alter the impacts of any one dimension of inequality taken by itself. Studies confirm that socio-economic status measures cannot fully account for gender inequalities in health. A number of studies show that both gender and class affect the way in which risk factors are translated into health outcomes, but their intersections can be complex. Other studies indicate that responses to unaffordable health care often vary by the gender and class location of sick individuals and their households. They strongly suggest that economic class should not be analysed by itself, and that apparent class differences can be misinterpreted without gender analysis. Insufficient attention to intersectionality in much of the health literature has significant human costs, because those affected most negatively tend to be those who are poorest and most oppressed by gender and other forms of social inequality. The programme and policy costs are also likely to be high in terms of poorly functioning programmes, and ineffective poverty alleviation and social and health policies.


International Journal of Health Services | 2007

The dynamics of gender and class in access to health care: Evidence from rural Karnataka, India

Aditi Iyer; Gita Sen; Asha George

This is the second part of the special section, edited by Professors Margaret Whitehead and Göran Dahlgren, on the equity impacts of different health care systems, which includes studies conducted within the framework of the Affordability Ladder Program. In the early 1990s, India embarked upon a course of health sector reform, the impact of which on an already unequal society is now becoming more apparent. This study sought to deepen understanding of equity effects by exploring gender and class dynamics vis-à-vis basic access to health care for self-reported long-term ailments. The authors drew on the results of a cross-sectional household survey in a poor agrarian region of south India to test whether gender bias in treatment-seeking is class-neutral and whether class bias is gender-neutral. They found evidence of “pure gender bias” in non-treatment operating against both non-poor and poor women, and evidence of “rationing bias” in discontinued treatment operating against poor women overall, but with some differences between the poor and poorest households. In poor households, men insulated themselves and passed the entire burden of rationing onto women; but among the poorest, men, like women, were forced to curtail treatment. There were economic class differences in continued, discontinued, and no treatment, but class was a gendered phenomenon operating through women, not men.


Social Science & Medicine | 2012

Who gains, who loses and how: Leveraging gender and class intersections to secure health entitlements

Gita Sen; Aditi Iyer

This paper argues that a focus on the middle groups in a multi-dimensional socioeconomic ordering can provide valuable insights into how different axes of advantage and disadvantage intersect with each other. It develops the elements of a framework to analyse the middle groups through an intersectional analysis, and uses it to explore how such groups leverage economic class or gender advantages to secure entitlements to treatment for long-term illness. The study draws upon household survey data on health-seeking for long-term ailments from 60 villages of Koppal district, Karnataka (India). The survey was designed to capture gender, economic class, caste, age and life stage-based inequalities in access to health care during pregnancy and for short and long-term illnesses. There were striking similarities between two important middle groups--non-poor women and poor men--in some key outcomes: their rates of non-treatment when ill, treatment discontinuation and treatment continuation, and the amounts they spent for treatment. These two groups are the obverse of each other in terms of gender and economic class advantage and disadvantage. Non-poor women have an economic advantage and a gender disadvantage, while poor men have the exact opposite. However, despite the similarities in outcomes, the processes by which gender and class advantage were leveraged by each of the groups varied sharply. Similar patterns held for the poorest men except that the class disadvantage they had to overcome was greater, and the results are modified by this.


Global Public Health | 2013

Deciphering Rashomon: An approach to verbal autopsies of maternal deaths

Aditi Iyer; Gita Sen; Anuradha Sreevathsa

Abstract The paper discusses an approach to verbal autopsies that engages with the Rashomon phenomenon affecting ex post facto constructions of death and responds to the call for maternal safety. This method differs from other verbal autopsies in its approach to data collection and its framework of analysis. In our approach, data collection entails working with and triangulating multiple narratives, and minimising power inequalities in the investigation process. The framework of analysis focuses on the missed opportunities for death prevention as an alternative to (or deepening of) the Three Delays Model. This framework assesses the behavioural responses of health providers, as well as community and family members at each opportunity for death prevention and categorises them into four groups: non-actions, inadequate actions, inappropriate actions and unavoidably delayed actions. We demonstrate the application of this approach to show how verbal autopsies can delve beneath multiple narratives and rigorously identify health system, behavioural and cultural factors that contribute to avoidable maternal mortality.


Global Health Action | 2013

Health system capacity: maternal health policy implementation in the state of Gujarat, India

Linda Sanneving; Asli Kulane; Aditi Iyer; Bengt Ahgren

Introduction : The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007–2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services. Objective : To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. Method : Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis. Result : Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health. Conclusions : The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes.INTRODUCTION The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007-2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services. OBJECTIVE To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. METHOD Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis. RESULT Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health. CONCLUSIONS The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes.


Archive | 2015

Health Policy in India: Some Critical Concerns

Gita Sen; Aditi Iyer

It is ironic that a major emerging economy like India should have health indicators that are similar to those found in Kenya, Madagascar, and Myanmar (WHO, 2013), low-income countries with half or under half of India’s gross domestic product (GDP) per capita (World Bank, 2014). In 2011, the country’s infant and under-5 mortality rates (at 47 and 61 per 1,000 live births) were worse than those found in all other BRICS countries and among the worst third of all 195 WHO member countries (WHO, 2013; see also Chapter 6 by Benoit et al., and Chapter 12 by Asakitikpi). The estimated maternal mortality ratio (200 per 100,000 live births) fared only marginally better. Although these rates and ratios have fallen over time, they nevertheless translate, in a population of over 1.2 billion, into thousands of preventable deaths.


BMC Proceedings | 2012

Verbal autopsies of maternal deaths in Koppal, Karnataka: lessons from the grave

Aditi Iyer; Gita Sen; Anuradha Sreevathsa; Vasini Varadan

Maternal deaths bear important lessons for death prevention, as they occur mostly due to failures to prevent and respond to obstetric emergencies. These lessons are worth taking. Verbal autopsies can enable such learning and become useful resources for programme managers and policy makers if they identify lapses in death prevention in ways that suggest what corrective actions can be taken. A review of worldwide literature shows that most verbal autopsy applications to date focus solely on identifying the medical causes of maternal mortality. While such autopsies reveal how the different causes of death are clustered, they do not directly address health system issues. A smaller group of studies examine social causes using the ‘three delays model’ to classify the factors that prevent timely access to medical care in an emergency. However, the model does not directly identify the operational issues that constrain health system functioning nor familial and community-level barriers. Given this, the Gender and Health Equity (GHE) Project developed a qualitative methodology that departs from existing approaches in significant ways and enables in-depth analysis of the social and medical causes of pregnancy-related deaths. In this paper, we aim to (1) to describe the methodology developed by the GHE project to analyse and learn from maternal deaths, (2) to identify from the autopsies the types of failures that result in preventable maternal death, as well as the factors that drive them, and (3) to make suggestions for how death prevention measures by public health services can be strengthened.


Social Science & Medicine | 2013

Unfree markets : socially embedded informal health providers in northern Karnataka, India

Asha George; Aditi Iyer


Archive | 2005

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

Asha George; Aditi Iyer; Gita Sen

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Asha George

University of the Western Cape

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Anuradha Sreevathsa

Indian Institute of Management Bangalore

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Chandan Mukherjee

Centre for Development Studies

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Vasini Varadan

Indian Institute of Management Bangalore

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