Maya Unnithan

Global rights and state activism: reflections on civil society-state partnerships in health in NW India

This article examines the changing dynamics of development in India, focusing on partnerships between civil society organisations (CSOs)1 and the state in the area of rural health. Drawing on ethnographic perspectives of CSO work, we examine the shifting meaning of these partnerships for the institutions involved and how they function given their differing institutional cultures and values. We argue that the adoption by the state of a global language of rights and its efforts to integrate civil society language, practices and representatives in the policy and implementation of health programmes point to collaborationist models which support the creation of an ‘activist’ state, as they simultaneously strengthen as well as weaken the role of CSOs as mediators in development.

Learning from infertility: gender, health inequities and faith healers in women's experiences of disrupted reproduction in Rajasthan

Infertility is a neglected area of public health in India despite the significant implications it has for the health of poor women. It is also less prominent in social science research due to its characterization as a biomedical problem. On the contrary, as suggested in this article, a focus on infertility provides important insights into the gendering of reproductive identity and the ways in which power is exercised by the family, religion, state and health personnel. Building upon recent studies of infertility as ‘lived experience’ elsewhere in the world, the article demonstrates that emic and situated meanings of gender, body and self as become apparent in local discourse on infertility in India are important for social theory as well as health policy. Focusing on individual agency and the social meaning of infertility the article critically evaluates the therapeutic intervention of faith healers to suggest ways in which local healers enable women to distance themselves from gender inequities in reproduction at the same time as they reaffirm them.Infertility is not an issue which has received serious attention in India until recently, either as a public health issue or as a matter of community concern. Characterised as a high fertility country, Indian population and health policy and programmes have predominantly focussed on fertility control and contraception. This is despite the fact that a high percentage of women in particular suffer from untreated reproductive tract and sexually transmitted infections which underlie conditions of secondary sterility. Over 13-15 million couples (or 10-15 % of the population) were estimated as being infertile in India in 2005 (ICMR National Guidelines, 2005), and approximately 98% of the women suffer from secondary sterility (Qadeer 2009, Oomen 2001). In Rajasthan in north-western India, poor reproductive health conditions are compounded by the poor quality of healthcare provision as well as poverty, malnutrition and poor availability of water.

Sexual and reproductive health rights and justice – tracking the relationship

As human rights frameworks increasingly pervade health development policy, planning and programmes globally, and most markedly in countries of the South, there is a growing sense that rights have arrived but justice has not followed. This swell of opinion has emerged from the ground up, challenging and interrogating the meanings, use and limits of rights by those who are ill, vulnerable and who seek and expect treatment, and from the health-workers and development actors who work to facilitate processes that promote reproductive and sexual health and well-being. At the level of social theory, the disconnect between rights and justice finds resonance in the work of social scientists highly critical of the moralising, neo-colonial and neo-liberal tendencies implicit in international human rights frameworks (see, for example, Brown 2004; Žižek 2005). These voices underscore the need to closely examine the relationship between rights and justice in sexual and reproductive health and its implications for healthcare practice and policy. While notions of justice have underpinned and moved rights forward in terms of a global health policy agenda – of which the concept of Reproductive Health formulated at the Cairo International conference on Population and Development in 1994 is a dramatic example – the need for a more comprehensive understanding of how to theorise structural injustices that underlie women and men’s sexual and reproductive lives is only now emerging (Aggleton and Parker 2010; Bailey 2011; Correa, Petchesky, and Parker 2008). Such work also begs the question of what the dominance of a rights-based approach entails for social and reproductive justice (Hodgson 2011) and what the alternative approaches to justice would be. We use the idea of reproductive justice, following Bailey (2011) and Correa, Petchesky, and Parker (2008), to signify contexts that are sufficiently enabled for women and men to make reproductive choices and health decisions that are meaningful and fully informed. Reproductive justice goes beyond a focus on marginalised populations because ‘examining the reproductive disciplining of some groups’ experience also highlights the reproductive privileging of others’ (Luna and Luker 2013, 328; also Unnithan 2013). Whereas rights are salient in a legal domain, justice more broadly engages individuals and community moralities in a wider sense, speaking to and challenging power inequalities. Reproductive justice is thus distinct from rights in its function as a ‘moral indicator’.

On reproductive justice: ‘domestic violence’, rights and the law in India

In this paper we draw attention to the difficulty of accessing reproductive rights in the absence of effective state and legal guarantees for gender equity and citizenship, and argue that if reproductive rights are to be meaningful interventions on the ground, they must be reframed in terms of reproductive justice. Drawing on multi-sited ethnographic fieldwork conducted in Rajasthan, Northwest India, we track two dynamic legal aid interventions on reproductive health rights in India, concerned with domestic violence and maternal mortality respectively, that have sought to fill this existing gap between ineffective state policies and the rhetoric on reproductive rights. Through an analysis of these interventions, we propose that requirements of reproductive justice cannot be met through discrete or private, albeit creative legal initiatives, pursued by individuals or civil society organisations but must involve comprehensive policies as well as strategies and alliances between state, non-state, transnational organisations and progressive political groups.

Re-situating abortion: Bio-politics, global health and rights in neo-liberal times

ABSTRACT New modes of neoliberal and rights-based reproductive governance are emerging across the world which either paradoxically foreclose access to universal health services or promote legislative reform without providing a continuum of services on the ground. These shifts present new opportunities for the expansion but also the limitation of abortion provision conceptually and ‘on-the-ground’, both in the Global North and South. The collection of papers in this special issue examine current abortion governance discourse and practice in historical, socio-political contexts to analyse the threat posed to womens sexual and reproductive health and rights globally. Focusing on abortion politics in the context of key intersectional themes of morality, law, religion and technology, the papers conceptually ‘re-situate’ the analysis of abortion with reference to a changing global landscape where new modes of consumption, rapid flows of knowledge and information, increasingly routinised recourse to reproductive technologies and related forms of bio-sociality and solidarity amongst recipients and practitioners coalesce.

Re-visioning evidence: Reflections on the recent controversy around gender selective abortion in the UK

ABSTRACT Reports in the British media over the last 4 years have highlighted the schisms and contestations that have accompanied the reports of gender selective abortions amongst British Asian families. The position that sex-selection may be within the terms of the 1967 Abortion Act has particularly sparked controversy amongst abortion campaigners and politicians but equally among medical practitioners and the British Pregnancy Advisory Service who have hitherto tended to stay clear of such debates. In what ways has the controversy around gender-based abortion led to new framings of the entitlement to service provision and new ways of thinking about evidence in the context of reproductive rights? We reflect on these issues drawing on critiques of what constitutes best evidence, contested notions of reproductive rights and reproductive governance, comparative work in India and China as well as our involvement with different groups of campaigners including British South Asian NGOs. The aim of the paper is to situate the medical and legal provision of abortion services in Britain within current discursive practices around gender equality, ethnicity, reproductive autonomy, probable and plausible evidence, and policies of health reform.