Patricia Jeffery

APPROPRIATING GENDER : WOMEN'S ACTIVISM AND POLITICIZED RELIGION IN SOUTH ASIA

Appropriating Gender explores the paradoxical relationship of women to religious politics in India, Pakistan, Sri Lanka, and Bangladesh. Contrary to the hopes of feminists, many women have responded to religious nationalist appeals; contrary to the hopes of religious nationalists, they have also asserted their gender, class, caste, and religious identities; contrary to the hopes of nation states, they have often challenged state policies and practices. Through a comparative South Asia perspective, Appropriating Gender explores the varied meanings and expressions of gender identity through time, by location, and according to political context. The first work to focus on womens agency and activism within the South Asian context, Appropriating Gender is an outstanding contribution to the field of gender studies.

Only when the boat has started sinking: a maternal death in rural north India.

This paper uses a close reading of villagers’ responses to the death in childbirth of a Muslim woman to raise questions about India’s current policy emphasis on institutional delivery as a means of reducing maternal mortality. After introducing the context and methods of our research, we describe recent policy interventions related to maternal health, including the National Rural Health Mission established in 2005. We then outline villagers’ commentaries on the specific maternal death, focusing on the costs to women’s health (and sometimes life) of high fertility; the lack of care available from rural government facilities and staff and the preference for delivering at home with the aid of local practitioners; the financial constraints that make people hesitate to seek medical treatment; and the high costs of private treatment and the poor treatment experienced in government facilities. Our core argument is that government health care provision in rural Uttar Pradesh is embedded in a moral universe characterised by widespread and long-term mistrust of state services and that encouraging institutional deliveries without addressing the perceptions of potential service users is a seriously flawed approach to reducing maternal mortality. The paper draws primarily on ethnographic research funded by the Wellcome Trust during 2002–2005, in a Muslim village in rural Bijnor district (in north-western Uttar Pradesh).

When schooling fails Young men, education and low–caste politics in rural north India

Scholarly discussions of formal education in the global South are increasingly moving away from a narrow focus on human capital to consider the meanings that people attach to ‘being educated’. This article advances current debates on the social construction of educational value in South Asia by examining how educated Chamar (Dalit) young men reflect on their education in the face of poor occupational outcomes. Since the 1960s, Dalits’ investment in formal education in rural Uttar Pradesh (UP) has seen a marked rise, in part through emulation of higher castes. The pro–Dalit Bahujan Samaj Party (BSP) has also been instrumental in promoting a vision of empowerment through formal education and entry into white–collar employment. Our research in rural Bijnor district suggests that the most recent generation of high school and college graduates amongst the Chamars has failed to find salaried employment. Some young men respond to this exclusion by reaffirming their faith in the BSPs model of progress and establishing them–selves as local political figures (netas). Other young men voice a growing alienation from the BSPs vision of empowerment and speak of themselves as people ‘trapped’ by education. Nevertheless, both these sets of young men continue to value education as a source of ‘cultural distinction’, sign of their ‘modern’ status, and means of challenging caste–based notions of difference.

Unmonitored Intrapartum Oxytocin Use in Home Deliveries: Evidence from Uttar Pradesh, India.

Intrapartum use of oxytocin should entail controlled dosages administered through infusion, continual monitoring of mother and fetus and surgical back-up, since several adverse outcomes have been reported. However, in Uttar Pradesh, north India, small-scale ethnographic studies as well as a large-scale retrospective survey have established that unmonitored intramuscular oxytocin injections are commonly given to birthing mothers to augment labour by unregistered local male practitioners and auxiliary nurse-midwives employed by government during home deliveries. India’s reproductive and child health policy needs to address the inappropriate use of oxytocin. Under a new 2007 policy, female government health workers at peripheral institutions are to be supplied with oxytocin to inject during the third stage of labour to prevent post-partum haemorrhage. The practice of injecting oxytocin intrapartum could readily be reinforced by this policy shift. There is an urgent need to ensure that home births are safer for mothers and babies alike, since India’s current policy goals of raising the numbers of institutional deliveries, ensuring skilled attendance at birth and improving referrals for emergency obstetric care cannot be met in the foreseeable future. In a context of enduringly high infant and maternal mortality, especially in Uttar Pradesh and other large northern states, the question of whether or not inappropriate use of oxytocin is contributing to maternal and newborn morbidity and mortality deserves further research. Résumé Pendant l’accouchement, l’ocytocine doit être administrée à doses contrôlées et par perfusion, avec une surveillance permanente de la mère et du fłtus et une assistance chirurgicale, puisque des effets indésirables graves ont été notifiés. Néanmoins, dans l’Uttar Pradesh, en Inde septentrionale, des études ethnographiques à petite échelle et des enquêtes rétrospectives de grande envergure ont montré que des injections intramusculaires non surveillées d’ocytocine sont fréquemment administrées aux femmes pour accélérer le travail par du personnel masculin local non diplômé et des infirmières-sages-femmes auxiliaires employées par l’État pendant les accouchements à domicile. La politique indienne de santé génésique et infantile doit se pencher sur l’administration impropre d’ocytocine. En vertu d’une nouvelle politique de 2007, le personnel de santé féminin employé par l’État dans des institutions périphériques doit recevoir de l’ocytocine à injecter pendant le troisième stade de l’accouchement, pour éviter les hémorragies post-partum. Cette modification pourrait renforcer la pratique de l’injection d’ocytocine pendant l’accouchement. De plus, il est urgent de veiller à ce que les naissances à domicile deviennent plus sûres pour les mères et les bébés, puisque les objectifs actuels de l’Inde qui consistent à relever le nombre de naissances en milieu hospitalier, garantir une assistance qualifiée pendant l’accouchement et améliorer le transfert des urgences obstétricales ne seront pas atteints à brève échéance. Alors que la mortalité maternelle et infantile demeure élevée, particulièrement dans l’Uttar Pradesh et d’autres grands États du nord, la question de savoir si l’utilisation impropre de l’ocytocine contribue ou non à la morbidité et la mortalité de la mère et du nouveau-né mérite davantage de recherches. Resumen El uso de oxitocina intraparto debe implicar dosis controladas administradas por infusión, monitoreo continuo de la madre y el feto, y respaldo quirúrgico, dado que se han informado varios resultados adversos. Sin embargo, en Uttar Pradesh, en la India septentrional, los estudios etnográficos de pequeña escala, así como una encuesta retrospectiva de gran escala, han establecido que las inyecciones intramusculares de oxitocina sin monitoreo comúnmente son administradas por prestadores de servicios de sexo masculino no titulados y enfermeras-parteras auxiliares empleadas por el gobierno, durante el parto domiciliario a fin de aumentarlo. La política de la India en cuanto a la salud reproductiva y la salud infantil debe tratar el uso indebido de oxitocina. En conformidad con una nueva política de 2007, las trabajadoras de salud gubernamentales en instituciones secundarias deben ser suministradas con oxitocina para inyectarla durante la tercera etapa del parto a fin de evitar la hemorragia posparto. La práctica de inyectar oxitocina intraparto fácilmente podría ser reforzada por ese cambio en política. Existe una necesidad urgente de garantizar que el parto domiciliario sea seguro tanto para la madre como para el bebé, dado que en el futuro inmediato no es posible lograr los objetivos de la política actual de la India de incrementar el índice de partos institucionales, garantizar asistencia calificada durante el parto y mejorar las referencias para cuidados obstétricos de emergencia. En un contexto de mortalidad materna e infantil perdurablemente altas, especialmente en Uttar Pradesh y otros estados septentrionales importantes, la interrogante en cuanto a si el uso indebido de oxitocina contribuye o no a la morbimortalidad de madres y recién nacidos amerita ser investigada más a fondo.

A Population Out of Control? Myths About Muslim Fertility in Contemporary India

Abstract This paper describes and criticizes myths about the scale and causes of fertility differentials between Hindus and Muslims in India. These ideas, associated with Hindu nationalist organizations, also have a more general common-sense quality. The paper challenges these views by examining how demographers have addressed Hindu–Muslim fertility differences, considering the impact of regional differences, variations in socioeconomic position, and occupation. We further suggest that these elaborate statistical analyses on large-scale data sets are not readily sensitive to local-level variations. Our micro-level research findings are used to illuminate both Hindu Right political rhetoric and the limitations of macro-level demographic analyses.

Safe Motherhood Initiatives: Contributions from Small-scale Studies

In India in 2000 between 115000 and 170000 women died in childbirth-about one-quarter of all maternal deaths worldwide. Far from declining over the 1990s maternal and neonatal morbidity and mortality rates in India have at best plateaued at worst increased. Regional class and caste inequalities remain far too high. The Millennium Development Goal for the reduction of maternal mortality means that by 2015 the maternal mortality ratio (MMR) should be reduced to about 100 maternal deaths per 100000 live births. Yet governmental action to deal with this scandalous state of affairs seems to be stymied by a lack of political will no new ideas a preoccupation with population control and an apparent lack of awareness of some of the key issues. A workshop in New Delhi in February 2006 considered whether small-scale studies could contribute new insights that might lead to policy proposals. Small-scale meant studies smaller than the nationally representative surveys that generate estimates of rates and relationships at all-India levels. Small-scale studies have different purposes: to elucidate contexts and processes to investigate peoples own understandings and to help explain patterns picked up by large-scale studies. The workshop papers included studies of a single district (Dharmapuri) survey and interview data from sub-district levels (blocks or talukas within Vadodara Diamond Harbour and Koppal) as well as ethnographic studies of villages slums and hospitals in Delhi Rajasthan Uttar Pradesh Jharkhand and West Bengal. (excerpt)

Agency, Activism, and Agendas

Feminist activism in South Asia has contributed both to raising people’s awareness of gender injustices and to directly combating them. In part, politicized religion may be a response to the challenges posed by feminist activism and by secular changes in the wider economy (Chhachhi, 1991). More certainly politicized religion has often been implicated in developments that are potentially deeply inimical to women’s interests—and yet many women’s energies have been successfully engaged in their support. Feminists can surely derive little satisfaction, for instance, from the Bharatiya Janata Party’s (BJP) ability to mobilize women in defense of Rām’s birthplace, often in far greater numbers than feminist organizations have managed to mobilize women to protest dowry murder.

'Money itself discriminates': Obstetric emergencies in the time of liberalisation

Citizenship rights in India are being transformed under economic liberalisation. In this article, we use obstetric crises to provide an entry point to explore recent changes in peoples access to health care and their understandings of their civic rights and entitlements. We draw on our research in rural Bijnor district (Uttar Pradesh) between 1982 and 2005. Over this period, the state has increasingly failed to provide a safety net of emergency obstetric care. Poor villagers seeking institutional deliveries in private facilities face either exclusion or indebtedness. Moreover, ‘consumers’ have no capacity to regulate the quality of private health care provision—but nor do the state or civil society organisations. Villagers critique the states failure to provide the health care that they regard as a citizens entitlement. Yet the health care market is accorded no greater legitimacy by its ‘customers’. Far from providing opportunities for empowerment, then, changes in health care provision serve to disempower the poor and to reduce the moral authority of both the state and the market.

Supply-and-demand demographics: dowry, daughter aversion and marriage markets in contemporary north India

The gendered character of Indias fertility decline has attracted considerable academic attention. In this paper, I offer a critique of the arguments of some demographers about the linkages between dowry, daughter aversion and the marriage squeeze that predict that increasing shortages of marriageable women will result in declines in dowry. I argue that such economistic readings seriously oversimplify the complexities of marriage arrangement ‘on the ground’ in contemporary India. Further, whilst one aspect of dowry might relate to the supply and demand of brides and grooms, dowry and daughter aversion are not simply outcomes of demographics alone. First, marriage migration is crucial in understanding daughter aversion. Second, dowry is not just a matter of marriage and kinship practices. Dowry is a polyvalent institution that also connects with conspicuous display in status competition in a hierarchical society and with peoples rising aspirations to possess consumer goods within the wider context of contemporary Indias rapidly changing political economy. Crucially, marriage migration, status competition and consumerism do not necessarily push in the same direction as the demographics of the marriage squeeze might imply when it comes to dowry and daughter aversion.

The Impact of Official Development Aid on Maternal and Reproductive Health Outcomes: A Systematic Review

Background Progress toward meeting Millennium Development Goal 5, which aims to improve maternal and reproductive health outcomes, is behind schedule. This is despite ever increasing volumes of official development aid targeting the goal, calling into question the distribution and efficacy of aid. The 2005 Paris Declaration on Aid Effectiveness represented a global commitment to reform aid practices in order to improve development outcomes, encouraging a shift toward collaborative aid arrangements which support the national plans of aid recipient countries (and discouraging unaligned donor projects). Methods and Findings We conducted a systematic review to summarise the evidence of the impact on MDG 5 outcomes of official development aid delivered in line with Paris aid effectiveness principles and to compare this with the impact of aid in general on MDG 5 outcomes. Searches of electronic databases identified 30 studies reporting aid-funded interventions designed to improve maternal and reproductive health outcomes. Aid interventions appear to be associated with small improvements in the MDG indicators, although it is not clear whether changes are happening because of the manner in which aid is delivered. The data do not allow for a meaningful comparison between Paris style and general aid. The review identified discernible gaps in the evidence base on aid interventions targeting MDG 5, notably on indicators MDG 5.4 (adolescent birth rate) and 5.6 (unmet need for family planning). Discussion This review presents the first systematic review of the impact of official development aid delivered according to the Paris principles and aid delivered outside this framework on MDG 5 outcomes. Its findings point to major gaps in the evidence base and should be used to inform new approaches and methodologies aimed at measuring the impact of official development aid.