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Article ; Online: Is decolonisation sufficient?

Jashodhara Dasgupta / Sana Qais Contractor

BMJ Global Health, Vol 7, Iss

2022 Volume 12

Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Using an intersectionality approach to transform health services for overlooked healthcare users and workers after covid-19.

Mothupi, Mamothena / Dasgupta, Jashodhara / Hosseini Jebeli, Seyede Sedighe / Stevenson, Jacqui / Berdichevsky, Karla / Vong, Sreytouch / Barasa, Edwine / George, Asha

BMJ (Clinical research ed.)

2023 Volume 381, Page(s) e072243

MeSH term(s)	Humans ; Intersectional Framework ; COVID-19 ; Health Services ; Health Facilities ; Delivery of Health Care ; Health Personnel
Language	English
Publishing date	2023-06-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj-2022-072243
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Article ; Online: “Our fear is finished,” but nothing changes

Marta Schaaf / Jashodhara Dasgupta

BMC Public Health, Vol 19, Iss 1, Pp 1-

efforts of marginalized women to foment state accountability for maternal health care in a context of low state capacity

2019 Volume 15

Abstract: Abstract Background Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a ...

Abstract	Abstract Background Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. Methods The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. Results The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG’s efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. Conclusion Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have ...
Keywords	Social accountability ; Collective action ; Corruption ; Global health ; India ; Gender ; Public aspects of medicine ; RA1-1270
Subject code	300
Language	English
Publishing date	2019-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: "Our fear is finished," but nothing changes: efforts of marginalized women to foment state accountability for maternal health care in a context of low state capacity.

Schaaf, Marta / Dasgupta, Jashodhara

BMC public health

2019 Volume 19, Issue 1, Page(s) 732

Abstract: Background: Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a ... ...

Abstract	Background: Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. Methods: The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. Results: The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG's efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. Conclusion: Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have made the task somewhat less difficult, but given the population making the rights claims and the rights they were claiming, widespread changes in demands for informal payments may require a much larger and stronger coalition.
MeSH term(s)	Adult ; Fear ; Female ; Focus Groups ; Health Expenditures/legislation & jurisprudence ; Health Expenditures/statistics & numerical data ; Humans ; India ; Islam/psychology ; Maternal Health Services/economics ; Organizations ; Parturition/psychology ; Population Groups/psychology ; Poverty/economics ; Poverty/psychology ; Pregnancy ; Social Class ; Social Marginalization/psychology ; Social Responsibility
Language	English
Publishing date	2019-06-11
Publishing country	England
Document type	Journal Article
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/s12889-019-7028-2
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Article ; Online: Ten years of negotiating rights around maternal health in Uttar Pradesh, India

Dasgupta Jashodhara

BMC International Health and Human Rights, Vol 11, Iss Suppl 3, p S

2011 Volume 4

Abstract: Abstract Background Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states ...

Abstract	Abstract Background Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as well as poorer women and less literate women appear to be significantly disadvantaged. The government of India has been attempting to improve maternal outcomes through a cash transfer within the National Rural Health Mission to encourage women to come to hospitals for childbirth. Methods This paper reviews documents of the last ten years describing the experiences of a Non-Governmental Organisation, SAHAYOG, in working with a civil society platform, the Healthwatch Forum, to develop ‘rights based’ strategies around maternal health. The paper builds an analysis using recent frameworks on accountability and gendered rights claiming to examine these experiences and draw out lessons regarding rights claiming strategies for poor women. Results The examination of documents over the last ten years indicates defined phases of development in the evolution of SAHAYOG’s understanding and of the shifts in strategy among SAHAYOG and its close allies, and responses by the state. The first three stages depict the deepening of SAHAYOG’s understanding of the manner in which poor and marginalized women negotiate their access to health care; the fourth stage explores a health system intervention and the challenges of working from within civil society in alliance with poor and marginalized women. Conclusion The findings from SAHAYOG’s experiences with poor Dalit women in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing effective lifesaving care. Creating a voice for the most marginalised and carving space for its articulation impacts upon the institutions and actors that have a duty to meet the claims being made. However, given the accountability deficit, the analysis indicates the importance ...
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2011-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Ten years of negotiating rights around maternal health in Uttar Pradesh, India.

Dasgupta, Jashodhara

BMC international health and human rights

2011 Volume 11 Suppl 3, Page(s) S4

Abstract: Background: Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as ... ...

Abstract	Background: Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as well as poorer women and less literate women appear to be significantly disadvantaged. The government of India has been attempting to improve maternal outcomes through a cash transfer within the National Rural Health Mission to encourage women to come to hospitals for childbirth. Methods: This paper reviews documents of the last ten years describing the experiences of a Non-Governmental Organisation, SAHAYOG, in working with a civil society platform, the Healthwatch Forum, to develop 'rights based' strategies around maternal health. The paper builds an analysis using recent frameworks on accountability and gendered rights claiming to examine these experiences and draw out lessons regarding rights claiming strategies for poor women. Results: The examination of documents over the last ten years indicates defined phases of development in the evolution of SAHAYOG's understanding and of the shifts in strategy among SAHAYOG and its close allies, and responses by the state. The first three stages depict the deepening of SAHAYOG's understanding of the manner in which poor and marginalized women negotiate their access to health care; the fourth stage explores a health system intervention and the challenges of working from within civil society in alliance with poor and marginalized women. Conclusion: The findings from SAHAYOG's experiences with poor Dalit women in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing effective lifesaving care. Creating a voice for the most marginalised and carving space for its articulation impacts upon the institutions and actors that have a duty to meet the claims being made. However, given the accountability deficit, the analysis indicates the importance of going beyond the normative to developing actor-oriented perspectives within rights based approaches, to take into account the complexity of the negotiating process that goes into claiming any kind of entitlements.
Language	English
Publishing date	2011-12-16
Publishing country	England
Document type	Journal Article
ISSN	1472-698X
ISSN (online)	1472-698X
DOI	10.1186/1472-698X-11-S3-S4
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Article ; Online: Beyond the template

Sana Q. Contractor / Abhijit Das / Jashodhara Dasgupta / Sara Van Belle

International Journal for Equity in Health, Vol 17, Iss 1, Pp 1-

the needs of tribal women and their experiences with maternity services in Odisha, India

2018 Volume 13

Abstract: Abstract Background Over the past 15 years, several efforts have been made by the Government of India to improve maternal health, primarily through providing cash incentives to increase institutional child birth and strengthen services in the public ... ...

Abstract	Abstract Background Over the past 15 years, several efforts have been made by the Government of India to improve maternal health, primarily through providing cash incentives to increase institutional child birth and strengthen services in the public health system. The result has been a definite but unequal increase in the proportion of institutional deliveries, across geographical areas and social groups. Tribal (indigenous) communities are one such group in which the proportion of institutional deliveries is low. The persistence of these inequities indicates that a different approach is required to address the maternal health challenges in these communities. Methods This paper describes an exploratory study in Rayagada District of Odisha which aimed to understand tribal women’s experiences with pregnancy and childbirth and their interactions with the formal health system. Methods included in-depth interviews with women, traditional healers and formal health care providers and outreach workers, observations in the community and health facilities. Results The exploration of traditional practices shows that in this community, pregnancy and childbirth is treated as part of a natural process, not requiring external intervention. There is a well-established practice of birthing in the community which also recognizes the need for health system interventions in case of high-risk births or complications. However, there has been no effort by the health system to build on this traditional understanding of safety of woman and child. Instead, the system continues to rely on incentives and disincentives to motivate women. Traditional health providers who are important stakeholders have not been integrated into the health system. Despite the immense difficulties that women face, however, they do access health facilities, but barriers of distance, language, cultural inappropriateness of services, and experiences of gross violations have further compounded their distrust. Conclusions The results of the study suggest a ...
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Developing political capabilities with Community-Based Monitoring for health accountability: The case of the Mahila Swasthya Adhikar Manch.

Balestra, Giulietta Luul / Dasgupta, Jashodhara / Sandhya, Yatirajula Kanaka / Mannell, Jenevieve

Global public health

2018 Volume 13, Issue 12, Page(s) 1853–1864

Abstract: Community-Based Monitoring (CBM) is a participatory process in which citizens gather evidence on services to hold governments accountable to their commitments. Research on CBM for health in developing countries has mostly measured its impact on service ... ...

Abstract	Community-Based Monitoring (CBM) is a participatory process in which citizens gather evidence on services to hold governments accountable to their commitments. Research on CBM for health in developing countries has mostly measured its impact on service performance. Overall, these studies have produced mixed evidence of CBM's effectiveness. This has led some authors to question the role of civic engagement, especially in communities where expectations from public services and power to demand for change are low. This conclusion, we argue, overlooks the role of the CBM process in fostering both participation and social change. Drawing from qualitative research with the Indian grassroots women's organisation Mahila Swasthya Adhikar Manch, we argue that CBM can foster political capabilities through mediating communities' relationships with the state as well as relationships within communities. The engagement of women and their power to demand for change in the health sector and beyond emerges at the intersection of these two spheres. This suggests that measuring the impact of CBM on health services is not sufficient. Expanding the focus of research on CBM to its process is necessary to fully understand the role of civic engagement and to restore its political relevance.
MeSH term(s)	Community Networks ; Humans ; India ; Maternal Health Services/standards ; Politics ; Qualitative Research ; Social Responsibility ; Women's Health
Language	English
Publishing date	2018-04-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2234129-8
ISSN	1744-1706 ; 1744-1692
ISSN (online)	1744-1706
ISSN	1744-1692
DOI	10.1080/17441692.2018.1464586
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Article ; Online: Beyond the template: the needs of tribal women and their experiences with maternity services in Odisha, India.

Contractor, Sana Q / Das, Abhijit / Dasgupta, Jashodhara / Van Belle, Sara

International journal for equity in health

2018 Volume 17, Issue 1, Page(s) 134

Abstract: Background: Over the past 15 years, several efforts have been made by the Government of India to improve maternal health, primarily through providing cash incentives to increase institutional child birth and strengthen services in the public health ... ...

Abstract	Background: Over the past 15 years, several efforts have been made by the Government of India to improve maternal health, primarily through providing cash incentives to increase institutional child birth and strengthen services in the public health system. The result has been a definite but unequal increase in the proportion of institutional deliveries, across geographical areas and social groups. Tribal (indigenous) communities are one such group in which the proportion of institutional deliveries is low. The persistence of these inequities indicates that a different approach is required to address the maternal health challenges in these communities. Methods: This paper describes an exploratory study in Rayagada District of Odisha which aimed to understand tribal women's experiences with pregnancy and childbirth and their interactions with the formal health system. Methods included in-depth interviews with women, traditional healers and formal health care providers and outreach workers, observations in the community and health facilities. Results: The exploration of traditional practices shows that in this community, pregnancy and childbirth is treated as part of a natural process, not requiring external intervention. There is a well-established practice of birthing in the community which also recognizes the need for health system interventions in case of high-risk births or complications. However, there has been no effort by the health system to build on this traditional understanding of safety of woman and child. Instead, the system continues to rely on incentives and disincentives to motivate women. Traditional health providers who are important stakeholders have not been integrated into the health system. Despite the immense difficulties that women face, however, they do access health facilities, but barriers of distance, language, cultural inappropriateness of services, and experiences of gross violations have further compounded their distrust. Conclusions: The results of the study suggest a re-examining of the very approach to addressing maternal health in this community. The study calls for reorienting maternal health services, to be responsive to the requirements of tribal women, cater to their cultural needs, provide support to domiciliary deliveries, invest in building trust with the community, and preserve beneficial traditional practices.
MeSH term(s)	Adult ; Attitude to Health ; Culture ; Delivery of Health Care/standards ; Delivery, Obstetric/psychology ; Delivery, Obstetric/statistics & numerical data ; Female ; Health Services Accessibility/standards ; Health Services Needs and Demand ; Humans ; India ; Maternal Health Services/standards ; Motivation ; Patient Acceptance of Health Care/psychology ; Pregnancy ; Qualitative Research ; Socioeconomic Factors
Language	English
Publishing date	2018-09-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1475-9276
ISSN (online)	1475-9276
DOI	10.1186/s12939-018-0850-9
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Article ; Online: The safety of women health workers at the frontlines.

Dasgupta, Jashodhara / Velankar, Jayashree / Borah, Pritisha / Nath, Gangotri Hazarika

Indian journal of medical ethics

2017 Volume 2, Issue 3, Page(s) 209–213

Abstract: This article, based on the report of the fact-finding team on the gang rape and death of an accredited social health activist (ASHA) in Muzaffarnagar in January 2016, attempts to analyse the issues of the safety and mobility of front-line women health ... ...

Abstract	This article, based on the report of the fact-finding team on the gang rape and death of an accredited social health activist (ASHA) in Muzaffarnagar in January 2016, attempts to analyse the issues of the safety and mobility of front-line women health workers. It argues that although the National Health Mission is often alluded to as a flagship programme of the government, it has failed in its basic responsibility as an ethical employer, since there is no support and back-up system that can be easily accessed by ASHAs in terms of dealing with the fallout of their social role as "change agents" in rural areas, and community reactions to their mobility and public exposure. The report stresses the need to consider the deeply patriarchal system within which ASHAs function in states such as Uttar Pradesh. It also discusses the fact that the workforce is increasingly shifting from the formal to the informal sector, which has given rise to an assumption that the employer is no longer accountable for women workers' safety at the workplace.
Language	English
Publishing date	2017-07
Publishing country	India
Document type	Journal Article
ISSN	0975-5691
ISSN (online)	0975-5691
DOI	10.20529/IJME.2017.043
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