Structures of poverty and health inequality: The Koppal experience

Abstract

Governance of healthcare includes using a rights framework to bridge equity gaps and this was the focus of the presentations on equity, rights and ethics.

Examining the structural factors that affect equity, Dr Gita Sen, Professor, Centre for Public Policy, Indian Institute of Management, Bangalore, talked of the conditions that result in chronic poverty conditions in Koppal, Karnataka, where health systems are largely absent or inadequate to meet healthcare needs. Such adverse conditions serve to normalise the drudgery of everyday living and the gender inequities that mark health outcomes in this region. She mentioned the restricted access that women have to maternal care in the region partly due to the impact of cultural beliefs and practices that constitute the context of maternal health. This belief system finds local temples and exhortation rituals more suitable than appropriate maternal healthcare. Culturally determined maternity care practices include poor nutrition during pregnancy and dangerous intra-partum practices during delivery; one of the latter is the practice of ignoring post partum haemorrhage due to the belief that it was “letting of bad blood”. Ethical research and practice for researchers in this setting means involvement in the politics of engaging with multiple systemic inequities and bringing the “truth of evidence” back into focus for maternal health policies and programmes.