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      Anthropologies of Global Maternal and Reproductive Health : From Policy Spaces to Sites of Practice 

      Conflicted Reproductive Governance: The Co-existence of Rights-Based Approaches and Coercion in India’s Family Planning Policies

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      Springer International Publishing

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          Abstract

          India’s current population policy is situated between two conflicting discourses of population management, one that is governed by a demographic rationale advocating strict State regulation of fertility, and the other that is delineated by a rights-based framework that promotes individual reproductive choice and bodily autonomy. In this chapter, I show how this conflicted policy discourse becomes supportive of processes that empower the State, rather than facilitate reproductive autonomy among claimants on the ground. The chapter draws on textual analysis of policy and programme documents and discussions with health providers, users and policy makers during long-term fieldwork in the state of Rajasthan. I show that, in their role in promoting regional state directives on reproductive health policies, health workers are at once agents and subjects of State policy processes and of their community’s ideologies, preferences and practices related to childbirth and reproductive care. It is in their work and embodied practice of family planning that we most clearly evidence the implications of ‘conflicted reproductive governance’. When health workers struggle for their own remuneration and recognition, the State’s rights-based health policy objectives will remain unreachable.

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          Reproductive governance in Latin America.

          This paper develops the concept of reproductive governance as an analytic tool for tracing the shifting political rationalities of population and reproduction. As advanced here, the concept of reproductive governance refers to the mechanisms through which different historical configurations of actors - such as state, religious, and international financial institutions, NGOs, and social movements - use legislative controls, economic inducements, moral injunctions, direct coercion, and ethical incitements to produce, monitor, and control reproductive behaviours and population practices. Examples are drawn from Latin America, where reproductive governance is undergoing a dramatic transformation as public policy conversations are coalescing around new moral regimes and rights-based actors through debates about abortion, emergency contraception, sterilisation, migration, and assisted reproductive technologies. Reproductive discourses are increasingly framed through morality and contestations over 'rights', where rights-bearing citizens are pitted against each other in claiming reproductive, sexual, indigenous, and natural rights, as well as the 'right to life' of the unborn. The concept of reproductive governance can be applied to other settings in order to understand shifting political rationalities within the domain of reproduction.
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            “I was obligated to accept”: A qualitative exploration of contraceptive coercion

            Despite narratives about empowering women through contraception, global family planning programs are evaluated primarily by their ability to increase contraceptive uptake and reduce fertility in the developing world. Some scholars have raised concerns that this emphasis on fertility reduction and contraceptive uptake may contribute to situations where women are coerced into adopting contraceptive services they do not fully understand or want. Yet surprisingly little data have been collected to investigate whether such coercion exists or how it might manifest. In-depth interviews with 49 women of reproductive age in a sub-Saharan African country begin to fill this knowledge gap. Respondents reported a range of non-autonomous experiences including biased or directive counseling, dramatically limited contraceptive method mix, scare tactics, provision of false medical information, refusal to remove provider-dependent methods, and the non-consented provision of long-acting methods. The results show that, rather than a binary outcome, coercion sits on a spectrum and need not involve overt force or violence, but can also result from more quotidian limits to free, full, and informed choice. The study finds that global family planning policies and discourses do appear to incentivize coercive practices. It also calls into question the central role of intentionality, by demonstrating how coercion can arise from structural causes as well as interpersonal ones. By showing how contraceptive autonomy may be limited even by providers working in good faith, these results argue for an end to the instrumentalization of women's bodies, and for a radical reconceptualization of family planning goals and measurements to focus exclusively on reproductive health, rights and justice.
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              ‘Trust and teamwork matter’: Community health workers' experiences in integrated service delivery in India

              A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011–2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive ‘teamwork’ and ‘building trust with the community’ (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology – which the health workers espouse – is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration.
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                Author and book information

                Book Chapter
                2022
                January 11 2022
                : 117-136
                10.1007/978-3-030-84514-8_7
                9bea476e-186c-49dd-b82e-3a271d2bdd38
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