The emergence of maternal health as a political priority in Madhya Pradesh, India: a qualitative study

Abstract

BackgroundPolitics plays a critical role in agenda setting in health affairs; therefore, understanding the priorities of the political agenda in health is very important. The political priority for safe motherhood has been investigated at the national level in different countries. The objective of this study was to explore why and how maternal health became a political priority at sub-national level in the state of Madhya Pradesh in India.MethodsThis study followed a qualitative design. Data were collected by carrying out interviews and review of documents. Semi-structured interviews were carried out with twenty respondents from four stakeholder groups: government officials, development partners, civil society and academics. Data analysis was performed using thematic analysis. The analysis was guided by Kingdon’s multiple streams model.ResultsThe emergence of maternal health as a political priority in Madhya Pradesh was the result of convergence in the developments in different streams: the development of problem definition, policy generation and political change. The factors which influenced this process were: emerging evidence of the high magnitude of maternal mortality, civil society’s positioning of maternal mortality as a human rights violation, increasing media coverage, supportive policy environment and launch of the National Rural Health Mission (NRHM), the availability of effective policy solutions, India’s aspiration of global leadership, international influence, maternal mortality becoming a hot debate topic and political transition at the national and state levels. Most of these factors first became important at national level which then cascaded to the state level. Currently, there is a supportive policy environment in the state for maternal health backed by greater political will and increased resources. However, malnutrition and population stabilization are the competing priorities which may push maternal health off the agenda.ConclusionsThe influence of the events and factors evolving from international and national levels significantly contributed to the development of maternal health as a priority in Madhya Pradesh. This led to several opportunities in terms of policies, guidelines and programmes for improving maternal health. These efforts were successful to some extent in improving maternal health in the state but several implementation challenges still require special attention.

Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens

“…Maternal health is prominently appearing on policy agendas of the Government of India (GOI) and the state government in Madhya Pradesh ( 11 – 15 ) . However, the quality of care and the use of maternal health services in the state remain low ( 16 – 18 ) .…”

Policy Process Theory for Rural Studies: Navigating Context and Generalization in Rural Policy

“…These nearly 20 applications favor qualitative or literature‐review‐like methods (Ainuson 2009; Akinola 2007; Dong et al 2009; Fischer and Bliss 2006; Gasteyer 2008; Jat et al 2013; Kwon and Reich 2005; Lehrer 2009; Ling, Ho, and Ali 2014; Maclennan et al 2013; Motsholapheko, Kgathi, and Vanderpost 2015; Peters 2006; Soderberg and Eckerberg 2013; Switzer 2001; Thiele et al 2011), a trait common to policy process theory studies (Sabatier and Weible 2014). They address policy problems broadly concerning the environment like biofuels (Lehrer 2009; Soderber and Eckerberg 2013), agriculture (Gasteyer 2008; Thiele et al 2011), natural disasters (Motsholapheko, Kgathi, and Vanderpost 2015), water (Ainuson 2009; Hardy and Koontz 2010), rangeland (Dong et al 2009), forest governance (Andersson 2006; Fischer and Bliss 2006), open space (Ling, Ho, and Ali 2014), environmental policy (Switzer 2001), health topics (Jat et al 2013; Kwon and Reich 2005; Takian, Rashidian, and Kabir 2011), and development (Akinola 2007; Lientz, Dickes, and Lamie 2014; Peters 2006). Additionally, they are recent, ranging in publication date from Switzer (2001) to Motsholapheko, Kgathi, and Vanderpost (2015).…”

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“…Though only half of existing MSA peer‐reviewed articles concerning rural policy use the three streams metaphor (Jat et al 2013; Kwon and Reich 2005; Maclennan et al 2013), MSA articles frequently employed both the policy window and entrepreneur concepts (Kwon and Reich 2005; Maclennan et al 2013; Switzer 2001; Takian, Rashidian, and Kabir 2011). Policy entrepreneurs are a critical facet of MSA, if not the most critical.…”

Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

“…There is a supportive policy environment with greater political will and better resources. This leads to several opportunities in terms of policies, guidelines and programmes for improving maternal health 19 . Regarding maternal nutrition, India has a better collection of programs and policies which can play a major role in improving MCH outcomes 28 Challenges for UHC to MCH according to health system building blocks a.…”