Annotated Source- Caste as a determinant of healthcare services

Saroha, Ekta. 2007. Caste as a determinant of utilization of maternal and neonatal healthcare services in 
       maitha, utta pradesh, india.The University of Alabama at Birmingham. In PROQUESTMS ProQuest     
       Dissertations & Theses (PQDT), http://search.proquest.com/docview/304893270?accountid=4488.


This was an awfully exciting dissertation. The abstract begins with the simple statement that upper-caste women receive better healthcare than low-caste women. This may seem obvious, but its implications are monumental. However this association has not been well researched. She introduces the many inequalities Hindus suffer due to the caste system. Despite government programs to subsidize health care, low-caste individuals have not reaped the benefits. These castes that receive affirmative action are referred to as "Scheduled Castes".


In 2000, Maternal Mortality Ratio was 540/100,000 live births and Neonatal Mortality Ratio was 43/ 100,000. The researcher narrowed her study to Uttar Pradesh, a largely Hindu state in India that has lower level of health care for women and children. Only 5% had trained live birth attendants and 22% used contraceptives. The link was further explained. Many low-caste women did have a traditionally trained attendant at their birth, despite their knowledge, they were not well trained enough. These attendants are generally the same caste as the woman. Generally, well educated doctors and midwives are high-caste. The difference in caste as well as an inability to pay results in low caste women receiving substandard care. The affirmative action needs some serious adjustment. These marginalized populations are not receiving the care they need and too many are dying as a result. 


This article was very relevant to my research. While I will probably not take caste into consideration during my research. I appreciated that the researcher did not discount traditional medical methods, but did note that with some training they could greatly reduce death. I will definitely return to this VERY LONG dissertation soon. 

Project Question

In our last class, each student discussed and critiqued one another's project question. This exercise made me realize how much revision and research my proposal still requires. I will be studying medical care in India. Before I began the class, I had not considered the problems I face as a woman researcher. I know it was probably quite obvious, but I did not think that my gender would limit my ability to research. With this knowledge I have narrowed down my research question to two options: women or children. 

In a chapter from Amartya Sen's book, Development as Freedom, he discusses the alarming phenomenon of "missing women". This is not "missing" in the traditional sense, but occurs when women are artificially outnumbered by men. This appears quite often in India. This phenomenon is not always caused by the sensational, like sex-selective abortions and female infanticide, but more subtle practices like preferential treatment of male children. I am interested in studying how gender affects the amount of medical care children receive. 

I am also interested in what kind of medical care women receive, particularly when pregnant. Do they receive prenatal care? Do they go to a western hospital for their delivery or do they have a traditional midwife? I do not know whether the village is large enough to conduct research exclusively on maternal health. 

I am still uncertain whether I will be doing my research in Coimbatore or with the Shanti Ashram. I need to consider the benefits of each. While studying in the village will allow me to set my own agenda and research exactly the way I wish, I will face the difficulties of having to work with a translator. Working alone may be difficult, especially since I have a minimal grasp of the language.  Working with the Shanti Ashram will expose me to women from all the surrounding areas. I will be able to work within their existing programs. This may also limit my research since I will need to work within their existing programs. 

I feel much closer to my research topic than before, but I still need to research more to narrow down my topic. It is important to keep my proposal in check. I read all these interesting articles, then suddenly think I can add a segment like how the remnants of the caste system affect the medical care people receive.