Gendered health systems biased against maternal survival : preliminary findings from Koppal, Karnataka, India

In this paper we outline the context of pregnant women’s lives and the plural health systems they encounter in Koppal, the most deprived district in the state of Karnataka, south India. We combine preliminary survey findings with qualitative work to illustrate the dynamics involved in seeking and receiving obstetric care. Despite high levels of poverty and scarce resources supporting primary health care in the region, women with obstetric complications do access a range of health providers. Yet they still die. Although addressing the technical and managerial capacity constraints to ensuring equitable access to emergency obstetric care is essential, we argue that maternal well-being and survival cannot be effectively ensured without confronting the gender biases that also constrain health systems from supporting women’s health and saving women’s lives. We analyse these biases as failures in acknowledgement and accountability for pregnant women’s needs and conclude with strategic steps to effectively respond to the situation that encompass technical, managerial and political action. Keywords: maternal health, maternal mortality, plural health systems, gender bias, acknowledgement, accountability.