Chapter Eight - The Reproductive Body and the State: Engaging with the National Rural Health Mission in Tribal Odisha

Summary

Despite India's economic growth, the country struggles to deal with inequities along the lines of class, caste, gender and region. Over the past decade, the Indian government's policy response to a persistent situation of poverty and inequality has been an increasing engagement with the rights regime. This is witnessed by the formulation of a plethora of rights-based regulations as policy instruments. These reflect a broader shift in Indian development policy from a perception of development as a welfare activity of the government to a recognition of basic development needs as rights of citizens (UNDP 010, 5–8). The guiding idea underlying this shift is the conviction that laws enabling citizens to assert their rights compel government performance and reforms (52). The focus of this chapter is the National Rural Health Mission (NRHM) as one such rights-based public health programme. It was introduced in 2005 as a response to the global call for accelerating the strategies related to the fourth and fifth Millennium Development Goals (MDG), targeting morbidity and mortality rates of children and women. The NRHM is a horizontal and integrated approach to healthcare that aims at ensuring universal access to affordable and quality healthcare, especially for the vulnerable rural populations – the poor women and children.

The Indian government’s rhetoric through the NRHM portrays the state’s relationship to the poor in general, and to poor women in particular, in a humanitarian light. The methodology of implementation is driven by concepts such as partnership, participation, engagement and decentralization. These are quite different from the earlier vertical regimes that Das has described as ‘military’ in their execution (Das 1990). This move to the rights regime involves an emerging tacit contract between the woman and the state. The thrust on maternal health in the NRHM seems to imply that women must carry out their reproductive functions and the raising of children in a specific way, while the state in turn should lend support and assistance. As such, it signals an important change in state–society relations.