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Improving access to quality care for female slum dwellers in urban Maharashtra, India: Researching the need for transformative social protection in health

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Abstract

Although quality health facilities in Mumbai and Pune are plenty, slum dwellers do not benefit fully from these. Next to financial barriers, low quality treatment and discrimination form major hurdles to entering public care. A lot of them prefer to buy services from ill-qualified private providers. Without social protection in health (SPH), their predicament often boils down to the uneasy choice between forgoing treatment and risking impoverishment. Currently, some SPH interventions try to protect poor urbanites and increase their access to quality care. This article provides more insight into the health service encounter experienced by female slum dwellers. Using data from focus group discussions with members of three SPH interventions and in-depth interviews with providers, challenges faced by the women during their health seeking process are discussed. By using Bourdieu's theoretical concepts on field, capitals and habitus, this study shows that a more subtle reproduction of social inequities and domination in the medical field forces slum dwellers to either forgo treatment, buy ineffective care from private providers, or passively accept the abuse in the public sector. These insights demonstrate the need for transformative SPH interventions to address the power imbalances in society that create and sustain the social vulnerability of poor people when seeking health.

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Notes

  1. A search for articles published since 2008 with the ‘social determinants of health’ string in the title using the academic search engines ISI Web of Knowledge, MedLine and PubMed resulted respectively in 131, 133 and 218 hits compared to 67, 69, 136 before 2008.

  2. While the agency perspective focusses mainly on the individual capacities of calculating agents to act, choose and construct their worlds free from any influence of the macro context, the structuralists see individual action predominantly determined by the material, socio-political, cultural and economic conditions that constitute the broader society (Williams, 2003).

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Acknowledgements

The research was funded by a PhD grant from the Flemish Interuniversity Council – University Development Cooperation (Belgium, Brussels) (VLIR-UOS. VLADOC2007 – 20473 to J.M.) and the Department of Sociology of the University of Antwerp (Belgium, Antwerp). The authors thank Tom De Herdt and the anonymous reviewers of Social Theory & Health for their valuable feedback on the earlier versions of the article. Next, as the principal researcher in the realist evaluation project I (J.M.) take the opportunity to thank the management staff and field workers of the three non-profit organisations in Mumbai and Pune under study for the feedback on the research proposal and the logistic support during the field work.

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Authors and Affiliations

  1. Research Centre for Longitudinal and Life Course Studies (CELLO), Department of Sociology, Research Centre for Longitudinal and Life Course Studies (CELLO), University of Antwerp, Sint Jacobstraat 2 (S.M.371), Antwerp, B-2000, Belgium

    Joris Michielsen & Herman Meulemans

  2. School of Population Health (SOPH), Faculty of Medical and Health Sciences (FMHS), The University of Auckland, Auckland, New Zealand

    Denny John

  3. SATHI-CEHAT (Support for Advocacy and Training into Health Initiatives), Pune, India

    Nilangi Sardeshpande

  4. Tata Institute for Social Science (TISS), Mumbai, India

    Nilangi Sardeshpande

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  1. Joris Michielsen
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  2. Denny John
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  4. Herman Meulemans
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Correspondence to Joris Michielsen.

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Michielsen, J., John, D., Sardeshpande, N. et al. Improving access to quality care for female slum dwellers in urban Maharashtra, India: Researching the need for transformative social protection in health. Soc Theory Health 9, 367–392 (2011). https://doi.org/10.1057/sth.2011.18

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