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Open Access Highly Accessed Research article

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

Tej Ram Jat123*, Prakash Ramchandra Deo1, Isabel Goicolea24, Anna-Karin Hurtig23 and Miguel San Sebastian2

Author Affiliations

1 United Nations Population Fund, UN Office, 41-42, Polytechnic Colony, Shyamla Hills, Bhopal, Madhya Pradesh 462013, India

2 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, SE 90187, Sweden

3 Swedish Research School for Global Health, Umeå University, Umeå, SE 90187, Sweden

4 Umeå Centre for Gender Studies, Umeå University, Umeå, SE 90187, Sweden

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BMC Pregnancy and Childbirth 2013, 13:181  doi:10.1186/1471-2393-13-181

Published: 30 September 2013

Abstract

Background

Politics 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.

Methods

This 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.

Results

The 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.

Conclusions

The 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.

Keywords:
Maternal health; Maternal mortality; Political priority; Madhya Pradesh; India