Assignment Task:
A 19-year-old woman from a poor area in India is pregnant for the fi rst time and only weeks from her delivery date. Wearing a long pardah to cover the lower half of her face and traditional maang tikka jewelry on her forehead to indicate married status, her attire refl ects the traditional values embedded in her culture. She wants to deliver her baby in her home village, which is an overnight's journey away. But her husband and in-laws have other ideas. They have just learned of a government program that provides a cash payment of 1000 rupees to women who opt for institutional delivery over home delivery. Her mother-in-law insists that the delivery take place in their district institution. The woman's parents, believing the in-laws to be driven purely by greed, support their daughter. With encouragement from her parents, the woman disobeys her husband and in-laws to travel to her parent's home, but goes into labor on the road and loses her child due to complications in the delivery. The young woman not only is disconsolate over the loss of her child, she must now face the wrath of her husband and in-laws. This is a poignant case, but only one in a dossier full of similar cases that you, as the state director for the maternal cash incentive program, have read that involve clashes between traditional ways and the incentive program. As a result, you have decided to convene an expert panel to consider recommendations to smooth not only the cultural friction the program is causing, but also the program's impact on the quality and safety of care, as well as access to it.
Discussion Questions
Q1. Who are the main stakeholders in the case of the 19-year-old woman and what values and cultural perspectives does each stakeholder bring to this situation?
Q2. How should you consider the issues about this and similar cases when deciding whether to revise the cash incentive program?
Q3. What are the pros and cons of cash incentive programs from a public health perspective?
Q4. What role should government play in improving the public's health?
Q5. In the context of inequities based on socioeconomic status, caste, and education, to what extent should you attempt to ensure that a woman's autonomy is not violated? Should the same notion of autonomy be applied in India or other unique contexts as prevails in European and North American countries?
Q6. Due to a financial downturn, the state government is thinking about eliminating the maternal cash benefit program. How can an ethical analysis assist in making this decision? What factors should be considered as part of this ethical analysis?