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

TLDR: Insight into the health service encounter experienced by female slum dwellers is provided and 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 is demonstrated.

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.