title: Women's political participation and health: a health capability study in rural India.
abstract: Understanding the relationship between women's political participation and health has eluded researchers and cannot be adequately studied using traditional epidemiological or social scientific methodologies. We employed a health capability framework to understand dimensions of health agency to illuminate how local political economies affect health. Exploiting a cluster-randomized controlled trial of a community-based behavior change management intervention in northern India, we conducted a qualitative study with semistructured, in-depth focus groups in both intervention and nonintervention villages. We presented scenarios to each group regarding the limitations and motivations involved in women's political participation and health. Thematic analysis focused on four domains of health agency -- participation, autonomy, self-efficacy, and health systems -- relevant for understanding the relationship between political participation and health. Elder women demonstrated the greatest sense of self-efficacy and as a group cited the largest number of successful health advocacy efforts. Participation in an associated community-based neonatal intervention had varying effects, showing some differences in self-efficacy, but only rare improvements in participation, autonomy, or health system functioning. Better understanding of cultural norms surrounding autonomy, the local infrastructure and health system, and male and female perceptions of political participation and self-efficacy are needed to improve women's health agency. For a community-based participatory health intervention to improve health capability effectively, explicit strategies focused on health agency should be as central as health indicators.
authors.affiliation: Harvard University.
authors.forename: Candace H
authors.initials: CH
authors.lastname: Feldman
authors.affiliation: Bill and Melinda Gates Foundation.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.affiliation: Community Empowerment Lab.
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Kumar
authors.affiliation: University of Pennsylvania.
authors.forename: Jennifer Prah
authors.initials: JP
authors.lastname: Ruger
mesh_terms: D000367:Age Factors; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006304:Health Status; D006801:Humans; D007194:India; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration; D008603:Mental Health; D026684:Personal Autonomy; D011057:Politics; D036301:Qualitative Research; D012424:Rural Population; D020377:Self Efficacy; D012737:Sex Factors; D012931:Social Environment; D012959:Socioeconomic Factors
keywords: India; health agency; health capability; women's health