A Frame Analysis Approach to Examining Conflicting Constructions of Rights-Based Maternal Health Policy Agendas in India

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United Nations Population Fund observes that maternal mortality is the single largest health inequity in the world, with 99 percent of deaths occurring in developing countries. The failure of traditional public health approaches to tackle the issue has led many health activists to consider alternative frameworks and re-frame the debate as a human rights issue to secure political priority. However, the growing literature on right to maternal health lacks empirical evidence to confirm this optimistic speculation by health activists and practitioners. Public policy theorists, particularly in the social constructivist tradition, caution us about the complexities (including unintended outcomes) involved in using framing as a strategy for mobilizing resources for progressive policy reform. Against this backdrop, this research evaluates the political resources and opportunities that a successful human right framing of maternal health can provide to those actors trying to improve access, distributional equity and quality of maternal health care for all women. It examines the historic and countrywide proclamation of maternal mortality as a human right violation (in a public interest litigation case) in a 2010 High Court verdict in India – claimed to be the first of its kind - using a qualitative case study method involving fifty key informant interviews with state and non-state actors. Preliminary findings indicate negligible impact of the new framing in provoking institutional change and no alteration in policy design, but suggest opportunities for smaller incremental changes that may improve technical efforts in the longer term and strengthen advocacy requiring activists to rely on research and evidence based approaches. However, a deeper inquiry, using frame analysis, reveals the existence of multiple and conflicting constructions of the problem definitions that fail to present the problem in its entirety and are selectively inclusive, leading to a potential policy stalemate. The incorporation of the language of rights by competing global and local forces – such as, international non-state champions of women’s reproductive rights, local feminist health activists reluctant to engage with a “maternal health” rights agenda, local women’s health activists pursuing competing political priorities, and an institutional policy approach dominated by overtly medicalized and technocratic methods – has led to a highly fragmented policy environment that is potentially inconducive to constructive deliberations over a rights-based policy reform. Ultimately, the framing efforts are limited in their ability to sensitize the health system to address the needs of women; in their efforts to counter the dominant and technocratic institutional approach, current advocacy efforts preserve, rather than adequately problematize the latter’s policy paradigm. The research helps public policy theorists understand how does framing, developed primarily in the Anglo-American context apply elsewhere – particularly in resource poor contexts that are equally susceptible to domestic and international political influences, even in the arena of social policy making. It also makes important empirical contributions to a number of fields on politics of women’s health and health care, human rights and international development.