Like a mother-daughter relationship
Nandagiri, R., (2019). “Like a mother-daughter relationship”: Community health intermediaries’ knowledge of and attitudes to abortion in Karnataka, India. Social Science & Medicine 239, 112525. https://doi.org/10.1016/j.socscimed.2019.112525
While this article was chapter four of my PhD thesis, it was the first empirical chapter that I wrote.
The original title of this manuscript was “They know everything” after a stray remark by one of my interlocutors describing the role of lay community health intermediaries (CHIs). During one of my observational/pilot visits to a Primary Healthcare Centre, the clinic administrator told me that the best people to speak with were the Accredited Social Health Workers (ASHAs) as they were the first port of call for reproductive healthcare in most villages. I hadn’t initially intended to interview them, but after this discussion, I expanded my study population to include them. As it transpired over the course of data collection, they really did know everything.
I couldn’t fit the anecdote in my article and the title seemed a bit odd/decontextualised without it, so I ended up re-naming the paper. In my head (/my heart) this is still the “they know everything” paper.
Instead, I chose another quotation: “like a mother-daughter relationship”. One ASHA described her relationship with women in this way, capturing a role that was at once nurturing, advisory, and grounded in trust. But it also gestures to something more complex: norms enforcement and norm-breaking, secrecy and disclosure, care and authority.
Conceptually, this paper argues that community health intermediaries are not simply passive conduits of information, but central actors who shape abortion knowledge, decision-making, and care-seeking. They do not just transmit information from the health system to communities; they interpret, filter, and produce knowledge in ways that are deeply embedded in social and relational worlds. Through these “mother-daughter”-like relationships, CHIs occupy a position of trust and authority that allows them to mediate not only access to services, but also how abortion is understood, discussed, and acted upon. In that sense, the paper shifts attention away from abortion as something that happens primarily within formal healthcare systems, and towards the relational infrastructures of care that underpin how people come to know about, navigate, and experience abortion.
Having skipped a few core readings (oops), I didn’t realise at the time that it echoed Shellee Colen’s germinal chapter ‘“Like a mother to them”: stratified reproduction and West Indian childcare workers and employers in New York’, in Ginsburg & Rapp’s still-essential-reading Conceiving the New World Order: The Global Politics of Reproduction. I plan to one day write about the echoes and reflect on where my work could/does overlap.
I agonised over this article, receiving three rounds of comments from Professor Coast, Dr Leone, and Dr Freeman. I also presented it at two conferences (inroads global gathering in 2018 and the Abortion and Reproductive Justice conference in 2018) and as a poster presentation (BSPS 2018, best student poster) before submitting it to Social Science & Medicine in March 2019. I received extensive comments from three very generous reviewers (including reviewer two!) for an R&R. My revisions were accepted with minor additional comments and the article was published in September 2019. Fortuitously, I received confirmation of acceptance the day before I submitted my thesis!
I’m still determined to use the title “they know everything” for something, though!