CASI Student Blog
When the pandemic hit, many of us who planned qualitative research were preparing to travel to our field sites. What was initially a ‘wait and watch’ scenario, ended up being a situation where we had to consider a complete revamp of our methodologies; I know of colleagues who had to change their topics entirely because of the difficulty in conducting ‘remote’ fieldwork. I used the CASI Summer Research Fellowship this year to attempt remote connections to my field sites. Here are my initial reflections from that exercise.
First, these initial conversations with research participants were very personal. Contrary to my assumption that my research participants would refuse to speak to me until they were ready, I realised that they wanted to talk; but those conversations were personal. They discussed individual and family stresses, issues better discussed with therapists than researchers. I certainly am not trained for this. In the end, I allowed them to talk and just listened cognisant of the fact that I wouldn’t be able to use much of this material. What I did build up were relationships that would hold good in subsequent periods of research.
Second, I learned that people like to tell stories, and using different media to solicit their stories gave my respondents more control over the narrative, and felt less like a formal ‘interview’. During this period, while my participants’ verbal conversations with me were personal, I asked them to take photographs and videos of their everyday-life in relation to my research question. I found this more useful to my research process. What I now have is an audio-visual repository of photo-voice stories that speak to adaptations to living informally during a pandemic. I plan to structure questions around the audio-visual material I have received personal to each participant later this year for more systematic inquiry.
Finally, I learned that technology was both a hindrance and a tool of communication at this time for two reasons. First, the communities I research are urban, but can also be socio-economically disadvantaged. I faced a variety of issues from a complete lack of smart phones to poor internet connectivity in those particular settlements. In an observation on gender-based access to technology, I found that even in households where smartphones were in use, my research participants (all female), either did not have a phone at all, or only had basic phones. In the rare cases they did have smart phones, they were very basic models. Other family members (husbands, and male children) had the latest models of smart phones they could afford. Very rarely could my participants access these smartphones, and given the requirements to protect their privacy, I did not encourage them to use this strategy. The lack of (smart)phones made communication difficult; I could neither interview them (or get clear recordings of the voices when I did interview them), nor could they take clear photographs with their phones. In the end, they we decided to get each research participant a smart phone with an adequate data plan. This really opened up communication.
Second, and in a related vein, while regulations for Human Subject Research are well developed for in-person research, the guidance is sparse for remote fieldwork. What happens when you ask the same sets of questions from a distance? How can you successfully protect your human subjects, particularly their privacy, while conducting research? The first hurdle was technology. What would be the best program to use for these remote interviews? While Zoom is ubiquitous with many people, for my participants, Zoom was an extra program to learn during a difficult period of personal adjustment. Most of them prefer WhatApp instead. Luckily WhatsApp calls and chat are encrypted end-to-end, but it is unclear whether this level of encryption would pass muster with IRBs. Thus far, I use WhatsApp to solicit photo-voice material, and am slowly introducing them to Zoom calls; the University of Pennsylvania has a HIPAA compliant Zoom license. The second hurdle is the space where these conversations are conducted. Anyone who has ever conducted fieldwork, including interviews in informal settlements in the Global South, knows that ‘conversations’ are rarely private. Even if you begin with one person, other members of the household join in or even neighbours from the street and passersby will proffer their opinions during your ‘interview’. But even in this case in-person controls are possible. For example, once rapport is developed, I usually speak to women during their ‘alone time’, for example between 5 and 6 am when the household is asleep, but the women are awake preparing for the day. In this remote setting such variables are hard to control for. The time-difference means that I am unusually situated to talk to them at whatever time is convenient for them. Whether they will engage with a video interview that early in the morning is another question altogether.
Kerala was lauded for being both, the most responsive to the pandemic, as well as the most effective in its state response to the pandemic. Oftentimes, the state’s response was seen as more restrictive than the national response, especially in the early days of the pandemic. As we will see, subsequent state action was aligned to national directives. Although there was initial success, Kerala’s case numbers have steadily climbed. Recent case numbers show that Kerala has at times even overtaken Maharashtra in its case numbers. This blog traces the pandemic response of the state with the four ‘Lockdown’ phases and four ‘Unlock’ phases of the Government of India comparing responses and finally demonstrating the impact in numbers from the state’s own dashboard. From March to September 2020, the Government of India issued 61 orders and letters to states regarding the pandemic; in the same period, the State Government of Kerala issued 68 government orders and circulars. This blog reviews those orders, juxtaposing state action with national action for pandemic response.
Kerala started early, earlier than most national governments the world over. Within a week of the WHO notification of the novel Coronavirus on 14th January, a Primary Control Room was set up with comprehensive guidelines on screening, testing, and admission issued. All airports followed pandemic protocols, isolation wards were set up in hospitals near these airports, and education and entertainment centres were closed. The machinery established to respond to the Nipah virus was now mobilised in all 14 districts of the state. By early February, with large numbers of workers returning home from the Gulf states, testing in state laboratories was now functional. At the national level, in January, early travel advisories had been issued and only passengers from China and Hongkong were being screened at three international airports.
The Kerala’s response in the pandemic’s first three months was a combination of the rapid action described above, combined with concerted action from March 2020 onwards. The first order issued ensured centralised control under the office of the Chief Secretary; in short, all action was to be coordinated directly by the Chief Secretary’s office and unified communication was to be issued. The second pillar of response was the War Room. In its original avatar, the War Room was a 24/7 contact centre for complaints, transportation, and logistics. The War Room was restructured in August to include a focus on increasing testing (including by private labs), ensuring the availability of health professionals, medical equipment, PPE, and adequate treatment facilities, and monitor the flood situation int the state. Finally, movement and safety protocols were issued, controlling behaviour to prevent community spread.
From March to May 2020, invoking the National Disaster Management Act, 2005, the Government of India had four successive Lockdowns, preceded by a national travel ban. From the first to the fourth lockdown, the strategy moved from complete containment of movement of people to defining hotspots or containment zones where people’s movement would be completely curtailed. In these periods of lockdown, movement of people was restricted to essential trade and orders to protect migrants on the move. From June to September 2020, each month had a successive “Unlock” period where restrictions of people’s movement were gradually relaxed, except within the containment zones (red). With the fourth “Unlock” period, free travel of people across states was permitted, and states were permitted to specify geographies smaller than districts such as wards or blocks for containment. By early May, states were ordered not to dilute the centre’s guidelines, and in August, states were no longer permitted to restrict inter-state movement, or issue special permits for movement of goods and persons.
From April 2020 onwards, Kerala launched its “Break the Chain” campaign. A reading of government orders and circulars shows that there were five pillars of this campaign. First, the state government aligned its action with national government orders. Often within 24 hours of the Central government issuing an order (or clarification), the state government would issue its own order, appending the national order, and clarifying how those orders would play out at the district and local levels. Second, Kerala placed strong emphasis on border control. Within the state, this translated into guidelines for the movement of people into and out of containment (red) zones, and across district boundaries. Within districts and cities, various restrictions were in place: For May and June, Sundays were under strict lockdown; Even in September, a night curfew (9pm to 5am) was still in place; All banks were closed on weekends; and for an entire month, Thiruvananthapuram district was shut down. The state also issued detailed guidelines for the movement of people into and out of the state, including through international borders (air and sea ports). Here, the state’s Covid19Jagratha portal, initially developed to trace people coming in from international ports, developed over the months to a comprehensive information and contact tracing portal. The state even made special requests to the Indian Missions in the UAE, Qatar, Kuwait, Oman, Saudi Arabia and Bahrain to test returnees before they boarded the plane.
Third, the state adapted existing facilities for COVID19 use. Given the strong tourism and hospitality infrastructure in the state, in May, Kerala ordered that at least 10 hotels per district be offered to international returnees to quarantine in. Initially Kerala Tourism Development Corporation (KTDC) hotels were assigned; district administrators would add to the list with private operators subsequently. In addition to hotels, Kerala ordered the setup of COVID Firstline Treatment Centres (CFLTCs) and Reverse Quarantine Facilities with at least 100 beds each to isolate the vulnerable from possible infection if quarantine facilities are not available to them at home. Fourth, these actions were accompanied by publicity campaigns and the establishment of helplines in each district.
Finally, the state issued two related ordinances. First, on 27th March, the Kerala Epidemic Disease Ordinance was published, followed by the Kerala Epidemic Disease Corona Virus Disease (COVID-19) Additional Regulations, 2020 was issued on 2nd July. This specified eight main restrictions, including mandating facemarks in public and while traveling, maintaining a six feet distance, the maximum number of participants at weddings and funerals (50 and 20 people respectively), banning social gatherings larger than 10 people, banning spitting in public, mandating that all travels register on the Covid19Jagratha portal, and finally, suspending interstate carriage road transport.Graph 2: Kerala’s COVID19 Numbers from the state government dashboard (January – September 2020)
From the numbers above, it is obvious that for the first half of the year, when the state government was in complete control of the pandemic response, the numbers were under control. There appears to be a strong correlation between the rise in Kerala’s COVID19 numbers from July onwards and the Government of India’s Unlock phases. Given that so much of Kerala’s response was predicated on the control of people’s movement, having to surrender that strategy has resulted in the freer movement of people, and subsequently the spread of the virus.
This is my final report on my summer research project, previously described here and here.
A striking feature of the literature of the ‘Indo-Anglian’ period is the proliferation of memoirs and autobiographical narratives that engage in what we would today call auto-ethnography. In libraries of the better sort, these memoirs can take up entire bookcases, checked out once every ten years or so by graduate students ploughing their way through yet another dissertation on representations of “home” or “Indian identity” in Anglophone writing . Thanks to a research grant from CASI, I had the chance to become one of these graduate students myself this summer. This blog post is about one of the better-known stories in this genre, Rohinton Mistry’s “Lend Me Your Light”, first published in the Toronto South Asian Review and later collected in Tales from Firozsha Baag (Penguin, 1987).
A typical ‘Indio-Anglian’ auto-ethnographic narrative tracks the ambiguous transnational journeys of a deracinated young man, whose Anglophone education (and/or years abroad) has left him introspective to the point of being narcissistic, burning with literary and sexual ambitions that he is incapable of realizing. The novels of the diplomat and Milton scholar Balachandra Rajan and the M.I.T.-trained corporate executive Arun Joshi exemplify this genre, whose politics range from politically incorrect paeans to the British Empire (such as Nirad C. Chaudhari’s The Autobiography of an Unknown Indian), to more ponderous ruminations on the incompatibility of European and Indian civilizations (such as Raja Rao’s The Serpent and the Rope). In the early post-Independence years, it was postwar England that was the default site for Anglophone Indian yearning; after the immigration reforms of the 1960s, north America became more prominent in the Indian imagination. While some of this exilic literature arose in response to racism and anticipated the postcolonial turn of the 1980s and ‘90s — I’m thinking , for instance, of Anita Desai’s Bye Bye Blackbird (1971) and Kamala Markandaya’s The Nowhere Man (1972) — this is not really a body of work known for its political radicalism or its attention to the metaphysics of race. No desi Frantz Fanon emerged from this churning, no poet who addressed his brown skin and declared “O my body, make of me a man who always questions”. The “double consciousness” of the Indo-Anglians, such as it was, was more likely to take the form of melancholia than rage.
Unlike many Indian languages, where post-Independence disillusionment often took the form of a return to the village— such as in Phanishwarnath Renu’s Maila Aanchal (Hindi, ‘The Soiled Border’, 1954), Srilal Shukla’s Raag Durbari (Hindi, ‘In a Courtly Mood’, 1968), or O.V. Vijayan’s Khassakinte Itahasam (Malayalam, ‘The Legends of Khasak’, 1969) — it was homelessness and exile that became dominant themes in English-language writing. A relatively late work in the genre, Rohinton Mistry’s “Lend Me Your Light” nonetheless contains many of the same melancholic, exilic motifs characteristic of the fictions of Balachandra Rajan and Arun Joshi: an adolescence spent in the shadow of an imagined West; a “failed” encounter with the village; and desultory international flights that bring no final answers or epiphanies, but instead render both the starting-point and destination into hazy, unreal places. Alongside other stories in Tales from Firozsha Baag, “Lend me Your Light” has been typically interpreted by critics as a work of immigrant art, reflecting a “double diasporic experience”: of Zoroastrians in India, and Indians in Canada. Yet, as my research on the literature of post-Nehruvian disillusionment suggests, a story like “Lend Me Your Light” can also be read in a multilingual and comparative framework: as a work of Indian modernism, belonging to its time and place in the same way as a Marathi poem by Namdeo Dhasal or a Bengali short-story by Mahasweta Devi.
“Lend Me Your Light” tracks the disintegrating friendship of three young men who try and escape the shabby hypocrisy of middle-class life in ‘80s Bombay— Jameshed (who emigrates to New York), the narrator (who emigrates to Toronto), and his brother Percy (who moves to a small village in Maharashtra, to take up the cause of destitute farmers against the local moneylenders). Even as they drift away from the Bombay of their childhood, the three men remain bound to each other, unable to come to terms with how differently each of their lives turned out. The idea of emigration is a cliché for Mistry’s characters, one their entire upbringing has prepared them for, everything else was expectation and waiting: “Absolutely no future in this stupid place… Bloody corruption everywhere And you can’t buy any of the things you want, don’t even get to see a decent English movie”. Mistry’s prose reflects this expectation as a form of gnostic spiritual anguish. The material world, with its squalor and indifference, becomes a frightening and alien place for English-speaking Indians, forcing them to retreat into clichés. More than two decades after Independence, the three protagonists of the story are brought up on a “version of reality” inherited from colonial times, that consigned ghatis (Anglophone slang for Marathi-speakers) to “the mute roles of coolies and menials, forever unredeemable”. The India that exists outside of their convent school barely registers in their minds, their childhood is mostly spent within gated compounds or indoors, fiddling with imported LPs and model airplanes.
What makes “Lend Me Your Light” one of the better allegories of the Indo-Anglian condition is the story’s refusal to yield any kind of redemptive meaning. Just as the narrator is about to leave Bombay, his vision is afflicted by conjunctivitis, and his last glances of the city are filtered through dark glasses — transforming familiar places into something dimmed and unreal. After two years claustrophobic years abroad, when he returns to India, the narrator is determined to break the spell, to see his country of birth with new eyes. But as his flight approaches Santa Cruz airport, Mistry’s prose falls back into the same weary clichés: the land is still “parched, brown, weary, and unhappy”, the airport still ugly and under-construction, and naked children still greet international travelers with requests for money. There is only one, brief moment of grace in “Lend me Your Light”, as the narrator watches kerosene lamps being lit by street side vendors hawking cheap goods by Bombay’s Flora Fountain, and feels a momentary sense of kinship with the ghati crowd. But this Tagore-ian moment of spiritual transcendence is fleeting (the title of the story refers to a poem from Rabindranath Tagore’s Gitanjali), and the narrator returns to Toronto, a place just as desolate as the story’s version of Bombay, neither described nor understood nor properly inhabited. Mistry’s story begins with Tagore and concludes with Eliot, quoting lines from “The Fire Sermon”: “I, Tiresias, [though blind], throbbing between two lives…”. For the Indo-Anglian modernist, the whole world had a tendency to become a wasteland.
Unlike the Britain-bound postcolonial elites of an earlier generation, best represented in Qurratulain Hyder’s Aag Ka Dariya [‘The River of Fire’, 1959], Mistry’s characters do not feel any kind of guilt at opting out of the collective project of ‘nation-building’. By the ‘70s, that discourse had run dry, and been replaced by a sense of morbid anticipation. While the rupture from the past created by emigration is certainly at the heart of Tales from Firozsha Baag (as in Naipaul’s Miguel Street, an obvious model), there is no precise moment in which the story becomes a fiction about migration and the South Asian diaspora. Even those who stay back and commit themselves to local struggles, like Percy, are not immune to the “soul-sapping” desire to escape the demands of history by speaking of India as a foreign country. This Trishanku-like in-between-ness is a key characteristic of some of the best English writing about India from pre-liberalization times: before the growth of major South Asian diasporas in the UK, US, Australia, and Canada; before prosperity and the relaxation of foreign exchange regulations made Europe and north America the backdrop of every other Bollywood movie; before the boom in Anglophone schooling and higher education made English the chosen vehicle of upward mobility for the large and amorphous Indian middle-class. It is not only the emigrants who are waiting for “the light”, in Mistry’s story, but all Anglophone Indians, wherever they are.
English! Six-armed God,
Key to a job, to power,
Snobbery, the good life,
This separateness, this fear
— from “Diwali”, by Vikram Seth
In my previous post for the CASI Student Programs blog, I provided a brief outline of my research plan for the summer of 2020. Thanks to generous support from CASI, I’m happy to report that I’ve finished a draft of my chapter, titled “The Indo-Anglians in Search of the World”.
Broadly speaking, I had three objectives in mind when I began the summer project: i), to analyze themes of disillusionment and disappointment in Indian literature from the 1960s and ‘70s, using a multilingual framework; ii), to explore the impact of the Cold War on representations of India in world literature; and iii), to re-animate the linguistic debates of Nehruvian India, through a comparative analysis of the English and Hindi public spheres in the post-Independence period.
My original plan for the chapter pivoted around the 1970s as a moment of crisis in Indian modernism, across languages. But COVID-19 made it impossible to for me to travel to India or access archives in other parts of the US, leading to a change in emphasis. Instead of the ’70s, I ended up spending much of the summer thinking about the messy process of transition between the late-colonial and post-colonial periods, as I read novels by the likes of Flora Annie Steel, Rumer Godden, Ruth Prawer Jhabvala and Santha Rama Rau. Instead of discovering forgotten nuggets of Cold War history, I gravitated towards thinking about the more insidious ways in which the Cold War impacted India during the 1960s and 70s, beyond the proxy battles between intellectuals and artists sympathetic to the Soviet or Western blocs. Over the course of the summer, I became increasingly fascinated by writers who refused to become wholly “Indian” and remained stubbornly “foreign”, serving as disenchanted witnesses to the years of political turmoil and economic stagnation that followed the euphoria of Independence.
I’m grateful for the support and wisdom of the CASI community, whose insightful questions and feedback opened up new lines of inquiry for me. In my next and final report for this blog, I’ll provide a brief window into the characteristic themes and styles of the “Indo-Anglian” literary world that I have been researching this summer.
I am a second-year doctoral student in the Political Science Department at the University of Pennsylvania. I am primarily interested in comparative politics and the political economy of development in modern India. Broadly, my research pertains to questions of state capacity and the role of identity in public provision of goods and services in developing countries.
After acquiring degrees in Economics and Development Studies, I worked in development research and the public policy space for over eight years before beginning my PhD, mainly conducting mixed-methods impact evaluations and process assessments of government programs in India with a focus on governance and service delivery in the realms of social protection, nutrition, and early childhood education interventions. Prior to arriving at Penn, I worked as a Senior Researcher on a CASI research project related to urbanization and female labour force participation in northern India, led by Prof. Devesh Kapur (Johns Hopkins SAIS), Prof. Neelanjan Sircar (Ashoka University) and Dr. Milan Vaishnav (Carnegie). I have also worked as a researcher in Oxford Policy Management’s Poverty and Social Protection portfolio; IDinsight; and the Poverty, Health, and Nutrition Division of the International Food Policy Research Institute in New Delhi. Over the years, I designed questionnaires and sampling strategies, developed analysis plans for evaluations and cross-section studies, and managed multiple large-scale household surveys of sample sizes ranging from 3000 to 14000 across India. In doing so, I interacted with multiple stakeholders including bureaucrats, frontline workers, rural communities, academics, policy think tanks and donor agencies.
While, on the one hand, policy research allowed me to explore new settings — across multiple states in India — that threw up a series of interesting questions about state capacity and local politics, the tight deadlines and limited scope of the specific policy problem at hand did not afford me the freedom to pursue this in any systematic manner. A PhD, I realized, was the appropriate way forward so that I could have the time and resources to explore issues rigorously while also equipping me with the language and additional tools for such an endeavor.
This is my second and final year of coursework, during which I also intend to work on a framework for thinking about politician-bureaucrat-frontline worker relationships at the lowest levels of government in India, particularly in terms of the interplay of social hierarchy and administrative hierarchy. In addition to this, I am currently engaged in some other collaborative projects which I will write about in subsequent posts.
The Sobti Family Fellowship will be immensely useful at this stage of my doctoral studies, specifically the opportunity to be directly supervised by CASI’s Director, Professor Tariq Thachil. My goal for this year is to work on my second-year research paper and lay the foundation for my dissertation prospectus. I will use the Fellowship funds in service of my research goal to investigate if (and how) identity – i.e. gender, religion and caste – plays a role in service delivery, primarily their impact on the ability of local bureaucrats, frontline workers and local politicians to liaise and coordinate their efforts to provide public goods. I will also develop partnerships with organizations in the field, fellow academics, and the existing network of CASI scholars. Achieving these goals in my second year will mean that I will be better positioned to design a coherent research agenda in my third year.
I am very excited to continue my association with CASI in a more formal way and I will use this blog to share the progress I make this year!
To end, here’s a picture of me piloting a questionnaire with a respondent in rural Patna (Bihar) in September 2018.
When I first thought to write an honors thesis for my Health and Societies major, I didn’t know what to expect. The idea of leading my own research and crafting my own interviews felt daunting, to say the least. A few months later, as I am nearing the end of my research phase, I look back feeling thankful for the difficult, yet rewarding process.
This summer, I conducted a qualitative research study on the rising rates of C-sections in Telangana, India. When I embarked on this project, it was a bigger scale endeavor, consisting of ethnographic fieldwork, patient interviews, and hospital observations. While my research question remains the same at its core, many of these plans didn’t quite pan out to be as I had imagined. With the dramatic takeover of COVID-19, my plans for researching on the ground in India were immediately scrapped. Due to the ethical implications, I decided to change my interview scope to providers only, leaving out the essential patient perspective. Most importantly, I was not able to see the workings of a maternity clinic and the intimate interactions between providers, patients, and families during the decision-making processes of childbirth.
However, I was able to get a deeper look into the opinions and perspectives of providers. When I began doing a literature review for this research, providers were cited to be the root of this entire problem of high C-section rates. Many were listing economic incentives and higher C-section payments to be the driving force behind providers recommending to perform C-sections on most mothers. However, many of these interviews revealed sociocultural factors that are embedded in society, well beyond the purview of the provider.
Factors of access to pain management, legal violence against providers, and the role of social class in healthcare decisions were some deeper structural concepts that were emphasized in many of these provider interviews. One interview with an OB/GYN who had been practicing for 30 years illustrated the crucial changes that have been shifting the nature of childbirth from a natural process to a medically induced, technical surgery. Many patients are also now associating these more medicalized births aided by C-section surgery to be more safe and predictable than vaginal birth. In addition, many providers claim pain tolerance to also be a changing idea amongst new mothers. With the more sedentary lifestyles of today, many mothers are unprepared for the pain that is associated with childbirth. Moreover, pain management and access to epidurals or other medications during childbirth is a very stigmatized topic in Indian healthcare. Beyond this, the legal violence against doctors with any bad outcomes, regardless of the doctor’s specific role in the outcome, is skyrocketing, especially in private healthcare settings, where the reputation of the hospital is everything to a doctor’s career. In such sensitive scenarios, the decision to perform a C-section delivery is oftentimes the safest decision for the doctor, as well.
These are just a few of the myriad of social reasons that back the decision to perform a C-section. Much more research is needed, especially from the patient side to determine how sources of maternal knowledge construct C-sections to be a safer method of delivery.
Throughout this summer, I’ve learned to interview, craft questions, translate conversations, analyze interviews, and pull out large themes. As I begin to write this thesis, the overwhelming feeling returns, but hopefully as I read over this again at the start of 2021, many of the ideas above will be written into the paper for everyone to read.
This summer I conducted phone interviews with elites, frontline workers, and resident men and women in Bihar. The goal has been to to use this as a hypothesis and theory building exercise for my dissertation project. I have completed 20 interviews that have helped me hone research questions and also shed light on the lives of women in migrant sending regions in Bihar.
For the uninitiated, my dissertation project looks at the political consequences of male migration on women’s lives in migrant sending regions. Migration in India is heavily gendered with men being away from home for long periods of time. While we are aware of the influence that migrants have on politics in destination regions, little is known about their impact on source regions in India. In this project I particularly look at the gendered consequences of migration in source region politics. My definition of political participation goes beyond voting to also incorporate civic engagement, claim-making and other interactions with state, and knowledge of politics/bureaucracy.
Here I outline some of my findings on the changes in women’s lives in teh absence of men:
- Changes in women’s lives: Women are experiencing higher levels of mobility – either to local markets or pachayat/ block offices. They are expected to travel to the GP or block office for “official work”. the increased mobility also increases their exposure and knowledge.
“You won’t believe it, but my sister knows even the name of her BDO while her husband who is away for long periods knows nothing about getting any official work done” – Broker in Bihar
2. Increased interactions with the state: The state looms large in the lives of people living in rural areas. Be it paying an electricity bill or getting the monthly ration or even seeking why they didn’t get the ration they were entitled – interactions with the state are necessary. They might also be required to fulfill paperwork to get their entitlements related to pension, MNREGA, Aadhaar etc. In the absence of men, women are expected figure out a way to get this work done (either on their own or with the help of others).
“Women have risen to the occasion by taking care of their homes, families and other official work” – Mukhiya in Bihar
3. Exposure increases political knowledge and political network: It was clear from the interviews that women in migrant households experience much higher levels of mobility which indirectly also exposes them to information on politics they would otherwise not be privy to.
“I have seen that when women go to the chauraha they hear others talking about politics and learn about candidates that are going to win. They get information that helps them with their decisions.” – Frontline worker in Araria
4. Women in local politics: Since not all men are able to go back home for local elections, women become important constituents. Politics continues to be male dominated and campaign strategies are targeted towards men, even if they are mediated through women (by asking women to request husbands to return or directly calling men to talk to their wives about whom to vote for).
Under normal circumstances fieldwork is not possible without help from local field researchers (whose knowledge and experience is invaluable). And this new normal is no different. This research would not have been possible without the invaluable help and support of Sitansu Sekhar, Chandan Kumar, and two frontline workers in Bihar. I am grateful for their time and help on all fronts.
One of the most exciting dimensions of data analysis is when you start to find patterns in your data. This summer, with the support of CASI Summer Research Funds, I have been analyzing data from 45 interviews I conducted in 2018 and 2019 with unmarried and recently married young Indians in New Delhi. As I have been re-reading the interview transcripts and coding passages for themes, I uncovered several interesting patterns that I plan to unpack in my dissertation chapters. One of these patterns was in how my respondents described the uncertainty of marriage. Interview respondents often spoke about marriage as a “gamble,” emphasizing the fact that they have little control over their marital fate. While coding the data, I discovered that the idea that marriage was a “gamble” came up in almost a dozen interviews. Here are a few quotes from different interviews which illustrate the way that respondents describe the gamble of marriage:
“Marriage is complete gamble…in arranged and love marriage… either you win or lose, there is no mid-way. If it’s a hit, it’s a hit. If it’s a flop, it’s a flop.”
“The arranged marriage set-up is such a dubious thing, I tell you. It’s a total gamble…the first three or four times you meet someone, you show them your best, you will never show your flaws.”
“I think both types of marriage are a gamble…whether it is love or arranged. With arranged, it is more of a gamble, it’s just that you have the backing of your families if something goes wrong”
Some respondents felt that both love and arranged marriage were a gamble, whereas others saw only arranged marriage as clouded in uncertainty. To the interview respondents, what made arranged marriage a gamble was the fact that you could not really know about the compatibility of the couple until after the wedding. As a result, emotional compatibility in arranged marriage was described by one respondent as “big dice.” Those in love marriages (where the marriage was preceded by a romantic relationship) often described love marriage as less uncertain because their pre-marital relationship reduced the uncertainty of married life.
Those who said that both love and arranged marriage were a gamble pointed to the fact that married life is quite different from dating. They explained that it was impossible to know your spouse’s “real nature” until you were living with them. As a result, love marriage is also a gamble. One woman summed up her views on the uncertainty of marriage by saying, “It’s luck. I have seen people who have been dating for seven or eight years, but after getting married they have problems because they cannot work together.”
This summer I worked on a chapter of my senior thesis that tracks the activities of the Ford Foundation in India between 1951-62. Since I have already blogged about my findings, I thought it would be useful to summarize the process of doing research during the pandemic.
Step 1: Complain to your friends, family, or advisor
Accessing a bunch of primary sources which you would ideally like to consult for your thesis is hard; complaining about that, though, is easy. Occasionally, complaining also results in people directing you to resources you were unaware of – in my case, the huge trove of digitized material made available through HathiTrust.
Step 2: Email archivists and librarians like your life depends on it
I am so grateful to librarians and archivists for going out of there way to fulfill my research and copy requests. The sources acquired through these requests form the backbone of the chapter I was working on. In particular, I owe a debt of gratitude to Bethany Antos (Rockefeller Archive Center), Dean Hargett (State Historical Society of Missouri) and Gary Barnhart (Merrill G. Burlingame Special Collections at Montana State University).
Step 3: Present half-baked arguments before the incredibly affirming group of CASI Fellows
The suggestions, feedback and questions I received during the monthly meeting of CASI Summer Fellows allowed me to probe deeper into my research question, and look for answers in places I had not thought of. These summer check-ins helped me stay on track and be accountable to someone who was not me.
Step 4: Understand that you will never write the ideal thesis
Even in non-pandemic situations, it would hard, if not impossible, to write the ideal thesis you planned in your head – things will go wrong and your writing calendar (if you even have one) will hardly resemble how things actually pan out. I tried to change my topic twice and to give up many more times than that, but this is not uncommon (I hope).
Step 5: Plan for the future and then abandon those plans
I hoped to seamlessly move on to the next chapter of my senior thesis after the summer. So far that process has been anything but seamless. It turns out planning is more iterative than final, so I will be trying to find the right balance between working on my thesis and focusing on my classes for the semester. This next chapter is devoted to Cold War economic theory and the role of numbers in political argumentation in India between 1962-5, and I will be turning to the work of scholars like David Engerman, Theodore Porter, Arunabh Ghosh and Sonja Amadae. Hopefully by the time I am done with the chapter, it matches this description.
I am a fifth year doctoral student in the Political Science department at the University of Pennsylvania. I hold an M.A. in Political Science from the University of Chicago and a B.A. in Psychology from St. Xavier’s College, Mumbai, where I grew up.
My research focuses on studying media and political behavior in India. My interest in studying political behavior was fueled by the summer of 2014, when India held its general election, the largest democratic exercise in the history of human civilization. The election was particularly special for me: it was the first time I was eligible to vote, and I was working on the campaign team for a Member of Parliament. I went door to door and spoke to hundreds of voters, many of whom mentioned their frustration with rising corruption in the country. The closer I looked at the election the more confused I felt; rampant corruption was visible to voters, and still it seemed to have no effect on the election outcome when as many as 186 ministers with criminal backgrounds were elected to power. Could it really be that party ID was so influential to the electorate that it was willing to
overlook corruption? Or did the extent of corruption in India actually give people a reason not just to tolerate but also to actively prefer candidates who knew how to “work the system”? As I looked for answers I realized that I did not have the insights or the data that I would need to answer them.
My experience with the 2014 election and my MA research brought to light how little we knew to answer the question of why a voter casts a ballot in a given way in the world’s largest democracy. In addition, it highlighted how little we knew about partisan identity in the Indian context. In America, scores of research studies focus on people’s attachments to parties and on partisan motivated reasoning, a phenomenon where people seek out information reinforcing prior partisan beliefs. In the world’s largest democracy, we knew little to nothing about the strength of ideology, partisan attachments, or motivated reasoning. Having little recourse to survey data – for such data simply did not exist in India – when I started my PhD I delved into the world of designing and conducting my own surveys and experiments. Little over four years since my doctoral studies began, my work is still focused on survey and experimental methods.
My dissertation, in particular, grapples with the challenges that the new world of the Internet and WhatsApp has brought to India, and my research aims to pilot and design tools to foster trust in the right kind of news and reduce the uptake of political misinformation. My research evaluates the effectiveness of interventions to combat political misinformation in India and the power of partisanship and motivated reasoning to affect information processing. To answer these questions, I develop and use experimental and survey methods to study the relationship between newer forms of media like WhatsApp and their effect on fake news, polarization, political participation, and quality of democracy.
My summer and final year dissertation research is being supported by a generous grant from the Sobti Family Foundation. This summer, I am pursuing new lines of research surrounding COVID-19 misinformation, affective polarization, and a survey on Indian-American political behavior and attitudes ahead of the 2020 US election.
As we begin a difficult fall semester, and as new projects begin to finally take shape, I look forward to updating this blog with more details on their progress.
COVID-19 has laid bare the magnitude and ubiquity of migration in India. Various sources across different studies estimate there there are over 100 million migrants in India. Economic migration in India, like in other parts of the world, is also male male dominated. In my dissertation project I look at the consequences of migration in source regions from a gendered perspective. Specifically, I look at how the absence of men due to migration is affecting women’s political lives in migrant sending regions.
Thanks to the generous support from CASI I have spent this summer conducting phone interviews with elites, frontline workers and resident men and women in Araria, Bihar. These interviews have helped me sharpen my hypothesis and make connections with those on the field so that I can hit the ground running once things begin to ease in India.
The interviews have revealed that men are away either for short duration (2-3 months) or for longer periods (8 months-1.5 years). Women experience extreme difficulties in the absence of men and often told me that they have to do things in majboori (or having no option). They take care of housework, children and official work related to ration, gas connections and other day to day work. Even though this is painful in many ways, indirectly, they experience greater exposure and empowerment.
Politics in India is considered a male arena. Through this project I aim to highlight the role played by women as political actors at the local level. The findings from this project will generate insights into our scientific understanding of women’s political empowerment, and the shifting nature of women’s interaction with political actors in the absence of men. In addition to this, it will allow us to better target policies in sending regions that specifically encourage women’s participation in the political and civic arena – a crucial driver of larger change in women’s overall well-being. Given that the nature of migration in India is identical to migration in other parts of the world, the results from this project will have wide application.
If you are like millions of people around the world, you have been binge watching Indian Matchmaking on Netflix. The reality TV show, which has generated buzz both in India and the US, follows the Mumbai-based matchmaker Sima Taparia as she scours her biodata profiles to find the best match for clients spread in cities across the US and India.
The show concludes with a roka ceremony between Sima’s clients Akshay and Radhika. A roka ceremony is a fitting conclusion to the series because the roka symbolizes that the search for a marriage partner is complete (the word roka comes from the Hindi word for stop). In a heartfelt scene Akshay’s mother, Preeti, whose frustration with her son’s indecisiveness on the marriage market had been a major plotline of the show, tells the camera “now the search ends and his new life begins with Radhika.” Its place as the concluding scene of Indian Matchmaking emphasizes the cultural significance of roka, an often-overlooked part of the marriage arrangement process in India.
This summer, with the support of a CASI Summer Research Grant, I have been analyzing interview data that I collected in 2018 and 2019 from interviews with matchmakers, parents, and both unmarried and recently married young Indians in New Delhi. These interviews are part of my dissertation project on marriage in India. My interview data suggests that roka plays a central but changing role in the arranged marriage process.
Roka ceremonies involve the exchange of gifts between the families arranging a marriage as a symbol that they have finalized the marriage negotiations and agreed to the match. Historically, the event is a muted affair and may take place in the living room of one family’s home with only a few family members gathered. Akshay and Radhika, like an increasing number of upper-class Indian families, hosted a more elaborate affair in a rented banquet hall with a catered meal and formal attire. This wedding ritual is similar to a proposal or engagement party in the United States as it signifies the beginning of an engagement period for the couple. The roka ceremony could take place anywhere from a few weeks to several months or even a year before the wedding. Though roka has its roots in Punjabi marriage practices, there is evidence to suggest that it is quite popular across much of North India. In 2016, CASI conducted a household survey in the Delhi National Capital Region (NCR) which included questions about marriage practices. Over 65% of households in the Delhi NCR reported that roka was a desirable practice in their household. The ideal gap between the roka and the wedding was, on average, 6 to 7 weeks.
The roka courtship
The qualitative evidence suggests that the period between the roka and the wedding is increasingly being used as a form of courtship for the couple to get to know each other. This is a deviation from the traditional practice where the couple was not expected or allowed to meet before the wedding. In interviews, some parents still reported that it would be inappropriate for the couple to meet during their engagement whereas others said that phone contact was ok so long as the couple was not spotted out together publicly. Regardless of the views of the older generation, the young middle-class Delhi-ites I spoke with told me that contact between the couple begins or intensifies after the roka, sometimes without the knowledge of the parents. There was significant variation in what the roka period looked like for recently married young people that I interviewed. Some couples only met or spoke on the phone a few times, preferring to wait until the marriage to get to know each other.
On the other end of the spectrum were Nishita and Sagar (all names anonymized). Their roka took place on the very same day that their families first met. After a successful afternoon meeting at a local mall, the families decided to formalize the match and went to the home of the groom to do the roka ceremony that very evening. During their two-and-a-half-month engagement, the couple was inseparable. They reported meeting two to four times a week for dates in the food court of the mall where they would sit and talk for hours over coffee. Their meetings were supported and encouraged by their parents. Nishita even attended a wedding with Sagar and his family. Nishita started calling her future mother-in-law on the phone daily, chatting with her about Sagar and learning about her future in-law family. By the time of Nishita and Sagar’s wedding they had gotten to know each other well, started integrating into each other’s families, and even worked through a few fights. Though their marriage was arranged and they did not know each other before the roka ceremony, their engagement period functioned like a courtship, allowing them to begin building the relationship that would later become their marriage.
Not all courtships are destined to end in marriage and similarly not all rokas lead to a marriage. With young people increasingly using the roka period as a test of the relationship, there are bound to be some relationships that fail the test. This may happen if there is a disagreement between the couple but can also happen over a disagreement between the families. In the 2016 CASI Delhi NCR Survey, 48.5% of households who found roka desirable reported that a couple should break the roka and call off the wedding if it becomes clear that the marriage will be unhappy. Breaking a roka was generally but not always seen as stigmatizing. Several respondents reported that women are often blamed for a roka breaking and that having a previous broken engagement would make it harder for a woman to find a new match.
Other respondents explained that it simply wasn’t acceptable to call off an engagement in their community. Ankita, a young woman who was married two years before our interview explained that, “After the roka there were a lot of differences between us. We both thought that we shouldn’t go through with this marriage, but [within] our society, our family, once the engagement has happened, nothing can happen.” Despite the fact that Ankita and her husband realized their incompatibility during the roka period, they felt unable to call off their wedding because of a strong social taboo within their community.
In other communities, however, broken rokas have become quite common. In fact, even Akshay and Radhika’s marriage didn’t pan out. The Los Angeles Times reported that none of the couples matched on Indian Matchmaking are still together. When reached for an interview by the paper, Akshay reported that they called off the wedding just a few days after the roka. He did not give a reason for why they ended their engagement.
A broken roka can be embarrassing for both families involved. Concerned about the increasing willingness of young people to call off their engagement due to a conflict, some parents are considering strategies to prevent them from doing so. Several parents that I interviewed said that they intended to have a short engagement specifically for the purpose of reducing the likelihood of a broken roka. Kriti, a mother whose son and daughter are both approaching marriageable age, explained why she thought the engagement period should be much shorter than a year noting that, “In a year there are many things you find out about each other, good and bad, and then there is no interest left… The beauty of an arranged marriage is that there are so many things you learn only much later about each other, and whether they’re good or bad, we can adapt to them.”
Kriti’s comment reveals how much long roka courtships are changing arranged marriage in India. Extending the amount of time that a couple gets to know each other both before and after the roka is an increasingly common modification of the traditional process. This has led some to argue that the distinction between “love marriage” and arranged marriage has become fuzzy. It’s likely that these trends will continue as young people push for a larger role in the process of selecting their marriage partner.
I have been working on the role played by the Kinsey Institute in the history of sexual science in post-colonial and contemporary India. My decision to work on the Kinsey Institute specifically was prompted by the accessibility of digitized archives of the institute. As I near the end of my research, I am glad that I undertook the project. Though the project started as being centered on the significance of the Kinsey Institute in Indian sexual history, I have been able to use the sources to paint a broader picture about the wider history of sexual science during this period. This project has also helped to broaden the temporal scope of my dissertation project which I had initially thought of concluding by the late 1950s or early 60s at the latest. But having found a significant number of sources from the 1980s and later, I have been convinced to extend my study further into the contemporary history of sexuality in India.
In my last post, I had raised a question relating to the conspicuous absence of women from the correspondences sent to or by the Institute and or even generally when it came to discussions on sexuality in India in the Kinsey institute archives. Having gone through a few more files, I did come across references to female sexologists who participated in the 7th World Sexology Conference which took place in Delhi in 1985. The event, as I mentioned in my last post, the was widely covered by the press. The Philadelphia Inquirer interestingly ran a feature on it as a number of sexologists from the Society for the Scientific Study of Sex (SSSS), based in Philadelphia, participated in the conference. The female sexologist chose to remain anonymous as she commented on the total absence of any sexual rights that women enjoyed in the developing worlds of Africa and Asia. Though the aim of the conference was to reduce the stigma surrounding sexuality and introduce a discourse on sex education, the Indian media appeared scandalized by the fact that the word ‘sex’ was used ten thousand times a day during the conference and chose not to cover it. The stigma surrounding sex and the conference also resulted in the then health minister, Mohsina Kidwai “respectfully” declining an invitation to inaugurate the conference on account of being Muslim and a woman.The Philadelphia Inquirer feature on the 7th World Sexology Conference, New Delhi, 1985.
Apart from the conference, I also came across an interesting letter written to the Kinsey Institute by Professor H.C Ganguli, who had established the Psychology Department in Delhi University in 1964. Ganguli wanted to spearhead a research on sexuality at Delhi University and wrote to the Institute in 1967 requesting material beyond Kinsey’s reports. Ganguli was particularly interested to know more about the methodology employed by Kinsey and his colleagues as he was beginning to devise a similar study in India. Facts such as these have given me another anchor to conduct further research study in India and know more about the history of sexual science in the post-colonial context.Professor H.C. Ganguli(1924-2013)
Another interesting aspect of sexology emerged as I read through a correspondence between the Institute and a biographer of Sir Richard Burton. Burton was a colonial officer and ethnographer who had travelled through the British Empire and was posted in Sindh in 1844. He would later establish the Hindoo Kamashastra Society in London along with F.F. Arbuthnot and translate into English, among other works, the Kama Sutra and the Arabian Nights. Burton came up with the theory of the “Sotadic Zone” which was a geographical zone right from the Mediterranean and the Middle East up to the South China sea in the east which included South Asia. According to Burton inhabitants of this zone were particularly licentious and predisposed to homosexuality. Burton interestingly cited an Italian sexologist of the times to “prove” how the nerve endings of the genitals of the inhabitants of the Sotadic Zone were connected to their anal region which explained their predisposition to homosexuality. Byron Farwell, as he wrote a biography of Burton in the 1960s wrote to the Kinsey Institute asking whether there was any truth to Burton’s ideas about the sexuality of the “oriental races.” Paul Gebhard, who was the director of the Institute from 1956 onward replied to Farwell stating that Burton’s views could be attributed to cultural and colonial bias rather scientific facts. What was interesting to me in this exchange was the way in which sexology was used by both Byron and Burton for truth making claims about sexuality albeit in different contexts.Richard Burton
As I wrap up this summer project and prepare my final presentation, I will be highlighting the findings I made by accessing these sources from the archives of the Kinsey Institute and how it will fit into my larger project on the history of sexual science in modern and contemporary South Asia.
This summer I have been working towards completing the second chapter of my honors thesis in Science, Technology and Society. In this chapter, I trace the history of the Ford Foundation in India from 1951-1965, paying close attention to its 1959 Report on India’s Food Crisis and Steps to Meet It.
By so doing, I make two interrelated arguments. First, that the development experts working for the FF irrevocably conceived of India as a country of peasants, and believed that any departure from a village-centric, rural-oriented and food-first strategy of development would, therefore, be fundamentally flawed. The work of Arturo Escobar and James Ferguson on development discourse, and Daniel Immerwahr’s excellent study of the India’s community development program in the 1950s has proven particularly generative here.
The second argument I make is that it was in large part due to the Western development expert’s village fetish that the Ford Foundation warned about a food crisis in India in 1959. The FF report reached the “inescapable conclusion” that if India was to continue pursuing rapid industrialization through the Second and Third five-year plans, as opposed to a food-first rural development program, India would face an unprecedented food crisis which no amount of foreign imports would be able to alleviate.
Crisis served as an incredibly potent tool to the FF to argue for what it considered the ideal kind of development in the Third World. They knew that the bigger the crisis, the bigger the potential for change. FF staff have written about the 1959 crisis and many other ones in India with remarkable self-awareness about crisis talk. Douglas Ensminger, for instance, who was the FF’s Chief Representative to India and Pakistan between 1954-70, complained that leaders of developing countries were riddled with complacency and that “timing and opportunity must either exist or be created to provide both the stimulus and guidance for change.”
Completing the chapter proved more difficult due to closure of archives and libraries, but the archivists I have spoken to have gone out of their way to facilitate my research. I am incredibly grateful to Dean Hargett at the State Historical Society of Missouri, Bethany Antos at the Rockefeller Archives, and Gary Barnhart at the Montana State University Library for making their collections accessible even during a pandemic.
Some records from the State Historical Society of Missouri’s collection on Douglas Ensminger, courtesy of Dean Hargett, Acquisition Librarian.
Soon I will be switching gears to work on a different chapter, which looks at the normative makings of ‘crisis’ by examining computer models that development economists used to declare a food crisis in India, partly motivated by their frustration with India’s industry-first strategy of development. More on that would be found in my next blog post!
Thanks to the financial support and intellectual community fostered by CASI, I completed the interview data collection for my dissertation this summer. I conducted 26 interviews with Indian citizens living in the U.S. and India who have some migration experience in the U.S., either for studies or for work. The interviews covered their motivations for migration, their experiences at U.S. universities and companies, and the factors that played into their decision to stay in the U.S. or return to India.
I am starting to analyze these interviews, as well as the larger interview and employment history data sets I constructed and am working on a journal submission reporting on the results of this mixed-methods project. The results of this study suggest that immigration policies play an important role in regulating the flow and nature of international student migration streams, and lead to simultaneous convergence and divergence in the educational attainment and field of study between Indian international students studying in the U.S., and their domestically educated peers in India. Many students have multinational educations, but the balance of students moving between Indian and U.S. universities leans heavily towards the United States. Indian international students are more concentrated in STEM majors than their non-migrant peers, and funnel into certain concentrations in engineering.
These findings are significant because they illustrate the ways that the very conditions enabling global integration in higher education can simultaneously contribute to a diversification of knowledge production in specific country contexts. Migration policy enables the partial convergence U.S. and Indian universities and labor markets as student and work visas contribute to the growth of international student enrollment and multinational educations, but the design of these immigration policies also leads to an asymmetrical flow of international students, and funnels international students into certain fields of study, creating divergence between international and domestic student educational attainment. And unpredictable fluctuations in migration policy related to higher education, like Trump’s announcement that was rescinded a week later about international student enrollment requirements to maintain visa status during the pandemic, can create stress and disruptions in students’ academic plans that can influence future enrollment behavior.
My next step for this project is to analyse the settlement patterns of Indian migrants by place of education.
In the past few weeks, much of my time for this research has been devoted to learning about maternal health care systems in India. For starters, how do new mothers choose a hospital for their care? What are the differences between private and public hospitals that motivate these choices? How do mothers choose an OB/GYN? How do they pay for these appointments? How are decisions made with the whole family? More importantly, how do doctors guide their patients through these decisions?
As I’ve read through more literature this summer, one of the biggest gaps I have seen is the lack of geographically-centered research on this issue in Telangana and Andhra Pradesh, as well as a dearth of extensive qualitative research methods used. Rising rates of C-sections is, by nature, a problem that is seen across all developing countries, as they reform their medical systems to reduce maternal mortality. Greater technological dependency in medicine has unknowingly placed surgery and other medical interventions on a pedestal over preventative care and noninvasive methods. As patient awareness grows over time, the role of the patient and family in medical decision-making increases, as well. Before the doctor can make a decision on patient safety and method of delivery during labor, many patients consult their own peers and research to present their own decision. Such decisions are influenced by many factors, such as their understanding of the pros and cons of each delivery method, pain tolerance, financial background, and more. Such factors seem to be playing a greater role more recently, as seen by these rising rates.
Over the last few weeks, as I began talking to more medical professionals who see and assist new mothers during childbirth, one of the most prevalent topics has been the patient side of decision-making. It has been interesting to hear providers speak about how violence against doctors and income status can sway decisions made by patients and providers. For example, a patient’s social status and financial capability can go so far as to motivate their decision to get a C-section. In such cases, patients’ families may be equating higher class to “better” care in the form of a C-section. From the providers’ end, an influencing factor can be the social pressure that comes in the form of violence against medical professionals. Many doctors cite fear of violence to be a factor in choosing the more predictable route of a caesarean delivery, even when this surgical procedure may be unnecessary.
Under such circumstances, it has been informative to learn of the various social factors that can impact medical decisions beyond the science itself. This also reveals the need for research to fill these gaps and ultimately explore the issues in an open-ended, qualitative manner that can then inform policy and health initiatives more precisely.
The experience of interviewing Indian medical professionals right from my bedroom has been challenging yet memorable for all these reasons. While phone interviews may not capture the full qualitative research experience that I had hoped for, it has given me a look into what a day in the hospital could look like and how a visit to the doctor entails so much more beyond sheer medicine itself. Interviews like these have motivated me to explore the political, social, and economic histories of these medical institutions that influence these trends in maternal health from the origin.