Paper short abstract

Sexual and reproductive health (SRH) gaps in rural India shape unequal cervical cancer outcomes. This paper examines how CAPED’s hub-and-spoke model addresses demand and supply barriers by strengthening PHCs and enabling collaboration between NGOs, ASHAs, and state health systems.

Paper long abstract

Sexual and reproductive health (SRH) interventions in the global South have long been shaped by vertical programming and top-down biomedical approaches. This is visible in cervical cancer prevention, which remains a major SRH challenge in India, especially in rural and underserved regions. Weak primary health care infrastructure, limited human resources, and fragmented referral pathways contribute to late diagnosis and poor outcomes. Addressing these gaps requires moving beyond hospital-centric models towards approaches that strengthen local health systems and build community trust.

This paper examines how the Cancer Awareness, Prevention and Early Detection (CAPED) initiative operationalises a decentralised hub-and-spoke model to address both demand and supply-side constraints in cervical cancer prevention. Drawing on implementation experience across multiple Indian states, the paper analyses collaborative relationships between non-governmental organisations, ASHAs, frontline health workers, and state and district health departments.

On the demand side, ASHAs with NGOs play a critical role in awareness-building, pre-screening counselling, stigma reduction, and patient navigation, particularly among women with limited access to information and services. On the supply side, CAPED strengthens rural primary health centres by supporting workforce training, infrastructure readiness, deployment of appropriate screening technologies, and structured referral linkages to higher levels of care.

The hub facilitates coordination, data-driven monitoring, and adaptive problem-solving, while the spokes, PHCs and community platforms, ensure local ownership and responsiveness. This enhances trust, improves continuity of care, and embeds cervical cancer prevention within routine SRH services showing how NGOs and CHWs can work with public systems to strengthen reproductive health outcomes in low-resource settings.

Paper short abstract

This paper examines how indigenous identity causally influences maternal healthcare utilisation among tribal women in India. It questions dominant policy assumptions and calls for decolonising understandings of maternal health by centring indigenous contexts in rethinking equitable care in practice.

Paper long abstract

Maternal health policies in Global South have long been shaped by inherited models of healthcare need that often overlook indigenous populations and lived realities. Maternal health remains a critical public health concern among tribal women in India, a historically marginalised population with distinct socio-cultural conditions and traditional beliefs. Tribal identity is often framed as being associated with poverty, remoteness, and marginalisation, which constrain maternal healthcare use. Using National Family Health Survey (NFHS-5) data from four states—Odisha, Jharkhand, Chhattisgarh, and Madhya Pradesh—this paper examines how indigenous identity causally influences maternal healthcare utilisation among tribal women and how agency and structural barriers shape this relationship. The study employs inverse probability of treatment weighting (IPTW) and moderation analysis. The findings show that tribal identity does not reduce antenatal care uptake and is associated with comparable or, in Madhya Pradesh, higher utilisation than non-tribal women. In contrast, being tribal consistently lowers the probability of institutional delivery across all four states. These results raise questions about effectiveness of the financing policy Janani Suraksha Yojana, which provides incentives for hospital births. Further moderation analysis shows that media exposure increases antenatal care utilisation and narrows delivery gaps, while cumulative access barriers substantially depress both antenatal care and institutional delivery. Greater decision-making autonomy is associated with higher antenatal use but not with comparable gains in institutional delivery. The findings point to the need to decolonise dominant policy assumptions underlying maternal healthcare provision and to develop understandings of care that are more attentive to indigenous contexts and lived realities.

Paper short abstract

Challenging top-down SRH models, I show how menstrual resources are "captured" by patriarchy in Nepal. In regressive homes, provided "privacy" becomes isolation, worsening distress. Policy must shift from material provision to dismantling power dynamics to ensure reproductive justice.

Paper long abstract

Mainstream SRH interventions often rely on a "resource universalism" logic i.e., a top-down development model assuming that providing material "hardware" (products and privacy) automatically enhances bodily autonomy. This study challenges that colonial logic by presenting empirical evidence of how local power dynamics subvert technical interventions.

Using nationally representative data from Nepal (N=6,480), I employ structural equation modeling to analyze the impact of Menstrual Health (MHH) resources on mental well-being, specifically testing the boundary conditions of patriarchal norms. The analysis reveals a "paradox of patriarchal capture." In progressive households, MHH resources function as intended, promoting agency and reducing distress. However, in households with regressive norms, the relationship reverses: the provision of "adequate" facilities is associated with higher burdens of infection and stigma, and as a result, greater psychological distress.

This finding suggests a "perverse inclusion": without addressing the "software" of agency, the "hardware" of development is co-opted to reinforce surveillance and exclusionary isolation. In these settings, "privacy" functions as confinement. By showing that material interventions can actively harm women when decoupled from justice, this study argues for moving beyond the "logistical" framework toward a paradigm centered on dismantling the structural power dynamics that govern the body.

Paper short abstract

Using repeated cross-sectional survey data, the paper examines effects of an Indian family planning programme on contraceptive use and related behaviours through conditional DiD within relevant states, finding higher usage and shifts in the method mix (modern vs. traditional; spacing vs. limiting).

Paper long abstract

This paper uses multiple waves of the Indian National Family Health Survey to evaluate the effects of a family planning programme on contraceptive use and related reproductive behaviours. Using two rounds of this nationally representative repeated cross-section microdata, the paper implements a conditional difference-in-differences design that compares changes in targeted areas to comparison areas, restricting the analysis to programme states so that treated and comparison units share a common policy and institutional context. The conditional specification relaxes the standard parallel-trends assumption by allowing outcome trends to vary with the baseline fertility and contraceptive usage practices; the programme effect is therefore identified conditional on these pre-existing differences between the treatment and control groups. The main specifications include area-wise fixed effects and standard errors clustered at the level of treatment. The paper also presents robustness checks which consider alternative ways of conditioning on baseline fertility, placebo outcomes, and reweighting approaches. The paper estimates the effects of the programme on both overall contraceptive use and method composition, distinguishing modern and traditional methods as well as spacing and limiting behaviours. Accordingly, it finds an increase in overall contraceptive use, accompanied by shifts in the method mix, underscoring the importance of assessing not only adoption but also the composition of contraceptive behaviour in programme evaluations.

Paper short abstract

Becker’s economic model of fertility explains fertility decision through a quantity–quality trade-off driven by rising incomes and the increasing cost of investing in children. This paper extends Becker’s framework by foregrounding care responsibilities as central to fertility decisions.

Paper long abstract

Becker’s economic model of fertility explains declining birth rates through a quantity–quality trade-off, where rising incomes and returns to human capital increase the cost of children. While influential, this framework treats childrearing primarily as a financial investment decision and under-theorises the role of care as a binding constraint on reproductive behaviour.

This paper extends Becker’s fertility model by explicitly incorporating care responsibilities—including childcare, eldercare, and unpaid domestic labour—as central determinants of fertility outcomes. Using household-level evidence from India, the analysis shows that reproductive decisions are shaped not only by income and education, but by the availability of care support systems that reduce the time and physical burden of reproduction. Historically, extended family networks—particularly elderly household members—played a critical role in subsidising care work. However, demographic ageing, migration, and the erosion of joint-family arrangements have weakened these informal care institutions.

At the same time, public provision of care remains limited, uneven, and poorly aligned with women’s labour market participation. The resulting care deficit increases the effective cost of childbearing beyond what is captured in standard Beckerian models, contributing to declining fertility even among households that do not face financial constraints in the conventional sense.

By bringing care explicitly into the economic analysis of fertility, this paper reframes reproductive outcomes as responses to time scarcity and care infrastructure failures rather than solely to preferences or income effects. The findings suggest that addressing fertility decline requires rethinking care provision as a collective responsibility, rather than treating reproduction as a private household decision.