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Paper Short Abstract:

Regulation of maternal health markets in Bangladesh is enacted as political and social-relational exercises that remain disconnected from national regulatory aspirations and peripheral to the creative work required to make biomedical maternal health technologies work in practice.

Paper Abstract:

In Bangladesh, transitions towards institutional birth care have been rapid, increasing from less than 10% in 2004 to 65% less than two decades later. This shift has been driven primarily by care seeking in minimally regulated private health facilities, where over 80% of births are conducted through caesarean. Despite this, maternal mortality has stalled. These trends have caused alarm in policy and programming circles. National and global health discourses often evoke regulation of private health services as the answer to ensuring the regularisation, i.e., achieving order and regularity of the quality of maternal health services delivered through health markets and restraining private health actors’ ‘unscrupulous’ inclinations toward patient exploitation. Based on 18 months of ethnographic fieldwork, this paper explores regulation of maternal health markets in Bangladesh as a sociocultural field of practice, elucidating the generation of national regulation discourses and the enactments of regulatory practices in peri-urban and rural peripheries. It contends that governance discourses in policy and programming circles operate primarily to stake moral claims and constitute tenuous state/economy divides. It then turns to the localised governance practices in sub-national settings. These everyday practices reveal health service regulation as primarily political and social-relational exercises that, while sometimes necessary to continue the animation of biomedical technologies with confidence in private health facilities, remain both disconnected from national regulatory aspirations and peripheral to the creative work required to make biomedical maternal health technologies work in practice. These ultimately result in differentiation rather than regularisation of maternal health services.