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Paper short abstract

This paper examines menopausal care in India’s health system as a shift from reproductive citizenship to chronic neglect. Based on 18 months of ethnographic fieldwork in rural North India, it shows how polarisation renders menopausal suffering invisible and pushes women toward informal care.

Paper long abstract

This paper examines how sociopolitical polarisation within India’s public health system reshapes care trajectories for midlife women experiencing menopause, producing forms of chronic neglect once reproductive citizenship ends. Drawing on eighteen months of ethnographic fieldwork conducted between 2022 and 2024 in rural North India, the study combines in-depth interviews with peri- and post-menopausal women, participant observation in primary health centres, and conversations with frontline health workers and physicians. It conceptualises menopause not as discrete biological transition but as a form of long-term, embodied chronicity that remains largely invisible within existing health infrastructures.

I argue that menopausal care is structured by competing imaginaries of health and citizenship. Biomedical frameworks that prioritise reproductive outcomes and risk-based interventions coexist with, and often override, women’s accounts of psychological distress, bodily discomfort, and social disruption. As women move beyond reproductive years, they encounter fragmented therapeutic pathways marked by dismissal, misdiagnosis, and moral judgement, revealing polarisation between medicalisation and institutional silence. These dynamics deepen epistemic, ethical, and political fractures within public healthcare, rendering menopausal suffering illegible in policy and practice.

Situating menopause within broader processes of neoliberal restructuring and gendered ageing, the paper shows how chronic care infrastructures in Global South systematically marginalise post-reproductive women. At same time, it highlights everyday practices of negotiation through households, informal networks, and local moral economies that emerge in response to institutional absence. By foregrounding menopause as a site where chronicity, care, and citizenship intersect, this paper contributes ethnographic insight into how fractured health systems are lived, contested, and reimagined.