Navigating Choice, Agency and Social Class: Maternal Health Care in Siliguri Town, India

This paper aims to discuss and analyze the culture of service in health care institutions in Indian context. Based on ethnographic observations and in-depth interviews, it argues that culture of service in medical institutions shapes the choices and agency of pregnant women regarding their preferences for place for health care. Culture of service in this context refers to the sum total of the whole material and non-material culture of a healthcare institution The paper examines the differential services in maternity care institution that lead to women belonging to specific classes choosing the health institution accordingly. In addition to the medical care institutions’ resource structure, social class also shapes the decision making of pregnant women. In this research one private and one public medical institution have been studied. And a total of 60 women had been interviewed, 30 from each institution.

Drawing on the social constructionist approach, this study shows how birth knowledge, which includes biological and social aspects of pregnancy and labor, differs between middle-class women receiving care at Private Hospital and disadvantaged women using public healthcare. It provides a comparative account of middle class women and poor class women's agency while they navigate the medical system. Middle class women prioritize continuity of treatment and prefer obstetricians who communicate well and build trust. Access to information and perceived technology advances in healthcare empower them to make birth choices, whether they prefer technological or traditional approaches. Although institutional issues hinder natural deliveries in privatized settings. Conversely, poorer women have fewer choices and control. They typically have to use impersonal public healthcare due to economic and educational constraints. Lack of continuity and contact with healthcare providers causes dissatisfaction and helplessness.