The politics of women’s health: Decentralization, state capacity, and maternal mortality disparities
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Maternal mortality reduction has been on the global development agenda for the last several years. Nevertheless, the evidence has suggested that while the number of maternal mortality has declined significantly, disparities between and within countries persist. What explains these disparities? Many studies on maternal mortality have stressed socio-economic development as the primary cause of these disparities while overlooking the influence of political and institutional factors such as state capacity and decentralization. The latter has been long-advocated by many international development agencies as a development strategy to improve the quality of state capacity, and public goods and service delivery. However, the extent to which the interconnection between decentralization and state capacity affects the disparities in maternal mortality is not well understood. To fill in this gap, this dissertation research examined the impact of decentralization and state capacity on maternal mortality. It is this researcher’s belief that a strong decentralized state, characterized with high levels of central and local state capacities is necessary for achieving the promise of decentralization to bring about and improve public health outcomes. This dissertation research focused on: (1) the importance of political, institutional, and historical dynamics for understanding maternal mortality disparities; (2) the “causes of the cause” or “fundamental causes” of maternal mortality disparities in sub-national levels including the variations of state capacity within a country; and (3) local government proliferation on maternal mortality disparities including social embeddedness of street-level of bureaucrats on the effectiveness of maternal health service delivery.