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In seeking to explore the meaning of chronic and chronicity, the association with infertility is neither immediate nor evident. However, this paper explores this relationship by analyzing the idea of infertility in relation to chronicity. In the linkages that come forth the idea of chronic lifestyle emerging from certain ways of being and living, as well the imaginings associated with the chronic body become important nodes of exploring the relationship between infertility and chronicity. Most importantly, the role that time plays in marking the chronic state is seen to be especially potent in the practice of infertility treatment, and the narratives that emerge around its temporal inevitability. The rhetoric that marks the diagnosis and prescription of treatment is often based on the identification of the body as susceptible to reproductive decline and failure, due to the contingencies of modern living. This often translates into a more sustained involvement with ARTs, which may or may not fulfil the required desire for a child. In this paper I seek to analyse the ways in which practitioners of infertility medicine create an image of an affliction that borders on chronicity. In the process, I question the idea of both chronic diseases and chronicity by looking at how illness is imagined in narratives that IVF specialists create in public, and through the idea of a cure for infertility. By analysing data collected through ethnographic fieldwork, this paper aims to build on the idea of the chronic as inevitable within clinical discourse and practice. [ABSTRACT FROM AUTHOR]

Drawing on ethnography of one family's life with diabetes in a poor settlement in Delhi's suburbs, this paper examines the relationship between emotional structures of care and kinship in the face of chronic illness. While anthropologists have argued for a relational understanding of care and discussed how, in India, modernity and social transformations have resulted in crises of familial care, less attention has been paid to the emotional terrains of care and its difficulties as they unfold in concrete relationships over time. This paper demonstrates how emotional intensities define the possibilities, limits, and ambivalence of kin care for the chronically ill. Described as care without heart, this mode of attention implies a continuation of care labour that maintains kinship ties and holds the possibility of kin futures, but is disinvested emotionally and feels unsatisfactory. The analytic of care without heart expresses a particular mode of care by which persons navigate dominant moral regimes around gendered family responsibilities and imperatives of love in relationships, but without fully subscribing to them. Care without heart at once signifies an inadequate form of care, invokes North Indian normative moral regimes around family care responsibilities and emotions, and acknowledges the shortcomings of these regimes and norms of relatedness. [ABSTRACT FROM AUTHOR]

Emergency Contraceptive Pills (ECPs) are increasingly available over the counter as a form of hormonal birth control in India. As use of ECPs is increasing over time, this paper draws on ethnographic research in Dehradun, in Uttarakhand (Northern State) to highlight the everyday material conditions under which women create narrative around choice and agency regarding these ECPs. Women viewed ECPs as better options than abortion, appreciated the sense of empowerment these provided them because they could be consumed in houses where women had limited 'space and privacy;' and finally that ECPs and their advertisements could act as 'agents of social change.' Feminist scholarship on reproduction demonstrates that choice is a form of agency that is enacted within certain constraints. Using this framework, the research here highlights how women create narratives about ideas of contraceptive choice and notions of 'empowerment' when talking about ECPs and their advertisements. In revisiting the dilemma about women's agency and choice, this paper builds on Rosalind Gill's concept of 'critical respect' to propose 'critical ethnographic respect' as an ethnographic tool to help read women's responses and respectfully contextualise the materiality from within which these narratives emerge. [ABSTRACT FROM AUTHOR]

Laparoscopic tubal ligation is the most prevalent method of contraception amongst India's rural and urban poor. Drawing on 18 months of ethnographic fieldwork in rural Rajasthan in 2012–2013, this paper investigates how rural women's perceptions of a biomedical instrument—the laparoscope—influence their perceptions of sterilization, a procedure often entrenched in coercive, target- and incentive-driven population control programme. By investigating how a laparoscope is entangled in global exchanges, national policies, institutional arrangements, and local moral worlds, this paper demonstrates that while wider biomedical discourses perpetuate the narrative of safety and convenience, people's everyday lives inform their understandings of technology that is widely known but rarely seen. [ABSTRACT FROM AUTHOR]

Private primary care providers are usually the first site where afflictions come under institutional view. In the context of poverty, the relationship between illness and care is more complex than a simple division of responsibilities between various actors--with care given by kin, and diagnosis and treatment being the purview of providers. Since patients would often visit the provider with family members, providers are attuned to the patients' web of kinship. Providers would take patients' kinship arrangements into account when prescribing diagnostic tests and treatments. This paper terms this aspect of the clinical encounter as 'kin testing' to refer to situations/clinical encounters when providers take into consideration that care provided by kin was conditional. 'Kin testing' allowed providers to manage the episode of illness that had brought the patient to the clinic by relying on clinical judgment rather than confirmed laboratory tests. Furthermore, since complaints of poor health also were an idiom to communicate kin neglect, providers had to also discern how to negotiate diagnoses and treatments. Kinship determined whether the afflicted bodies brought to the clinics were diagnosed, whether medicines reached the body, and adherence maintained. The providers' actions make visible the difference that kinship made in how health is imagined in the clinic and in standardized protocols. Focusing on primary care clinics in Patna, India, we contribute to research that shows that kinship determines care and management of illnesses at home by showing that relatedness of patients gets folded in the clinic by providers as well. [ABSTRACT FROM AUTHOR]

Drawing on fieldwork with the veterinary staff at an Indian wildlife sanctuary, this paper examines the controversy surrounding an epizootic outbreak of tuberculosis among a population of sloth bears. As these bears fell ill and began to die, the veterinary staff asked whether they might be culled, inciting allegations of incompetence and cruelty from both the media and government bureaucrats. This paper works through a series of ethico-legal questions regarding the cullability of these tuberculous bears, which depended in part on how the bears were classified – as wild or domestic, captive or free, curable or incurable. As boundary-crossing figures, the bears confounded straightforward efforts at classification, rendering their fates open to debate. In treating them, the veterinary staff feared that they were only extending their suffering, producing a form of life that might be thought of as iatrogenic. In this light, this paper suggests that cruelty – both the cruelty of culling and that of treatment – might be figured as an unavoidable aspect of the relation of dependency between animals and their human caretakers. [ABSTRACT FROM AUTHOR]

Under the aegis of the World Health Organization, the Movement for Global Mental Health and an Indian Supreme Court ruling, biomedical psychiatric interventions have expanded in India augmenting biomedical hegemony in a place that is known for its variety of healing modalities. This occurs despite the fact that studies by the WHO show better outcomes in India for people suffering from schizophrenia and related diagnoses when compared to people in developed countries with greater access to biomedical psychiatry. Practitioners of ayurvedic medicine in Kerala have been mounting a claim for a significant role in public mental health in the face of this growing hegemony. This study examines efforts by ayurvedic practitioners to expand access to ayurvedic mental health services in Kerala, and profiles a rehabilitation center which combines biomedical and ayurvedic therapies and has been a key player in efforts to expand the use of Ayurveda for mental health. The paper argues for maintaining a pluralistic healing environment for treating mental illness rather than displacing other healing modalities in favor of a biomedical psychiatric approach. [ABSTRACT FROM AUTHOR]

This paper explores the capacity of yoga narratives and practices to contribute to and relate ideas about health. It adds theoretically to existing literature on yoga by introducing the concept of the 'health imaginary' as an analytic lens for considering yoga discourses in late modern times, where personal health care and spiritual ambitions are once again becoming blurred. With this perspective, the paper provides a thorough analysis of how yoga postures (asanas) are conceived to work therapeutically, in yoga's recent history and in present-day yoga therapy. Taking case studies from India and Germany, it is shown empirically how the application of asanas is rationalized differently in specific geographical and therapeutic environments – particularly regarding the presumed theory of the body. Thus, the concept of the health imaginary not only provides analytic space to explore the implicit logics and goals of healing in different contexts, but also offers clues about the distinct social, cultural/religious, and local influences that draw people into yoga and contribute to its selective appropriation across the globe. [ABSTRACT FROM AUTHOR]

Existing literature demonstrates agro-chemicals result in physical toxicity and damages human health, flora and fauna. However, little is known about how such ‘toxicity’ relates to mental well-being and social suffering. This paper aims to demonstrate how local, national and international vectors are interlinked to shape social distress among cotton farmers in India. Ethnographic interviews and focus group discussions were conducted in a cotton-growing village of the Warangal district, Telangana state, India. The results advance the concept of counter therapeutic spaces and hypothesise that toxic landscapes emerge through a dynamic interaction between dispersed agencies that interact and reconfigure agricultural spaces into socially toxic places. The paper argues that the disciplines of public health and agriculture suffer from a failure of imagination to forge vital interdisciplinary links that could address farmer suffering. Unpacking local ecologies of farmer suffering offer innovative ways for enhancing mental health policy and interventions in India. [ABSTRACT FROM AUTHOR]

Despite the recent growth of social science literature concerning the traditional medicine industry in Asia, insights into the contemporary dynamics of so-called ‘classical formulae’ remain relatively scant, as do studies of small-scale, less capitally intensive and technologically advanced modes of production. This paper seeks to address these gaps by considering a single Sowa Rigpa (Tibetan medicine) formula known as Samphel Norbu, or ‘wish-fulfilling jewel’, which appears in numerous texts and is today among the most popular Tibetan medicines in the world. Drawing primarily upon long-term fieldwork in Himalayan India, the paper follows Samphel Norbu's rise from exclusivity to popularity and examines the ways it has been transformed in the process, both materially and in its economic, social and clinical significance. The paper shows how Samphel Norbu acts as a marker of inequality between different groups of healers, and examines the role the medicine played in the development of commercial pharmacy and the proliferation of complex medicines. Tracing out wide variations in the medicine's formulation, composition, mode of production and pattern of circulation places the issue of multiplicity at the centre of analysis, and leads to a questioning of the assumptions that underpin the category ‘classical formula’. The paper reflects upon the repositioning of such formulae within emergent configurations of knowledge, power, industry and market, and on their transformations and transformative effects both over time and in the present moment. [ABSTRACT FROM AUTHOR]

The paper analyses the experiences with government sanctioned Ayurvedic college education of 14 young Ayurvedic doctors working at the Integrative Health Centre in Bangalore, India. Unfamiliarity with Ayurvedic logic and Indian natural philosophies, lack of clinical training and the mixing-up of Ayurvedic and biomedical notions are their main complaints. The 14 young Ayurvedic doctors also missed a convincing perspective on how to integrate Ayurvedic logic, modern scientific knowledge and biomedical diagnostics. Ayurvedic state sanctioned education seems to be caught between Ayurveda's natural philosophy of health and the techno-science of biomedicine. The Ayurvedic doctors under scrutiny face the danger of becoming ‘half-baked products’ when they do not learn to reflect on the tension between Indian traditional knowledge and biomedical learning. The paper argues that the logic of modern science and biomedicine's claim to value-free knowledge captivates Ayurvedic education and research. This hinders Ayurveda's development as a vibrant alterity to biomedicine. What is needed is a critical social science perspective on the construction of medical knowledge and India's hierarchical medical landscape. [ABSTRACT FROM AUTHOR]

This paper engages critically with the global assemblage framing sickle cell and thalassaemia disorders as a ‘global health crisis’; and the promise of genomics, largely DNA-based carrier/pre-conceptual screening, prenatal diagnosis with a view to terminations, deployed in framing a solution to these historically racialised spectrum of diseases as essentially preventable. Sickle cell and thalassaemia are recessively inherited, potentially life-threatening haemoglobin disorders with significant variation of severity, often needing life-long treatment. I argue that the re-classification of inherited blood disorders (IBDs) under ‘prevention and management of birth defects’ by the WHO in 2010 can be read as an ethical moment within the ‘globalising turn’ of IBDs and the use of genomics in addressing structural inequalities underpinning health in low- and middle-income countries. Using an Indian case study, the paper aims at first examining the language of risk through which genes and IBDs are mapped onto pre-existing populations (e.g. caste and tribe) as discrete, categories. Second, it discusses the likely social and ethical ramifications of classifying these recessive gene disorders as essentially preventable, despite cheaply available diagnostic tests and treatment options available in most countries in the South. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

Within public health, investigations into the rise of metabolic syndrome disorders, such as obesity and type II diabetes, following on the heels of globalisation have tended to focus on the twin axes of diet and physical exercise. However, such a limited focus obscures wider transformations in bodily and health-related practices that emerge in response to globalisation. This paper is an exploration of public discourses about PCOS—a hormonal disorder that affects menstruation, is associated with obesity, heart disease, and type II diabetes, and has been on the rise in India since the liberalisation of its economy in 1991— and it examines the concerns regarding sociocultural, environmental, and political–economic changes brought by liberalisation that these discourses index. Attention to medical semantics, as revealed through public discourses about PCOS, can help counter the limited focus of diet and physical activity-centred models through an emphasis on the political ecology of health. Such engagement can reveal how an emerging relationship between the body and its environment, which is seen as characteristically modern, is implicated in the rise of metabolic disorders. It can also offer critical insights for biomedical and public health research into such disorders. [ABSTRACT FROM AUTHOR]

From research in central Chhattisgarh, this paper interprets the bearing that healthcare beliefs and practices may have in shaping maternal and child nutrition both in the light of biomedical recommendations and within the context and constraints of a rural village setting. It contends that health beliefs and practices that are at variance from biomedical recommendations appear to have few consequences for gestational nutrition and for child health in relation to pregnancy. In the postpartum however, health ideas at variance from biomedical recommendations appear to have an important bearing on maternal nutrition and infant feeding, and may put mothers and children at risk of nutritional deficiency. Maternal 'eating down' following a surgical procedure such as a caesarean delivery or tubectomy is especially noteworthy, since food intake quantity is reduced over an extended time frame. While caring practices are influenced by cultural formulations, they also reflect, perhaps, adaptations to health risks. [ABSTRACT FROM AUTHOR]

In this paper, the author traces two parallel movements of institutionalized Ayurvedic psychiatry, an emergent field of specialization in Kerala, India: the ‘work of purification’ and the ‘work of translation’ that Latour has described as characteristic of the ‘modern constitution.’ The author delineates these processes in terms of the relationship of Ayurvedic psychiatry to (1) allopathic psychiatry, (2) bhutavidya, a branch of textual Ayurveda dealing with spirits, and (3) occult violence. The aim is to offer a model of these open and hidden processes and of Ayurvedic psychiatry's positioning within a hierarchical mental health field characterized simultaneously by biopsychiatric hegemony and a persistent vernacular healing tradition. Through these processes, Ayurvedic psychiatry emerges as a relevant actor. It demarcates itself from both allopathic and vernacular epistemologies and ontologies while simultaneously drawing upon aspects of each, and, in this way, shows itself to be both deeply modern and highly pragmatic. [ABSTRACT FROM AUTHOR]

In this study the author analyzes the relationship between the individual body and the body politic in a region of the north Indian state of Uttarakhand, in connection with social changes occurring at the local and trans-local level, which are impacting the status of the different healing systems. By investigating these issues, this paper aims to shed light on some of the complex ways in which practitioners and patients who take part in a local method of healing, in this case ritual healing through possession, respond to the expansion of biomedicine. [ABSTRACT FROM AUTHOR]

The paper discusses the many forms and representations ofcyavanaprāsh, Ayurveda's best-selling medicine, already mentioned in Caraka's Compendium (c. 200 CE). The medicine's compositions, applications, and meanings, change over time and from locality to locality. Cyavanaprāshis, for example, a patriotic formula, a booster of the immune system, a modern geriatric drug, and one of the elements in canonical Ayurvedic treatments. In the beginning of the 19th centurycyavanaprāshwas a patriotic formula for fortifying Indian bodies and the nascent Indian nation. Nowadays the medicine is a Fast Moving Consumer Good (FMCG) and a money maker for Dabur India Ltd., the world largest Ayurvedic manufacturer. Instead of vitalising the nation its consumption now promises to make urban middle class consumers effectively modern. Branding and modern science must make Dabur Chyawanprash attractive in the eyes of these consumers. Ayurveda and cyavanaprāshare also part of a global counter culture marked by neo-Orientalism and Ayurvedic medicines as facilitators of spirituality. The marketing ofcyavanaprāshby India's largest Ayurvedic manufacturer is used as a case study for discussing the proliferation of Ayurvedic brands and its critics. The imaging of Ayurvedic brands such as Dabur Chyawanprash threatens to obscure the fact that Ayurveda represents a unique way of looking upon health, disease and the human body. The proliferation of brands also makes Ayurvedic medicines more expensive and puts pressure on the natural environment as the main supplier of Ayurvedic ingredients. [ABSTRACT FROM AUTHOR]

The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2–3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful. [ABSTRACT FROM AUTHOR]

Evolving knowledge of genetics and improved clinical care have re-shaped life choices for those suffering from chronic, incurable conditions and their families. Yet the realisation of care requires complex navigation to access vital therapies which is often difficult for individuals or their family carers. In the article, we explore the struggles and strategies of parents of children with thalassemia (a genetically inherited blood disorder) in a North Indian city, who have come together to ensure better long-term health of their children. A focus on the ways in which families come together and remain apart in their quest for guaranteed access to life-saving substances such as filtered blood, provides insight into the diversity of bio-social strategies at work. It is not only family relationships and kinship, we suggest, but bio-sociality itself which is reshaped with the advent of new rights-based languages, evolving therapies and state support which hold out new possibilities for young people with thalassemia to live as normal a life-course as possible. [ABSTRACT FROM AUTHOR]

The Type 2 diabetes epidemic in India poses challenges to the health system. Yet little is known about how urban Indians view treatment and self-care. Such views are important within the pluralistic healthcare landscape of India, bringing together allopathic and non-allopathic (or traditional) paradigms and practices. We used in-depth qualitative interviews to examine how people living with diabetes in India selectively engage with allopathic and non-allopathic Indian care paradigms. We propose a ‘discourse marketplace’ model that demonstrates competing ways in which people frame diabetes care-seeking in India's medical pluralism, which includes allopathic and traditional systems of care. Four major domains emerged from grounded theory analysis: (1) normalization of diabetes in social interactions; (2) stigma; (3) stress; and (4) decision-making with regard to diabetes treatment. We found that participants selectively engaged with aspects of allopathic and non-allopathic Indian illness paradigms to build personalized illness meanings and care plans that served psychological, physical, and social needs. Participants constructed illness narratives that emphasized the social-communal experience of diabetes and, as a result, reported less stigma and stress due to diabetes. These data suggest that the pro-social construction of diabetes in India is both helpful and harmful for patients – it provides psychological comfort, but also lessens the impetus for prevention and self-care. Clarifying the social constructions of diabetes and chronic disease in India and other medically pluralistic contexts is a crucial first step to designing locally situated treatment schemes. [ABSTRACT FROM PUBLISHER]

The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses. [ABSTRACT FROM AUTHOR]

Over the last three to four years, an increasing number of private and public sector tertiary level hospitals and research centres in India have been using stem cell therapy, especially adult stem cell therapy, in the guise of experimental therapy for a variety of medical conditions. The promotion and growth of this experimental field across local and national borders traverses regulatory, ethical, social and financial boundaries. In this complex context, the article examines how healthcare centres in India negotiate bio-medical and health care circumstances in promoting a therapy that raises questionable medical, technical and ethical issues. The process of promoting experimental stem cell therapy is explained here by employing the concept of bionetworking and illustrated by two case studies of hospital groups. The case studies show how through bionetworking a centre creates and maintains novel networks of mutual exchanges with other collaborative bodies situated in local, national and global relations of inequality. Drawing on a three-month period of fieldwork and interviews in various locations in India, this article shows that: (1) Questionable stem cell therapy is promoted through bionetworks that resonate across local, national and global constellations; (2) Regulatory gaps facilitate the growth of such therapeutic practices; (3) The experimental stem cell therapies augment the healthcare divide in Indian society; (4) The weakening Indian state facilitates commercialisation of health, indirectly supporting the 'bionetworking' practices of therapy providers. [ABSTRACT FROM AUTHOR]