Caste Prejudice and Infection

In light of India’s continuing efforts to reduce maternal mortality, why government hospitals continue to be dangerously unhygienic, posing serious infection risks to patients, is explored. Through interviews and observations at public hospitals in Uttar Pradesh, Bihar, and Madhya Pradesh, we find that unhygienic practices and behaviours by health staff abound, leading to an environment with high potential for infection. Deep caste prejudice against cleaners prevents the professionalisation of their work, leaving them overburdened and under-equipped to maintain standards of hygiene.

The authors thank the cleaners and hospital staff who so generously shared their time and insights with them. They thank Diane Coffey for her encouragement and for helpful feedback, and appreciate comments from the anonymous reviewer.

In light of India’s continuing efforts to reduce maternal mortality, why government hospitals continue to be dangerously unhygienic, posing serious infection risks to patients, is explored. Through interviews and observations at public hospitals in Uttar Pradesh, Bihar, and Madhya Pradesh, we find that unhygienic practices and behaviours by health staff abound, leading to an environment with high potential for infection. Deep caste prejudice against cleaners prevents the professionalisation of their work, leaving them overburdened and under-equipped to maintain standards of hygiene. Casteist notions of cleanliness also weaken rigorous implementation of infection control measures by hospital staff. Rather than addressing these deeper issues, antibiotics are routinely prescribed as a shortcut to deal with the risk of hospital infection.

Despite progress in reducing maternal mortality in recent decades, India represents one-fifth of all maternal deaths. At 45,000 deaths in 2015 (World Bank 2015a), this is more than any other country in the world. India’s maternal mortality rate (MMR) in 2015 was 174 per 1,00,000 live births (World Bank 2015b). In contrast, India’s neighbours, China and Sri Lanka, had MMRs of 27 and 30, respectively. Developed countries, like the United Kingdom (UK) and the United States (US), have MMRs below 15.