Healthcare privatization and women's experiences of care: a qualitative study on Bangladesh

This dissertation traces the influence of global policies on the transformation of the healthcare system in Bangladesh, and how these transformations impact women's navigation of care. In-depth qualitative interviews were conducted with 52 women who accessed obstetric and gynecological healthcare, as well as interviews with 28 healthcare providers, and 12 health administrators and health policymakers. Findings are presented in two original manuscripts. The first manuscript describes the experiences of economically poor women who went for hysterectomy surgeries to private providers, experienced iatrogenesis and ultimately developed genital fistula. The study sheds light on the influence of middlemen (locally known as dalal), who are informal health personnel that channel patients to private healthcare providers, on maternal health outcomes. The study demonstrates that increased contact with healthcare providers stemming from middlemen's services could not ensure better health outcomes for poor women; in fact, it frequently worsened their health conditions while creating financial hardships for their families. The second manuscript focuses on upper-class women who could afford any healthcare they chose in Bangladesh. This group incurred high expenses for childbirth in reputable private healthcare facilities. Nevertheless, the ability to pay did not always guarantee access to high-quality care. Women often lacked the option to choose a vaginal birth even if they desired one. The excessive use of non-medically indicated C-sections that contradict international standards of obstetric practice is related to the context of Bangladesh's current era of healthcare privatization. The thesis emphasizes the need to prioritize high-quality healthcare globally and locally by enhancing accountability, monitoring, and regulation. Overall, the findings highlight a lack of concern with regulation in health systems as a major lacuna in the current global push for universal health coverage.