Health inequity and women's self-help groups in India: The role of caste and class

With the United Nations Millenium Declaration of 2000, the establishment of Self-Help Groups (SHGs) has been identified as a significant strategy in addressing the alarming levels of poverty and marginalisation that have accompanied global development. SHGs are small, voluntary associations of people from the same socio-economic background that have been established for the purpose of solving shared social and economic problems through self help and mutual help. Such grass-roots commonality, it has been assumed, will promote community empowerment and prevent economic marginalisation. Such an assumption is largely based on the global, neo-liberal agenda of seeing the withdrawal of the State from social provisioning. SHGs have been widely adopted in India, especially to eliminate the social exclusion of poor women and improve their access to health. This article reviews the scope and limitations of SHGs in improving women's health, focusing on their implementation in the State of Bihar in India. It critically assesses the extent to which SHGs: can be involved in attaining better health for women and children by exploring the crucial role of caste and class in access to health services. The article concludes that solutions such as SHGs, which emanate from international policy circles, fail to capture local structural contexts such as caste and class and, as a result, develop instrumentalised approaches that are unlikely to produce equitable health services provision to poor and marginalised people.