"Our health is in our hands": Women making decisions about health care in Tamilnadu, South India

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Susan S. Wadley


Women, Health care, Tamilnadu, India, Decision-making, Self-medication

Subject Categories

Anthropology | Social and Behavioral Sciences | Social and Cultural Anthropology


This dissertation explores the multiple ways in which poor women in Tamilnadu, South India make decisions about seeking health care. Located in a state known for a relatively better health care infrastructure, poor women from lower castes have to still maneuver their way through a complicated system of government and private doctors, in addition to many indigenous systems of medicine, and self-proclaimed 'doctors'. Based on fieldwork conducted in an urban slum (Thiru Nagar), villages in a rural town (Tirupattur) and in a tribal hamlet (Yelagiri), between February 2001 and June 2002, this study brings out women's nuanced understanding of their health and health care options available. Women contend with the demands of Tamil notions of womanhood by articulating their positions as mothers, especially of sons, in order to circumvent the lack of support they get from their "household head", their husbands. They also demand more autonomy and bargaining power in expressing a preference for marriage with non-kin. By marrying non-kin, women believe they can "question" injustice targeted at them, and also protect themselves from relatives who may harm them through sorcery. In rural areas, women consult sorcerers but are ambivalent about their efficacy. Instead their main aim is to find a cause for their suffering and act toward relieving themselves of it. Women accuse the state health care system of being slow, corrupt, condescending and indifferent. Private biomedical doctors are more efficient, but also more expensive. Therefore urban women bypass the licensed biomedical system and directly interact with pharmacists, indulging in rampant self-medication, and endangering their own health. In choosing doctors too, women make decisions assessing various factors, which contribute to the doctor having "healing hands", which sometimes means they consult healers who are not qualified to practice. By focusing on women's sense of agency, I argue that we can understand the permutations and combinations involved when poor and illiterate women of lower caste and class undertake to ensure some semblance of control of their bodies and their health.


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