Registration and monitoring of pregnant women in Tamil Nadu, India: a critique.

In 2008 a pregnancy registration system was introduced in rural Tamil Nadu, India, which is now being scaled up. It will collect data on antenatal, delivery and post-partum care in pregnant women and infant health. This is seen as an important public health intervention, justified for its potential to ensure efficiency in provision and use of maternity services. However, from another perspective, it can be seen as a form of control over women, reducing the experience of safe pregnancy and delivery to a few measurable variables. The burden of implementing this task falls on Village Health Nurses, who are also women, reducing their time for interacting with and educating people and visiting communities, which is their primary task and the basis on which they are evaluated. In addition, they face logistical constraints in rural settings that may affect the quality of data. In a health system with rigid internal hierarchies and power differentials, this system may become more of a supervisory and monitoring tool than a tool for a learning health system. It may also lead to a victim-blaming approach ("you missed two antenatal visits") rather than health system learning to improve maternal and infant health. The paper concludes by recommending ways to use the system and the data to tackle the broader social determinants of health, with women, health workers and communities as partners in the process.