Health development and Sasak women: A political and practical analysis of medical intervention in rural East Lombok, Indonesia

This thesis explores the question of why health development, indicated by a reduction in maternal and infant mortality rates, has been relatively slow in the district of East Lombok, in the province of Nusa Tenggara Barat, Indonesia. It describes the political, economic, social and cultural character of Sasak village life, and the historical and wider politico-economic context in which it is embedded. The thesis fulfils the requirements of the emerging field of critical medical anthropology, paying attention not only to culture, but also to political economy; not only at the local (or micro) level, but also at the macro and intermediary levels. The objective of part one is to offer a broad analysis which demonstrates the local, regional and national political and economic constraints upon reducing maternal and infant mortality rates in rural East Lombok. Part two critically examines international and national health development discourses, which, it is argued, depoliticise the issue of health inequalities, and represent local people as sole cause of their poor health status. It also discusses the political effects of the process of medicalisation. This thesis is based on ethnographic research, the focus of which is the interface between rural Sasak women and local government health staff, who deliver medical interventions through the national family planning and primary health care programmes. At the local level economic, political, social and cultural factors determine the everyday decisions women make about where and when to seek preventative and curative treatment for themselves and their infants. It is at this local level that the disjuncture between Sasak theories of illness causation and healing practices, and those of biomedicine which inform the policies and interventions of government health development planners, are revealed. Similarly, it is at this level that the disjuncture between the planned and the actual quality and quantity of health interventions delivered can be observed. Part three of the thesis describes the specific effects of these disjunctures in limiting the impact of health development interventions in reducing maternal and infant mortality in rural East Lombok