Unsettling Care Infrastructures: From the Individual to the Structural in a Digital Maternal and Child Health Intervention

Abstract

Information services for maternal and child health are increasingly being implemented at scale and integrated into public health infrastructures in Global South countries. These services often disseminate tailored health information and provide channels for families to ask questions to health workers. With increasing uptake, these services are intervening into a highly gendered space and shaping care work and information-seeking in new ways. We present a study of a patient education program and associated WhatsApp-based information service deployed across multiple states in India, drawing on observations, interviews, and analysis of chat records. Building on notions of "unsettling care"[63], we examine what it means to deploy such an intervention in inequitable, fragmented health systems. We find that even as the intervention focuses on individual behavior change, it also runs up against structural issues, such as the overburden of health workers, an illegible health system, and gendered power dynamics that extend beyond the realm of the home. We use our findings to unsettle notions of how the intervention provides care, and to reframe how we might think about the design and implementation of health information services to also engage with structural issues.