JavaScript Required

The P4H website is designed to perform best with Javascript enabled. Please enable it in your browser. If you need help with this, check out

Social norms and values impacting health expenditures in India - P4H Network

Social norms and values impacting health expenditures in India

Household resource allocation in India is not just a pragmatic and calculative exercise, it also involves multi-layered tacit and explicit contestation, bargaining and negotiations that occur at the intersection of social norms, economic class, caste, gender, age, and productive status within the family. 

This multi-methods study uses illustrative narratives to provide valuable insights into socio-cultural factors and dynamics shaping healthcare-related spending choices and decisions within households in India.

The stories illustrate how various notions such as being healthy or unwell, if unwell, for whom, how much, when one should intervene, the choice of healthcare, and the expenditure on healthcare are driven by social and cultural explanatory antecedents. While the stories highlight the importance of social and cultural factors in understanding household resource allocation, they also reveal that factors like social and gender norms do not exert causal effects themselves. The stories show that causal effects emerge and manifest at the intersection of other structural forces viz economic class, caste, gender, age, and productive status, to both constrain and enable human agency and decisions. They ultimately also expose how an entrenched patriarchy underpins these causal processes.

The stories spotlight how the decision-making processes within this economy of the family are negotiated and “dialogic (rather than monologic) in construction”: dialogic in the sense that it is framed in terms of a set of moral dilemmas and contradictions”, and how the intra-household contestation and grappling with these dilemmas and contradictions is underpinned by an imagined patriarchal ideal type of an Indian family and “a ‘traditional’ and culturally authentic form of Indian family life.

They also reveal that not only do social norms play crucial roles in setting the limits to intra-household contestation, negotiation, and bargaining, they also circumscribe individual power and how bargaining and contestation happens within the economy of the family – the moral economy of the family. Our findings reveal that these resource allocations decisions and decision-making processes are not only shaped by and negotiated at the intersection of competing social norms and moral imperatives, but these decisions also reproduce, reiterate, and maintain the very social norms that produce them, often problematically.