The State, Gender, and Privacy in India: An Exploration through the Mother and Child Tracking System

Sarah Hodges (2006, p2) argues that reproduction is "always simultaneously a physiological as well as social act" highlighting that reproduction is often socially determined. Faye Ginsburg and Rayna Rapp, borrowing from Shelee Colen's work on West Indian childcare workers, define stratified reproduction as the local and global circumstances whereby 'some categories of people are empowered to nurture and reproduce, while others are disempowered' (Colen, Ginsburg, &Rapp 1995). In India, reproduction is stratified by class, religion and caste. The general onus of population control lies on the poor, who are often also the ones who have to interact with the state directly through welfare measures on matters of reproduction. The Hindu right wing's demands for population control have also served as a tool for Islamophobia in the country with (debunked) conspiracy theories suggesting that the Muslims (15% of the Indian population) produce multiple children to overrun the Hindu population (79% of the Indian population) to seize political power. Further, caste also acts as a determinant of reproductive healthcare access as evidenced by the poor maternal health outcomes and low utilisation of maternal healthcare services of Scheduled Caste Women. Since colonial times, in the context of reproductive healthcare policies, the state has been more concerned with the question of population control and demography rather than with discourses of autonomy for women. Women's access to reproductive healthcare facilities such as abortion continues to exist mainly within discourses of population control, sex ratios and maternal health (sometimes their 'right' to abortion simply a function of their husbands' refusal to use contraceptives) and not within discourses of autonomy and privacy (Menon 1995)
In 2009, the Ministry of Health and Family Welfare (MoHFW) launched the Mother and Child Tracking System to function as a national database in India's reproductive health information ecosystem. It aims to leverage information technology in delivering healthcare and immunisation services to pregnant women and children up to the age of 5. Various state-level systems run parallel to it or are subsumed by it. It ostensibly aims to establish a two-way communication between the service providers and the beneficiaries. There are multiple ICT elements involved in the system: the database captures detailed information of the beneficiaries such as their unique IDs, names, location, contact details and caste; a maternal health card containing a unique 16-digit unique identification number encoding the health centre location and serial number of the woman/child; mobile-based SMS technology to "communicate with beneficiaries and grassroot level healthcare service providers as well as health and family welfare policy makers, health managers and health administrators at different tiers of the health care delivery system" (MoHFW Press Release 2013). A call centre, the Mother and Child Service Facilitation Centre, serves to verify the MCTS records and collects feedback on the provision of services. Through this system, the MCTS collects a wide range of information of not only the targeted beneficiaries (such as personal details of all pregnant women, the details of all the welfare schemes they avail, data of all visits from conception to 42 days post-partum), but also demographic details and contact numbers of all health workers in each facility. In the absence of a data protection framework, the collection of such a large assemblage of data exposes the participants to serious risks of data misuse and surveillance.
Given the complicated social history and context of access and the nature of reproductive healthcare in India, it becomes necessary to investigate the implication of adding ICTs to the mix. An intersectional enquiry of such processes will help shed light on the interaction of the state and citizens in the context of technology-mediated welfare measures.