Local hierarchies and distributor (non) compliance: a case study of community-based distribution in rural north India

Health Care Women Int. 2011 Mar;32(3):225-42. doi: 10.1080/07399332.2010.529217.


Community-based distribution of family planning services is particularly appropriate for South Asia, which has hard-to-reach rural populations. In Uttar Pradesh (UP), India, local status hierarchies of gender, caste, and generation shape the nature of relationships that community-based distributors (CBDs) create with their clients. In this case study of an "ideal" distributor, we uncover the conflicting expectations that many CBDs experience: to comply with project objectives without violating local social norms that limit interactions across status boundaries. Our CBD responded to these dual pressures with varying strategies, often perpetuating social distance and restricting information and services for men, adolescents, and other marginalized populations.

MeSH terms

  • Adolescent
  • Adult
  • Community Health Services / methods
  • Community Health Workers* / psychology
  • Community Health Workers* / standards
  • Family Planning Services / organization & administration*
  • Female
  • Hierarchy, Social*
  • Humans
  • India
  • Male
  • Rural Population
  • Social Environment
  • Socioeconomic Factors
  • Task Performance and Analysis
  • Young Adult