The power and perils of 'hard' indicators in global maternal health research
Katerini Storeng (University of Oslo)
Dominique Behague (Vanderbilt University)
Paper short abstract:
Creating ‘hard’ maternal mortality indicators has become a global research priority. Researchers recognize that such indicators distort the reality they supposedly measure. Yet, they have limited power to rectify such distortion within a culture in which such indicators have acquired immense power.
Paper long abstract:
Statistical indicators have acquired a life of their own within the global health enterprise, though not all indicators have equal value. Today, the donors who drive global health tend to value 'hard' indicators of health outcomes over 'softer' indicators of the processes involved in healthcare delivery. This paper examines how the cultural value and prestige associated with methodological rigour reinforces not only the scientific, but also political, authority of such indicators. The paper draws on a broader ethnography of the global advocacy coalition for safe motherhood that has, since the late 1980s, sought to generate political commitment to reducing maternal mortality. Through in-depth interviews and participant-observation within elite global health academic networks in Europe and the US, we show how the creation of better indicators of maternal mortality has become a research priority, displacing the field's earlier emphasis on methodologically diverse health systems research. While they have vigorously pursued the production of such indicators, in private many researchers question their value for improving global health practice, not least because they recognise that certain indicators distort the reality they supposedly measure. While researchers express a wish to rectify such distortion, their limited power to do so reflects not only the scientific prestige associated with specific indicators, but also the extent to which researchers have become positioned as key actors within global health initiatives that compete with each other - a competition in which 'hard' indicators have acquired immense power.
Anthropology of health indicators and statistics