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The crafty Fadnavis has followed a carrot and stick policy in dealing with the Maratha regional chieftains. Giving in to the vociferous demand for Maratha reservations was a key step in wooing the younger generation of Marathas who feared they were losing out in a competitive job market. The carrot of reservation was followed by the stick of systematically targeting the financial clout of local Maratha leaders who might offer political opposition.

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More children below five years die in Uttar Pradesh than anywhere else in the country. Within UP, Shravasti death rates are alarming. According to data from the National Family Health Survey 4, of every 1,000 children born alive here, 130 are dead by the age of 5 the number of similar deaths for the rest of UP is 78.

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In the 1980s, Kleinman's influential book Patients and Healers in the Context of Culture2 emphasised the importance of self care and its relation to the medical and traditional healthcare sectors (fig 1).Fig 1 Three sectors of healthcare adapted from Kleinman modelFollowing Kleinman, medical anthropologists have shown how self care involves treating everyday health problems at home and in communities with modern or neotraditional drugs (traditional medicines packaged as modern pharmaceuticals) obtained from pharmacies, stores, and markets.3 People are often influenced by health messages and apply medical or traditional treatments themselves, especially when they are constrained by costs or access to healthcare facilities.456 For example, in rural northeast Thailand, anthropologists found that 80% of self reported uterine complaints, such as vaginal discharge and pelvic pain, were self treated, often with small doses of antibiotics purchased from markets (eg, one to three pills) after advertising campaigns promoting branded tetracycline for these complaints.7 The Lao speaking Isaan villagers cited hard work, menstruation, and tiredness as the most important triggers of reproductive ill health and feared that recurrent uterine symptoms would progress to cervical cancer.7A disproportionate burden of sexual and reproductive ill health falls on women and girls.8 Globally, almost all 4.3 billion people of reproductive age have inadequate sexual and reproductive health services; an estimated 200 million women report an unmet need for modern contraception; 45 million lack adequate antenatal care; and an estimated 266000 women die each year from cervical cancer that could have been prevented through screening or vaccination.9Health systems increasingly rely upon individuals, families, and communities to administer and manage many sexual and reproductive health interventions. Ethnographic studies, however, suggest that how and why people already engage in self care are often overlooked in the development of policies and programmes. This can lead to a mismatch between the care promoted by healthcare professionals and the self management that already takes place at home and in communities.

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