‘You have to do some dhora-dhori’: achieving medical maternal health expectations through trust as social practice in Bangladesh

Abstract: In contrast to prevailing conceptualisations of ‘trust’ as an object in popular and political discourses, this article takes the concept of trust as future-oriented practice as a launching pad for understanding relationships between people and medical systems in Bangladesh. Based on ethnographic fieldwork in Bangladeshi peri-urban and rural spaces, it focuses on expectations related to advanced maternal biomedical technologies delivered through medical institutions. These technologies have recently come to dominate practices and expectations around pregnancy and childbirth care and women’s navigations of health systems to realise these expectations. Within this context, trust in institutions in the public or private health sectors remains peripheral to women’s experiences of accessing desired maternal health resources. Rather, women leverage social connectedness through the patronage-related practice of dhora-dhori, translated as mutual grasping or holding. Dhora-dhori is based on social rootedness, trust in that rootedness, and reciprocity. Women act as embedded agents within their families to appeal to various social connections through dhora-dhori to tactically access desired services and resources, with the expectation that this will result in better care at a lower cost, whether in public or private health sectors. It is through such practice that women and families work to realise their expectations of care through institutions, collapsing distinctions between ‘trust’ in personal relationships and ‘trust’ in institutions, as it is through inti-mate relationships that relationships with medical institutions are engaged.

Keywords: trust, health systems, maternal health, childbirth, ethnography, Bangladesh

Article posted to the Journal of the British Academy, volume 11, supplementary issue 6 (Exploring Medical Mistrust: From Clinic to Community)