Financializing Maternal and Newborn Care: Temporal Tensions within a Development Impact Bond in India

Abstract

Since the 1980s, multilateral agencies and governments in many parts of the world have curtailed public spending for the health sector. The same period also witnessed the emergence of ‘innovative’ health financing approaches which combine social service provision with financial return. This article discusses one such mechanism, the first health-focused development impact bond (DIB) implemented in India in 2018–21. Drawing on interviews with key actors and analyses of documents and reports, the article examines the transformation of maternal and newborn care into an investment opportunity. It argues that DIBs introduce the prospect of financial return in the provision of social services while at the same time imbuing financial investments with the promise of moral value. After situating the impact bond within broader global trends in health financing and India's specific history, the article illustrates the processes of valuation involved in converting maternal and newborn care into a financial asset. In doing so, it highlights the tensions that emerge when healthcare is made amenable to the logic and time horizon of finance capital. The article concludes with a discussion of the possible long-term consequences of financialization in the health sector, emphasizing the new vulnerabilities and inequalities that DIBs generate, particularly outside financial centres in the Global North.