Maternal Health Governance and Tribal Women’s Reproductive Rights under Article 21

Maternal health in many tribal regions continues to fall behind national averages not because government schemes are missing, but because existing governance structures often fail to recognise the lived realities of tribal women. This study examines how autonomy, dignity and informed decision-making operate within the maternal health system in tribal areas, and why state interventions remain ineffective despite a strong policy framework. The research question guiding this study is: how the maternal health systems operating in tribal areas affect women’s everyday experience of autonomy and dignity, and what changes could make this care truly centred on women’s autonomy. Based on doctrinal analysis and field insights gathered during my postdoctoral research, including a review of governance models such as PHCs, SHCs and PMCs, the paper explores the gap between constitutional guarantees under Article 21 and the everyday healthcare experiences of tribal women. Although reproductive autonomy and dignity are increasingly acknowledged in legal discourse, these principles rarely shape service delivery on the ground. In several tribal areas of Udaipur, persistent communication barriers, pressure for institutional deliveries, and weak transport and referral systems restrict women’s real agency. Digital health initiatives and monitoring tools, while well-intended, often overlook issues of access, literacy and cultural compatibility. Consequently, governance becomes compliance-driven rather than autonomy-centred.