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Rice University

Publication Date

Spring 2013

Program Name

India: Health and Human Rights


Seva Mandir, a non-governmental organization working on tribal development issues in the Udaipur District of India, offers pregnant women and mothers one kilogram of lentils for every visit they make to the organization’s monthly immunization camps. This study assesses whether it is ethical to use incentive-based systems, as opposed to empowerment through health education, to “nudge” the rural poor in Udaipur toward immunization. The information presented in this study is based on twenty-nine interviews with pregnant women and mothers of children less than two years old conducted during six field visits to Seva Mandir’s immunization camps. Through data obtained from personal interviews, the present study identifies the most likely explanations for the low rates of immunization among the tribal populations in rural Udaipur: the natural human impulse toward procrastination and skepticism about the benefits of immunization. Considering these two factors, this study argues that it is ethical to “nudge” the populations in rural Udaipur toward immunization by referring to research in behavioral psychology and medical ethics. It also examines several specific ethical dimensions such as patient autonomy and awareness within the context of the program’s implementation, revealing that Seva Mandir's program is ethically acceptable in some domains, but requires improvement in others.


Community Health | Community Health and Preventive Medicine | Health and Medical Administration | International Public Health | Medical Immunology | Public Health Education and Promotion



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