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Anthropological enquiry into brokers and brokerage practice provides a prime entry point for making sense of social change. This article tends to the ways in which the trope of the broker and the everyday practice of those identified as enacting brokerage act as linchpins in broader moral grappling during a period of rapid social change. It draws from the ethnographic context of brokerage discursively constituted and enacted within maternal health markets in Bangladesh, focusing on the trope and actual practice of those identified as morally compromised dalals: brokers bringing women and families from public to private health institutions. It argues that the trope of the dalal operates as a metaphor for immorality ascribed to morally ambiguous spaces of the private health sector, a way for people to contend with a moral discomfort integral to applying market logics to health services enacted largely outside the jurisdiction of formal regulatory mechanisms. The practice of those identified as embodying dalals, in contrast, while flourishing in these conditions, is rooted in economic precarity, primarily of young men with limited power waiting for better opportunities, who negotiate and balance moral and economic imperatives in their line of work. [ABSTRACT FROM AUTHOR]

Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what has been learned about the 'social lives' of POCTs from in-depth qualitative research, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries and selected 13 papers for synthesis. The findings illuminate five value-based logics—technological autonomy, care, scalability, rapidity and certainty—shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests that POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates nonstandard processes, diagnoses and treatment pathways as essential to 'fluid technologies' rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers, and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, this multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognize the socio-technical complexity of health systems. [ABSTRACT FROM AUTHOR]

Background: In Bangladesh, over half of women give birth at home, generally without the support of a skilled birth attendant. In this article, we examined the decision‐making around birthplace and explored the reported reasons of preferring home birth over facility birth in a rural district of Bangladesh. Methods: A cross‐sectional household survey with 1367 women was conducted in Brahmanbaria district. Choice of birthplace and actual place of birth were the main outcomes of interest. Associations between the outcomes of interest and background characteristics were analyzed through binary logistic regression. Effects of the covariates and confounders were adjusted through multiple logistic regression. Results: Sixty‐four percent of women planned to give birth at home, and 62% gave birth at home. Planning to give birth at home was significantly associated with eventually giving birth at home (AOR [CI]: 4.93 [3.79‐6.43]). Multiparous women and women from larger households were significantly more likely to give birth at home, whereas more educated and wealthier women and those attending antenatal care were significantly less likely to give birth at home. The main reported reasons for home birth were perceived lack of importance of facility birth, financial reasons, fear of cesarean section, and not being permitted by a husband of other family member to seek facility birth. Conclusions: Home is the preferred birthplace and main actual place of birth in rural Bangladesh. The maternal health program of Bangladesh should look critically at the preferences of women and reasons for those preferences for further promotion of skilled attendance at birth in rural settings. [ABSTRACT FROM AUTHOR]