Privatization of maternal care and women's access to quality healthcare: a case study on middlemen in Bangladesh.

This study critically examines how the unregulated expansion of private healthcare, coupled with health-system challenges such as corruption, and lack of monitoring and accountability, affects women's experiences of obtaining healthcare in Bangladesh. Based on in-depth qualitative interviews with 31 female patients, 28 biomedical providers, and 12 health administrators and policymakers, we found that the absence of effective regulation, supervision, and accountability, particularly in the private healthcare sector, has fostered an environment where private biomedical providers can engage in harmful practices. These practices are often facilitated by informal actors, popularly known as "dalal" (middlemen or brokers). These middlemen serve as marketing channels for many private healthcare providers, directing socially and economically marginalized women toward unregulated services. This situation can result in harmful medical practices, such as unnecessary hysterectomy surgeries, leading to serious complications like genital fistula. Our findings illustrate that increased access to healthcare providers, without adequate regulation and monitoring, fails to ensure a better quality of care for disadvantaged women and instead exacerbates their health issues while creating financial burdens for families. The presence of middlemen in healthcare is not merely indicative of individual misconduct but reflects broader policy and systemic failures. Addressing their role requires structural reforms that emphasize regulation, public accountability, and quality of care, alongside a critical re-examination of global health metrics that emphasize contact and access over equity and health outcomes.