Chronicling Care: Ethnographic Case Dossiers and Charts to Investigate a Safe Motherhood Intervention in Northern India

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Ethnographic research has demonstrated how clinical practice is shaped by institutional, social, and material conditions, yet it is seldom integrated into the evaluative frameworks used to assess health system performance. In maternal health, reliance on documentation and indicator-based audits can obscure how risk develops and is managed within everyday clinical work. This paper advances a methodological approach—ethnographic case reconstruction—that brings qualitative inquiry into direct analytic relation with clinical processes and reporting systems. The study drew on fieldwork conducted alongside a Safe Motherhood intervention in select public hospitals of Uttar Pradesh, India. Combining sustained observation, case-specific interviews, and analysis of medical and administrative records, the research assembled detailed case dossiers and temporally structured charts mapping sequences of care. These reconstructions were compared with the ways that cases were later represented in hospital records and audit systems. A reconstructed case of postpartum hemorrhage illustrates how clinically significant deterioration can take shape through successive gaps in monitoring, interpretation, and response, while remaining only partially reflected in formal documentation. By tracing care as a temporally extended and distributed process, the method reveals how evaluation systems may misrecognize clinical realities and produce administratively coherent but incomplete accounts. Ethnographic case reconstruction offers a complementary approach to audit-based evaluation, generating context-sensitive evidence that can inform clinical oversight, strengthen intervention design, and expand the evidentiary basis of global health assessment.