Citizenship rights in India are being transformed under economic liberalisation. In this article, we use obstetric crises to provide an entry point to explore recent changes in people's access to health care and their understandings of their civic rights and entitlements. We draw on our research in rural Bijnor district (Uttar Pradesh) between 1982 and 2005. Over this period, the state has increasingly failed to provide a safety net of emergency obstetric care. Poor villagers seeking institutional deliveries in private facilities face either exclusion or indebtedness. Moreover, 'consumers' have no capacity to regulate the quality of private health care provision - but nor do the state or civil society organisations. Villagers critique the state's failure to provide the health care that they regard as a citizen's entitlement. Yet the health care market is accorded no greater legitimacy by its 'customers'. Far from providing opportunities for empowerment, then, changes in health care provision serve to disempower the poor and to reduce the moral authority of both the state and the market.