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Women's Health in Post-Soviet Russia: The Politics of Intervention
Abstract
An unparalleled study of a transforming and privatizing Russian health care system, of the promises and perils of prescriptive programs for change, that points to the areas that need change in the change-makers themselves.... part of a larger story about the inherent dangers of current neoliberal economic transformations of fragile post-socialist social welfare arrangements.... "Rivkin-Fish takes the reader into a new understanding of the fragile and tense relations between state and market transitions, and into the deep and largely silent struggle for gender and health equity in Russia. - Adriana Petryna, author of Life Exposed: Biological Citizens after Chernobyl In the first decade after the collapse of the Soviet Union, deteriorating public health indicators such as below-replacement fertility and high rates of sexually transmitted diseases, abortions, birth traumas, and maternal mortality raised acute anxieties about Russia's future. This study documents the efforts of global and local experts, and ordinary Russian women in St. Petersburg, to explain Russia's maternal health problems and devise reforms to solve them. Examining both official health projects and informal daily practices, Michele Rivkin-Fish draws ethnographic and theoretical insights about the contested processes of interpreting and managing neo-liberal transitions in Russia and explores the challenges of bringing anthropological insights to public health interventions for women's empowerment.
... Most studies of postsocialist health care focus on informality as the primary strategy in obtaining individual continuity of care. 6,[12][13][14][15] Women seek personal connections with doctors, mostly through kin-and-friendship networks but also through gifts and bribes. 13,16 The assumption is that informality will shield them from well-documented 6,[12][13][14][15]17 mistreatment during childbirth. ...
... 6,[12][13][14][15] Women seek personal connections with doctors, mostly through kin-and-friendship networks but also through gifts and bribes. 13,16 The assumption is that informality will shield them from well-documented 6,[12][13][14][15]17 mistreatment during childbirth. However, even these informal strategies ultimately do not guarantee protection from medicalization and unnecessarily routinized and unconsented obstetric procedures (episiotomies, enemas, induced labor, etc). ...
... However, even these informal strategies ultimately do not guarantee protection from medicalization and unnecessarily routinized and unconsented obstetric procedures (episiotomies, enemas, induced labor, etc). 13,14,17 What informality offers to women is a chance to become more than a birthing body and to establish personhood within the depersonalized public hospitals. [8][9][10]12,17,18 Rather than relics from a socialist past, 19 informal strategies are a response to ever-increasing inequalities, which are only exacerbated by ongoing neoliberal transformations of CEE countries after socialism. ...
Background
For pregnant and birthing women, maintaining a relationship with the same health care practitioner is critical to establishing a sense of safety. In postsocialist Serbia, where care is fragmented and depersonalized, this continuity is often missing. Patients are frequently handed over to new practitioners, sometimes without even knowing the name of the person overseeing their care. In response, many women turn to the private sector to keep the same practitioner across their prenatal period and their birth by establishing a personal “connection” within the hospital that they believe will shield them from mistreatment during childbirth.
Methods
Data presented in this paper were collected through participant observation in one public maternity hospital and one public primary care center in Serbia; semistructured interviews with 14 physicians; and semistructured interviews with 80 women who had given birth in one public maternity hospital in Serbia.
Results
Public maternity hospital physicians who supplement their income working in the private sector have the power to blur the distinctions between favors and services. They offer continuity of personalized care to their private clients/patients once they enter the public system, and they themselves obtain social and economic security unavailable to those working in only one sector. At the same time, there is evidence that personalized continuity of care does not actually shield women from mistreatment in hospitals.
Conclusions
The private sector is reshaping existing informal strategies and blurring the lines between formal and informal payments. In the postsocialist context, consumer practices are not separate from, but entangled with, informality. Neoliberalism has not brought about empowerment and eliminated informality, but has instead further exacerbated existing inequalities in maternity care in Eastern Europe.
... У Србији значајан печат на целокупни здравствени систем је оставио период југословенског социјализма, али и касније постсоцијалистичке, неолибералне промене. Битна одлика источноевропског технократског модела рађања је деперсонализација и бирократизација (Baji et al. 2017;Rivkin-Fish 2005b), која онемогућује успостављања континуираног односа између лекара и пацијенткиња. ...
... Колективна одговорност најчешће постаје "колективна неодговорност" (Rivkin-Fish 2005b). Бирократизован систем и колективна неодговорност онемогућују континуитет приликом пружања бриге и стицање поверења и одговорности (Baji et al. 2017;Rivkin-Fish 2005a, 2005b. ...
... Истраживања неформалних односа указују на улогу и значај друштвеног положаја на могућност приступа различитим аспектима бирократског система државе, као што су системи социјалне и здравствене заштите (Brković 2012(Brković , 2017aBrković 2017b;Rivkin-Fish 2005a, 2005bStan 2012). Појам везе, као домаћи пример неформалног односа или праксе, односи се на употребу неформалних контаката за добијање приступа могућностима које или нису доступне или су тешко доступне формалним каналима (Brković 2012;Stanojević, Gundogan & Babović 2016). ...
Anthropological research on post-socialism points to the need for informal relations when navigating social and health care systems, while feminist research on childbirth points out the negative consequences of the dominant medicalized model of childbirth on women?s experience. This paper combines these two types of research and points to the role of informal relations in negotiating childbirth in Serbia and the role of peoples social positioning influencing the possibilities of using these relations. Based on eighteen months of ethnographic fieldwork on the practices of providing maternal health care in Serbia, the aim of this paper is to show how a woman's social position affects her ability to establish a relationship within the state health care system, and to reconsider the claim that informal relationships can protect women from interventionism during childbirth in Serbia. Using informal relations (veze) in order to have your doctor during childbirth is a key concern for women in Serbia. Informal relations transform women from (no)bodies into somebodies, someone?s patient. Women of poorer economic status, women from rural areas, and often women of Roma ethnic origin have limited opportunities to establish informal relations in state maternity hospitals. Informal relations do not fully protect women from interventions but affect the type and timing of interventions.
... Leaving aside the second meaning, we agree with M. Rivkin-Fish (2005) that khamstvo used to be an important tool to control women, placing them under clinicians' authority, and shaping the attitudes of all participants, including the clinicians themselves, who often claimed to feel helplessness in the rigid state paternalistic hierarchies. ...
... Soviet maternity hospitals were closed to any visitors and could be characterised as quasi-total institutes in Goffman's (1961) terms, with opaque rules and practices resistant to challenges from the outside. Consequently, there was unlimited space for healthcare providers to exercise direct power and control over women through the subordination of the latter to medicalised procedures and disregard for their feelings (Rivkin-Fish, 2005). ...
... Women in our and others' studies who had experience of childbirth in Soviet or early post-Soviet periods, endlessly repeat stories about the doctors' and midwifes' boorishness and neglect of their individual needs in a conveyer-like service, in which overloaded wards and ignorant, brusque and overburdened personnel were common (Schepanskaya, 1999;Rivkin-Fish, 2005). ...
This article explores emotional styles of Russian maternity hospitals and their recent changes. We focus on two emotional practices that characterise different emotional styles: the Soviet-associated emotional practice of khamstvo (rudeness) and the post-Soviet neoliberal practice of smiling. Emotional styles in healthcare in Russia have been transformed under childbearing women’s consumer demands and new professional standards. However, maternity care in Russia has not been changed entirely into a neoliberal capitalist one. It is ruled by both bureaucratic paternalist (including direct state control) and consumerist logics simultaneously. The hybridisation of these logics has led to numerous problems in the coordination of institutional inconsistencies, which in turn cause emotional dissatisfaction of healthcare recipients. Doctors and midwives are expected to cope with these interactional and institutional challenges and consequences. They juggle emotional practices that refer to repertoires of different emotional styles, performing one or another according to their reading of the situation and type of patient (‘extra demanding and aggressive’, ‘miserable’, ‘ignorant and noncompliant’, ‘service-oriented’). We argue that the shift from one emotional style to another is nonlinear and leads to the appearance of a hybrid form that makes both emotional practices of khamstvo and smiling coexist in maternity care.
... McClellan (2017) 32. Rivkin-Fish (2005) After reading the preface and introduction of each book to get an overall view of the subject discussed by the author(s), every chapter on medicalization was read multiple times, including endnotes. A list of 228 initial numeric variables (227 nominal and one ordinal) were created with the help of independent evaluations by two other experts on the topic. ...
... Some professionals were cited as working within democratic governments with reinforcing medicalization, as the case of social workers and psychologists (e.g., Sanders, 2017;Conrad and Schneider, 2014), while some worked against communist governments like psychologists during the Cold War (e.g., Rivkin-Fish, 2005). Others were pictured as trying to make the judicial system work (e.g., Ferguson, 2002). ...
... Some authors criticized the way international agencies implement health and maternal policies without taking into consideration cultural norms and structures of local communities (e.g., Sanders, 2017;Chrisler and Gorman, 2015;Cosminsky, 2016;Morsy, 1995;Rivkin-Fish, 2005). ...
Medicalization has been one of the most important topics for feminist agenda and gender studies. During the second wave of feminism, when sexual and reproductive rights were the top concerns for women, is exactly when the studies of medicalization started to grow. The goal of this research is to present some characteristics of the studies that are concerned with the gendered medicalized body by indicating how the medicalization process has been explained, understood and interlaced with different institutions and people. One main concern in this review is to pay attention to how gender is expressed in medicalization studies. Within a qualitative design, and the support of SPSS™, we constructed a mapping review on the literature published in books, and thereafter we developed a content analysis of the chapters on medicalization. An overview of the characteristics of the studies are presented, and after two categories are discussed: (a) meanings of medicalization and (b) medicalizing bodies and its entrepreneurs: a rhizomatic expression. It was concluded the medicalization thesis should be considered as one line of a “rhizome” that connects to different actors, corporations and organizations. In deconstructing the rhizome, the analytical category gender should be understood as a socio-historical construction related to relations of domination and to resistance as well. Also, the medicalization authors should be sensitive to the epistemologies of the Global South.
... In the course of ethnographic research starting in 2017, I have collected contemporary birth narratives describing the decisions and interactions of women and their families with medical professionals and midwives, doulas, and other external perinatal specialists. In narratives from the Soviet and post-Soviet eras, there was practically no mention of independent choice and freedom of action in medical institutions and official discourses, or indeed of the involvement of family members or independent participants in medical care during childbirth [Belousova 2003[Belousova , 2012Olson and Adon'eva 2013;Rivkin-Fish 2005;Rouhier-Willoughby 2003, 2008. However, in contemporary narratives, Russian women convey their agency in some detail and negotiate with the obstetric system for various options [Gramatchikova 2020;Kuksa 2020bKuksa , 2021aKuksa , 2021bKuksa and Shnyrova 2021;Temkina and Rivkin-Fish 2020]. ...
... In this framework, we would be forced to classify tactics to counteract medical authorities as part of a contemporary feminist agenda and as a struggle for political and neoliberal rights and social control over reproduction. Any evaluation of grassroots activism and legal and vernacular protest in Russia must take into account the following essential factors, which the feminist approach ignores: 1) the variable meanings and functions of bureaucratic and vernacular texts (depending on genre, addressees and communicative contexts (or frames) [Bakhtin 1986;Kuksa 2020b]; 2) differences between collective and individual forms of legal prose; 3) obstetric policies at different regulative levels and in local contexts [Kuksa 2021b]; 4) illegal and stigmatized homebirth practices, which are difficult for ethnographers to observe [Kuksa 2018[Kuksa , 2021a; 5) recent medicalization, financing, and technologization of Russian obstetric care; and 6) the majority of obstetricians and gynecologists, from the Soviet era to the present, are women, unlike in the United States [Kuksa 2018;Rivkin-Fish 2005;Rouhier-Willoughby 2003, 2008Sargent and Gulbas 2011]. My approach highlights how informants reclaim agency in vulnerable situations and their oppositional and adaptive tactics when interacting with the obstetric system. ...
The paper analyzes the opposition and adaptation of Russian patients, independent perinatal specialists, and professional human rights activists to normative regulation of obstetric care, medical authorities, and the practices of the Russian maternity hospital. During my ethnographic research, I have collected personal stories about the clashes of women in labor and their assistants (primarily doulas) with the medical system, stories of collective and individual appeals to authorities, and protest flash mobs. The article presents the history of the transformation of the Russian system of obstetrics and the development of grassroots movements by midwives and doulas. It outlines the features of human rights and perinatal protest discourses and identifies the tactics of legal and vernacular resistance and non-resistance to medical authorities encountered during fieldwork.
... Still, for their patients, physicians were clearly institutional representatives of the state health care system -and their authoritarian attitudes seemed to be the very embodiment of the power-hoarding, bureaucratized state. Doctors and patients accused each other of manifesting the negative effects of the Soviet system (Rivkin-Fish 2005). This profound ambivalence over the state furthered physicians' reluctance to align themselves with blatantly politicized agendas, and led them to insist that their perspectives were firmly based on their medical expertise. ...
... The first part of the meeting was quite in tune with the new consumerist culture emerging in the post-Soviet health system, in which, at least discursively, the clients' needs, desires and interests were the focus of health providers' practices. Elena's sudden change of tone recalls Soviet-era disciplining practices aiming at showing patients care through emphasizing physicians' expert authority (Rivkin-Fish 2005). ...
We explore obstetrician-gynecologists’ (ob-gyns’) shifting involvement in late Soviet and post-Soviet reproductive politics and track broader political-economic dynamics of the profession’s ambivalent relations with state demographic discourses. Soviet ob-gyns largely distanced themselves from explicitly pronatalist agendas. Post-soviet national politics of ‘population renewal’ and the neoliberalization of health care have significantly restructured ob-gyns’ orientations. To assert their authority and gain economic footing, ob-gyns have highlighted their contributions to the state’s demographic agendas. The post-Soviet context illustrates how understanding the medicalization of population problems requires examining the political-economic relations between physicians and the state – dynamics that can transform ideologies and medical practices.
... Military chaplains bypass Soviet-era models that medicalise bodies and render the patient passive while medical experts heal (Rivkin-Fish, 2020). Similarly, they shirk neoliberal ideas of individual responsibility as essential to health transformations and reject explanations of 'low levels of kul'turnost' [literally, culturedness, but implying ignorance] as culprits for emotional and physical problems (Rivkin-Fish, 2005). They steer clear of Soviet-era attitudes of khamstvo (rudeness) as inappropriate for healing, just as they reject the new neoliberal 'service with a smile' tenor of paid care providers (Temkina et al, 2020). ...
... One key distinguishing factor emerges among ethnographic studies of therapeutic healing and personhood that are conducted in Russia versus in Ukraine. In Russia social scientists have argued that processes of healing amount to remaking personhood in a mode conducive to a neoliberal economic order that stresses forms of subjectivity that include individual responsibility, discipline and a certain work ethic (Rivkin-Fish, 2005;Lerner, 2011;Raikel, 2016;Matza, 2018). In Ukraine, the emphasis of such programmes has been different. ...
This article analyses the religiously infused talk therapy provided by military chaplains to soldiers as they transition to civilian life. They offer a form of empathic care that centres on dialogue and existential engagement, which often begins in hospital and extends beyond physical healing. Proposals to treat the emotional distress soldiers experience include creating residential centres in monasteries and the use of a religiously oriented therapeutic idiom to ‘work on the self ’ so as to hear and obey the ‘voice of one’s soul’. State-sponsored military chaplains harness religion for therapeutic purposes with the goal of transforming soldiers into high-functioning, religiously committed, patriotic, moral citizens dedicated to protecting a newly fortified sovereign country. This normativises a spiritual dimension to care, healing and understandings of the sources of wellbeing. More broadly, this injects religious practices and symbolism into secular social institutions and shifts the emotional tenor of public domains by mobilising the therapeutic qualities of religion for the purposes of social healing.
... These practices have been found to lower economic growth, increase infant mortality and decrease life expectancy, and increase inequality. (See Olken and Pande 2012 for an overview; see also Shleifer and Vishny 1993;Mauro 1995;Paul 1995;Gambetta 1996;Larrea-Santos 1997;Rose-Ackerman 1998;Heymans and Lipietz 1999;Nwabuzor 2005;Rivkin-Fish 2005;Bertrand et al. 2007;Prasad and Zaloznaya 2021.) Proto-bureaucracies suggest that alternative models are available from within the society itself. ...
The emergence of bureaucracy is often described as occurring at a particular historical period in a society, as a result of the pressures of war, the improvement of communication and transportation technologies, or societywide cultural changes. But recently many scholars have drawn attention to examples of meritocratic bureaucracies in societies otherwise organized according to patrimonial logics, what I call proto-bureaucracies. In this article I investigate one aspect of proto-bureaucracies that has not been examined in the literature: in a society characterized by patrimonial relations, the sudden introduction of meritocratic principles of recruitment may be interpreted as violating the principles of rewarding loyalty or kinship. This can fragment the political coalitions necessary to sustain a proto-bureaucracy. I argue through in-depth examination of one case, and secondary analysis of several others, that to manage the problem of exclusion successful proto-bureaucracies enact performative adherence to nonmeritocratic logics while protecting their meritocratic core. I argue that understanding contemporary proto-bureaucracies can help to develop an organizational strategy for strengthening governance and reducing corruption. The main lesson of proto-bureaucracies is that effective institutions generate exclusion, but meritocratic practices can be sustained if the exclusions they generate can be addressed in other ways.
... In Russia, despite several healthcare reforms, childbirth is still largely medicalized and over-bureaucratized. Sociological research demonstrates that Russian public maternity hospitals are dominated by an 'assembly line' service, in which women do not receive proper care and emotional support (Rivkin-Fish 2005;Temkina 2014). Meanwhile, the commercial maternity care sector contributes more to the empowerment of medical professionals and does not facilitate women's active decisionmaking (Borozdina and Novkunskaya 2020). ...
The Ambivalence of Power in the Twenty-First Century Economy contributes to the understanding of the ambivalent nature of power, oscillating between conflict and cooperation, public and private, global and local, formal and informal, and does so from an empirical perspective. It offers a collection of country-based cases, as well as critically assesses the existing conceptions of power from a cross-disciplinary perspective. The diverse analyses of power at the macro, meso or micro levels allow the volume to highlight the complexity of political economy in the twenty-first century. Each chapter addresses key elements of that political economy (from the ambivalence of the cases of former communist countries that do not conform with the grand narratives about democracy and markets, to the dual utility of new technologies such as face-recognition), thus providing mounting evidence for the centrality of an understanding of ambivalence in the analysis of power, especially in the modern state power-driven capitalism. Anchored in economic sociology and political economy, this volume aims to make ‘visible’ the dimensions of power embedded in economic practices. The chapters are predominantly based on post-communist practices, but this divergent experience is relevant to comparative studies of how power and economy are interrelated.
... Similar ideas started traveling between Cambridge and the Max Planck Institute of Social Anthropology, where "survival" strategies and the study of legal pluralism became a central topic in the early 2000s (Hann 1998;Humphrey 2019;Mandel and Humphrey 2020;Bridger and Pine 1998). This was accompanied by the use of the word informality to refer to the art of "getting things done" while also referring to a wider range of activities, becoming in the process a synonym for graft, corruption, mafia business, the black-market, patronclient relations (Böröcz 2000;Misztal 2000) and studies on the building of support networks (Lonkila 2010;Patico 2002;Rivkin-Fish 2005b). ...
Despite a growing number of studies featuring “informality” in their title, including many from the post-socialist region, little has been done to reach a consensus on what informality means, how to measure it and, more generally, to develop it into a widely agreed and shared theorization. Instead, and paradoxically, given that a significant number of studies rely on intuitive understandings of the phenomenon, often intended as “the opposite of formal”, this increased attention to informality has contributed to topical confusion rather than better defining what informality may be. By surveying and cross-comparing regional and world literature on informality, this article attempts to provide a coherent framework for delineating and understanding “informality studies”, outlining its main characteristics and eventually better understand its applicability and boundaries. While doing this, it calls for more attention to the political dimensions of informality and ways in which measurement of informality can be used both as a proxy for quality of governance and a deeper grasping of state–citizen relations.
... By accenting not just the values of human capacity, individuation and person-to-person linkages, but more so the specific emotional cultures of humanistic psychology, one outcome of these exchanges (and interventions) may also have been to build a bridge between former adversaries that eased tensions and reset détente while also developing a shared language of personal freedom and capacity just before the neoliberal assault on the social, and the spread of capitalism into Russia. As ethnographic research on the post-Soviet context shows, the psychological individualism at the heart of humanistic psychology would appear in a variety of commercial psychological trainings, forms of addiction treatment, privatized forms of women's reproductive services, and municipal institutions in Russia after the Soviet collapse (Zigon, 2011;Raikhel, 2016;Rivkin-Fish, 2005;Matza, 2018). Indeed, my own ethnographic work among psychologists in Saint Petersburg in the 2000s (Matza, 2018) illuminated how the "psy" boom offered new frameworks for personal aspiration, self-cultivation and success, while also reproducing class-based psychological differences through its commercialization. ...
This article discusses a series of US citizen exchanges to the USSR that were termed track two, or citizen, diplomacy. The track two model was meant to address the freeze in high-level diplomatic engagements at a time of heightening tensions between rivals. Intriguingly, track two diplomacy was explicitly emotionalised – that is, linked to a psychologically informed approach to conflict resolution and contact. I focus on two sets of diplomatic delegations – those co-organised by the Esalen Institute and the Association for Humanistic Psychology, as well as grassroots citizen exchanges. Of particular interest is the famous visit by Carl Rogers to the USSR in 1986 where he held a set of workshops that were part of the AHP Soviet Exchange Project. I show the various central roles that discourses on emotions (psychological theories), emotional discourses (the expression of emotions) and emotion-evocation played in these US endeavours. What is particularly interesting to see is how, as the Cold War began to wane, the United States’ emotionalised exchanges became more unidirectional and interventionist in nature. I term this form of emotionalisation ‘emotional warfare’ and conclude that, as pedagogies, techniques and informal contacts, they should be read not only through the prism of friendly exchange, but also through those of geopolitical agonism, as well as the neoliberalisation of both empires in the post-Cold War period. In focusing on these exchanges in the 1980s, the article also makes a contribution to contemporary studies of emotion culture in the post-Soviet context by describing some of the prehistory of Russia’s ‘psychological turn’.
... At the same time, professors claim that while relationships with students have become more emotional, and by this they echo patronage relations, they have also become less intimate and more impersonal. The impersonal emotionality is experienced as alien in Russia, where the previous model of patronage relations in various spheres of public service implied hierarchical or even authoritative relations combined with verbal expressions of care and intimacy (Rivkin-Fish, 2005). ...
In this study, we reflexively focus our gaze on the global shift toward the emotionalisation of academic culture, taking the perspective of a university institution and its staff. We argue that emotional consumerism is fundamental to the current condition of academic teaching; it is embedded in its institutional agenda and shapes faculty’s subjective experiences. Our ethnographic analysis reveals also that understanding emotional academic capitalism requires a cross-cultural lens. Thus, we probe the meanings of teaching in three academic contexts – Russia, Israel and the US – tracing how local neoliberalism, cultural emotional communicative scripts and educational traditions, as well as political cultures, shape the emotionalisation of university teaching differently. Academic teaching in the US appears as care combined with fear; teaching in Israel is articulated as a therapeutic power struggle; while in Russia, teaching is interpreted as a peculiar combination of authoritative impersonalised services. This juxtaposition exposes different local manifestations of neoliberal emotional university discourse that merges therapeutic logic and its emotional language, reconfigures hierarchical relations, and integrates national political ethos into the act of teaching.
... hospitals, private maternity hospitals were opened across the country, etc.), and on the other, it faced an increase in bureaucratic and state control, expressed in additional forms of reporting, threat of criminal prosecution for a medical error, etc. (Rivkin-Fish 2005;Temkina 2014;Novkunskaya 2019;Litvina et al. 2020). The programme of birth vouchers (2006), which could be used at prenatal care centers, maternity hospitals and children's clinics, aimed at increasing the financial interest of medical institutions in attracting patients. ...
The article discusses discursive practices of official and alternative perinatal specialists: obstetricians and gynecologists, midwives of maternity hospitals, domestic midwives and doulas. To analyze these practices, the author uses the notion of authoritative knowledge proposed by Brigitte Jordan and dating back to the power-knowledge concept by Michel Foucault. The author focuses on controversial but widely used concepts such as obstetric violence and natural childbirth . Additionally, the author regards such relatively new for the Russian community concepts as humanization of childbirth, obstetric model , demedicalization of childbirth , etc. The study is based on the materials of the founding conference of the professional non-profit association Obstetric Union , which was held at Moscow Perinatal Medical Center Mother and Child on November 30 – December 1, 2019.
... Référence électronique 3 Un Nouveau mode de vie porte sur la construction d'une sphère privée chez « les jeunes cohortes de la nouvelle classe moyenne » (p. 9). ...
... Diffi culties in the social and economic life of Russian families mean not only diffi culties in providing proper nutrition or accessing satisfactory health care, but accumulate into other problems in the long run, narrowing the possibilities of taking care of oneself and one's children. The logic of the concern over socio-economic diffi culties is that little by little, misery lowers "health culture" (see Larivaara 2007;Rivkin-Fish 2005), "parental culture" and "moral culture". Furthermore, the decreasing educational potential of parents, for instance, maintains low fertility rates, because people in uncertain circumstances are not willing to have children or, according to rhetoric, they simply are not capable of conceiving as a result of their poor state of reproductive health. ...
This article deals with fertility concern in Russian and Finnish population policies. The article points out that some commonly known discourses are persistently used as arguments in fertility-related population policies. In Finland, these include, for instance, discourses on ageing nation and economic competitiveness. Russian policymakers use a crisis discourse that consists of three sub-discourses: demographic crisis, reproductive health in crisis and family crisis. The Russian government implements pronatalist population policies, whereas Finnish authorities hesitate to use the term population policy because of its emphasis on reproductive rights on the one hand, and the negative associations of population policy on the other. Russia has both population and family programs, as well as a new law with a speci? cally pronatalist emphasis. Conversely, Finland uses family policy as a tool of population policy.
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
Boundaries of illegality in markets for goods and services are blurring.
These boundaries are associated with the development of capitalist relations. The illegality becomes pervasive and gains increasingly sophisticated links with formal legality and social legitimacy. At the same time, the role of the state in the illegal market exchanges is intensified by preserving the institutional gap between formal and informal rules. In this respect, the book The Architecture of Illegal Markets. Towards an Economic Sociology of Illegality in the Economy develops a non-trivial research task for the modern economic-sociological paradigm. Its authors contest the existence of boundaries between the phenomena of legality and legitimacy, including mechanisms for compliance with informal rules within formal institutions that regulate illegal markets. The purpose of this review is to demonstrate the paradoxical interdiction of legality and legitimacy that the book’s authors describe, using the metaphor of interfaces that build the essence of illegal market architectures. The review reference points are the most important topics that the authors of the conference proceedings mention, such as the types and components of illegality in the markets of goods and services; the question of the boundaries between legality, illegality, and legitimacy; and the role of the state in the development of illegality in the markets. This text concludes that the book draws the landscape of illegality, which is viewed in close association with the phenomena of legality and legitimacy. The authors’ research goes beyond the phenomenon of illegality and expands the understanding of the informal economy constituents.
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... Реформирование системы родовспоможения проходило постоянно в течение всего постсоветского периода, и его последствия уже получили достаточно широкое освещение в литературе (см.: [Rivkin-Fish 2005;Здравомыслова, Тёмкина 2009;Бороздина 2014а;Тёмкина 2014;Новкунская 2019]). В результате либеральных реформ 1990-х гг. ...
... In Russia, for example, the case of maternity care reforms after the collapse of the Soviet Union shows that the dissolution of the previous regime and the introduction of the "spirit of democracy" are not sufficient to grant women's rights unless the economic and political organization of health care is transformed. 11 While former regimes in both countries provided primary health services, including sexual and reproductive health services, the collapse of the system of power brought about new inequalities and made access to health ...
In this article, we explore the effects that Tunisia's post-revolutionary democratization process has had on the right to abortion, drawing on ethnographic material, interviews, and medical files that we collected between 2013 and 2017, as well as the professional experience of one of us. We show that despite the existence of a relatively liberal abortion law for more than 40 years, women in Tunisia have trouble getting abortion care for economic and organizational but also ideological and political reasons. The existence of the abortion law constitutes but one factor among many others that determine women's ability to access abortion services; medical practices and women's abortion itineraries are caught up within complex arrangements that entail multiple socioeconomic and cultural factors, political transformations, the variability of rules in medical and administrative institutions, and contradictory interpretations of the legal apparatus. Examining the abortion itineraries of seven women we met in a large hospital in Tunis, we argue that these abortion itineraries shed light on the ordinary constraints experienced by poor Tunisian women who cannot afford to turn to the private sector. We maintain that attitudes toward the right to abortion in post-revolutionary Tunisia are problematic and that the democratization of local society has brought about unexpected consequences that do not extend but rather reduce women's rights in the domain of sexual and reproductive health.
... Within the last decade or so, St. Petersburg emerged as a key destination for Western anthropologists, resulting in a growing stream of pioneering research (e.g., Rivkin-Fish 2005, Höjdestrand 2005, Raikhel 2016). With his detailed account of psychotherapeutic practices in St. Petersburg, Matza successfully continues this tendency in Shock Therapy, offering a theoretically enhanced view of the self after Communism. ...
... If, he argued persistently, Perm were to become the best place to make artistic careers, both out of city residents and new arrivals, and if it had the best new art museum, the best experimental theater, the most renowned festival life in the summer months, then federal aid for infrastructural projects such as renovating the train station, airport, or local roads would follow in short order. 1 * * * At the center of the cultural field at the end of the 2000s in the Perm region was, then, a not uncommon paradox: massive state-funded cultural production, recognized by all as such, that was nonetheless cast as a way to diminish the power of the regional state apparatus and to direct the source of creativity, transformation, and entrepreneurship away from the state itself. In the 1990s, the active work of creating selves and state agencies in the wake of socialism was quintessentially that of Western aid agencies, nongovernmental organizations, and other sorts of advisers (see, in a very large literature, Mandel, 2002b;Rivkin-Fish, 2005;Hemment, 2007). In the early 2000s in the Perm region, as I showed in earlier chapters, much of this task was taken up by the oil industry and state agencies working in close concert, in good part on the terrain of culture, through state-corporate grant competitions and the spread of the project movement. ...
This article analyzes interviews with women who use drugs in Ukraine to understand the care conundrum they face as members of a stigmatized group. In the interviews, the women sought to position themselves as deserving and needing care as members of a vulnerable category—sometimes as women who use drugs or people living with HIV, but also as mothers—yet also themselves capable of providing care for others. We examine how women who use drugs in Ukraine navigate a moral economy of care involving judgments about deservedness and social worth, the obligatory nature of care, and expectations for reciprocity. For programs for women who use drugs to be successful, they must acknowledge and engage with the moral economies of care in which these women operate. We offer recommendations for how health and social service providers can better meet the unique needs of women who use drugs.
The sphere of reproduction as an integral part of the health of population today is medicalized at all stages of the formation of reproductive decisions — from conception to childbirth. The choice of reproductive strategies is influenced by two polar trends: the increasing importance of innovative methods of assisted reproductive technologies (ART) and medically-associated reproduction (MAR), on the one hand, and the growing popularity of traditional methods of pregnancy and childbirth management based on folk healing, yoga, oriental medicine and health improving practices, homeopathy, popular psychology and so on., on the other. Thus, two sides of procreative behavior manifest themselves: both the patterns reflecting a biomedical approach based on scientific innovations and the social behavioral models related to public perceptions of health, well-being and gender roles in the society. The article presents the results of a pilot survey of women of reproductive age (n=54) conducted in April 2022 via an electronic questionnaire. The study focused on two topics: ART (awareness and attitude to various ART programs) and pregnancy and childbirth (perception of different forms of preparation for childbirth, the preferred form of childbirth, attitude to medical interventions in the birth process). Data analysis showed that women's reproductive intentions remain medicalized and take into account the possibilities of ART. Also, the results of the survey confirm the growing demand for humanization of maternity care, which is reflected in the desire of women to carefully approach organization of their own childbirth and team of assistants, to attend courses for expectant parents, be more informed and comprehensively prepared.
This article looks at six months of the author's repeated attempts to obtain the approval of three Helsinki Committees (HCs, Israeli hospitals’ research ethics committees) to conduct ethnographic research with Palestinian physicians in Israeli hospitals. While the research was eventually approved and carried out in two of these institutions, correspondence with HC representatives, as well as evidence of their informal moves with institutions’ management, reflect their perceptions of the risks the study posed. In the Israeli hospital, acknowledging Palestinian political subjectivity challenges the definition of Israeli nationhood as exclusively Jewish and contaminates the allegedly politically neutral medical sphere. These committees exerted their power to serve their institutions and state ideology. This, I argue, should not be understood as anomalous instances of negligence. I show how the committees’ censorship was attuned to the Declaration of Helsinki as their guiding text and Zionism as their underlying ideology. Embedded in the powerful regimes of ethics, bureaucracy, science, and health, ethics committees employ “unarmed power” that is beyond critique. They are well‐oiled “anti‐politics machines,” rearticulating political concerns into a depoliticized moral discourse. As such, they not only limit academic inquiry but also redefine, in political terms, the realm of the moral. Este artículo analiza seis meses de intentos repetidos del autor para obtener la aprobación de tres Comités de Helsinki (HCs, comités de ética de investigación de hospitales israelíes) a conductas de investigación etnográfica con médicos palestinos en hospitales israelíes. Mientras la investigación fue eventualmente aprobada y llevada a cabo en dos de estas instituciones, correspondencia con representantes de los HCs, así como evidencia de sus movimientos informales con el manejo de las instituciones, reflejan sus percepciones de los riesgos que el estudio planteaba. En el hospital israelí, el reconocer la subjetividad política palestina reta la definición de sentido de nación israelí como exclusivamente judía y contamina la esfera médica alegada políticamente neutral. Estos comités ejercieron su poder para servir a sus instituciones e ideología estatal. Esto, argumento, no debe ser entendido como instancias anómalas de negligencia. Muestro cómo la censura de los comités estuvo sintonizada con la Declaración de Helsinki como su texto guía y el sionismo como ideología subyacente. Embebidos en los regímenes poderosos de ética, burocracia, ciencia y salud, los comités éticos emplean el “poder desarmado” que está más allá de la crítica. Son “máquinas antipolíticas” bien aceitadas que rearticulan preocupaciones políticas en un discurso moral despolitizado. Como tal, ellos no solo limitan la investigación académica sino también redefinen, en términos políticos, la esfera de la moral. [etnografía hospitalaria, neutralidad, nacionalismo, IRB, Israel/Palestina] מאמר זה בוחן שישה חודשים שבמהלכם ניסה המחבר להשיג אישור משלוש ועדות הלסינקי (ועדות אתיקה של בתי חולים בישראל) לקיים מחקר אתנוגרפי עם רופאים פלסטינים. המחקר אושר לבסוף, והתקיים בשני בתי חולים, אך התכתבות עם נציגי הועדות ועדויות למהלכיהם הנסתרים עם הנהלות המוסדות הצביעו על תפיסתם את הסיכונים שבמחקר. בבתי חולים בישראל, הכרה בסובייקטיביות הפוליטית של פלסטינים מאתגרת את הלאומיות הישראלית כיהודית בלבד ו“מזהמת” את המרחב הרפואי שנתפס כניטרלי פוליטית. הועדות האלו הפעילו את סמכותן כדי לשרת את המוסדות ואת האידיאולוגיה הלאומית. אני טוען כי זו אינה רשלנות מקומית ומראה כיצד הצנזורה שהפעילו הייתה בהתאמה עם ‘הצהרת הלסינקי’ כמסמך היסוד, והציונות כאידיאולוגיה המנחה. ועדות אתיקה נהנות מהסמכות שבארבעה משטרי שיח חזקים: מוסר, ביורוקרטיה, מדע ובריאות ומפעילות כח ‘בלתי חמוש’ אשר אינו נתון לביקורת. הן מכונות משומנות היטב של ‘אנטי‐פוליטיקה’, מנסחות שאלות פוליטיות בשיח מוסרי. ככאלו, הן לא רק מגבילות מחקר אקדמי, אלא גם מגדירות מחדש, באופן פוליטי, את השדה המוסרי. يدرس هذا المقال ستة أشهر من المساعي للحصول على موافقة ثلاث لجان هلسنكي (لجان الأخلاقيات البحثيّة في المستشفيات الإسرائيلية) لإجراء بحث إثنوغرافي مع الأطباء الفلسطينيين العاملين في المُستشفيات الإسرائيلية. في النّهاية، تمت الموافقة على الدراسة، وتم إجراؤها في مستشفيين، لكن المراسلات مع ممثلي اللّجان والأدلة على تحركاتهم غير الرّسمية مع الإدارات المؤسساتية تشير إلى إدراكهم لمخاطر الدراسة. فَفي المستشفيات الإسرائيلية الاعتراف بالذّاتية السّياسيّة للفلسطينيين يتحدّى القوميّة الإسرائيليّة باعتبارها يهوديّة بَحتة و“يلوّث” الحيّز الطّبيّ الذّيّ يُنظر إليه على أنه محايد سياسيًا. مارست هذه اللّجان سلطتها لخدمة المؤسسات والفكر الإسرائيليّ. أنا أزعم أن هذه ليست حالة شاذة من الإهمال وأن الرقابة التي مارسوها تتماشى مع “إعلان هلسنكي” والصهيونية كإيديولوجيا. تتمتع لجان الأخلاقيات بسلطة الأخلاق والبيروقراطية والعلوم والصحة وتمارس قوة “غير مسلحة” غير خاضعة للنقد. إنها “آلة مُجَهَّزَة جيداً لمُعاداة السياسة”، تعيد صياغة الاهتمامات السياسية لخطاب أخلاقي غير مسيَّس. فبذلك، لا يحدّون من البحث الأكاديميّ فّحسب، بل يُعيدون أيضًا، تعريف عالم الأخلاق سياسياً.
Практика обучения беременных женщин на специальных курсах приобретает все большую популярность в связи с широким распространением сознательного родительства. Подготовка к родам выполняет множество различных функций: получение информации, физическую тренировку, гендерную социализацию, общение, психологическую настройку и пр. В статье на основе полевых материалов, включающих интервью с женщинами и инструкторами, а также данных включенного наблюдения рассматриваются различные стили подготовки к родам, представленные в родительских центрах. Концепция авторитетного знания о беременности и родах позволяет провести анализ знания, которое производится и передается в рамках подготовки к родам и охарактеризовать его как своеобразный синтез (био)медицинского и альтернативного знания, в том числе опытного знания индивидуальных (домашних) акушерок. Этот подход также обращает внимание на форму распределения авторитетного знания, обусловленную характером взаимоотношений между акторами – горизонтальными (партнерскими) или иерархичными (патерналистскими). Автор приходит к выводу о существовании нескольких моделей подготовки к родам, которые условно можно обозначить как радикальный, неолиберальный, традиционалистский и рефлексивный. Радикальный вариант подготовки, восходящий к модели, сложившейся в среде альтернативных родителей в 1980–1990‑е гг., использует риторику личной ответственности женщины за исход родов и не рассматривает беременных женщин как пациенток. Неолиберальная модель, тесно связанная с идеологией интенсивного материнства, ориентируется прежде всего на экспертное знание врачей, но также на знание профессиональных акушерок и руководителей курсов подготовки к родам. Традиционалистский подход апеллирует к патриархатным семейным ценностям и гендерным ролям, и стремится к воссозданию атмосферы расширенной семьи и доброжелательному общению в «женском круге». В рамках рефлексивного подхода предпочтение отдается психологическим и медитативным практикам, подготовка к родам позиционируется как творческий проект самой женщины, в который вкладываются важные смыслы.
Interwar educators founded choir associations to cultivate “composed” emotional forms of ethnic minority solidarity, and this chapter is based on ethnographic participant observation of contemporary Catholic singing groups. While contemporary choirs identify with their predecessors’ ethical goals, teaching others to sing virtuously also enables Catholic singer-educators to carry forward the socialist-era project of civilizing the peasantry. However, the Szekler cultural revival, a cultural initiative promoted by the county government, threatens to destabilize virtuous singing, especially when choirs are drawn into performances of “uncivilized” rural masculinity. How and when choir members do the work of addressing their doubts and renewing their commitment to educational reform demonstrates not only their cultural creativity but also how this labor is unequally distributed among vocational educators.
Sociological scholars of healthcare professions are becoming increasingly aware of the organisational dimension of professionalism, including how professionals as institutional actors are exposed to and influence organisational transformation. By tracing the ground‐level professional efforts of Russian doulas—a caring profession that has been plunged into a reforming health system—in this article I explore how meaning‐making activities and professionals' emotional labour build into and advance institutional changes in post‐socialist maternity care. Drawing on qualitative research materials, I define three ways through which doulas' institutional efforts engage with emotions in clinical settings: (1) redefining emotional labour as a compound of maternity care; (2) grounding emotional labour in the context of reforming institutions; (3) using emotional labour to bridge discrepancies within organisational arrangements in healthcare. My research findings provide new insights into how marketisation influences professional care, as well as about caring professionalism in post‐socialist maternity care. Attention to doulas' professional efforts allows for the affective transformation and inequality in the context of healthcare reforms to be analytically grasped. In particular, I trace how doulas' institutional agency embodied in emotional labour constructs the neo‐liberal patient's identity.
To most, if not all, people active in the anti-corruption industry, this transaction that I witnessed has all the features of a bribe. The nurse could (or should) have refused the money since she had already a salary paid from the state and was not going to declare that extra income. But such a gesture has a different meaning in a hospital in London and Kyiv. In the latter context, doctors would work long hours for a salary that is a fraction of what they need to get to the end of the month.
Research into private businesses in post-Soviet Russia began with the collapse of the Soviet Union. This paper focuses on a specific segment of private entrepreneurs—semi-informal SME—and revises the concept of a ‘new entrepreneurship’ in Russia. The persons under study who entered into business were not always motivated by economic gain. Morality and loyalty play an important role in the modus operandi of such enterprises. In their activities, entrepreneurs are led by local social norms that often do not support the earning of direct profit. This attitude contradicts the dominant approach in academic writing, where private entrepreneurs in post-Socialist countries see entrepreneurship as a new perspective and an act of self-fulfilment. The strategy of the entrepreneurs under study is also oriented against constant expansion and innovation. Such practices are caused by the current economic climate in Russia, where the state shows little interest in the activities of small and medium-sized entrepreneurs. This article suggests that there is a need for new conceptual tools to analyse these facets of the private economy.
Our paper looks at e-nformality as the bodily and spatial relationship between people and the state and various services changes, available online, and now people from teachers to doctors can be contacted via WhatsApp if you have the right relations, when earlier it used to be phone calls or knocking doors. Besides, it illustrates how the above relationship become more visible for people and also for researchers as new semi-public and informal spaces emerge in the multiple WhatsApp groups which seem to surpass Diesel and other online platforms from old-school times (odnoklassniki). Furthermore, we trace here these informal networks in order to better understand how informal access to public resources works along inter-generational dynamics (elderly people, intergenerational solidarity, gendered division of responsibilities and support), and to better understand how it works through lateral support (exchange of services) networks, involving groupmates (odnoklassniki) and other social networks, especially in the context when the state institutions are weak.
In the recent years, Poland has emerged as an attractive migration destination and has witnessed a substantial growth of the migrant population, especially coming from Asian countries. This has been especially visible in the urban and suburban areas around big cities. The chapter discusses the visible shift to diversity in the character of a suburban neighbourhood of Warsaw, and tries to uncover what it means for the different migrant groups in terms of access to the labour market, the formal and informal practices they engage in, and the role it plays in the migrant imaginary of post-socialist Poland. Thus, we take a closer look at migrant networks that are the basis of migrant life in Poland and allow them to legalize their stay, find employment, and build a safe environment for themselves. Not being part of the Polish informal networks leaves migrants unable to use the local strategy of “załatwianie” (getting things done”), and thus not integrated into the official labour market. We argue that using informal migrant networks in order to cope with everyday life in a foreign country is a substitute to the local practice of “getting things done”. Thus, we analyse how migrants, excluded linguistically and socially from the Polish labour market, are also being pushed into ethnic niches. These businesses are concentrated in the food and beauty sector. The last strategy we describe is entering the grey zone economics through undeclared or half-legal work.
In 2017, the Ukrainian Parliament approved a bill that marked the start of long‐awaited health care reform. Yet it met opposition from the Trade Union of Health Care Workers, which organized a mass protest against the proposed reform. I argue that the union’s resistance can be understood as an accrual of insecurity experienced by providers of clinical labor in Ukraine’s changing health sector in the last several decades. Although no comprehensive overhaul of the health care system had taken place until 2017, there have been changes on the level of everyday practice; these changes have left health care providers disillusioned about the commitment and expertise of politicians to effect positive change in the health sector, forced them to combine several lines of work to generate enough income, and have left them and their patients vulnerable to the market. Supporters of the union found that the language of the reform lacked a commitment to social protections, and instead it focused on poor health indicators, eliminating inefficiencies, cost‐saving mechanisms, and physicians’ failures in providing quality care. Trade union demands have attempted to refocus the narrative by drawing attention to the difficult conditions faced by clinical labor in Ukraine and the need to recommit to health care as a human right.
For fifty years, first-trimester abortion has been steadily available, legal, safe, and cost-free in Cuba. But in the context of enduring gender disparity, societal attitudes surrounding the procedure vary widely. Women’s often-recurring use of abortion evokes sexual emancipation for some, while others see abortion as a wound that men inflict on women. Men and women express a variety of emotional and practical concerns that highlight the complexity and dynamic nature of the issue. Drawing on ethnographic research from 2016 to 2020, this article argues that men and women’s influences on one another are central to the ways in which abortion is “lived” and to the process of determining abortion’s intimate significance. Whether abortion is experienced as a normalized practice or viewed as something that could never be “normal,” a thorough consideration of men and women’s shared generation of this meaning is crucial to understanding the place of abortion in Cuban society.
Framing the Fantastic examines the social and material processes of imagination, co-constructed by children and adults in institutions of childhood in the city of Almaty. This dissertation shows how make-believe endeavors create and maintain relations with present and absent others, these creative processes nonetheless part of the sensory, material worlds in which people live. This project examines how people animate objects and humans – bringing them to life or compelling them into action, revealing the ways citizens – including children – become involved in shaping and creating ideologies of childhood and futurity. In Almaty, the former capital and largest city of Kazakhstan, children appear in public life, adults valuing child performance as a source of entertainment and as a pedagogical method. Meanwhile, adult artists use puppetry to socialize young children, a form of entertainment that became institutionalized under Soviet times in urban centers around the USSR. According to local puppet artists, the medium of puppetry offers a material instantiation of essential qualities that make these animated objects ideal forms for children to understand abstract qualities, such as good and evil. Based on participant observation and the analysis of video collected over the course of 24 months of fieldwork, Framing the Fantastic examines the rehearsals and performances of a government-run puppet theater alongside the daily activities of a temporary, state-sponsored home for preschool-aged children, called Hope House. Parents placed children at Hope House with the promise of resuming care for them when the children were old enough to begin school. Fantasy played an important role at Hope House in two ways: First, children and teachers, in play and in daily lessons, imagined and anticipated life outside Hope House, these fantasies often centered around the children’s family homes, to which they would return. Second, due to the complex network of state, corporate, and nongovernment sponsors providing material support for the home’s functioning, a regular influx of visitors meant that children became adept at singing and dancing for visiting adults. These performances offered outsiders evidence of the children’s abilities in a context of frequent stigmatization of institutionalized children. At the puppet theatre, a massive renovation of the theatre’s building prompted an overhaul of the troupe’s repertoire. An influx of new directors gave rise to new techniques of animation, which they linked to larger-scale questions of the theater’s role in reaching audiences in twenty-first century Kazakhstan. Attempts to change modes of artistic production highlighted tensions within ideologies of performance as both work and play. The processes and discussions surrounding animation and de-animation, moreover, reveal these endeavors as both intimate and hierarchical, as actors move through other bodies or treat their own bodies as instruments of manipulation. This dissertation reveals the intersensory and intersubjective processes through which children and adults give life to characters and to stories, and the ways these processes create, alter, or maintain social relations. It examines slippery relationships between humans and nonhumans, and between “play” and “real,” as actors distribute and accept agency, responsibility, and sentimental attachments. It rejects common separation of childhood and children — or of ideology versus lived experience — to show how these projects of animating childhood shape children’s experiences and their relationships with adults. In contemporary Kazakhstan, children become symbols of futurity, offering the possibility of social transformation, while also anchoring nostalgia for adults’ own pasts.
As a result of reforms aimed at adjusting it to the market economy, the Polish health care system has become a complicated mix of public and private services. Using as an example maternity services, I show how private services allow a subtle process of patient selection to emerge, contributing to the fragmentation of public care. The process of selection is based on social relations formed between health care providers and patients through the use of private services. This has a negative impact on women who do not have the social or financial resources to engage in private services.
W wyniku reform mających na celu dostosowanie do gospodarki rynkowej, opieka zdrowotna w Polsce przekształcona została w skomplikowaną mieszaninę usług publicznych i prywatnych. Na podstawie świadczeń położniczych, pokazuję, w jaki sposób prywatne usługi zdrowotne stały się „oknami” pozwalającymi na subtelną selekcję pacjentów. Selekcja ta oparta jest na relacjach społecznych nawiązywanych pomiędzy lekarzem/położną a pacjentką przy okazji korzystania z prywatnych usług i prowadzi do fragmentaryzacji opieki publicznej. Proces ten szczególnie negatywnie wpływa na kobiety, których zasoby społeczne i finansowe nie pozwalają na korzystanie z prywatnych usług zdrowotnych.
The article relies on qualitative research methods to investigate how by the means of institutional work healthcare professionals introduce patient-centered care in Russian maternity hospitals. Post-socialist healthcare is commonly viewed in academic literature as a highly centralized and state-controlled domain, where autonomy and agency of both patients and practitioners are significantly restricted. Our research contributes empirically to scholarly debate by questioning this assumption and by providing shreds of evidence of healthcare professionals’ ground-level initiatives. On the conceptual level, we add to the discussion about the dynamic interrelation between institutional change, clients’ demands, and the transformation of professionals’ position. We argue that neoliberal reforms in Russian healthcare have created institutional uncertainty which is strategically used by professionals to expand the scope of their workplace autonomy and to develop patient-centeredness as an institutional innovation. However, our research shows that the resulting model of patient-centeredness contributes to empowering healthcare practitioners, rather than to increasing patients’ participation in decision-making.
This article situates feminist research and activism in the post‐socialist world. Focusing mainly on Ukraine and Russia, but drawing on research from around the region, this genealogy explores the unique contributions of feminist and gender‐based activism before, during, and after state socialism. It is organized around the tension between feminism and nationalism that has been present in Ukraine from the 19th century to the present day, and it asks how this tension has generated a vibrant feminist discourse despite backlash. The article highlights the overlap between feminist scholarship and activism, treating both as essential to the development of a regional feminism.
Статья представляет собой краткий обзор ключевых российских и зарубежных исследований перинатальной культуры. В работе рассматриваются разнообразные теоретические подходы к изучению и анализу практик родовспоможения и текстов о родах, а также обозначается многообразие научных проблем, концепций и методов, применяемых для исследований культуры деторождения и родовспоможения в отечественной и зарубежной академической среде. Материалами для обзора и анализа послужили академические публикации российских и англоязычных исследователей за последние 40 лет.
Статья посвящена обзору наиболее актуальных концепций гуманизации деторождения в современном мире в целом и в России в частности. Причиной выделения российского опыта в самостоятельную проблему стало очевидное усиление в последние годы «родильного нарратива» в информационном пространстве Рунета, где молодые россияне выражают недовольство существующей практикой оказания акушерской помощи в российских родильных домах. Однако повышенная активность россиян в оценке современных акушерских процессов характеризуется высокой степенью неопределенности ценностных ориентиров. С одной стороны, молодые женщины обсуждают проблему медикализации родов, а, с другой стороны, в блогосфере Рунета растет осознание такого понятия, как гуманистические роды, учитывающие убеждения и чувства женщин, их достоинство и независимость при принятии решения в процессе оказания акушерской помощи.
The dramatic drop of the fertility rate in Brazil, from 6.2 births per woman in 1960 to 2.5 in 1996, has been attributed to women’s increasing use of sterilisation. Despite the fact that sterilisation was illegal, Brazil had the second highest rate in the world in 1996, at 40.1%. Political concerns regarding the abuse of the operation led to the legalisation of sterilisation in 1997 to provide regulation of the procedures. Subsequently, rates of reversible contraception have increased, and sterilisation rates dropped to 21.4% by 2013. Sterilisation in Brazil is thus a useful case study to examine how changing socio-legal contexts can influence experiences or understandings of this contraceptive technology.
This research is based on semi-structured interviews conducted in 2013 with 35 women from a variety of socio-economic and ethnic backgrounds in Rio de Janeiro. This thesis is informed by a sociological perspective on health technologies that takes account of the social context and of lay users’ views of their experiences. Several different domains of social life that have an influence on participants’ understandings of sterilisation are thus examined, including: wider reproductive discourses, family and intimate relationships, the medical institution within which contraception is provided, and prior experiences of reversible contraceptive technologies.
The thesis demonstrates the importance of examining sterilisation as a socially-mediated practice. At the institutional level, my analysis illustrates how women navigate the shifting ambiguous socio-legal context, as well as the systemic barriers to healthcare, when accessing sterilisation. The influence of intersections of gender, race and class are highlighted in this process, and is evident in women’s experiences of family and intimate relationships. At the embodied and individual level, the significance of the design of contraceptive technologies is emphasised, as well as women’s prioritisation of their own emotional and physical wellbeing and sexual pleasure. Furthermore, the analysis highlights how reproductive discourses intersect with cultural notions of family ideals and everyday practices, to influence both decisions about and understandings of sterilisation. Overall, the thesis illustrates how sterilisation is a socially mediated practice that varies dependent on macro contexts of cultural reproductive discourses, as well as institutional, interactional and individual levels.
In this article I explore the extent of women's participation in the executive and legislative branches of Russian government, with emphasis on the federal level. In the executive organs of power the absence of women stems from decisions made by powerful political figures and leading bureaucrats; in parliament, public opinion plays a larger role. I will direct attention toward historical continuity, since much in contemporary Russian society, including barriers to women's political participation, reflects ties with the past. At the same time, the 1990s have given birth to new trends and unprecedented events, such as the growing activism of independent women's organizations and the surprising electoral victory of the Women of Russia bloc in the 1993 Duma elections. It should be noted that by focusing on the federal level, I inevitably neglect the greater success that women have had in securing political representation across Russia's regional units.
The health care systems of most advanced industrialized countries are currently undergoing extensive reforms. In Europe, in addition to economic and political issues, issues of "equity" and "solidarity" are very much on the minds of some health care reformers. Elsewhere in Europe, economics and politics dominate health care reform, and concerns about fairness are either absent or of secondary importance. Similarly, the recent health care debates in the United States were largely carried out in terms of payment schemes, cost-containment and outcome measures, campaign strategies, and political concessions. Issues of fairness were either hidden in the many features of the competing proposals and the debates about them, or totally ignored. In both cases, there has been no practical way to gauge how a given change would alter the equity or fairness of existing health care services. This article addresses that void by presenting ten scorable benchmarks of fairness.
This paper examines managed competition as a solution to the inefficiencies, bureaucracy and sclerosis of national health care systems. Managed competition promises to overcome the many dangers and limitations of using competition in medicine that have been previously identified. However, the inner logic of managed competition has several contradictions and flaws that undermine its own goals and may even make equitable, efficient health care more difficult to attain. The paper concludes with recommendations for attaining the same goals more effectively.
Since the mid-50s, induced abortion (IA) has been the principal method of birth control for as much as 80% of the U.S.S.R. population, with more than 9 million of terminations performed annually. After brief discussion of the general and specific reasons for a long-term IA dominance in family planning practices, data of the national statistics and local surveys on IA prevalence, contraceptive use and their determinants are critically reviewed. Although most couples are willing to use contraception, they have to rely on traditional methods with high failure rates (withdrawal, condom, rhythm/calendar). Due to many years of misleading information, population views on pros and cons of various birth control methods are severely biased. Public health implications of multiple IA are summarised.
Modern socio‐cultural studies of medicine demonstrate the symbolic character of much of medical reality. This symbolic reality can be appreciated as mediating the traditional division of medicine into biophysical and human sciences. Comparative studies of medical systems offer a general model for medicine as a human science. These studies document that medicine, from an historical and cross‐cultural perspective, is constituted as a cultural system in which symbolic meanings take an active part in disease formation, the classification and cognitive management of illness, and in therapy. Medicine's symbolic reality also forms a bridge between cultural and psychophysiological phenomena; the basis for psychosomatic and socioso‐matic pathology and therapy. This in turn becomes a central problem for medical theory and for a philosophical reinvestigation of medicine.
Recent studies have noted a new conservatism among international health organizations as they shift from policies of comprehensive primary health care to more vertical programs of disease control in the Third World. Health care efforts in Nicaragua since 1979 offer an arena in which to analyze the role of the World Health Organization (WHO), the Pan American Health Organization (PAHO), and the United Nations International Children's Emergency Fund (UNICEF) in the elaboration of Nicaragua's health development policy and practice over time. I conclude that international health organizations can play an important role in the consolidation of popular democracy in developing nations, especially when this is part of the political agenda of the host country.
The socialist and postsocialist contexts offer important challenges for anthropologists developing a critical analysis of fertility. The need for fertility studies to address class and gender inequities is often overlooked by postsocialist scholars, whose work is mired in responses to the socialist past and ongoing pronatalist campaigns. I examine the ways that fertility analysis has been used in national political struggles in Russia, and explain why supporters of democratic reforms and women's rights have neglected to address gender and class issues in their fertility studies. While Russian nationalists cite fertility decline as proof that market reforms threaten Russia's existence, defenders of neoliberalism draw on demographic transition theory to redefine fertility decline as a universal sign of socioeconomic development. Working with conventional demographic paradigms and a postsocialist cultural logic, Russian transition theorists simultaneously oppose pronatalist politics, support women's reproductive choice, and reproduce the limitations of liberal paradigms regarding the family, society, and public policy. This article shows how anthropological critiques of demographic transition theory can be expanded and nuanced by considering the ways this theory gets adapted to particular cultural logics and political contests. [Keywords: anthropology and demography, postsocialism, Russia, fertility decline]
Over the last decade, many developing nations have embraced Primary Health Care (PHC) within their national health plans. PHC, in contrast to earlier approaches to national health development, emphasizes community participation and basic health care for the poorer segments of society. The research reported here finds that in the enthusiasm for the PHC concept in Nepal, important sociocultural processes have been overlooked. This paper describes the relationship between certain sociocultural factors and PHC activities in rural Central Nepal. It reveals a contradiction between the stated PHC intentions to address local interests and promote community participation on the one hand, and the actual approach taken on the other hand. Specifically it argues that PHC is encountering problems in Nepal for three reasons: (1) PHC fails to appreciate villagers' values and their own perceived needs. In particular, PHC is organized primarily to provide health education, whereas villagers value modern curative services and feel little need for new health knowledge. (2) PHC views rural Nepali culture only pejoratively as a barrier to health education. Alternatively, local cultural beliefs and practices should be viewed as resources to facilitate dissemination and acceptance of modern health knowledge. (3) In attempting to incorporate Nepal's traditional medical practitioners into the program, PHC has mistakenly assumed that rural clients passively believe in and obey traditional practitioners. In fact, clients play active roles and are themselves in control of the therapeutic process. Thus, instead of attempting to recruit traditional practitioners to do its work, PHC should recognize the precedent for community participation in Nepal's traditional medical system and develop the respect for villagers' own ideas and values that traditional practitioners already possess.
This paper describes the changes being introduced into the Russian health care system, particularly the introduction of a compulsory social health insurance system which is paralleled by encouragement of independent health insurance. An example of the implementation of these changes is provided by the early developments in St Petersburg. The effects of the likely changes on health care providers and users are discussed. It is argued that in the light of these reforms, as well as change in other countries, a revision is necessary in the perspectives adopted by geographers of health care to compare national health systems.
A survey was made of 375 Russian gynecologists. The questionnaire on family planning and contraceptives was distributed at the beginning of three local educational symposia. Almost all participants filled in the questionnaire on attitudes, knowledge and experience with family planning. The sample consisted of departmental specialists and heads of departments/clinics, working mainly at in- or out-patient women's health clinics. The mean age was 37 years; 83% were women, living in medium-sized or large cities (80%). Half of them had been working as a gynecologist for more than 10 years. Only 55% had been trained in family planning. The main reasons mentioned for the high abortion rate in Russia were the lack of education, non-involvement of male partner, and lack of modern contraceptives. Most of the gynecologists were in favor of special family planning clinics with special attention to services for the users. About half of the physicians knew how the pill works and estimated that 41% of women know that the pill contains estrogens. Sixty-two percent found that patients are badly informed about available contraception. Main sources of information on contraception were journals/books, colleagues and mass media. The majority reported having a directive style of patient counseling, and stated that parents should be informed of their teenagers' sexual experiences. The more experienced physicians with a training in family planning were better informed on contraception and showed a more patient-concerned attitude. It is concluded that health care providers should be the main target group of training and education in family planning, and need the support of Western European family planning organizations.
Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process.
Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research.
Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion.
Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes.
The authors compare the development of state and non-state public health. They analyze the potentialities of non-state noncommercial medicine and the peculiarities of its development. With this aim in view, they consider the forms of property and numerous organizational and legal forms of institutions and organizations in public health, as well as the mechanisms of quality control within the framework of non-state public health.
The authors discuss the new approaches to the solution of a complex of medicosocial problems which should not be disregarded when developing the strategy of public health development under conditions of reformation of the Russian economy. An integral system of medicosocial care of the population both at the federal and regional levels should be formed and the mechanisms and methods of its realization developed in order to pursue an effective medicosocial policy, which represents an integral element of the strategy of public health development, with due consideration for the social, economic, demographic, ecological, sociohygienic, and other factors. The authors believe that medicosocial policy should be characterized by clear-cut strategic direction as regards all public health services.
This article examines medical utilization patterns and attitudes toward the medical care system among the citizens of Russia's second largest city, St. Petersburg. It focuses upon the extent to which both attitudes towards and usage of medical care institutions have changed in the immediate post-Soviet period. A particular concern has been to determine the degree to which utilization and perceptions vary across the socioeconomic status hierarchy. The data were collected in two stages: a mass survey (N = 1500) conducted in mid 1992 and intensive follow-up interviews (N = 44) conducted in late 1994. The findings indicate that urban Russians were very critical of their medical care system at the end of the Soviet period. Most feel that the system has deteriorated even further since the end of 1991, and they are particularly worried about the emergency care system and about hospital conditions. Although people believe that the system now includes more alternatives, very few have changed their medical utilization patterns to take advantage of these new possibilities. This is more a product of their perceived high cost than of principled opposition to "pay" medicine. The analysis also demonstrates the extent to which medical utilization differs by socioeconomic status. lower status individuals tend to utilize the formal medical care system. High status individuals seek help from a variety of sources and, in particular, rely much more heavily on informal connections to the medical care system. The medical help-seeking strategies of higher status groups have proven to be reasonably adaptable to the post-Soviet medical marketplace, while for others finding good quality medical care remains more problematic.
Elements of a "managed market" for health services have been introduced into the Russian health care system, which under the Soviet regime was run as a comprehensive state-managed system. The authors examine the recent development of health service reforms in a case study of the city of St. Petersburg and the surrounding Leningrad region. Evidence from key informants and a local survey of service users shows how alternative models of the managed market are being introduced in different parts of the study area. A critical review of the market-oriented strategies for reform emerging in the case study suggests that such reforms carry risks associated with the "traps of managed competition." Future policy for health service systems in Russia must take these risks more fully into account.
As development organizations undertake the task of improving the public health in former socialist states, their interventions are shaped by a particular cultural logic and predetermined frame of possible action. In the context of local encounters, however, they often confront competing interpretations of a society's prevailing needs. How they manage such differences may not only explain the outcomes of a given project, but may also reveal the capacities and limitations of development agencies to engineer post-socialist change. This article examines a recent WHO project in St. Petersburg, Russia, which defined women's "social well-being" as a local health concern. While the project employed a discourse of "democracy" to promote women's empowerment in the clinic, its parameters of intervention neither incorporated local knowledge nor addressed the structural relations underlying clinic-level conflicts. Two kinds of results ensued: the ideology of democracy was rejected, while WHO's recommendations were partially appropriated as profit-making strategies.
�� All societies have organizing accounts—what anthropologists call myths — about the nature of their social institutions, how they came to assume their current accomplishments and troubles, and what needs to be done to overcome those troubles. These myths, sometimes called accounts or ideologies, are often used by institutional and political leaders to guide and explain their policies or decisions and may in fact be quite different from the accounts they give. Both those who profit and those who suffer from these actions understand their riches or plight as “the way the world works.” The seers who teach, elaborate, and sometimes overthrow modern myths are often professors. From a comparative sociocultural point of view, “competition” is a dominant myth or ideology in modern society that is used to explain and justify how economic activity is organized. As an organizing ideology, competition is socially radical because it encourages individuals and institutions to do whatever they can to maximize their own gain, and it deplores government, even democratic forms of governing social life, as inefficient impediments to “unfettered competition” and “free markets.” The compelling promise of competition is that the energy and imagination unleashed by maximizing individual gain will increase the wealth and power of the society as a whole, though beneficial competition only occurs if a number of conditions or restrictions are in place. Otherwise, this unleashing of selfish pursuits benefits insiders and or exploits outsiders in a number of schemes to make easy profits, rather
In keeping with the introduction of market-oriented reforms since the collapse of the Soviet Union, Russia's health care system has undergone a series of sweeping changes since 1992. These reforms, intended to overhaul socialized methods of health care financing and delivery and to replace them with a structure of competitive incentives to improve efficiency and quality of care, have met with mixed levels of implementation and results. This article probes some of the sources of support for and resistance to change in Russia's system of health care financing and delivery. It does so through a national survey of two key groups of participants in that system: head doctors in Russian clinics and hospitals, and the heads of the regional-level quasi-governmental medical insurance Funds. The survey results demonstrate that, on the whole, both head doctors and health insurance Fund directors claim to support the recent health care system reforms, although the latter's support is consistently statistically significantly stronger than that of the former. In addition, the insurance Fund directors' responses to the survey questions tend consistently to fall in the shape of a standard bell curve around the average responses, with a small number of respondents more in agreement with the survey statements than average, and a similarly small number of respondents less so. By contrast, the head doctors, along a wide variety of reform measures, split into two camps: one that strongly favors the marketization of health care, and one that would prefer a return to Soviet-style socialized medicine. The survey results show remarkable national consistency, with no variance according to the respondents' geographic location, regional population levels or other demographic or health characteristics, age of respondents, or size of health facility represented. These findings demonstrate the emergence of well-defined bureaucratic and political constituencies, their composition mixed depending on the particular element of reform under discussion, for and against specific avenues of continuity and change in Russia's health policy. As Russia struggles to devise policy strategies and tactics that balance access, equity, quality, and efficiency, it confronts not only policy choices but also political challenges that look not dissimilar to those faced by health reformers elsewhere in the world.
This article views reproductive health activism as a fruitful site for analyzing the cultural logics through which legitimate claims for women's needs become expressed and circumscribed. It begins from the observation that in the United States and Britain, reproductive health has been a key arena for feminist political claims and struggles for women's rights, bodily integrity, access to health care, and demands for authority in relations with experts. These concerns and struggles have not, however, emerged in all postsocialist contexts, and new activism in Russia reveals strikingly different agendas. Innovative groups of health providers seeking to increase women's access to birth control methods and safe sex, home birth opportunities, and improved health services work outside of feminist perspectives and reject political paths for change. By examining the ideological inspirations, cultural logics, and political-economic constraints shaping the outreach work of Russian health practitioners, the article explains how and why health activism became a site for personal "spiritual" revival and the strengthening of nuclear families. It also explores how conditions following the collapse of socialism have further legitimized activists' rejection of political agendas for change.