Book Review—Women’s Health in Post-Soviet Russia
The book Women’s Health in Post-Soviet Russia is an account of the politics surrounding the transformation and privatization (both officially and unofficially) of the Russian health care system. It examines gender and health amid a period of post-socialism change, specifically highlighting the roles of each as vehicles for understanding the larger political, economic, and social changes of the state. The study is carried out through various phases of analysis of actors and the interactions between them, with key actors being: “international development consultants, state policy makers, demographic experts, clinic-based professionals, community activists, and laypersons” (Rivkin-Fish, 2009, p. 1).
Author Michele Rivkin-Fish, now an Associate Professor of Anthropology at The University of North Carolina at Chapel Hill, began ethnographic study in 1993 in St. Petersburg, Russia—the first decade after the collapse of the Soviet Union. She began her research through a project sponsored by the World Health Organization (which endorsed the equality of reproductive health among Russian women) in 1993. This partnership afforded her access to the “maternal hospitals,” where she was able to use her position to observe both official health projects and daily health practices. Topics of projects and practices centered on reproductive health, ranging from abortion to fertility to rates of maternal mortality; and, the “condition” of each issue stands to reaffirm the degenerating nature of the public healthcare system. Subsequently, each of these outlets of study brought interaction with Russian women, local specialists, and global experts; and, it is here where Rivkin-Fish most successfully expresses and explains the maternal health problems plaguing Russia. Additionally, in doing so, the audience more clearly comprehends the efforts in place to shape new policies of reform. It is these observations (accompanied by anthropological commentary and skilled theoretical insight) that became the six case studies that guide the book.
Below the surface, her WHO assignment provided a unique perspective and gathering of data: it allowed Rivkin-Fish to “observe how efforts to promote democratic reform and women’s rights came together on a daily basis” (Rivkin-Fish, 2005, p. 2). Her research was guided by several significant questions of inquiry: What did Russian women patients and Russian doctors—most of whom were also women—think about the reforms WHO advocated? How did they implement them and improvise with them in the daily work of providing maternity care? How did Russian experts and laypersons respond to WHO’s rather politicized vision that recognizing women’s self-determination was central to improving maternity care? What could Western democracy activists and feminists learn from observing this maternity care reform process and listening to Russian voices? (Rivkin-Fish, 2005, p. 3). In her later years of fieldwork, Rivkin-Fish widened her sphere of query to incorporate additional issues of social, political, and economic uncertainty: What kinds of social change did pregnant and birthing patients, and Russian health care providers seek as they struggled to improve reproductive health? How were their efforts shaped by political-economic constraints of both the socialist health care system and its democratic market transitions? (Rivkin-Fish, 2005, p. 4). Moreover, it is particularly this broadened scope that allowed Rivkin-Fish to discover and draw her alarming conclusions.
Rivkin-Fish argues that the public health care system acts as a channel for implementing and on her part, interpreting, the “beneath the surface” social and political transformations. Specifically, she contends that healthcare serves as a veil to the disparities in defining issues of (and thus, positions on) equity and well-being. She highlights three distinct ways or strategies for creating social change: individualizing strategies (includes “educational projects aiming to develop people’s personality such as new attitudes or behaviors or self-imposed discipline aiming to create social change”), personalizing strategies (“recognizes certain persons as our people…potential for trust, mutual understanding, ad reciprocity”), and privatizing strategies (includes “global and state policies that seek to privatize formerly public services”) (Rivkin-Fish, 2005, p. 10). These strategies can separately or concomitantly execute social change. However, she makes point that not all social changes are desirable, direct, or truthful. Particularly, I reference her posing of democratically-based reforms for women’s rights against increased authority for professionals. She concludes that the best interest of the first is frequently sacrificed for the advancement of the latter. Consequently, she promotes the improvement of healthcare as a unique platform for social reform and restructuring. This improvement, however, seems impeded by the apparent disconnect between peoples’ ideals—between beliefs about how is and what are the most effective ways for achieving improvement. She offers the contestation of the state as an initial platform for transition. In closing, she states that women’s empowerment (and, therefore democracy) came to encompass the amending and reforming of behaviors (as well as values) at the individual level (This approach, she sets against a more unified, communal effort—one that strengthens and improves a the group level). Further, Michele Rivkin-Fish expressively voices this conclusion:
It argues that many everyday strategies for overcoming systemic inadequacies strove to realize ethically sound tactics in interpersonal relations…as the new constraints of market democracy became increasingly visible to many Russian people, they gave up believing that the necessary amounts of public resources would be allotted to keep welfare services functioning or that legislative acts would actually ensure citizens’ rights (Rivkin-Fish, 2005, p. 31).
The book is organized into two main parts—projects (Part I) and practices (Part II)—with three chapters devoted to each halve (totaling six chapters). These sections are bookended by an introduction (which serves to conceptualize the politics of intervention) and a conclusion (which discusses the transforming of feminist strategies). The sequential focus (and structure) of the book takes the reader through the journey of state delegitimation by women doctors, patients, and professionals. It begins with the WHO affiliated health project and the urge for “women’s self-determination in birth” and flows into the use of financial incentives in stimulating doctors. These suggestions are trailed by the discussion of sex education (its problems, projects, and continued research). From here, the author analyzes the birthing practices implemented to guarantee a healthy pregnancy (although we quickly find that this is not always the case). This methodology of organization acts to strengthen the author’s arguments, as each commentary and discussion seems to build on the previous. Consequently, I believe her argument to be poignant, strong, and firmly rooted in thorough, methodical research. With this, I must note that the novel’s key fault may lie in my responsibility. As stated, I believe her case; however, at the same time, I am given little reason not to because I possess no significant or extensive knowledge of this particular academic area of study. This, I attribute, in part to my own lack of exposure and also in part to Rivkin-Fish’s lack of preface. Moreover, I strongly feel that a foreword—with its central focus being a historical background of the time period and events—would further strengthen the author’s arguments and as a result, the reader’s understanding of the material.
Furthermore, it is important to note that this weakness does not wholly overshadow the significance of Rivkin-Fish’s principal argument: that is, “health and reproductive health in particular, have been sites for conceptualizing and implementing a renewed social order in Russia” (Rivkin-Fish, 2009, p. 5). This understanding, I believe, is an awareness and perspective that ought to be carried elsewhere—carried over into other areas of (my) academic study. In doing so, I find common patterns and tendencies with women’s healthcare in the United States since the Victorian Era. Specifically, I notice a similar social trend: in America, the social reforms and changes of a time period (decade, etc.) are reflected and reinforced through the institution known as women’s healthcare. With this, I draw the conclusion that there are a number of other “vehicles” that also reflect (and arguably, carry the burden of) the social changes and transformations in our society.
The findings in this novel directly relate to the research and readings we have studied throughout the semester. Specifically, I recognize similar arenas for understanding and interpreting social change: conflict of land in Katherine Verdery’s What Was Socialism and What Comes Next, new persuasive form of advertising in the film Czech Dream, products like “Frugo” in Privatizing Poland, identity struggles in Where the World Ended, and products like “Spreewald Pickles” and “MoccaFix Gold” (the shift in types of products stores carried and the shift in advertising is also applicable) in the film Goodbye Lenin. Despite being different mediums, they parallel in both their purpose and message.
Furthermore, in recommending this piece of literature, I believe future audiences must possess a keen understanding of the shift from socialism to post-socialism across Europe and particularly, the Soviet Union. Additionally, the reader would benefit from having some knowledge—both historical and contemporary—of the conditions, circumstances, and conflicts surrounding health care. The individual should also enjoy an interest in (and preferably academic exposure to) social and political change—and the accompanying affairs of a state. Also, due to the dense, textbook-like nature of this writing, one must put forth a dedication of time as well as a willingness to “work” for full comprehension and understanding of the text itself.
However, let it be noted that such an extensive background need not be required (as I myself possessed only limited knowledge); it is merely a guiding suggestion to get the most out of this academic text. This novel is scholastically challenging and intellectually stimulating for the individual who is willing to sift through dry facts, raw data, and often dull commentary. Nonetheless, if you choose to read this piece, I am convinced you will feel a since of scholarly achievement upon the turning of the last page.
Rivkin-Fish, Michele R. Women’s Health in Post-Soviet Russia: The Politics of Intervention. Bloomington, IN: Indiana UP, 2005. Print.
Rivkin-Fish, Michele. “Michele Rivkin-Fish: Faculty Bio.” The Department of Anthropology at UNC Chapel Hill — Department of Anthropology at the University of North Carolina at Chapel Hill. 2009. Web. 29 Oct. 2011. <http://anthropology.unc.edu/people/faculty/mrivkinfish>.