The Aftermath of Reforms: Health, Medicine, and Care in Contemporary Turkey
Panel 275, 2019 Annual Meeting
On Sunday, November 17 at 11:00 am
Panel Description
Health and medicine have long been significant sites for state intervention for the oversight of populations and remaking of citizen-subjects in modern Turkey. This interdisciplinary panel probes the cultural politics and social impacts of recent reform projects in Turkey's medical institutions while situating these projects within a long history of nation-building. The health care system under the Justice and Development Party (JDP) rule has gone through significant changes over the last decade, blending the global health organizations' terminology of “good governance” with the government's desire to expand late capitalist market logics and pronatalist population policies. These changes included, among others, restructuring the financial and administrative organization of hospitals and clinics, establishing performance-based audit mechanisms for health care practitioners, implementing new digital technologies for the collection and monitoring of health data, reshaping sexual and reproductive health policy and practice, and building health centers specialized in providing care for refugees.
While contemporary developments have expanded the types of health services provided especially for urban poor populations, they also created new regimes of inclusion and exclusion for both providers and recipients of health care. Situated in the aftermath of the Reproductive Health Program (2003-2007) and the Health Transformation Program (2003-2012), the papers in this panel examine how these transformations unfold at the everyday level in hospitals, clinics, and health centers. Through close attention to the far-reaching consequences of health reforms, we explore how health, medicine, and care are imagined and materialized as expert practice and lived experience in contemporary Turkey. In this way, the panel probes how biomedicine, religion, and late capitalism intertwine in practices of population management and public health but also reformulate racialized, class-based, and gendered boundaries and subjectivities in the Middle East and beyond.
Over the last three decades, a series of neoliberal populist reforms have restructured the health care system according to the rationalities of efficiency, competition, and the supremacy of consumer demand in Turkey. On the one hand, the demand for urban health care services has grown due to the immigration flow from rural areas to large cities. A series of health reforms significantly expanded the access to health care services for the economically disadvantaged groups in urban areas. On the other hand, health professionals’ working conditions have more and more become precarious as they have to meet the growing demands and work under the increasing pressure of competition among their public and private employers who are seeking to maximize their profits in the market.
Based on extensive fieldwork on male circumcision in Turkey, I examine the consequences of the neoliberal transformation of the health care system for lower urban class families. As part of new welfare governance of poverty in Turkey, municipalities have been organizing circumcisions for “poor” families on means-test basis at low-ranked hospitals in urban areas wherein health professionals work under significant time constraints. By tracing the historical changes in the organization of these circumcisions since 1960s, I show how the basis of class inequality in access to circumcision services has shifted from physical to emotional care in the neoliberal era in Turkey. My paper draws our attention to the connection between consumers’ changing experience of inequality and the precarization of healthcare work.
In 2008, the Ministry of Health in Turkey launched an ambitious yet controversial public health surveillance project in hospitals and clinics to fight against high rates of maternal and infant mortality. Known as GEBLIZ (Pregnancy, Postnatal, and Newborn Monitoring System), the project tracks reproductive health information of not just pregnant people but all women of childbearing age in the country through a big data infrastructure. While the Ministry praises the project for its success in providing efficiency in health care planning and delivery, reproductive health activists see it as a further step in the Turkish government’s attempts to curtail women’s rights, bodily autonomy, and reproductive privacy. In this paper, I explore GEBLIZ from the eyes of two groups of people: (1) activists who protest and organize against being watched by the state-imposed infrastructure in an increasingly pronatalist climate, and (2) pregnant women and new mothers who do not see the infrastructure as an intrusive mechanism and instead demand to be watched by it. Drawing from two years of ethnographic research in activist groups, health clinics, and women’s homes in Istanbul, I discuss what this discrepancy between the two responses tells us in terms of surveillance, docility, and agency. I argue that reproductive health activists’ opposition to GEBLIZ situates a de-racialized, de-classed, liberal subject at the center of its argument while actual pregnant women and their families face increasingly stratified health care and welfare regimes. Therefore, rather than framing women’s willingness to comply with medical surveillance as a form of docile citizenship, I argue for seeing it as another form of politics that claims redistribution, justice, and equity. Amidst the ongoing datafication of public health services, this work sheds light on contemporary conceptions and limits of privacy in the Middle East with ramifications beyond.
This study looks at the moral economy of immigration in Turkey with a specific lens on African-origin immigrants’ access to healthcare. Turkey, in addition to currently hosting the largest number of refugees in the world (including over 3.5 million Syrians), is witnessing an influx of immigrants from various sub-Saharan African countries. While some of these immigrants reside in Turkey only temporarily on their way to European countries, many others are settled and engage in taxed or untaxed work activities such as shuttle trade, street vending, construction work, or opening their own businesses. Due to the nature of the healthcare system in Turkey, these immigrants struggle in accessing and paying for health services. By drawing on data I collected through interviews and ethnographic fieldwork in Istanbul, Turkey, I explore how this visible racial minority group navigates the complexities of healthcare. I show that immigrants organize their healthcare through what I call ‘shadow health’: collaboration between immigrant individuals and communities and local and international NGOs, charities, and volunteering physicians, which oftentimes involves provision of unregulated and undocumented care in private and public facilities. I specifically point to how immigrants’ racial, ethnic, and religious identities and boundary-drawing practices play a role in that endeavor and how immigrants pursue community building simultaneously with searching for health care solutions. I also document how different actors such as health care providers, government bureaucrats, and NGOs categorize and racialize immigrants with impacts on their access to care.
Alarmed by the skyrocketing C-section rates, the Turkish Ministry of Health (MoH) launched the "Mother-Friendly Hospital Program" in 2015. In the following years, the MoH has continued the program and several public hospitals have reorganized their services according to the National Mother-Friendly Hospital criteria. As of 2018, there are 42 mother-friendly hospitals in Turkey. Drawing from two years of ethnographic research in the first mother-friendly hospital of Istanbul, I raise the following questions in this paper: What exactly is mother-friendly reproductive healthcare in Turkey? What are the boundaries of mother-friendliness? What does being a mother-friendly hospital entail in a context where pronatalist population policy and neoliberal transformation in health are imbricated? What is the "logic of care" (Mol 2008) in mother friendliness? How is this mother-friendly reproductive care organized and practiced? Situating mother-friendly reproductive care within the overarching organization of the Turkish healthcare regime under the Health Transformation Program, I analyze the launch of performans sistemi (performance-based system), which organizes life at public hospitals based upon a meticulous calculation of performance and reproductive monitoring. In doing so, I demonstrate how mother-friendly healthcare materializes in medical settings, and illuminate how class, gendered citizenship and ethnicity are reproduced by over-medicalizing certain bodies and excluding certain rights.
