Women's Health as a Prism of Russia's Social Change: An Anthropological Approach
At a recent Kennan Institute noon discussion, Michele Rivkin-Fish summarized the findings in her recently published manuscript, Women's Health in Post-Soviet Russia: The Politics of Intervention. During her fieldwork, Rivkin-Fish examined changes in the Russian health care system during the 1990s from an anthropological perspective through six case studies involving public health and development projects. While statistical data is vital to the study of public health, she investigated beyond the numbers to analyze the contested processes of social change in post-Soviet Russia found in the case of women's health care.
As an anthropologist, Rivkin-Fish became particularly interested in the clash of cultural assumptions that emerged between Russian doctors and their Western counterparts when Western development projects were introduced. The attempts of Western specialists to promote a value-free model of treatment, which emphasized democracy in health care and respect for women's rights and the ability to choose, was met with resistance deeply rooted in historical culturally-specific definitions of medical treatment and the doctor-patient relationship. Under the Soviet socialist system, the expertise of Russian doctors was not questioned and a good doctor instructed a patient on how to best restore or preserve her health without presenting options. Doctors frequently scolded or berated their patients for living "unhealthy" lifestyles.
As privatized health care has slowly begun to emerge in Russia, material conditions have improved in the expensive fee-for-service sector, which now exists outside of the state hospital network, but there has been little structural change in the health care system. Quality controls are no more standardized than they were during Soviet times and incentives to provide unbiased, exceptional care are no more developed.
Health crises in recent history (i.e. low fertility, high mortality, high rates of disease transmission) have further exacerbated the cultural divide between Russian health care providers and Western aid workers. Right-wing Russian nationalists have attacked Western family planning and reproductive health programs as subversive attempts at "demographic correction," in other words, Western attempts to hasten the demise of the Russian nation by promoting birth control to citizens whose numbers were already drastically shrinking. When defined in terms of "individual choice" and "birth control," health became a site of political and moral contestation. Rivkin-Fish recommended removing the issue from this ideological context and speaking instead about a woman's reproductive health in terms of achieving and maintaining well-being in order to be able to conceive and deliver healthy children.
Rivkin-Fish concluded her talk by providing additional recommendations for Western and international organizations planning to work on women's health issues in Russia. She emphasized the need to pay attention to local conditions and beliefs and respond to them rather than training doctors who do not share their ideals. She urged practitioners to pay particular attention to the language they use about health and to Russian modes of legitimacy and advocacy.