Creating health care consumers: The negotiation of un/official payments, power and trust in Russian maternity care

Over the last three decades, the Soviet model of universal, free health care has shifted to a mix of public, private, and semi-private services influenced by neoliberal ideology. These changes have been particularly palpable in the emergence of new consumer relationships between health care users and providers. Examining St. Petersburg childbirth services from the early 1990s to the present, this paper examines the gradual development of consumer subjectivities and their impacts on authority, trust, and domination in Russian health care relations. We trace three processes: (1) women’s emerging uses of monetary payments for care in both unofficial transactions (“in the doctor’s pocket”) and through official channels (“at the cashier”), as symbolic expressions of new consumerist subjectivities; (2) hospitals’ transformation of unofficial, personalized health care relations into officially paid consumer relations; and (3) the partial transformation of providers’ power, authority, and domination through consumer relationships with patients. We argue that Russian childbirth services illuminate the ways consumer relations address particular problems of Soviet health care while remaining a severely limited means of empowerment for patients and providers.