Private within the Public: Negotiating Birth in Serbia

Abstract

This dissertation is about trust, authority, social personhood, and the importance of everyday negotiations that take place within a shifting health care landscape. Specifically, this was an ethnographic inquiry, grounded on twelve months of fieldwork, of how maternal care is provided in a low-income Eastern European country, Serbia. Maternal care is the case study for understanding how the previously exclusively public health care system is slowly unbundling along the seams of the different levels of care and thus opening new avenues for interventions by the private sector. While previous studies focused on the civil sector and informal economy, private medical sector has been an invisible avenue in the studies of informality. The private sector is not just reserved for elites, nor has it, as some scholars of Eastern European public health predicted, ended informal economies such as those expressed through the concept of “connections” (veze). The starting point in this dissertation was the concept of “negotiating,” as a signal for looking at the practices and intersections of seemingly fixed dimensions, such as private and public, formal and informal, trust and mistrust; and how through the articulation of these seemingly fixed binaries we gain insight into how a health care system actually works. I looked at the sites of negotiations to understand the importance of sociality and social personhood within health care systems thus demonstrating that while the public health care system is being disarticulated in segments, neoliberal reforms are not replacing them but reconfiguring them. The selective privatization of maternal care has generated new avenues for (re)negotiating trust and authority between patients and providers, and thus contributed to reshaping the health care landscape. My work shows how patients and medical providers, in different but mutually congruent ways, leverage the emerging private medical sector as brokering strategies with and within the public health institutions.