The bio-political governance of pregnancy in Turkey through the current Family Medicine Model’s pregnancy-monitoring mandate

Abstract

This dissertation examines the bio-political governance of pregnancy in Turkey with a focus on the current Family Medicine Model (FMM), which has a specific mandate to monitor pregnant women to increase their access to prenatal medical care, thereby decreasing national maternal and infant mortality rates. This mandate is fortified through official performance-based payment and warning-point schemas, which have economic incentives and disincentives to pressure medical professionals employed in the family health clinics to fulfill their pregnancy-monitoring responsibilities. I specifically examine the practices of the medical professionals who work under these performance regulations and the experiences of the pregnant patients who are in contact with the family health clinics and their further implications. Because of the inherent limitations in a solely discursive approach, which focuses on understanding the discourses and rationales of bio-political governance, I employ a feminist discursive-materialist approach, which combines the foucauldian productive-discursive notion of governance with a feminist materialist approach, thereby developing a critical relationship between the discursive and materialist aspects of political governance. In addition to providing an understanding of the rationales and discourses that mediate the pregnancy governance through the Family Medicine Model’s pregnancy-monitoring mandate, I explore the materialist ramifications of this mandate for Turkish women in the axes of gender and class relations. I undertake this exploration at two different but related analytical axes: the state’s apparatus of the bio-political governance (by drawing on official regulation of the FMM and the practices and strategies used by medical professionals to comply with the regulation) and the techniques of self-governance (by drawing on the experiences of pregnant women in regarding health self-governance and the FMM’s pregnancy-monitoring mandate). The main finding of this dissertation is that the FMM’s pregnancy-monitoring mandate works both as a productive and a repressive apparatus of bio-political power with empowering and disempowering ramifications for Turkish women. While this mandate increases some women’s access to prenatal medical care, it also perpetuates a gendered regime of surveillance in which women’s sexual and reproductive activities are under communal and state monitoring with critical implications.