Chapter 19: Commercialization in maternity care: uncovering trends in the contemporary health care economy
Maternity care processes reflect health systems’ relationship with society, sometimes ameliorating but often reproducing inequality and privilege. Analysis can highlight, inter alia, issues of gender, class inequalities and power on local and global scales. This chapter seeks to examine some of the ways in which women’s experiences of pregnancy, childbirth and post-partum and the related healthcare services in low-income and middle-income countries are being affected by commercialization trends that have been invigorated by recent ‘development’ policy and by the evolution of the transnational healthcare economy. Market exchange has come to be a central and accepted principle within health care in a number of ways, and commercial actors have been accorded new spaces and new roles. Examples range from the use of user fees and co-payments in public sector services, to the public subsidy of private sector maternity care providers and of businesses that construct and managing hospitals, to public sector and development non-governmental organization (NGO) ‘partnerships’ with commercial actors which become framed by their agendas. Effects of commercialization can be diverse, ranging from the sacrifice of rural maternal health to fund large public_private partnership (PPP) hospital projects promoted by international finance corporations, to the insidious marketing of infant formula via public sector services, to escalating private sector caesarean section rates. The search for profitable healthcare business investment has also resulted in a ‘boutique’ birthing centre industry aimed at the discerning middle-class consumer, and the commodification of women’s reproductive labour and the ‘renting’ of their wombs for commercial surrogacy. Maternity may not be as visible a feature of the global health care economy as joint replacement or cosmetic surgery. However, it is far from untouched by the contemporary trends that favour market principles and burgeoning national and transnational health care industries.
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