In Women’s Health in Post-Soviet Russia, Michele Rivkin-Fish explores why recent efforts to improve women’s reproductive health in Russia have reinforced socialist values and power relations. Focusing on the World Health Organization’s (WHO’s) attempts to democratize maternity hospitals in Saint Petersburg, she interrogates the logic of neoliberal reform in Russia, Western feminist politics, Russia’s medical infrastructure, and the Russian sex and gender system. The result is an informative and fascinating study of women’s health crisis on institutional and personal levels. Rivkin-Fish challenges feminists and nongovernmental organizations to reconcile their own objectives with the realities of local Russian knowledge and practice.

In “Part One: Projects,” Rivkin-Fish engages in a macrostudy of the conflicts surrounding the privatization of health care. On the basis of the platform of women’s universal right to self-determination, WHO officials stressed the “dehumanizing” nature of maternity care as the main reason to retrain doctors. Democratizing seminars advocated marketizing maternity wards to include patients in decisions about the birth process. Saint Petersburg hospital officials, however, “saw the maternal health crisis as an issue of low fertility, related to government-created poverty, technological deficits, and women’s apathy” (p. 42). Rivkin-Fish pertinently demonstrates how WHO initiatives privileged personal relationships and silenced discussion about “the structural bases of disempowerment” (p. 37). As a result, the creation of paid and unpaid birthing wards ultimately sharpened class divisions in Russian society. In a similar development, clinic doctors, attempting to educate youth about appropriate sexual relations, refused to acknowledge the socioeconomic reasons for women’s poor reproductive health. These doctors oriented their lectures toward addressing the low level of culture among young people. They therefore “shared the tendency of policymakers to target the self for moral transformations” (p. 91).

In “Part Two: Practices,” Rivkin-Fish provides a microlevel investigation of how Russian doctors and patients responded to these institutional initiatives. Her vignettes of women’s attempts to navigate the system to benefit themselves and their unborn children are at times inspirational and heartbreaking. The same could be said for the overworked female obstetricians and gynecologists, for Rivkin-Fish is interested in why they go out of their way to help some women but ignore the suffering of others. To guide her thinking through these findings, she uses a modified version of Michel Foucault’s theory of “medicalization” to analyze “how Russian doctors and patients distinguish between appropriate and abusive expressions of professional power, and strategized in particular ways to create ‘benevolent’ forms of expert power” (p. 23). She also relies on Pierre Bourdieu to understand how physicians misrecognized the ways that they controlled their patients by seeing these practices as completely different from those employed by other state bureaucrats whom they resented. She insightfully demonstrates how paid care has increased a woman’s choice for luxury accommodations, but it has done little to give her a say in the actual birth process, for that is still up to the doctor’s discretion. Physicians, in turn, feel trapped by the new moral economy of money. They welcome extra cash to pay for their daily life needs, but they find unjust the establishment of “distinct levels of comfort and care under the rubric of paid services,” criticizing the state for “abdicating its role in supporting health care” (p. 191). Market reforms ironically silenced both patients and health providers in the realm of public policy.

Rivkin-Fish has crafted a study that appeals to a broad audience, and this appeal is the book’s asset as well as its shortcoming. She eloquently speaks to policy makers and feminists, aiming to make them understand that Russian culture counts in implementing effective institutional and personal development programs. As a feminist anthropologist committed to “gender equality, social justice, and community empowerment” (p. 212), Rivkin-Fish concludes her work with a clear set of proposals to provide women and their doctors with more agency in the medical system. She encourages Western reformers “to offer a middle ground” that is open to “Russian concerns with personal morality and interpersonal obligation” and holds the state accountable for the welfare of its citizens (pp. 221, 218). However, in offering anthropology as the way to alert WHO and other bureaucrats to “what is really going on,” Rivkin-Fish portrays ethnographic knowledge as the “Truth,” a concept much debated in the discipline. I would have appreciated a more nuanced and forthright discussion of her own positionality as a researcher, mother, feminist, and friend in Saint Petersburg, a city that cannot represent the realities of Russian life beyond the metropolis. That said, however, Women’s Health in Post-Soviet Russia is a must read for specialists in the region, medical anthropologists, feminists, and policy makers alike.

[notes, works cited, index.]