Health Policy in a Time of Crisis : Abortion, Austerity, and Access

Health Policy in a Time of Crisis is a vivid ethnographic account of women and providers navigating the Catalan health system to obtain and provide publicly funded abortion care. Grounded in critical medical anthropology, the book situates access to publicly funded abortion care in the context of austerity and ongoing threats to recently liberalized laws, examining the actual levels of access in the region. In so doing, it examines the disparities experienced by immigrant and other women, documenting the diverse approaches adopted to overcome obstacles to care. Using accounts from both providers and women seeking care, Ostrach’s richly grounded analysis illuminates a healthcare system during a period of economic crisis and disagreement over reproductive governance. Researched against a backdrop of growing movements against austerity and for Catalan independence, the result is at once a study of true access to public health care in times of crisis and a compelling account of some women’s determination to go to any length to get the health care they need. Engagingly written, it will make interesting reading for scholars and students of anthropology and public health, as well as policymakers and the general reader concerned with the politics of abortion and public health. Health Policy in a Time of Crisis- Front Cover -- Health Policy in a Time of Crisis -- Title Page -- Copyright Page -- Dedication -- Contents -- List of Illustrations -- Figure -- Tables -- Acknowledgments -- Chapter 1: People, Policy, and Practice -- Research Site Selection -- The Granting of Abortion "Rights" vs. a Grassroots Demand for Bodily Autonomy -- Abortion Access, Safety, and Legality -- The Catalan Push for Full Independence -- Abortion Law Reforms and Abortion in Spanish Health Systems -- Immigrant Women, Abortion, and Health System Cuts -- Institution-based Participatory Research -- Positionality -- Access to Sites -- Methods -- Women Who Sought Abortion Care at the Today Clinic -- Structural Factors and Critical Medical Anthropology -- "Tell Me Everything ..." -- Notes -- Chapter 2: Catalunya, Crisis, and Cuts -- La Crisis, Threats to Abortion Legality, and Popular Responses -- Austerity and the Health System -- Abortion Law Reforms -- Immigrant Women and Abortion in Catalunya -- Shifting Politics and Identities: Threats to the Abortion Reforms, Cuts, and Independentism -- Notes -- Chapter 3: Uneasy Collaboration -- Global Variations in Abortion Accessibility and Safety as a Function of Legality -- Abortion Access in Publicly Funded Health Systems -- An Uneasy Relationship Between a Public System and Contracted Providers -- Women's Experiences with Health System Coverage of Abortion -- Immigrants and Public Health System Coverage of Abortion -- Observations from Inside the Clinic -- Implications of CatSalut Restructuring of Clinic Quotas -- Notes -- Chapter 4: Las Dones (The Women) -- Travel, Time Off, and Childcare Obstacles -- Women's Perceptions of Specific Obstacles -- Emergence of the "Superwoman" Theme -- Differences in Perceptions of Obstacles Between Immigrant and Catalan Women -- Rural Women This timely book examines a fundamental international issue in health care access: the gap between codified policy-including health laws that guarantee access to particular kinds of health care as a human right, right of citizenship, or right of residence-and the actual ability of people to receive the supposedly guaranteed health services. The author-draws on her extensive fieldwork at an abortion clinic in Catalonia, Spain, to reveal the diverse problems women, and other marginalized people, face in seeking health-care services;-examines the larger political-economic and cultural contexts of Catalonian society to show how women can and do overcome obstacles;-using the ethnography of the abortion clinic, analyzes the impact of economic crisis, and the resulting shifts in cultural and political identities, on women's and providers' perceptions of proper access to public health services;-looks beyond Spain-to Europe, the U.S. and elsewhere-to the global problem regarding the delivery of health care to powerless peoples