Motherhood, medicine and markets: the changing cultural politics of postnatal care provision

In high-income countries welfare states play a crucial role in defining - and re-defining - what is offered as publicly provided care, and as a result shape the role of families, markets and the voluntary sector in care provision. Fiscal policies of cost containment, coupled with neoliberal policies stressing individual responsibility and reliance on market forces in recent decades, have resulted in the contraction of state provided care services in a range of sectors and states. There has also been widespread retrenchment in public health sectors across many countries resulting in policies of deinstitionalisation and early discharge from hospital that are predicated on the assumption that the family or voluntary sector will pick up the slack in the care chain. At the same time that this loosening of medicalized control has occurred, services to families with young children have become increasingly targeted on 'at risk' mothers through widespread population surveillance. To date, analyses of the implications of these important changes in care provision have primarily focused on health services and outcomes for birthing women and their newborns. In this paper, we make the case that post-birth care is a form of social care shaped not only by welfare state policies but also by cultural norms, and we suggest an analytic framework for examining some of the recent changes in the provision of postpartum care. We use examples from three developed welfare states - the Netherlands, Australia and Canada - to illustrate how variations in welfare state policy and cultural norms and ideals shape the provision of home and community based postnatal services