Pregnancy, Medicaid, State Regulation, and Legal Subjection

Abstract

For 18 months in 2007 and 2008, the author conducted ethnographic fieldwork in the obstetrics clinic of a large, public hospital in Manhattan, New York. The large majority of patients who receive their prenatal care from this obstetrics clinic rely on the Medicaid-funded Prenatal Care Assistance Program to cover their medical expenses. As a condition of receipt of this aid, women are required to meet with a battery of professionals—namely social workers, health educators, nutritionists and financial officers—who are legally obliged to inquire into areas of women's lives that exceed the realm of the medical. The author finds that, in demanding patients to meet with a constellation of officials who inquire into women's personal lives, Medicaid mandates intrusion into women's private lives, and it produces pregnancy as an opportunity for state supervision, management, and regulation of poor, otherwise uninsured women. Thus, Medicaid may be understood as an occasion for the initiation of poor women into the state regulatory apparatus and a circumstance for creating disempowered legal subjects of poor women.