Seda Saluk, a 2020 Collegiate Fellow in the Department of Women’s and Gender Studies, investigates how people experience health and medicine. She examines reproductive data collected by health professionals and activists in Turkey, studies how medical technologies emerge, investigates barriers to healthcare, and explores the ethics of healthcare and reproductive rights to understand these issues from patients’ perspectives.
Saluk says that public health issues, such as maternal care, access to reproductive rights, medical surveillance, and vaccine hesitancy are part of longer social, cultural, and national histories. Her work surfaces these histories and investigates how and why people’s experiences of medical care might be coupled with fear, anger, mistrust, or skepticism.
As we’ve seen with the COVID-19 pandemic, the consequences of refusing to observe public health best practices, of distrusting medical professionals, or of being unable to access necessary care because of its expense are grave. But Saluk identifies historical precedent for these fears, especially for minoritized populations, for whom medical abuse is a not-so-distant memory. By listening to people’s experiences and addressing the very real stories and disparities behind the mistrust, Saluk hopes that healthcare can be safer and more accessible for all.
LSA: So much of your work has to do with breaking down barriers to information and access. Can you give some examples of how access and information play into your observations of maternal and infant healthcare?
Seda Saluk: Information means power. It can expose inequalities in healthcare access and quality. It can also hide or hinder issues that create health disparities in the first place. In Turkey, there is extensive health data related to maternal and infant health—what pregnant people eat, how much they exercise, their sexual and reproductive histories, and newborns’ growth patterns. Collecting this information can potentially identify the reasons behind low birth weights or high rates of maternal and infant mortality, particularly in disenfranchised communities. Information can help us to plan and deliver care in better and more informed ways so that we can overcome health disparities.
On the other hand, while there is abundant information on the health practices of individuals, a great deal of the information related to social and structural inequalities affecting health outcomes is missing.
For instance, we do not know the effects of sexual, gender-based, or state violence on people’s reproductive experiences. We do not have enough information to know how many poor or racially minoritized women struggle to become pregnant, die during childbirth, or have infants who die as compared to their more privileged counterparts. Both the selective production and systematic lack of data is informative because it reflects the institutional indifference towards ongoing injustice that affects health outcomes. It is important to not only pay attention to what kind of information is collected and for what purposes, but to also find what is often omitted or neglected in medical documentation and visibility.
LSA: You also research medical surveillance. Can you describe the connections you've observed between reproductive or public health and surveillance? Why is surveillance part of public health governance, and what are the implications for patients?
SS: When we think about the long history of medical surveillance, discussing access and inclusion is not enough because this information is used to colonize and control as well. Collecting health data about individuals and oppressed populations has long been an integral part of colonial and imperial powers, and of succeeding political regimes in the Middle East. Political elites have placed a special emphasis on reproductive and public health. They have calculated fertility patterns, birth and death rates, and the prevalence and distribution of diseases to have a better grasp of the communities that they govern.
Part of my research is about how Turkey's current health information practices are rooted in this long history. Earlier periods used pen-and-paper methods to collect and document people’s medical histories. Today, we see a mushrooming of digital modes such as centralized databases. As digital tracking spreads, people are becoming more and more concerned about who is monitoring them, how they’re being monitored, and to what end. Widespread health tracking can save lives, as we have seen in the COVID example. On the other hand, it can also be used to support or strengthen existing regimes of policing and surveillance, particularly for individuals and communities who have historically been tracked more rigorously and in more violent ways.
People’s differential encounters with state or medical institutions can also influence their responses to health services. For instance, in Turkey in the 1980s and ’90s, birth control devices inserted into the uterus, such as IUDs, created fear among Kurdish communities. It was the peak of state violence towards these communities, and Kurdish women, who thought that IUDs were listening devices inserted into their bodies by the Turkish military, often refused to use these services.
Similarly, many young women are afraid to use public institutions for abortions due to the ongoing stigma surrounding the procedure. Abortion is technically legal and publicly funded in Turkey. Still, women fear that their medical histories could be recorded and shared with third parties without their consent, which might negatively affect their safety. These concerns sometimes push them to go to private clinics or unregistered facilities, where they think they can protect their information to a certain extent. Unfortunately, this situation disenfranchises them further by limiting their access to care, burying them into financial debt, and sometimes putting their health into grave danger.
LSA: You’re currently working on a book on the sociopolitical dimensions of vaccine hesitancy. What hesitations do people have about the COVID vaccine? What are its implications and how might they be ameliorated?
SS: Vaccine skeptics are not a homogenous group. They refuse or delay getting vaccinated for different reasons, but one thing worth highlighting is that some of them do so because of a deep distrust of the state, of biomedicine, and/or of pharmaceutical companies. Historically these institutions have marginalized certain groups, used them as test subjects, or profited from selling expensive drugs that should have been free or publicly available. So, again, vaccine hesitancy or refusal cannot be separated from the long and fraught history of public health and medical technologies in the global South.
There is also the issue of global inequalities in access to vaccines, which is increasingly becoming the main factor affecting people’s decisions regarding the COVID vaccine. People are concerned about which vaccines they will get, whether they will get the ones with lower protection rates, or if they have access to infrastructures needed to distribute and preserve vaccines safely, such as freezers.
Rather than making simple judgments, listening to people’s concerns about these issues are important to understand the reasons behind their hesitancy and to ameliorate it potentially. But at the end of the day, most of these concerns can only be resolved from a social justice perspective that makes vaccines free, accessible, and safe for all.
*This interview has been edited for length and clarity.
This story is part of a series highlighting the research of LSA Collegiate Fellows, a program of the National Center for Institutional Diversity (NCID) at the University of Michigan. The LSA Collegiate Fellows is one of the most unique and innovative programs in higher education, recruiting and retaining faculty who are experts in their fields and have demonstrated commitments to diversity, equity and inclusion through their scholarship, teaching and/or engagement.