Life and Abortion:

The Post-Biopolitics of Reproductive Health in Ulaanbaatar, Mongolia

Mari Valdur

Doctoral thesis, to be presented for public examination with the permission of the Faculty of Social Sciences of the University of Helsinki in Hall 1, Metsätalo, Unioninkatu 40 and via Zoom online on 18th November 2020 at 12 o’clock.

Helsinki 2020

Academic dissertation Doctoral programme in Social Sciences, University of Helsinki

The Faculty of Social Sciences uses the Urkund system (plagiarism recognition) to examine all doctoral dissertations.

Opponent: Prof. Rebecca Empson, UCL Custos: Prof. Sarah Green, University of Helsinki Pre-examiners: Prof. Susan Gal, University of Chicago Prof. David Sneath, University of Cambridge Supervisors: Prof. Sarah Green, University of Helsinki Dr Toomas Gross, University of Helsinki

Research Series in Anthropology, Volume 32 University of Helsinki, Finland

Distributed by Unigrafia https://unigrafia.fi/en/ [email protected]

ISBN 978-951-51-6802-3 (paperback) ISBN 978-951-51-6803-0 (PDF)

Unigrafia 2020

Abstract

This thesis is an ethnographic study of how various insecurities and vulnerabilities are produced and maintained, such as the health risks of informal abortion in a context where abortion is legal. Throughout this thesis I suggest that the answer to this question has to do with particular and gendered forms of governance rather than individual experiences of the general stigmatisation of abortion. I first unfold this by taking up the concept of biopolitics and its prevalence in the anthropology of reproduction: in studying reproductive technologies, the subdiscipline has been shifting towards harvesting temporal and discursive ruptures, which is often paired with the framework of biopolitics. While biopolitics remains bound to the life of an individual, and through this to the governance of imagined wholes like populations, this study shows that when it comes to abortion and reproductive health in Ulaanbaatar, there are a number of competing conceptualisations of life at work, several of which surpass the individual lifespan. Therefore, the thesis provides a different perspective of governance as dependent on the time and place in which it occurs. I study six relevant and overlapping spaces in Ulaanbaatar: the nation state and macropolitics; religion, medicine and kinship; care and motherhood; sexuality and knowledge; biomedicine; and the medication market. Gender appears at the core of these forms of governance: for instance, through the establishment of biomedicine as a predominantly feminine sector, and reproductive healthcare as synonymous with women’s healthcare. Moving beyond ‘public’ and ‘private’, and ‘formal’ and ‘informal’, I propose that ‘doctor’ in the Mongolian reproductive healthcare system can be viewed as usufruct, as a type of temporary ownership: the credentials are provided by the state, but these can be used to seek profits and practice beyond what a doctor’s work involves on paper. Meanwhile, the informal abortion medication market reveals that the prevalence of informal abortion is shaped by a range of socioeconomic and healthcare system specific considerations. In this context, the seeking of trustworthy

iv information and services draws on people as infrastructure rather than any ‘formal’ structures. This thesis is post-biopolitical in the sense that it recognises the core relevance of ethnography, gender and the need for more nuanced approaches to governance as directly and indirectly linked to reproductive health.

v Table of Contents

Abstract ...... iv Acknowledgements ...... viii Translation and Transliteration ...... xi Chapter 1. Introduction ...... 1 Reproductive healthcare and biopolitics ...... 3 Position and subjectivity in and out of the field ...... 9 Mongolia: Broader context of the study ...... 12 Outline and contribution ...... 16 Chapter 2. ‘Abortion’: A Brief Political History in Mongolia ...... 21 Introduction ...... 21 Population development ...... 27 Capitalism ...... 38 Legislation ...... 42 Rights and freedom ...... 50 Conclusion ...... 56 Chapter 3. ‘Life’ in the Bone Marrow: Traditional Medicine and Kinship ...... 59 Introduction ...... 59 Legitimacy of Mongolian traditional medicine ...... 62 Conception and the composition of a human ...... 66 Mutuality of the child and the mother ...... 69 Motherhood and reproductive challenges ...... 72 Transmissions of Mongol-ness ...... 86 Conclusion ...... 92 Chapter 4. The Practical Matters: Motherhood in the City ...... 95 Introduction ...... 95 Liminal student years in the city ...... 97 Plots of womanhood ...... 104 Spaces of care and their lack ...... 106 Motherhoods of secondary care ...... 111 Conclusion ...... 121

vi Chapter 5. Contraceptive Knowledge: Making Sexuality for YouTube ...... 124 The beginning ...... 124 The video-making process ...... 126 Failures without the state ...... 128 Gendered qualities ...... 137 Intimate contraceptive knowledges ...... 145 Conclusion ...... 151 Chapter 6. The Gynaecologist: Usufructuary Gains and Losses in Healthcare ...... 156 Introduction ...... 156 Job position as usufruct ...... 157 The usus ...... 160 Shortcomings of ‘privatisation’ ...... 165 The fructus ...... 171 Conclusion ...... 181 Chapter 7. ‘A Little More than a Period’ at the Market: Infrastructures of Informality ...... 184 Introduction ...... 184 Dying of informality, dying without sociality? ...... 186 Infrastructures of informality ...... 189 Conclusion ...... 207 Chapter 8. Conclusion ...... 210 References ...... 217

vii Acknowledgements

I would like to thank all of my friends and acquaintances in Mongolia who took the time and trust to share their experiences, lives and reflections with me. You are at the heart of this work and it would have not been possible without you, nor would it have been as enjoyable. Thank you, Prof. Sarah Green and Dr Toomas Gross, for your hugely insightful, generous and well-balanced supervision, and the time you have invested in me and the project. I am thankful to Nasantogtokh bagsh and Tserenchimeg bagsh from Sodon Chimee language school for teaching me Mongolian all these years. I am indebted to the Lhagvasuren family, Ariuna, Zoloo, your kind parents and siblings, for your patience with me and for caring for me. I am grateful to all of my friends in Mongolia: Javzandulam Batsaikhan, Amgaa, your beautiful daughters and other family members for showing me what az jargal is; thank you, Saki, Maralaa, Zulaa, Gulya and Beverly for your friendships. It was a true joy and privilege to spend this time with you, my friends and contacts at Manba Datsan. I am grateful for the generosity of Ani Gyalmo, Enhmaa egch, Duuya egch and Enhee ah from the FPMT Mongolia and Dolmaling. I would also like to thank the National University of Mongolia, namely Dr Bumochir Dulam and Sarantsetseg Dugersuren for your kind and efficient assistance with my Mongolian visas. Thank you, Dr Karolina Zygmanowska for your help when I started my fieldwork. Thank you, Munkhmaral Tumennasan for your help and advice on the most challenging sections of the translations in this thesis. I am very grateful to Dr Rosemary Deller who edited this thesis, it was a pleasure working with you. My fieldwork would not have been the same without it overlapping with that of Jessica Madison-Pískatá, Dr Kip Hutchins, Jade Richards, Anne-Sophie Pratte and Sam Bass. Particularly, I would like to thank Kenny Linden who is also part of this group, for the uplifting study sessions. I thank Dr Joseph Bristley for his friendship and the many laughs over the years. I am thankful to everyone at the MIASU at the

viii University of Cambridge for welcoming me for a brief visit during the final phase of writing up. My colleagues and friends in Helsinki have been at the core of making up an exciting yet a supportive environment where to plan and write up the thesis. Thank you, Dr Tuomas Tammisto, Dr Suvi Rautio, Dr Senni Jyrkiäinen and Dr Heikki Wilenius for paving the path and being there for me with wisdom. Thank you, Agnese Bankovska and Dr Daria Krivonos for your friendship, support and encouragement; Salla-Maria Korhonen and Maija-Eliina Sequeira for the life you bring to anything you are involved in; and Annastiina Kallius for being ‘my cohort’. Thanks, Tuire Liimatainen, Marina Vulovic, Veera Kankainen, Frederik Ørskov and Matthias Au for making my time in Helsinki so fun and having appreciated free-drink receptions as much as I do. I was very fortunate with the people I shared the office with over the years, Dr Ibrahim Abraham, Dr Petra Autio, Dr Matti Eräsaari, Katri Hirvonen, Dr Antti Kääriälä, Bjørn Sjødin, Aleksis Toro, Roman Urbanowitz and Jenni Viitala. I am grateful to everyone at our discipline and office for your generosity, insight and the overall atmosphere you have created for us at Helsinki. I particularly valued being the teaching assistant on a course that Dr Anni Kajanus taught – I learnt so much. Also, I thoroughly enjoyed the History and Anthropology course by Prof. Nikolai Ssorin-Chaikov. I found the PhD seminar first led by Prof. Timo Kaartinen and then by Dr Andrew Graan hugely useful. I am grateful to everyone else who participated in it and the PhD students who shared this time with me in Helsinki overall. I want to thank my parents Maie and Väino, and my sister Riin for everything, all that you have sacrificed for and contributed towards my education, and me as a person. I am so fortunate to have you as a sister, Riinu. And thank you, Rauno, for being such a lovely brother to me. Thank you, Lauri Valdur, for sparking an interest in research in me. Thank you, Britt, Ester, Helen H., Helen O.-M., Katya, Liisa and all of my other dear friends – I am so glad you are in my life. I am indebted to the two pre-examiners of this thesis, Prof. Susan Gal and Prof. David Sneath, who read this thesis with exceptional care and commitment, providing extremely useful and inspiring feedback. I

ix am very glad and excited that Prof. Rebecca Empson has agreed to take on the role of the Opponent at the thesis defence. Last, but not least, this research would not have been possible without the very generous funding from the Doctoral School of Humanities and Social Sciences of the University, and the Faculty of Social Sciences, all the travel grants, infrastructures, and other forms of security and assistance the University has provided me over the duration of this project.

x Translation and Transliteration

At the early stages of working with my materials, I translated parts of the recorded interviews from the Mongolian language into simpler Mongolian or English with the help of my Mongolian language teacher, Nasantogtokh bagsh. At the final stage Munkhmaral Tumennasan provided a translation for selected sections of the interviews which I found most challenging. After comparison and valuable advice from Munkhmaral, I resorted to my own translations, making edits according to hers with a few exceptions involving sections where I had made very extensive content mistakes and where it made sense to use her text as the basis for further editing. In the cases of such collaboration I paid extra attention to secure the full anonymity of my interlocutors. All of the other materials, such as the rest of the interviews, books, newspaper articles, web sources, field notes and so on, I translated myself. My intention has been to provide the most accurate translations to the best of my ability, and I am solely accountable if I have failed to do so. In the thesis I draw on the Mongolian terms used in order to indicate how these were addressed in a specific context and to show the particular connotations and variance between contexts to the reader who is familiar with the Mongolian language or interested in tracing these word usages. There are exceptions to this aim: there are also sections in the thesis that review Mongolian word use and general discussions where mainstream terminology is relevant. The in-text transliterations in the thesis are from the written Mongolian Cyrillic script, spoken language and occasionally from the Mongolian language that had already been romanised. The transliteration I use for the Mongolian Cyrillic letters not present in the Latin script or for the letters that can be romanised in various ways is the following:

xi Ёё yo Жж j Зз z Йй i Өө ö Үү ü Хх h Цц ts Чч ch Шш sh Щщ sh Ъъ i Ыы i Ьь i Юю yu Яя ya

I have not imposed my transliteration onto names and words which are commonly used in a different romanised form from the transliteration system I am following.

xii Chapter 1. Introduction

A socialist realist painting depicting a mother and her child in soft colours in an elaborate frame hung on the wall. A thick folder of laminated slides was open on the page depicting surgical abortion. On the other side of the room, pinned to a stand, were printed graphs of national statistics of abortions, miscarriages, births... I had heard they carried out abortions in the clinic, although it was not registered to do so. I was waiting for an interview with the gynaecologist, which had been set up by a friend. The doctor appeared to oversee the queue as the office hours were almost up, and she asked me what I needed. Her tone was abrupt and accusative – rude, frankly – with her gaze indicating that she saw me as akin to trash. I wondered why that was and the speculations in my head unfolded. Was the assumption that I had been sleeping around and of my own accord had gotten into trouble of some kind, such as pregnancy or a sexually transmitted infection (STI), and now was appearing without a time slot and necessary tests to ask for favours? This impression, however, did not hugely differ from my observations of how young Mongolian women were often addressed in public clinics. After I mentioned a common connection who had set up the meeting for an interview, the doctor instantly warmed, causing me to acknowledge how nice it was to be treated without contempt, even if there was not the stress of going into a gynaecological examination. I, unlike others, was there just for an interview, after all. My wait on the bench with the few remaining patients continued, although the office hours were up. In front of me in the line was a young woman, a university student, who had probably timed her appointment to be the last one of the day. She and her boyfriend had been there for a while, and he was hovering out in the corridor. Coming to call her in, the doctor did not seem eager to proceed with the consultation, asking her about the tests that she had undergone, while the girl maintained she had taken all the necessary ones in the morning and showed the paper slips she had collected as proof. Through the cracked door, which was never fully closed for privacy, I heard the doctor speaking to her rudely and scolding her. She responded

1 with something unintelligible, crying. From the exchange, the boyfriend and the pad she was carrying with her, I assumed she was there to have an abortion and my presence was about to ruin this undertaking. And shortly after she did indeed appear again, looking annoyed, quickly changed into her clothes and left.

An edited excerpt from field notes, 2018

This research started off with the question: ‘why is abortion in Ulaanbaatar often informal although legal?’ Throughout this thesis I am suggesting that the answer to this initial question has more to do with the particular and gendered forms of governance involving healthcare rather than a general and ‘individually’ experienced stigmatisation of abortion. I understand governance as the historical and otherwise specific ways that determine and shape outcomes. My core contribution lies in showing that gender matters in studies of governance, and through my ethnographic material I provide specific insights into how it does so in Ulaanbaatar. I dissect some of the aspects of the vast and open-ended politics surrounding reproductive health, shifting the disciplinary focus from various Eurocentric and/or Americentric dualisms and conceptualisations still underlying anthropological studies of reproductive health to the relations involved and everyday life. In achieving this I start with one of the most prevalent concepts and analytical tools taken up by anthropologists of reproductive health and those studying governance alike – biopolitics. The first part of the thesis has a clearer comparative engagement with this, and as the ethnography progresses, I then shift to proposing other means to address gendered forms of governance while taking seriously the inconsistencies and contradictions they might involve. I propose that this can aid analysis in understanding how insecurities and vulnerabilities surrounding reproductive health are produced and maintained.

2 Reproductive healthcare and biopolitics

‘What about biopolitics?’ ‘Have you read Foucault?’ ‘Of course, Foucault has talked about this.’ These were some of the generous and well-meaning comments my scattered ethnography provoked after I had returned from the field up until the point when I made answering these questions the focus of my thesis. I was quick to disregard these suggestions at the time they were made, always with a grimace as though looking at something at a great distance with a slight shake of my head accompanying it. Much like Foucault noted about refraining from taking up the state ‘in the sense that one abstains from an indigestible meal’ (Foucault 2004: 78 in Lemke 2007: 43), I, too, felt like delving into answering these justified enquiries would have been beyond the task and time limit of the thesis at hand. As time went on and my engagement with my material led me to experience recurring overlaps of vocabularies and themes that came up – involving sexuality, politics, medicine, subjectivity and so on – in reading those who have taken up Michel Foucault’s work or the scholarship of the man himself, avoiding these questions became increasingly hard. Therefore, in this thesis, drawing on ethnographic material is essentially twofold. Of course, there was the urban, fragmented and emotionally charged ethnography I carried out in Ulaanbaatar, Mongolia, between May 2017 and August 2018. But there were also the discussions after the fieldwork, which not only involved the scholarly literature, but also human encounters within academia where Foucault made an appearance. These were, of course, justified enquiries as Foucauldian frameworks have in recent decades been frequently and rigorously applied to reproductive healthcare. Meanwhile, reproductive healthcare has as a whole been led forward by scholars engaging with various ruptures of kinship and gender. Recent leading studies in the areas of kinship and gender have overwhelmingly involved the (bio)technological (Carsten 2004; Franklin 2013; Gammeltoft 2012; Inhorn 2012; Strathern 1992), an approach that has often been mediated by the biopolitical (Greenhalgh 2009; Greenhalgh and Winckler 2005; Inhorn eds. 2007;

3 Kaufman and Morgan 2005; Melhuus 2012; Rabinow and Rose 2006). Various rich ethnographies have also provided alternative approaches to reproductive health, focusing on demography and political history (Greenhalgh 2008); morality and ethics (Paxson 2004); subjectification and belonging (Gammeltoft 2014); neoliberalism, political economy and globalisation (Chapman 2010); social injustice (Schaffner 2006); and race, racism and biotechnologies (Harrison 2016), to name just a few. These, however, remain sporadic when compared to the biotechnological canon. Needless to say, the latter body of work responds to the ethnographic realities that scholars have encountered, but it is also worth noting that many of these studies emerge from Euroamerican contexts and/or focus on technologies that on a global scale remain high-end services, indicating a (sub)disciplinary fascination with novelty and emergence. Foucault outlines the concept of biopolitics as ‘the power over life’ that has two non-antithetical poles: the first where the body with its qualities is equated to a machine; and the second, which focuses on the body of the species (Foucault 1978: 139). The biopolitical in the reproductive literature has been taken up for its various analytic capacities. However, characteristically, these conceptualisations that are linked to life not only remain inherently defined by ‘the human life cycle – from birth to menopause’, but also how ‘women (and sometimes men) are actively involved in revising or resisting local biopolitics, thereby challenging the influence of political, economic, and social forces over their reproduction’ (Inhorn 2007: xi). In Marcia Inhorn’s (2007: xi) use, biopolitics is taken up to address people’s struggles with normalcy, and the importance of politics and history in determining the latter. Michael Hardt and Antonio Negri (2017: xviii) argue for the ‘ontological’ (defined by them as ‘the world as it is’) form of life and discuss this in dialogue with Foucault’s conception of ‘life’, which they find to concentrate on ‘the power over life – or, really, the power to administer and produce life – that functions through the government of populations, managing their health, reproductive capacities, and so forth’ (Hardt and Negri 2009: 57). In a similar vein, their interest lies with ‘life as resistance’, and they distinguish two powers: ‘the biopower against

4 which we struggle is not comparable in its nature or form to the power of life by which we defend and seek our freedom’ (Hardt and Negri 2009: 57). It is worth noting, however, that biomedicine not only subjects women to a ‘gaze’ (Foucault 2003a: 8-9; Lock 2007: 200), but also usually tends to do something else to people and their bodies, such as make them feel less pain, extend one’s own or a loved one’s lifespan or act as a location of hope when it comes to the impasse of not being able to conceive, to name just a few potential effects. For this reason, women and men engage with various forms of medicine, and this requires alternative analytic approaches beyond ‘passive acceptance’ or ‘self- conscious resistance’ (Lock 2007: 220). Along this argument, Hardt and Negri (2009: 57) distinguish ‘biopower’, which is ‘power over life’, and ‘biopolitics’ as ‘the power of life to resist and determine an alternative production of subjectivity’. But as Thomas Lemke (2011: 34) has pointed out, Foucault’s use of ‘biopolitics’ is not entirely consistent and its meaning often shifts in his work. This has also meant that the way ‘biopolitics’ has been taken up varies hugely both in terms of what aspect or definition of it is used and how it stands in dialogue with the topic at hand. Perhaps the most commonly used definition of biopolitics draws on Foucault’s Discipline and Punish (1975) and The History of Sexuality (1976), as found in the work of Hardt and Negri (2009: 56). For the sake of clarity, I will constrict the discussion solely to biopolitics. It has been noted that Foucauldian biopolitics has rarely been studied in post-Soviet or post-socialist contexts, although there is a wealth of scholarship involving health and sexuality (Bernstein 2013: 10). Indeed, the latter has been one of the foremost areas that has contributed to the ‘post-socialist’ area studies literature on the former Soviet Union and its satellite states (see Gal 1994; Kligman 1998; Kligman 2000; Rivkin-Fish, 2003, 2005). Meanwhile, the former studies of reproductive health in the context of Eurasian post-socialism could easily be framed as biopolitical if not for the emphasis on gender and the significance of the gendering of bodies discussed, which Foucault has been critiqued for overlooking (Inhorn 2007: 12).

5 There are, however, non-ethnographic inter- and cross-disciplinary exceptions when it comes to bringing biopolitics together with post- socialism, such as Andrey Makarychev and Alexandra Yatsyk’s (2018) approach to illiberal Russian (geo)politics through analysis involving ‘the issues of corporeality, body politic, and life and death’1. The most well- known analysis following this line of thought is that of the anthropologist Stephen Collier. In Post-Soviet Social (2011), he does not seek out specific definitions of biopolitics from Foucault’s material as many engaging with his work – including myself – have strived to do; instead, Collier designates ‘liberalism’ and ‘modern government’ as locations to study biopolitics, and not vice versa (Collier 2011: 16). Drawing on Foucault, he proposes a conceptual loop:

Foucault’s examination of liberalism and neoliberalism suggests a template for the study of biopolitics; and that the frame of biopolitics, in turn, provides an orientation for the study of liberalism and neoliberalism that diverges substantially from the one suggested by conventional understandings. (Collier 2011: 16)

This rethinking of neoliberalism involves novel compromises ‘with the idea of social justice’ that Collier sees the biopolitical approach as encompassing (Collier 2011: 3). He approaches neoliberalism ‘as a critical reflection on governmental practice’, which can mean a range of very different things – and possibly all of them at once – as long as ‘life’ is involved (Collier 2011: 3). Collier underlines that biopolitics in Foucault’s lectures of 1978-1979, which he mostly draws on, do not refer to the political management of questions that we would today call ‘biological’, but instead:

that if a new figuration of “Man” or “anthropos,” defined at the “finitudes” of life (biology), labor (economic activity), and language (sociocultural existence), emerged in the late

1 For their broader approach bringing together an analysis of biopolitics and the post- Soviet, see Makarychev and Yatsyk 2019. 6 eighteenth and early nineteenth centuries as the object of the human sciences, then biopolitics designates the entry of this figure into the workings of political sovereignty. (Collier 2011: 17)

Collier continues:

In this sense, the term “biopolitics” may serve (and has indeed served) as a source of confusion. Foucault might just as well have referred to an “econopolitics” or a “sociopolitics,” or invented a more general term. But since he did not, since the obvious alternatives do not exactly roll off the tongue (anthropos-politics?), and since biopolitics is an accepted term of art, I will stick with it. (Collier 2011: 17)

This thesis, on the other hand, proposes that ‘biopolitics’ has conceptually been accorded considerable stretch, and calls for more specific vocabularies of governance to engage with the vulnerabilities and insecurities that reproductive and various other ‘lives’ involve beyond Euroamerican contexts. Contrary to Collier, I seek a definition of biopolitics that is not only historical, but also regional and specific. Writings on biopower and biopolitics, particularly if these are taken up as useful analytic concepts, need to be significantly more specific than how they appear in the literature today, particularly regarding various ‘breaks’ and the emergence of novel discourses. One such site has been the biotechnological. Both Foucault himself and prominent anthropologists who have taken up these concepts located them in a particular moment in time: namely, the eighteenth and nineteenth centuries (Fontana and Bertani 2003: 276-277; Rabinow and Rose 2006: 204). Paul Rabinow and Nikolas Rose (2006: 215) have proceeded to suggest that the current moment might be another break similar to the rise of ‘the clinic’. Overall, biopolitics suggests a shift in time in which the governance of living beings has gained ground: ‘as an explicit rupture with the attempt to trace political processes and structures back to

7 biological determinants’ (Lemke 2011: 34). When it comes to issues surrounding abortion and reproductive healthcare, these may involve, but are not limited to, ‘biological’ conceptualisations of life. I primarily follow my material and that of Ann Stoler (1995) in her critique of Foucault’s contribution and its subsequent uptake by contemporary scholars. Stoler engages with The History of Sexuality, Volume I, suggesting that Foucault ‘links racism and the technologies of sexuality directly to biopower, without linking racism and sexuality explicitly to each other’ (Stoler 1995: 35; see also McClintock 2013: 7, 21-74 for a parallel argument). As explained above, biopolitics or biopower was essentially linked to the location(s) of liberalism, according to Foucault, and only then bled into racism and sexuality, rather than such discourses in themselves being fragmentary and shaped by colonial contexts. For example, dating the transition ‘from a “people” to a “population”’ to the eighteenth century does not necessarily make ‘metahistorical sense’, for Stoler (1995: 39) argues that both notions were continuously shaped by colonial projects in plural geographic locations and beyond the historical moment Foucault points to. Following this argument, ‘biopolitics’ is historical in the sense of drawing on a specific rupture in time in a specific place, but also in how ‘biopolitics’ itself incorporates the suggestion of a certain history and spatial location of emergence. Many of the works taking up biopolitics repeat the latter flaw by overlooking the spatial complexity of various ‘emergences’ or by discussing these in highly general terms through the pronoun ‘we’ that Foucault as well as Rabinow and Rose (2006: 215) have resorted to when addressing the situation and their audience alike. This encourages me to ask: who are the ‘we’? Whose experience exactly do these generalisations draw on? And would others belonging to the same societies exclude themselves from this ‘we’? After all, the biotechnologies that Rabinow and Rose (2006) are interested in tend to remain high-end areas of services in reproductive healthcare not only in certain parts of the world, but also in societies that Rabinow and Rose would include. Additionally, emergence of this kind could be contested by ethnographic accounts of other developments, such as the presence and prevalence of non- biomedical services that perhaps expand into the ‘we’-societies.

8 Position and subjectivity in and out of the field

Who the ‘we’ exactly encompasses is crucial, yet is often still overlooked, assumed or assigned to vast geographic territories or humanity as a whole. Consequently, I resist the ‘we’ form of address in any academic writing that involves the reader in the assumption of communities that do not exist. In Lila Abu-Lughod’s words, ‘every view is a view from somewhere and every act of speaking is speaking from somewhere’, and this sort of position does not only rely on the ethnographer’s self-identification and agency in a direct sense (Abu- Lughod 2014: 387-388). Rather, in this regard, I view both myself and other anthropologists as ‘bundles of social relations and past experiences combined with intellectual traditions’ (Green and Laviolette 2018: 3), no individual or no body of work being void of these. It would be an impossible task to untangle ethnography from biography and the interlinked moralities, relationships and broader histories along which it unfolds (Carsten, Day and Stafford 2018: 7). Needless to say, besides being ‘from somewhere’, these forms of location are neither stable nor perceived in the same way by everyone involved in these ethnographies. In the following section I share some brief commentary on ‘where’ I am from in that sense. The first time I ever entered a gynaecologist’s office in Ulaanbaatar was in 2014. It was at the city’s district clinic just behind the apartment I was renting a few minutes’ walk away from the school where I was working at the time. I was looking for the X-ray room to confirm that I was not suffering from pulmonary disease. Just prior to this, I had sorted out blood tests fairly quickly to evidence that I did not have HIV. It was the fourth time that I had been tested that year for various paperwork for visas, which together took such a length of time that the official proof of my health occasionally expired. In one of the long corridors, I stopped a doctor to ask for directions to the X-ray room, but instead she instructed me to sit and chat with her in her office. The gynaecologist, who was slightly past middle age, had been educated in the former Soviet Union, and like many others belonging to her generation, she instantly seemed to locate us as sharing a past due to my Estonian origins. She therefore

9 switched to speaking Russian to me. I sat next to her desk not understanding what she was telling me, wishing intensely that I did, both because of the awkwardness of not knowing what was going on and for its informative potential, as the conversation shifted to the apartments she owned with visual aids provided. As she looked up photos on her phone and took sheets of paper out from her desk drawer to negotiate a price, it became obvious that she was seeking to lease her flats, while I was uncomfortably sitting on a stool next to a tray of cold-looking metal instruments and an examination chair that, just through a glance, made me feel a small wave of unease as though at any moment I would be lifting my feet up into its rests. I explained in my beginner Russian – which was temporarily going through a revival of sorts owing to the Russian Buryat colleague I shared the office with – that I already had a place to live and promised to keep her in mind concerning my foreign friends who might be interested. We cordially exchanged phone numbers. After some further broken chatter about the present conditions of our lives, mainly mine, she directed me to the other wing to find the X-ray room locked and the pulmonary doctor going out to lunch with a friend. My foreign yet locatable and relatable appearance came into play again as the pulmonologist placed her stethoscope on my chest in the corridor, said I looked healthy and, to my greatest joy, signed me off as not having tuberculosis. Mongolia, like Estonia where I grew up, used to be socialist and is now designated as ‘post-socialist’. What the two countries share are the quick changes that have occurred in just one lifetime: in my case, from the late 1980s onwards. The question of the society-individual relationship, specifically when it comes to abortion and what in some contexts is suggested as a ‘family breakdown model’, is particularly close to my heart due to my own deep appreciation for what I perceive as my independence, which has led me to strive to live a different life to that of my parents’ generation and their experience of the everyday. My appreciation for my independence from ‘family’ overall created some defining limitations to this research: mainly my inability to live as part of a family unit as an unmarried young woman or daughter long term, and my unwillingness to write about it. While contradictory material is

10 plentiful, my time in both Estonia and Mongolia also indicated that family is not only a place of safety, enablement and growth, as well as a social prerequisite for other aspects of life, but also a context of violence, power imbalance and, needless to say, ‘personal sacrifice’, negotiation and loss, which are not shared equally between its members. Unlike the nine months I spent in Mongolia working between 2014 and 2015, my doctoral fieldwork brought forth some extended reflections on these and other matters, as well as comparisons to Estonia, presumably because I found myself idle more often than during my earlier stays. There was another broad set of more contemporary developments and reflections which overlapped with this project. These were instances involving gendered violence, like the increased addressing of rape in Indian media; the killing of a young female journalist Kim Wall in Danish waters; and the chopping-up of the body of a young woman by her boyfriend, a history professor in Saint Petersburg, Russia, to name a few incidents. A few months into my fieldwork in August 2017, on a day that happened to be my birthday, a drunken man rather violently grabbed my arm and announced he wanted to joke or play (togloh) with me. My physical weakness was extremely frustrating, and due to an overall shift in attitude following similar incidents including the groping of my chest, I became rather physically assertive during my fieldwork. In the days and weeks following my birthday and this first incident, I read in the news of how Kim Wall had disappeared in Denmark. While the #MeToo and Mongolian anti-violence movements (Chapter 2) were unfolding, so too was my sense of personal unsafety, although I recognised the contextual nature of such feelings to a degree. Personal histories of violence often entered conversations I had in the field, either initiated by myself or my interlocutor, even prior to these events in August 2017. Reflections on my own experiences and the often ongoing struggles of those I cared about around me affected my mood, and consequently during my fieldwork I struggled with my mental health. There were better and worse times, leading to the growing recognition that for this project and for my own existence to be sustainable, my (mental) well-being had to become a priority and part of the methodology. After a few Skype sessions with a psychologist that I had previously seen failed due to poor

11 internet speed from the Estonian side, I resorted to occasional meditation sessions and Buddhist classes at the Centre of the Foundation for the Preservation of the Mahayana Tradition, which provided a safe, quiet and supportive space. Unlike some of my friends in Ulaanbaatar who were in the process of diverging from their prior networks and distancing themselves from shamans and lamas to seek assistance from psychologists and psychiatrists, I shifted towards particular Buddhist spaces, although I did not become a Buddhist. Both in fieldwork and academia, as well as outside of these spheres, I sought spaces where I could take rest from the need to stand up for myself and possess some sort of authority, which I would much rather not need to project or consider. Although this thesis does not explore these topics in much greater depth than presented here, I have included this reflection as part of my considerations concerning methodology, because I have found these issues missing from the area studies literature, which is otherwise so rich. I can only hope that, going forward in this ongoing #MeToo context, there will be more accounts of what it is like to be in the field, and perhaps outside of it, too, as a specific person at a specific time, as well as how well-being and mental health are maintained in such circumstances.

Mongolia: Broader context of the study

Today’s Republic of Mongolia is a rare democracy in its geographic region. With a territory approximately equivalent in size to three Frances and a population of 3.2 million people, it is the least densely populated sovereign country in the world. The country’s capital, Ulaanbaatar (carrying its socialist name ‘Red Hero’), is an exception, struggling infrastructurally, environmentally and often socially to accommodate nearly half of the country’s population. It was a nomadic city until 1778 when it settled in the valley of the River Tuul (Bawden 1968: 11). Currently about half of the capital’s people – and therefore a quarter of the country’s population – live in the sub- and

12 periurban ger districts2, which are usually made up of small wooden dwellings and Mongolian yurts. These areas expand onto the four mountains in each direction surrounding the valley. While struggling with various elements of infrastructure, the ger districts cannot be equated to suburban slums in other countries as they are not only inhabited by recent migrants to the city and those belonging to the lower income groups, but also middle-income groups, made up of highly educated people, such as doctors, teachers and governmental officials, among others. While different parts of the thesis focus on different contexts, not limited to the ger districts or other parts of the city, nearly all participants of this research belonged roughly to lower and middle-income groups. One of the core conditions making this study relevant is the country’s young population. According to the official statistics in 2018, people aged 0-14 years of age made up 31% of the whole population of Mongolia (NSO 2020). This means that, proportionally, every year a huge number of young people enter reproductive age and adulthood, which comes with its own vulnerabilities. This thesis aims to provide ethnographic insight into some of these spaces and complexities when it comes to reproductive health, parenthood or avoiding parenthood. Mongolia’s healthcare could be described as medical pluralism, but this term tends to fall short when it comes to the division of forms of services and the assistance people seek to address specific health concerns (see also Turk 2018). Currently there is a three-tier state healthcare system in place, based on social insurance; there are private biomedical3 service providers; also shamans; massage therapists and healers of various kinds and expertise, such as those working with spirit affiliations inherited down through family lines; massage therapists who follow Buddhist healing techniques; and those whose expertise mainly draws on biomedical training. Lamas or Buddhist monks, and less frequently nuns, are visited for various health concerns: for instance, while acute illnesses and operations are mostly treated in or in affiliation with biomedical

2 For common English use, I will refer to the ‘ger district’ rather than the ‘ger district’ throughout this thesis. 3 In this thesis the term ‘biomedicine’ is used interchangeably with ‘modern’, ‘Western’ or ‘European’ medicine, as it is also addressed in Mongolia. 13 facilities, lamas are often consulted as to whether to seek a biomedical treatment at all (for example, consulting on treatment for cancer for a loved one without necessarily involving them). Buddhist medicine in its more institutionalised forms is known as Mongolian traditional medicine, aligning with Tibetan traditional medicine and its core text, ‘Four Medical Tantras’, which was initially translated from Tibetan into Mongolian in the eighteenth century (Duoer 2019: 1). This followed other religious and governmental developments in the area. While Buddhism was established as the de facto state religion in the thirteenth century under Qubilai Khan of the Mongol Yuan Dynasty, it was particularly the second conversion in the sixteenth century under Altan Khan that led to the popularisation of Buddhist medicine (Atwood 2004: 345 in Duoer 2019: 1; Duoer 2019: 1). The Manchu Qing empire, which ruled over the area from the seventeenth century, oversaw the further flourishing and development of the Buddhist institution, which also meant the development of Buddhist medicine (Duoer 2019: 2; Norov 2019: 1-2). The Qing Empire fell in 1911, and Mongolia announced independence from China as a monarchy under the leadership of the Jebtsundamba Khutuktu the Eighth, the reincarnation of the spiritual leader of Mongolia (Bawden 1968: 187). This arrangement lasted only briefly: the Jebtsundamba Khutuktu died in 1924 under unspecified (possibly suspicious) circumstances (Baabar 1999: 255). While until the early twentieth century Mongolia remained a feudal theocracy (Kaplonski 2004), the extended power struggles of the early twentieth century resulted in the Mongolian People’s Revolutionary Party eventually coming to power in 1921 and Mongolia embarking on a full-speed socialist programme as the Mongolian People’s Republic in 1924 following the death of the Jebtsundamba Khutuktu. This involved the persecution of religious institutions and the development of the infrastructure and practice of ‘modern’ medicine. Simultaneously, the ideas of national unity were established. The politicisation of collective terms like nationality (ündesten) has been a rather recent phenomenon in Mongolia (Bulag 1998: 31). For instance, yastan (nationality or race) was taken up to designate the Mongol group in the 1930s (Bulag 1998: 31). Previously the term was not

14 used among Halh Mongols (the current political and ethnic majority in Mongolia); rather ‘the Buryats as a whole were referred to as a yastan’ (Bulag 1998: 31). Ethnicity (yas ündes) can literally be translated as ‘root of bone’ (Bulag 1998: 31; Park 1998: 127). ‘Bone’ is relevant to how nationality and ethnicity are referred to. Nationality or race (yastan) includes two parts: bone (yas) and people/group (tan) (Park 1998: 127). In the mainstream national discourse, ethnicity has been and still is understood as inherited quite strictly from the father through the yas (bone) line (Billé 2015: 25), although there are cases where family identity or ethnic identity can be and is inherited from the mother (Humphrey and Sneath 1999: 27). In addition to the aforementioned socialist developments towards communities of belonging, there have been projects where the state has produced forms of previously non-existent kinship (Sneath 2007: 95). The seeking of clan or family surnames (ovog ner) for administrative purposes that escalated in 2004 was a creative endeavour, rather than a process of ‘finding roots’ as it was presented in the Western media because Mongols did not historically have such unitary personal names (Sneath 2007: 93- 95). A similar administrative process of seeking names to aid administration unfolded during the Qing rule (Sneath 2007: 95-97). Contrary to an evolutionist imagination of patrilineal groupings building the ‘society’, a 1930s study of 100 encampments (hoton) found that a minority of the organisation of these was based on descent, and the majority was based on unequal wealth and labour division (Simukov 1933 in Sneath 2007: 97). It has been recognised that throughout history the political organisation was not based on common ancestry or descent groups, although these played an important part in the political theory and were subject to administration themselves (Atwood 2012: 3; Sneath 2007). Following the collapse of the Soviet Union – Mongolia remained a satellite state during socialism – and the Democratic Revolution of 1990, Mongolia became a semi-presidential representative democratic republic. The designation of the ‘Mongolian cultural area’ or pan-Mongolism includes various ethnicities and covers areas of Inner China in The People’s Republic of China and Buryatia in the Russian Federation. In

15 this thesis I prefer the term ‘Mongol’ as an identity based on general or ‘cultural’ belonging beyond the country’s borders versus ‘Mongolian’ as designating mainly citizenship, although in the Mongolian nationalist discourse these somewhat overlap. Following the collapse of the subsidised medical system, the revival of various practices and novel forms of historicisation, the biomedical approach to health and the body has subsided to make up one of many options towards securing health and well-being, even in the state’s approach to the life of its population. Meanwhile, Mongolian traditional medicine and other non-biomedical services became institutionalised, subject to taxation (see Anderson 1999), and were selectively included in the medical services covered by health insurance. Various medical approaches in themselves overlap and are integrated: for example, recently there has been a search for and discussion of the ‘shamanic gene’, which brings together the biomedical and the shamanic (Ölzii 2011: 328- 331). Besides the aforementioned collapses of the medical and the religious, various forms of Christianity are prevalent in Ulaanbaatar and elsewhere in the country, which subscribe to biomedical practices and at times provide medicine as part of their outreach programmes. As this thesis will discuss, reproductive health services are not limited to the biomedical, and if they are, the seeking of them draws heavily on trustworthy relations and proximities relying on various means. In my own case, seeking entries into these spaces came forth mostly through friends or through my assumed shared background due to having been born in the Soviet Union, where many of the gynaecologists practising today were trained.

Outline and contribution

In the following Chapter 2, I will provide further detail on the political history of abortion. Drawing on the public sphere, I will unfold four particular spaces that abortion has come to stand for and be linked to: population development; capitalism; legislation; and rights and freedom. This section will introduce several themes that will recur

16 throughout this thesis, including womanhood and motherhood, issues involving ‘rights’, discussions surrounding fetal belonging to the nation, kinship/lineage structures and the body of the pregnant woman. These themes will be further built on in Chapter 3, which is largely based on a specific form of knowledge of Mongolian traditional medicine and kinship in its ‘ideal’ form. This chapter will go into greater depth on one approach to how life should be ordered in the Buddhist universe, but it also will begin to indicate how these ideas can be contested by various claims on legitimacy on the part of overlapping reproductive healthcare services and a person’s place in the world. Much of the discussion will revolve around motherhood and reproductive challenges: namely, why these are important and what connotations abortion has in this context. Making a contribution to the area studies literature by suggesting that it is the bone marrow where biological and cosmological notions of ‘life’ intertwine, this chapter will introduce the next by establishing a specific approach to ‘Mongol kinship’. Chapter 4 will discuss ‘kinship’ and the making of ‘family’ in a very different setting to the overarching notion of how things ‘should be’ by exploring the perspective of young mothers. By proposing that motherhood is inherently linked not only to providing care, but also to the need to receive it, this chapter will show how motherhood gives rise to gendered subjectivities and reflections on the state and everyday life in the city. This chapter will essentially provide a discussion surrounding the alternative to abortion: namely, carrying the fetus to term and becoming a mother. While many women never seriously consider an abortion in the case of an unwanted or unplanned pregnancy, becoming a mother in today’s Ulaanbaatar in one’s early twenties without completing higher or vocational education and without having supportive networks of care can be vulnerabilising and may induce insecurity. Drawing on the Mongolian child money programme, instead of linking these conditions to biopolitical population development, I suggest that through the structural adjustment programmes the Mongolian government focuses on the management of budgets and financial flows rather than on the ‘life’ of its population in any singular sense.

17 Chapter 5 will focus on the premise that unwanted and unplanned pregnancies are linked to knowledge and the lack of it, as well as experience of reproductive matters. The chapter will follow the making of a sex education YouTube video, which involves the discussion of contraception by a group of young professionals in their twenties and early thirties. Returning to the discussion of rights, the concept of responsibility for seeking and providing contraceptives will be introduced, suggesting the lack of a singular or linear ‘rights’ scale concerning how women or men approach the matter of preventing unwanted pregnancies. The discussion will also indicate the informal nature of how knowledge about contraceptives is sought and the spaces to which it belongs: while family members would be a desired site, this knowledge is mostly passed between peers and friends. As noted in Chapter 5, ‘formal’ healthcare and education are not the spaces in which reproductive knowledge and advice are sought, and Chapter 6 will take up healthcare specifically to explore the reasons behind this. Suggesting that public offices, such as the gynaecologist’s job position in Ulaanbaatar, have become a usufruct – temporally bound ownership that serves to deliver ‘fruits’ beyond its immediate properties – I will argue that there are historical, political and economic foundations to the collapses of the ‘private’ and ‘public’ in healthcare. The focus here lies with the status and work of the ‘doctor’. The chapter will explore in more depth what is ‘additional’ to the state gynaecologist’s job, namely care and attention, and how patients experience healthcare when accountability lies with people rather than institutions. Therefore, many reproductive health services, like abortion, cannot be categorised as ‘private’, ‘public’, ‘formal’ or ‘informal’ for the reasons this section unfolds, yet these denominations maintain their importance as emic terms both in their use by those immediately involved and in international economics and developmental discourses. Chapter 7 will follow the notions of legitimisation and verification of reproductive knowledge and services through reliable contacts. As another prevalent site of informal abortion aside from biomedicine studied in the previous chapter, the informal abortion medication market manifests as a space where various infrastructures of informality are

18 relevant. Certain forms of informality (such as seeking an abortion through securing the medicine at the market) relate to others (like law enforcement by the police or usufructuary healthcare), being gendered and specific in their occurrence. Abortion in this context is legitimised through personal experiences of it and everyday lives involving economic hardship, rather than through ‘formal’ structures, such as legislation, which is unknown and unknowable in its essence, manifesting itself only through the mediation of other informalities. In summary, the first two content chapters (2 and 3) will largely work towards familiarising the reader with the nuanced contexts of abortion, kinship and governance in Mongolia. These will build towards two core ethnographic chapters (4 and 5) in which the issues of reproductive health, knowledge and the gendered nature of potential parenthood will be explored in some depth. The last chapters (6 and 7) will propose more nuanced conceptual approaches to answer the question, ‘why is abortion in Ulaanbaatar often informal although legal?’ Corresponding to the above listed order of the chapters, I discuss governance through macropolitics and the nation state; religion, medicine and kinship; care; sexuality and knowledge; biomedicine; and infrastructures of informality. I conclude that these forms of governance are inherently gendered, meaning they are linked to ‘women’ as a category. Firstly, while the state orders have changed, ‘women’ have maintained a status as a category to be managed, improved and reformed. This category has important parallels with the establishment and maintenance of biomedicine. Secondly, this often happens through women’s position as mothers, which is an inherently relational status. However, these governmental forms of assumed and claimed relationality by various others do not necessarily line up with women’s priorities and experiences in today’s Ulaanbaatar. In this gap, it is not only governance that shapes the outcomes but also gendered subjectivities – the affective and agentive (Kajanus 2015: 7-8), various experiences, learning and reflecting on issues that may have not come to occur otherwise. Yet, rather than being empowering in an Euroamerican sense, these subjectivities can be disappointing, tiring and frustrating, involving health and other risks which need to be weighed and negotiated. Therefore, I contribute to the

19 studies of governance, particularly to the previous approaches to neoliberalism and capitalism (such as Bear et al. 2015; Empson and Bonilla 2019; Pfeiffer and Chapman 2010; Povinelli 2006; Wacquant 2012), bureaucracy (Graeber 2015a; Hertzfeld 1993) and informality (Ledeneva 2018a; Simone 2004; Makovicky and Henig 2018) by suggesting specific ways in which gender is relevant beyond its conceptual attachments to individual bodies and persons when shaping health and other outcomes. The thesis also suggests that ethnography is a particularly well- suited methodology to study issues involving reproduction for its potential to involve ‘expanded notions of historical time, whether individual or collective’ (Ginsburg and Rapp 1995: 7), or both. And address the messiness and uncertainty that (reproductive) lives involve.

20 Chapter 2. ‘Abortion’: A Brief Political History in Mongolia

People in this chapter

Tsakhiagiin Elbegdorj The President of Mongolia 2009-2017 Khaltmaagiin Battulga The President of Mongolia 2017- Khamba Lama Natsagdorj The Head of Manba Datsan, the largest traditional medicine institution in Mongolia

Introduction

In spring 2017 Mongolia’s then President Tsakhiagiin Elbegdorj (President of Mongolia 20174), a politician praised for his intellectual capacities, his promises to curb corruption and his calls for the increased participation of women in politics, opened the spring session of the State Great Hural, the Parliament, with an emotionally charged speech. He suggested that, alongside drug use, abortion was one of ‘the most perilous threats facing us’, for they both target ‘Mongolia’s future, and Mongolia’s gene pool’. ‘What a heartbreaking tragedy!’, he exclaimed when discussing the abortion ‘problem’. He began this thematic section of the speech by drawing on estimations of relevant statistics and by arguing that abortion had become problematic owing to its association with the livelihood of its providers:

Informal data show that in the past 30 years, Mongolia has lost about one million children to abortion. Most regretful of all, seven out of ten women of reproductive age have received abortion at some point of their life. We regularly hear about a growing number of institutes or individuals

4 These excerpts are taken from the 2017 speech, published in English on the President of Mongolia (2017) website. Particular expressions and translations are compared to the original speech in the Mongolian language (Elbegdorj 2017). 21 pursuing abortion as their main source of income. (President of Mongolia 2017)

He proceeded by addressing the problematics of abortion, involving the ‘nation’ and ‘motherhood’, and his position as the President of Mongolia regarding this:

Many girls and young women suffer serious health consequences due to unregulated trade and abuse of abortion pills. More and more women are now scarred for life; unable to bear children and to be called “mom.” … [I] had no choice but to speak loudly of this silent murder5 that is abortion. Mongolia, as a nation that cherishes its children, must put an end to this matter with a clear and coherent policy. No one in Mongolia should have the right to murder an unborn. No one should have the power to cut short a woman’s natural right6 to become a mother. (President of Mongolia 2017)

He then presented his position on the actions to be taken, again repeating why – which sounded like a call for the criminalisation of abortion – before suggesting that the Minister of Health should become involved in this matter:

We must curb, and consequently, put an end to this crime against the Mongol nation. Even a single Mongolian is precious for Mongolia. There is never one, a thousand, or a million too many Mongolians for Mongolia. The only acceptable reason is when there is a risk to the life of the mother and/or the child. However, it must be strictly regulated and meticulously enforced. … [M]ongolia must become a nation, which does not slaughter its unborn

5 Allaga (in Mongolian in the original version of the speech; Elbegdorj 2017). 6 Huvi zayaa, which could also be translated as ‘destiny’. 22 children in the womb of their mothers.7 (President of Mongolia 2017)

As taken up by President Elbegdorj, abortion has clear parallels with Foucauldian biopolitics, which ‘deals with the population, with the population as political problem, as a problem that is at once scientific and political, as a biological problem and as power's problem’ (Foucault 2003b: 245), particularly when this is married to liberal forms of government8 (see Foucault 1978). Biopolitics, when taken up as a form of governance, involves various strategies or contestations surrounding life and death in a collective sense, together with ‘forms of knowledge, regimes of authority and practices of intervention that are desirable, legitimate and efficacious’ (Rabinow and Rose 2006: 197). It has been recognised that these modern forms of governance may have the aim of ordering, improving and optimising human life, while at the same time remaining problematic and dangerous (Greenhalgh and Wincker 2005: 6) as well as being highly gendered. This particularly aligns with the socialist state and the nation-making project in Mongolia, at the core of which lies the category of ‘women’ due to women’s capacities to become part of the labour force and, even more importantly, women’s citizen- and workforce-producing capacities by giving birth and bringing up children. In this speech the President summarised and touched upon a number of interlinked themes beyond the literal fear of losing out on the population rise. These also provide the following openings for further scholarly analysis through which abortion is problematised in Mongolia and elsewhere: abortion as an economic occurrence through its link to doctors’ work; the value bestowed on motherhood as a woman’s ‘natural destiny’; infertility and various health concerns attributed to having had an abortion ; the ‘murdering of an unborn’ as a definition of abortion; and the statement of the ‘slaughter’ of ‘unborn children’ as an entry point into

7 ‘Монгол Улс тэнгэрийн тамгат алаг үрсээ эхийн хэвлийд нь алдаггүй улс болох ёстой.’ (Elbegdorj 2017). 8 For Foucault, liberal governance is not ‘an economic theory or a political ideology’, but rather ‘a specific art of governing human beings’ (Lemke 2011: 45). 23 conceptions of what an embryo or a fetus9 is, together with the address to the personhood of the pregnant woman in relation to the embryo/fetus. Although many of these themes could offer a worthy analytic intervention into the field, my material indicates that none of them is sufficient. Instead, in Ulaanbaatar abortion tends to be a location where meanings converge. It appears in various forms and through various definitions, which occasionally engage with others.

‘Abortion’

Becoming pregnant is addressed in Mongolian as jiremseh (‘to become pregnant’), hüühedtei boloh (‘become with child’), hüühed oloh (‘find a child’) and bie davhar boloh (‘body to become dual’). Abortion and miscarriage overlap somewhat when it comes to the terms used: the lowers (dood) or strongest levels of the vocabularies10 addressing the matter being zulbah (‘to miscarry’; or zulbalt, ‘miscarriage’), which is also occasionally used to address induced abortion, particularly when discussing abortion pills (zulbah em, ‘miscarriage medicine’). A lighter synonym for miscarriage is dutuu töröh (‘incomplete birth’) or dutuu törölt (‘incomplete birth’). Abortion is mainly addressed as ür höndölt (noun, ‘stopping or termination of seed’), as in legal and formal documents and most everyday discussions of the topic. Ür in a parallel meaning is also ‘child’ or ‘progeny’, and children are often affectionately addressed by their parents or grandparents as ür mini or ‘my child’. Abort, a foreign term, is also used in media or in colloquial exchanges. However, the levels of intensity assigned to abortion do vary, and in certain contexts are defined through or paralleled with other concepts like ‘murder’, as President Elbegdorj did in the 2017 speech.

9 In Western medicine the development of a human in the womb from fertilisation to week eight is addressed as the embryonic phase, and from week nine until birth as the fetal phase; the biological matter is accordingly referred to as the embryo and the fetus, respectively (Moore, Persaud and Torchia 2018: 1). 10 As explained to me by my Mongolian language teacher, there tends to be three levels of intensity to address a concept in the Mongolian language, although there is often no clear distinction between these three categories and this does not apply to all concepts. 24 In Euroamerican discourses, abortion is one of the prevailing symbols of both the twentieth and 21st centuries, and in past decades has also become one in Mongolia. Marilyn Strathern (2016: 19) in Before and After Gender approaches ‘symbol’ as:

an item, often a concrete, material object, which stands for something else, often an abstract notion, a value, an aspect of a relationship. It describes one thing in terms of another. Like myths, symbols make statements which put certain values on the things being symbolized. They express emotions people have (or should have) toward these things. (Strathern 2016: 19)

Drawing on this, she addresses various symbols that have shaped and become bound to ‘gender’: for example, how ‘sexual, in the sense of erotic/coital relations between the sexes, has for a long time in European cultures been a central symbol in terms of which the male-female relationship as such is thought about’ (Strathern 2016: 207). The analysis surrounding and extending from abortion in this chapter is somewhat inspired by Strathern’s approach to gender. However, my starting point will be different: instead of beginning with a notion (like Strathern with gender) that something, a symbol, stands for (e.g. in her approach to erotic/coital relations), I start with abortion as the symbol. Abortion has the capacity to carry certain values or affective qualities, but it also involves various transitions that enable the symbol to become ‘another relationship’: the relationship(s) that abortion carries at its core, that which it is intrinsically considered to be or that it manifests. Tracing the connections and distances between what it stands for, abortion in various spaces can be a symbol for different things or relations while making reference to others, but also carries ‘biological’ connotations surrounding pregnancy, the abortion event and fertility. A somewhat similar approach to abortion as symbol unfolds in Amy Fried’s (1988) sociological analysis of abortion politics, which she sees as symbolic by deconstructing belief systems as part of the analysis. However, for Fried (1988), abortion is symbolic as different individuals

25 tend to possess polar attitudes towards it, such as the pro-life and pro- choice activists in the US where the debate is rooted in the discourse of women’s rights, while others see the matter as complex and unable to be located on a single axis. For pro-life activists in Euroamerican contexts such as the US, Ireland and Poland, the relationship, besides including the woman, involves the problematisation of the relationship of the citizen and the life of the unborn: both in the sense that the embryo or fetus could be considered a citizen, and that other citizens would have the right and responsibility to speak for it. Citizen in this meaning can have large overlaps with the subject of God, drawing on religious discourse and legitimisation. For pro-choice activists, abortion most often arises as a symbol of (or stand for) gendered rights, somewhat overlooking the economic inability to prevent unplanned and unwanted pregnancies in the first place (as well as other constraints). Analyses involving the relationship between the state and the citizen have pointed to how privacy, liberty and sexuality intertwine, which lies at the core of the cases that have since become highly formative concerning abortion, such as Roe v. Wade (Garrow 1994: 705). Since the US constitutional principle has been summarised as meaning that ‘the right to privacy is inherent in the right to liberty’ (Garrow 1994: 705), the determining factor in the outcome to this case for the woman able to carry out an abortion was the right to privacy (Ely 1973: 928-932). In Euroamerican contexts, discussions of abortion remain most closely linked to the discourse of rights. On the other hand, in the literature addressing abortion in Japan (Oaks 1994) or Taiwan (Moskowitz 2001), the discursive relationship that arises involves the woman and the fetus, and this relationship gives rise to religious economies and mediation, such as the consolidation of aborted spirits by various, often monetarised, services. In these studies, too, there tends to be one discursive plane foregrounded over others. Indeed, whether to call something ‘a symbol is largely a matter of analysis’ (Strathern 2016: 19), as are any bounded or nuanced points of departure in research. However, there are some differences between analyses of abortion discourse versus approaching abortion as symbol. In such approaches that engage directly with ‘abortion’, the existing gender

26 relations, the occurrence of pregnancy, knowledge of and access to contraceptives and steep economic disparities can be overlooked. Needless to say, abortion is not only discourse or shaped by it, but also an experience for those who have had an abortion. There are also ‘practical’ political-economic foundations that shape abortion industries and experiences. The thesis diverges from being a discourse study in a direct sense in seeking to more deeply understand what is involved in the relationships or notions that abortion stands for. Therefore, abortion here arises as a plural symbol – it ‘stands for something else, often an abstract notion, a value, an aspect of a relationship’ (Strathern 2016: 19) – which I will follow as a methodological choice in order not to delimit the meanings and relevance it may have. The chapter proceeds to unfold four contexts in which abortion is ‘problematised’: population development; capitalism; legislation; and rights and freedom.

Population development

Geopolitics of abortion

One of the key contexts in which abortion appears could be roughly summarised as ‘population development’. Abortion as a means of managing state population and national goals – as well as the consequent policy-making and the intervention into the intimate lives of the reproductive citizen – has been applied by various states, the prominent examples of which do not need to be sought from afar. Although the following discussion largely focuses on the geopolitics of abortion in the former Soviet Union, Mongolia/Mongolian People’s Republic and People’s Republic of China, the rhetoric used by President Elbegdorj indicates clear parallels with pro-life speeches and politics elsewhere. The 2017 speech took place in the same year that saw an upsurge in abortion restrictions in the US, and also restrictions to public funding for family planning in the states of Iowa, Kentucky and South Carolina (Nash et al. 2018).

27 Parts of the former territory of the Soviet Union making up the Russian Federation, and the People’s Republic of China, the only two neighbouring countries of Mongolia, have historically had the most centralised approaches to abortion in connection to population development, which has had various implications for the discourse of reproduction in Mongolia. The Soviet Union, under the influence of which the then socialist Mongolian People’s Republic fell, was the first country to legalise abortion in 1920. This was a reaction to the prevalence of abortion, which was seen to pose a serious health threat to women due to its informality (Solomon 1992). Doctors criticised the law, which at the time was based on medical considerations and health concerns; the ‘demographic argument’ of abortion limiting population growth gained prominence only in the early 1930s, which prompted the outlawing of the procedure in 1936 (Solomon 1992). Shortly after the death of the USSR leader Joseph Stalin, the prohibition of abortion was revoked and its legality was re-established. Abortions, however, remained a topic over which the USSR Ministry of Health held a statistical monopoly and the abortion figures were not made available to the public until 1988 (Popov 1991). The latter development aligned with glasnost11 and perestroika12, the reach for transparency and reform, which in Mongolia, together with the ongoing modernisation project, was apparent in the legalisation of abortion in Mongolia a year earlier. Meanwhile, in China the merging of the state and reproductive issues followed a different and more severe path. The one-child policy was announced in 1979, by which time ‘birth planning’ as a concept had already existed for a quarter of a century (Greenhalgh 1994: 6). ‘Birth planning’, however, stands apart from the liberal Western ‘family planning’, which has broadly been taken up by international and developmental discourse, in that ‘birth planning’ was at its root linked to

11 Governmental transparency popularised by USSR leader Mikhail Gorbachev from the mid-1980s onwards. 12 The reformation of the Communist Party of the USSR at the end of the 1980s and into the 1990s. 28 the state’s management of births, much in line with other forms of ‘production’, like the production of material goods (Greenhalgh 1994: 6). For family welfare and for providing care to parents as they age, boys have been preferred as the only child in China. Both traditional and modern medicine have been used in finding out the sex of the fetus, and sex-selective abortions became common particularly from the mid-1980s onwards when ultrasound became available (Junhong 2001; Zeng and Hesketh 2016). Further review of the Chinese reproductive agenda will clearly be beyond the scope of this project, but it suffices to say that the prevalence of coerced as well as voluntary abortion shifted abortion technologies and their means forward, together with other cotemporal industrial and medical developments. Arising from this, informal abortion medication, particularly the market for pills, has boomed in China with their informal export-import, such as when ‘Chinese illegal abortion pills’ surfaced at marketplaces in New Zealand (Kiong and NZPA 2006). Abortion pills are available on the Chinese side of the Chinese-Mongolian border town Ereen, from where they are freely imported to Mongolia. The medication, colloquially known in Mongolia as the ‘miscarriage medicine’ (zulbah em) or ‘Chinese medicine’ (hyatad em), as well as how it is closely connected to the broader public attitudes assigned to ‘abortion’, will be discussed in more depth below concerning the specifics of capitalism and ‘business’ (below), the ‘poisonous’ connotations of the medicine (Chapter 3) and the market for informal abortion medication in Ulaanbaatar (Chapter 7). At the same time, the proximity to China – Mongolia’s main historical rival and enemy, as often pointed out during this decade – has repeatedly taken a place in the population development agenda as a justification for the need for population growth due to the direct and indirect threat of China undermining Mongol-ness, the population and even aspects of the Mongolian state. At times this erupts both in private communication as well as on the public level as paranoia (see Figure 1; for more on sinophobia, see Billé 2015). With Mongolia once an empire, and now seeking to re-establish the glory of Mongol-ness which currently lies somewhat dormant as potential, the population size is considered by some as a necessary means towards this or, as a minimum, for securing a

29 nation that is considered to have come under threat through various degrading direct and indirect effects, such as Mongol women’s marriage to foreigners, as was occasionally explained to me by male taxi drivers as we were stuck in Ulaanbaatar’s traffic jam. The issue was also addressed by President Elbegdorj in connection to the notion of abortion being a threat to ‘Mongolia’s future, and Mongolia’s gene pool’13.

Figure 1. In spring 2018 a photo of the Mongolian University of Science and Technology’s physical education course, which included hiking just south of Ulaanbaatar, went ‘viral’ on Facebook. It was claimed that it depicted ‘the Chinese’, (using the derogatory term hujaanuud) invading Mongolia from the south, creating considerable turmoil as well as its rapid

13 See also Bulag 1998: 151-158. 30 circulation on the social media platform, until one of the students who had participated in the trip stumbled upon it and clarified the origins of the photo. Source: Photo Chaminchimeg Tömörhuyag (2018) shared to the Facebook group Delhiigeer Ayalagchid World Wonderers.

The President’s 2017 speech concerning the ‘lost one million citizens’ was particularly grave for the associated connotations of Mongolia’s position: a nation between the two superpowers, while also being the world’s most sparsely populated independent country. ‘A country the size of Mongolia could easily fit 10 million people,’ a state official told me, an opinion which was shared by many. Somewhat ironically, and rather tragically, Ulaanbaatar’s accommodation of about half of the country’s current population has, in many ways, led it to reach its population limits for transportation, pollution levels and services due to its topography; municipal registrations to the capital came to a halt in 201714. There has been some disagreement as to when exactly the ideas of the political and national unity of Mongolia arose. Christopher Kaplonski (2004: 18) suggests that Mongolian socialists at the beginning of the twentieth century first had the task of creating a sense of political and national unity in order to involve various groups spread across Mongolia, before proceeding with propagating Soviet-style socialism. However, it was only after the 1950s that nationalism as ‘a distinct form of identity’ became widespread (Kaplonski 2004: 18). While this form of nationalism became mainstreamed during socialism, Kaplonski (2004: 18) acknowledges that country-consciousness, understood as a ‘general cultural identity’ (discussing Atwood 1994: 70), also existed previously. In addition, the collapse of the socialist state in the early 1990s was followed by an era of redefinition of legitimate Mongolian history. The Mongolian identity arising in the 1990s shifted from the territorial to the ethnic identity of ‘being Mongol’ in relation to neighbouring giants Russia and China (Kaplonski 2004: 7). This has by no means been

14 See Chapter 4. 31 straightforward; rather, it has been a fragmented process with the selective exclusion of previous decades, while identity and belonging have been built on the pre-socialist past (Bulag 1998: 18; Kaplonski 2004: 7; Chapter 3).

Population health: mothers and children

The importance of the statistical and the goal of increasing the population possess clear parallels with the socialist agenda, where the health of the nation was an aim, and this has been manifested in the country’s population numbers and increase (Bulag 1998: 133; Billé 2015: 140). Both women and children were seen as being at the core of the modernisation project through their additions to the labour force and the production of the ideal future socialist citizen through the correct upbringing or hümüüjil. Taking this approach to the population and its health, the situation in the country in 1918 was indeed rather bleak: there were only 647,504 people registered in Mongolia. A number of factors are likely to have contributed to this, such as a low birth rate and the low survival rate of fetuses and young children. One of the factors was the STI epidemic taking root in the region. At the beginning of the twentieth century, ‘almost the entire population was infected with venereal disease’ (Bawden 1968 in Norov 2019: 4). In Buryat Mongolia, most of which is now under the rule of Russia, it was reported that 42% of the population had been infected with syphilis (Solomon 1993 in Norov 2019: 4). The pro-natal programme was in full swing between the 1960s and the 1990s, with direct incentives including free healthcare, daycare for children, reduced working hours for mothers of young children, financial assistance and an earlier retirement age for those who had given birth to four or more children, among other factors measured (Bawden 1968: 406; World Bank 1996: 59). Having children within marriage was considered a due contribution to the workforce (Odontuya 2015: 35; Terbish 2013). As a further appraisal of the status of motherhood, ‘Mother Heroine’ was established in 1944 in the Soviet Union as an honour for mothers with

32 more than ten children (Heer and Bryden 1966: 157), with the lesser honours of the Order of Maternal Glory for mothers with seven to nine children and the Maternity Medal for mothers with five or six children15. Mongolia started rewarding the First Class Order of Mother Glorious in 1958, granting women with more than eight children a monthly stipend worth half of the average salary at the time (Odontuya 2015: 36, 38), and a Second Class Order to mothers with five to eight children. The award was revised in 2011: to receive the First Class Order a woman would need to have six or more children, and for the Second Class Order four or five children (Ooluun 2017). This makes sense in the context of falling birth rates, which have decreased from 7.6 births per woman in 1966 to 2.7 in 2014 (World Bank 2016). The medals are awarded on Children’s Day on 1 June each year. In 2018, President Khaltmaagiin Battulga framed the handing out of these honours by stating that: ‘Children are the joy of a family and the future of a nation. Children are everything we have’ (President of Mongolia 2018). As a result of the pro-natal programme and the development of medical services and healthcare as a whole, the population reached two million by 1987 (Bulag 1998: 30, 105). It must be emphasised that besides the pro-natal programme and healthcare, the steep rise in life expectancy in Mongolia has played a huge role in the population increase. However, there were tremendous setbacks and the collapse of these aims when Mongolia transitioned from socialism to democracy in the 1990s. Advances made in what was seen as ‘gender equality’ and healthcare stalled: for example, the rate of maternal mortality nearly doubled from 12 per 10,000 pregnancies in 1990 to 21 in 1994 (World Bank 1996: 60). Simultaneously, while the population size has kept increasing, many areas of life stagnated, particularly for certain groups, such as ‘women’. ‘Women’ became rapidly linked to ‘poverty’ as one of the ‘disadvantaged groups’ (see World Bank 1996), having previously

15 The programme also benefitted my own family as my grandmother was awarded this latter honour for giving birth to five children. She occasionally presented the Maternity Medal to me as a child, together with her children’s baby teeth and some wrapped hair strands belonging to my father, aunts and uncles. 33 been part of the ‘progress’ discourse. Yet, ‘women’ maintained their status as a group to be managed. It was around this time that the generation that have now become parents were born: 1992 was the year of birth for the parents of a baby girl who became the three millionth Mongolian citizen in 2015, which was welcomed in the newspapers as a national cause for celebration. It indeed becomes apparent how, using Benedict Anderson’s (1991: 6) terms, nation is ‘an imagined political community – and imagined as both inherently limited and sovereign’. The limited quality of the community draws on the number of citizens, on the one hand, and justifies the necessary advancement and ‘management’ of the population on the other, both through ‘women’ as a broader category and their bodies. After all, the modern Mongolian state at its establishment was tightly bound to the ideas of production and modernisation. With the rise of machinery and the trade-offs between the productive qualities of humans and machines, women became the reproductive vehicle to be managed as production and reproduction were aligned ideologically (Jacobus, Keller and Shuttleworth 1990: 5). It is not coincidental that STIs in today’s Mongolia have not claimed similar affective public and symbolic qualities to the issue of abortion, although they repeatedly arose as a serious health concern in my conversations with gynaecologists and health workers. It is worth pointing out that medically it is impossible to link STIs solely to women’s bodies, promiscuity and the choices women are imagined to make. While STIs could be tied to similar notions of morality, virtue and infertility as abortion, on the public level they are not seen as directly linked to the production or abortion of future citizens and the population size, and therefore are not politicised or even addressed publicly to a significant degree. Therefore, it is relevant that the population, nation and the modern state share a history, but also that the control and management of female bodies is intertwined and integral to these histories. For this aim, the apparent statistics were of particular importance.

34 Figures

As evident from the above, as part of the brief discussion of the population development agenda, the statistical has been the foremost means of validation and comparison, both concerning the population as a whole – as a sort of biological entity – and the aspects of its ‘health’ as well as deviances from it. For years the total number of registered abortions as a statistical ‘reality’ with a quality of validation tended to be at the centre of the abortion discourse. Various approaches and publications engaging with abortion were built on these, achieving similar effects to the crime figures in South Africa: ‘being assertions of the real’, they filled ‘the space between the unknowable and the axiomatic, imagination and anxiety’ (Comaroff and Comaroff 2006: 209). The regularly quoted figure in articles and other forms of media had been the 2015 statistic of 18,168 abortions16 per year in Mongolia (NSO 2017a). Of these 13,164 had been reported to have been carried out in Ulaanbaatar (NSO 2017a). Overall, the inclusion of the official figures in either videos (see the making of the sex education YouTube video in Chapter 5) or various news stories indicated ‘professionalism’: for those involved, being able to navigate and present various statistics worked to legitimise the argument that was to follow. These figures were based on clinics and doctors reporting – or not reporting – abortions they had carried out at their facility. In the statistical sense, the most accurate broad-scale research on the topic to date was arguably carried out in 2013 in a survey that asked women about the abortions they had undergone over the past two years. Women in Ulaanbaatar reported having had abortions in the private sector with over 70% prevalence (National Statistical Office, UNFPA and UNICEF 2015: 267). Meanwhile, the national data collected from health organisations suggests that the share of abortions performed in the private sector in Ulaanbaatar in 2013 was 38%; by 2016, it had dropped to 24% (Ulaanbaatar City Health

16 The Mongolian Statistical Information Service defines abortion as ‘the termination of a pregnancy before 22 weeks by the removal or expulsion of a fetus or embryo from the uterus, resulting in or caused by its death in hospital [comfort] place’ (‘comfort’ edited due to misspelling) (NSO 2019a). 35 Department 2016: 26). This indicates a large gap between how many abortions have been assigned to the private sector officially versus through asking women directly. Further mismatches are presented as part of other forms of inquiry into abortions. For example, the traditional medicine doctors at Manba Datsan, the largest Mongolian traditional medicine institution, revealed that according to the medical questionnaires they carried out in 2018, almost 98% of their female patients in ambulatory care had undergone abortion. Furthermore, in the media or the public discourse the quoted abortion numbers were rarely compared to those of other countries: they were viewed as proof or validation in themselves without needing to be relative to the past or other places. However, when these statistics are compared17, Mongolian official abortion figures do not appear high. For example, in 2016 the national data suggests that there were 18,316 abortions (NSO 2019b) and 78,194 live births (NSO 2019c), which means the official abortion ratio18 was 234. In the same year, again according to the official statistics, the abortion ratio in Russia was 44319 and in the United Kingdom 26120. As far as the statistical representation of ‘reality’ goes, the matter is clearly complicated for a range of reasons beyond the problematics of making claims about ‘reality’ and the degree to which numbers can represent it. In Mongolia an uncountable number of abortions are carried out privately through the buying and consumption of the aforementioned abortion medication, which have not been recorded anywhere due to the informal nature of the market. Obviously, private facilities or practitioners that are not licensed to carry out the procedure do not register abortions. But even in state clinics or clinics providing services to the public sector,

17 I do recognise these are not comparable due to informal abortion and the overall means of producing this data though. 18 Abortions per 1000 live births. 19 This calculation is based on the official statistics, according to which there were 1,888,729 live births and 836,600 abortions in Russia in 2016 (Federal State Statistics Service 2019). 20 There were 774,835 live births in the United Kingdom (Office for National Statistics 2019). There were 190,406 abortions in England and Wales and 12,114 in Scotland (National Statistics 2019). In 2016 abortion was still illegal in Northern Ireland. 36 abortions are not necessarily recorded even if the clinic is licensed to carry out abortions. My interlocutors suggested that one of the main reasons why abortions in the public sector are underreported is that an abortion for non-medical reasons requires a fee from the patient; if the abortion is not registered, the fee can be kept by the medical staff. And as one of my Mongolian friends explained concerning an unrelated matter, when seeking statistical data, figures and statistics were made in Mongolia for a particular purpose, and not the other way around. State clinics are likely to adjust various figures forwarded to state institutions if the numbers appear too high and would potentially attract unwanted attention to the doctor reporting or the facility as a whole. It is important to have the right figures when presenting them to those who request them, but the relationships between those doing the accounting and that which is being accounted for also matters (Green 2005: 170): for example, how underpaid medical staff in the state sector seek additional avenues for income through abortion fees, which otherwise would be paid either in part or full to the facility. The public use of abortion figures shifted when President Elbegdorj’s 2017 speech brought along a wave of news stories and debate in the media in which the loss of one million citizens was frequently quoted21, although abortion as a national and population development- related problem had been widely discussed previously. A similar argument had already been broadcast in 2014 when television news stated that the total populations of 4 million Mongolians were ‘not present’ due to abortion, a claim originating from an estimate that 40,000 women had undergone an abortion, and therefore Mongolia was ‘missing 40,000 people’ per year (MASS Official 2014). It is unclear what either of these estimates was based on. However, it proved to be ‘a medium of communication and a species of commodified knowledge, one whose value and veracity accumulates as it circulates’ (Comaroff and Comaroff 2006: 209-210; emphasis omitted). The official figures of abortion, as well as the President’s commentary on the ‘real’ numbers, seemed to have gained cumulative truthfulness as they were circulated. It was suggested

21 For instance, in Anand 2017; Sevjid 2017; and unuudur.mn 2017. 37 in the media22 that President Elbegdorj’s speech was the first time that the abortion ‘problem’ was addressed at the state level. This equated the state to the President and the Parliament that was his audience, and excluded the ongoing discussions of abortion in various news outlets as well as the legislation of it. Meanwhile, the President’s representation of ‘one million citizens’ having been lost drew on the imagination of the whole Mongolian population, but also on the informal nature of abortions in Mongolia: through his argument, he also indirectly suggested that abortions were being underreported by more than double by state statistical tools23.

Capitalism

This error partially arises from abortion’s economic aspects, or what President Elbegdorj attributed to ‘a growing number of institutes or individuals pursuing abortion as their main source of income’ and the ‘unregulated trade’ (President of Mongolia 2017): namely, the abortions carried out informally in clinics and the selling and use of abortion medication. Often such claims of abortion being an economic occurrence are addressed as biznes or the business ‘that abortion has become’, as pointed out to me by Khamba Lama Natsagdorj, the head of Manba Datsan, the largest traditional medicine institution in the country, which includes a hospital, a university and a monastery (see Chapter 3). Biznes is a type of chaos that manifests itself as the deregulation of abortion and various other morally laden occurrences as well as the lack of accountability, and it can be linked to the wider post-socialist condition, as was explained to me by the Khamba Lama. Abortion as biznes, as discussed by President Elbegdorj in his speech, the Khamba Lama and my other interlocutors, refers to the medical staff of doctors and nurses carrying out abortions for monetary

22 In Sevjid 2017. 23 According to official statistics there were 458,365 abortions between 1989 and 2017, including both years (NSO 2019d), while President Elbegdorj claimed there were one million citizens lost. 38 gain, while these professions in the state sector are extremely underpaid. The claims on ‘business’ here refer to the immorality of doctors and the wider healthcare sector, the members of which should act according to values other than income. The notion of biznes, how doctors experience it and how various reproductive healthcare experiences unfold within it will be explored further in Chapter 6. At times, the broader money- making at any cost is also assigned to the saleswomen of informal abortion medicine (Chapter 7). The claims of biznes and the lack of accountability are an issue beyond abortion. This, more often than not, is presented as a sort of accusation: not all things should be ‘business’ (see Figure 2).

Figure 2. The drawing ‘Short of Mongol Idea?’ by Ch. Hishigdavaa from 1991. The top picture is titled ‘Selling Mongolia…or skin?’; the middle, 39 ‘This bag is opened and emptied’; and the bottom, ‘What if they said they did not sleep with her but with Mongolia?’ The last picture shows the country as feminine and comparable to the female body, the protection and appropriate moral behaviour of which should be controlled (Bulag 1998: 151-152). Source: Bulag 1998: 152.

The ‘age of the market’24 and democracy25 have overlapped in their beginnings, giving the ‘age of democracy’26 somewhat negative connotations (see Pedersen 2007; Pedersen 2011: 2; Plueckhahn and Bumochir 2018; Wheeler 2004). This has frequently manifested in the ‘recent era’27 as a temporal trope in people’s commentary on abortion as an emic address to the post-socialist condition. It is also the case that the legalisation of abortion largely overlapped with the disorganisation produced by the processes of setting up the new state, the collapse of the former economies and the flourishing of informal economies as people lost their jobs and moved to the cities, primarily Ulaanbaatar. Not everyone has equally been able to find ways to make a living, but the criticism of the ‘recent era’ does not only address those who have gathered considerable wealth. The collapse of the Mongolian People’s Republic in the early 1990s was followed by rapid reform. The transition to privatisation as part of the structural adjustment programmes28 was placed at the core of the economic reform and supported by international organisations such as the World Bank. This institution particularly pressed for the transfer of ownership of property from public to private, which did not respond to the predictions of economic growth in failing to accumulate wealth for the state and those to whom this property was assigned (Griffin 1995: 11-13). Anthropological literature on Mongolia has recently contributed to the studies of fluid forms of property (Sneath 2002a; Empson 2018). This sort of economy or market29 consistently

24 Zah zeeliin üye. 25 Ardchilal. 26 Ardchillyn üye. 27 Orchin üye. 28 See Chapter 4 and Chapter 6. 29 Zah zeel. 40 exists in the discourse of ethics, usually in connection to the activities of others or Mongolians as a whole, rather than being manifested in some sort of personal self-reflection. Caroline Humphrey and Ruth Mandel (2002: 1) argue that in the 1990s and the years following, ‘the market’ appeared in people’s lives in various forms beyond the singularity of an economic phenomenon, which can involve various daily observations of ‘chance’ and the emergence and visibility of various morally laden situations. In the former Soviet Union, ‘making profits from marketing was illegal in most circumstances and state ideologies branded private trading activities as immoral’, an attitude that was shared by citizens to varying degrees (Humphrey and Mandel 2002: 1). It also stands alongside the previous principle of socialism that capitalist self-making was based on egoism: an ethically bound judgement (Bloch and Parry 1989: 4). It is worth noting, however, that it has been a project of governance to push medical services to the private sector for the cost, expertise and technologies that are too pricey for the state to provide. Furthermore, doctors who work at the collapse of the private-public divide, providing abortions at either state or private clinics without being authorised to do so, discuss the matter in dialogue with the overall poor working conditions and below-average national salaries they receive (see Chapter 6), but also as the responsibilities of helping others (Chapter 7). Where abortion appears as a symbol of biznes, the critique is directed at doctors, as in President Elbegdorj’s approach to the issue. In some cases, this involves withholding agency from ‘girls’ or ‘women’ and not involving boys or men at all, instead levelling responsibility at the doctors and the abortion industries as such. This is linked to ‘modern’ medicine and the shifts in work that no longer maintain the ethics that have previously been attached to it, similar to other changes that the city has brought about through encounters between strangers, anonymous services and transactions (see Chapter 4). Biomedicine, although privatised through state reform and structural adjustment programmes, was in previous decades an area ‘where one can observe the play of truth, power and ethics in relation to the subject, and to the possibilities of a good, or as the Greeks would have it, a flourishing, life’ (Rabinow and

41 Rose 2006: 200), due to the co-development of ‘modern’ medicine and the population rise. Instead, now medicine has become an area that counteracts ‘life’ as desired for the Mongolian population by the state, or rather the President, due to it being a location for administering abortions. Furthermore, rather than addressing the reasons behind unwanted pregnancies or abortions (which were rarely addressed in discussions of abortions at the public and political level), here the reason for abortions was equated to their availability. It matters that it is the relationship between the woman and the doctor that brings forth the commentary on biznes: in being able to escape the monitoring and control of other spheres of claims on the moral and national, it is this relationship that public commentators on the matter, such as President Elbegdorj, see as problematic. This concern does not lie with women’s health and the safety of abortions, but rather in seeking control over the birth of children through the illegalisation of abortion, as President Elbegdorj’s speech so clearly (but also somewhat irrelevantly) suggests.

Legislation

In the 2017 speech President Elbegdorj took a strong stance regarding the legality of abortion in Mongolia, suggesting that ‘the only acceptable reason is when there is a risk to the life of the mother and/or the child’ (President of Mongolia 2017). This was the case legally from 1943 until the 1980s when abortions in Mongolia were allowed for medical reasons (Tsogt et al. 2008). The Criminal Code was amended in 1986 to legalise abortion and further amendments were made to the Health Law and the Code in 1989 (UN DESA 2002). Additionally, it is telling that President Elbegdorj’s vocabularies involve mothers and children, rather than women and embryos or fetuses, and that it differs from that of the legislative. The early and late abortion30 sections in the Health Law of Mongolia were last updated in the 2010 decree (The Integrated Legal Information

30 Term used: ür höndölt. 42 System 2010)31. Early-term abortion is defined as abortion during the first twelve weeks or the first trimester of pregnancy. Late-term abortion is from the thirteenth week until the 22nd week of pregnancy. It outlines the required conditions for the first-term abortion, such as the 24-hour service – which in practice means the clinic needs to be furnished and staffed to accommodate its patients – and accreditation of the clinic. When an abortion is requested by the woman, it includes a fee, but it is free when carried out at the request of the doctor. Only obstetricians and gynaecologists are allowed to carry out abortions. Furthermore, the second-trimester abortion is available only at the request of a qualified doctor at limited locations. There are six conditions that can justify a late- term abortion: the pregnancy poses a danger to the life or health of the mother and the fetus32; at the request of a girl younger than eighteen years with the consent of a parent; at the request of a woman older than 40 years; in the case that the pregnant woman suffers from a mental disorder; in the case of incest33; or in the case that the pregnancy is a result of sexual violence. Prior to the 2010 update, a late-term abortion could be requested if the pregnant girl was younger than sixteen years or the pregnant woman was older than 45 years (Woman on Waves 2019). This means the law has become somewhat more relaxed concerning the matter. In his speech, President Elbegdorj said:

I am confident in the leadership and the role of Mongolia’s women parliamentarians on this issue, which currently is more destructive to the fate of our country than a war. In particular, I would like to express my trust in the leadership and initiative of Ms. Tsogtsetseg, Minister of Health. (President of Mongolia 2017)

Overall, the speech could be understood as a call for the illegalisation of abortion due to the statements that Mongolia ‘must put

31 Prior to that, the Law was updated in 1998. 32 Urag, which also means ‘kin’ or ‘family’. 33 Tsusan töröl oirtoh. 43 an end to this matter with a clear and coherent policy’ and that ‘no one in Mongolia should have the right to murder an unborn’ as well as for the suggestion that abortion should be allowed only on the basis of health concerns (President of Mongolia 2017). However, televised news addressing abortion a few months after the speech showed the Minister of Health not supporting the illegalisation of abortion, justifying her case by saying that the negative consequences could be even more severe if abortion was illegal34 (SBN 2017). Concerning legal updates, or the law in general, media coverage has been rather limited. Instead, the focus on ‘illegal’ abortion in recent years has led to speculations on whether abortion is legal at all, since both online newspaper articles and television news have addressed the problematics of ‘illegal’ abortion without clarifying the legal aspects of it. The legality of abortion has been seen as a temporary mistake by some, like President Elbegdorj, a sort of false remnant from socialism to be overturned. But similar to President Elbegdorj’s statement and his seeking of stricter regulation, for Khamba Lama Natsagdorj it is not socialism that is to blame, but the collapse of control from the 1990s onwards, together with the change in people’s thinking or consciousness (uhamsar) and abortion having become business or biznes at the time. Prior to 193835, Mongolians did not have abortions and followed a ‘natural’ way of carrying children to term, he explained to me; while prior to socialism contraceptive medicines were known to traditional medicine specialists, their actual use was exceptional and rare according to him. Such an approach was also common in the public discourse and came up in various discussions I had with my interlocutors: namely, that Mongolians have always valued their ‘children’, which in some cases was expanded in its meaning to include embryos and foetuses. When under the broader administrative area of the Qing dynasty – which ruled China proper, as well as today’s Mongolia, from the

34 Huuli bus. 35 1938 was a year in the midst of the worst Stalinist repression in Mongolia (1937- 1939) and witnessed purges of Buddhist clergy, which also included traditional medicine doctors at the time. Traditional medicine was the mainstream form of medicine in Mongolia prior to the introduction of Western medicine in the twentieth century. 44 seventeenth century until the beginning of the twentieth century – the legislative situation concerning present-day Mongolian territory was somewhat different, not least due to what has been presented as the lack of ‘abortion history’. Countless the specifics of the legislation of the Mongol territories, I will provide some insight into the adjacent Qing legislation, where the authority to a large degree was based on parental power. The killing of a disobedient progeny was not considered a crime and the enforcement of the law was largely clan-centred and male- dominant, projecting control top-down towards junior members and women (Luk 1977: 381). This law’s approach to the carrying out of abortions and their ramifications was twofold: firstly, by addressing abortion as a consequence of an assault; and, secondly, legal engagement with induced abortion in cases when it resulted in the woman’s death (Luk 1977: 379). Bernard Hung-kay Luk provides further detail:

In the former, the offense was considered relatively light – only a little more serious than breaking two of the victim's fingers or knocking out two teeth, and less serious than breaking a limb or causing permanent blindness in one eye. The foetus seems to have been taken as a part of the mother's body, and its life was equal in value to her ribs and her eyes. It was certainly not considered as a full human life between the time it assumed human shape (at 90 days) and the time it reached full term, and abortion-in-assault even during the eighth lunar month of pregnancy was not homicide against it; no special protection of the law was accorded to it. Rather, the protection was given to the woman made particularly vulnerable to injury by her pregnancy. In the second kind of circumstance, the protection was again given to the mother, this time against unscrupulous adulterers and abortionists. Not only was she not prohibited from seeking to abort; it may actually be inferred that the law extended some marginal protection to her when she did so. (Luk 1977: 379)

45 As part of the traditional understandings on which the legislation was built, the fetus was ‘formed by the harmony of yin and yang elements of the parents, and sustained by different circuits (of “acupuncture points”) during each lunar month of its development’ (Luk 1977: 383). Therefore, a fetus that was aborted, miscarried or born prior to its full term would not be complete because it had not ‘received all the cosmological forces it needs’ (Luk 1977: 383). As a result, ‘unlike the Western dichotomy where the only choice is between one human life (animated, viable) and zero, the Chinese duality allows much variation in between’ (Luk 1977: 383). This means that before being born, the fetus was, to a significant degee, considered as part of the mother’s body, which to a degree aligns with the Mongolian traditional medicine approach (see Chapter 3), but importantly diverges in how this is contextualised in public discussions surrounding abortion in today’s Mongolia. Children in Mongolia have become the most important persons – that is, the most important socially recognised idea of the individual (following Empson’s 2011 approach to ‘person’) – but literature suggests that this was not the case unanimously throughout the pre-socialist history of the Mongol territories. Charles Bawden (1968: 139-141) described a case of infanticide, drawing on a legal document from 1789. In a lengthy story, a ‘slave-woman’ called Dashjid is married multiple times, in each case leaving her husband and returning home; as a result, she is left with three ‘bastard-children’, as she termed them according to Bawden (1968: 139). The story of her multiple returns proceeds with the woman and her mother becoming impoverished. Dashjid ends up stealing sheep from a man called Tseveen. The case is tried and Dashjid is sentenced to reimburse Tseveen with one cow, a calf and her daughter. The officials also arrange for her to be sold into marriage again, and she becomes pregnant. After hearing rumours that her daughter has been treated particularly brutally by Tseveen, which later turn out to be false, Dashjid decides to take her own life and that of her two children who are still with her. However, she only proceeds with the strangulation of her son. The whole affair is reinvestigated, and it turns out that Dashjid, in fact, never stole any sheep. Almost everyone involved gets punished in some way, seemingly with the important exception of Dashjid herself. It also turns

46 out that Tseveen has sold Dashjid’s daughter to a lama in another municipal unit, which was a crime, and the price he received for her gets recovered to Dashjid, together with the girl. What the document does not mention is a punishment for the infanticide that launched the second investigation, which seems to be overlooked in its resolution (Bawden 1968: 139-141). Another story from more recent times further points to a discrepancy between the past as imagined and how it arises through documentation and personal histories. Ms. Yüm was a 73-year-old woman from Inner Mongolia, who told a story of how she was married in 1946 at the age of fifteen (Konagaya, Sarengerile and Kodama 2011: 127-132). While she got on well with her husband, her mother-in-law, who was a single mother of four and originally from a well-known wealthy family, was violent towards her, on one occasion beating her up rather severely. Ms. Yüm says she got pregnant when she was sixteen, a year after her wedding. She tells the following story of how she miscarried:

When I was in my eight month of pregnancy and while we were moving to another place, my mother-in-law told me on the way to take some kind of medicine, and I took it. However, soon after I took the medicine, my stomach started to hurt, and then I suffered a miscarriage. I have never been pregnant in my entire life since then. I do not know even now that what kinds of medicine my mother-in- law gave me, and, in the first place, why she let me take the medicine and get an abortion. (Ms. Yüm in Konagaya, Sarengerile and Kodama 2011: 129; text as in the source)

This story implies that knowledge of abortions existed beyond the biomedical institution. Furthermore, both of these accounts suggest the degree to which women were subjected to law and kinship arrangements that made decisions regarding their bodies and almost every aspect of their lives, even if certain (attempted) divergences might have occurred.

47 Pars Viscerum Matris

I will now discuss the two cases in the light of legal definitions. The first case discussed an infanticide, which, according to the legal materials, did not result in further punishment to the mother beyond what she had already experienced through her misfortunes. The second case indicates how the body and the fetus did not ‘belong’ to the mother, but rather to her superior in the kinship and household structures who took the decision to abort the fetus and carried out with this plan without involving the pregnant woman in these discussions. The Latin legal term pars viscerum matris means ‘part of the mother’s body’ (USLegal 2019) or ‘part of its mother’s body’ (Legal- Glossary 2019). ‘It stands for an unborn child who is still in utero’, the destruction of which or whom ‘cannot be charged as murder because it does not have a separate or independent existence’ (USLegal 2019). The term belongs to Criminal Law in reference to ‘a situation where killing of an unborn child will not be punished by courts, because it did not have a separate individual existence apart of the mother’s body’ (Legal-Glossary 2019). Furthermore, in 1825 Theodric Romeyn Beck and William Dunlop point out that:

The English law “considers life not to commence before the infant is able to stir in its mother’s womb.” The law of Scotland, adopting the creed of the Stoics, believes that foetus in utero, previous to quickening, to be merely pars viscerum matris. In Saxony, in consequence of the disputes of medical men on this subject, it was formerly decided, that the foetus might be esteemed alive after the half of pregnancy had gone by. (as formatted in original; Beck and Dunlop 1825: 137)

In a comparison of English and Scottish law, they write:

Mr. Hume, in his Commentaries on the Criminal Law of Scotland, says, that all procuring of abortion, or destruction

48 of future birth, whether quick or not, is excluded from the idea of murder, because, though it be quick, still it is only pars viscerum matris, and not a separate being of which it can with certainty be said whether it would have become quick birth or not. Since Mr. Hume wrote, a case occurred in the High Court of Justiciary, where the subject was discussed. A surgeon and midwife were indicted for the violent procuring of abortion, were convicted, and sent to Botany Bay for fourteen years. (Beck and Dunlop 1825: 187)

Their description of the situation concerning abortion shows the development of medicine and provides further detail of how fetal development has become the basis for the law. Abortion in Mongolia like in many other countries upon the request of the woman is available within the first twelve weeks of pregnancy, the time in which most miscarriages also occur. Second-trimester medical abortions within 22 weeks are in place due to the potential viability of the fetus outside the womb after this point in the pregnancy (Ely 1973: 924; thejournal 2018). Biomedical advancements, however, are changing the extrauterine viability of fetuses and shifting it to earlier stages of gestation. The issue is obviously complicated by the question of if and when the soul inhabits the embryonic or fetal body:

After Aristotle, a plant was considered to have a nutritive soul; an animal, both that and a sentient soul; and a human alone possessed, in addition, a rational soul. The three souls were supposed to enter a foetus at different points in its development, and it was when the rational soul came into the foetus that it became embryo animatus and acquired full human status. /---/ Hence merely assuming human shape was not of primary importance. The line to be drawn in Western discussion was not so much "formation" as "animation." Before the latter, a foetus was pars viscerum matris; after that point, it acquired equality before God and

49 canon law with any other human being. The trouble was, both Jerome and Augustine, who provided the loci classici on abortion in the West, affirmed that one did not know when the rational soul was given by God. (Luk 1977: 380)

It has been argued that women in the Qing dynasty had more freedom to abort because the life of the fetus was integrated with the mother’s life and formed from hers (Luk 1977: 383). Therefore, a child was not more than her or his parents and the impersonal cosmic forces that assembled things in the world (Luk 1977: 384). However, it is worth noting that the pregnant woman in the Qing context owed children to her husband’s lineage (Luk 1977: 384), similar to the kinship discourse present also today in Mongolia36. The discourse on owing offspring to the state does not seem to be present until the establishment of the nation state, which in the Mongolian context falls to the beginning of the twentieth century and the further establishment of the socialist programme only between the 1920s and 1940s. In his speech, President Elbegdorj said: ‘No one in Mongolia should have the right to murder an unborn. No one should have the power to cut short a woman’s natural right to become a mother.’ I have aimed to show how this claim has a very short history, as well as what that history might have entailed. I will now turn to explore categories such as ‘women’, ‘mothers’ and ‘children’ further, rooting the following discussion in a more recent time: my fieldwork in 2017 and 2018.

Rights and freedom

The Mongolian constitution that was revised in 1992 ‘underscored individual freedom by guaranteeing the welfare of individuals including their access to health care, political participation, freedom of religion and opinion, gender equality and geographic mobility’ (National Statistics Office 2002: 3). Needless to say, this ostensibly definitive statement on

36 See Chapter 3. 50 freedom has little implication for how the notions of rights and freedom are lived as part of the everyday in today’s Ulaanbaatar, or who should and can advocate for various rights. For example, the current Law to Combat Domestic Violence came into force as recently as early 2017, making domestic violence a punishable legal violation. Despite the law, law enforcement made up of overwhelmingly male police officers often submit to the idea that if violence and even deaths occur at the hands of family members, these crimes do not belong to the area in which the state or the officers should interfere, as was explained to me by a victim of violence whose court case I was following. Instead, in line with kin- legitimacy, these have been considered ‘internal’, domestic issues. This friend’s and others’ accounts of engagement with the police align with Veena Das’s (2004: 236) ethnography where she shows ‘how police officers may be charged with implementing the rules and regulations of the state, but they do not cease being members of local worlds with their own customs and habits’. During my time in the field, conceptualisations and awareness of valuable citizens and persons went through some important shifts as part of the anti-violence movement that unfolded in 2017 and 201837. Although this movement was cotemporal with the unfolding of the #MeToo and ‘Time’s Up’ movements elsewhere, its direct mainstream aim was not to increase women’s rights, at least not in a straightforward, verbalised sense. The beginning of this movement in Mongolia, lined up with the start of the school year, was set in motion when a thirteen-year-old girl was found dead in a hotel on 23 August 2017, the news story breaking on 1 September 2017. This was considerably earlier than October 2017, when the New York Times article about alleged sexual harassment and abuse by the Hollywood film producer Harvey Weinstein called attention to the film industry and sexual abuse in both the US and elsewhere. The girl’s body was found with evidence of violence indicating sexual assault, but for a time it was her fatal blood alcohol level that was given as her cause of death by officials, which contributed to the stalling

37 See Valdur 2018 for detail and a timeline. 51 of the case and the dispute over its status as a murder. Meanwhile, there was CCTV material available identifying the two men who had picked the girl up from the bus stop and taken her to the hotel. The victim’s father, Lkhagvasuren, appeared in the media to describe the stalling of the case, suspicions of corruption on the part of officials and what he saw when entering the hotel room. He pointed out that his daughter was missing teeth, indicating the level of violence she had endured. Despite this, the court case went on for months, during which the family kept advocating for the case publicly, as the knowledge of and affective responses to the case on the public level were presumed to be in correlation with the proceedings of the jurisdiction. Lkhagvasuren later spoke at the anti-violence movement events. The news broadcast and updates on the case on television sparked considerable fear, concern and compassion in other parents. In the same autumn, more stories about extreme sexual violence and assaults on children were shared in the media and online. Here it is relevant that the strains of the movement began and were built around sexual violence. Drawing on statistics, domestic violence was given attention as the main context in which child assault takes place. The movement gained ground primarily due to mothers’ fears for their children, and as various stories were shared publicly, the movement moved on to include discussions addressing domestic violence. There were several demonstrations, with the largest ones taking place in spring 2018. By that time, the division within the movements had grown so strong that some mothers were hesitant to attend the anti-violence protest in fear of it turning violent over the death penalty issue: it was heatedly debated whether the re-establishment of capital punishment was the way to tackle the problem of sexual violence and child abuse. One of the core locations for such discussions was The Official Group for Peaceful Demonstration Against Child Abuse38, which was created on Facebook in mid-March 2018. Within a month it had more than 400,000 members, a significant number given that Mongolia’s population was just above 3 million. Odgerel, a mother to a son, told me she had created the group

38 Huuhdiin huchirhiilliin esreg taivan jagsaaliin alban yosnii grupp. 52 in reaction to the increasing number of child abuse cases just ahead of a demonstration scheduled for the following week. She invited six other mothers to join her in moderating the group and did not expect such an explosion in its online following. She insisted that none of the moderators of the group were linked to the parts of the movement that also advocated for women; like herself, they advocated only against child abuse. Such statements are linked to the historical lack of a women’s movement and the related mainstream discourses on rights and freedom concerning gender and women; the topic may also be avoided for various social and family-related reasons, even if there is awareness surrounding this39. Mainly, I argue, such statements were prevalent and also voiced to me by women attending the protests, due to the mainstream discourse; this activism did not address women as valuable persons, but rather focused on children, publicly advocated by their mothers rather than by women. During the anti-violence movement there were also strands that advocated for women, like Nudee Nee or ‘Open Your Eyes’, mostly led by Lantuun DOHIO, a non-governmental organisation (NGO) registered in the US with representation in Mongolia against human trafficking and violence against children. Women’s rights discourse has a strong presence in Mongolia through NGOs (Tseden 2012), and clearly not all women see themselves solely as mothers. Many also reflect on the situation in the wider country using the vocabularies of rights (erh), like my gynaecologist friend Gaya, who noted that the situation concerning rights for women was poor. However, I have argued here that when it comes to the movement, this woman-focused approach had a separate and much less popular online presence, and for many participants of the movement it was important to distinguish themselves from the movement that emphasised women’s rights. As indicated by this discussion, the most valuable persons in Mongolia are children. Also children are also highly politicised. Children’s centrality to Mongolian nationalism, but also their politicisation as ‘populist politics’, has remained, becoming further

39 This is also highly relevant to the degree to which pro-choice activism or collectively voiced perspectives in support of legal abortion are missing from the public discussion, even if calls for criminalisation are present. 53 apparent through President Battulga’s engagement with the topic. He replaced President Elbegdorj in summer 2017 after the latter had come to the end of his two terms. Battulga was primarily a businessman who had accumulated his initial wealth and fame by being a wrestler of international acclaim. In October 2017, when the cases of sexual assault against young children were increasingly addressed in the media, one of the core stories involved a five-year-old girl who was sexually assaulted by her stepfather; she was taken to an emergency room and initially turned away for being unable to pay the 10,000 tugrik service fee40. President Battulga announced that he had fired the staff member who had demanded the payment. In December 2017, the stepfather was sentenced to eighteen years in prison. Around the same time, President Battulga started working towards re-establishing the death penalty in connection to these reported crimes, providing validation and an outlet for the anger and discontent that the reports had provoked. The removal of capital punishment from the Criminal Code, however, had come into effect only in July 2017, in the same month as Battulga took office. During the most active protest season on the matter, in spring 2018 the Deputy Minister of Justice and Internal Affairs commented that the ministry has not found a legal basis for the re-establishment of the death penalty. Around the same time, President Battulga attended an event on the main square in Ulaanbaatar with children lined up in the shape of Mongolia reading a poem ‘Independence’ (see Figure 3).

40 At the time equivalent to around 3.4 euros; This and all the following conversions from tugrik to euro are based on the rates at the time of the original reporting (newspaper articles etc.) or the time during which the conversations involving these sums of money took place. 54

Figure 3. Mongolia’s President Battulga, pictured among 3333 students dressed in the national clothing (deel), the first row of whom are wearing a military-inspired imitation gorget, reading the poem ‘Independence’, overlooked by the Chinggis Khaan statue. Source: Office of the President 2018.

Exploring this specific case involving rights and freedom, I have shown how these by no means occur in a linear and increasing manner. The case of the movement suggested that the notion of women as valuable persons with an ability to advocate at a mainstream scale in Mongolia remains linked to their personhood as mothers. Meanwhile, issues such as domestic violence could be taken up also through ‘children’ rather than through ‘women’. This sheds light on how women remain linked to the children they produce and how these children can be a platform for broader attempts at societal change. As the anti-violence movement gained momentum in 2017, criminalising accounts of teenage pregnancies became contested by linking sexual and domestic violence with unwanted pregnancies. Up until that moment, the issue of teenage pregnancies had been predominantly linked to ‘girls’ and problematised by infertility,

55 suggesting that those who have had an abortion are not able to get pregnant again (SBN 2017). There have been various estimates of the percentage of women or girls who have had an abortion that face infertility. In SBN (2017) news, this was quoted to be 30% of women or girls (SBN 2017), pointing out that 6% of teenagers between the ages of fifteen and nineteen become pregnant. The problem was presumed to be that many cannot become pregnant again, and this works against population rise (SBN 2017). The need for education on this was mostly linked to changing the behaviour and knowledge of girls; even if couples were mentioned, boys, boyfriends or men were rarely mentioned as the group that needed attention. However, one such news article contesting this approach was written by Haliun (2017), with a rather lengthy title drawing on figures: ‘In the past two years 1613 women aged 12-17 gave birth and 18,168 girls and ladies had an abortion’. This title and the content of the article suggested a parallel between teenage pregnancies, which had become discussed as potential outcomes of sexual violence, and abortions. While Haliun’s approach was uncommon in suggesting that teenage pregnancies and sexual violence could have a correlation, there was a slowing of the public criminalisation of abortion and its national connotations in the media at the time.

Conclusion

There are certain histories, values and imaginations that have shaped the way President Elbegdorj addressed abortion in his 2017 speech. If abortion needed to be defined, as presented by him, it would be a crime against the nation. I have suggested, however, that these claims are both rooted in the political history and are rather recent. I approached ‘abortion’ as a symbol ‘standing for something else’ (Strathern 2016: 19), and I sought these notions and relationships under the themes of population development; capitalism; legislation; and rights and freedom. In the discussions of population development, ‘abortion’ occurs as a relation between a woman’s body, the population, the nation and the ‘modern’ Mongolian state. This is also a geopolitical concern that

56 Mongol-ness needs to be protected. In the section on capitalism, I suggested that the issue lies with the collapses in certain relationships, moral and ‘chaotic’ in their nature, particularly those between the state and healthcare on the one side, and between doctors and women on the other. Abortion legislation and President Elbegdorj’s attitude towards it hint that what is legal may not be considered legitimate, while the past in which the latter is sought can prove to be rather different to what is imagined. The degree to which abortion legislation is relevant and known, and how those who work in abortion industries or have had abortions relate to it, will be discussed in Chapter 7. Looking into rights and freedom, Mongolian women as active citizens and their status as mothers emerged as of particular importance concerning advocacy. Meanwhile, the ways in which ‘children’ were taken up also by President Battulga, who succeeded Elbegdorj, indicates the degree to which the politicisation of children is an ongoing process. I started by suggesting that the conceptualisation of ‘biopolitics’ involves various strategies or contestations surrounding life and death in a collective sense, together with ‘forms of knowledge, regimes of authority and practices of intervention that are desirable, legitimate and efficacious’ (Rabinow and Rose 2006: 197). However, rather than suggesting that President Elbegdorj’s speech on abortion achieved something in sense of involving ‘all Mongolians’ beyond perhaps legitimising certain ideas for some members of his audience, I hope to have shown though the discussion of the political history of abortion how he was able to make such claims in the first place. In this chapter, I have discussed the human life as linked to abortion because the life of a Mongolian is to contribute to population increase and the community of Mongolians, but also towards the protection of Mongol-ness. Here, life is both limited to a single biological life of a human being as well as the vitality, persistence and survival of the nation. I suggest the 2017 speech I have quoted in this chapter is both a search for legitimacy and its performance, and I aim to show further in the following chapters that it is one example of these among many others.

57 While these ideas of collective bodies and ‘life’, as well as the different forms of governance linked to them, would align with biopolitics, this chapter has suggested that gender and the historical specificities of the political economy that the Mongolian case constitutes are relevant. Both biopolitics and the broader discourses presented in this chapter do not focus on women, but rather on their bodies and the capacity to bear a child. These approaches neither fully respond to people’s experiences of reproductive issues nor to other forms of governance that exist in parallel with them, as I proceed to show throughout this thesis. In the case of biopolitics, the Foucauldian approach to the body has been taken up in feminist scholarship (Butler 1989; McNay 1992: 16-18). Furthermore, critical engagement with the lack of focus on women largely lies at the core of the literature on abortion politics, particularly where the personhood and the moral status of the embryo or fetus have been foregrounded over women’s personhood, which has remained linked to the capacity to bear children (Luker 1984: 3-6). This thesis aims to add to these approaches by further shifting the focus on relations involved (kin and non-kin, bureaucratic etc.) away from studying the links between ‘liberal regulation and individualized discipline’ (Mansfield 2012: 588) towards understanding gender’s relevance beyond the qualities and agencies attached to individuals. As a whole, the chapter aimed to introduce several of the topics that will recur in various forms throughout this thesis and will be developed further in ethnographic accounts, which are often striking for the distance or absence of the state rather than its presence and control. In other cases, control is sought (see Chapter 5). More immediately, however, building in particular on the discussions of pars viscerum matris and the notion of women as mothers that I elaborated on in this chapter, in the next I will focus on other conceptualisations of the body and ‘life’ as arising as part of Buddhist Mongolian traditional medicine and Mongol kinship. With some important overlaps between the latter two, it becomes apparent that who or what makes claims on life and women’s bodies, the temporalities involved and their legitimisation unfolding in the following discussion are not identical to the ones made on behalf of President Elbegdorj that aimed to represent the state or the nation as a whole.

58 Chapter 3. ‘Life’ in the Bone Marrow: Traditional Medicine and Kinship

People in this chapter

Khamba Lama41 Natsagdorj The head of Manba Datsan

Core people with pseudonyms in this chapter

Oyunaa A woman in her early thirties, a traditional medicine doctor Ariuna A woman in her early thirties, a traditional medicine doctor Tsetsee A woman in her late twenties, a staff member at Manba

Introduction

This chapter is largely based on the knowledge practised at Manba Datsan, the largest traditional medicine institution in Mongolia, drawing on but not limited to what was generously taught, shared and reflected upon in conversations with me by Manba staff and the institution’s head, Khamba Lama Natsagdorj. Many of these discussions covering reproduction unfolded at the intersection of topics covering medicine, kinship and ‘life’. The previous chapter focused on the approach to abortion, drawing on the former President Elbegdorj’s 2017 speech that called for the outlawing of abortion. I argued that in that context, abortion is positioned as a crime against the nation because of its effect of limiting population growth and also going against the values ‘Mongolians’ hold. Through this argument, abortion was presented as legal but illegitimate.

41 Senior Buddhist lama, a head of a Buddhist institution or monastery. 59 This chapter traces ‘life’ at a different medical and religious site, also involving very different temporalities, yet it engages with the many histories and historicisations discussed in the previous chapters as fractures in Mongolian history. After the Democratic Revolution in the 1990s, Mongolia’s biomedical healthcare services not only suffered budget cuts and massive reforms, but were also opened up as spaces for structural adjustment by various transnational financial organisations, international high-end clinics and the vast, unmanaged pluralisation of medical, healthcare and well-being services. Medical pluralism, as viewed here, is not only the presence of many often overlapping and inclusive practices, but also awareness and reflection upon this. This is particularly critical for the very centrality of the topic of reproduction in women’s lives, concerning women’s belonging and position in society within the nuclear, extended family and more widely. As I suggested in the previous chapter, due to the change of state orders, the past and its imaginary qualities are not only engaged in the projects of legitimisation and speaking for the ‘population’ and ‘nation’, but also affect how a person’s place in the world is constituted as well as ‘Mongolians’ as a whole, in reference to elements making up ‘Mongol- ness’ which need to be protected, such as the genome. Political elites and others taking this up often draw on pre-socialist Mongolia, a time when the mainstream form of medicine was provided by the Buddhist institution, now known as ‘traditional’ medicine, drawing on the legitimate undisrupted lineage from these times and the work of practitioners up to the present moment. Indeed, as Elizabeth Turk (2018: 237) has suggested, legitimacy in healthcare has extended out of ‘popular notions of Mongolian “tradition” during state socialism, despite the official ban’ on non-biomedical practices. In this chapter I propose that there are a number of processes of making claims of legitimacy. Rather than understanding legitimacy as concerning ‘rulers’ legitimacy across society’ (Pardo 2000 in Pardo and Prato 2019: 2; emphasis in the original), here I focus on the processes and the content of legitimisation. Furthermore, while going into much depth regarding the theory or onol of traditional medicine, this approach does not focus on the relation between the legal and legitimate, which I will

60 return to in Chapter 7. Instead, legitimacy appears as a claim – rather than a belief of a reflecting subject (Hurd 2012) – on power or authority when it comes to specific medical knowledge and practice. It is important to note that there are a number of such claims present, which often come into existence in dialogue with one another. Although how people relate to certain knowledges will also be discussed, this chapter will be in particular dialogue with aspects of kinship and health as presented in Chapters 4 to 7. While the discussions I take up here are often positioned in relation to Mongolian traditional medicine knowledge and expertise on the topic of reproduction, I follow David Graeber (2015b) in taking seriously the claims and statements my interlocutors make, including ‘not believing’ or carrying out practices due to this being ‘a tradition’. I suggest, both in this chapter and what is to follow, that reproductive healthcare is mostly characterised as ‘chaotic’ and lacking accountability, but I refrain from any suggestions of this making up a holistic and horizontal condition of unknowability. The way individual/family health histories were explained to me and how I myself came into encounters with topics such as fertility were hugely personal, but not ahistorically and apolitically so. First, I will provide some background on traditional medicine, the universe and human positionality in it. The chapter proceeds to discuss conception, the constitution and the composition of a human. I will move on to address the problematics of abortion from the Buddhist perspective and outline its strong links to infertility in the Mongolian context, the need to be a mother and a woman’s position within the family and society depending on whether she has children. I will return to discussions of a human’s composition through the discourse of the inheritance of organs and body parts of various importance either from the mother or the father, showing how this overlapping medical and kinship discourse shapes a gendered scalar ‘life’, where the body can at once be biological and a result of the fortune and vitality of those from whom it is inherited, blurring the understanding of ‘life’ as either linked to a human lifespan or as a continuation across human lives.

61 Legitimacy of Mongolian traditional medicine

It was a blazing summer afternoon when I first walked up to Manba Datsan on the edge of the north-eastern ger district. Sweat was dripping from my face and my fingers had swollen into pink soft sausages from the walk uphill as well as from my nerves at appearing at such a respectable and large medical and Buddhist institution. As I entered the large courtyard in front of me, northernmost stood the temple with a shining golden dharma wheel and a pair of deer facing it on each side. To my left, the west, stood the Manba Datsan hospital and to the right, the east, the affiliated university Otoch Manramba. Manba Datsan includes a monastery and a temple, a university, a hospital, a pharmaceutical factory and several other affiliated units. Manba’s monastery was established in 1990 and the medical institution itself in 1991, but the larger complex opened in 2014. Since the Democratic Revolution, the Mongolian government has recognised the importance of Mongolian traditional medicine on the state level. In 1990 the Traditional Medicine Department was established at the National University of Mongolia, teaching a programme covering ‘its own unique integrated theoretical system considering the body as a whole entity, containing within itself eternal contradiction and, at the same time, unity’ (Bold 2010). The Mongolian National University of Medical Sciences also has an institute for traditional medicine. Manba has now been accredited to carry out some health insurance- subsidised or covered health services. Like the tantric Mahayana Buddhism in Mongolia, Manba aligns with the Tibetan tradition when it comes to medicine with the specifics of the Mongol body and environment in Mongolia. With its complementary approach, Manba also incorporates aspects of ‘modern’ medicine, particularly when it comes to diagnostics and equipment, such as ultrasound, x-rays and laboratory work for various tests. Within the Mongolian traditional medicine discourse, as the head of Manba, Khamba Lama Natsagdorj pointed out that his work is possible due to the lineage of teachings that had remained undisrupted during socialism due to lamas who had managed to salvage their lives and

62 knowledge across the socialist era and the persecution carried out at the time. For this, he was a one-of-a-kind practitioner in Mongolia, he noted. When it comes to traditional medicine as such, it can simply be the duration of time that people have practised this form of knowledge that is legitimising in itself. A Ministry of Health official has outlined Mongolian traditional medicine as ‘one of the most valuable heritages of the Mongolian people’, which arises from it having a history of ‘more than 5000 years’ (Bold 2010). Manba, however, relayed Mongolian traditional medicine as having been ‘inherited’ from ‘the era of the Lord Buddha for 2970 years’, but stated that this knowledge has been lost in the past 100 years (Natsagdorj 2019). Yet, as it was pointed out, much of the ‘tradition’ has been disrupted, and in the early days of the newly established Manba, the suggestion to visit it among many other options was shared between patients by word of mouth. Oyunaa, a traditional medicine doctor at Manba, explained that for years the patients had come to Manba hearing about the experiences and services from others, which was the main form of legitimisation of the healthcare and well-being services in Ulaanbaatar as a whole (see Chapters 6 and 7). In recent years, many patients found their way to the facility after first acquainting themselves with Manba’s work online owing to the growth of the institution’s Facebook page and website. The Khamba Lama occasionally appears in the media and on the national and international scale is seen as the foremost expert on both Mongolian traditional medicine and Buddhist medicine for the country as a whole. Mongolian traditional medical knowledge was also seen as something to be shared with the world: an epistemological and ‘cultural’ export, similar to shamanism. For the search of ‘the lost’, somewhat in dialogue with ideas of non-modern forms of knowledge, the film Medicine Buddha, starring the Khamba Lama, was released in 2019, with the premiere in London. Being internationally recognised and having international affiliations and clients also worked towards establishing trust among Mongolian clients. Indeed, the Khamba Lama is widely known in Mongolia: most people I mentioned him to knew who I was talking about and at times expressed being impressed by the fact that I knew someone as honourable and, frankly, famous. The reputation of the Khamba Lama

63 and Manba also rubbed off on me as a ‘researcher’, as the dropping of these names conveniently sometimes helped when my researcher status and research goals were under speculation and questioned. However, beyond the accounts of miraculous healing within Mongolia and among overseas patients alike – such as successfully assisting the latter with infertility and miscarriage, as the Khamba Lama told me – the actual success of Mongolian traditional medicine relies on the right action, merit, knowledge of what constitutes a human and his or her place in the universe. For both the Khamba Lama and traditional doctors, the practice of this epistemology made their work possible. Ethics was crucial in this, and from what I observed during my time at Manba, there was a reason why they and the institution was held in such high regard: it was because they were highly qualified and did their work extremely well. Healing and assistance could only be based on specialist knowledge, a large part of which, in its detail, depth and practice, would simply not be accessible to a layperson. With these limitations in mind, I will introduce the theory or onol with some reference to other matters or practices. As it was explained to me, the universe (ogtorgui ertonts), in accordance with the Buddhist view, includes six worlds: three of them are upper and three are lower. The lower realms of lower birth (dood gurvan töröl) include hungry ghosts (bird), hell (tam) and animals (adguus). The upper realms (deed 3 töröl) include sky (tenger), gods (burhan) and humans (hün). Due to the tenger realm with which shamans work, there is a dislike and division between shamanism and Buddhism from the Buddhist perspective: shamans draw on non-enlightened beings still suffering from incorrect behaviour and often wrapped up in self-interest. This was one of the first things that Tsetsee, a staff member of Manba Otoch University, pointed out to me concerning where the institution stood in relation to shamanism, which is also a broad area of well-being and health-related services in parallel with ‘modern’ medicine in Mongolia. For the pluralisms of practices, there were also claims of cosmological legitimacy to be made. Discussing the matter with the family members with whom I was staying at the time in the ger district, it was pointed out to me that shamans were often linked to a certain lifestyle,

64 which included alcoholism more often than not. Referring to one of our neighbouring households that included a shaman as an example, the family members knowingly disassociated themselves from this worldview. Additionally, in the mainstream shamanism practised by Buryats and the Halh, a human has three souls, which come to inhabit and have different abilities to temporarily leave the body (Tatár 2018: 220-221; Tatár 2019: 401-402). However, the assumption of body-soul dualism in this context would be highly misleading (Humphrey and Onon 1996: 213; Pedersen and Willerslev 2012). Meanwhile, in the ‘ideal-type’ Buddhist theory, humans do not have intrinsic souls but rather consciousness. From the Buddhist perspective, existence in the aforementioned worlds is of varying timespans not necessarily corresponding to that of the human realm. Karma (üiliin ür) determines the realm into which someone is born. Translated literally, üiliin ür means ‘action’s seed’ or ‘result’ (Abrahms-Kavunenko 2018: 903). The underlying ‘theory’ of Mongolian traditional medicine has strong parallels with Tibetan medicine. There are five elements (mahbod) that make up the world: earth (shoroo); water (us); fire (gal); wind (hii); and space (otgorgüi). The human body in Mongolian is biye or biye mahbod. Human illnesses originate from imbalances of the three humours – wind (hii), bile (shar) and phlegm (badgan) – and therefore various health concerns are categorised along these lines. Diagnosis mainly includes listening to the pulse and examining the tongue and urine qualities, among other observations. Diet is considered hugely important due to the hot-cold qualities of consumed foods and the six tastes42, which affect the humours and are also linked to emotional states to a degree; while some qualities may not be as pleasant as others, they can be good for the body. Diet is also one aspect of traditional medicine that is most broadly shared in the media and knowledge about various foods in terms of their hot-cold qualities and their seasonal appropriateness is widely held. Food is commonly used as a remedy beyond traditional medicine:

42 Bitter, astringent, pungent, sweet, sour and salty.

65 for example, horse meat is considered a hot meat, and therefore it is particularly appropriate for consumption in the winter; horse meat soup is a remedy when someone is suffering from a cold.

Conception and the composition of a human

There are female and male trees. Edelweiss is considered a female plant, while a male tree is a “stick”. Fire needs small firewood. Edelweiss is flammable, it burns in the heat of the sun. It alights by itself from the direct sunshine. The embryo’s development is similar. Metaphorically, the stick is the man, the edelweiss is the woman, with the sun’s help the soul (süns) of the child is arriving, and when the fire ignites a pregnancy happens (hüühedtei bolno). Oyunaa, on conception

In this section I retell some aspects of reproductive knowledge and challenges as addressed in traditional medicine, starting with conception as it was explained to me by Manba doctors and the Khamba Lama in accordance with Mongolian traditional medicine. Conception (ür toglolt) happens when a number of conditions come together. First of all, both the mother’s and the father’s body need to be healthy. The male substance is sperm, ‘the father’s white seed’ or ‘substance’ (etsegiin tsagaan dusal), and the ‘female red seed’ or ‘substance’ (ehiin ulaan dusal) is menstruation (sariin demdeg). Both of these should be healthy and there are certain qualities that indicate whether they are. However, menstrual blood can be affected by the woman’s age and sexual activity; after losing one’s virginity, it becomes pinkish red, ‘the colour of a rabbit’s blood’, and translucent, which are considered the signs of good health. Another indicator for this is that menstrual blood can be easily cleaned when it stains clothes. Additionally, the time of the cycle according to the lunar calendar is relevant. If the period starts between the first and the fifteenth day of the new month, it is considered good. For a pregnancy to happen, it is

66 particularly important that the woman is healthy: the sexual relationship (belgiin zam) needs to be free of illness and particularly of any gynaecological issues. The male substance can be diagnosed by its consistency, qualities and taste, as is common in traditional medicine diagnostics: it should be white, heavy and sweet (amtlag). If there are any reproductive issues found concerning these, it will be treated according to the illness’s categorisation along the three humours. If the substances are healthy, the child, too, will be born beautiful, intelligent, without defective developments, with long fingers, healthy nails, eyes and lips, as was explained to me. If the parents’ substances are infected, the child can be born blind, deaf or with developmental issues. When the parents’ ‘drops’ and the spirit are combined, the body of the fetus is established from the five elements, none of which can be lacking. The earth ensures that the body strengthens; water provides moisture; fire ensures that the body does not deteriorate like meat left out and also maintains the body’s inner warmth; wind in the body ensures that it always flourishes and, for example, hair grows on the impact of the element. Similarly, the embryo and fetus develop as a result of the movement of wind. Lastly, the element of space means air and wind, and it is in space that the child’s growth is enabled, for the child cannot be in a vacuum, as Oyunaa patiently explained. Therefore, the father’s white substance, the mother’s red substance and the child’s soul that has collected past karma need to come together, and the above five elements need to be combined. Furthermore, the merit (buyan nügel) and karma (üiliin ür) of the parents and the child need to align. At the time when the karma of the three assembles or combines (bürdsen tsagt), the pregnancy occurs. The fate (huvi tavilan) of the three needs to be shared. Even though the other conditions might be met, if it is not ‘meant to happen’, the conception will not occur. As a result, according to the Buddhist philosophy that Manba was following, a human life starts at the moment of conception, although both the person’s and the body’s composition and development are ongoing, requiring the lining up of various conditions to continue to support this. Oyunaa and Ariuna, like many Mongolians, calculated their age

67 accordingly: namely, one year back from the lunar year when they were born, rather than based on the date and year of birth as recorded in official documentation. This means that their age changes with the Lunar New Year celebration rather than with the date of birth. Not all of my friends of the same generation did this, however, and I occasionally asked the person’s year of birth rather than their age to be sure of which mode of counting they used. However, there are still moments in a person’s life when the astrological counting of age (hii nas) is important, such as the year of the child’s hair-cutting ceremony that I will return to below (Michelet 2015: 287). The sex of the child can be determined by the day of conception from the menstrual cycle. Menstruation usually lasts three to five days; if it lasts, for example, for three days, the fourth is counted as the first day of the new cycle43. If the couple has sex on the first, third, fifth, seventh or ninth day, there is a high chance of conceiving a son. Meanwhile, if sex takes place on the second, fourth, sixth, eighth, eleventh or twelfth day, the couple is likely to conceive a daughter. It is dangerous for a man to enter into a sexual relationship on the eleventh day of the woman’s cycle44. The sex of the child is also determined by the relative proportions of the male and female substance contributed by the parents. If both parents contribute an equal amount of the substances, it is possible that the child will be born with both sets of reproductive organs or will have disabilities. While these approaches to the child’s sex, as explained to me by Oyunaa, are very much in line with the Tibetan Four Tantras, the core text of Tibetan medicine that is also used in Manba as the main text, she did not suggest that the female sex of the child could be the result of her having ‘less merit’ than her male counterpart as the Four Tantras do (Fjeld and Hofer 2011: 194).

43 ‘Modern’ medicine counts the first day of menstruation as the first day of the menstrual cycle. 44 According to ‘Western’ medicine, the length of the woman’s cycle varies, but if it is around 28 days, ovulation should take place on or around day fourteen, and the most fertile days would be those days preceding ovulation, including the day of ovulation. Whether that eleventh day falls to the day of or the day preceding ovulation would be speculation. 68 Furthermore, when the embryo or fetus is developing, the five elements make up the body as well, beyond what was above described. Earth forms the meat, bones, nose and the olfactory system responsible for the sense of smell. Water is responsible for the development of moisture in the body, blood, the tongue and the sense of taste. The fire element creates the heat in the body and the colour of the body (öngö züs), which determines whether the appearance (tsarai) is tired (yadarsan tsarai) or good-looking (tsarailag), which I will return to in some detail below. Also, the fire element develops the teeth, eyes and the sense of vision and its quality. Wind creates growth in the body, the respiratory organs, the skin and the sense of touch, temperature and so on. Space is responsible for inhalation and exhalation, the immune system of children, excretory body parts, ears and the sense of hearing. The growth of the child’s body in the uterus is bound to what the mother eats. However, as one of my young female friends who was working as a medical practitioner in traditional medicine said, she was not quite sure when exactly the life of a human through conception was supposed to start: that was something to be checked from the ‘theory’. What she did know was that life was supposed to be carried on across human lifespans, and that was why motherhood was so important. This can be seen as somewhat characteristic of Mongolian traditional medicine but also other expert services: it was not knowledge shared by all but rather an epistemological practice, which in this case came into being in the form of the material presented above through my enquiries and answers to these, sometimes after prior consideration (see also Mair 2008; 2015).

Mutuality of the child and the mother

However, it is not only that the mother impacts the expected child, but also that the condition of pregnancy as well as the post-natal period can be characterised as the mutuality of the child and the mother45, with some parallels with pars viscerum matris as introduced in the previous

45 See also Empson 2011: 153-154. 69 chapter. For example, most women in Mongolia follow gam or a post- natal confinement period of one to three months46, because after birth the mother’s body is considered to have become infant-like (biye nyalhardag). As Aude Michelet (2015) points out, ‘infant’ or nyalh itself means ‘weak’. Post-natal care of similar length has been observed elsewhere in Inner Asia and today’s China and Taiwan (Pao 1966: 421- 423; Pillsbury 1978). During this time, new mothers need the help of others, as a pregnant woman in her early twenties, Hulan, explained47. She lived in Ulaanbaatar, while her family lived in one of the provinces hundreds of kilometres away. She was considering going to give birth in the area where she was from, and ended up doing so, one of the reasons for which was gam and being unprepared to spend that time alone in Ulaanbaatar: ‘I will keep gam (gam barih) for a month. There are many gam. I can’t put my hands in the cold water, can’t chop meat, must cover my head and I will plug my ears.’ This was due to vulnerability to the wind element (hii mahbod hyamardag), as Tsetsee explained to me. Young women particularly did not necessarily know why and how the practice of gam is followed before they do it themselves. Tsetsee explained to me that as a result of not having worn a scarf to cover her head during the whole of one month of one of her gams, she sometimes got headaches. Having grown up in a ger or a Mongolian yurt but now living in an apartment block, she noted that she was not sure how the type of dwelling would impact gam. Because there may not be as much wind and air circulation in apartments, washing oneself (not washing oneself was one gam to be kept) may be acceptable, suggesting that generally the following of restrictions was by no means absolute and was open to interpretation. The movement of air within gers, she went on to explain, is considered one core characteristic of living in the ger as it breathes much like a human, which was seen as one of the health benefits to the development of a child.

46 In today’s Ulaanbaatar this mostly lasts one month, as suggested by Tsetsee and other women with whom I discussed the matter. 47 Chapter 4 will discuss Hulan’s pregnancy in more depth. 70 The diet during gam mainly includes mutton soup, although it might vary depending on the location in Mongolia, as one woman, a mother of one, told me, laughing: she ate a whole sheep in soup form by herself during this time. The soup aids lactation and recovery from exhaustion. At this time the mother also wears a lot of clothes. Both the baby and mother were expected and needed to sleep and rest a lot during the period. Only after this time was visiting the mother and the newborn allowed; generally, it needed to be in a calm, quiet place. Due to her not being able to shower and following other gam, another woman with several children who lived in a one-bedroom house with her family said that during this time she had sought some distance from her immediate family, and if the season allowed, she stayed at their summer compound. However, for most women, particularly young mothers, gam was essentially spent around close family members who could help with various aspects during this extremely vulnerable time, when the mother and her baby needed care alike. It has been suggested that the child can be considered part of the mother’s body until the hair-cutting ceremony (daahi avah yoslol, üs avah yos), ‘when children are symbolically integrated into their patrilineal group’ (Michelet 2015: 287; see also Empson 2003; Empson 2011: 174- 175 in Michelet 2015: 287; Namjil 2014: 385-387). The ceremony involves the lineage members, but in today’s Ulaanbaatar, friends also cut the hair of the child, giving him or her gifts and good wishes for her or his future. Girls’ hair-cutting ceremonies take place at the age of two or four and boys’ ceremonies at the age of three or five, depending on their astrological age. The only hair-cutting ceremony I attended during my fieldwork symbolised not only a bodily separation of mother and child, but also a social one. It created a spatial and social separation between the father’s line’s guests, who were present when I visited, and the mother of the child. Rather than the mother take on the care of the child, she was committed to the normal duties of a ber or daughter-in-law, and her presence was almost invisible as she was cooking food in the kitchen, quickly providing it for the guests only to briskly return to her tasks in the other room, although this arrangement was also generally the case during other celebrations.

71 Motherhood and reproductive challenges

One summer afternoon I was sitting in one of the offices with Oyunaa and Ariuna, both of whom were the mothers of young children themselves, discussing the reproductive issues and challenges that women and their families faced. I made an observation that having children in Mongolia was, indeed, of great importance, with which they both agreed and to which Oyunaa responded with the following explanation:

It is believed that when we have children we extend the lineage. I must give (gargaj ögöh) children to my husband. Doing so my husband’s lineage extends (udam zalgah), his genes (geni) are kept (üldeeh). Even if I die, my child stays. /---/ Mongolians say that if a boy is born he extends (zalgah) his father’s hearth (gal golomt). /---/ In Mongolia the sentiment (setgel) for children (ür hüühed) is strong. There are many fathers and mothers who would do anything for their child. Some fathers and mothers aren’t like that, but there aren’t many such people, very few. That’s because it can be linked to religion, it can be linked to keeping the genes and their origin (udam ugsaa). So if the woman who became a wife in that household (ail) cannot give birth (gargah) to a child her reputation (ner hünd) is bad and she becomes a bad woman.

This multifaceted explanation summarises a number of relations at the core of the ideal type of kinship as an institution and what that means from the perspective of young women as well, which has served as the topic of some in-depth studies in previous ethnographic accounts of Mongolia (see Empson 2003; Empson 2011: 151 for Mongolian Buryats). Children in the kinship discourse are considered virtuous or meritorious (buyan) (Kohl-Garrity 2015; Michelet 2015: 285; Odontuya 2015: 36) and pure (ariun) (Michelet 2015: 285). But beyond this, children are also necessary for the woman concerning her position and belonging, as Oyunaa pointed out in the above reflection.

72 Childlessness

‘Becoming a bad woman’, which Oyunaa referred to, entails various repercussions, and these seemed to be linked to the age of the woman as well as different perspectives on the matter. One of the rather extreme examples of a ‘bad’ childless woman, who was approaching her sixties, was explained to me years before this PhD project, when I had changed my job in Ulaanbaatar and had started working as an English teacher. As it tended to be with superiors in Ulaanbaatar, my colleagues and I intensely disliked the head of our department at the school. This, along with other hardships, brought us closer together. While my Mongolian colleagues listed her methods of bullying, including random pay cuts, I myself had a different challenge involving her at the time: when I was offered the job, she had confirmed to me that my visa could be transferred from my previous employment. Some months into working at the department as my visa was in progress, I found out that, in fact, this process had not even begun, while my former employer had ended my visa with them. This meant I was in the country without necessary documentation, and besides not having funds to leave, I was unable to do so now legally without further consequences: leaving the country required an exit visa, the getting of which depended on having a valid visa in the first place. An option would have been to leave and be ‘blacklisted’, which would have resulted in being prohibited from entering the country for a certain period of time. When I found out that for months I had been misinformed although I had regularly enquired about progress, I was very frustrated, angry even, and expressed that sentiment to the head of the department in front of some of the other teachers. Eventually it was sorted out with the help of my connections elsewhere, while other teachers were assigned to proceed with the paperwork, such as registering me to my new address and collecting other necessary documents. It was about a month or two after this that my grandfather passed away. A few weeks after that, a friend of mine, another teacher, came to sit on the couch in my office to chat, which led her to reflect on the whole situation without me bringing it up or directly mentioning my loss. She explained that in Mongolia there was a

73 belief that ‘old childless women’ have the ability to cause harm to the family of a person who angers them and that I must have wondered why no one ever contested the head of the department: it was a risk none of the teachers was willing to take, because they all had small children. However, there were varying ideas and also a lack of them, making it hard to pin down exactly what ‘becoming bad’ meant. Another woman in her thirties, for example, suggested that ‘bad’ meant that a childless woman’s reputation would become negative, as though she had mental health problems which stood in the way of her becoming a mother48. As explained to me by a single childless friend in her mid-thirties, the bad reputation might also occur as a suspicion on the part of others, including men, that the woman would try to snatch husbands from their families for the purpose of having a child. As explained to me by some married women I knew, like my doctor friend Gaya, after ‘starting to live with a man’ and reaching a certain age, ‘everyone’ – mostly the extended family – started asking about children. She had put off starting a family because she was a university student, and some years passed before she had her first child. Finishing her Master’s studies49 with an infant was not easy, she explained, but she had managed. During these years between marriage and having her child, she faced frequent questions concerning her reproductive capacities, such as whether she was experiencing challenges in conceiving. The ‘asking’ for new pregnancies and children continued when the married couple already had children, and some women, including Gaya, questioned if it was their place to make such consistent enquiries, suggesting that the next child was expected from them soon after the previous birth.

48 I also asked her if childless women’s sexuality was ever under speculation and whether ‘mental problems’ could have been a euphemism for being gay, but my friend said no. Being gay was not ‘widespread’ in Mongolia, she said, and indeed this topic rarely came up in any form at my field sites. Meanwhile, in Estonia, both myself and some of my single female friends were occasionally thought to be gay, and these conversations came up both among friends and family members in what were often surprisingly confident but inaccurate (at least for the time being) speculations on my and others’ sexuality. While in Estonia it was necessary to determine and categorise a person’s sexuality, in Mongolia it was presumed everyone was straight. 49 Medical studies are divided into Bachelor’s, Master’s and Doctoral studies. 74 Oyunaa, the traditional medicine doctor, explained that it was a huge problem for a couple to be childless and that a lot of effort is put towards this: ‘It’s connected to the specific characteristics of Mongolians. To be childless is a really big problem, it’s very important, it’s especially important to give birth to a boy.’

The daughter-in-law

Mongolia has traditionally been patrilineal: as Oyunaa points out, it is the wife’s responsibility to give birth to children who will ‘extend the husband’s lineage’. The woman who marries into her husband’s lineage will not change her kin belonging, but she will remain ‘an outsider’ to her husband’s lineage (Namjil 2014: 463). By giving birth to children, the ber (daughter-in-law) improves her position within her husband’s kin group, particularly when she gives birth to sons. Therefore, her belonging to her husband’s kin group will increase through her affiliation to her children, but also through seniority as a whole50. A mother of three sons is bestowed a title darhan ber or ‘master daughter-in-law’, and she will be treated better by her husband’s mother and other family members (Namjil 2014: 465; Park 2010). These matters are of relevance when the different generations live closely together; however, not everyone in today’s Ulaanbaatar knows about the concept of darhan ber. Studying the topic of childbirth in the Khorchin banner51 in today’s Inner Mongolia between 1925 and 1944, Kuo-Yi Pao notes that children were desired mostly as a source of labour and as assistance to parents in their old age. Again, sons were particularly desired:

After marriage, a woman usually has a stronger desire than her husband to have a child although she realizes the pain and possible danger involved in bearing one. The reason is that to bear a child is not only regarded a woman’s duty, but

50 For further discussion on seniority, see Kohl-Garrity 2015, particularly page 66. 51 Territorial unit. 75 also elevates her status in her husband’s family. (Pao 1966: 407)

As sons reveal the ‘virtue and destiny’ of that family, bearing sons in particular will be beneficial to the daughter-in-law, and ‘it is almost certain that her mother-in-law will start treating her better than before’ because ‘all mother-in-laws, unanimously, wish to have’ grandsons (Pao 1966: 408). While life has significantly changed since such historical accounts, several of my female interlocutors in Ulaanbaatar did point out that it was preferable to live separately from the husband’s family52. One of my friends who was seeking a divorce from her violent husband said that a ber was often treated like a servant when living with the husband’s family. Another woman sharing a home with her husband’s family and their children pointed out that while in their working career and professional lives she and her husband were equals, at home the situation was different and she needed to ‘follow his word’. While I knew older women who frequently praised their children and grandchildren, I heard no positive accounts of daughters-in-law while in the field. Instead, bers were occasionally the focus of extensive criticism as bad mothers and for generally not being good enough for the son in question53. In folklore young Mongolian women who become bers in their husband’s family are often described as and honoured for being courageous, clever and wise, at times resorting to punishing their husbands if they turn out to be unreliable or unfaithful (Park 2010). However, it must be noted that the context for this is the extremely trying situations that bers tend to encounter. Caroline Humphrey (1978: 91-92) writes about taboos involving the ber with regards to her husband’s kin group (hadamud). The ber had to replace all the names of the senior hadamud members or, in fact, any words in ordinary language that resembled the names of her husband’s hadamud, meaning her husband’s older male kin and the wives of close hadamud. Besides being subjected to a number of taboos, her cleverness was evaluated in accordance with

52 See also Empson 2011: 176. 53 Also, see Empson 2011: 176. 76 her ability to navigate these taboos as akin to tests. However, the ber was both mentally and, in some cases, physically abused, and was expected to look tired and hungry. Due to her posing a danger as an outsider for the hadamud, the ber had to hide her sexuality from her father-in-law by covering her body with clothing and generally aiming to appear invisible (Humphrey 1978: 99-100, 107). Both regarding sexuality and the ability to leave an undesired union, Mongolian women have historically been described as ‘free’, and such discourse has remained to strongly shape how gender relations are described today in national, but also at times academic, contexts (see Park 2010). Traditionally when brides-to-be were asked for their hand in marriage (güih), a bride price was paid to her parents. Meanwhile, the bride took with her the heirloom, which, according to the time or place, could have involved a chest full of goods and animals to make her own property. In academic and popular scientific discourses, Mongol women have been suggested to have been relatively independent or ‘free’. This draws on their economic independence: if things went wrong in the marriage, it was an option for the woman to return or to seek independent livelihood with the animals she had inherited from her parents. It is also suggested that she had a bigger say in the matter involving the herd, because part of it was hers.54 Such claims are frequently generalised to all historical Mongol women, although there has been significant variance in experiences and gender relations depending on the time period, place and class, and more detailed historical accounts or personal histories refute such generalisations. In Batshireet, in Mongolian Buryatia, where Rebecca Empson carried out her fieldwork, a dowry of concrete objects was needed (Empson 2003: 81):

Dowry is important, in the sense that it reminds both the woman and her husband that she belonged somewhere before. But this belonging, as a daughter is already aware,

54 Sexuality and ‘freedoms’, both in historical perspective and as these are discussed today by a specific group of young professionals in their twenties, are the focus of Chapter 5. 77 is always tinged with a sense of impending separation. It is for this reason that although daughters may be overly indulged when at home, they know from a young age that “daughters are another family’s child” (okhin öör ailyn khüühked) and that at marriage they will be placed in a kin group where they again are recognised as partial kin. (Empson 2003: 81).

In her analysis of patriarchy, Mette High (2008: 34) suggests that the social organisation of a household is maintained largely by other family members rather than the head of the household himself. Furthermore, drawing on literature on daughters-in-law, she suggests that the ber’s ‘relative independence’ enables other household members to reflect on their position and ‘separation from the household group’ (High 2008: 34). However, it is worth noting that in many cases, this ‘relative independence’ remains a theoretical one. What remains hugely understudied – and is also not covered by this project – is what prevents both daughters-in-law55 and daughters from being able to practise that theoretical ‘freedom’. Since first-hand accounts of domestic violence that appeared in my discussions of women’s lives in Ulaanbaatar, as well as statistical attempts at research into the matter,56 suggest that its incidence remains high, academic approaches need to focus on this topic beyond historical accounts of the relative ‘freedom’ of Mongolian women by extending research to today’s contexts. As a whole, this thesis addresses the tensions between the above accounts of what it means to be a decent and good woman in Mongolia – a mother of many children, whose personhood comes into being through her relations to others depending on the life stage – and abortion. This

55 Not least legal and juridical systems, and what the seeking of divorce, property and the custody of children might entail in today’s Ulaanbaatar and elsewhere. But the examination of this topic needs to include aspects from societal stigmatisation to practicalities like one’s physical well-being and safety. The many cases diverging from the norm might be followed by life-threatening beatings. 56 A study in 2017 found that more than 30% of women had ‘experienced physical and/or sexual violence’ by an intimate partner during their lifetime (National Statistics Office and UNFPA 2018: 49). 78 does not axiomatically suggest conflict between the two, but it does indicate vast gaps between the conceptualisations of women according to kinship status and how everyday life, kinship and family and parenthood are experienced in today’s Ulaanbaatar.

Abortion

Addressing the patients in his facility, the Khamba Lama mentioned that it seemed like two to four abortions per person were ‘almost normal’. After I mentioned such estimates to Oyunaa and Ariuna, Ariuna said that she thought that seven sounded too few:

There are people who have had fifteen abortions, from sixteen pregnancies, a woman may have had an abortion for fifteen and given birth to one. There are examples of individual cases when there have been abortions had for many pregnancies while giving birth to few.

She went on to explain that, according to the questionnaires filled in during recent years, around 98% of their female patients in ambulatory care had undergone an abortion, suggesting the degree to which abortions are used as a contraceptive method. Discussing the matter of abortion with me, Oyunaa suggested that hundreds of years ago, abortion did not exist, backing up her claims with the fact that then it was common to have many children, like her own grandfather and grandmother: ‘families had twelve or thirteen children, the highest being 23’. At the time, ‘there were few families with less than eight children’, while now there are few with more than two, although she added that this number seemed to be rising recently, but so was the number of abortions. Marking a break in time and in the history of Mongolia and Mongolians, the Khamba Lama explained how the early 1990s was a time when society changed, state ‘control’ was lost and people’s consciousness (uhamsar) altered. He said that while during socialism abortions were carried out in state hospitals in limited numbers

79 under strict control, gynaecologists now had started to approach abortions as business57. The Khamba Lama pointed to the abortion medication that was imported from China and other countries from the 1990s onwards, which had become ‘disorganised’ or ‘messy’ (zambraagui). These medicines have damaged the health of many people who have used these ‘toxic drugs’ (hortoi emnüüd). The way it was pointed out to me that these imported abortifacients were poisonous is complementary to issues that Turk (2018) has studied, looking at toxicity and poison as terms through which treatments were discussed in Mongolia. She suggests that these frame the importance of ‘state-sanctioned regulation and practitioner skill’ for their associations with both ‘Soviet-era toxicological studies and regulation and Buddhist medical discourse’. The Khamba Lama explained that abortion ‘is a great sin’, going on to clarify that there are sins of varying gravity, concluding that this is of the most serious, because ‘it is a human life’ (hünii ami). One of the causes of infertility both on the national level and at Manba was considered to be previous abortions. In a further detail from the Khamba Lama, abortions may give rise to other health concerns, like cysts and benign (horgüi) tumours. But malignant tumours might result too, and interrelated complications with the kidneys, the bladder and the urinary tract might arise from these. The consequences of abortion fell on all four parties involved: the to-be mother and father, the doctor carrying out the abortion and the ‘victim’ – that is, the ‘soul’ that was about to undergo human rebirth. There are also other forms of birth, but the Khamba Lama suggested that perhaps that soul would undertake another rebirth as a human. Referring to karmic effects but also basing this on his experience of having known some of the people who provided abortion, he suggested that the life of these people would not go well: they would fall ill and perhaps die before their time. There have been a few studies viewing abortion as a primarily karmic or cosmologically problematic event: for instance, in China, in the Buddhist-Confucian context, both the woman and the doctor were seen to

57 See also Chapters 2 and 6. 80 be ‘punished by supernatural forces’ (Nie 2005: 73); and in Thailand, the karmic debt that can be created by abortion for women needs to be balanced in the future (Whittaker 2004: 2). Abortion in both traditional medicine knowledge and in the mainstream nationalist discourse remains open-ended for its negative karmic effects and the physiological impact for the couple and the doctors who have been involved. For the woman, these misfortunes can manifest in infertility, miscarriages, cancer and cysts as well as various other health concerns and misfortunes. Indeed, occasionally my female friends told me of second-hand accounts of someone who had an abortion and due to this was now not able to conceive; they therefore regretted the abortion. In another instance, the relative of a woman with ovarian cancer asked me if it was indeed the case that the cancer had been caused by an abortion. Instead of being solely attributed to karmic causes, these consequences seemed to arise from abortion’s potential ‘biological’ and unknowable effects on the body. This, however, stands apart from how women who had abortions talked about the matter. With the religious revival in Mongolia, the specialist knowledge concerning these topics also suggested shifts in ‘knowledge’ and its legitimacy. Here, I have presented one of the institutional views on abortion and its effects. What the wealth of these discussions indicates is the lack of legitimising authority on the part of the state and its interlinked institutions concerning ‘Western’ medicine, including the silence and lack of knowledge on behalf of the abortion industries when it comes to speaking of abortion’s ‘biological’ consequences or the lack thereof. While abortions belong to ‘modern’ medicine due to its methods and locations58, the problematisation of abortion, its linked results and the treatment of some of these effects to a large extent belonged to other forms of knowledge, medicine and treatment, not limited to traditional medicine. However, as discussed with me, this was not necessarily due to the cosmological nature of these

58 I did not hear anyone ever bring up abortions through acupuncture or massage, although theoretically it is possible to induce an abortion through these methods. Both acupuncture and massage are also traditional medical healing practices. 81 problems, but rather the fact that ‘modern’ medicine treatment in today’s Ulaanbaatar has been sought but has proved unreliable. The situation of broader medical pluralism was also frequently reflected upon and not taken for granted in its current form. For example, doctors in the state clinic insisted on the need for one woman, Suva, who shared her medical history with me, to have a hysterectomy following a miscarriage59. However, she declined this as she was in her mid-twenties and only had one child. She said: ‘Religion has greatly expanded. Generally, if things prove impossible, people have started to go to a shaman.’ This was also the case for herself, as she was able to conceive after seeing a shaman, but not before seeking assistance from ‘modern’ healthcare. She had undergone one examination since the hysterectomy was suggested, which showed that the growth in her uterus was still there. Yet, she said that she was not going to the doctor much of late and had disregarded the state doctors’ recommendations, stating that their first advice had been wrong concerning her ability to give birth to another child. She concluded that ‘they only try to forcefully remove a kidney’, contributing to the circulating speculations of an organ trade. After her miscarriage she had offered sweets to Hüüdhiin Tenger (‘Children’s Sky’)60 in front of her house for the soul of the lost child to return as a new pregnancy.

Infertility and miscarriage

Infertility (ürgüidel) and miscarriage (zulbalt) in traditional medicine were considered as distinct problems with separate and multiple causes. Miscarriage could be linked to the woman’s fertile capacity (ür togtooh chadvar) and previous abortions. Environmental conditions, such as the huge variations between hot and cold that are characteristic of Mongolia, potentially have an enormous influence on women’s fertility.

59 An operation to remove the uterus. 60 Shamanic practice. 82 Oyunaa added that women work harder in almost all areas, which is likely to have a role in miscarriages but also infertility. Infertility, on the other hand, was linked to more ‘karmic’ reasons. Here, the problem could be from ‘the side of the woman’, meaning that she has had many abortions. The reason can also be linked to the man’s health. Furthermore, the issue can be more complex for the reasons of destiny (huvi zayaa):

Considering this, in connection to destiny, the father, mother and the child given from god (burkhan) are with three separate destinies. So the merit (buyan) and karma (üiliin ür) need to be exactly on one level, at that time human birth is found. If the merit of the father is poor, the mother and the child can’t meet (uchirch), or if the child’s merit is poor, the three cannot meet. So, it is understood that because of this it’s not possible to have a child. (Oyunaa)

There are many patients who visit Manba with their inability to get pregnant or ‘find a child’ (hüühed oloh), particularly when neither the wife nor the husband is seemingly suffering from any health concerns. While such challenges originate from separate reasons, there are a number of practices to successfully address and cease these problems without the use of medication through the Khamba Lama’s mastery of the citation of mantras or by carrying out secret tantric practices characteristic of Mongolian Buddhism. At Manba the treatments are based on the treatment of the imbalance of the humours or through sacred text citation (zasal nomoor). Bringing together the treatment of specific conditions of the three humours to which the doctors would attend and the karmic reasons behind the condition tended to be a successful cure, the Khamba Lama noted. On one occasion discussing these reproductive matters, I asked Oyunaa if people were aware of these multiple reasons behind reproductive challenges. Her response was no: they would only be aware if this was well explained and if they were taught lessons on it, otherwise they would follow superstitions, and without knowing the further

83 background of the situation, they would think simply that ‘it is god’ (burhan)61.

Position as a childless foreigner

One evening I went to the pub with my Manba friends, who were all women in their late twenties or early thirties with children, to enjoy each other’s company, eat and drink well. The conversation shifted from the reason for the split of the actors Angelina Jolie and Brad Pitt – their headshots, alongside other international celebrities, were decorating the walls and we took turns pointing out the ones we also recognised – to the reasons for my being in Mongolia, which to my joy was deemed karmic as it was seemingly working out for all of us: I was teaching English language classes in exchange for the traditional medicine ones taught to me. This was followed by discussions involving their children and my childlessness. Ariuna, one of the most renowned young doctors at Manba, asked me when I was going to have children. Despite having very little desire to be a mother, at least in the foreseeable future, I responded, ‘perhaps in two or three years’. I was 29. I pointed out that my sister, who was five years older than me, did not have children. In an attempt to further mitigate my childlessness and indicate my knowledge of Mongolia, I said that I knew it was too late considering ‘Mongol standards’. I hoped that this would somewhat excuse me by drawing on my foreignness and non-Mongol body, as it often successfully did for other things, like approaching ovoos (ritual cairns) that were otherwise forbidden for women. I seemed to get away with this without immediate social repercussions, although potentially I was simply ignorant of them. I thought this was mainly owing to politeness and the pointlessness of fighting my ignorance, not necessarily because it was acceptable in itself. But to my concern, this time Ariuna’s answer was simply ‘too late’. When parting with another friend of mine, who was in her mid- twenties and a mother of a particularly cute daughter, her last wish for me

61 Generally meaning ‘god’, but it can also be translated as ‘Buddha’. 84 as we said goodbye was for me to have a child soon. While I myself felt little urgency, I came to recognise that in a lot of those conversations concerning my being single and childless among my female friends in Mongolia, this was a true concern, and discussing it with me was a form of care, particularly when it was apparent that I liked to spend time with their children. Generally, my childlessness did concern those closest to me as I was approaching 30 years of age, but at times I could pass as a foreigner to whom such temporal expectations did not apply. This was the case with an informal taxi driver, a father to a daughter of just over twenty who was attending university and had recently got a job at one of the malls, and whom he was going to pick up after dropping me off. He told me that in Mongolia, people have children while ‘still children’ themselves, seemingly and somewhat unusually approving my plan to have children a few years after finishing my PhD. My appraisal of him was relative to my experience with other informal taxi drivers, who usually tried to flirt with me and with whom I tended to have a discussion after the first lengthy enquiries about my availability had finished. Most of these enquiries, which came fast after a quick-fire round of questions asking my reasons for being in Mongolia, my age and my country of origin, concerned my relationship status and my plans to start a family with my fictional boyfriend, about whom I told made-up but elaborate details to the male taxi drivers to keep the flirtation at bay. Sometimes all my morally conflicted lying was in vain: one taxi driver told me straight out that it did not matter, I could also have a Mongolian boyfriend, ‘because this is how it works in Mongolia’. At the time of my being in the field, it was fairly acceptable and sometimes desirable for Mongolian men to marry – and definitely pursue – foreign women, as was the case with the popularity of Russian brides during the socialist years, when many of the socialist political elite had a Russian wife. President Battulga – who took office in 2016 after having initially gathered his connections and wealth by excelling in wrestling, which is one of the national sports and the glorious expression of hiimori or masculine vitality – also allegedly has a Russian wife.

85 In addition, as one of the highest forms of compliment, on a few occasions a Mongolian mother sought to facilitate a connection between me and her son, while I did not hear of such light matchmaking for any of my foreign male friends for the reasons of transmission of Mongol-ness. Instead, Mongolian women and foreign men who walked around Ulaanbaatar in public tended to be showered with insults (‘slut!’) and experienced physical intimidation to such a degree that at times these couples avoided public outings. As a foreign single woman, I was in a hugely different position from my male counterparts, and while my ongoing sexualisation and the interest in my relationship status did exhaust me daily, I was also more welcomed. This could be attributed to the fact that theoretically I could have been included in Mongol-ness by giving birth to Mongolian children, while my male colleagues with their local girlfriends would have undermined Mongol-ness in certain nationalist and kinship discourses, as I will discuss below in relation to ethnic inheritance.

Transmissions of Mongol-ness

According to overlapping understandings in Mongolian traditional medicine and kinship, the bones (yas), head (tolgoi), brain (tarhi), spinal cord (nugas) and the bone marrow (chömög) are assembled from the genes of the man. While it is the father’s line that reproduces the determining parts of the child’s body and life, it is the mother’s body’s elements that assemble it. Echoing other discussions, Oyunaa explained that:

/---/ Therefore, important things are inherited (övlögdöj ireh) from the father. The brain is also inherited from the father’s side. The brain is assembled from the whole knowledge of the father.

86 From the mother, the child inherits the skin (aris), flesh (mah) and blood (tsüs) (see also Bulag 1998: 114; Humphrey and Sneath 1999: 26- 27) – the ‘general’ parts of the body.62 Ethnicity is understood as inherited quite strictly from the father through the yas (bone) line (Billé 2015: 25; Chapter 3), although there are cases where family identity or ethnic identity is inherited from the mother (Humphrey and Sneath 1999: 27). Ethnicity (yas ündes) can literally be translated as ‘root of bone’ (Bulag 1998:31; Park 1998: 127). In the 1990s, news about the need to protect the gene pool was published and the country’s President ‘issued a special warning about this’ (Bulag 1998:113). The interest in this was linked to the occurrence of mental disabilities, which were attributed to intermarriage between close relatives (Bulag 1998: 113-114). To tackle the issue, the Ministry of Health sought to ‘revive the traditional social organization’ and integrate it with biological knowledge (Batsuur 1988 in Bulag 1998: 114). While the Ministry, schools, teachers and a public campaign advocated for the taking up of the pre-revolutionary forgotten ovog or clan system, which essentially recorded the paternal line, Uradyn Bulag (1998: 116) notes an important change in kinship as many people were not only concerned with their patrilineal descent but also relatives from the maternal line. Empson (2007: 60) writes about how the Buryat ideas of ‘shared bone’ (etsgiin töröl, yasan töröl) still constitute relations in Buryat life. Meanwhile ‘shared blood’ (ehiin töröl, tsüsan töröl), which is between a woman and her children as well as her siblings, will result in being apart from one another as these relations ‘are considered to be too close to live with’ (Empson 2007: 60). However, as Empson has also pointed out, these notions of mutuality ‘coexist with other idioms of relatedness’ (cf. Stafford 2000b: 38 in Empson 2003: 33). For example, another form of extending the lineage is through the hearth (gal golomt), which Oyunaa also referred to. Traditionally, the youngest son would make a home

62 A similar bodily inheritance system is in place in Tibetan medicine (Khangkar 1986: 89) and elsewhere in Asia, such as in the case of the ethnic and national unity of South and North Korea present as a discourse in both countries. 87 where his parents live and therefore be most strongly connected to the hearth (Bulag 1998: 71). Manduhai Buyandelger (2013: 259) elegantly shows how the importance of biological and patri-centric lineage can be contested or complemented by the hearth around which the family is brought up. Buyandelger (2013: 259) follows the story of Baasan, a Buryat woman living in Eastern Mongolia, who is in search of ancestral spirits whom she suspects of having caused misfortune for generations. In this endeavour she consults shamanic and Buddhist practitioners. In Baasan’s years of long research, she eventually finds that the misfortune came about in connection to Otgon, who was Baasan’s grandfather’s step-grandmother. Baasan’s grandfather was brought up around Otgon’s hearth, and Otgon had great importance in her grandchildren’s lives. However, during socialism it was impossible to give Otgon the burial she deserved, therefore leaving her wandering around as uheer (spirit gone evil). Also, the family kept respecting Baasan’s biological family’s spirits. In Otgon’s family, Hoimorin Högshin, a Buryat deity protecting children and families, had been forgotten, which was also of relevance (Buyandelger 2013: 233-266). This story, however, also shows how many of the uheer can be female and have to do with some sort of divergence from the ‘bone birth’ organisational centrality. However, these stories also manifest the danger that women with their potentially precarious and shifting belonging pose (Terbish 2019), even as adoptive mothers. Of the bodily elements that extend across generations to form a lineage, the most important is bone marrow for it clears (tungalag boldoh) the drinks and food that humans consume, as Oyunaa explained to me. When the nutrition (shim tejeel) is cleaned, it can remain in the body. The final product from food is stored in the bones and the marrow itself. My Mongolian teacher, who grew up in one of the southern provinces, said that in her childhood animal bone marrow was considered an aphrodisiac and children were not normally allowed to eat it. Concerning the comparable nature of the animal’s body that was consumed or used in healing a human body part in traditional medicine, it makes sense that there were such parallels for the centrality of bone marrow in human

88 continuation. Meanwhile, in the case of a lack of lactation, gazelle bone marrow was prescribed as a remedy (Tsedevsuren and Bathuu 1990: 17) Diet is central to health and involves balancing the body depending on the season, such as through a more meat-based diet in the winter and consumption of white foods (like milk products) in the summer. Tsetsee pointed out that all food in Mongolia was no longer clean due to vaccinations and the use of vehicles, like cars and motorcycles, for herding. For the meat – a Mongolian staple – to be of high quality, the animals should not be scared, including during death. However, generally Tsetsee thought that Mongolian food was clean and it therefore made Mongolians strong. Purity and strength were generally related to one another in the case of national genetic purity, too, which in Mongolia’s case was thought to still be in existence and somewhat intact, compared to other countries like my own that had been conquered over and over again. Bulag (1998: 263) approaches the matter historically and speculates as to whether Mongol-ness and men are seen to have lost the ability to incorporate and neutralise difference and pollution by the external as well as the feminine through, for instance, the consumption of certain foods. He writes:

During the Mongol Empire period, arriving foreigners had to go through two fires. The idea persists today among older people, who still purify their hands and clothes by incense smoke after returning from a journey. Things walked over or stepped over by women are also purified. This ideology may be further seen in the milk and meat system. Woman are “flesh”, and both women and flesh (meat) are “consumed”; yet they could be dangerous, as can be seen from the fact that the incoming bride had to be purified between two fires in the wedding ceremony. They are polluting to the “bone” – that is, the patrilineage, or clan. The Mongols have another system for purification: fermented mare’s milk (airag). Although most kinds of milk are handled by women, mares used to be milked by

89 men only (now by women!), and the symbolic consumption of airag was virtually entirely to do with men. The function of airag (men usually drink 10-20 pints a day in summer) is to detoxify the flesh (meat), which is regarded as mildly noxious when consumed in the summer. The essential point is that the Mongols had a mechanism to handle the pollution, and were able to absorb it. (Bulag 1998: 263)

The bone marrow: Quality, pollution and gendering

The person’s appearance or complexion depends on the bone marrow; people who live in poverty have a darker complexion, and when encountering people with such an appearance, it is asked ‘Are you tired?’, Oyunaa elaborated. So, the appearance is different for people who live poorly, she went on, and that is due to the bone marrow. In connection to their conditions of süld hiimori, people have a different appearance, and this is precisely dependent on this organ. The people who have süld hiimori are successful in their work and have a brighter appearance, which is the result of their bone marrow. Süld hiimori can be generalised, simplified and translated as ‘luck’ or ‘life-force’.63 Hiimori has been explained as ‘vitality’ (Empson 2012a: 118; Humphrey and Ujeed 2012: 152), ‘potency’, ‘life-force’, ‘personal psychic power’, ‘inspiration’, ‘might’ (Empson 2012a: 119;’), ‘luck’ (Michelet 2015: 281); and sülde as ‘might’ (Empson 2012a: 119; Humphrey and Ujeed 2012: 152), potency (Humphrey and Ujeed 2012: 152), ‘vital force’ (Michelet 2015: 281) or ‘life-force’ (Pedersen and Højer 2008: 87)64. Caroline Humphrey and Hürelbaatar Ujeed (2012) explain that hiimori is sülde’s parallel ‘in the Tibetan world’, literally meaning ‘wind-horse’. The concepts in Inner Mongolia for the Urad are ‘both inner qualities of vigor and success, and both are also located in objects outside’ (Humphrey and Ujeed 2012: 154). These can be

63 For spirit or sür süld among Buryats, see Swancutt 2012: 112-113. 64 For other notions of luck and fortune, see Humphrey and Ujeed 2012; Empson 2007, 2011, 2012a; Swancutt 2012. 90 influenced externally and affected by contamination, which can result in the diminishment of one’s fortune (Humphrey and Hürelbaatar 2012). Hiimori ‘is connected to ideas regarding movement of energy and of the air’ (Abrahms-Kavunenko 2018). It is common to see hiimori flags on mountain-top ovoos. The tugs, banners or battle standards, made up of a pole around which horse or yak hair is arranged to tangle in the air, are themselves called süld. Süld hiimori also means ‘coat of arms’, which suggests it has to do with the lineage or yasan töröl (‘bone-birth’) and its well-being. In many cases, it is viewed as outlined above, but some practitioners and diviners in Ulaanbaatar equate it to one of the souls of a person that can go astray when he or she acts poorly or if other life events enable a person to lose it, which shows the transitional nature between shamanism and Mongolian Buddhism. It then needs to be summoned back. For others, it is an essence and a quality: as another friend pointed out, if there is an inkling that someone is not succeeding in life or not successful in something more specific, he or she can visit a lama to call the person’s süld hiimori. It is particularly important for a Mongolian man to possess it or, in the case of its lack, restore it. The hiimoriin san prayer at Buddhist temples is a popular one and can help with the internal energies (Abrahms-Kavunenko 2018; Humphrey and Hürelbaatar 2012). These matters of gendered forms of luck, its harnessing and its loss, however, served also as the topic of some reflection, which differed hugely from what was outlined above. On one occasion walking in the ger district with a friend following a visit to a third party, I thought that it was potentially a good moment to enquire about what hiimori is, which remained very confusing to me. My friend, on the other hand, defined it according to men’s physical characteristics, particularly the possession of reproductive organs that women are lacking. She expressed frustration that such a concept would define what men and women should do, which in practical terms meant men were exempted from hiimori-reducing household tasks. Just minutes before this discussion, we had run into an intoxicated man. Standing on the gate of his compound sporting a haircut paying stylistic tribute to the ancient warriors, resembling visuals circulating of Chinggis Khaan and his contemporaries, he tried to engage

91 with us with particular enthusiasm. As my friend’s frustration grew in her attempts to explain such an elusive concept as hiimori, she referred to the guy, saying this is ‘exactly the type who would be into hiimori’. I guessed this was due to his confident and slightly forceful gendered ways and his visual – and perhaps general – glorification of the past. Up to now, the area studies literature has been limited to referring to bone as the metaphor of patrilineal kinship, rather than suggesting that bone marrow is the location where biology, descent and cosmology intersect, as I have shown in this chapter drawing on traditional medicine. While this sort of current ‘excavation of knowledge’ reveals the various aspects through which the bone marrow manifests certain ideas of ‘life’, it also makes visible the gaps in knowledge and understandings of legitimacy in reproductive healthcare in today’s Ulaanbaatar. Therefore, these explanations and accounts contest viewing the ‘bone marrow’ as in any way underlying Mongol-ness in a direct manner, but rather invoke further attention to expert knowledges, claims on histories and work on the body and destinies.

Conclusion

This chapter has reviewed what various forms of claims on legitimacy may involve and some of their content concerning Mongolian traditional medicine within the broader politics of the emergence and ‘revival’ of various forms of knowledge and practice, and how these relate to one another. This chapter has suggested that the specific form of expert knowledge is not known and shared by all. Rather, women’s stories indicate uncertainty and the search for legitimacy when it comes to reproductive health, which is often not found, even if it is desired or claimed. Within this space, much of the core work of legitimacy as trust is undertaken by people who spend their days trying to help their patients to the best of their ability, trained over years of study and practice, holding themselves to extremely high and demanding personal and work ethics and standards of kindness while doing so, like Oyunaa and Ariuna. I will return to the issue of doctors’ work in Chapter 6.

92 ‘Life’ as arising from these discussions is not a singular matter, although it mostly arises through the importance of a human life that manifests the transmissions of life beyond an individual on broader scales. Firstly, through looking at ‘life’ through discussions surrounding abortion, abortion is a ‘karmic crime’ for inhibiting a ‘soul’ from undertaking precious human rebirth, as the Khamba Lama pointed out. Abortion therefore inhibits this ‘soul’ from continuing its path towards enlightenment, although it might undertake another rebirth as a human. Humans are conceived as being alive from the moment of conception, which essentially means that abortion is an aborting of human life; although as the broader discourse shows, the forming of a human body and personhood is a process carried on throughout the human lifespan, where various environmental, cosmological and social conditions need to fall into place. It could be argued that studying ‘life’ itself is a historically shaped, if not a biopolitical, occurrence (Kaufman and Morgan 2005: 327-328); however, this tends to be the case when ‘life’ is delimited to ethnocentric notions of the biological body and the human lifespan. A somewhat divergent account of human life arises from Mongolian kinship discourse. Not having children or undergoing an abortion could be seen as problematic because women ‘owe’ children to their husband’s lineage, as Oyunaa explained. This continuation as such has less to do with the national as a whole or a singular human life, but the ‘extending’ of descent and lineage across human lives. While the ‘daughter-in-law’ as a kinship relation has served as a justified and extensive focus in the anthropological literature on the subject, I suggest the importance of acknowledging that broader categories such as ‘mother’ and ‘woman’ need to be equally examined in order to understand what motherhood or womanhood entails, both in relation to being a daughter-in-law and a kin relation, and particularly what these may involve beyond their structural locations within the kin unit and in relation to family members. In the national and kinship discourse, children and large families are praised. At the same time, the number of abortions remains high, even in the case of women who are already married. This indicated that it is not only the role of a daughter- in-law or kin relation that is relevant when it comes to pregnancies and

93 births. Besides being a body – which Foucault has overwhelmingly focused on – people also have other experiences that matter (McNay 1992: 9). Additionally, the status as a kin relation can also be rejected by those who should receive the expecting mother and the to-be-born ‘child’ into their family and potentially provide the needed care to them. Chapter 4 takes up this topic, following the notion of care beyond the parent-child relationship and the domestic.

94 Chapter 4. The Practical Matters: Motherhood in the City

People with pseudonyms in this chapter

Hulan A young woman pregnant with her first child Saraa Hulan’s landlord, a woman in her mid-twenties Tsetsee A woman in her twenties, a mother of three Zaya A woman reflecting on child benefits

Introduction

When Hulan was almost eight months pregnant, she told me she had recently started to feel angry, an emotion particularly undesirable for those expecting a child. It seemed to arise from within herself and she did not quite understand her frustrations, but she attributed such feelings, to a degree, to being alone. Her partner was rarely home and she spent her days cleaning the ger that was spotless, watching TV series and chatting to friends and family members over the phone. Then one day she had experienced a sudden surge of pain and a strange urge to go to the bathroom, after which she grew worried of what would happen if she went into labour alone. While women in Mongolia can give birth anywhere in the country regardless of their municipal registration – though perhaps it was more complicated without one, Hulan speculated – she was considering going to the countryside to give birth, to be around her grandmother, who had brought her up, and her numerous relatives: ‘Perhaps it would be okay to be at a place with many people. I’m giving birth for the first time so I don’t know anything. I need a person to help me.’ Hulan, a twenty-year-old student, had moved to Ulaanbaatar from a province several hundred kilometres away to study at one of the state universities, like many other young women. She became pregnant during the second year of her Bachelor’s degree; she had managed to take time

95 out from it and was hoping to continue the degree after having the baby. Hulan’s considerations are important here for two reasons. Firstly, she experienced her place in Ulaanbaatar as somewhat precarious: the set regulations were not clear and they could have involved unexpected complications that needed to be taken into account before they arose. She lacked networks and senior family members to advise her and negotiate healthcare, as I will discuss below. Secondly, entering the new stage in her life as a mother was both emotionally and practically something that Hulan felt unequipped to plunge into alone in Ulaanbaatar. Children are praised both in Ulaanbaatar and Mongolia, and motherhood is often seen as intrinsic to a woman’s personhood (Chapters 2 and 3), while Ulaanbaatar has seemingly reached its population limits. In 2017 registrations to Ulaanbaatar without valid enough reason to stay came to a halt due to overpopulation, which made itself apparent through congested streets, smog and educational institutions working over capacity, among other challenges. Womanhood and motherhood for many in today’s Ulaanbaatar unfold in the gap between developments to the national agenda and the specifics of this particular city. Unlike in the cases of other countries and cities, such as Mongolia’s neighbouring China, here national population development is in stark contrast to the life and conditions of the capital city. While this is the case, this chapter will focus on the everyday and how it is constituted by the absence of various institutions and relations including, but not limited to, kin. While in the cases of lack, lives go on and other relations do unfold, they do not do so without some reflections on the losses and costs that were involved, as well as an awareness of the peculiarity and arbitrariness of things. This chapter attempts to give a sense of what life is like for young women when a wish, but also a need, to become a mother encounters the ‘overpopulation’ and other challenges of Ulaanbaatar. Hulan was on the verge of becoming a mother in Ulaanbaatar without having a municipal registration, and Tsetsee, a mother of three in her twenties, was tackling securing secondary care and education for her children. Zaya, on the other hand, shared her confusion and frustration with the child money programme administered by the state and international financial organisations.

96 I will study various forms of care – both as needed by mothers and as provided by them in order to secure education or other services for their children. Owing to Foucauldian analysis, the studies of governance and care have overwhelmingly focused on healthcare due to the emphasis on the body and the human lifespan (Mackenzie 2009: 506). But as I noted in the concluding remarks in the previous chapter, it is not only the body that requires care, that shapes experiences and that matters. Therefore, here I explore the notions of care that are relevant beyond healthcare. Nor does ‘care in this chapter focus on the intimate or as arising through primary care to the child, but rather as inherently crossing ‘private and institutionalized settings’ (Feldman-Savelsberg 2015), being shaped by the presence or absence of kin and the state, and Ulaanbaatar as a place. I will start by giving a sense of Ulaanbaatar and the kind of sociality it constitutes. Care and getting-things-done are neither complicated by the informality and wealth of non-formal relations that various services are considered to involve – which has been a particular focus in the literature addressing healthcare in post-socialist contexts65 – nor by the aspects of ‘productive’ relation-making among strangers. Instead, they are complicated by resistance to and avoidance of such relations in the first place, as well as the frequent inability to create them. The relevance of this lies in what it manifests for those who find themselves in this situation: the lack of care, which may involve undesired experiences of anger or violence; lack of accountability; and added monetary costs due to persecution, mitigation and attempts at relationality.

Liminal student years in the city

According to the official statistics, of the 3.2 million Mongolians, around 1.5 million live in Ulaanbaatar, whose name carries its socialist history, meaning Red (Ulaan) Hero (Baatar). It has been estimated that at least half of those 1.5 million, including Hulan, live in Ulaanbaatar’s spanning ger districts, which are usually made up of small, wooden

65 See Morris and Polese 2013; Polese 2014; Polese, Morris and Kovács 2015; Stan 2012; Stepurko et al. 2015; Williams and Onoschenko 2013. 97 houses and Mongolian yurts. The areas contribute to one of the most urgent issues in Ulaanbaatar: the air quality. From November until March, smoke from the heating of gers and houses with raw coal creates a thick blanket of smog, a problem that is gaining momentum, particularly concerning its harmful effects on pregnant women and young children. However, it is not only the air quality that is an issue, but also the practicalities of living in a city stretched out from the east to the west in the Tuul river valley and somewhat contained by the four mountains in each direction. The city tends to be stuck in a traffic jam, near to or in absolute collision, making particularly bravado drivers swear at one another and – not as rarely as co-commuters would perhaps like – exit their vehicles to punch each other in the face. Sally Engle Merry (1981) takes this up in her study of urban danger, pointing out that for decades, the academic work on the matter was somewhat in reaction to Louis Wirth’s, giving rise to emphases on ‘urban settings in which people know one another and treat each other in terms of intimacy and interdependence’. Merry’s (1981) interest in Wirth’s work, similar to mine, lies in its potential to understand aspects of the ‘boundaries between separate social worlds’, which involve the politicisation of aspects of ‘intimate’ lives. It is such boundaries and gaps that tend to induce decreased information flow (Merry 1981) and a lack of the care that at times comes to stand approximate to knowledge. Stranger-ness in Ulaanbaatar and beyond was not only notable for its creative potential, like hospitality,66 but also involved various dangers (Delaplace 2012; High 2017; Humphrey 2012). Elisa Kohl-Garrity (2015: 54) notes that her ‘conversational partners seemed to mention in a self- evident fashion that strangers are not respected’; this was not limited to Mongolian ‘urban’ or ‘rural’ contexts. However, here the everyday discussions and encounters in Ulaanbaatar did involve reflection on this dualism, positioning the location as something that mattered. In this chapter, the approach to stranger-ness is rather elusive, simply pointing towards the stigmatising, precarious and danger-inducing capacities that non-familiarity and non-relationality with and in Ulaanbaatar brought

66 As in Pedersen 2018; see also Chapter 7 on the creation of relations, trust, legitimisation and verification. 98 forth. In his article ‘Urbanism as a Way of Life’ (1938), Wirth linked urban life and strangers. Following Marshall Sahlins (1965: 148-149), the goal will be to specify some of the ‘social or economic circumstances that impel reciprocity toward one or another of the stipulated positions’: what Sahlins calls ‘negative reciprocity’, or ‘variety of seizure’, where relations are not extended in the way that they should be or was hoped for. Living in Ulaanbaatar was not considered particularly easy, as it was frequently pointed out to me, most often taking the form of a comparison. Those who had moved to the city during their lifetime from the countryside, as well as others, found that life there was incomparably better than in Ulaanbaatar, which had become distanced from the true Mongol ways and its interlinked moralities. Or, as my host father said as we were driving around looking for water in our district during Tsagaan Sar67, when all of the water points in the area were closed and a household with a private well had denied us water, ‘this would never happen in the countryside’. Those who had visited other cities elsewhere compared Ulaanbaatar to the ways in other countries. And there were those who still fondly remembered the city before the mass migrations, when it accommodated its inhabitants with less pollution, dirt, traffic and what was seen as danger produced by the imposed proximity to strangers. Those who were not wealthy or cultured (soyoltoi), as the city seemed to demand of one – including unexpected groups like the first-year students from the countryside whom some administrative staff held accountable for the ‘uncultured’ littering of the corridors of the university with spat- out pine-nut shells – were no longer considered the ‘real Mongols’ from the countryside nor persons with actual claims to Ulaanbaatar and the ways to be in it. Hulan, like many other young women, had come to the city from the countryside to study. And, like many others in the case of Mongolia and other places alike, ‘urbanisation’, as arising from her story, could be characterised by the wealth of relations at the collapse of the urban-rural axes – at least within her existing ‘social worlds’ – rather than an absence or polarity of them. In recent years, (peri-)urbanisation has received some

67 An elaborate Mongolian Lunar New Year celebration. 99 justified attention in the scholarship, with the recognition of the shortcomings of urban studies’ approaches in the Mongolian context (Fox 2019a; Hutchins 2020; Plueckhahn and Bayartsetseg 2018). Meanwhile, studies of urbanisation processes in Mongolia have often assigned ‘mass migration’ events to the turn of the 21st century, although there are a range of continued reasons to relocate.68 While families seek better employment opportunities and education for their children, which countryside or regional centres have fallen short on as existing networks of kin may have already left for the city, another group is often overlooked – those moving to the city on the brink of adulthood in order to attend a higher education institution. In 2018 about 60% of students registered in tertiary education were women (Mongolian Statistical Information Service 2019). After graduating high school, girls are sent to the city to study more often than boys for various reasons. Traditionally, it has been the youngest sons who should take care of their aging parents. Girls tend to get better results in schools compared to boys, making it easier for girls to enter university programmes, provided there is no parental advocation through connections and favours involved (see Bamana 2016). Empson (2003: 79) noted that in her field site in Batshireet in north- east Mongolia, mostly made up of people of Buryad ethnicity, the education of daughters seems to have become a form of dowry, as parents hope that educated daughters can achieve firstly, a hypergamous marriage, and secondly, ‘an independent income in case their marriage fails’. Yet when a young woman returns to Batshireet with a ‘year or so of higher schooling’, it is harder for her to find a husband, as it is expected that she will marry someone who has acquired equal or better educational and vocational training rather than a herder, and it was ‘generally felt that a man would not like to marry a woman who is more formally educated than himself’ (Empson 2003: 80). The main campuses of the five national universities are all located in Ulaanbaatar, while only a few branches and colleges are located in other towns. Ulaanbaatar has largely an educational monopoly within

68 See also Fox 2019b; For international Mongolia-Korea marriage migration of Mongolian women, see Tseden 2014. 100 Mongolia: there are few options for higher education elsewhere. Not everyone wants to move to the city, however. Some young women find it hard in the city as students: they may have taken up a place at the university dormitory or be relying on relatives to put them up in homes that might already accommodate extended families. Being a young unmarried woman at a relative’s house can bring its own restrictions, such as being unable to avoid or decline requests that typically involve household tasks. A student from one of the remote aimags or provinces explained to me that she found the capital dangerous and unpleasant, which was the reason why she decided to relocate from there after a year of study to a college in Darhan, a town in northern Mongolia, as this was also some hours closer to home, which was more than a day’s journey away from Darhan. She planned to study for another couple of years and graduate before her mid-twenties, because she found it necessary to be a mother by the age of 25. She was hoping to return to the area where she was from. Hulan found out about her pregnancy at two months, after which she hid it for some time. While her pregnancy was not planned, she said she did not have doubts about having the child. Instead, finding out about her pregnancy immediately plunged her into a new life stage: she sorted out her living situation and took time off from her studies. Motherhood and marriage in heteronormative ‘Western’ contexts have often been linked to ‘independence’ brought forth by its links to adulthood. In Mongolia, leaving one’s family for the husband’s has been seen to create novel forms of relationality (see Humphrey 1978; Empson 2003; Empson 2007; Chapter 3). However, neither of these approaches would be appropriate when attempting to describe Hulan’s experience of entering this stage of womanhood. After giving birth, mothers are considered to become child-like and require extensive care by their immediate family during this time, particularly through the knowledge of senior female family members and the care provided by them. Motherhood’s link to care shifts here from mother-child relations to receiving the care that mothers are entitled to but are also dependent on, particularly during gam after giving birth (see Chapter 3). Being in the city with no strong or direct network of relations

101 and connections was relevant both during pregnancy, but also, crucially, during and following the birth. As Hulan did not enjoy close relations with her partner’s family, not unlike several other bers or daughters-in- law I also discussed the matter with, she therefore could not depend on them during the time ahead. Meanwhile, both concerning knowledge and practicalities, she was unable to take up motherhood alone, and wished to give birth at a clinic where the staff were somewhat known to her or her family members, so the option of going to her place of origin to give birth seemed most feasible. Had she lived in a flat, the situation could have potentially been different, as Tsetsee explained, due to the exact aspects of care, the air circulation and other specifics of living in a ger, as Hulan did; and had the healthcare situation been different, perhaps her family members would have come to stay with her for the duration of gam. Overall, ‘being pregnant, giving birth, having children, and caring for children tie mothers to families, to communities, and to states’ (Feldman-Savelsberg 2015), but also to their partners. Hulan was not married to her partner – whom she referred to husband (nöhör) – could be attributed to multiple reasons: for instance, his family’s dislike of her and her family; the fact that she was brought up by her grandmother; that she did not come from a place of particular wealth; for the physical distance that would need to be travelled to ask her hand in marriage; the cost of weddings, and so on. However, these are all speculations as I was never able to bring myself to ask her about the specifics of this. From what I gathered from Tsetsee, who brought up the matter herself, the engagement (‘asking for a daughter-in-law’, ber güih) and the marriage situation were stressful even if there was an intent to marry and the bride came from a ‘respectable’ family from not too far away. Laughing, Tsetsee said it was not easy for her at the time, because she got pregnant as a first-year student at the university. Her parents did not live in Ulaanbaatar and trips had to be taken for her then boyfriend and his family to ask for her hand. Her parents lived only a few hours away from the city, however. They refused the first two times, and the whole process took a while, as they had to time it to favourable days in accordance with the lunar calendar in order to proceed.

102 I was often told by other young women that it was the first-year students who became pregnant in the city, out of the reach of the careful eyes of their parents or grandparents; ‘later they learn to take care of themselves’. And, indeed, the whereabouts of my former students, who were now first-year students at various universities, were rather strictly checked by their parents. However, my friends who had finished their university studies and were single seemed to enjoy a much more relaxed family life compared to those still in their early twenties. Figure 4 shows an illustration of how getting pregnant in Ulaanbaatar is portrayed as the prevalent reason for marriage.

Figure 4. The title of this humorous poster shared on Facebook in 2019 and on Twitter in 2020 reads ‘There are several ways to divide and classify Mongolia’, with subtitles ‘Religion’, ‘Dialect’, ‘When getting

103 married…’ and ‘In summertime’. The ‘When getting married…’ section (bottom left) provides the following options from top down: ‘“Marry me” or bride kidnapping’ (Kazakh); ‘“Piece together sables at your place, hunt deer…”’; ‘“Should we live together?”’; ‘“Are you from a lineage of wrestlers?”’; and lastly, corresponding to the red dot standing for Ulaanbaatar, ‘“I’m pregnant!”’. Source: Taatai Anir 2019.

Plots of womanhood

One unmarried woman under her extended family’s line of regular and intensifying questioning was Saraa, who had grown up in Ulaanbaatar. She was in her mid-twenties; realising that her time as a single person was almost up, options needed to be weighed. In late spring Saraa moved to the ger district into a small wooden house in a hashaa (literally ‘fence’) – a plot of land surrounded and separated from others by a high fence – owned by her parents. Her family had moved to an apartment building a while ago when she was still a child. After that, her brother’s family had stayed there, but they had also moved, leaving it uninhabited. Summers in general allowed much more freedom for everyone, not least due to the liberation of movement: setting up a camp or staying at someone’s place required little effort, if any. My unmarried friends could stay with their siblings’ families, friends or even on their own if such rare opportunities arose. The fact that everything slowed down in the city and many went on their short annual holidays, as well as that practicalities like getting the water and heating did not require equal efforts compared to the cold seasons, made summers stand for freedom and relief from the city. The road to the Ulaanbaatar-adjacent Gorhi-Terelj national park tended to be congested and the Tuul riverside some 50 kilometres upstream from the city reminded one more of an international outdoors festival site rather than unorganised holidaying in a country with the world’s lowest population density. Only the fact that there was no other organised activity besides relaxing in the company of one’s family or friends indicated that this might not be the case. Summers in and around the city

104 were a cause for celebration, because as everyone knew, it was not going to last long (the many Mongolian celebrations were responsible for unwanted pregnancies, joked Tömör in Chapter 5; autumns came with a wave of abortions as people returned to Ulaanbaatar, noted a gynaecologist). Some weeks after living alone and feeling a bit uneasy with the lack of people around her, Saraa saw an advertisement at the nearby bus stop placed by a young couple looking for a plot for their ger. Soon Hulan, who was six months pregnant with her first child, and her husband put up their ger in Saraa’s hashaa. The area was very central with a bus stop some ten minutes away, but was walkable to the centre, so much so that apartment blocks and business developments were rapidly eating away at the district’s edges. By the time winter arrived and Hulan’s family had grown by the addition of a baby girl, Saraa was too accustomed to her living arrangement to relocate to the apartment block with her parents. Because of this intermediary stage in her life, which was due to end either through her finding a partner or leaving the country, Saraa saw this as a temporary and convenient place to live. Furthermore, the plot’s location not too far from sites already sold for construction69 meant it was only a question of time before her parents would sell it. Not everyone saw ger districts as such, of course, in line with what has been discussed above. Referring to the public transport and dirt in the streets in particular, a woman in her sixties told me that in her view, all of the recent migrants, those populating ger districts without steady jobs, should be sent back to where they came from or to places where there were work prospects available. During the socialist state-managed labour force, diaspora was part of the everyday politics, career and kinship of

69 Prior to 1992, it was not possible to own land in Mongolia (Anderson and Anderson LLP 2016). After the Land Law came into force in 1994, with revisions in the early 2000s, each Mongolian was entitled to 0.07 hectares in the capital, 0.35 in aimag or province centres and up to 0.5 hectares in the soum or rural administrative unit centres. (World Bank 2015a: 23). The arrangement was a type of free-of-charge lease from the state for a term of up to 60 years, although this still carries a sense of permanence, particularly in the sub- and peri-urban areas surrounding Ulaanbaatar, due to the high prices at which such land plots can be sold (Plueckhahn and Bayartsetseg 2018). 105 belonging and separation. And within a year between 1965-1966, around 1500 families (totalling 5000 people) without authorisation or a valid enough reason to be in the capital were expelled from Ulaanbaatar, but people kept coming (Bawden 1968: 408). There was also the fact that the year of this exchange, 2017, had arrived with new regulations halting registrations to Ulaanbaatar, initially until the beginning of 2018 (General Authority for State Registration 2017). In September 2017 this was extended until the beginning of 2020 (Government of Mongolia 2017; Ulaanbaatar City Mayor’s Office 2017). Healthcare and being able to participate in elections were the main reasons why Hulan wanted to register in Ulaanbaatar and she was waiting for the halt to come to an end; however, it was extended instead. The decree was focused on migrants from the countryside, with a number of exceptions, such as those relocating to Ulaanbaatar for medical assistance or those buying and therefore owning a flat in the city (Government of Mongolia 2017). Hulan and her partner also put up their ger on an existing plot in one of the central districts, and when it came to physical infrastructure, they simply pulled an overhead wire of some five metres from their landlady Saraa’s fuse box. Talking about settling in Ulaanbaatar, Hulan said she was no longer getting lost and always knew where she was. It was the social infrastructures, or rather the lack of them, that made Ulaanbaatar challenging for her, and as our discussions on the matter revealed, made her uncertain of where she stood when it came to (health)care. These concerns were not limited to the bureaucratic.

Spaces of care and their lack

For Hulan, being unregistered was not supposed to impact her healthcare during pregnancy and her maternity benefits de jure, but in effect it contributed to the overall precarity of the state healthcare also experienced by those native to the city. First of all, as Hulan did not have a registration in any of the districts in the city, she was unsure of which family clinic to visit to get directed to a district clinic. Primary healthcare

106 is provided by family clinics (örhiin emneleg) on the sub-district (horoo) level providing minor check-ups, medical advice and referring patients to secondary or tertiary facilities. Secondary level includes district (düüreg) facilities providing specialised care; and at the tertiary level, or the state level (uls), there are specialised centres, which all are located in Ulaanbaatar. Accessing state healthcare requires a filled-out insurance notebook and the payment of health insurance, both of which Hulan had completed.70 Like most of my interlocutors in their twenties and thirties, Hulan had no experience visiting a gynaecologist prior to her pregnancy. Hiding her pregnancy at first, and unsure of which clinic to visit without registration, she ended up going to the doctor five months into her pregnancy. She paid a small sum of money to an acquaintance (tanidag hün), a shared contact with the family doctor, to mitigate the anticipated anger at her late visit71. To her relief, the family doctor did not scold her. Although the doctor who assigned the time slot at the district clinic was ‘a little stressed out’ and angry, the visit went well overall, she thought. She saw a doctor for internal medicine twice, arranged a heart ultrasound and also visited the gynaecologist-obstetrician. The latter sent her to get necessary tests at a private clinic because she had come to the appointment late in her term and the queues at the state clinic were too long, meaning there was a wait of a few days to get the tests done. The tests at the private clinic, however, cost Hulan around 80,000 tugrik72: this, it must be pointed out, was a rather large amount of money73. The tests indeed tended to take a while as a young mother in her early twenties, also from the countryside, told me: she had spent almost a week in clinics during her pregnancy, mostly waiting, to complete the

70 I turn to look at the healthcare system, privatisation processes and the work of doctors in Chapter 6. 71 The first check during pregnancy should take place within the first twelve weeks, which is just under three months. 72 Equivalent to around 28 euros; all of the conversions hereafter are also based on the currency rates of the exact month when I was told about these prices, costs or salaries. 73 See Chapter 6 for the collapses of the private and public in healthcare and privatisation as a state of healthcare, often located in public institutions through reference systems similar to what Hulan describes. 107 check-up. She announced with obvious relief and satisfaction that her sister was a paediatrician: she now had swift and stress-free access to advice and assistance whenever needed. Here, medical interactions have clear parallels to what has previously been discussed as part of the studies of bureaucracy: time and timing can in themselves suggest an unequal power relation, particularly due to the lack of interest in whether the client’s, or in this case the patient’s, time is wasted (Hertzfeld 1993: 163). Hulan thought the gynaecologist was not too committed, carrying out the examination without an ultrasound and prescribing her the necessary vitamins that she now was taking. She later got a 2D ultrasound, which was unable to determine the sex of the baby. Seven months into her pregnancy, Hulan received a monthly benefit of 40,000 tugrik from the state, which she collected from the social insurance office without any complications and used to purchase her pricey pregnancy vitamins74. She said that the vitamins were sometimes provided by the family clinic for free in accordance with the registration, although there were small amounts available and doctors tended to give them to their own connections. Overall, the pathways in healthcare and tests are extremely flexible: it tends to be up to the doctor to send the patient to get the necessary tests from private clinics. As a result, one visit tends to expand into various steps that need to be taken, many of which involve additional costs. Meanwhile, for Hulan, her appointment with the doctor at the state clinic did not involve a consultation or advice as part of the service, and it was rather unheard of for young women to think of gynaecologists as experts who could provide a consultation without addressing a particular health concern or issue at hand. She went on to explain that this kind of knowledge was not provided at the clinics and hospitals, although it depended on the doctor’s personality: ‘If it’s a nice doctor it is possible to get all kinds of advice from her.’ As she acknowledged, doctors needed to see patients within fifteen minutes, and if it got crowded, as it often did, there was no chance of such exchanges at all. When I asked her where she gathered information about becoming a mother, she said she relied on the

74 Elevit costing 30,000 tugrik and iron supplements costing 80,000 tugrik: equivalent to around 39 euros. 108 internet and her older female relatives, particularly her older sister. Accessing knowledge and care, similar to gam as explained above, required pre-existing relationships or the maintenance of these as knowledge is approximate to care. However, knowledge and care were not necessarily part of the medical or other services provided. Women without the necessary networks resorted to inaction or avoidance, which, like informality, did not expand horizontally across everyone’s lives in the same way and to the same degree. This could then have very real effects on health and financial costs as well as other eventualities in the future. As rumours went, women who did not get tests during their pregnancy and showed up in the district maternity unit without such paperwork were particularly vulnerable to mistreatment and sometimes physical violence, like slapping. Giving birth in the city also meant added payments like setgeliin yum, ‘a thing from the heart’, given on behalf of the family to the doctor and nurses. Such forms of payment were not only categorised as gifting, but also served to secure heightened attention and care during the birth (Chapter 6). So, although healthcare should have been free of charge for Hulan, it was not. Additionally, lurking around in clinics’ corridors and examination rooms potentially meant the danger of not only not being paid sufficient attention, but also of experiencing someone’s anger, which Hulan considered before proceeding with the examination. Knowledge, on the other hand, was part of the care which resisted medicalisation and the baseline state healthcare services that Hulan, as a young pregnant woman, was not entitled to through her health insurance. Given Hulan’s situation with her partner’s family, the changes to her body and the care forthcoming, as well as the broader system of Ulaanbaatar’s healthcare system that remained precarious for her, she gave birth in her nutag or homeland within Mongolia. These conditions also meant that her own family took care of her prior to, during and for a month following the birth, although her partner went to visit too. Upon Hulan’s return to Ulaanbaatar, her pre-birth condition of relative loneliness continued, although now with a baby, who she often left in Saraa’s care in the evenings when her landlady had returned from her new job in order to run errands and do her shopping. I now turn to look at

109 secondary childcare, which is a continuous concern for mothers of young children, in relation to both state and kinship. Pamela Feldman-Savelsberg (2015) has noted that ‘in addition to kin, community associations and government institutions offer their own versions of care – as well as social control – to mothers and children’, and that ‘these flows of care embed mothers in overlapping fields of social relationships’. For Hulan, becoming a mother in Ulaanbaatar not only meant operating through the thinning of ‘social worlds’ for a range of reasons – related to her partner, his family and bureaucratic belonging to the city – but also continued reliance on her own family across the rural- urban axis. Rather than a ‘family-model-breakdown’, it becomes apparent that at moments of lack, young women turn to their own families for assistance and care. When Hulan’s daughter was around one year old, they started staying with her older female relative, who had recently bought a flat in Ulaanbaatar. The maternal grandmother to Hulan’s baby was not actively part of their life. While Hulan was glad to be a mother, her pregnancy and first year of motherhood had been somewhat precarious, and potentially precarity- inducing unless she was able to secure childcare to proceed with her degree or find a job, a concern somewhat in dialogue with what has appeared in this chapter as her partner’s absence. At the intersections of the city, the state, care and kinship, parenthood may be desired and at the same time potentially vulnerabilising, as education, establishing income opportunities and a career often collide temporally with the life stage when it is expected and desired that a woman will become a mother (also see Odontuya 2015: 44-46). The right and need to receive care as shaping relatedness has been studied as arising from care for the ‘vulnerable’, for children (Carsten 1991), the elderly (Buch 2015), reciprocally both children and the elderly (Coe 2012; Stafford 2000) or in cases of illness. Parenthood also involves direct and indirect aspects of care that are needed on behalf of the mother, some of which, like gam, have been touched upon in this section. The following will focus on the indirect aspects of care, or rather the processes and reflections behind seeking forms of secondary care for children by their mother. In this section this topic was mainly viewed through the

110 shortcomings of the healthcare system, but it was also noted that without additional caregivers, being a mother to a young child can be quite alienating and limiting when it comes to activities and opportunities outside the home.

Motherhoods of secondary care

Rather than solely a matter of ‘domestic’ or kin relations, tracing care indicates how it ‘connects its recipients and its providers and crosses private and institutionalized settings’, bringing ‘together individuals, relatives, working relations, communal services, societies, policies, and nation-states’ (Drotbohm and Alber 2015: 14) – as well as the ways it divides them. Through the study of motherhood and womanhood in today’s Ulaanbaatar, I call for greater attention in depth and scope to how care in its plural and overlapping forms has been and is being shaped. This is an important aspect of governance at the intersections of parenthood, kin relations, the state, the city, international policy and bureaucracy. In her study of tracing alternative food provisioning practices, Agnese Bankovska (2020) reveals the gendered forms of invisible, routine and often unappreciated care in Latvia, such as cleaning and dishwashing. In many ways, the seeking of secondary care in Ulaanbaatar is similar for these elements of motherhood often go unnoticed to those not directly involved in these proceedings: while spending time with children and providing them with affection and primary forms of care are acknowledged as constituting motherhood, encounters with bureaucratic and welfare forms of the state and other services tend not to be, although they can be extremely time-consuming and financially costly. Additionally, these activities as part of motherhood also create gendered forms of citizenship and encounters with the state as plural, such as bureaucracy and welfare, and as a questionably sovereign and adequate form of governance. On one of the late summer days, I met with Tsetsee, who at the time was assigned by the traditional medicine institution I was affiliated with to give me lessons on traditional medicine to reciprocate for the English-

111 language classes I was teaching to the staff there. Tsetsee was a mother of three in her late twenties who moved to Ulaanbaatar for education; like many other young women, she became pregnant during the first year of her university degree. Our meeting was supposed to cover the preconditions of conception ‘theory’, but both of us felt somewhat uninspired to tackle the topic at hand. After some failed attempts, the conversation naturally shifted towards the ‘hot’ agenda of the time, something that at the brink of a new school year was on the minds of most mothers of young children that I knew: how to secure a kindergarten spot for the coming academic year. In particular, it was the kindergarten ‘lottery’ that took over the chats and gatherings I had with my friends, which included enquiries as to whether one was successful in this, particularly as some of our shared connections happened to have been lucky in this year’s horoo or sub-district draw. Our mutual friend had recently received a text message from the sub-district about having secured a spot in the kindergarten through the random selection that was carried out for the few state spots. The actual ‘randomness’ of this was under speculation. Perhaps there was some string-pulling involved that those unfortunate in the allocation of a kindergarten spot had not anticipated and had therefore missed out on? Getting a kindergarten spot at all was by no means a straightforward endeavour. In autumn 2017 Tsetsee’s two children were going to a kindergarten in central Ulaanbaatar, and as one of them was already attending, it was easier for her to approach the issue of secondary care for her youngest child. She knew the teacher at the kindergarten, who advised her to pay 650,000 tugrik75 to the headmaster of the kindergarten; as a thank-you for this tip on how to proceed in the matter, she paid around 100,000 tugrik76 to the teacher. Tsetsee addressed this money as avilgal or bribery. The class her children attended should have had 25 children, but in fact it had 70 for the non-state-allocated additions to the headcount. Tsetsee continued to estimate that in the sub-district where she lived, there were around 200 kindergarten-aged children, which meant that only one

75 Around 225 euros. 76 Around 35 euros. 112 in three could attend a state facility, which according to her was crowded and the teachers paid little attention to child development. Worse still, the parents of some 130 children had to find alternative solutions for childcare if they did not want to stay at home themselves. This was an important matter for Tsetsee: since giving birth to her first child eight years ago, who was now attending school, she had been able to finish her Bachelor’s degree and secure a job. But this was not the end of the costs that Tsetsee had to consider. She estimated the cost of a child at a state public school annually came to around 800,00077 tugrik, which was equivalent to her monthly salary. Education demanded rather extensive out-of-pocket payments from parents, including in the public schools. There were constant monetary collections for this or that, like the kettle in the classroom. Cleaning tasks were usually outsourced to the students, but some of the public-school cleaners’ salaries were also collected from the students, who regularly updated their parents on the sums of cash needed, which Tsetsee found rather frustrating. She added that those children whose parents could not afford to pay were treated poorly and sometimes dropped out eventually. During my brief two-semester career at a half-private high school in Ulaanbaatar in the years preceding this project, I often thought that the work undertaken by myself and my Mongolian colleagues resembled subsidised entrepreneurship (the kind where people do not surface with surplus): although we were paid by the school, the work of the teacher involved much more than preparing for class, teaching and evaluating students’ progress. The teachers had to find relevant teaching materials (depending on the subject and the situation regarding educational reform and the particular textbooks available), print these materials privately and provide one’s own technologies like a CD player, not to mention various markers or whatever else was needed to carry out even the minimal tasks at school. The teachers used Facebook to seek and buy textbooks. Besides managing these extended teaching-related tasks, they also balanced extensive reporting to various superiors as well as managing the student body: for example, by planning and supervising cleaning activities. The

77 Around 286 euros. 113 teachers’ salary seemed to buy all these services rather than pay for what the position of ‘teacher’ meant on paper78. Tsetsee added that education cost a lot because of school supplies and uniforms, estimating that these totalled 1 million tugrik79 in her family for all three children, breaking down the individual prices for all the shoes and shirts that were still needed before the academic year commenced, but also those that she had already managed to acquire. All in all, bringing up children was not cheap in Ulaanbaatar. Also, when parents could, they registered their children in areas with city-centre schools, which resulted in a confusing and shifting registration system to access education beyond where the family actually lived. As one of my friends noted, she was worried that her daughters would be bullied by the other ‘tough ger district children’ if they remained registered in the district where they lived, so they registered to live at her mother’s apartment before the eldest entered school. The expansion of the city has also meant that many of the schools are now working in two or three shifts, which had to be taken into account, especially when younger children went to school far from home and started or were released from class during working hours. Both concerning pre-school education and schooling, it mattered where the child’s grandparents lived and what kind of relationships their parents, particularly their mother, had with them. With the lack of kindergarten spots, women needed to stay at home if their parents or in- laws were unable to carry out babysitting duties, because private kindergartens remained too pricey for the women with whom I discussed this matter, who mostly belonged to lower or middle-income groups. It was not rare for children to live with grandparents for extended periods of time. However, for those who had moved to the city and were the first generation, it was likely that there was no grandmother with whom to leave the children, which was currently the case for both Hulan and Tsetsee. In one instance, a young woman, who had two pre-school-aged children and had pursued higher education and a previous career in her

78 This is similar to developments in the work of the ‘doctor’ in Chapter 6. 79 Around 350 euros. 114 field of study, had been pressured by her husband and his relatives to stay at home to take care of their and his siblings’ children. She came from the countryside, both of her parents were deceased, and as time passed, it became increasingly unlikely that she would be able to return to her field of expertise, although she wished to do so. While women wanted to be mothers, they often also desired a professional outlet and a life outside the home, not to mention that it was often their salaries that remained a stable source of income for the family. The state and its institutions here appear as people – for instance, the kindergarten teacher or the headmaster. There is little else behind the bureaucracy and networks to be found in these infrastructures and institutions, although the accounts of securing a ‘state’ price-capped kindergarten spots were seriouesly discussed and shared between mothers to whom these manifested a puzzling occurrence. Another take-away is that bringing up children is not cheap in Ulaanbaatar. Calculating, negotiating and covering these costs is part of motherhood, and it created encounters with the bureaucratic, unknowable and informal, with at times rather extensive and emotionally charged verbalised reflexivity on the matter. Fathers do not necessarily encounter the ‘state’ in the same ways, for such tasks generally are carried out by women.

Child benefits, structural adjustment and ‘populist politics’

The Mongolian child money programme was established in 2005, and the women I knew thought of these payments as important to mostly spend on the most urgent things that their children or family needed. In their analysis of the general elections in June 2004 and the hung parliament that followed, Anthony Hodges et al. (2007) identified the establishment of the child money programme in Mongolia as feeding ‘populist politics’. The child support benefits have been an area of continuous ‘reform’ (see Figure 5)

115

Figure 5. Since the establishment of child benefits in 2005 up until the end of 2016 – that is, within eleven years – there have been eight revisions to the amount of money available and the conditions attached. Adapted from: Tsogtbaatar 2019.

A mother of three, Zaya, explained to me in May 2017 how childcare social funds had become a ground for political meddling, again as part of a discussion on a different topic that became sidetracked and then passionately heated. In this process of meddling, as Zaya described it, each sub-district had developed a list of families according to salaries, cars, property and other forms of wealth like electronics. There were 22 categories for families, category one being for the lowest income. Zaya’s family had been located in category nineteen, although, according to her, it was simply that she and her husband both had an average income. At the time, only families who were scored between categories one and seven received a monthly children’s benefit worth 20,000 tugrik80 per child. All families between categories eight to 22 were to get the full amount of child benefits collected over three years in one forthcoming payment, when the economy was estimated to have improved, as Zaya explained. This, according to her, was due to be in 2020, not coincidentally just prior

80 Around 7.5 euros. 116 to the next parliamentary elections. Calculating again, she noted that for three children, this would indeed be a huge amount of money suddenly released by the government led by the Mongolian People’s Party (MPP). Zaya wondered how many other families would cope as there were some fifteen categories between hers and those who received their child benefits monthly. Her message was clear as she laid it out with some contempt: the government of the MPP was meddling with something as important as child benefits in shameless ways in their attempts to double what the money could do and to pay for a desired election outcome. Zaya told me about the child benefits in May 2017, just around the time when the International Monetary Fund (IMF) had approved a bailout for Mongolia, which was requested back in 2016. What she described was a proxy means test (PMT), which was to estimate the family’s need for the benefit. In 2017 60% of children got money from the government every month (Jargalsaikhan 2017). This test was called for by the IMF and the World Bank bailout to reorganise social benefits in the institutions’ attempts to reduce poverty. On the international developmental organisation level, however, the government of Mongolia had been recognised for its efforts towards providing universal child benefits (Development Pathways 2015), and later as having lost the universal system due to the pressuring of the IMF in order to release the bailout loans (Development Pathways 2018). James Pfeiffer and Rachel Chapman (2010: 150) define structural adjustment programmes (SAPs) as ‘the practical tools used by international financial institutions (IFIs) such as the International Monetary Fund (IMF) and the World Bank at country level to promote market fundamentalism that constitutes the core of neoliberalism’. This has been much at the heart of the reform and and the long process of becoming a functional capitalist state after democratisation in the 1990s. Privatisation was placed at the centre of the economic reform and was supported by international organisations such as the World Bank. Much of this reform is ongoing in its specificity, like the privatisation processes in healthcare. In February 2017, the IMF presented its conditions for the loan, which included the 2017 state budget revision. The IMF’s main

117 conditions included reforming the banking system and for the government to proceed with the 2017 budget revision, which included other spending cuts, tax rises (of fuel, alcohol and tobacco), an increase in the social insurance tax and a gradual increase in the retirement age for women to 65 (Jargalsaihan 2017). Under the IMF social protection category, it states that:

The program includes important safeguards to protect the vulnerable groups, and gives priority to health and education. For instance, the savings from better targeting the Child Money Program will be used entirely to increase spending on the food stamp program for the most vulnerable. (IMF 2017)

In 2017 the IMF required a reduction of budget allocation for child money to 40% from 60%, and for 20% of this budget to be spent on food coupons for very poor families. The food stamp programme was established on the initiative of the Asian Development Bank in 2008 and the current 2017 bailout has a strong focus on this (Asian Development Bank 2016). The bailout was eventually approved at the end of May 2017, exactly at the time when Zaya was telling me about the inadequate reform of the child benefits that she attributed to the MPP’s election meddling. Meanwhile, the Democratic Party had been particularly vocal about opposing the measures required by the IMF. The bailout programme had lagged due to the lack of approval from the Parliament. But the IMF was not alone in this rescue package: other financing partners included the Asian Development Bank, the World Bank, Japan, Korea and the People’s Bank of China (IMF 2017). Part of the package was the World Bank’s 120 million US dollars, which came through at the end of 2017 and focused particularly on the social protection system. In the World Bank (2017) programme document of the loan, it clearly drew links between the child money programme, elections and populist politics:

118 Prior to the second round of voting in the presidential elections in 2017, the Government pledged to make the CMP universal, retroactive to the beginning of the year. From 2018, however, the CMP will return to a targeted program available only to the poorest 60 percent of households based on the PMT, as called for in the Government’s agreements with other development partners, and as reflected in the 2018 draft budget. (World Bank 2017: 27)

The Committee for the Abolition of Illegitimate Debt has pointed out that ‘at the heart of the IMF’s and the World Bank’s approach is the belief that ‘poverty targeting can be undertaken successfully’ (Committee for the Abolition of Illegitimate Debt 2018). While substantial research is not yet available on the topic, existing studies have not found that the structural adjustment has led to a decrease in poverty (Committee for the Abolition of Illegitimate Debt 2018; Hodges et al. 2007). Furthermore, the reform of the system requires a huge amount of work by officials that perhaps could have been put to better use concerning temporal, financial and intellectual resources. While in international and local liberal circles, universal child money programme implementation in Mongolia has been labelled ‘populist’, it has also been shown that it is one of the measures that has actual effects on school enrolment and reaches the poorest families (Hodges et al. 2007). While I encountered many claims either directed towards certain politicians or policies, what stood out overall was not only the gap between the reform and its enforcement, but also the degree to which all these emerging and reversible reforms created confusion, openings for different interpretations of enforcement and a consequent lack of accountability. For example, in May 2019, it was revealed that everyone who applies for the child benefits will receive them, and that from the total number of children, the parents of 85% had expressed the wish to receive the benefits. However, as of this moment, a friend of mine, a single mother of two who applied, was half a year later still undergoing the evaluation process. It is unclear how many children are de facto paid the

119 child benefits and what percentage of that 85% are still under evaluation, for what reasons and for how long. Another woman, a mother of a two- year-old, does receive the 20,000 tugrik monthly benefit and a new mother’s salary of 50,000 tugrik81, which is granted to mothers of children below the age of three. For mothers who already need to navigate complex social networks and bureaucratic structures in Ulaanbaatar as part of parenthood, child benefits are another area of precarity and speculation. This uncertainty often is related to how the government and the main political parties are seen. They both call on and produce knowledge of politics in Mongolia, if not internationally. At the time, for both Tsetsee and Zaya, and many other women and mothers, being a parent involved rather critical and extensive reflection on the contexts in which their daily lives unfolded. Without calling into question their love for and commitment to their children, which I thought was immense, I suggest that being a mother in Ulaanbaatar means engagement with the state (bureaucratic, governmental and welfare) or its various representatives, but also with broader macro-politics, like elections, in gendered ways. These aspects of parenting tended to be part of motherhood, rather than being shared between the parents equally. These experiences can be hugely exhausting and at times disappointing, but they also create connections and knowledge that were not there before such encounters took place. And many of these encounters occur only once a woman has become a mother to children. Graeber (2015a: 3-4) observed that in the mid-1970s the use of the word ‘bureaucracy’ started to decrease in ‘our’ vocabularies in books written in English, because ‘we’ simply got used to it, but also that this trend did not apply to the less financially secure for even longer proportions of their day were spent seeking social services. This decrease was also not present in a second area: the middle-class engagement with the internet. The case of Mongolian mothers’ experiences seeking child benefits for their children brings together these two aspects now that applying for these funds has been taken online. Similar to the case of the

81 Around 18 euros. 120 US, the meaning of ‘democracy’ has been attached to the ‘market’ (Chapter 2), but unlike in the case of the US, ‘bureaucracy’ seems often to fall short in its meaning when used to refer to the (state) government’s interference with the market (Graeber 2015a: 11), because the state is subject to international financial governmental programmes.

Conclusion

Drawing on very different examples, the chapter has reviewed the forms of care a pregnant woman or a young mother may require. The lack of care is apparent in the state healthcare system, where it needs to be negotiated or where care does not necessarily appear as part of the service at all. Reproduction and reproductive health do not only involve care to the body or human life as has been seen to constitute the governance of biomedical healthcare, owing to Foucauldian approaches (I will continute this line of analysis in Chapter 6 by further exploring the beyond- biological governmental forms of ‘healthcare’). Nor is care for one’s children limited to child-parent and affective forms of care, but also involves the considerations and practicalities of securing (preferably trustworthy and quality) secondary care, so that children can enrol in and attend a kindergarten or a school, or so that young children can be taken care of by their grandparents. This seeking of secondary care puts mothers into encounters with kin relations that are to be established or maintained, but also with state services, institutions and bureaucracies. For both kin relations and the state welfare system, there can be expectations of care that are not met. Therefore, care that is secured tends not to be taken for granted; instead, it is reflected upon, often with some dissatisfaction, owing to the difference between what the state should be and do and how it actually appears in people’s lives. With the example of the child money programme in particular, it becomes apparent that state involvement and support are expected and underscores the degree to which these engagements with the state involve international and transnational governance. Again, this creates gendered subjectivities and critique that

121 can be scaled towards certain political entities and the current Mongolian state as a whole. In the case of post-socialist East Central European discourse, Susan Gal and Gail Kligman (2000: 68-69) point out that because family is viewed as an ‘authentic’, more constant and stable location, change is somewhat easier for women for their inherently stronger link to this ‘private sphere’. Men, in this discourse, being more linked to the ‘public’, experience a more rapid and turbulent change (Gal and Kligman 2000: 68-69). While in the previous chapters I indicated how being a woman was inherently linked to motherhood, here being a mother does something completely different: motherhood becomes the motor for gendered political subjectivity. However, I refrain from viewing it as necessarily individualising, creative or empowering, but instead emphasise that motherhood in today’s Ulaanbaatar can be vulnerabilising and insecurity- inducing. The approximate age when many women become mothers, and are expected to do so, overlaps with the time when they are expected to finish their studies, find a job and secure it. Working is not only a means of financial independence, but also is often the only stable income for the family. There tends to be more jobs for women, both because work in the service sector is often considered unsuitable for men and because international organisations and companies find women more suitable, reliable and, due to educational disparities, often more qualified for the jobs (Kuo 2018). Meanwhile, for the men I discussed the matter with, like the often highly educated taxi drivers or my friends’ husbands, there were other considerations that equally inspired reflection on electoral politics and the position and responsibilities of the state, concentrating on the lack of jobs and the desire to have stable employment opportunities in or adjacent to the city, like the factories during socialism82. While for both men and women there was an absence of the state either through services or its enabling effects, for women the state often manifested itself as an excess of bureaucracy and various relations that needed to be maintained and negotiated, like the ones with the employees of the kindergarten.83

82 See also Valdur 2016. 83 The ways in which (in)formality is not experienced as flattened across genders and economic means will be the topic of study in Chapter 7. 122 Similar to relations involving family members or their absence, such forms of subjectivity in Ulaanbaatar tend not to be individualising. Furthermore, it is not only state ‘institutions’, such as the medical and the educational, that were experienced as lacking; it is also relevant that ‘life’ and forms of care became directed by transnational financialisation and bailout programmes as part of structural adjustment. In other words, within these global governance systems there has been a shift from the state managing the ‘life’ of its populations – which has been much at the core of the biopolitical approach to governance albeit beyond ‘the state’ as such – towards management of spreadsheets and budgets to comply with set standards. Talking about her pregnancy, Hulan noted that she did not have knowledge on how to avoid getting pregnant nor had she been to a gynaecologist prior to her pregnancy. The following chapter examines why this may have been the case for her and many others, with a focus on the current situation of first encounters with reproductive healthcare as well as on sex education and knowledge as arising at the crossroads of kinship, the state and entrepreneurship in heavily generational and gendered forms.

123 Chapter 5. Contraceptive Knowledge: Making Sexuality for YouTube

People with pseudonyms in this chapter

Sarnai A woman in her late twenties, the head of the young professionals’ club, the video initiator and process leader Tömör A man in his mid-twenties, the most active discussion participant Names ending with a vowel Female participant Names ending with a consonant Male participant

The beginning

Sarnai’s husband Od and I were sitting by a low table in Sarnai’s parents’ living room chopping beef into mince-like tiny cubes. My fingers had gone numb since the meat was almost frozen but not enough to stop wobbling around and sticking to the knife as I rather pathetically tried to contribute towards making the filling for the dumplings, buuz, ahead of the Tsagaan Sar, or the Lunar New Year celebration, which was a few weeks away. Sarnai and Od, a rather trendy couple in their late twenties, were the owners of a marketing company that had recently outgrown its start-up status and based its approach on the explanatory storytelling method. I was staying with Sarnai’s family in the ger district, and I knew the couple through Sarnai’s sister and family. I had met Sarnai and Od on several occasions, but we had not yet properly gotten to know each other, though this was changing because I had temporarily acquired adopted daughter status with Sarnai’s parents. As we bonded over our chopping techniques, Od suggested we adopt a method he had come across watching a TEDx video and was now applying to his work in the office: the simple optimisation of some twenty minutes of work followed by five minutes of rest. Presumably Od sensed

124 that I was not sold on the idea and he reached for his phone to find the video he was referring to. For the next few minutes we chopped in silence, the phone lying between the piles of chopped and unchopped meat, with its screen adjusted to the angle of my face. I spent our first break going to the toilet, but I skipped the next ones as I thought myself to be a very busy and serious meat-chopper. Sarnai and Od visited Sarnai’s family again on the second day of Tsagaan Sar. That day we were all shamelessly tired, because we – that is, Sarnai’s younger sister, a relative who was staying with us and I – had made another batch of buuz the night before. Since there were no other guests at that moment, we were lounging on the couch around the table. Sarnai and Od told me about their plan to potentially shift the funding model of their company and try to make a viral video, for which a foreigner’s expertise and opinion (mine) was very welcome. Some months before in the field, I had spent my many idle hours and days watching YouTube videos, mainly on the Buzzfeed channel, so I felt I may have acquired some expertise. Not long after this, we gathered at the co-working hub in a tower that sprung up in the smog on the northern edge of the ger district: a building I was familiar with due to another organisation that had offices a few floors down. That day, and in the next meeting too, there were a number of ideas and even arguments: was it possible to intentionally make a viral video? What was the purpose of the video? To what degree was this to be for ‘societal benefit’? What was its relevance concerning the funding model of the company? Was this to be part of a new channel or a playlist of similar videos? The core team was the same as our buuz- making line, with a few exceptions: namely, the addition of Sarnai and Od’s company’s employees and the absence of Sarnai’s parents. The first stage involved finding an answer to some of the above questions, but the group was rather in disagreement about this. Sarnai maintained that the video should have a societal benefit and should potentially bring funding to the company; Od thought we should make an internationally viral video. I did not mind either option, but I thought we could not necessarily achieve everything at once, and I acknowledged that, concerning my fieldwork, a focus on some reproductive topic along

125 the lines that Sarnai was thinking would indeed be of interest to me. Later we brainstormed around 50 ideas, with ‘How Not to Get Pregnant?’ taking the top place of proposals through a vote of smiley-face stickers, and ‘How to Poop?’ following as a close second. Sarnai explained that various organisations had ordered animations on the topic of reproductive health from the company before, so they had prior insight into how to approach the matter and useful contacts. It was badly needed knowledge in Mongolia, Sarnai concluded, and she decided that she would make the video with the involvement of her young professionals’ club, a branch of an international clubs’ network, of which she was the president. This chapter is based on a sex education and contraceptive advocation YouTube video-making process, which was initiated at a family event, not because discussing the thematic knowledge of reproductive issues and health inherently belongs to such spaces, but rather because it initially seemed to us as a sort of cross-boundary, potentially societally beneficial business venture. While neither of Sarnai’s younger teenage brothers had a smartphone, and there was no data for internet access on mine, all my twenty-something connections belonging to middle-income groups tended to have one and actively used it, although occasionally there were extended gaps in use when the phone broke down or was stolen.

The video-making process

What followed were a few months of planning and numerous meetings to push forward with the video. After the topic of the video had been decided, somewhere in the mid-to-early stages Sarnai involved the young professionals’ club’s members, upon which most of the following description of events and discussion is based. At this meeting we discussed the necessary knowledge, what would be the most useful format for the video, what it should include and to whom it should be targeted. The first half of the meeting involved a general discussion on knowledge – personal, second-hand and ‘societal’ – as well as what aspects of these

126 the video should address. It was agreed that the video was meant for those aged between sixteen and 30-35. On that day, after the general discussion, each of us presented a storyboard, which is a comic-book-style, scene-by-scene version of the video as each of us saw it. One by one we stood up and, at times with some discomfort, talked others through ours. The storyboards varied hugely and addressed numerous anxieties and angles regarding the topic. They suggested particular scenes where these became apparent, rather than proposing a list of information to be communicated to the audience. The discussion itself took the form of a talk between friends who were familiar with one another, although most stories and vignettes based on real events – which were much at the core of knowledge about reproductive issues as discussed in informal settings overall – were second-hand, focusing on situations that someone’s acquaintance had experienced, informative, sometimes cautionary and humorous all at once. In other instances, the occasion was seen as an appropriate social situation for learning about the topic: for example, when Bayar sought to confirm whether women’s bodies ache less during menstrual periods after having lost one’s virginity, to which the women gave a few vague answers before changing the subject back to the topic of the potential takeaways from the video that was under discussion at that moment. The people involved were young professionals who were mostly in their mid-twenties with a few exceptions. Some of them were parents and some not; some of them were brought up in Ulaanbaatar, while others had come to the city to study and stayed. They were not in any way part of the high-income groups or the elite; instead, they came from average or below average financial backgrounds, yet were committed to their career and ‘improving themselves’ through various means, such as belonging to the club. Only one of the young men was still a student; others had advanced to positions in various professions, such as translators or business managers. They had all received higher education. They came together to undertake various ‘societally useful’ projects, to share contacts and experiences, to spend free time together and improve their social networks that were so crucial in Ulaanbaatar to getting things done and accessing

127 trustworthy information. The video essentially became possible because of the friendship and trust present within the group, Sarnai’s advocacy within it as well as her determination and willingness to contribute the working hours of the employees of her company for free to actually produce the video. After the meeting on which much of this chapter is based, there were further gatherings to finalise the actual outline of the video. We also met with several of the young professionals’ club’s members to photograph the scene-by-scene action as they took on the roles of the actors for the actual video. Following this, there were the actual design, animation and content meetings as the video was being produced. Drawing on Laura Bear et al. (2015), the chapter goes on to argue that this process ‘of production, distribution, and consumption’ is a conversion of ‘diverse life practices, relations, experiences, and contexts—shaped by kinship, charisma, sentiment, status, race, gender, class, nation, etc.’ into the end result of the video, but also the creation of knowledge of sexuality beyond it.

Failures without the state

Reproduction and sexuality

There has been a wealth of studies on reproduction and sexuality as part of the anthropological literature. Bronislaw Malinowski (1929) produced one of the first extensive ethnographic attempts to approach the topic, covering ‘procreating’, ‘lovemaking’ and ‘erotic life’, along with other topics, in his Sexual Lives of Savages. The academic discussions involving sexuality in the mid-twentieth century indeed are indebted to two major lines of thought. The first makes sense of sexuality through psychoanalysis, drawing on the theorisations of Sigmund Freud and others (Mead 1928) that have reemerged in attempts to engage with the affect of love and sexuality (Mazzarella 2009: 297). The second prevalent approach to sexuality has been the rise of a discourse that could be forced under the rights and personhood umbrella, growing out the existentialist

128 tradition (de Beauvoir 1953), which has contributed to myriad approaches that contest heteronormativity but have also moved on to point to the ‘Western’ biases in these approaches (Strathern 2016). However, the fact that sex might be missing from studies of sexuality has long been addressed and is even somewhat characteristic of anthropological approaches (see Ortner and Whitehead 1981: 24-25). In this chapter too, sex appears mostly as a gap, such as in the final video when it is disguised visually in a cloud of action around which there are discussions of how negotiating and using contraceptive methods are practised, talked and thought about when either sex is planned or when sex occurs with a partner without prior planning. During the discussion sex was mainly referred to as ‘have’ or ‘do’ sex (seks hiih, belgiin havitald oroh), ‘do’ (hiih) and ‘to sleep’ (untah); and pregnancy as to ‘become with child’ (hüühedtei boloh) and get pregnant (jiremsen boloh). The vocabulary used did not rely on certain aspects of the spoken language, which Amanda Roberts et al. (2005: 1492) review as a list of metaphors for vaginal sex, such as ‘fish play’, ‘to negotiate’, ‘to scrape’, ‘to get something from each other’, ‘to inflict’ and ‘the function of cloud and rain’. There are also various equivalents to the English-language verb ‘to fuck’ (e.g. shaah) that were not uttered. While ‘reproduction’ is of interest to the anthropological oeuvre for manifesting an ‘intersection of group interests, including families, households, kinship, ethnic, and religious groups, states, and international organizations’ (Dudgeon and Inhorn 2004: 1381), ‘reproduction’ or ‘procreation’ (nöhön ürjihüi) as terms, on the other hand, possess certain biological and medical connotations, not least for their English meaning of reproducing a human life. In Mongolian, the term is more associated with a multiplicity beyond the human life. ‘Sexuality’ or ‘sexual life’ (belgiin amidral) is a broad enough term to include contraceptives and other, often gendered or gendering, issues surrounding the use of birth control with its forms of knowledge and ignorance. Sex education in socialist Mongolia arose to respond to STIs. Having children within marriage was considered a duty towards the nation. The health of a socialist woman and her body were to be under control as important sites for population development, which was the

129 national goal (Chapter 2). Contraception was not available to most people in socialist Mongolia, and those who were able to control their pregnancies were seen as highly educated and advantaged due to having access to contraceptives (Odontuya 2015: 36). Considering ‘formal’ education concerning sexuality, in recent years Mongolian state schools’ approach to sex education has been lacking, and its occasional development has depended on the party that has held a four-year term in government with little continuity or application beyond this. There has been speculation by those who had been involved that the full sex-education programme that had been developed in the early 2010s was scrapped because of the overpopulation of schools in Ulaanbaatar, some of which work in three shifts and are not able to bear any additional curricula. In Paula Haas’s (2016: 96-98) analysis of ‘trusting the untrustworthy’ among Barga Mongols in Inner Mongolia, she shows that trust is the act of trusting, an intention and quality of the person carrying out the act rather than a quality of trustworthiness. The notion of knowing about sex and contraceptives in Ulaanbaatar is somewhat similarly equated to doing; sex education is seen in parallel ways by certain groups, for example in the US, through arguments that knowing about reproductive matters will encourage engagement in sexual activities. One of the main arguments against sex education has remained that it promotes promiscuity (see also Nayyar 2013). Access to contraceptives in Mongolia as a whole has depended on subsidies from international organisations like the United Nations Population Fund (UNFPA). This underwent a steep decrease in funding to ultimately awarding nothing as Mongolia was upgraded from lower- middle-income status to upper-middle-income, as determined by the World Bank in 2015 (World Bank 2015b). It then returned to lower- middle-income status the following year. The Mongolian Family Welfare Association (MFWA) and the UNFPA are at the core of creating educational programmes and training events for young people on the topic of sex education. The MFWA, as a male coordinator of its training events explained to me, relied on qualified ‘student experts’ leading workshops lasting one or two days. The

130 programme worked with schools in Ulaanbaatar and in wider Mongolia. There is also a network of ‘adolescent friendly’ or youth clinics being established across Mongolia, mainly linked to these two organisations. However, the ‘medical’ or clinics were not discussed as options for knowledge, education or advice84 in the video-making meetings, although the ‘girls’ examination’ (ohidiin üzleg) or ‘adolescent rooms’ came up at the very beginning of the discussion, as they often tended to do throughout my fieldwork when women in their twenties and thirties were involved in discussions about their reproductive health experiences. Unlike the youth clinics that now can be housed together with other medical services or in various NGO facilities, the ‘adolescent rooms’ manifested themselves as one-off virginity, morality and health checks in high-school classes. Young women that brought this up, or of whom I enquired about this, all agreed: it had been uncomfortable and unpleasant. These checks at schools were also portrayed in a popular Mongolian film I Love You (Bi Chamd Hairtai, 1985), where the heroine finds out that she is pregnant as part of this check. The adolescent cabinets were a remnant from the socialist programme, but had made a comeback after its collapse with the support of the World Health Organization (WHO) in the late 1990s. These ‘cabinets’, which usually involved a health worker coming to the school to perform gynaecological checks on high-school girls, resembled a morality check, and no consultation or information was provided. The health worker would check whether the girl’s hymen was intact, and if not, would carry out some further tests if needed. Today these checks no longer take place. Nasaa, a 27-year-old woman who was not part of the group discussion towards the video-making, described her first gynaecological check in high school as follows:

The very first time I got checked was in high school as part of the girls' examinations in high school. The doctor carrying out the check was a female relative of mine. And she knows that I don’t have any problems. They examine whether the girl has entered a sexual relationship or whether

84 See also Chapter 3. 131 she has had an abortion. I was assigned the task of registering the girls and measuring and recording their height and weight, so I was kind of an assisting doctor to her that time. So that time I didn’t get the examination but another time I did. After hearing “lie on this bed and let’s see”, my whole body was shaking. I was maybe in the tenth grade at the time. It was a little scary to lie on that bed never having been touched before, so I almost cried.

There were also schools where a doctor was present as part of the Red Cross programme (Roberts et al. 2005: 1490). However, the many stories and memories of these checks, which were the first gynaecological examinations for the girls, were told to me in a similar format to Nasaa’s: the women, who now were in their twenties or thirties, all said that they did not have any problems and were not sexually active at the time, but described these checks as traumatising at that age and recognised these may have been even scarier for girls who were sexually active, due to the wildfire of rumours and possibility of getting in trouble. The medical system is currently not considered one of the primary locations for women or men to seek advice. As Hulan explained in Chapter 3, this is due to a number of reasons when it comes to the free state medical services if one has an insurance: the complex situation with registrations to the municipality, which means that healthcare is not available; the amount of time that seeking an examination or consultation entails; doctors’ attitudes, due to being overworked and not having time because of the number of patients needing a consultation, and so on. Doctors at private clinics would have more time and would have a better attitude, I was told, but for many the private sector remains too pricey for such consultations and the seeking of contraceptives. However, the memories of when the medical and educational did make an appearance as undesired control or engagement with one’s body or ‘life’ linger. This differs from how the ‘formal’ medical and educational mostly appear in women’s reproductive lives, where they are part of the discourses of unaccountability and lack.

132 Socialities behind unwanted pregnancies

The brainstorming with the club had started with the moderator, who worked as an animator for the company, asking why there are unwanted pregnancies. He then scribbled down all the explanations that were offered on a large whiteboard. Answers came mainly from the guys: ‘one night’s fun’; not enough knowledge; no protection and having sex while being drunk; because of the many celebrations Mongolia has, added Tömör. Sarnai then equated an unwanted pregnancy with an abortion, giving the answer that the main reason for abortions is that people are not ready (belen bish) and that there may be financial reasons (sanhüügiin asuudal) or health concerns. This echoed the opinions of the doctors with whom I discussed this issue. Having given birth recently and one’s career were brought up as well, before Solongo proposed the issue of an ‘irregular family’ (togtvorgüi ger bül). ‘What is the exact “irregular situation”?,’ asked Sarnai. Solongo explained that this meant ‘a little difficult’ situation between a husband and a wife; if the woman gave birth to the child, she would enter a difficult situation. Another woman contributed by saying it could be a family experiencing domestic violence where having another child could hinder the prospects of the woman eventually leaving the husband. Children in this discussion can be seen as preventing certain actions and futures due to the care and environment they need. Drawing on women’s experiences from north-eastern Mongolia, Buyandelger (2013: 181) points out that the lack of control of one’s body and life that women experience when looking after young children is linked to not being able to leave their violent husbands; and although most people love their children endlessly, sometimes women would describe them as ‘flesh padlocks’ or ‘shackles’ preventing them from undertaking activities beyond the home. These approaches to children and pregnancy diverged from what was previously discussed in this thesis at some length on the ways that reproductive issues are talked about in Mongolian kinship and traditional medicine discourse: namely, in terms of extending patrilineal lineages (udam zalgah) and keeping genes (geni üldeeh). As part of this patrilineal

133 kinship discourse, having children on the part of the wife was noted to be a duty to the husband’s lineage and the inability to do so was problematic, contributing to the woman becoming ‘bad’ (Chapter 3). There are some vast distinctions in how having or not having children are discussed here as part of the video-making process compared to the aforementioned discourse, which is also indicated by the language used. During the video-making, such vocabularies or explanations did not directly come up; the issues related and the values attached to children were also not discussed. The notion of reproductive issues as context- specific was picked up by the participants, suggesting that ‘extending lineages’ and other matters of reproduction do have discursive overlaps. As Tömör suggested during the discussion, issues surrounding contraception depended on the relationship status, whether it was a one- night stand (gants shöniin yavdal), cheating, whether it was the first time and whether the people involved were adults. This came up as part of the discussions on the target audience of the video and the debate as to whether contraceptive knowledge was necessary for women who were married. Tömör’s question – ‘Why is it necessary to tell a married woman who is in a sexual relationship with her husband how not to get pregnant?’ – followed a lengthy exchange on why unwanted pregnancies occur, including within families, which the female participants had outlined in some detail. Furthermore, while the men in the discussion focused on the reasons behind getting pregnant, the women’s answers mainly addressed the reasons why giving birth to the child after becoming pregnant were impossible or complicated. The answering of this question by the club’s focus group was comparable to how this issue was approached elsewhere: the doctors and women did not typically refer to contraceptives, their failures or the overall lack of these nor did they bring up ‘accidental’ pregnancies like the men did. Instead, they tended to focus on the socioeconomic reasons which contributed towards a woman not being able to have the child, and hence needing to have an abortion. Here the question about unwanted pregnancies was swiftly equated to abortions rather than the context in which these pregnancies occur.

134 Bayar contributed a story that provoked a few giggles before the discussion turned serious. When he was studying at university, he lent money to a friend who was seeing a girl who had become pregnant before the couple had discussed marriage. His friend borrowed money for an abortion. As part of these stories where men and women were both present, it tended to be the men who were often shown in the active role of seeking, and sometimes failing to acquire, birth control. These stories did not place blame on the men, but rather showed the broader relations in which these situations unfold, although for years the public abortion discourse in Ulaanbaatar tended to locate blame with teenage girls who were considered careless and immoral85. This discussion overall provided rich counter-narratives, which were very clearly apparent in Maika’s storyboard presented at the end of the session:

Two school-aged kids begin dating. In the beginning the girl asks her mother what to do. Her mother gives her a confusing answer that she was born from a flower. The boy asks advice from his older brother. His brother gives him misleading advice, and then says, “Okay, okay, you can go with a condom.” But the boy is worried to enter the pharmacy and buy the condom, and standing outside he meets his guy friend. So the friend asks him “What will you do with a condom? If you’re having fun you don’t need it,” so he follows his friend’s advice and doesn’t buy it. Then the couple soon has sex (belgiin haritsaand oroh). The girl gets pregnant because they didn’t use protection. From this a problem arises. She’s a teenager, that’s why she has an abortion. After having had an abortion her body and health are damaged. Concerning the boy, if he truly had feelings for the girl, he enters into psychological (setgel züi86) problems.

85 See also Chapter 2. 86 Or ‘mental’. 135 There’s very little information about the reasons leading to this situation. Concerning the family, the parents didn’t provide the right information and weren’t open. In the society there’s no publicity and information about sex education. Storyboard by Maika

What arises is the sociality of getting or not getting pregnant, the speculation, discussions and avoidance, where the parents, friends and the public sphere all tend to fail. Although the video in its end result suggests the need for ‘individual responsibility’, the discussions that built up to the video suggested that the issue of contraceptive use was seen in a much broader social context. Maika’s storyboard was rare in its presentation of the issues addressing the ‘society’, which she later outlined as television and social media, both of which were a target medium for sharing the end result of the video. Sex education and knowledge about contraceptives belonged neither to ‘state’ education nor to the medical in this discussion. There was also the embarrassment about buying a condom from the pharmacy. And as the girlfriend and boyfriend tackle the issue to the best of their ability on their own, there seems to be no conversation about all this between the couple: this is not presented as part of the concerns or interactions involved when an unwanted pregnancy arises. Early on in the discussion, it was pointed out that there was no formal education addressing these issues, and indeed the ‘formal’ rarely made an appearance in the discussion beyond the desire for there to be trustworthy knowledge and points of reference. In the light of the broader context of ‘formal’ education and medicine, it could appear that the voluntary gathering of a group of young adults to create a YouTube video is seen as potentially the most reliable and accurate form of advice available on how to avoid pregnancy and STIs – a sort of contraceptive in itself. Rather than suggesting that sexuality and intimacy are solely occurrences between the people who engage in sex with one another, here they are viewed as broader social processes.

136 Gendered qualities

‘Guys’ talk’

As appeared in this discussion group, the topic of not getting someone pregnant took the form of light boasting, gossip and speculation shared among friends and siblings roughly within the same age group; not getting pregnant seemed to inhabit a separate space, with different means and forms of discussion. Quite early on in the group discussion, after some stories of abortion, one of the guys pointed out that it is believed to be impossible to get pregnant during one’s first experience of sexual intercourse.

Bayar: There’s also this understanding, for example, there is a common understanding that if having sex for the first time, the guy must enter without using a condom. Sarnai: Really? Why? Bayar: Women also say so, men also think that way. I saw this from many examples. Tömör: Yes, there is such a thing. There is an understanding that first time must be without using a condom. The major reason is that a condom will lower the pleasure, especially during the first time. Bayar: If men express this understanding, then women accept that this is how it should be. Sarnai: A thing of following one’s man, isn’t it? Tömör: Both sides have this understanding. Bayar: There’s this wrong understanding that even when a man would more actively advocate for use of a condom, the woman would not use a condom. Sarnai: I don’t know. A wrong understanding. Tömör: It’s also because men like to do it without a condom.

This gave way to a lengthy discussion – involving speculation, stories and their contestation – on how it was possible to avoid pregnancy.

137 Can a woman become pregnant during the first intercourse? Or during breastfeeding or menstruation? And do condoms really protect from HIV? (see Figure 6).

Figure 6. A still frame from the video that was made: here, overturning the ‘misconception’ that it is impossible to get pregnant when having sex in water.

After a while, when only the young men and mainly Sarnai had been active in the conversation, Sarnai attempted to involve the women more; following some encouragement, they started to share their thoughts on contraceptives. Similar to the unreliable condoms, intrauterine devices (IUDs) came up, with the experiences of others suggesting their use will cause pain and heavy menstrual cycles. It was mostly friends who shared experiences of this, it was pointed out. This conversation was quiet, almost private between Sarnai and Solongo. One of the men asked if men can also use ‘spirals’ – ‘can’t they?’ – and the whole conversation was derailed as we all burst into laughter. Tömör, of course, presented his version of how this might be achieved and concluded that the video we were making was meant for people ‘exactly like you guys’ as the whole group was close to tears. Sarnai called a break.

138 Returning from this, Sarnai continued to ask the women about contraceptives. This created a long, long silence, although Tömör did join in the encouragement: ‘No need to be shy!’ Two of the women recognised that IUDs only offer protection from pregnancy and are hence only suitable for ‘family people’. Someone else pointed out that although she was up to date with various options, she was using a calendar-based method with the help of an app. After the conversation continued with further tips and speculation, one of the young women pointed out that how not to get someone pregnant (jiremslüülehgüi baih) was mainly ‘men’s talk’. Although women possess various knowledge and tools on how not to get pregnant, it seemed to be separate from that of the men and was addressed that way. To this, one of the guys responded that there was very little information available for boys and men: ‘Only to use a condom, that’s it.’

Of responsibilities and rights

After this, the conversation shifted to hopes regarding the outcomes of the video in question. The use of condoms needed to be explained and women needed to be more responsible were the prevalent conclusions – that is, until everyone presented their storyboards. The focus on women’s responsibility echoed the common understanding that because pregnancy happens in a woman’s body, it was mainly her responsibility to protect herself from it occurring. Here it is relevant that the following discussion is rooted in the discourse of responsibility (hariutslaga) rather than rights (erh)87.

Tömör: /---/ (talks about a letter that circulated when he was in grade nine that stated that it was not possible to get pregnant when having sex in water.) Pregnancy becomes a direct concern for the man. When a man’s semen enters a woman and a woman gets pregnant, in reality it turns into a

87 An alternative discussion on ‘rights’ can be found in Chapter 2. 139 man’s problem. Because of this I think the woman needs to be more responsible, and take charge of using a condom and follow her menstrual cycle. Why can’t a woman buy a man’s condom? Solongo: A woman needs to have more initiative (sanaachlagatai baih). Tömör: Women need to be a little responsible (hariutslagatai baih).

Maika did follow up to contest Tömör’s view of women needing to more responsible:

Men and women need to be responsible together. /---/ Thinking (setgel) needs to change. We are currently all the time talking about the aspect of having [sex], for example, one-night stand, if it happens suddenly, then what? A problem comes up suddenly. When every woman carried a condom with her, men need to understand. So that men would understand when a woman suddenly takes out a condom, that she likes it and that she is prepared. What needs to change is the understanding that when men carry a condom with them it’s considered cultured but when women do it is strange.

Rather than a compromise of sorts or a shared humanity drawing on the discourse of rights, the suggestion was for women to acquire traits or activities that otherwise would be considered masculine, or that they were thought to lack. This came up in various forms: for example, when Tömör suggested that while in society there is an understanding that men need to be more responsible, this should be shared so that it would become 50-50 with women. Being responsible in today’s Ulaanbaatar concerning reproductive matters could not be described as a part of the ‘society’ where men were more responsible than women, and the discussion as a whole was shifting towards adding responsibility to women, with less focus on an overall normalisation of contraceptive use as I had

140 anticipated. This came with some anxieties, which became particularly apparent in the storyboard of one of the youngest female members, Anu, at the end of the discussion.

A teenage couple have never had sex although they’ve been dating for a few months. It's really nice. One day when they were eating dinner, watching movies, and playing – basically spending quality time, it suddenly starts to rain heavily. The man is thinking of different things. At that moment, the thought of wanting to sleep with his girlfriend is born. And the man is happy about the pouring rain for this gives him a chance. Since they are far away from home, he’s forcing the girl to go to a hotel with him to wait out the rain. Both are shy and ill-prepared. There is also no condom. But, the girl does have a condom. The woman is thoughtful (bodoltoi) and she’s smart (uhaantai) for thinking about things from many different perspectives. And, the man has no idea of what to do, but the woman is thinking about the matter in two ways. If I take it out, my boyfriend might get angry, get offended, maybe ends up breaking up with me. Or he would just end up surprised. Then she decides to test him on whether he really loves her, and takes the condom out to see. After she takes it out he is certainly surprised, but doesn’t get angry. He asks: “Why do you go around with a condom?” She replies: “You are forgetful, so I picked it up.” “Why did you think that you would be in a hotel today?” In that strange situation, she acts intuitive and says that she had seen the weather news today. And that guy replies: “I do not know whether you saw the weather news but I respect and love you. You made me understand many things with this action. But this time I'm not sleeping with you and I will wait until you're ready.”

141 Then they hug and it ends. Anu’s storyboard88

While in the discussion group most of the men said they liked the idea of a woman carrying a condom, the story presented by Anu at the end of the discussion showed some anxieties concerning having a condom: the anger of the boyfriend at the girlfriend potentially being promiscuous and initiating sex; what can save her from this is her willingness to show her complete devotion, even if her aim was to test him. The girlfriend said her role in acquiring the condom was to make sure they had it in case the boyfriend was forgetful, recognising that he should have been the one to bring it. The boyfriend is in a position to question her about the possession of a condom, and she resorts to lying about the weather, because admitting that she is just prepared would not be acceptable and comfortable for her or her boyfriend. Both in the exchange that Tömör initiated about condom use and Anu’s storyboard, it is worth noting that the discourse of ‘rights’ neither enters conceptually nor in the vocabularies used to discuss the matter. The shift under discussion is about responsibilities and being active – both masculine traits – rather than as rights to advocate, which in other times and locations have been masculine traits later to be shared with women: for example, voting rights. Being a ‘good’ ‘Mongol woman’ can involve traits like being clever/crafty (urlag) and smart/wise (uhaantai), being prepared and adaptable and often being able to direct those around her towards her preferred outcomes without people, mostly those socially superior to her, realising it (see Baabar 1999: 308-309; Humphrey 1978; Terbish 2013).89

88 A particularly appropriate soundtrack to this discussion on deciding not to sleep with a woman is a 2015 hip-hop hit ‘Untahgui’ (‘Ain’t Sleeping with You’ (direct translation ‘Won’t Sleep’)) by Enerel, NMN and Munkhjin, where one of the two male voices raps: ‘What do I need to do not to sleep with you?’ It is humorous because being virtuous is mostly reversed: although there are three performers, including one female, the two men decline ‘sleeping with you’ with particular passion and conviction. 89 In Anu’s story, too, the girlfriend possessed these traits, but the whole situation ended up playing out so that the boyfriend put off sleeping with her, which perhaps suited her because initially he had ‘forced’ her to go to the hotel. 142 The contemporary notions of women still propose that women should not be ‘uncontrolled’ (zadgai), and educating girls means also educating them about their relations to their male kin (Bamana 2016: 97). The man should be responsible (hariutslagatai), which was pointed out, but also more ‘traditional’ ideas of the household head (here drawing on Namjil 2014: 470-471) involve men being perpetually powerful and able (‘zuurdiin bish chadaltai’) as well as wise in farsighted ways (‘holiin uhaantai’). However, what women should be like is a common topic for various news outlets and memes on social media, while men rarely appear on such platforms as linked to ideas of ‘becoming’ or ‘needing to be’ (see Figure 7).

Figure 7. An inspirational poster shared on Facebook that reads: ‘To be a wife is a matter of intelligence/ To be a head of the household90 is a matter

90 Female; meaning mistress of the household, also hostess. 143 of responsibility/ To be a mother is a matter of education/ To be a woman is a matter of cleverness/craftiness’91. Adapted from: Uugantsetseg 2018.

Presenting some told and retold narratives here, I have aimed to indicate that it is not only that the presumed advocacy of ‘successful’ contraceptive use may not be present, as has long been recognised in studies of contraceptive use (see Paxson 2002), but also that these acts of advocacy may take forms that are not defined on the ‘rights’ axis, at least not by all of those involved in the matter. Despite my initial assumption that this would turn into a video promoting men’s interests, knowledge and their willingness to use contraceptives, the discussion mainly suggested that the change was expected primarily from women, apart from Maika’s counterargument. This diverges somewhat from approaches where the state or the overall governance as such is concerned with population control and suggests instead that the management has shifted towards financialisation as its primary focus and aim. For Foucault, sexuality’s relevance is that it links an anatomo-politics of the human body to state-administered biopolitics (Foucault 1978: 139; Rabinow and Rose 2006: 208).92 In the most famous study of sexuality ever written, The History of Sexuality, Volume I (1978), Foucault suggests that talking about sexuality is a work of seeking freedom (Foucault 1978: 7). This argument is largely based on talking about sexuality and repression jointly, seeking to understand not

91 The physical aesthetics of being a woman, which are also apparent in the photograph, are not verbally addressed. For ‘erotic capital’ or perhaps aesthetic capital, see Waters 2016. 92 Alessandro Fontana and Mauro Bertani (2003: 276-277) suggest, of course, that Foucault had been quite specific in his outline of biopolitics, which was ‘established as early as the eighteenth century by medical policing and then taken over in the nineteenth by social Darwinism, eugenics, and medico-legal theories of heredity, degeneracy, and race’. Foucault is concerned with Europe and France in particular, and does not engage with the cultural diversity of sexuality. 144 why ‘we’93 are repressed, but instead why being repressed has become the predominant way of talking about sexuality (Foucault 1978: 8-9). If knowledge and education are equated to the institutional ability ‘to speak about it’ (Foucault 1978: 18), I believe that the questions that I – and perhaps my interlocutors – instead ask or struggle with concerning power and knowledge are: why are we not more ‘repressed’, drawing on Foucault’s terminology? Who experiences a lack of trustworthy and accountable knowledge; why and how? And how do the people involved go about it? The rough suggestions of answers to these questions might diverge from Foucauldian vocabularies in the degree to which sexuality remains here an inherently social notion and experience, and discussions surrounding it involve calls for an increase in the shared engagement of those beyond the individual or couple in question.

Intimate contraceptive knowledges

Finally, I will turn to one more storyboard where various relations – ones where women do not make it into the lead roles – result in a pregnancy or avoiding one. Neither medical nor state education, besides the protagonists being students, appears as relevant. Instead, as discussed above, it is about parents and families, and how openness and a sort of control are desired, as well as the consequences that the lack of these may bring about.

/---/ My topic is Is Bold mannered? Or is Bat? This is about two families. One is Bat’s, Bat is the child of the household. It’s about the contrast between the two families. Bold’s family talks openly about sex education and provides the right understandings about this. Bat’s mother and father don’t talk about this and if asked they provide wrong

93 Foucault does repeatedly point out that this is not a universal ‘we’, but ‘our civilization’, ’Western civilization’ or simply ’civilization’ (Foucault 1978: 9, 58, 70, 157). I suggest this might be too broad a term, for I inherently see today’s Mongolia as part of ‘our civilisation’, but with important differences to how Foucault characterises it: for example, regarding sexual repression. 145 understandings. Bold and Bat go to the same class. Then the school graduation party takes place. In Bold’s family there’s condoms, in Bat’s family there’s no understanding of condoms. Because Bold’s family is open, his parents send him to the graduation party with a condom. Bat does not have a condom. At the graduation party, they drink beverages mixed with vodka. When Bold has sex, he uses a condom and no problems arise. Bat has sex and the girl gets pregnant. Bat did not have feelings for the girl but because of this incident he gets married to her. He pays for this his whole life. Because Bold gets the right information from his parents, he shares that with his friends. Bat’s parents’ teachings are based on messy and wrong examples. Bold’s view is controlled (hyanalttai) and Bat’s isn’t controlled (hyanaltgüi). Temuujin’s storyboard

All in all, state and formal education are the context in which many of the stories are set. The matters of education also provided a starting point as did Sarnai’s previous projects with local and international NGOs. These provided inspiration to her as well as being the source of the brochures that she already had to inform us on the format of the video. The medical came up through the ‘adolescent cabinets’ as well as the abortions in ‘dodgy’ clinics that were discussed. Couples were another context, mostly as a site of conversations about family planning or, as some examples of the discussion showed, the lack of these. Many of the deliberations and the informing knowledge arose from personal experiences to be shared with friends, which was the main space where such knowledge could be acquired and freely discussed. Families were seen as a desirable, but more often as a failing, site for this. Television, YouTube and Facebook were seen as potential sites for sourcing knowledge, and it was to these that the video-makers themselves were aiming to contribute, recognising that these forms of media needed to include more reliable information than they did currently. Sex shops in

146 particular, as well as porn, were mentioned as sources of knowledge by the men participating in the discussion. I have tried to portray here some of the relations these spaces have to one another. For one, how a friendly discussion, on a scale that not many of us had been part of before, could give rise to a YouTube video edited by Sarnai and her team. Or that while YouTube can indeed inform the viewer about contraceptives, it does not mean that possessing a condom in one’s home would be acceptable to the parents or to one’s partner if a condom was presented. The boundaries between a contraceptive method and knowledge about it became blurred in the case of the contraceptive calendar app, but were also presented by stories where pregnancies happened due to a lack of knowledge, which was pointed out at the very beginning of the session as a reason for an unwanted pregnancy. After the video had been online for a while, Sarnai told me how she saw the outcomes achieved within the club as equally important: she said she thought this was really useful to everyone and she herself was carrying a condom with her. While knowing and experiencing, even if mediated by others’ experiences, are often considered as being the same, I argue that these are not only intrinsic qualities to how knowledge is perceived, but are also open to being shaped by the media available, including socialities and the forms of intimacy that have emerged in Ulaanbaatar. The task of video- making was confined by the model of an explanatory video: the narration was to follow a straightforward sequence of stating the problem, why and how this is the case, the solution and the steps that the viewer needs to follow to resolve this. The video kept its overall format, being compatible with other sex education videos created elsewhere, and did not greatly diverge from the approaches of the various NGOs within Mongolia with the nuance resting on the focus on the ‘myths’ of not getting pregnant and advocating for non-shame in the possession and use of condoms.

147 The video, which was a few minutes long, started with asking ‘how to do it without getting pregnant?’94, which was answered by listing the most popular medication or barrier contraceptives. Unreliable methods of birth control were then explained: namely, the pull-out method; having sex in water; the belief that women who have had a baby recently will not be able to get pregnant; or the idea that it is impossible to get pregnant when having sex for the first time. The storyline goes on to suggest that perhaps the viewer already knows all these things, but there are some unpredictable ‘YOLO’95 moments – as it blinks on the screen next to a cloud of action – after which one can start worrying if protection was not used. It then reads: ‘And if the two are not ready – abortion’, with a screen presenting official statistics for this and STIs. Tracing the steps back to the scene before ‘desire’ took over, the narrator suggests that condoms are needed for both men and women. And two are better than one; there is no shame in going around with a condom (see Figure 8).

Figure 8. Still frame from the video: everyone should have a condom.

94 For a while there were different titles and such questions were under discussion. This specific question indicates a focus on women, because in Mongolian, by changing the verb, it is also possible to ask, ‘how to do it without getting someone pregnant?’ 95 You Only Live Once. 148 The takeaway message of the video ended up two-fold: either protect yourself and your partner, and if you wish, seek further information from such-and-such websites; or if you are not ready to do this, stick to masturbation, here shown as a toilet roll, which created some confusion among viewers as was expressed in the comments thread of the published video on YouTube. The male narrator’s voice was calm; he knew exactly how things were, unlike us in the room. He relied on statistics, and at one moment two characters in white coats – institutions were important, after all, as a form of legitimisation – appeared to point to the facts. Meanwhile, in our discussion, the examples of pieces of knowledge and opinions were rarely represented as the speaker’s own: it was mostly a close friend or other secondary stories that were discussed as being representative of the whole. As the young men pointed out, they spoke freely about such things with their friends, discussing tips but also pointing out that sex shops were good places for advice, explaining how sometimes communication on the topic in such locations was much freer than between the couple. While the company’s videos are usually animations relying on various techniques, the storyline of ‘How to Do It Without Getting Pregnant?’ was acted out by the club’s members, who were photographed and designed into paper-doll-like figures who slid across the screen with animated, round, blinking eyes, thereby preserving the anonymity of the people involved as well as raising the mood of the whole visuals. The acting with the photography was undoubtedly the most entertaining and funny part of the process: there were laughs and awkwardness was overcome; looks and cheeky smiles were exchanged. Sarnai encouraged the actors to remove some clothing. The rest of us were either useful in the production or were taking photos of each other’s smiles as much as the production being staged (see Figure 9).

149

Figure 9. The photographing of the material that was later used in the animation was light-hearted and a little cheeky. Photo: author.

Overall, this video was largely produced by people who shared a certain familiarity with one another, which was not based on kinship or any other strict hierarchical relation, for instance, a working or professional relationship. I was rather passive in the process, but I provided elements like the statistics and the Mongolian-English translation of the script for another version of the video when they were asked of me. I also suspect that my general engagement, interest and the openness I had acquired by that stage of my fieldwork made me an appropriate ally to encourage Sarnai to take on this project. This initial ‘business’ venture or general plan to do something, as well as me being involved, was rooted in my familiarity with the people who were organising this at the family level. This is not unlike how reproductive matters were discussed otherwise – mostly between friends and peers – although the making of the video involved both women and men in the same space at the same time having these discussions as well as the uptake of a medium, which enabled the reaching of broad audiences beyond one’s own direct control once the material was uploaded and

150 started circulating. It must also be pointed out that besides other interests, like an initial wish to gain more viewers on Sarnai and Od’s company’s YouTube channel, the overall focus remained producing something that was deemed useful and necessary. Elizabeth Povinelli (2006: 4) bases much of her analysis of intimacy – which deals with individual freedom and social constraint, but also surpasses these – on a notion of an ‘autological subject’ that she defines as a signifier of ‘discourses, practices, and fantasies about self-making, self-sovereignty, and the value of individual freedom associated with the Enlightenment project of contractual constitutional democracy and capitalism’. Foucault (1978: 145) sees the roots of freedom or ‘the "right" to life, to one's body, to health, to happiness’, 'to the satisfaction of needs, and beyond all the oppressions or "alienations," the "right" to rediscover what one is and all that one can be’, as a reaction ‘against the system that was bent on controlling it’. However, in these subjective discussions, the vocabularies of ‘rights’ or ‘freedom’ did not appear here, although the overall goal was to secure health, well-being and long-term happiness (like not having to marry someone one did not love). These notions were recognised to rely on other people – partners, family members, friends and other club members. Temuujin’s storyboard suggested that the future happiness of the two male high-school graduates depended on the level of ‘control’ of ‘a view’, essentially meaning knowledge. The video both engaged with and called upon certain intimacies that were not sexual – or, in the case of bordering on this, were dissolved by laughter – which were seen as needed for sexual intimacies to be non-harmful.

Conclusion

The chapter started with a vignette about making buuz, dumplings, instead of videos. It aimed to indicate how everyday life in today’s Ulaanbaatar tends to involve technologies and mobile phones in everyday use, even when making buuz, as well as how ‘family’ contexts and relational proximities can give rise to all kinds of undertakings beyond

151 the domestic, such as the video-making process that I followed. In less than a year since the video was published on Sarnai and Od’s company’s YouTube channel, it had been viewed more than 300,000 times96, making it the most viewed post on the channel by far. Although not strictly ‘viral’, the video performed fairly well given that Mongolia’s population is just above 3 million. It was enthusiastically shared by the club members on Facebook and a TV channel showed it as part of a news story on the club having made such a useful video. It was also available for any organisation to use as much as they wished. Sarnai moved on to another project of writing a book about the most successful Mongolian entepreneurs, covering 50 women and 50 men. Her creativity in going about the projects she undertook often brought together her aims regarding business and livelihood, wanting to create something for others and improving and learning on the way herself, as she explained to me. In many ways, Sarnai’s story is a counter-account to the angles of the story I focused on in this chapter: she was neither quiet nor shy about these matters nor only a part of the conversations and ideas about what reproduction, sex education and knowledge is or should be; rather, she was the lead creator of these through the online platform. To start with, it was Sarnai, with her charisma, leadership skills and qualities that, together with her being very hardworking, had already led to her having co-founded a company and being the leading force behind the young professionals’ club. However, the making of the video involved a wide range of opinions and voices – one of the loudest during the discussion meeting was perhaps Tömör’s. While hardly represented equally, the meeting of these voices was essentially enabled by the relationships these people enjoyed or did not enjoy with one another: the relationship was not imposed on them by kinship, their career or other structures directly. It was particularly obvious that gender structures kept resurfacing in the discussion. There was no consensus on these matters, and the discourse of ‘responsibility’ was discussed in some depth. The family was mostly considered a favourable location for reproductive knowledge, but it fell short of providing such information and at times failed those

96 Over the course of a year and nine months, it had been viewed more than 700,000 times. 152 involved. While the medical and education as locations for these types of knowledge did not come up frequently, it was pointed out that this sort of knowledge was not provided as part of these spaces, and that there was an overwhelming unaccountability of knowledge that was circulating as part of informal spaces, even if these were preferred sites for such knowledge. However, the video outcome was influenced by the brochures, Sarnai and Od’s company’s previous experiences of making materials for organisations, existing exemplary videos and the involved anthropology student. The video was not a direct translation of the voices into visual and educational material, but simply involved them. These were shaped by specific technologies and media to produce and share them. Yet, like Sarnai pointed out, the making of this video was in itself considered a learning curve with practical outcomes for those involved, as she hoped. At one of the later meetings, Sarnai gifted each of us with a condom. Making the video to address the lack of knowledge concerning reproductive issues could be seen as a form of the neoliberalisation of knowledge and intimacy due to the ‘deregulation, privatisation, and withdrawal of the state from many areas of provision’ (Harvey 2005: 3–4 in Wacquant 2012: 69). In addition, this form of creation largely relied on the fact that Sarnai had the company, which meant we could use the office spaces they were renting and, not least, the video was materialised through her employees’ skillsets regarding animation and graphic design. Therefore, the video could also be framed as a form of politico- economics, where the need for this strain of knowledge is driven by the market, and hence was manifested in the video (see Larner 2000). After all, the initial thought behind the video had been linked to profit or its indirect creation, although the goals shifted somewhat in the process. Furthermore, Wendy Larner (2000: 6) suggests that ‘neo-liberalism is both a political discourse about the nature of rule and a set of practices that facilitate the governing of individuals from a distance’, although also ‘historically specific and internally contradictory’. Particularly calling for attention to governmentality, Larner (2000: 6-7) proposes this could be a constructive approach to understanding what has been happening to the welfare state. However, governmentality is a particularly elusive term: indeed, it is overly ‘broad and promiscuous, overpopulated with

153 proliferating institutions all seemingly infected by the neoliberal virus, and veers toward critical solipsism’, being a type of ‘political rationality’ that merges with many ‘kinds of regimes and insinuates itself in all spheres of life’ (Wacquant 2012: 68). Bear et al. (2015) discuss a form of capitalist accumulation and how this potentially creates forms of inequality and insecurities in incomplete, inconsistent and incoherent ways. The voices and ideas that produced the video were uneven to start with, and some were muted while others were enhanced in its long process of production. Nevertheless, having been part of it at various stages, the underlying aim to create something that was useful and the video-making suggested the degree to which concern for others does exist, and that work and production are not only led by goals of financial gain. Indeed, it were the ‘diverse life practices, relations, experiences, and contexts’ (Bear et al. 2015) that contributed towards the ‘accumulation’ of knowledge and eventually the YouTube views of this video. Rather than being ‘liberal’ in their essence or involving ‘individualized discipline’ in the Foucauldian sense (Mansfield 2012: 588), there were interpretations and reflections on both Mongolia-specific notions, experiences and relationships and the transnational approaches that together shaped the outcome. There was no single subject involved, but many, and with many contradictory views on what was expected from them as ‘men’ or ‘women’. Reflections on this involved anxieties and concerns as certain expectations were repeatedly pointed out: men were expected to lead and know; women to be inexperienced and not to take the lead. The video- making project at its core called such dualisms into question and quickly refuted them as determining outcomes; however, this did not mean these considerations became irrelevant overall. The previous two chapters have overall attempted to ethnographically unfold two distinct spaces involving reproductive issues where these occur. Having previously in this thesis found the notions of ‘biopolitics’, ‘neoliberalism’ and ‘governance’ either too broad or historically laden to address the rise of inequality and insecurity concerning reproductive issues in today’s Ulaanbaatar, I propose some more nuanced approaches to governance in the following two chapters to

154 indicate what the production and maintenance of these forms might actually involve.

155 Chapter 6. The Gynaecologist: Usufructuary Gains and Losses in Healthcare

People with pseudonyms in this chapter

Dr Gerelsuren A gynaecologist in her late fifties Dr Narantsetseg A gynaecologist who attempted to assist me with the Mongolian medical research permit

Introduction

It has been pointed out that ‘public’ services in Mongolia are considered difficult to access (Dalaibuyan 2012: 51). This is very apparent in the case of gynaecology and obstetrics in Ulaanbaatar. Accessing a ‘public’ service requires health insurance, various other steps like acquiring a time slot and then, at times, extensive waiting. However, as described earlier in the thesis, the experiences and subjectivities which unfolded in such medical spaces were not only complicated because patients had to skip other activities to wait in the queue, but also due to the encounters being emotionally and affectively charged. Authority in this context, for the patients and the PhD student alike, did not involve the ‘medical’ institution, but rather the doctor as a specific person – either known or not – who determined what is possible, for whom, when and how. The collapses of the ‘public’ and the ‘private’ occur in many different ways. First of all, ‘formally’ several of the clinics I worked with or visited provided both ‘private’ and ‘public’ services to its clientele, some covered by insurance and some not. However, how ‘public’ and ‘private’ services manifested themselves at the clinics, was not limited to this. For example, in one of them, a doctor provided a ‘private’ abortion service after working hours. Additionally, characteristic of many such clinics, the gynaecology department did not have ultrasound diagnostics available, so if these were deemed necessary, the patients were directed

156 to adjacent ‘private’ service providers to undergo these or other tests. The patients had to acquire and pay for medications that were prescribed to them, and the pharmacological company or the pharmacy could also have links to the doctor providing the prescriptions. In the previous chapter, I drew on Bear et al. (2015) in pointing out that various occurrences of capitalist accumulation can produce forms of inequality and insecurity, and do so in incomplete, inconsistent and incoherent ways. In this chapter, I study one of the spaces where this happens, hoping to provide some insight into why and through which mechanisms this unfolds in one of the foremost spaces linked to abortions (Chapter 2): the biomedical and doctors’ work. ‘Public’ and ‘private’ in this chapter and in Ulaanbaatar more broadly are terms denoting the state and the market in the distinction between ‘governmental’ and ‘nongovernmental’ (Weintraub 1997: 8, 34), taken up by policy-makers, medical staff, patients, international organisations and researchers alike. The ‘apparent indispensability of this grand dichotomy’ (Weintraub 1997: 38) in this chapter lies in the fact that most of the ongoing ‘reform’ and open-ended reach towards ‘becoming’ a ‘functional’ capitalist economy after socialism is built and continuously draws on this distinction. To work towards understanding why healthcare can be vulnerabilising, I will study the job position of the ‘state’ (ulsiin) gynaecologist or ‘women’s doctor’ (emegteichüüdiin emch), finding both ‘privatisation’ and ‘corruption’ to be insufficient analytical concepts. Instead, I draw on the concept of usufruct from the perspective of both doctors and patients.

Job position as usufruct

Empson and Lauren Bonilla (2019) suggest that the rise of the temporary is ‘a fundamental feature of a new kind of capitalism’. Addressing this characteristic, they take up ‘usufruct’, originating from Roman law and meaning ‘a legal relationship in which someone may be granted temporary access to a thing (res) while it remains owned by someone else’ (Empson and Bonilla 2019). Referring to A Text-Book of

157 Roman Law, Frederick Goldie (Buckland 1963 in Goldie 1985) defines usufructus as ‘the right to enjoy the property of another and to take the fruits, but not to destroy, or fundamentally alter its character’. Empson and Bonilla (2019), who introduced this notion to the discipline of anthropology, somewhat extend the original concept by emphasising its temporalities – the temporary – together with the blurring of ‘boundaries of what was owned or possessed and by whom’ (Empson and Bonilla 2019). Across disciplines, usufruct has been taken up in analyses of various resources, including the deep ocean floor, outer space, tools, clothing, money (Goldie 1985), scientific data (Walford 2019), artwork (Empson and Bonilla 2019), cryptocurrency (Cherkaev 2019), the Earth (Petersen 2019), infrastructures (Muehlebach 2019; Schindler 2019) and, most commonly, land, harvest and land tenure (Bize 2019; Goldie 1985; Plueckhahn 2019). Similar to this previous body of work, this chapter proposes that what constitutes ‘property’ or ‘resource’ has shifted to include non-material and non-fixed forms. This is an important underlying distinction from ‘usufruct’ as a solely material form of property, such as land. The latter understanding has largely been the instigator of the use of this vocabulary. The term has two parts: usus and fructus (Goldie 1985; Empson and Bonilla 2019). Simply, usus denotes use, and fructus the literal or, more commonly, metaphorical fruits, which in the uptake of the term has been accordingly abstracted to broader meanings of ‘managing’ and ‘benefitting’ (Cherkaev 2019; same also in Goldie 1985).97 In the case of property, usus and fructus have also been defined as the right to use an asset and the right to benefit from it (Minkler 1989); however, here the definitions accordingly remain closest to simply the asset and the benefit from it. In the case of urban land access between ‘developers, construction companies, or governments’, space is transformed ‘from public to private and from municipal to corporate’, but also what occurs is the creation of various partnerships between public and private, thereby creating

97 In some cases, ‘gleaning’ is taken up as a literal activity or as an abstract harvesting of surpluses or the left-behind (Bize 2019; Cherkaev 2019) 158 ‘pseudopublic urban spaces’ (Plueckhahn 2019). The ‘pseudopublicity’ is hugely relevant beyond land tenure and is descriptive of various other sectors and areas of life, manifesting one of the key characteristics of the healthcare sector in today’s Ulaanbaatar as it was discussed with me and as I observed and experienced myself. Such transitional forms are financialised to a higher degree than the privatisation processes of the 1990s and the 2000s (Sassen 2014, Bear 2015 in Empson and Bonilla 2019; Empson and Bonilla 2019), which have been the focus of many studies when it comes to transitions from socialist to capitalist economies, particularly as part of the broad spectrum of post-socialist studies. I argue that in healthcare, too, such transitional forms involve ‘a greater blurring of private and public domains and increasingly hazy demarcations of responsibility and sovereignty’ (Sassen 2014; Bear 2015 in Empson and Bonilla 2019). Therefore, I am proposing another type of usufruct, where the initial ownership does not belong to the ‘private’ sphere, even if in the abstract. I am arguing that the position of ‘doctor’ can be conceptualised as a type of usufruct as a temporally bound harvestable inhabitation and ownership of the job in the public sector. After one doctor inhabits it for the length of her career, she vacates it, returning it to the ‘state’ briefly to be handed to the next doctor. This job is sourced for seniority, networks and meritocracy to ‘make a living’ in private healthcare, but also to establish ‘control’ over various aspects of work, the clientele and the moral principles of what being a doctor should entail, as I will discuss below. I suggest that usufruct’s key analytical rigour lies at the collapses and overlaps of the public-private dualism, and that in certain contexts, the traditionally public or state forms of property and resources in the broadest sense have become usufructuary (much like in the case of land use), though these forms might maintain their connections to the ‘state’ as the ‘owner’. This is one of the core reasons why the notion of ‘privatisation’ falls short in addressing these forms of ownership, although it similarly raises questions concerning sovereignty and governance as does ‘privatisation’ (see Verdery 1996: 210-211). However, ‘usufruct’ enables a focus on the ways in which ‘temporary possession allows for access to a range of resources and assets, but on the

159 condition that we broker relations with custodians or owners, and on terms that are not always our own’ (Empson and Bonilla 2019). Besides being typically temporally bound by retirement, the complex work of a gynaecologist in Ulaanbaatar means navigating authorities of various forms. Therefore, work not only involves providing consultation and treatment to patients, but also an ongoing management of bureaucracies and networks beyond a state doctor’s job contract and how the job at its minimum could be conceived. The following section will look into the development of the ‘state’ doctor’s job position, therefore outlining the rise of its usus form.

The usus

Establishment of the ‘doctor’

The goal of the Mongolian People’s Revolutionary Party, which claimed leadership of Mongolia for seven decades following the 1921 revolution, was to ‘by-pass the capitalist state of development’ in their communist state-making programme (Baabar 2016: 200). Currently Mongolia’s history tends to be split into three eras when it comes to the country’s medical development: before socialism; socialism; and after socialism (Ministry of Health 2019). The time period 1921-1940 is seen as foundational of ‘modern medicine’ (Ministry of Health 2019; Tsolmongerel et al. 2013). The ‘modern’ medical healthcare system in the Mongolian People’s Republic aligned with the Soviet Union’s Semashko model, which was centrally planned with healthcare services provided to all citizens de jure for free since 1924 (Billé 2015: 140). Socialism, however, also included a ‘second economy’ of gifting, favours and bribes (Verdery 1996: 215). This was not a divergent form of capitalism set apart from the state order; rather, these actions ‘depended upon their integration with the state sector’ (Verdery 1996: 215). In medical healthcare, it is within this context that the ‘doctor’ had been constructed in the first place. According to Darjaagiin Ölziisaihan (2009: 60), in 1920 there were only two ‘modern’ medicine doctors amongst a total of ten biomedical

160 workers in the country. The medical system prior to the revolution integrated with the Buddhist institution, now known as ‘traditional medicine’ (Chapter 3). However, ‘modern’ or ‘Western’ medicine quickly became synonymous with ‘medicine’ overall. By the 1950s, Mongolia’s new healthcare infrastructure had been largely established, but its ‘development’ continued with the focus on specific areas and quantitative reach. For example, from 1957-1960, the number of medical doctors increased from 607 to 873; the number of hospitals from 60 to 70; hospital beds from 5314 to 9846; and venereal disease clinics from zero to nineteen (Rupen 1964: 441). STIs had been a huge health concern at the time: in 1927, a doctor called Shastin found that more than 28% of the population had an STI, and in 1936 it was estimated that STI prevalence had risen to 33% (Baabar 2016: 314). The management and eradication of some of these diseases were an important element in increasing the population size, which was seen to contribute to the labour force and to manifest as an indicator of the nation’s health. Another avenue for this was maternal and infant health (Chapter 2). Overall, the nation state and socialist programme went hand in hand with the establishment of a relatively novel group of people: the biomedical doctors. The biomedical staff then and now includes trained doctors (‘great doctors’, ih emch), ‘small doctors’ or paramedics with limited training (baga emch) and nurses (suvilagch). Although prior to socialism medical practitioners and specialists were honoured, spared from massacres and exempted from taxation (Atwood 2004: 345 in Billé 2015: 144), the rise of biomedical doctors brought a whole other set of characteristics that were novel additions to the aspects of respect that the profession demanded. Medical staff were often juxtaposed to other ‘backward’ practitioners and practices, which is particularly apparent in a new form of ‘revolution’ on the ‘cultural’ manifested in the production and distribution of films.98 These intrigues of modernisation made it into films such as Serelt (Awakening, 1957): in this, after an encounter with a Russian female doctor, a boy destined to be a Buddhist monk trains as a

98 A cinema in Ulaanbaatar was established as early as 1930 (Baabar 2016: 319). 161 biomedical doctor and consequently becomes a national hero (Billé 2015: 141-142; Empson 2012b). In another film, Moritoi ch boloosoi (I wish I also had a horse, 1959), a young female driver for the collective’s99 hospital and a local young man on a horse enter a race. At first it is all good, light-hearted fun, but then the exhausted horse falls to its death. In both films it is women who are the carriers of the modern mentality and navigators of the modern in comparison to their male counterparts, at least initially. Men are often shown as more conservative overall and much more reluctant to incorporate ‘modern’ technologies or methodologies, though this is sometimes possible. News stories or opinion pieces on the gendered nature of the modernisation were prevalent also in the Mongolian People’s Revolutionary Party’s newspaper Ünen (Truth), with titles like ‘The work of education (hümüüjil100) organised among women’ (Hajidmaa 1967) and ‘Women – the educators (hümüüjlüülegchid) of the new age’ (Altantsetseg 1987). Women were both a category who were to be most transformed though the benefits of healthcare (Mönhöö 1986; Central Committee of MPRP 1986) and through becoming part of the labour force (Ünen 1987), and the expected transformers, largely through being mothers on whose shoulders rested the upbringing of the new generation of socialist citizens. While women were involved in work of a bureaucratic nature, the jobs available to them remained lower in terms of leadership scales and belonged to sectors such as culture, education and healthcare (Verdery 1996: 67). Today, too, biomedical reproductive healthcare, in terms of both workers and clientele, is a field that remains overwhelmingly female, as does the healthcare sector overall. Female doctors and nurses make up more than 85% of the workforce in Mongolia (USAID, The Asia Foundation and IRIM 2014: 13). Somewhat as a consequence, almost all of the doctors I became acquainted with were women. The Ministry of

99 Cooperative ownership, negdel. 100 Hümüüjil, meaning education or upbringing, was a particularly popular term during socialism to address the specifics of what the upbringing of the socialist citizen entailed. The mainstream word for ‘education’ is bolovsrol, which has more formal connotations, while hümüüjil has stronger emphasis on moral upbringing. 162 Health has continuously been one of the few ministries with female leadership. In the 1986 article ‘Healthcare – society’s precious resource’101, the head of the Ministry of Healthcare, Ch. Tserennadmid, defined doctor’s work as ‘a unique profession demanding the giving of one’s whole life and heart for the sake of the human being’102 (Tserennadmid 1986). For such personal sacrifice, which was expected from socialist citizens overall (Verdery 1991), and for dealing with the life of someone else, patients remained indefinitely indebted to doctors. Various out-of-pocket payments or gifts were also presented to medical staff. During socialism medical staff not only received a salary, but also often an apartment and other benefits like stays in recreational facilities. Many doctors-in- training earned their degrees in the Soviet Union as the first faculty of medical sciences was only established in Mongolia in 1942.

The job position

Excluding matters of informality and medical pluralism, the current structure of the biomedical ‘state’ healthcare system in Mongolia involves three levels. Tertiary- or state (uls)-level facilities involve specialised centres, which are all located in Ulaanbaatar and serve the whole country. Specialised care is provided on the secondary level and includes district or düüreg facilities: these are the sites where routine gynaecological services are provided. In case there is need for it, patients are directed to the tertiary centres: for instance, to receive treatment for infertility or cancer. Primary healthcare is provided by family clinics (örhiin emneleg) on the district or horoo level. These provide check-ups, refer patients to secondary facilities and should provide consultations. Family clinics were introduced in 2002 (Tsolmongerel et al. 2013). The approach in this

101 The article’s title in Mongolian is Erüül mend – niigmiin ünet bayalag; I have translated bayalag as ‘resource’, but its conventional meaning is ‘riches’ or ‘wealth’. 102 Hünii tölöö. 163 chapter engages mostly with the district- or düüreg -level doctor’s job position. A gynaecologist’s job at a state clinic includes a workplace, working hours during which the doctor needs to be present, carrying out patient consultations and writing reports on this when necessary. By and large, the work of a gynaecologist remains defined as biomedical in being essentially linked to examinations, as well as providing prescriptions and required treatments according to diagnoses. There is little overall consultation or interaction beyond this in state facilities, such as answering questions and responding to complaints or confusions that patients might have about the matters that motivated their appointment. The time slots for patients are short, and in the state clinics the noun achaalal103 or workload is frequently used by both doctors and patients to describe the limitations to doctor-patient interactions, as well as doctors’ attitudes overall. Maintaining the job position itself can and usually does involve maintaining relations with superiors like the administration of the clinic or hospital. For this work, the doctor is remunerated with a monthly salary. While the average salary in Mongolia in 2017 was around 967,000 tugrik104 per month (NSO 2017b), state doctors earned 558,000-634,000 tugrik105 and nurses 405,000-471,000 tugrik106 (Tsolmon 2017). This means their salaries, similar to others employed in the ‘public sector’, are much lower than the average salary in the country, a fact that doctors and patients alike are aware of. Drawing on her own career, Dr Gerelsuren, a gynaecologist in her late-fifties, described the work of a doctor as challenging due to the low pay, the lack of benefits, the negative reputation of hospitals ‘that always get criticised’ and the lack of equipment, while doctors tried to improve and study ‘on their own’. The way she described her employment as a gynaecologist suggested insufficient support through salaries and training, while also being criticised and having a negative reputation. Dr

103 Also capacity or crowdedness. 104 Equivalent to around 351 euros. 105 Equivalent to between 203 and 230 euros. 106 Equivalent to between 147 and 171 euros. 164 Gerelsuren had encouraged her daughter to become a doctor as well, but although she had entered medical school, she abandoned the idea of becoming a doctor after a few years of study: ‘She said that’s because it’s inconvenient to study so many years, the salary is low and the responsibilities are high, so she abandoned it. So I misdirected her.’ Overall, however, Dr Gerelsuren was optimistic and said that things were getting better for the new generation and herself too, as she had recently established a private practice to which she planned to commit full-time once she retired. What Dr Gerelsuren enjoyed the most about her job was simply treating people and seeing them healthy afterwards. She monitored around 100 pregnant women per year, and she found it pleasing when her patients came to her to show her their healthy babies; or when her or the other doctors working at the clinic managed to diagnose cancer at very early stages, ‘because if it was diagnosed very late, the patient was likely to die’. The clinic where she worked did not have an ultrasound or other advanced equiptment, which complicated matters of diagnosis on that front. I am proposing that this form of work can be considered usus in that it is brokered with the state through the salary, the workplace and other baseline aspects of the job, such as seeing patients. However, what makes it usufructuary are the added aspects which are supplementary to the job as conceived at its minimum, like the issue of providing or withholding care and the ability to establish ‘private’ services both located within and beyond the state institution, which I will discuss in greater depth below after reviewing some relevant matters concerning the concept of ‘privatisation’.

Shortcomings of ‘privatisation’

‘Privatisation’ and ‘reform’ are administered by the state and international organisations towards a functional capitalist state. In this, the private sector is seen by policy-makers to have an important place, both in relieving state services of a number of patients – an issue related to the explosion in Ulaanbaatar’s population – but also in providing

165 specific technologies, equipment and expertise that are too expensive for the state to cover. According to the Ministry of Health of Mongolia (2019), from 1991 to today, owing to the democratisation of the state, Mongolia has entered into the era of the market economy (zah zeel), while healthcare has entered an era of ‘development’ (högjil). Gynaecology is one of the most privatised areas of medicine in Mongolia, meaning that many private clinics are registered as gynaecological practices of sorts, only exceeded by dentistry and blepharoplasty107. While in the socialist Semashko model of medical infrastructures in which the presence of in- patient facilities was central, the model itself became one of the core drivers behind the later reform as such in-patient facilities and the overall medical infrastructure were considered too expensive for the state to maintain when Mongolia became a democracy in the early 1990s. Since then, there have been various reforms in support of privatisation and public-private partnerships, driven by ‘cost- effectiveness’. Sheila Smith and Joyce Lannert (1995: 79) report that of the previously existing 320 maternity hostels, by the mid-1990s 50% had closed ‘since they used to be maintained by the agricultural farms and cooperatives’. This meant women had to wait to give birth at home, and not all women in remote areas made it to the hospital in time for the delivery; as a consequence, the number of home deliveries increased. Furthermore, they linked the increasing abortion numbers with the rising mortality rate, as abortions were used ‘as a form of contraception in the absence of access to other means’ (Smith and Lannert 1995: 80). While health sector expenditure increased108, the number of ‘treatment events’ in healthcare and their quality decreased: for instance, ‘the number of hospital admissions fell from 584 000 in 1988 to 493 000 in 1991, and outpatient consultations fell from 16.4 million in 1988 to 12 million in 1991’ (Smith and Lannert 1995: 80). Doctor consultations per person also decreased (Smith and Lannert 1995: 79).

107 Cosmetic eyelid surgery. 108 Between 1980-1990 the health sector took up ‘between 7.5 and 8.5 per cent of total government expenditure’ and ‘6.7 per cent of GDP in 1990’ (Smith and Lannert 1995: 77). During the transitional years the expenditure did not decrease, however, and by 1992 it had risen to 14.4%, which was ‘associated with a sharp decline in real levels of expenditure’ (Smith and Lannert 1995: 77). 166 In 1994 compulsory health insurance was established, financed by tax on salaries. In the making of ‘vulnerable’ groups, the insurance of ‘children under 16, students, pensioners, mothers with children under the age of 2, people with legally-recognized disabilities, and military personnel’ was covered by the state (Bolormaa et al. 2007; Janes et al. 2006). Over the years there have been several revisions to the health law, particularly concerning funding and health insurance. The first steps in the healthcare privatisation of service providers were taken in 1997 and the licensing and accreditation system was established between 1998-2002 (Bolormaa et al. 2007), although in 1995 there were already 238 private hospitals and clinics in Mongolia (Health Sector 2003 in Tsolmongerel et al. 2013: 79). Social sector privatisation guidelines were passed by the State Great Hural in 2001. By 2003, there were over 840 private health facilities registered in Mongolia, mainly private pharmacies, and by 2011 the number had increased to 1184 (MOH 2011 in Tsolmongerel et al. 2013: 22). In 2008, a government regulation outlined which private healthcare providers could be funded from public funds; consequently, in 2009 all private hospitals were supposedly evaluated and the ones that passed gained the right to receive public funding and increased reimbursement (Tsolmongerel et al. 2013: 26). Early on, public-private partnerships were seen as being at the core of reform due to their assumed job-creating capacities both by international organisations and the government (see World Bank 1996: 50). This point of view was enforced by international institutions, such as the World Bank, Asian Development Bank and the IMF, which pressed for quick reform and the privatisation that has been ongoing ever since. After the collapse of the socialist economy, these institutions applied structural adjustment programmes in order to reform the market, improve cost efficiency and ‘promote market fundamentalism’ (Pfeiffer and Chapman 2010: 150). While the goal has been to improve the quality of healthcare services and the targeting of vulnerable or ‘poor’ groups, research has found that, in fact, these programmes can be vulnerability-inducing for the groups they originally set out to reach (Thomson, Kentikelenis and Stubbs 2017). In Mongolia’s case, the various facets of these programmes and their

167 temporary nature have contributed to the insecurity of various services and experiences of healthcare as untrustworthy. Meanwhile, doctors’ work in the ‘public’ sector and salaries have been directly bound to these structural adjustment programmes as they cap state budgets and public spending, and hence the salaries of those working in the ‘public’ sector: the IMF and other institutions’ 2017 bailout package (Chapter 4) also involved this capping (see Figure 10).

Figure 10. Medical staff protesting in front of the Mongolian government building for salary increases in spring 2018. The protest also took to the headquarters of the IMF Mongolia office to address the caps it had set on public spending as part of its bailout progamme. Photo: author.

For instance, the establishment of family clinics was at the core of the Asian Development Bank-funded and ‘technically supported’ healthcare reform which accelerated from the late 1990s onwards (Janes et al. 2006). The family clinics are financially considered private practitioners, although they are restricted by the state so that their services would remain available to the poorest. Family doctors neither charge patients for services nor sell medication. However, currently family clinics tend to have a notoriously 168 bad reputation, with exceptions in districts where the staff is more permanent and the queues are shorter. The main complaint patients or potential patients make against family clinics is ‘incompetent’ staff: that young and inexperienced doctors who have recently finished the education training required to work in the position for a few years before specialisation do not have sufficient expertise; and that due to staff shortages, there are also less consistently practising and competent doctors employed at these centres. Yanji, a mother of two in her mid- thirties living in one of the more remote ger districts, explained that the main problem is the staff: namely, their poor ‘quality’. In her district the doctors change a lot, and she was reluctant to go there except when her younger child got sick and she needed a reference for the higher-level state clinics, the pediatricians of which she trusted more. Mostly, from the patients’ point of view, the importance of the family clinic rests in referring patients to specialised clinics at the state level. Some of the criticism levelled at the family clinics draws on the lack of clarity as to which medications are available for doctors to hand out to patients free of charge. Hulan in Chapter 4 suggested that pricey vitamins, which are available in some quantity, are either sold or given to acquaintances; Undra109 suggested that while contraceptives used to be available at family clinics a few years ago, they no longer are – ‘only rarely can you get them from the family clinics’ – but she managed to acquire hers through a contact who works at the district clinic. Because it is mostly suggested that doctors share these with their acquaintances or sell them, this opens up the supply of various free medications as a field of speculation. However, many of the medication supply programmes funded by the UNFPA and other international organisations have come to an end. This leads to the second and often overlapping occurrence, which as a form of privatisation escapes the formerly expected locations and forms of governance. As I have discussed in Chapter 4 concerning the excessive reform of child benefits, it is also the case with healthcare that, together with international involvement, the sheer scale of reform has become a

109 See also Chapter 7. 169 source of insecurity and vulnerability for some, for it is hard to seek and find accountability. It is difficult to keep up with what is really free of charge, who owns and manages the resources and who has the right to disperse them, characteristic of usufructuary forms in ‘absolving responsibility and blurring intentionality’ (Empson and Bonilla 2019). One example is how women experience the lack of access to prenatal vitamins and contraceptives that used to be handed out for free and which they thought they should have had free access to but did not, which they often attributed to the doctors and other medical workers. Rather than a managed process led by any specific institutions or towards any specific goals as a state of healthcare, after the collapse of socialism many of the post-socialist states have become subjected to an open-ended becoming, either towards relative (e.g. vis-à-vis Europeanness, see Dzenovska 2018) or absolute economic, political and moral goals (see Gal and Kligman 2000: 11-12). Buyandelgeriyn (2008) has critically approached the notion of post-socialism in her article ‘Post- post-Transition Theories: Walking on Multiple Paths’, arguing that the current moment is not a bridge between socialism and capitalism, but instead a dynamic and uncertain time that is not in evolutionary development towards ‘something’, a goal (potentially ‘capitalism’). She writes that:

the double loop of post-post-transition moves us beyond predetermined ideas of transition to more nuanced and unexpected newly emerging practices and ideas. /---/ Thus post-post-transition theories are based on the exploration of the experiences of the peoples who accommodate, resist, interpret, and shape their lives in relation to, and despite, the failed transitions brought upon them. (Buyandelgeriyn 2008)

The privatisation of healthcare, in fact, has slipped out of the reigns of policy and reform and takes place in various locations within and around what could be seen as ‘public’ or ‘private’ healthcare. Doctors send patients from state clinics to private facilities, often owned by

170 themselves, to get tests or to visit them for services that were unavailable in the public sector (or interpreted as such). It is often the case that gynaecologists at the state clinics do not have ultrasound available, so patients would need to access this at another location and pay for it. Of course, this is not where payments ended. There are also various out-of-pocket costs needed even in the state hospitals, such as a fee for the stay. There is no clear job division between medical staff, mainly nurses, and family members in state hospitals that are understaffed. The care by no means falls to the medical, but rather is provided primarily by the family members of patients who are unable to carry out these tasks themselves. This may extend to cleaning shared spaces. Therefore, hospitalisation may involve extensive input on behalf of the family both with regards to time and other resources, which is likely to put a particular strain on those visiting specialised hospitals from outside of Ulaanbaatar. It is not completely clear what is and is not included in the health insurance owing to the ‘privatisation’ process where services are outsourced to private providers or public-private alliances.

The fructus

‘State’ gynaecologists’ work in Ulaanbaatar could hardly be described as easy and disproportionately profitable (as compared to other jobs); however, through various means and mediations, the job at state- sector clinics and hospitals could be sourced for fructus – benefits – beyond its usus form. I am proposing that there are multiple forms in which fructus arises for the state clinic’s job position of gynaecologist, and these are not limited to monetary or necessarily immediate material gains. Fructus may manifest itself also as seniority and networks, or what is considered as control over one’s work practices.

171 Payments, attention and care

Needless to say, a large part of the earnings of those who are employed both in ‘public’ and ‘private’ practices comes from the ‘private’ aspects of work: this can occur as supplementary work in a non-state facility; nesting whole ‘private’ services like abortions in ‘public’ facilities that are not authorised to carry out abortions; or being subsidised by patients for aspects of the service that ‘the state’ is not considered to cover, such as care and attention. Without having established a prior relationship, women visiting a gynaecologist or another doctor experience the service at its minimum – in its usus form. This does not necessarily mean the encounter would be emotionally neutral, however. Like Hulan pointed out in Chapter 4, doctors are not considered the ones to provide consultations or advice, but the mitigation of their potential anger also had to be taken into account. Anger on the part of doctors, as well as the lack of care and accountability, were the core affective and emotional aspects of doctors’ work that were seen as being problematic when it came to their attitudes in the ‘public’ or ‘state’ sector, beyond the practicalities like extensive queues. Waiting in the ‘public’ sector is somewhat symbolic of patient-doctor relations as a manifestation of power relations110. More often for doctors than patients, the withdrawal of attention and a lack of care are also attributed to working beyond capacity or the workload (achaalal). These emotion-related and affective aspects shaped the differences between the ‘public’ and ‘private’ sectors, although these overlapping spaces often involved the same doctors. For instance, Suva111 shared a story of her miscarriage with me which suggests the level of distrust of doctors’ diagnoses and the measures they suggested to have been necessary. This already difficult situation was made more problematic by the anger and scolding of the doctors:

110 Waiting in other contexts was also a form of punishment and an establishment of a power relation, as one of my friends explained after she was summoned to a corridor next to her superior’s office only to wait there for an hour or two after a misunderstanding at work. 111 See also Chapter 3. 172 At the time of having a miscarriage I wasn’t aware that this is what was happening. Maybe a month passed since I first had had spotting. And then I went to the hospital, it was terrible, I was scolded by the doctors a lot. As a result of getting the ultrasound I got some hopeful news, so I wanted to keep the baby. It was impossible with all the yelling there. I had shed a lot of blood, so they wanted to clean it out, but after seeing the ultrasound I wanted to keep it for another day. So my husband who works at the National Emergency Services came directly from work and took me to doctor Enhtuya’s112 clinic. Then we waited for a day. The fetus’s heartbeat had stopped [so eventually they induced the abortion], however, the private clinics listen to the opinions of the patients.

It is common to shift between private and public clinics for diagnostics, diagnosis and treatment. While the diagnostics and the following diagnosis (which does not always need to be forthcoming) belong to the private clinics as these tend to require longer time and ‘care’ to be achieved, treatment itself would be too costly to be carried out in the private realm, particularly if it involves hospitalisation, which many of the diagnostic clinics also do not offer. Uka describes how they sought treatment for her younger sister, who had given birth to her first child in the countryside where they were from and to her second child in one of the district hospitals in Ulaanbaatar. Uka had planned and taken steps to secure much of the treatment and attention that her sister needed at this vulnerable time in Ulaanbaatar:

Right after giving birth my sister was discharged from the hospital, the next person was already getting ready to give birth in her place. /---/ After she gave birth her breast was hurting a lot, so we were hoping that this was because she had been expecting presents, so we all gave her presents,

112 Name in the quote changed. 173 but it still didn’t get better113. We then visited a private clinic and found out that the blood was not fully drained from the uterus and it was affecting the breasts. Secondly, the huge discharge of hormones following the birth was affecting her emotions. I went to the private hospital with her, she had a fever and when the doctor checked the ultrasound it looked really black. We then immediately went to the doctor who was the head of the district hospital – we had two acquaintances in the hospital – and they hospitalised her then to give her treatment. Also, very funny... When they were draining the blood, it caused internal injuries, which caused a discharge of the blood vessels and damaged the wall of the uterus. She almost went unconscious. The nurses were acting ignorant when I told them she was bleeding, she was bleeding a lot as if she was giving birth, she was wearing a big diaper. Then again, we talked to the doctor because the nurses and the shift doctors were not being caring (toohgüi), but the doctor we called was the head of the department and she called the shift doctor in order to give [my sister] medication. The next morning the actual doctor whom we knew arrived. /---/ We knew that person, and if we hadn’t, she would have died with a baby less than a month old. /---/ The countryside is different. The oldest one was born in the countryside in the province centre. There was no bureaucracy, nor queues, psychologically a different experience. The person who delivered the baby was a relative, maybe that’s why it felt that way. I often think that when I get pregnant, I will get closer to my mum in the countryside.

In other words, care is neither considered to be nor often experienced as part of the public healthcare services; instead, steps need to be taken to continuously secure it.

113 Pregnant women should receive gifts to prevent various complications, in this case manifested physically and retrospectively mitigated. 174 While corruption is an emic concept among many others concerning gifting and informal payments (see Sneath 2006), when connected to various healthcare services it falls short in addressing the facets of gynecologists' work as well as patients’ experiences in today’s Ulaanbaatar. The wealth of terminology in Mongolian indicates that what in English would simply be called ‘bribery’ or ‘corruption’ is a much more complicated and plural field in Mongolia, and not all contributions, monetary or otherwise, are seen in a negative light (Sneath 2002b; Sneath 2006). Like Uka observed: ‘In public hospitals, the salaries of doctors are low, and it won’t even cover the fare of the bus, so how could the doctor possibly smile and provide the service calmly?’ Hahuuli can be translated as ‘bribery’, ‘an unambiguous bribe’, which is giving something to someone as thanks for solving a personal problem (Sneath 2002b: 91). David Sneath (2002b: 85) has pointed out that corruption ‘cannot be treated as some sort of human universal’, for it ‘appears as a category in historically and culturally specific discourses of administrative legitimacy’. For this reason, it needs to be understood in relation to forms of gifting, expressions of respect and gratitude: ‘it is important to regard “bribery and corruption” in the wider context of reciprocity and obligation’ rather than assume all material transfers are transactions in order to recognise that some may be ‘enactions of aspects of persons and roles’ (Sneath 2002b: 86). One of the more common terms in biomedicine for such informal payments is setgeliin yum or ‘something from the heart’. It is paid, for instance, prior to surgery to several people like administrative staff, nurses and, most importantly, doctors. While setgeliin yum was described as a bribe, linking it to negative connotations for some, these matters of health were deemed too important to commit to ‘ethics’ or ‘right conduct’, even if this was nevertheless reflected on. Chimgee, who made such a payment to the doctors carrying out an operation on her mother to remove her ovarian cancer, explained that surgeons have ‘learned to take’ this money and linked this to their otherwise low salaries; she understood that providing this money was a must. The term was also used to address payments at childbirth.

175 Hulan (Chapter 4), who was preparing to give birth soon, explained that ‘bribes’ (gar tsailgah) are always given: ‘I would also give it to the doctor once I give birth.’ It seemed to vary whether these payments were made before or after birth, but Hulan said she was likely to give it when she was leaving the hospital: ‘Some doctors also don’t value the gifts. The care given by the nurses is usually better if the liking is established (taltai baival) prior to giving birth. Otherwise, there won’t be any care. I heard that they don’t even care when the woman is in pain, suffering.’ The sums of money put towards these payments varied hugely. A mother of three, whose family belonged roughly to the middle-income group, said that she and her husband has paid 300,000 tugrik114 for each birth. She also viewed this payment as showing appreciation for the work the medical staff did in acknowledgement of their otherwise low income. However, another woman of a similar income background thought this to be too much, saying that everyone paid as much as they could. The sums also seemed to vary according to the more specific conditions of giving birth: those women who were deemed high risk, like those who were considered ‘too old’ to give birth, were likely to make higher payments to secure care or mitigate against prejudice. In his study of more specific vocabularies behind such informal practices, Sneath (2006) finds that the expression gar tsailgah or ‘hand hospitality’ is ‘a positively-valued offering that confers honour on those who give and receive it’. While these enactions can materialise certain relationships (Sneath 2002b: 86, 91), in biomedical reproductive healthcare these payments can also be a means of establishing familiarity and relationality, ‘reciprocity and obligation’, without which care would not manifest itself in the situation where it is most needed. Therefore, these payments can also be seen as something on which someone’s life and death depends, mostly because creating and maintaining these relations are beyond the role of ‘the state doctor’s’: in other words, their work does not automatically include affective add-ons to the job such as care or attention, which need to be sought through other means.

114 Equivalent to 109 euros, which was about half of the doctor’s official salary in the state sector. 176 When visiting a private clinic, there was a much higher chance of establishing an acquaintance compared to state clinics, because the information and recommendations to trusted and preferred clinics spread mostly along connections, while state clinic appointments were made according to registration to a municipality. Suva explained further:

The private clinics work for their income from us, so they treat us much better. In the state hospitals the service is a little moody and frustrated, they’re only thinking about themselves. They don’t listen to people. Whatever our goals or interest are, it doesn’t matter to these people. It’s just about themselves.

Dr Gerelsuren’s description of work in a private clinic was hugely different from her current full-time job, where her workload was so heavy that she occasionally did not have time to eat lunch:

Everything’s done as one wants in a calm manner. Not all people visit one practitioner, you visit only the person whom you choose yourself. Therefore, the examinations are carried out after booking a time as suits one. Hopefully things will become more like this.

Dr Gerelsuren suggested that in her newly established private clinic she would also see people who could not afford some services, and that if all doctors would follow this conduct, the situation would improve. However, I met no women who have accessed a service free of charge at a clinic where the doctor was not their close connection or relative. I was repeatedly told by doctors working in the private sector that their work allowed them to adjust the prices and provide services even to those who would not be able to pay the full price. Although during Dr Gerelsuren’s career attitudes towards going to the gynaecologist have changed a lot, she acknowledged the existence of a group of people who are unable to visit the doctor because of the cost. This is similar to the costs of giving birth where a family would pay ‘as much as they could

177 afford’. Usually this was pointed out as a positive side of private healthcare, either by the doctors or the clinic owners, in order to suggest that they also assisted people of lower income in paying for the services that they needed. However, this also involved judgement and the ability to make decisions as to who essentially deserved treatment and under what conditions. For doctors, working at private clinics can mean setting one’s own standards and being able to provide a quality service according to these. Beyond the cost, this involved other aspects like the speed of service and what Dr Gerelsuren described as ‘explaining everything really well to the patients’. It also included forward-thinking ideas about new technology and means of treatment that were not available in state clinics.

Seniority and networks

Dr Gerelsuren noted that she could retire straight away after 30 years of work, but she would not do that because of the people (ard tumen115), although establishing – and maintaining – a private practice was a complicated matter as the requirements are demanding. For this, an extended time plan was necessary and the medical space needed to be distinct from that of the state facilities, along with other more specific demands. There had to be funds to achieve all this. To be able to open a private facility, the doctor would need to have extensive experience. However, as with any bureaucratic process, the lengthy guidelines provided by the Ministry of Health were open to interpretation and updates. As a result, the process of proceeding with this, like other forms of work beyond biomedical bodies, depended on broader connections, which needed to be maintained and established through a long-standing presence in the sector or affiliations with people shaping it. However, Dr Gerelsuren disapprovingly pointed out that young doctors have started opening clinics, which was due to their relations with those in places of power. Sneath (2002b: 96) suggests that ‘in some areas – such as customs, business licensing, and health and safety inspections, we see the sort of

115 Also ‘public’ or ‘nation’. 178 bureaucratic appropriation that can be described in terms of rent-seeking officials who use the quantity and complexity of state regulations as a means of extracting payment from individuals and businesses’. One of the core issues arising from the enforcement of such rapidly changing regulations is that they remain open to interpretation due to inconsistency in the staffing and long-term work at state institutions. Indeed, the matter of additional payments or favours to get things done is relevant on both sides of the usufruct: concerning the additional earnings in the salaried position, as well as the establishment of private clinics when doctors seek progress with the requirements needed for this. The medical, however, was not only limited to the job of a doctor, but also involved other lines of work such as research and administration in ‘public’ or international offices, where the establishment of international networks and the ability to carry out research were resources in themselves. This became obvious to me when I attempted to conduct my ‘research’ ‘formally’, although I did not have senior medical affiliations in the field at the start. My attempt to retrieve data from one of the state institutions became hindered by the question of ‘who is your teacher (bagsh)?’, and my non-medical affiliations mattered little. Although I was initially told that accessing this statistical dataset would be fine, the conversation with the female department head faded into emails, text messages and later ghosting on her part. I was not completely devoid of contacts, however. Before arriving in Ulaanbaatar for fieldwork, I had been in touch with Dr Narantsetseg, a member of the teaching staff at the Mongolian National University of Medical Sciences (MNUMS), a gynaecologist in one of the district (düüreg) hospitals and, as I later learned through a common contact, an owner of a private clinic as most senior doctors were. I met Dr Narantsetseg in person and we discussed our overlapping interests. She offered to help me in acquiring an ethics permit to have access both to the district hospital in which she was working and the family clinics, although I had initially set up the meeting in order to obtain general information about the field. This drew me into a lengthy, confusing process and required me to provide materials that I was somewhat reluctant to hand over to Dr Narantsetseg for my own unjustified suspicions. These owed

179 to my previous experiences briefly working at another university in Ulaanbaatar and my friends’ stories of struggles with academic seniority scales, which involved the publishing of their work by their superiors without consent. Due to her seniority, it was clear that time was a resource to be managed by Dr Narantsetseg. I put together several revised lengthy research proposals adjusted to suit a readership who were not familiar with ethnographic methodology and I attended meetings in the hospital and the university to discuss our strategy with Dr Narantsetseg. I also sought to find out about the situation with the persons we considered favourable or not for their interests concerning Dr Narantsetseg and her friends’ positions – meaning the politics within the university. Someone died; someone went to the countryside; someone had changed their position. This meant either waiting for or seeking out another person to approach with this joint project. Being able to carry out research was not only to be monitored for ‘ethics’, but also was a resource for career advancement and was managed accordingly. Five months after we had embarked on seeking the approval, we found out two things at two separate meetings. Firstly, although Dr Narantsetseg had put considerable pressure on me concerning the need for a memorandum of understanding between our universities over the past half-year, and I had with corresponding consistency underlined that this was not possible from my university’s end as was made clear to me, the document proved unnecessary. Secondly, at another meeting with a more senior staff member, we found out that it was no longer possible to get the ethics approval from the university, although another official had confidently advised us earlier to go forward with the internal boards. This meant approaching the Ministry of Health with this, which was as chaotic and re-organised as any state institution, regardless of its size or area of work, following the appointment of the new cabinet in October 2017. Dr Narantsetseg kindly took trips to the Ministry of Health, returning unsure of who was responsible for the ethics approvals; presumably the situation

180 was the same within the Ministry of Health itself. ‘We don’t know anyone there,’ was the conclusion Dr Narantsetseg made.116 As Empson and Bonilla (2019) point out, the ‘limited and contingent access to resources, objects, and forms of wealth define contemporary capitalisms, generating new patchworks of association between those who own, those who possess, and those who manage the relations in between’ (Empson and Bonilla 2019). In a similar vein, doctors’ work beyond the usus of working with patients and their bodies drew on their primary job status in the first place, and this extra work needed to be advanced and managed through this securing and locating of status. Doctors’ work, together with further relation-making and maintenance, opened up other opportunities such as research and administrative offices or establishing private practices, although this was not seen as a given.

Conclusion

In this chapter I have suggested viewing the ‘state’ gynaecologist’s job as usufruct for its temporary nature – there is a beginning and an end to holding the post. Therefore, I covered ‘gynaecologist’ or ‘doctor’ as a type of inhabitation of a title, what this involves and what can come in addition to it. Reviewing the development of the role of the ‘doctor’ in the first place and drawing on what the job does and does not entail, I suggest that this form of resource, which essentially is ‘state’ ‘property’, is usufructuary. This all suggests that the governance of biomedical healthcare surpasses its biological connotations. The definition of usufruct offered by Goldie proposes that when taking the fruits of property not owned by oneself, this property is neither destroyed nor is its core character altered (Buckland 1963 in Goldie1985).

116 The cabinet of the previous Prime Minister, J. Erdenebat, was being reshuffled as U. Khurelsukh took over. Consequently D. Sarangerel took over the ministerial position of the Ministry of Health from A. Tsogttsetseg, resulting in the characteristic reshuffling and reappointment of various official positions at the ministry and at the relevant university alike. Having taken over the leadership from another female health minister, Tsogttsetseg was initially one of two women in the new cabinet, until 2019 when the Minister of Education, Culture, Science and Sports, Ts. Tsogzolmaa, was replaced by a male colleague, Yo. Baatarbileg. 181 What maintains the usufruct in its form is not only how doctors conceptualise their work, but perhaps even more importantly, how it is also maintained as such by various others. Structural adjustment programmes have capped the salaries that doctors can earn from the state. Also, doctor’s jobs as such are still bound to the ‘state’: while there are a few who go from graduating from their university medical degree to the private sector, this is rather exceptional. Instead, doctors’ work remains linked to how they are able to facilitate relations with the ‘state’ if they want to proceed in their career. At the start, before specialisation, young doctors are required to work in family clinics. Beyond healthcare, ‘usufruct’ could be a way to address a broader shift concerning the meanings of, and attitudes towards, ‘state’ jobs in and beyond Mongolia. It has been observed that the ‘electioneering landscape’ is increasingly shaped by the economic (Bonilla and Shagdar 2018). Here, job titles manifest as ‘a kind of material fetish - magical objects conveying power in their own right, entirely apart from the real knowledge, experience, or training they're supposed to represent’ (Graeber 2015a: 22). Indeed, it could be asked in this context whether there is any ‘state’ to be found or if it is a construct created by specific individuals towards their own authority (Herzfeld 1993: 1). Overall, ‘public’ sector jobs have become sites of ‘harvest’ for many due to their low salaries and the work’s temporary nature owing to the four-year election cycles. The selling of public office indicates the degree to which this has been established as a temporary site of gain. For instance, as part of what became known as the ‘60 Billion Tugrik’ case in Mongolia, it was alleged that public office positions were sold prior to the parliamentary elections in 2016 to finance the election campaign of the MPP (Sambuu and Menarndt 2019; Uul.mn 2018), which won the election. This carries very clear parallels with how land plots – while de jure owned by the state – are sold, albeit for longer durations. Although it is difficult to verify to what extent the ‘60 Billion Tugrik’ scandal was itself political badmouthing induced by other political players, the existence and breadth of the discussions indicated not only discontent with the level of corruption, but also the recognition of how and to what degree the jobs in ministries and other, even small, state-run institutions have become

182 valuable in democratic Mongolia. Indeed, the temporary arises as defining these economies and politics, which are not devoid of emotion and affect. In this chapter I also suggested that while ‘corruption’ and ‘privatisation’ are relevant as far as they are vocabularies used by those involved, the concepts fall short of encompassing all aspects of doctors’ work. It is this particular form of governance that contributes to abortions being legal yet informal: the economic, historical and affective conditions shape biomedical reproductive healthcare in itself as transitional on the public-private/formal-informal scales. Also, historically healthcare has been shaped as an inherently gendered sector, where work can never fully be monetarily renumerated because it involves something too valuable for this to be achieved. At the same time, together with sectors such as culture and education, salaries remain relatively low. In the following chapter I take on another term that has remained particularly prevalent: informality. Focusing on the informal abortion pills market and abortion specifically, I explore infrastructures of informality where gender and keeping certain spaces apart from others shape people’s health outcomes.

183 Chapter 7. ‘A Little More than a Period’ at the Market: Infrastructures of Informality

People with pseudonyms in this chapter

Baigalmaa egch A retired vendor of abortion pills; egch or ‘older sister’ is an appropriate respectful address to a woman obviously senior to the addresser Gaya A gynaecologist in her twenties Undra A woman in her thirties who shared her reproductive health history with me

Introduction

Belonging to the lowest income group, the retired abortion pills vendor Baigalmaa egch now sold various edible and inedible items; the business model rested on these being neither acquired nor sold in bulk. She sat on a tiny stool by her small portable counter in the blazing sun at a spot where various buildings congregated into a stuffy corner without the slightest breeze as masses of shoppers pressed past on this busy street close to the main market. ‘Who can judge us? We are selling these to live,’ Baigalmaa egch said about the informal abortion pills market as we squatted by her stand of individually wrapped pieces of gum and hard candy. Morality simply had to take a back seat to matters of livelihood and the conditions that shaped them. Morality has often been at the core of studies of abortion. It has been suggested that moral experience ‘is always about things that are most at stake for us when encountering the very real dangers of the social world’ (Kleinman 2005: x). But these ‘things that are most at stake for us’ (Kleinman 2005: x) are not always about, or at least are not limited to, morality. Engagements with abortion in Ulaanbaatar arise as kaleidoscopic everyday practice and work beyond the predominant motivations of or reflections on morality, instead involving specific

184 ‘priorities, social pressures and values’ (Humphrey and Mandel 2002: 12). As I aim to show in this chapter, informal abortion in this context is strongly rooten in the overall healthcare system and various, often socioeconomic conditions. This is to add to research in contexts where informal and unsafe abortion comes about from the top-down legislative ban on induced abortion (see Kligman 1998). In this thesis, particularly in Chapter 2, I have looked at abortion as a plural symbol; how and what it stands for in various spaces; and how values and notions are intertwined with abortion as symbol – that is, when abortion stands for other things or relations. I have also discussed various aspects of the medical, motherhood and sexuality, suggesting answers to the question of why abortion in Ulaanbaatar is overwhelmingly informal although legal. It is not coincidental that reproductive healthcare, which in Mongolia’s case has almost entirely focused on women, is as gendered and non-formal in its specific facets to the degree that it is. I attribute this to the historical shaping of ‘reproduction’ as inherently linked to women, their bodies and the children they are expected to produce for the nation as well as to the broader privatisation histories and ongoing efforts of ‘reform’117. This chapter largely explores abortion as a non-symbol and seeks to answer the question of what maintains the gap between abortion’s symbolic properties and how it is experienced, sought and provided. In the preceding chapters, I have tried to indicate how in the making of abortion as a symbol of biznes, this dichotomy collapses, as does the public-private divide118. However, the informality of reproductive healthcare and abortion arising here, and the informality in other areas of life or economic sectors, however abstract, are not informal in the same ways: informality is neither a flat plane nor in a binary relation to formality. Nor is it analytically void of use. Instead, what surfaces as relevant here are the forms of informality that relate to one another, and which are at the core of understanding abortion as legal yet unsafe. ‘Informality’ alone is an inadequate umbrella term to account for the gendered, economic, political, moral and other aspects of the

117 See Chapters 2 and 6. 118 See Chapter 6. 185 infrastructures involved. What I argue here is that how reproductive healthcare, particularly abortion, is experienced by women does not concern interactions between formal-informal, but rather between different forms of informality. I propose that the reason for this rests with the distance between abortion as everyday experience and abortion as a ‘formal’ or politicised nationalist discourse. Instead, reproductive healthcare services and economies in Ulaanbaatar arise from different forms of informality and the encounters within these spaces, which in themselves involve specific sources of vulnerability, unpredictability and insecurity. One such space was the market where Baigalmaa egch worked. The legitimisation of these ‘informal’ services requires specific interactions and networks to secure their trustworthiness, and hence safety.

Dying of informality, dying without sociality?

The issue of the widespread availability and use of abortion medication – ones that Baigalmaa egch had sold – erupted in 2014 with a public scandal that was followed by an attempt at law enforcement. A woman had been taken to a state hospital in a serious condition after having self-medicated with abortion pills. Unlike what Nancy Scheper- Hughes unfolds in Death Without Weeping (1993), where the loss of life was accepted and to be expected, there was a sense in Ulaanbaatar that responsibility for both abortions and the deaths of women brought about by the consumption of abortion medication had to be placed on someone. Yet, there was little consensus or continuity regarding on whom or what that blame should be placed, indicating the fragmentation of governance surrounding reproductive health and the interlinked economies. Following the publicity surrounding this hospitalisation, other women came forward with complaints regarding informal abortion medication. As a result, the trinity of Ulaanbaatar City Health Department, the Specialised Inspection Agency and the Bayanzurkh District Police Department united their powers and raided Narantuul market, the largest in the country, resulting in the arrest of a saleswoman

186 and the confiscation of her drugs (Ayanga 2014). It was reported that ‘Chinese’ abortion medication119 (mifepristone, misoprostol and/or oxytocin) was sold at market for 40,000 tugrik120 (Amartuvshin 2012; Ayanga 2014). It was also suggested that out of the 86 women who were admitted to maternity hospitals due to complications of medical abortion that year, 63 had bought the unregistered abortion medication from the market (Munkhtsetseg 2014). Several years later, in 2016, Narantuul market was still present in media discussions as a problematic location for the sale of the medication. The ‘medication problem’ was linked to the statement that an average of 400 women per year visit state clinics with complications induced by taking the medication (mnb.mn 2016). Drawing on the statistics retrieved from the Ulaanbaatar City Health Department, ten of these women underwent hysterectomy and oophorectomy121, and in 2014, five women died as a consequence of taking the medication (mnb.mn 2016). At the time of my fieldwork it seemed the medication was stored at other locations and available to be ordered from saleswomen whose business focused on the retail of other goods, as well as the members of their networks who took frequent trips to China to acquire stock, as became apparent to me and a local friend of mine when seeking an entry into the topic at the market. Between women in specific spaces, the secrecy surrounding this market and abortion overall was not particularly great, which was also indicated by the fact that in 2014 a number of women came forward with complaints regardless of the fact that they had acquired the medication informally for self-medication. While abortion advertisements have disappeared from print newspapers, it is not uncommon to see women asking on Facebook groups for suggestions: for example, ‘sorry, is there a good medication for being 14 days pregnant?’, as one woman in her twenties from a personal account asked. In responses

119 The abortion medication is known as zulbah em or ‘miscarriage pill’, ür zulbuulah em, ‘medication to miscarry the seed/child’, and hyatad em, ‘the Chinese medication’119, owing to its origin of importation. I am using the term ‘abortion pill’ in the text when I am sure that the medication involved pills rather than injectables or both. 120 At the time equivalent to about 15 euros. 121 An operation to remove ovaries. 187 visible to the group members, she received a few angry-faced emoticons and a frustrated-sounding reply of ‘for what do you need a good medication??’, but the post was not deleted and stayed up for months. The market has never been the only site for the purchasing of abortion medication, but it has certainly drawn the most attention due to its somewhat tangible networks, not to mention the physical location of the trade. Baigalmaa egch happened to be one of the people prosecuted when the informal abortion medication issue caught the media’s attention, adding another layer to the public moralised and politicised discussion of abortion as ‘business’, criminalising healthcare staff for such activities122. Baigalmaa egch was arrested and had to pay a steep bail to be released as part of the sentence. Some ten people were prosecuted, as they, according to Baigalmaa egch, were played against one another for reduced sentences, getting her in trouble as well. Shaking her head in disapproval of how events had transpired, Baigalmaa egch was convinced that it all had only happened because the woman in question, whose critical condition had made the abortion medication’s illegality apparent, had in fact not bought the pills herself but had sent someone else, and had consequently taken them three months past the term of pregnancy during which the pills were safe to use. Baigalmaa egch indeed possessed very detailed knowledge of the pills and under which conditions they were to be consumed to induce an abortion. Furthermore, the pills had started to come with instructions in the traditional Mongolian script, for they were bought from Ereen, an Inner Mongolian city in China that borders Mongolia. Baigalmaa egch’s comment suggests that in relation to abortion and the market for abortion medications, infrastructures of legitimisation and security exist – similar to what the Ulaanbaatar City Health Department, the Specialised Inspection Agency and the Bayanzurkh District Police Department set out to stand for in 2014 – but at these markets these infrastructures tend to be people, which require certain interactions to secure information and ensure the safety of an abortion.

122 See Chapters 2 and 6. 188 Infrastructures of informality

The notion of ‘people as infrastructure’ focuses on the activities of people, here that of women, and foregrounds economic collaboration among urban dwellers, particularly those who are marginalised yet are still immersed in the life of the city (Simone 2009; also see Malasan 2019). While this chapter will not offer a deep study of the urban, it is very much rooted in the ‘social infrastructure’ that is made up of personal relationships and everyday struggles (Simone 2009; Malasan 2019), which, as became apparent to me, shaped women’s reproductive lives in Ulaanbaatar. It is how these particular forms of ‘people as infrastructure’ come into encounters with other forms of informality that specifically shapes reproductive healthcare in Ulaanbaatar today. The notion of ‘people as infrastructure’ is largely separate from ideas of ‘informality’ and ‘corruption’: the latter two can be seen in their essentialised form to appear in the collapses of the formal (even if only imagined) and the informal, as is the case with public hospitals and clinics. This form is often seen as the overarching ‘informality’, which seems to exist on a flat plane, extending into all parts of the society. Instead, here this gendered reproductive space seems to arise as part of ‘people as infrastructure’ and is rarely defined by the institutional, although it does at times come into relations and dialogue with other spaces of informality. For the task at hand, it would be helpful to abstract three levels of informality. The ‘formal’ does not only exist as an analytic category: there are ‘formal’ institutions, like the State Great Hural, that are seen as needing to be comparatively free of corruption, even if only imagined as such123. Government politics being infused by ‘corruption’ is an ongoing discussion in Mongolia, both publicly and privately. Formality can also be expected to occur through the ‘international’ or high-end services – such as the expensive clinics and hospitals in Ulaanbaatar, like SOS Medica or Intermed – that none of my connections was able to visit, although they were aware of the existence of these institutions. Medical services abroad were similarly seen as ‘formal’ for

123 Corruption in state politics is linked to business and the few powerful extended families who seep through both. 189 the presumed lack of ‘corruption’. For example, one of my interlocutors sought a medical examination from abroad in support of her assault case because she did not trust the local services, which relied on one state ‘police hospital’ to provide the necessary paperwork to go forward with the prosecution. However, this hospital’s approach was seen as ‘who gets there first’ when it came to making a case and buying alliances, unlike foreign medical services. The ‘formal’ was often wrapped up in nostalgic memories of institutions from a different time, whether the lawful historical Mongol state or the socialist era. Also, as I discussed in Chapter 5, the formal and ‘control’ were desired by some young adults in Ulaanbaatar, who discussed and reflected upon the overwhelming informality and unreliability of sex education. The state’s imagined part in this was still sought but not found. At times the formal took on connotations of trustworthiness, reliability and justice: qualities that the state law should have embodied. However, since law depended on its interpretation and enforcement, it was generally not thought of as legitimately formal, or at least not directly accessible as such. The mainstream form of ‘informality’ would therefore broadly include Mongolian jurisdiction124 and the macro-political sphere, as well as various forms of engagements with ‘institutions’. Overall this informality could be linked to notions of corruption, gifting and other favours. Often this involves kin or other close connections and their interactions with the first ‘formal’ level described above, forming transitional spaces that are neither one nor the other, such as the police or ‘state’ healthcare. These alliances can also be hugely specific, as I have argued in Chapter 6 regarding the example of the job position of doctors. These infrastructures of informality are not necessarily maintained by hugely different means – connections – to the third level of informality. The latter is made up of networks between women and, as became apparent to me, shaped women’s reproductive lives in Ulaanbaatar. The following sections will provide some detail on what these social infrastructures could entail as the fragments of them were revealed to me.

124 See Valdur 2018. 190 Before this, I will review aspects of connections and friendship in more general terms. In the last part of the chapter, I will explore what the encounters between the reproduction-related ‘people as infrastructure’ and the other (in)formalities might involve.

Friends and acquaintances

The topic of informality has been widely studied, particularly in post-socialist contexts and in conceptual approaches: for example, manifesting in three volumes of the Global Encyclopaedia of Informality (Ledeneva 2018a; 2018b; 2019/2020 forthcoming). These collections include reviews of blat, the sourcing of friendship ‘to get things done’ in Russia (Ledeneva 2018c: 40-43); amici and amigos or ‘friends’ in the case of the Mediterranean and Latin America (Giordano 2018: 102-105); guanxi or ‘relationship’ or ‘connection’ in China (Yang 2018: 75-79); and the Georgian natsnoboba or ‘acquaintances’ (Aliyev 2018: 67-71), to name just a few. All of these, at first glance, are conceptually adjacent to acquaintances and friends in Ulaanbaatar, as I set out to show. The topic of informality, which is widely covered with regards to post-socialist healthcare, tends to either focus on individual strategies or political economy, increasingly shifting to understand the prevailing conditions like novel private-public alliances as arising from the present rather than as manifestations of remnants of the socialist past (Stan 2012; see also Chapter 6). The intersubjectivity that I often slipped in and out of during my time in Ulaanbaatar had less to do with womanhood as externally relational; rather, it was a more nuanced and temporary form of relationality within a shared space of womanhood. This often came forth from me, my friends and interlocutors, at times owing to having certain bodies with bodily functions and experiences, but importantly also through other experiences that were assumed from both sides to be shared. For example, I had to leave one of the anti-violence protests because I was hit by the worst period flow since my teenage years. I told my friend I was there with why I had to leave so soon after arriving, taking stops on

191 the way home in restaurant bathrooms to free-bleed because nothing else seemed to work. I would not have said that to a male friend or an acquaintance, but I did not hesitate too much to share it with my female friend. After all, she would have been more confused by my untimely departure from the event we had just arrived at than by the fact that my body was shedding unusual amounts of blood that were soaking my clothes despite the use of menstrual products. Similarly, my interlocutors and friends would have been unlikely to share certain aspects of their experiences or reflections with me had I not been a woman and had there not been notions of shared experience present: comparing an abortion to a period, as I will discuss below, would not have been likely unless there was an assumption that I knew what a ‘normal’ period was. These assumptions of shared experiences as perceived by myself and those around me shaped this project overall. However, I am not arguing for there to be some sort of universal womanhood (see Strathern 1981): these assumptions were not always shared, but the ones that were formed a basis for common interests and points of departure. Perhaps unsurprisingly, what made this thesis possible was getting to know other women. This proved to be most important when going about this research in ‘formal’ ways and when involving the medical state institutions failed125. Becoming a known person, an acquaintance, a tanidag hün or tanil126, was not only at the core of my fieldwork, but also of reproductive healthcare in Ulaanbaatar in general. Engagements with reproductive healthcare for me happened most often through my friends, who provided swift validation for the establishment of steady and reciprocal relations with their family, relatives, friends and acquaintances. Similar to what Huseyn Aliyev (2018: 69) describes in the case of natsnoboba or ‘acquaintances’ in Georgia, this ‘allows individuals to expand their connections beyond fairly narrow groups defined by kinship or close friends’ as these networks are largely open-ended. Tanil has often been linked to necessary connections and networks that were in place during socialism to gain access to services and to get things done (Dalaibuyan 2012: 50; Sneath 2006), similar to the many

125 See Chapter 6. 126 Interchangeably also tanil tal (see Dalaibuyan 2012: 51). 192 adjacent notions in the countries listed above. Here, I discuss tanil not only as a way to access healthcare directly, but also as a necessary process for the exchange of information, often related to trustworthiness while also extending to the seeking out of direct contacts. Having a connection can result in rather polar shifts in the attitude towards and treatment of the person. Most often patient-doctor127 relations without this could include verbal scolding, treatment bordering on and including physical violence, such as the beating of women during childbirth by midwives, or what was often considered worst of all – indifference. These experiences could be mitigated with gifting or payments, which occurred in various forms in the reproductive health sector. The studies of informality have somewhat shifted towards (inter)subjectivity and morality (Makovicky and Henig 2018: 37-39). This has also meant a degree of removal from a broader study of power and sources of inequality following this approach. For instance, this has involved questioning ‘the very assumptions that informal economic practices are primarily driven by the structural constraints of socio- economic inequality’, to propose instead approaching favours from a perspective of a ‘moral aesthetic of action that endows the actors with standing and a sense of self-worth’ (Humphrey 2002 in Makovicky and Henig 2018: 39). Somewhat owing to this line of research, the ways that kin relations and other forms of close and binding connections have weaved a tight fabric with institutions of governance – those that have perhaps once been, or are imagined to have been, ‘formal’ – have been predominantly studied through concepts like ‘corruption’, ‘reciprocity’, ‘hosting’ and ‘gifting’ in the Mongolian context128. However, my focus on tanil does not necessarily rest on the essence of ‘the favour’ or its event, including its ethical and moral connotations, as parts of the literature on informality have shifted to do (Makovicky and Henig 2018). Instead, I am more interested in its importance as part of the wider proximities and socialities that occur in relation to reproductive healthcare. These in themselves involve continual considerations that are both moral and economic. Baigalmaa egch’s rhetorical question at the

127 See Chapters 4 and 6. 128 See Fox 2019a; Sneath 2006. 193 very beginning of this chapter regarding who can judge the saleswomen of abortion medication if they are trading these ‘to live’ suggests that there is awareness of a moral plane. Yet, the statement also verbalises concerns beyond ‘ethical and expressive aspects of human life’ (Makovicky and Henig 2018: 39), which do not suffice to address ‘informal’ economies and networks. Rather, conceptual and analytic approaches need to be rooted in the everyday and empirical work that can also reveal forms of historical and contemporary power relations that these forms of informality materialise, manifest and give rise to. Often these involve everyday economies and making ends meet. Maintaining such informalities ‒ for instance, by having appropriate connections in reproductive healthcare ‒ was not a homogenous process: this meant that it did matter what kind of relations were sought and maintained, rather than operating on a more-is-more basis. Acquaintances could also come about through chance encounters as well as by simply hanging around long enough to get to know someone to establish acquaintance status. The connections I address here were sometimes sought, but Ulaanbaatar also made them happen through repeated chance encounters in the deCerteauian sense: the ways in which routine practices and movement in the city could produce these encounters and ‘weave places together’ (de Certeau 2002: 97). For instance, one of the first interviews I undertook with a gynaecologist working at a private clinic was suggested, and the necessary introductions were made, by one of my connections who occasionally covered her relative’s shift at a shop. There she had gotten to know the doctor, a customer, to such a degree that they had exchanged phone numbers and she was able to ask for her time as a favour in order to be interviewed by me. There was a rather relaxed air about these connections, and they were sought both at a time when the favour was not yet needed (as with the temporary shopkeeper above) as well as when the particular requirement had already established itself (such as me needing to meet doctors informally). The opportunities were endless, as Morten Axel Pedersen (2018) lays out in his entertaining Incidental Connections, where his interlocutors in Ulaanbaatar ‘were “leaping into” a

194 “superabundant reality” (as opposed to anticipating a finite number of possibilities) to actualise potentialities that could, by definition, not be known by them in advance’. He argues that ‘planning and anticipation only make sense when “the potential” is erroneously equated with and reduced to “the possible” as a prospective space for future tactics and strategies’. This approach would manifest informality as flat and overarching for the whole of ‘society’. While seeing some parallels with Pedersen’s suggestion that specific potentials were not necessarily distinctly and temporally outlined, connections with people, in particular professions, were knowingly sought by the women I knew and discussed the matter with. As Uka, a woman in her late twenties129, revealed: ‘Mongolians say that a person in his or her life needs to be friends with a doctor and a police officer.’ She found the idea of contacting a known (tanidag) police officer when having committed some crime or violation strange, although she had friends (naiz nöhöd) who were police officers, her friends’ (naiziin) husbands. However, she said she had indeed understood ‘that being friends (naiz) with a doctor is definitely necessary’130. Therefore, informalities experienced and emerging in Ulaanbaatar were both gendered and variable in their specifics across different areas of life. For women seeking reproductive healthcare, or for the PhD student trying to find out about it, it was mostly friends who facilitated reproductive healthcare knowledge and often determined what was possible or not when it came to reproductive issues. In anthropological literature friendship has been rather understudied, and it has not been granted the status as a methodological opening into insight that it often serves, supposedly as the concept possesses strong connotations of ‘Western individualism’ and somewhat uncomfortably rests at the intersections of ‘home’ and ‘the field’. Sarah

129 See also Chapter 6. 130 It is worth also noting that the police is overwhelming made up of men, and healthcare of women. Close friendships between unrelated men and women (meaning friendships with a sexual relationship) were not considered common. However, friendships or reciprocal relationships between men and women could occur between former classmates and extend to female friends’ spouses, not to mention distant relatives. 195 Winkler-Reid’s (2016) study of girls’ friendship at a London school starts by pointing out that ‘Western’ persons tend to be understood as ‘individualized’ and ‘non-joined-up’. While her study largely remains rooted in personhood, selfhood and ethics, it also calls for ‘a focus on intersubjectivity, and the quality and nature of engagements between persons’ (Winkler-Reid 2016). Meanwhile, an opposition between friendship and kinship has provided one of the leading entries into analysis, though this has also been recognised as ‘misleading’ (Pitt-Rivers 2016). An alternative analysis offered would position it as approximate to the Maussian gift for its reciprocal potentialities and qualities (Pitt-Rivers 2016), which has again been bound to questions of the morality of exchange, gifting and commodification131. The first in-depth studies of friendship tended to create categories for it, such as ‘expressive or emotional’, ‘instrumental’ and ‘practical’ (Reina 1959; Wolf 1966). For me, friendships occurred as all of the above as well as being for passing time eating, drinking and gossiping; for my friends, this particularly manifested as a break away from domestic work and responsibilities. Some of my friendships were more transactional and involved favours, and sometimes my emotional neediness was awkwardly welcomed. While perhaps at times I made for a rather useless friend apart from my constant willingness to emotionally engage, my foreignness and privilege often came to my aid, as it was not only a resource for myself but also for my ‘connections’ too, even if much of this potential lay dormant. Friendships, as far as I was involved, were indeed intersubjective and involved learning and adjustment from both parties; if the balance went awry or life got busy, they seemed to involve avoiding calls or making plans for the unforeseeable future that never materialised. As with my other Mongolian and non-Mongolian friends, it also generally happened that friendships were no longer based on similarity or likeness, as they had once been in my teenage and young adult years; instead, friendships tended to be made in time, due to existing in the same space, generating a level of intimacy that meant knowing and being involved in the other person’s life. This, to a degree, seemed to also be the case in

131 See Makovicky and Henig 2018: 35-39 196 Ulaanbaatar, where best female friends were usually former class- or coursemates and former or current colleagues. This, I thought, owed much to the fact that the lives of the women I knew were extremely full and busy, but also because it was necessary to have spent time with a person to trust her or him.

Discussing matters

I subsequently asked one of my local friend’s help with my ‘research’. I paid her for her time when she accompanied me to interviews because I could and it seemed like the right thing to do, although she kept insisting she would help me either way and that what we learned in this process was also interesting to her. Our friendship did not seem shaken by this in any way, I thought; indeed, if anything, this common undertaking brought us closer together. After I explained my interest in the abortion pills, she asked another friend of hers, who worked at a pharmacy nearby, who then suggested we visit a specific part of the market. First it was my friend who went, her face snuggled deep in her signature cap as she asked different people if they sold abortion medication132. She eventually met some women who took an interest without shooing her away. After that, we paid visits to them together. My friend kept insisting in her compliments that it was my foreignness and baby-like pink skin that made people so friendly and trusting towards me; they had been rude to her, yet it was clear that I would have hardly found anything out about the issue without her help. On one occasion I tried to go and see the women myself, but I was simply unable to locate them in the narrow alleyways of the market that suddenly all seemed so similar. Therefore, this was very much a joint undertaking.

132 I would not have insisted that someone do this nor suggested it myself. In addition, women who buy these medications or have informal abortions have so far not been prosecuted. As noted above, in certain online and market spaces, secrecy surrounding informal abortion medication is not particularly great. This section is written with awareness of and debt to those who participate in research in various forms. It aims to create a space where these participations in each other’s lives can be given greater space in ethnography and induce interrelated discussions concerning ethics and who the fieldworker really is in certain moments. 197 The two women whom we got to know, one in her thirties, the other in her fifties, directed us to two other people. One had a stall fairly close to where we were chatting, but she appeared understandably hostile towards the whole project that our small group of women tried to engage her in. The second person was Baigalmaa egch. The two women told us that things around the market concerning the abortion pills had changed rather drastically after the 2014 raid. Importing the pills from China was easy enough, they said, as there were no checks on the border and the pills were widely available in the border town where they did their shopping, so bringing them to Ulaanbaatar was not hard. The selling was the tricky part. One of the women also noted that she would sell the pills herself if the law was not ‘that strict’, but currently it is simply not worth risking her freedom for some 15,000-20,000 tugrik133 profit margin, although in further pricing detail, they explained that while the price of the medication in China was around 10,000 tugrik, the price in Ulaanbaatar would be around 50,000 tugrik134. The elder of the two women suggested, however, that selling the medicine was not only to do with money, but also involved trying to help those in trouble, such as teenage girls. Using the medication for an abortion was ‘no problem at the early stages of pregnancy’, which, according to her, was within the first few months. Years before, when the pills first appeared, it was possible to buy them in Mongolia for 7000 tugrik. After this, the price climbed up little by little. While abortion prices have multiplied, so too have other services and goods like contraceptives. For instance, as a secondary account (which the bulk of abortion stories that were shared with me were), I was told of a woman who had induced her own abortion six months into her pregnancy, because this was about how long it had taken her to save up to be able to buy the abortion medication. At a later occasion the women asked about my ‘research’ and the purpose of it, which I gladly chatted about in my broken Mongolian, happy that I was being asked questions. The piece of information that was

133 Equivalent to around 5-7 euros. 134 This suggested that the profit would near 40,000 tugrik if transportation and labour were not deducted. 198 picked up was my potential familiarity with gynaecologists and women’s clinics in Ulaanbaatar. The conversation then shifted to the trustworthy and affordable women’s clinics, with me providing details on which I thought would be best to visit, as I had repeatedly accessed them myself for the many HIV tests I had needed over the years for visa purposes. I prided myself on having lingered long enough for my knowledge to have become relevant: it took some time for my opinions and contacts in healthcare to have any worth at all to those I discussed the matter with. It did not matter who I was ‒ a foreigner, a researcher, a woman of reproductive age ‒ until I became somewhat known. At first glance, this informality was in many ways similar to the personal networks that Rachel G. Fuch and Leslie Page Moch (1995) describe in outlining how working-class women secured and proceeded with their reproductive strategies, including abortions, in nineteenth- century Paris, where information circulated, and chance and trust, but also rough anonymity, became relied upon. While these sorts of sociality and solidarity were at the core of women’s reproductive lives in Ulaanbaatar, the specifics of these did not only arise as the precarity of belonging to the lowest income groups, but also occurred in various forms for both the middle-income and lower income women with whom I mainly spent my time in Ulaanbaatar. The ability to pay did not necessarily determine one’s experiences of trustworthiness and desired outcomes. Despite the fact that the middle-income group could afford to visit private clinics, the quality of the service, and particularly a connection to a doctor, nevertheless needed to be verified beforehand. Furthermore, as Baigalmaa egch mentioned in her critique of the medication scandal and her prosecution, this was all brought about by the lack of direct contact or intimacy between the pills saleswoman and the woman who was the consumer of the pills: it all could have been avoided if this relation had been present. She could not take on responsibility for the absence of this relationship that was at the core of health-related concerns in Ulaanbaatar135. After all, as one of the market ladies said, ‘everything is possible in the private clinics’ if there is money, setting out

135 This is given much deeper attention in Chapter 6. 199 some rather mythic upper prices between 300,000 and millions of tugriks for an abortion. However, even with the existence of personal relations and networks ‒ in other words, ‘people as infrastructure’ ‒ the outcomes could still be unexpected. This needed to be taken into account. Abortion in Mongolia is legally permitted for the first twelve weeks of pregnancy simply on the request of the woman or, in the case of an underage person, with the permission of one parent. A second-trimester abortion within 22 weeks is allowed in the case of medical intervention if the pregnancy poses a threat to the pregnant woman’s health and life or in the case of fetal abnormalities. It is also allowed for other exceptional, non-medical reasons. However, the conditions under which abortion was considered possible both differed between spaces and also from the law. I will proceed further discussing these informalities and others from three perspectives on abortion: that of a gynaecologist; that of a woman who has had an abortion; and that of the retired abortion pills saleswoman.

Flexible services

As expanding one’s networks went, one day another long-term friend rather unexpectedly announced that we could visit her relative Gaya, a young gynaecologist who worked at a clinic where abortions were carried out without the necessary licensing, so that I could get to know her. This is what we did on a typically chilly Ulaanbaatar evening after we had carried a frozen mutton carcass – gifted to my friend by another connection – to its destination, my friend’s kitchen. Naturally, Gaya also became a friend as soon as we sat down to eat a meal she had pre-prepared for us when we got to her place, hungry from moderately heavy lifting and life in Ulaanbaatar. Gaya went on to share her own networks with me and provide me with presents, although she was the one helping me. She, like a huge number of young women I knew, was in the midst of planning to leave the country. Gaya explained the matter of ‘informal’ abortions simply: the salaries were low and pushed doctors to seek additional earning opportunities. So, in the afternoon, doctors carried out abortions ‘privately’, similar to a private service. This

200 differed from the state or district136 clinics’ doctors, who carried out abortions in the morning before noon, she noted. Many women, however, came to the facility seeking assistance after already having proceeded with an abortion, bleeding, according to Gaya, as a result of buying and self-medicating with abortion pills. When asked about the pricing, Gaya said that it depended on a number of things, such as the method and the particular case: the cost started from 60,000 tugrik and went up to above 100,000 tugrik137. It was important to know if the woman had given birth previously and whether the delivery had been through a caesarean section. They had two options for the abortion: the medical, which was expensive, and the ‘instrumental’ procedure by the doctor, which took some ten to fifteen minutes and was the cheaper option. ‘It also depends on the person’138, she said, which was a statement I encountered across ‘private’ and ‘public’ services: the ability to determine and have a say over this was important to doctors and saleswomen alike. ‘Depending on a person’ could, of course, appear to be a question as to whether an acquaintance had been established, but this also included the ongoing work of judgement of character, and the position of being either willing or unwilling to take up the work or service asked from her139. As another gynaecologist further explained, it also involved the woman’s ability to pay, which was under evaluation and discussion in relation to monetary remuneration for the service. Patients seeking an abortion came to the clinic where Gaya worked for a range of reasons and at various stages in life: teenagers came without telling their parents or with their parents, thinking about the future and wanting to study; women between the ages of twenty and 30 could have given birth recently or could not have a child due to their financial situation; women above 40 were afraid they were unable to give birth or felt ashamed to have a child at such an age. Women asked one another and found their way to a private clinic, while people with lower financial means needed to go to the district clinic, where abortions were cheap

136 Düürgiin. 137 At the time, approximately equivalent to 20 euros up to 34 euros and more. 138 ‘Hüneesee shaltgaalaad bas öör öör baidag.’ 139 See Chapter 6. 201 compared to other places. Abortions were available at Gaya’s clinic within the first twelve weeks, although during the first week ‘the child’ was not ‘visible’. To her knowledge, in the district clinics abortions were carried out when the pregnancy was below seven weeks, and this is where her clinic differed from the state ones. Therefore, it was not the law that determined until what stage of gestation abortions are available, but rather how senior medical staff interpreted and applied the law. Additionally, the procedure and the abortion services as an abstracted whole were shaped by how these various spaces carried out such interpretations. Undra was one of the women who had undergone an abortion at a private clinic several years before and who told me about her considerations at the time in retrospect. Years after the abortion, Undra had grown worried as to whether the abortion had caused infertility, because she had been unable to conceive her second child for some years140. However, she had not resorted to any mitigating steps or conciliatory practices after the abortion, such as getting a sutra reading or making an offering; she said that perhaps people did so ‘back in the day’ and noted that perhaps people did something like that when they regretted the abortion. Together with her family, Undra lived in a relatively remote and hilly ger district, which was categorised as ‘most impoverished’ according to the city maps. But Undra, like many others who lived in the area, belonged to the middle-income group and would have not considered herself ‘poor’ by any means, having a steady job as a pharmacist with a salary approaching the national average and additional income from her husband. Their family lived in a nice house with a kitchen-living room and a bedroom that overlooked the entire area. She considered herself fortunate for having two children, a son and a daughter, who were born almost a decade apart. Since her younger child’s birth a few years back, Undra had been using a birth control implant that she bought from an acquaintance working in the public sector for 35,000 tugrik, while the cost of these in private clinics can be 70,000-80,000 tugrik. ‘Birth control is expensive,’

140 See Chapter 3 for concerns regarding infertility. 202 she said: for example, at the pharmacy where she worked, contraceptives started at 30,000-40,000 tugrik. She had been using the implant for three years and she was set to continue for another two years. Undra was content with it after having looked extensively into different options, as she knew she would be unable to take contraceptive medication daily and she was interested to know what side effects141 could be expected from birth control. Fortunately, only her menstrual cycle changed slightly, and she had not experienced any other inconveniences or adverse side effects. Undra’s husband did not want her to have the abortion and tried to convince her to drop the idea, but she proceeded nevertheless. She had an abortion at a time that she considers to have been particularly hard financially: few women were pregnant at the time and the abortion rate was high, she said, though the situation had now improved. Family and economic well-being went together, as a senior gynaecologist also explained about the same period, the late 2000s, when abortion was particularly common. The reason for Undra’s abortion at the time was to do with work: she had given birth to her son only a few years before and she did not want to lose her job opportunity, a steady one that was not easy to come by. Expanding on the reasons why women have abortions, she said: ‘The main reasons depend on the society, if you’re unemployed or have just recently found a job, and then if things suddenly get worse in the society. Generally, there are all kinds of different reasons. It can also be a difficult husband, if he drinks a lot, it’s hard.’ Undra had discovered her pregnancy early on, and after asking friends, she had gone to a private clinic where she paid around 10,000 or 15,000 tugrik142 for the abortion. Undra was not sure if public clinics carried out abortions at all. She noted that even if they did, she thought it might have involved negotiating one, which was a complicated and uncomfortable endeavour that she was unwilling to undertake. This was one of the reasons why she asked friends and had undergone her abortion at a private facility. Overall, she did not like the state services for their quality, although the state clinics could not turn away patients. She

141 See further discussion of contraceptive side effects in Chapter 5. 142 According to the currency rates of the time, this was equivalent to roughly between 5 and 8 euros. 203 particularly did not like the local health stations, which had notoriously bad reputations, although this varied somewhat from area to area; she said she visited these only if her younger child got sick, and even then rather reluctantly. ‘Contraceptives should be given from the local clinics for free, but there are only a few that are handed out as free and these are hard to find. So people consider the options, look for them, and then perhaps settle to buy them from a private clinic’s pharmacy,’ she said, drawing on her own work. ‘I suppose that people think of getting a supply for the future, so they buy in bulk.’ She had heard from her female friends that abortion costs had now risen to 65,000 tugrik143 in private clinics. ‘It’s fine to talk about those things with your friends, it is not a thing of complete secrecy. Friends can advise you where would be the best place to get it and discuss the information heard from others.’ Indeed, the women I discussed the matter with, whether they had undergone abortions or not, seemed rather well- informed about the practicalities of this as well as matters surrounding abortion medication. However, what often came across as significantly vaguer was abortion’s legal status: like Undra, many others were unsure as to whether abortion was legal in Mongolia at all. What shaped how and where abortions were carried out relied on women’s networks or ‘people as infrastructure’ and how the position of doctors at the collapses of the ‘public’ and ‘private’ ‒ what I have previously called usufruct ‒ shaped and often determined patients’ healthcare choices. Needless to say, this also shaped and was shaped by the selling and consumption of informal abortion medication. As I have aimed to show above, it is not simply that acquaintances are required, but that certain acquaintances are required in certain situations for certain people. Furthermore, Ulaanbaatar’s reproductive economies are not only described by the specific forms of these informalities – one of which, I would argue, is doctors’ work as usufruct (see Chapter 6) – but that, more importantly, these are shaped by encounters with and between various forms of informality. Characteristic

143 This is equivalent to around 23 euros. 204 of such forms of capitalism, these encounters often happen in random, unpredictable and precarious ways inhabited by specific forms of power or their lack thereof (see Chapter 5). This applies also to the urban space of Ulaanbaatar more widely, which I will discuss here from the perspective of abortion, its legality and legitimacy. The way space and time have been discussed has involved the vocabularies of ‘stretching’, ‘folding’ and ‘compressing’ to address ways in which the non-cotemporal and distance have a relevance to certain outcomes (Allen 2016: 1). In this chapter I am interested in occurrences that might take place in a shared space and time, but are kept apart from one another: for example, surrounding law and its enforcement.

Legislation’s legitimacy

After Elbegdorj, then President of Mongolia, addressed the ‘abortion problem’ in his 2017 speech144, which had brought forth a wave of news stories, I was casually asked by a friend if abortion in Mongolia was legal at all: the news stories addressed ‘illegal’ (huuli bus) abortion without including aspects of the procedure’s legality. This came across as if all abortion in Mongolia was potentially illegal. The use of the sector for an additional livelihood by doctors145 through biznes and the reforms, including the Health Law and the Criminal Code146, had left doctors and women alike unsure of whether and under what conditions abortion was allowed in Mongolia, if at all. Meanwhile, doctors could also have been involved in other legitimation processes regarding the issue, such as professional seniority structures. Either way, as Undra and Gaya both pointed out, there seemed to be uncertainty concerning abortions in public facilities. The formal legislative seemed to be such a distance away that it was hard to determine its actual content. Meanwhile, law and regulation at the market, as discussed by the vendors, did not have any moral weight in themselves beyond the real

144 See Chapter 2. 145 See Chapter 6. 146 See Chapter 2. 205 threats they may have posed and their consequences, which were also flexible. For instance, although Baigalmaa egch did not have an acquaintance in the police force to side with her, as some thought necessary, this did not completely diminish her own capacity to negotiate with law enforcement, as she humorously told us. Besides having had to pay the bail and drop much of her business, she described her punishment as heavily transitional on the legal-formal-informal-illegal scale: she had to go to the police station every morning for three months, sit there ‘the whole day’ and wait, endlessly, to be interrogated. Every morning at eight she was supposed to be there ready to be interviewed yet again. Baigalmaa egch’s punishment came to an end when it reached a point of excess. ‘One morning I realised I would rather sleep, even if this was to take place in prison,’ she said as we laughed lightheartedly in acknowledgement of her humorous attitude towards her punishment situation. She never went back, and years later, while her case was still open to her knowledge, no further steps had been taken towards her by the police. As David Jacobson (1971) has pointed out: ‘A system of social control involves two related components: identity – in contrast to anonymity – and continuity. In other words, a system of social control depends not only on the availability of sanctions but also on the ability to enforce them.’ Enforcement, which could have involved systematically following the law, was something else, and was not constant: like the women at the market suggested, the law had become ‘strict’ only after the police got involved. Therefore, Baigalmaa egch’s and other women’s experiences with the police and law enforcement does not call into account any specific law, but the latter’s tangible and stable status as such (see Das and Poole 2004: 15). Moreover, what had legitimised abortion for both Baigalmaa egch and the women at the market was something other than the state law and selling these ‘to live’. Baigalmaa egch maintained the abortion pill was ‘a good medication’ and that bringing about an abortion was ‘like a period’, backing up her claims with the fact that her own family members – namely, her daughter – had taken the pills. For the market vendor in her fifties, it had been her own abortion through the injectable oxytocin: ‘It was little more than a period, it was nothing.’

206 Baigalmaa egch explained that the price for the pills had skyrocketed because women were scared of the ‘mechanic’ abortion and were willing to pay to have a ‘natural’ abortion. However, as I have suggested previously in Chapter 6, seeking healthcare services can be complicated for patients for a number of reasons, including a wish to simply avoid interactions with doctors whenever possible. Also, Baigalmaa egch suggested that women came to seek the pill without discussing it with their partners, because it was ‘not easy to bring up many children’. This reflection stands in some dialogue with pars viscerum matris147, when the embryo or fetus is essentially seen as part of the mother’s body, therefore giving her the legitimacy – and in the historical accounts, the legality – to abort. Instead of viewing legality and state law ‘as cultural artefacts that tell us about legal as well as popular conceptions of the moral matrix of life’, as has been observed in the case of small-scale illegal mining in Mongolia (High 2012), legislation here becomes instrumental in non- linear ways where not only outcomes can be negotiated, but also the very existence of law as unknowable, changing and incomprehensible in its enforcement. This shapes the abortion market, making the de jure law irrelevant to accessing abortion and its ‘safety’, despite being linked to them in many contexts involving global public health and development discourses.

Conclusion

The chapter began with the 2014 scandal that led to the prosecution of Baigalmaa egch, who used to sell abortion medicine. For her, the problem emerged only because the woman had self-medicated without direct contact with the saleswoman. By therefore not following advice and information, she had induced an abortion past a safe term in her pregnancy. This introduced law enforcement at the market, which had not been consistent and was characterised as confusing and flexible in itself.

147 See Chapter 2. 207 What legitimised the selling of abortion medication for Baigalmaa egch was not the legal status of abortion or abortion medication, but rather the poverty she found herself in. The everyday struggle to make ends meet and essentially ‘to live’, as well as her commentary on it not being easy to bring up many children, suggests another aspect of ‘life’ that is important concerning abortion and its services: the non-biological everyday ‘life’ as it is lived from one day to the next with aspirations to make living possible for oneself and one’s loved ones. Secondly, what legitimised the selling and consumption of informal abortion medication were experiences of it, whether that of Baigalmaa egch’s daughter or the woman herself, which proved that the medication was ‘good’ and safe to use. There is not one story of abortion in Ulaanbaatar: it tends to stand for different things for different people. In spaces where abortion is not simply a symbol standing for something else or some other relationship, abortion tends to be bound to encounters of informality. Therefore, what matters are the ‘diverse flows of conduct of which fertility is composed’, particularly how ‘activities of which fertility is composed serve as structuring resources, one for the other’ (Carter 1995). In order to understand this, I abstracted three levels of (in)formality. I pointed out that the spaces where abortion was sought and experienced are largely separate from the ‘mainstream’ and generalised conceptualisations of ‘informality’ and ‘corruption’ that appear at the collapses of the formal (even if only imagined) and the informal, which together shape public hospitals and clinics, the police and other state institutions. This latter form is often seen as the overarching ‘informality’ that is understood as seemingly homogenous and as seeping into all aspects of life, regardless of gender, the financial situation or other conditions shaping the everyday for those involved. Instead, here this gendered reproductive space seems to arise as part of ‘people as infrastructure’ or women’s networks, and is rarely defined by the institutional or governmental, although at times it comes into relations and dialogue with other spaces of informality. I developed this argument by indicating the rather random, unpredictable and precarious ways that other forms of informality, as well as legislative and law enforcement,

208 enter these spaces of informality between women. These encounters with the different forms of informality bring about a situation where abortion is legal but unknowable, and thus unsafe, as there is no other way of tracing accountability beyond what ‘people as infrastructure’ – women seeking out, gossiping, speculating, advising, connecting – provide to one another. The gap between abortion as a formalised procedure in legislation and the forms of informality that it has been pushed towards and shaped as by the healthcare system and broader forms of governance, create a situation in which abortion is legal, yet this has little, if any, relevance to its safety. Men and the masculine neither enter into these spaces of seeking an abortion as active participants in family planning nor as voices carrying widespread and mainstream148 notions of what family, Mongol-ness, morality and proximity should be. Here, proximity and intersubjectivity may involve, but are neither defined by nor limited to, kin relations. Abortion as everyday experience, while often at the core of family planning in Ulaanbaatar, exists on the margins of kin relations and its institution, instead quantitatively drawing on acquaintances and friends, while hardly manifesting advocacy in any empowering sense as ‘Western’ discourses surrounding the right to abortion might have it. Studies of (in)formality would benefit from studying the everyday when seeking to address who relies on certain techniques and infrastructures to get things done as well as how and why they do, alongside the very real risks, trade- offs and costs of various kinds that these informalities may involve.

148 See particularly Chapter 2, but also the other preceding chapters. 209 Chapter 8. Conclusion

This thesis covered a range of spaces and themes relevant to reproductive health in Ulaanbaatar. Throughout this thesis I provided ethnographic approaches to forms of governance. I started by providing a political history of abortion in Mongolia, focusing on the biopolitical forms of governance through macropolitics and the nation state. I proposed that biopolitical forms of governance were very recent. I moved on to outline reproduction through the lens of Mongolian traditional medicine in Chapter 3, and governance occured here at the intersections of religion, the medical and kinship. This built towards the fourth chapter, which explored kinship and family through motherhood as well as structures of care. I found care to be one form of governance that mattered and that brings forth certain gendered subjectivities. After noting that young women do not tend to visit gynaecologists prior to pregnancy and lack knowledge of how to avoid becoming pregnant, the next chapter, Chapter 5, explored knowledge of contraceptives (and knowledge as a contraceptive) through the process of making a sex education YouTube video. The form of governance involved here is bound to sexuality and knowledge. The last two chapters returned to reproductive health spaces in a more literal sense. Chapter 6 focused on the biomedical and its workings, and Chapter 7 on the market and networks through which informal abortion medication and other services are sought. Respectively, I studied the ‘modern’ medical and informality again as forms of governance, which I defined earlier in the thesis as the historical and otherwise specific ways in which outcomes are determined and shaped. The thesis returned to a number of issues throughout, such as motherhood and womanhood, ‘rights’ and the historical development of the current healthcare system. The thesis suggested that reproduction in Ulaanbaatar can involve elements of biopolitics – which is one of the most prevalent analytic tools in disciplinary studies of reproduction and governance alike – but also called for moving beyond this conceptual approach by exploring a broad range of its underlying assumptions

210 through ethnography and studies of the everyday. This involves moving beyond Eurocentric and Americentric dualisms, assumptions and imagined forms of belonging as well as surpassing the anxieties that ‘gender’ may involve in itself for the disciplinary histories of feminism and women’s studies. So, finally, this is what gives the thesis its name and calls for post-biopolitical studies of governance. I will now unfold and revisit some of the specifics of the themes explored throughout the thesis, and hence the particular contributions made by it. The thesis started by suggesting that both biomedical healthcare and the building of the Mongolian nation are rather recent projects. Largely aligning its policies with the Soviet Union, and like many other countries, Mongolia never experienced a grassroot women’s movement in a Euroamerican sense. Abortion was legalised as part of the broader modernisation project. The change of state orders and shifts have been followed by a pluralistic reimagination of histories. These referential ‘other times’ have become arenas where legitimacy can be sought and found. The medical, as well as many other areas of life, is here divided into the pre-socialist, socialist and modern democratic eras. For example, it has been claimed that abortions and even the limiting of women’s reproductive capacities did not occur in previous ‘eras’, which other historical and personal accounts contest. Concerning reproductive health and the ‘birth of the clinic’ (as compared to Rose and Rabinow 2006: 215), it would be hard, if not impossible, to find a biopolitical rupture in time beyond the broader socialist project. Rather than one rupture or shift bringing about change, there are a number of these reflected upon, and many of these (pre- socialist, pre-democratic) are sourced in projects of legitimisation of various claims, which became apparent in how family models and morality were discussed by traditional medicine doctors and the head of Manba Datsan. For example, in Chapter 3, I explored one such medical space: traditional medicine as a ‘theory’ of a Mongol person and his/her place in the world. I proceeded to show how history and ‘tradition’ in itself have become means of legitimisation in a process in which multiple claims on life, the human body and how to secure its health are present.

211 Different historical state orders and ‘logics’ behind these have contributed to constructing what is now considered reproduction and ‘abortion’, and there are specific histories and temporalities attached to these notions. Additionally, the construction of ‘reproduction’ has been inherently gendered. There have been two recent large-scale programmes for this. Firstly, the population development of the socialist state and its counterparts like the Soviet Union, where women and children were the focus of modernisation. In socialist Mongolia, there were many pro-natal policies in place, which provided maternal healthcare, maternity leave, access to kindergartens, reduced working hours and so on. Both women and children were seen as being at the core of the modernisation project as additions to the labour force and to ensure the production of the ideal future socialist citizen through the correct upbringing. However, with the fall of the socialist state and the establishment of democracy, ‘women’ and also ‘children’ rapidly shifted to become viewed as ‘vulnerable groups’. Various programmes, like the Millennium Development Goals, focused on maternal health. These two larger shifts that have maintained ‘women’ at the core of change have led to a situation where reproductive healthcare is almost synonymous with women’s healthcare. Meanwhile, like Inhorn (2007: 5) points out, it is rarely women who are able to outline issues involving their health for this, as a discursive field, tends to be defined by others. Unlike the socialist modernisation programme, the ‘modern’ medical neither emerges as working against ‘life’ nor as maximising it, as it had been seen to do throughout the socialist ‘biopolitical’ project: abortions were frequently suggested to take place because of what ‘medicine’ has become and due to doctors’ work having become a ‘business’. Consequently, there is no consensus over the temporalities that are at play and what constitutes ‘life’. For example, in Chapter 2, regarding the case of President Elbegdorj’s 2017 speech, I reviewed the political history of abortion in Mongolia and in this discourse found it to be defined as a crime against the nation for it is connected with population size. ‘Life’ here appears as linked to a singular human life that is to contribute to the vitality or even ‘life’ of the nation as a whole. As I indicated, claims on

212 ‘life’ on behalf of the state are fairly recent. These claims and discussions surrounding ‘life’ are linked to the potential birth of a baby, rather than the ‘life’ of the woman. In the Euroamerican literature on abortion, the question leading the problematics is when life begins as well as how to value the personhood of the pregnant woman against the fetus. While I was seeking a stronger emphasis on this throughout my fieldwork, the knowledge of the exact moment of ‘life’s’ beginning was often addressed as vague, an ongoing process, unknown or even irrelevant to a degree. Women, doctors and others alike did not necessarily possess expert knowledge of when exactly ‘life’ as such was to begin. Rather, the question seemed to be to whom that ‘life’ belonged: the nation, family lineage, the pregnant woman. For example, as part of traditional medicine, ‘life’ was seen as a matter of work towards enlightenment, karma and consciousness traversing human lifespans; for the women with whom I discussed the matter, early pregnancy was akin to a period. Therefore, the relevant questions are not only ‘when does life begin?’, but also if life is an occurrence beyond a human lifetime or considered as the life of a human being. Abortion was most often critiqued through the issues surrounding the question, ‘who does life belong to?’ One example is when the husband’s lineage was seen to have the right to claim children; in this process, the daughter-in-law and her body were also claimed as her reproductive capacities. Women, however, pointed out how bringing up many children was difficult: careers, job opportunities and other socioeconomic conditions needed to be taken into account, providing another notion of ‘life’. When it comes to abortion economies but also for those who seek abortion, this can be indicated by the shift from ‘living beings’ to ‘making a living’. Another approach to life arises from what the former abortion medication saleswoman described when addressing her job as a means ‘to live’: this life as the everyday, making the best of it for oneself and one’s loved ones from one moment to the next. Most importantly, most abortion stories that were shared with me were conceptualised along this conception of ‘life’: the everyday life as it unfolds in its specific struggles.

213 Rather than resulting in individualisation or the thinning of relations when kin relations fall short when seeking desired outcomes, reproductive lives involve specific forms of relation-making. For instance, the failures concerning undesired reproductive outcomes are assigned to one’s broader social surroundings and not necessarily seen as a personal failure. Furthermore, the thesis proposed that there might be alternative discursive scales in addition to that of ‘freedom’, which has been prevalent both in the biopolitical and Euroamerican approaches to abortion. Particularly, I pointed out how transitioning ‘responsibilities’ – generally seen as a masculine trait – to women when it comes to contraception can take the place of discussing ‘women’s rights’ as the ‘right to contraception’. Despite the overall critique brought forth in this thesis, it also proposed that trustworthy knowledge is seen to protect health and contribute towards desired reproductive or other outcomes, unlike situations in which the failure to secure contraceptive knowledge is shared by many of those who surround the person whose life is directly affected. Here, the many ways ‘the state’ occurs in reproductive health and parenthood in Mongolia are by no means limited to the control and the unconscious subjectification it involves; the state is also often knowingly reflected upon and seen as enabling, a quality that is often referred to or pointed out as absent due to the lack of care, knowledge and accountability the state provides. In this context, everyday life becomes gendered through how reproduction and parenthood have been constructed, as do the specific engagements and encounters with the state. Bureaucracy shifts life towards incorporating its struggles of the everyday in today’s Ulaanbaatar. This entails gendered encounters with the state through reproductive healthcare and parenthood, particularly motherhood. Therefore, motherhood in Ulaanbaatar not only alters a woman’s personhood through her shifting kinship relations or through contributing to the nation as a whole, but also produces a range of reflective, ongoing and often extremely trying gendered engagements and subjectivities vis- à-vis the state. Chapter 4 built on this by asking what kinds of care motherhood in Ulaanbaatar involves beyond the affective and parent- child aspects of it, which can shed light on what ‘kinship’ can also be

214 without limiting it to the ‘domestic’ sphere. How these aspects of care potentially shape parents’, particularly mothers’, encounters with the ‘state’ leads to the overall conclusion that there is no process of linear ‘individualisation’ happening. Instead, the patriarchal public discourse and macro-politics, the state as bureaucratic and the city itself, with its limited services like kindergarten places, seem to provide further shifts towards viewing maternal kin groups and other forms of relationality as relevant, such as friends and acquaintances. Furthermore, I have argued that through structural adjustments, the state governance is de facto concerned with managing financial flows, debt and the state budget rather than the population. In dialogue with the anthropology of reproduction, which has shifted towards a focus on reproductive technologies and biopolitics, I proposed the need for more nuanced vocabularies for the forms of governance and subjectification that may involve. Firstly, I drew on the notion of ‘usufruct’ (Empson and Bonilla 2019) to discuss the ‘state’ doctor’s job position as a harvestable temporary ownership of the role, enabling other goals at the collapses of the public and private. This approach emphasises the non-material, non-fixed and temporary forms of ‘property’ or ‘resource’ which have become relevant to democracy in Mongolia. The temporality in micro- and macropolitics, and everything in between, matters as public offices have been established as sites of gain through a certain detachment caused by low salaries, but also on a broader level through the cyclical nature of democracy. When it comes to healthcare, emotion and affect shape people’s experiences of healthcare and the outcomes of what is often considered to come in addition to the state job position of a doctor: namely, the care and attention which are required by the patient. In this, it is hugely relevant that the establishment of biomedicine in Mongolia has been a project of developing a feminine sector, and that reproductive healthcare is largely synonymous with women’s healthcare. Secondly, studying the infrastructures of informality, the seeking of legitimacy and accountability appear heavily gendered, arising from encounters between informalities rather than through engagements with any ‘formalities’ like legislation. I proposed that informalities are not

215 horizontal but incorporate specific power relations that make certain notions approximate and effective to one another across space and time, while keeping others apart regardless of their proximity. In the case of informal abortion, I have suggested that this ‘keeping apart’ is largely due to the ‘middle’ space of informality, such as usufructuary biomedicine and law enforcement. This contributes to the situation in which abortion is legal yet informal and often unsafe in Ulaanbaatar. Most importantly, such studies of governance would benefit from starting by seeking understanding of what is important to the people involved and why, without limiting these answers to morality or other singular analytical approaches, such as biopolitics. As a whole, this thesis has argued for the methodological importance of the everyday in studies of reproductive health, to balance the trend of conceptually drawing on various ruptures or paradigmatic shifts – such as the rise of ‘the clinic’ or reproductive technologies – with work towards understanding the specific ways in which vulnerabilities and insecurities continue to emerge and shape lives.

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