‘MY BODY IS KOREAN, BUT NOT MY CHILD’S…’: A FOUCAULDIAN APPROACH TO KOREAN MIGRANT WOMEN’S HEALTH-SEEKING BEHAVIOURS IN THE UK JEUNG YEON LEE, BA, MA, MRes, MPhil Thesis submitted to the University of Nottingham for the degree of Doctor of Philosophy DECEMBER 2010 For my parents, with love and respect Abstract This thesis examines the health-seeking behaviours of Korean migrant women living in the UK. Theoretically, it argues for treating migration as a process of ‘subjectivisation’, in the specific sense in which this concept is employed in the work of Michel Foucault, and claims that migrants’ health- seeking behaviours always presuppose and refer back to a fundamental process of assuming, appropriating and manifesting the dominant form(s) of subjectivity within the domain of medicine of the host country – in the case of the UK, the medical subjective form of the ‘active patient’ and/or ‘healthy citizen’. In the present work I show that Korean migrant women tend to resist this process of becoming-subject to the ideal active patient model until they happen to undergo some profound and life-altering experience that forces them to come to terms with the British system and its ideal forms of knowledge and behaviour. For most (but not all) Korean migrant women, this life-altering experience is that of pregnancy, delivery and childrearing. Pregnancy and childbirth constitute the turning point in a process of subjectivisation that culminates in the institution of a dual medical citizenship. In other words, while they never totally reject their former autochthonous mode of medical subjectivity (‘good patient’), they nevertheless come more and more to approximate the British model subjective form. On the other hand, when it comes to their children, who are ethnically Korean but born and raised in the UK, they tend almost fully to surrender to the British ideal, recognising that their children, while Korean, i nevertheless possess originally British bodies that demand British treatment. This causes them to become extra vigilant and resourceful regarding their health-seeking behaviours, bringing them more fully in line with the ideal form of medical subjectivity of the active patient/healthy citizen. ii Acknowledgements Reflecting back on the writing of my PhD, I realise that it was not just an academic journey but indeed a life journey. I am indebted to so many people whose generosity and support were constantly present throughout this long, difficult and rewarding process. This research would not have been possible without the Korean women who shared their stories with me, particularly those young mothers who willingly made time for the interviews while looking after (or breastfeeding) their children. I am extremely grateful for my supervisors – Dr David Parker and Professor Ian Shaw – whose patience and guidance enabled me to accomplish this project, as well as the Department of Sociology and Social Policy for providing me with a scholarship to support my work. My examiners – Dr Ruby Chau and Professor Brigitte Nerlich – also contributed to strengthen my argument with their constructive criticisms. I have been fortunate to work for Dr Caroline Bowden as a research assistant; the advice and encouragement that I’ve received from her and her husband, Mr Richard Smerdon, could never be repaid. My thanks also go to Professor Chris Jenks, Vice Chancellor at Brunel University, whom I also iii worked for as a research assistant. Because of him, I have been privileged to work in both academic and non-academic environments. I have benefited from unusual friendship: my special thanks go to Andrew Tyler, Joo-Kyung Lee, Starlet Lin, Yongsoo Kim and Sowan Wang, for their long time friendship and love. I am particularly grateful to Andrew, who has generously shared his time as my interlocutor. Also, my godmother, Nancy Chu, and the people from my prayer group, whose love and prayers gave me strength to complete the PhD. The most thanks go to my family for their love and support. I would never have been able to study abroad without the constant encouragement from my sisters – Kyung Eun and Joo Young – who have willingly taken over my responsibilities as the eldest daughter, and from my brother-in-law, Jin-Man. I am lucky to have had a wonderful grandmother and grandfather who throughout their lives taught me the importance and value of studying. I wish they were with me at the final destination of this journey. I am so privileged to have my parents, who have been constantly supportive of my study despite the fact that I have managed to remain a student for most of my life. For their infinite patience, I dedicate this thesis to my parents with much love and respect. iv Contents Chapter 1: Introduction...............................................................................1 Chapter 2: Literature Review....................................................................14 2.1 Lacunae in the current literature..................................................17 2.1.1 Studies on Korean (im)migrants...........................................18 2.1.2 Literature on migrants’ health-seeking behaviours.............23 2.2 Setting the context............................................................................29 2.2.1 Migrants’ health-seeking behaviours....................................29 2.2.2 Women’s health-seeking behaviours.....................................30 2.2.3 Pregnancy and childbirth.........................................................32 Chapter 3: Theoretical Framework..........................................................36 3.1 Public Health vs Private Health…………………………………...45 3.1.1 Governing the health of the public………………………….47 3.1.2 Foucault's subjectivity and the construction of ‘healthy citizenship’………………………………………..51 3.2 Limitations of the Active Patient Model…………………………..60 3.3 Feminine subjectivity – Gendered subject………………………...62 Chapter 4: Methodology...........................................................................67 4.1 Data collection.................................................................................67 4.1.1 Korean Immigrants, New Malden and access negotiation................................................................67 4.1.2 General information of the participants...............................69 4.2 Qualitative interview......................................................................73 4.2.1 Epistemology and reflexivity................................................73 4.2.2 Strength of the interview......................................................78 4.2.3 Weakness of the interview and strength of ethnography.....................................................................79 4.2.4 Producing and negotiating roles..............................................80 4.3 Translation: researcher as translator.................................................82 4.4 Reflection on the development of theoretical framework..........87 Chapter 5: Traditional/Modern Korean Medical Systems.....................99 5.1 Neo-Confucianist Body..................................................................102 5.2 The Korean National Health Insurance System and the 2000 Reform.....................................................................106 5.2.1 Delivery of medical care.......................................................113 5.2.2 Cost-sharing.........................................................................114 5.2.3 Overuse of medical resources..............................................116 5.3 Autobiographic account..................................................................119 Chapter 6: Concepts of health and illness..............................................124 6.1 First medical encounter with the NHS......................................126 6.1.1 Normalising illness...............................................................128 v 6.1.2 Preventive care in the NHS...............................................132 6.2 Awakening a sense of responsibility.........................................134 6.2.1 Conforming to the ‘healthy citizen’ mode of subjectivity.....................................................................137 6.2.2 Resisting against the British expert knowledge...............141 6.3 Re-defining health and illness.....................................................145 Chapter 7: Pregnancy and Childbirth in the UK..................................156 7.1 Pregnant subjectivities..................................................................157 7.1.1 Planning pregnancy..............................................................159 7.1.2 Midwives and healthcare professionals..............................167 7.1.3 Ultrasound scan....................................................................169 7.1.4 Medication during pregnancy..............................................173 7.2 Childbirth and Postpartum Care..................................................177 7.2.1 Normalising childbirth..........................................................180 7.2.2 Nationalising bodies–‘Korean’ body and ‘British’ body............................................................184 Chapter 8: Mothers as Health Ambassadors of the Family.................190 8.1 Healthcare for mothers.................................................................192 8.1.1 Parental responsibility and passive healthy citizen..........192 8.1.2 Health Imperatives................................................................194 8.2 Healthcare for children.................................................................199