Current debates on health care policies are often rife with emotional content pointing to competing values, beliefs and interests and raising through this competition the question about who is the relevant expert to decide over a health care measure, what knowledge counts as the right one and how this knowledge should be communicated. Not only patients are those who are being seen as increasingly empowered in these debates (e.g. Nettleton 2000, Novas and Rose 2001 or Prainsack 2014), but the citizen empowerment draws the analogy between the change in the relationship between patients and doctors and the interactions between experts and lay persons stated repeatedly in the current research on the role of discourses in public policies (see e.g. Bevir & Rhodes 2010, Fischer 2003 and 2009, Fung 2006, Newman 2012 or Turnbull 2006).
This paper analyzes the case of the Czech controversy around homebirth in order to show how the latter reshapes the relation between experts, patients and policy makers and to anticipate a novel understanding of public policy through intimacy. Intimacy refers here to the concern about the appropriateness of a particular emotional experience of birth and is transmitted through appeals to particular values and beliefs and interests related to the way of giving birth. Czech home birth policy debate has raised to a controversy presenting homebirth primarily as a threat to the child’s security, to maternal responsibility and revealing by that the conflict over professional territorialism between obstetrics, midwifery and mothers. In that way, the controversy problematizes the issue of citizen empowerment in health care policies. By focusing on arguments for and against homebirth and by identifying the actors taking part in the debate the paper suggests that the particular choice for a way of giving is being translated as a choice based on intimacy.
The central aim of the paper is to develop on that basis a novel understanding of intimacy as a key tool of public policy. The paper paints the problem of homebirth controversy as an issue of citizen empowerment in public policy that has recently become rife with emotional content. The phrase “empowerment through intimacy” joins here the public policy debate on citizen empowerment and the relationship between experts, patients and policy makers and traces how intimacy affects it. Three intellectual traditions shape this paper: critical approaches to public policies that enable to conceptualize intimacy as a key elements of governing; gender studies, problematizing the link of body and intimacy; and the health-related research in Science and Technology Studies and sociology that grasps the interaction of actors and discourses in health controversies.
