Since 1997, Iran has implemented the world’s only program for living paid kidney donation. The program has been developed and administered by a non-profit NGO – the Kidney Patient Foundation (KPF). Though sanctioned by Shi‘a Muslim jurists and celebrated in the West as the “Iranian Model,” the program has been rife with moral unease and uncertainty in Iran. While organ donation after death is valorized, undergoing transplantation for cash is stigmatized. Furthermore, there is little agreement among policy actors that facilitating paid organ giving is a good idea. In this dissertation, I examine kidney “selling” both at the level of the exchange – where I analyze the experiences of kidney givers and recipients – and at the level of institutional and bureaucratic process, legal and scientific reasoning, and practical and ethical negotiation, to explain how Iran came to uniquely sanction and bureaucratically routinize kidney selling. I disentangle the dense threads of moral reasoning and experience among a range of actors - from donors and recipients to doctors, policy activists, and Islamic jurists – that undergird the policy’s development and implementation. I have conducted ethnographic field research (2011-2013), including observation inside medical and Islamic institutions in Tehran and Qom, and indepth interviews of kidney givers and patients, KPF personnel, doctors and legal scholars and jurists. I have also analyzed Islamic legal texts, as well as visual and textual media.

My analysis brings together analytic approaches within the anthropology of public policy, medicine, morality, and exchange, while also contributing to a growing interest in Iranian Studies to venture beyond themes of repression and resistance. I consider Iran’s living kidney giving program within the context of Iran’s post-revolution medical modernization projects, its haphazard economic liberalization, and ongoing commitment to social welfare, alongside an examination of the role of Islamic jurists and other “experts” in policy making. I elucidate the socio-economic conditions and aspirations that motivate kidney givers, and the “medical imaginary” that facilitates their decision as well as the legal reasoning of jurists. Lastly, I offer an alternative to the “commodity paradigm” in examining exchanges involving money that can contribute to bioethical discussions of organ sales.

This dissertation examines the creation of a new model of Mexican midwifery education as a response to national concerns about maternal mortality. Amid these concerns, debates have emerged between midwives and the state about the best way to standardize midwifery education. In this dissertation, based on 17 months of ethnographic research with midwives, students, doctors and politicians, I describe the historical roles that midwives have played in Mexico, situate Mexican midwifery within broader trends in development and the expansion of Western biomedicine, and trace the lived experiences of Mexican midwives and their students to see how such trends impact their daily practices, experiences, and goals. My findings about midwives and their shifting fields of practice illustrate the stakes, challenges, and productive possibilities of large-scale attempts to standardize new models of medical training and care. They also refresh our understandings of what midwives do and know, and reveal how medical innovations from the margins may arise unexpectedly.

By engaging critically with actors at all levels of Mexican midwifery, I reveal how claims to truth, such as in debates over best practices in women’s health care, cannot be separated from the broader socio-political contexts from which they emerge. Specifically, I argue that we must critically examine how medical practices and training develop, especially outside of the global North. My work further engages with discussions about processes of development in Latin America, arguing that we must broaden our conception of what might count as “modern,” while not forgetting the historical legacies tied to notions of modernity. Mexico’s current investment in midwifery destabilizes assumptions about the roles of indigenous, traditional and biomedical knowledge within the development paradigm. I show how both expertise and marginalized knowledge are strategically levied in light of international standards, national projects of development, and local conceptions of appropriate knowledge forms. Finally, my work contributes to debates around reproductive politics by interrogating the relationship between women’s health and national development concerns; international pressures to reduce maternal mortality in Mexico have allowed midwives, who had long been categorized as unsafe, to regain authority in the field of reproduction.

This dissertation analyzes community engagement practices as a fundamental feature of democracy, planning, and policymaking processes. Multiple disciplines, including public policy, planning, and public health, understand community engagement as a mechanism to make planning, policymaking, and research processes and their outcomes more democratic, effective, and sustainable. Yet scholars, practitioners, and community residents continue to observe and experience difficulty collaborating in the design and implementation of policy. I investigated these conundrums of democracy, representation, governance, and collaboration through this dissertation, a four-year ethnographic study of community engagement in a foundation-funded neighborhood health initiative in Southern California.

In this dissertation research, I inductively expand current understandings of exclusion and inclusion in planning and policymaking by enlisting practice theory as a theoretical and analytical lens. Practice theory entails both agency and structure; thus, it provides an alternative view to social phenomena, like community engagement, that are commonly studied using an agentic focus (e.g. practitioners need more training to be inclusive) or a structural analysis (e.g. practitioners have the decision-making power and thus exclusion persists). Using a practice lens, I define exclusion through a set of exclusionary practices, all of which prevent connections between different stakeholders, between their issues, and between current and preexisting advocacy and community organizing efforts. I also relate exclusion and inclusion to structural advantages and disadvantages, including the use and maintenance of common organizational and institutional practices in community settings. I describe structural advantages and disadvantages as practices that constitute community power dynamics. Specifically, I explain the relationship between power, defined as the ability to take action, and practices of exclusion and inclusion. I explore the rationale and implications of exclusionary and inclusionary practices by drawing from scholarship on institutional logics. I conclude that community engagement and planning and policymaking are ontologically nonlinear and emergent processes, and that empirical or practical approaches to community engagement must embrace nonlinearity and emergence in order to be inclusive.

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