Neoliberalism, welfare, and mass male circumcisions in Turkey

This article explores the neoliberalization of mass male circumcisions, a type of social assistance in Turkey. Male circumcision is a religious and medical practice widely performed in Muslim-majority Turkey, and when this procedure is organised for the poor in large numbers, it is referred to as mass male circumcisions. The article argues that since the 2000s, the AKP (Justice and Development Party) has neoliberalized mass male circumcision by transforming it into an economic and symbolic resource for competing hospitals as well as shaping the ‘deserving’ urban poor families into consumer-like actors. The article further shows the limits and contradictions of this process. In doing so, it challenges the binary between neoliberalism and welfare, and views social assistance as another potential site of neoliberalization that recrafts the society and the state in the image of the market, cutting across economic and non-economic spheres.

The AKP (Justice and Development Party) has dominated the Turkish political field over the last two decades – the longest single-party rule that the Turkish democracy has ever experienced since the beginning of the multiparty electoral democracy in 1950. The party has inherited former pro-Islamist parties’ ideological and organisational repertoire, which began to rise in the 1990s, and has made it compatible with westernisation, secularism, and neoliberalism. Although neoliberalization in Turkey goes as far back as the 1980s, it only consolidated after the AKP came to power. One of the key features of this process was the expansion and modification of welfare provision at the central and local government levels. Successive AKP governments have forged new forms of social assistance networks that have blurred the public-private boundaries and have created solidarities across classes.

This article traces neoliberalization under the AKP by focusing on the historical transformation of a particular form of social assistance: mass male circumcision. Male circumcision is widely performed and ritualised for mainly religious reasons in Muslim-majority Turkey. The age for circumcision typically ranges from three to eleven years and the practice involves not only the operation itself but also communal celebrations, parades, gifts, and special outfits. Circumcisions for the poor and non-poor differ from each other in their organisational forms, and this article exclusively focuses on mass circumcisions for the poor: unlike individual circumcisions for the non-poor, the sons of families at these circumcisions are typically circumcised in large numbers within a short period of time.

This article demonstrates the role of mass male circumcision in establishing new links between the urban poor, politics, and neoliberalism in Turkey. While, in the hands of municipalities, the politicisation of mass circumcisions was already underway before the AKP appeared on the political scene, it has gained a distinct form over the last two decades. The article argues that the AKP has transformed the practice into an economic and symbolic resource for competing hospitals while morphing ‘deserving’ urban poor families into consumer-like actors in the market. The twofold process has further solidified the AKP’s policy of restructuring healthcare services along neoliberal lines as well as the party’s ties to the urban poor, whose support has historically been critical for pro-Islamist political parties. The article discusses how and why the neoliberalization of mass circumcision has resonated with the formerly medically disenfranchised urban poor and reflects on its limits and contradictions.

In Turkey, as in some other non-Western countries, the neoliberal period has witnessed welfare expansion since the 2000s, constituting the backbone of electoral competition in multiparty systems.¹ Scholars often consider this expansion as mitigating measures against the destructive effects of economic liberalisation, positing a series of binaries between neoliberalism and welfare, market and non-market, and consumer and non-consumer. Diverging from this perspective, this article instead sees ‘welfare’/ ‘social assistance’ itself as another potential site of neoliberalization. It views neoliberalism as an art of government that attempts to recraft society and the state in the image of the market (its symbolism, language, and metrics of worth and success), cutting across economic and non-economic spheres. Thus, this article claims that the AKP has neoliberalized mass male circumcision as a social assistance programme in the sense that the practice has become an object of poverty management that rests upon a market-informed distinction between ‘deserving’ and ‘undeserving’ poor, while also being turned into a stake among competing hospitals in the market, transforming the ‘deserving’ urban poor into consumer-like subjects.

The empirical findings of this article are drawn from a larger ethnographic and historical investigation of male circumcision in Turkey. The work analyzes the discursive, organisational, and institutional transformations of male circumcision from the 1920s until the present. For the article, I draw on twenty life stories of male urban migrants residing in two districts (Fatih and Bağcılar) of Istanbul known for their unfailing support for pro-Islamist parties in both municipal and general elections since the 1990s. I talked to these men who were in their thirties and forties before or after their sons’ circumcisions at the venues (festivals and hospitals) where the circumcisions happened. By focusing on these stories, I aim to capture the intergenerational differences in circumcision practices and how families’ evaluation of neoliberal healthcare policies is, in part, mediated by their past experience of mass circumcisions. These life stories are supplemented by thirteen interviews I conducted with health professionals who performed mass circumcisions in both the pre-reform period (pre-2002) and in the present, and with municipality employees who were in charge of organising mass circumcisions. These interviews helped me better understand the dynamics of the new network of mass male circumcision consisting of private hospitals, municipalities, and the central government.

Moreover, my analysis relies on popular archives (especially, newspapers) that show the politicisation of mass circumcisions in the hands of pro-Islamist municipalities after the 1990s. I also use the ethnographic data I collected on mass male circumcisions taking place at hospitals, which provide a basis of comparison between mass circumcisions in the pre-reform and the post-reform periods. This helped me acknowledge not only the differences but also less visible similarities in the organisation of mass circumcisions between the two periods.

In the 2000s, Turkey witnessed an expansion of welfare both in terms of state expenditure and population coverage. The AKP, on the central government and municipality levels alike, has implemented new social assistance programmes and expanded some of the existing ones. The AKP’s ‘pro-poor’ policies were, in part, influenced by former pro-Islamist parties’ experiments, which successfully turned welfare provision into political gain. Having the advantage of ruling the country without coalition partners and controlling large cities’ municipalities, the AKP has more or less rationalised, systematised, and more efficiently coordinated the social assistance networks than its predecessors.

In the literature on Turkish neoliberalism, the AKP’s formal and informal redistributive politics are often considered as fuelled by ‘disillusionment with the orthodox neoliberal development strategy that dominated policy agendas in the previous decades’ (Dorlach, 2015, p. 521). This strategy, it is argued, was marked by aggressive free-market policies such as mass privatisation, corporate tax reduction, fiscal stability, flexible labour markets, the reduction of agricultural state support, and limiting union rights (Cosar & Yegenoglu, 2009; Dorlach, 2015; Öniş, 2012). These policies are usually thought to be derived from ‘Washington Consensus’ or ‘Neoliberal Orthodoxy’, serving as a testament to governments’ commitment to the neoliberal transformation of the society with no regard to social protection.² Welfare expansion in the 2000s is, thus, understood as emerging from political awareness of the urgency to compensate those whose lives have been deteriorated under the destructive economic policies.

The welfare expansion during the AKP period where the ‘free market’ policies more or less continued constitutes an anomaly within this literature that views neoliberalism as essentially indifferent to social protection. Typically, this anomaly is theoretically overcome by conceptualising the welfare expansion as deviation from the precepts of neoliberal doctrine – a change described by coining new terms such as ‘social neoliberalism’ (Dorlach, 2015; Öniş, 2012), ‘regulatory neoliberalism’ (Öniş, 2019), or ‘neoliberalism with a human face’ (Bozkurt, 2013), to name a few. While neoliberalism is seen as a primarily macro-economic doctrine, the terms ‘regulatory’, ‘social’, and ‘human face’, include welfare as another social and political element in the neoliberal framework. The growing state interest in social protection (e.g. an increase in allocated budget for welfare programmes) is thus taken as a sign of ‘post-neoliberal development’ (Dorlach, 2015) or ‘post-Washington consensus’, (Öniş, 2012) and of the unsustainability of exposing society to unbridled market forces.

Salient in this conceptual manoeuvre to capture the spirit of AKP’s neoliberalism is the assumption of separate spheres: economic and political, neoliberalism and welfare, market and non-market, and consumer and non-consumer. This approach, this article contends, prevents us from acknowledging more subtle working of neoliberalism outside the sphere of market/economy: welfare/social protection, for instance. Our analysis of neoliberalism should instead cut across these supposedly separate spheres, and a Foucauldian line of investigation of neoliberalism can be helpful here.

For Foucault (2008) and Foucauldian scholars (Brown, 2015; Collier, 2011; Dardot & Laval, 2014; Ferguson, 2015), neoliberalism doesn’t merely indicate a macro-economic doctrine, but a governing rationality attempting to fundamentally change how we as humans think about and value ourselves, others, and our relationship with each other. It refers to a particular art of government that recrafts the society and the state in the image of the market (its symbolism, language, and metrics of worth and success). As an art of government, neoliberalization does not have to involve monetisation or commodification, since it essentially describes the process of dissemination of the market model that incentivizes actors to think, feel, and act like market subjects in the non-monetized and non-economic as well as economic spheres.

From a Foucauldian perspective, welfare is not to be seen as necessarily outside of neoliberalism. Instead, it becomes a potential target for neoliberal techniques, discourses, and knowledge. This suggests that the very fact of welfare expansion (e.g. increasing state expenditure in social protection) cannot automatically be seen as at odds with neoliberalism, but should encourage us to investigate more closely the effects of the concrete arrangements that the welfare provision engenders. Foucauldian perspective opens up the question of what subjectivities different welfare arrangements produce, and entertains the possibility that neoliberalism may extend (albeit not inevitably so) into the welfare through, for instance, producing the poor as ‘entrepreneurs’ and ‘market actors’.

This article adopts a Foucauldian approach to neoliberalism as a governing rationality and shows how the AKP has channelled mass circumcisions into competition between hospitals through the hands of municipalities in urban areas and boosted consumer empowerment for the ‘deserving’ urban poor.³ These circumcisions have, on the one hand, become not only an economic but also a symbolic resource (e.g. marketing) for hospitals, particularly private hospitals located in migrant neighbourhoods. On the other hand, with the healthcare reform (‘Health Transformation Program’) aiming at universal coverage supplemented by means-tested social assistance, the hitherto excluded segments of the society has become part of the neoliberalized healthcare system as either ‘consumers’ or ‘consumer-like’ actors. The new network consisting of municipalities, private hospitals, and the central government has transformed mass circumcisions in the name of efficiency, competition, and consumer empowerment and choice.

However, the article also sees neoliberalism, usually much to the distaste of Foucauldians, as an ideology in two interrelated manners: one is a classic Marxian approach that sees ideologies as the concealment and perpetuation of contradictions and inequalities within society. The article reveals how the AKP’s neoliberalization of healthcare system, while redressing some forms of inequalities, has engendered new forms of inequalities under the pretense of universal access to healthcare. The consumerization of the urban poor that attempts to erase class differences under the signifier of ‘consumer’ exists, I show, alongside unequal access to medical care in male circumcision.

Moreover, despite the gap between the AKP’s promise and the experienced reality, of which the urban poor is consciously aware, the healthcare transformation still holds a strong grip on the urban poor. To understand this dynamic, the article analyzes the urban migrants’ affective investment in hospital-based male circumcisions by tracing their memories regarding healthcare in general and male circumcision in particular. This approach can help us avoid assuming that being a market (-like) actor is inherently desirable, asking instead how and why it becomes (or does not become) so. The significance of accessing the hospitalised circumcisions should, as we shall see, be understood against the background of the viscerally experienced medical disenfranchisement of the urban poor in the past.

Rural-to-urban migrants have constituted a critical base for the rise of Political Islam in general and pro-Islamist/neoconservative parties in particular in Turkey. Starting in the 1960s, migrants began to move to large cities where they mostly worked in the informal sector and remained outside of the state’s formal social security system. The then-corporatist social security regime distinguished between formal and informal sectors, covering only a small portion of the society via three public insurance schemes for civil servants, formal workers, and the self-employed. In the absence of formal redistributive schemes, the urban migrants relied on two informal security networks: their sustained ties to the villages of origin and electoral bargaining. The Turkish state’s agricultural support policies during the developmentalist period (1960s – 80s) helped to maintain small peasant holdings and those urban migrants who owned land in rural areas and/or relatives who stayed in the village benefitted from this source of income (and the relatives, in turn, could benefit from the remittances from the cities).

The second informal social security network was based on gecekondu settlements. Migrants built gecekondus (makeshift houses) on public land, which literally means ‘built overnight’, without permission from public authorities. The 1966 Gecekondu Law enabled the incorporation of these irregular settlements into the municipal order with the same access to resources as their middle class counterparts (Buğra, 1998). Urban migrants’ access to basic services (e.g. electricity, drinking water, and proper roads) improved over time, especially because the migrants used their votes as bargaining chips vis-à-vis political parties.

However, these two relations of reciprocity and informal security networks came under pressure after the 1980s. Trade liberalisation combined with reduced state subsidies to agriculture made maintaining small peasant holdings very difficult, leading to a significant decrease, if not an absolute loss, in urban migrants’ crucial livelihood (Buğra, 1998). Also, the integration of gecekondus into the real estate market exacerbated urban poverty. During the 1980s, local and national powers began to construct an image of Istanbul as a global city, generating a wave of high-rise buildings, shopping malls, and gated communities at the expense of urban poor migrants (Candan & Kolluoğlu, 2008). By the beginning of the 1990s, unemployment had risen and the average wage of unionised workers remained lower than in 1980 (Cizre-Sakallioglu & Yeldan, 2000).

The same historical period witnessed a significant change in the demographic composition of poor urban migrants, too. From the early 1980s, the Kurdish Workers’ Party (PKK), a Kurdish militant organisation, led an armed uprising against the Turkish state in the Kurdish region (Southeastern and Eastern Regions). To block growing popular support for the PKK, the Turkish military burned thousands of villages and forced Kurdish peasants to flee to large cities. Deprived of ties to villages of origin as a means of economic support, Kurds began to move into the same slum areas as their Turkish counterparts, forming the ‘emerging informal proletariat, by constituting a cheap labor force, without professional qualifications, and ready to work in any job they can find’ (Yörük, 2012, p. 521). The forced migration and the economic restructuring have therefore led to ‘the creation of an informal Kurdish working class population in the cities of western Turkey’ (Günay & Yörük, 2019).

Against the background of these socio-economic changes combined with the crushing of the left by the 1980 military coup, pro-Islamist parties emerged as a political actors that articulated class-based social justice message in public. In addition to growing number of voluntary associations overtly using Islamic references,⁴ these parties expanded and diversified the field of social assistance, strengthening ‘social assistance’ as the norm of welfare provision. The laws introduced after 1980s assigned municipalities new responsibilities such as social services for the poor and the disabled, which paved the way for pro-Islamist municipalities to arise as a key hub of network of welfare provisions in the 1990s. The WP (Welfare Party) municipalities, for instance, (both metropolitan and some districts including the ones I visited for my research) distributed in-kind aids (e.g. coal, food, and clothes), provided free healthcare (e.g. screening campaigns for breast cancer) (Yilmaz, 2013), and improved the quality of urban services (e.g. cleaner streets, more regular bus schedules, and more efficient garbage collection).

The party also began to fund and organise mass circumcisions as a form of social aid. The mayors of municipalities sought to receive political gain for organising these events, sometimes sharing it with their party leader, Necmettin Erbakan. For instance, Erbakan himself attended a mass circumcision in Konya – a city where pro-Islamist parties have been overwhelmingly powerful – and distributed gifts to the one hundred children who were circumcised in 1994.⁵ A year later, he appeared at another mass circumcision ceremony in Sultanbeyli, a working class district of Istanbul governed by a mayor from his own party in 1995.⁶ Along with other public events organised in the same district on the same day (e.g. an inauguration of a fire department and a ceremony for the provision of water for two neighboorhoods), the mass circumcision ceremony became a political platform wherein Erbakan expressed to locals and the media his views on current national politics as well as highlighted his party’s local welfare policies. Male circumcision, whether mass or not, has a strong ceremonial and communal dimension, and the WP aimed to manufacture its party identity as a ‘caretaker of the poor’ by capitalising on the dramaturgical aspects of circumcision.⁷

Up until the rise of the WP, mass circumcisions were largely funded by private actors such as benevolent individuals or voluntary associations (e.g. charitable organisations, private companies, trade unions and associations, and sometimes news agencies). The WP expanded the politicisation of mass circumcisions in the 1990s, as municipalities gradually became local power contenders funding and organising these events for the urban migrants. However, neither the WP nor its successor the VP (Virtue Party) changed the medical dimension of mass circumcisions. Neither did they introduce a formal centralised bureaucratic mechanism assessing the eligibility of the poor for these services. During this period, mass circumcisions continued to be performed by state-authorized health officers at non-medical venues in large numbers within the same day. The hospitalisation of mass circumcisions and their inclusion within means-tested procedures only began with the rise of the AKP’s single-party rule.

The AKP emerged as the leading party from the 2002 national elections and have been in power since then. One of the reasons for its consecutive electoral voctories was the parties’ central and local social assistance policies. The party has expanded means-tested social assistance, in kind or cash transfers, and has provided food stamps, housing, education, and disability aid for the poor, to name a few. Between 2000 and 2010, the government’s social assistance budget increased by 226 percent (Yörük, 2012). At the local level, municipalities continued to act as key actors in the social assistance networks. The central government encouraged the municipalities to work with non-state actors and voluntary initiatives (e.g. NGOs and private sector) to relieve urban poverty (Buğra & Candas, 2011; Yazici, 2012). Accordingly, municipalities have increasingly assumed the role of ‘brokers in charity’ (Buğra & Keyder, 2006) by channelling resources (e.g. soup kitchens, food, clothes, and shoes) to the destitute. In addition to limited public funds, municipalities collected donations from businessmen in exchange for favours granted for their commercial activities. In doing so, they sought to create an affective union between the (compassionate) rich and the (grateful) poor and strengthen the AKP’s claim to represent the common good and the public interest.

The AKP has continued the politicisation of mass circumcisions as well, but with one key difference: it also made mass circumcisions compatible with the neoliberal transformation of healthcare. The neoliberalization of mass circumcision has two interrelated components: turning the practice into a stake within the hospital care system and the production of ‘deserving’ urban poor as consumer-like subjects. The next two sections detail this process.

I had spent an entire day observing Dr. Mehmet perform mass circumcisions, and I got an opportunity to speak with him later that evening. When I asked him the number of circumcisions he usually performed per day, he responded with frustration in his voice:

Mass circumcisions of the poor, but also circumcisions of the non-poor have undergone hospitalisation over the last three decades. In the past, mass circumcisions were, as I have mentioned earlier, performed in non-medical settings (sports facilities and parks), including those organised by the pro-Islamist WP and VP. Hundreds of boys were placed on the ground or floor, lying next to each other (one of my informants who was a health officer compared it to a ‘factory’). Health officers often performed these circumcisions in only few hours with the help of an assistant and occasionally with no assistant. In contrast to individual circumcisions for the non-poor, health officers at mass circumcisions rushed the circumcisions and significantly lowered the quality of care they provided for the boys. While using local anesthesia and providing post-surgical care – suturing the incision – for the non-poor, the same practitioners often skipped one of the two steps or sometimes both. They also indicated, with regret, that they sometimes made mistakes such as cutting too much or too little of the foreskin that they would not otherwise make. The older male members of the migrant families I interviewed were circumcised either at these mass circumcisions or by itinerant circumcisers who also fell short of meeting the standards for what was considered quality care (i.e. the proper use of surgical instrument) that was available to middle class families at that time. These family members have, as we shall see, disturbing memories of these circumcisions, which serve as a basis of comparison between the past and the present, enmeshed with parental obligations and desires about the welfare of their own children.

In contrast, (upper) middle class families’ sons were usually performed at homes despite the fact that these families as beneficiaries of the corporatist social security regime were entitled to utilising medical institutions for operations. But they instead used health officers’ services primarily because male circumcision including the operation itself was embedded within the communal networks of kinship and neighbourliness. Non-poor families usually had their sons circumcised at their homes where they also organised gatherings for the extended family and neighbours.⁸

 However, a dramatic shift in the venue of circumcisions occurred under AKP rule. Circumcisions across social classes have increasingly been channelled towards hospitals. The hospitalisation of mass and individual circumcisions has been based on a series of developments: one is the larger transformation of the healthcare system under successive AKP governments (Agartan, 2012; Yilmaz, 2013). As part of the healthcare reform, the AKP sought to attract private investments in healthcare services by providing subsidies accompanied by the private sector’s increasing lobbying activities for further commodification of healthcare services (Yilmaz, 2017). Consequently, the number of private hospitals increased from 271 to 562 and the number of beds in private institutions increased from 12,387 to 43,645 between 2002 and 2015.⁹ Between 2009 and 2017, the private provider sector has grown with 13% p.a., undertaking 1.6 million operations (34% of all surgeries) per year and performing 53% of most complex surgeries. Between 2002 and 2010, the number of minor surgeries including male circumcision performed at private hospitals has gone up from 54.975 to 615.745.¹⁰ In 2015, 13% of private hospitals consisted of top five hospital chains.¹¹ Through public-private partnerships (PPPs), these chains were enticed to build and operate hospitals with generous debt assumption undertakings where the government committed to taking on the debt of the private partners. The majority of these private hospitals are located in large cities of Turkey. The AKP has, in other words, managed to introduce ‘a new contour of capital accumulation’ (Yłlmaz, 2017, p. 163) by incorporating the private sector into the provision of healthcare services.

When the private sector began to expand its influence in healthcare services in the 2000s, male circumcision services had already proven to be economically lucrative in the hands of health officers. Hospitals aimed to usurp male circumcisions by claiming via media that hospitals, not homes, are the ideal venues for providing proper hygiene, and specialists (urologists or pediatric surgeons), not health officers, are the only medical professionals with credentials and expertise required for medicalized male circumcision.

In the case of mass circumcisions, two legal and institutional changes have granted (both private and public) hospitals a competitive edge vis-a-vis health officers: first, the Turkish Ministry of Health introduced a new regulation in 1997 (before the AKP came to power in 2002), stating that mass circumcisions should take place in hygienic venues that adheres to the standards of asepsis and antisepsis so as to prevent post-operative complications. Moreover, the funders of the mass circumcisions were now mandated to acquire permission from local state authorities (İl Sağlik Müdürlük), individual practitioners were prohibited from performing more than eight operations per day, and the total number of children who were circumcised at a single mass circumcision organisation could not exceed fifty per day. With the regulation, the government aimed to address the problem of overcrowded and unhygienic mass circumcisions. The new regulation also required that the practitioners work with an assistant and sterilise the medical instruments or otherwise not to use the same equipment twice. The total number of the sets of surgical instruments was decreed to be at least twice as many as the total number of operations. The regulation also mandated the attendance of a specialist during the operation, preferably a urologist. In case no urologist was available, surgeons would be the second choice.

The new regulation increased the economic costs of mass circumcisions (i.e. fees for an assistant and a specialist, and higher standards for the equipment) while limiting the number of circumcisions that could be performed within a day. This, as my interviewees said, made mass circumcisions more or less an unfeasible option for health officers. The regulation also encouraged further involvement of specialists in male circumcision and inadvertently made hospitals the most convenient settings for mass circumcisions as they could better meet the new standards for what was considered as safe operations that health officers.

Second, the AKP transformed the social security and healthcare system with the purposes of increasing access to healthcare, boosting competition among service providers, and enhancing efficiency in delivering healthcare services. To replace the old inegalitarian corporatist security regime, the AKP introduced a compulsory premium-based universal health insurance scheme in 2008. According to the new system, contribution to the public health insurance fund is obligatory. Both formally employed citizens and employers are required to pay a certain percentage of their monthly earnings to this fund. For those who cannot pay the premiums, the government expanded the coverage of the Green Card,¹² a means-tested free healthcare programme for the poor. These policies have increased the poor’s access to public and private hospital services including male circumcision. Health insurance coverage drastically expanded within a short period of time. Between 2003 and 2008, the coverage of premium-based health insurance expanded from 59% to 69% of the total population, and the number of Green Card beneficiaries from 2.5 million to 9.5 million (Aran & Hentschel, 2012). Between 2002 and 2010, annual per capital (The Ministry of Health, University, and Private) hospital visits increased from 1.88 to 4.11, private hospitals in particular visits from 0, 09 to 0.65 (The Ministry of Health of Turkey, Health Statistics Yearbook), and the private health expenditure of households tripled between 2002 and 2010 (as cited in Özden, 2014).

The assemblage of central government, municipalities, and hospitals (especially, private hospitals) has increasingly become the main social assistance network providing mass circumcision services (both the operation and the ceremony) in large cities. Following its predecessors, the AKP municipalities have continued to politicise mass circumcisions. Additionally, they have made the provision of these services as part of the means-tested procedure and have turned, as Dr. Mehmet also emphasised, them into a resource for the competition between private hospitals. The Social Security Institution (SSI), the governing authority functioning as the main consumer buying and financing private and public health services, capped each operation at a certain amount (50 liras) in 2007. However, mass circumcisions have proved beneficial for private hospitals more symbolically than economically. Like municipalities, these hospitals located in migrant neighbourhoods have been using mass circumcisions for publicity, representing themselves as ‘caretaker of the poor’.

If one of the constitutive components of the neoliberalization of mass male circumcision in large cities is the hospitalisation of the practice that has made the practice a stake among private hospitals, the other is that it has turned the urban poor into consumer-like actors. The next section discusses this process.

In summer 2014, I attended a circumcision festival organised by a municipality serving a district with a large migrant population. Municipalities organise these events either before or after the operation, which may include Bosporus tours, concerts, and entertainments with clowns, and games. The apex of this particular celebration was a concert given by a well-known singer. When I finally arrived at the venue, the mayor was giving his speech on a stage in front of families and children lying on the grass, playing, laughing, and running around. As I settled in, I started paying close attention to mayor’s speech:

Since the Istanbul municipal elections were coming soon, the mayor concluded his speech saying that he believed that families were going to support their party candidate who was promising new projects for ‘our youth, children, and women’. Except for this overt party propaganda, his speech was standard across mass circumcision events: harnessing paternalistic imaginary identifications that rest upon unity and wholeness (‘our’, ‘we’); boasting the number of circumcisions as a signal of generosity; emphasising private hospitals as a sign of good care for the poor; and expressing gratitude to the state (read: AKP). Historically, however, what was new to these mass circumcisions is their new venues: hospitals.

Institutions (e.g. education, marriage or military) hold their grip on us as much through inclusion as exclusion. The aura of institutions owes its effect, in part, to the limited access conditioned by the same institutions while embodying promises of good life. Access to these institutions can thus feel empowering, as has been observed in the immediate outcomes of the healthcare reform under the AKP rule. With this reform, the formerly uninsured or underinsured citizens have increasingly gained access to healthcare services including hospital-based male circumcisions. This development has resonated with families, especially parents whose memories of healthcare services including male circumcisions were vivid, and who regarded the access to private hospitals as a sign of not only good medical care, but also prestige. Zafer was one of them.

Zafer,¹³ a thirty-one-year-old father of a son and a daughter, was working as a security guard at a bank when I met him at the festival. His son was an eight-year-old boy with a warm smile. He and I very briefly chatted about his favourite soccer team and school before he impatiently ran back to his friends. Zafer was born in Erzurum, an eastern city of Turkey. When I asked him about his own circumcision, he said with a smile ‘It was chaotic. No one knew what they were doing. Hürriyet¹⁴ organised it in Zeytinburnu. They placed us on a park and then chopped it. There was no hygiene. Everything is different now. These kids are lucky’. He went on to say that although he was ülkücü (ultranationalist)¹⁵, he voted for the AKP in the last election. When I asked him why, he answered that he was pleased with AKP’s policies, including healthcare. ‘You know, I can now go to any hospital I want to’, he said. As for his son’s circumcision operation, he stressed that he first wanted to make sure that his son would be circumcised at a good hospital, adding ‘I wouldn’t want to take my son to a public hospital. This is a milestone in a boy’s life. You know, a father has three duties: having his son circumcised, providing education for him, and marrying him off’.

The key components of Zafer’s remarks such as the rhetoric of choice (‘I can now go to any hospital I want to’), the unpleasant memories of his own circumcision (‘they chopped it’), and his moral self-image as a father (‘a father has three duties’) were common in my interviews with fathers at mass circumcisions. And besides male circumcision, in our conversations, families overall often evaluated the AKP’s healthcare reforms positively because they emphasised that they could now consult doctors more easily that in the past. This confirms the surveys conducted about the AKP’s healthcare reform. According to the Turkey Life Satisfaction Survey, satisfaction with healthcare services boosted from 39.5% to 73.1% between 2003 and 2010.¹⁶ During my fieldwork, even those of my informants who harshly criticised the AKP for its other policies that have, they thought, islamised the society (e.g. the ban on serving alcohol at public facilities), they often softened their bitter remarks when it came to the changes in healthcare services and social security regime.

Mustafa, an employee at the press and public relations office of the municipality that organises circumcision festivals, also emphasised families’ preferences for private hospitals and their diligence in assessing which hospitals their sons would be circumcised:

The festival I attended in summer 2014 was one of those that took place before the operations. A few days after the celebration, the operations were performed at a private hospital. Along with other private hospitals, this particular hospital had been serving the migrant neighbourhood since 1998. The banner draped over the hospital building declared, ‘we are providing circumcision services for free’. Although the service is free at the point of service to families, hospitals, as described earlier, actually receive fees from SSI for the operations. The hospital advertised the total number of the mass circumcisions they had performed over the years and emphasised the hygienic conditions that they provided for families.

On the second floor of the hospital I was waiting with families for the specialist to come and perform the operations. As time passed, the floor became crowded with families waiting for the urologist. The nurses said to the families that the doctor was late since he was performing another surgery. After a delay, the urologist finally arrived. A nurse brought one boy at a time to a room for local anesthesia. Once the anesthesia took effect, boys were taken to another room for the operation. A few minutes after the door closed behind them, we could hear the boys scream through the walls. Other boys waiting for the operations started screaming, too. Meanwhile, the nurses went through the list of the boys scheduled for circumcision. The parents tried to calm their children by shushing, scolding, offering candy, or promising gifts.

I interviewed Ahmet, a Kurdish father and a textile worker and his wife, Ruken, a Kurdish mother and a housewife, at the hospital. He and his wife migrated to Istanbul from a village in Bitlis, an eastern city of Turkey in 1996. They had two sons, four years and seven years old, and both were going to get circumcised on the same day. I asked them about their sons’ circumcisions:

Ahmet: awful. Blood everywhere. He used to just cut and then leave.

Ahmet went on to say that he really liked the idea of taking his son to a private hospital for circumcision. It was, he said, hygienic and the operation was completed with (local) anesthesia. During my research, male adults, like Ahmet and Zafer, invoked, sometimes unprompted, their own circumcisions when they talked about their sons’ circumcisions at hospitals. They were either circumcised by itinerant circumcisers with no local anesthesia and limited post-surgical care villages or at mass circumcisions by health officers with limited medical care, as described earlier. In their accounts, they often provided distinct memory images such as ‘blood everywhere’ and ‘chop up’.

These affectively intensified and condensed memory images act as precipitates of their circumcision experiences. These images are not simply meant to communicate biographical facts. The force and excessiveness of such images lay in their craving for fullness and plenitude in language, also marking a sense of being out of joint with the present – a present of male circumcision with drastically changed moral and medical norms and possibilities. The contrast between now and then amplified these men’s sense of deprivation while simultaneously boosting their self-image as parents. Hence, they moved back and forth between childhood memories and their appreciation of their sons’ circumcisions: ‘they [hospitals] numb the penis now and you do not feel pain’, ‘we can bring our kids to private hospitals [özele] now’, or ‘we survived our circumcisions by luck’ [Biz şansa sünnet olmuşuz].

Memories of past male circumcisions act as an affective underside of the AKP’s grip and its ideological claims (caring for the poor, medical progress, and consumerism) among this population. However, it would be misleading to assume that the conversion of the poor into consumer-like actors through the new mass circumcision assemblage has occurred without contradictions, limits, and tensions. On the contrary, the seemingly clear-cut boundaries between the past and the present instantly falls apart when it comes to other aspects of the current mass circumcisions. Crowded hospital floors populated by families waiting for their sons’ circumcisions were not uncommon at these circumcisions, which made them strikingly similar to the circumcisions in the pre-reform period. Although hospitals introduced an appointment system to mass circumcisions to avoid cramming many people into a limited space – as was the case in the pre-reform period – and pay individualised attention to each boy, this system, as demonstrated by Dr. Mehmet’s above account, failed to work efficiently.

The shortage of time allocated for each patient has been a part of a larger problem in the reformed Turkish healthcare system: the lack of strong primary care network and the sudden spike in accessing hospitals have put strains on health professionals – especially those who serve low-income neighbourhoods. Specialists, more and more, began to see patients with minor problems that should normally be handled by primary caregivers. Hospitals have also introduced a stricter disciplinary regime to increase efficiency and productivity of health professionals. This has led to longer working hours for health professionals, and correlatively decreased allocated time for each patient (Agartan, 2015; Kılıçaslan, 2018). And mass male circumcisions were no exception. This indicates that the ostensibly universal potential of consumerism, which makes up its glamour, continues to reproduce class inequalities in new forms.

Neoliberalism is frequently associated with the rollback of welfare state and is characterised by its so-called blind attitude toward, and its attack on, social protection (see, for instance, Evans, 2008; Harvey, 2007). The latter is considered an obstacle in the way of the all-encompassing power of the former that dismantles social relations through monetisation, commodification, consumerism, and privatisation. In a zero-sum game fashion, the losses of social protection become the gains of neoliberalism. However, the analysis of the recent changes in mass circumcision in Turkey should alert us to the workings of neoliberalism evading the binary of neoliberalism versus social protection reverberating across other binaries such as consumer/non-consumer and market/non-market.

At first glance, shouldn’t the expansion of state expenditure in male circumcision indeed be seen as at odds with neoliberalism? After all, with this social aid, families have gained protection against the market forces recently embodied by private hospitals that have encroached into male circumcision over the last decades. Yet, this article suggested that this approach does not pay due attention to the different rationalities and configurations that social protection mechanisms can take on. First, mass male circumcisions have, through legal and ideological means, become part of the reformed social security system that partially rests upon bureaucratic means-tested procedures and of the reformed healthcare system where public hospitals are incentivized as autonomous entities to compete against the rising number of private hospitals. Both the economic and symbolic values of mass circumcisions have turned into a prize among hospitals through the medium of municipalities and central government. This has been accomplished in the name of efficiency and better care, leading to neither simply ‘commodification’ (the expense is met by the state) nor solely ‘privatisation’ (public hospitals, at least in theory, can participate in the competition).

Second, the extension of hospital-based circumcisions to the formerly medically disenfranchised urban poor has enhanced consumerist aspirations among them. It has turned the ‘deserving’ urban poor into consumer-like subjects fascinated by the access to private hospitals widely seen as a sign of prestige and good medical care. Put differently, neither mass circumcisions have been ‘commodified’ nor the poor has become ‘consumers’ in an ordinary sense. Yet, neither do they remain outside the bounds of the market. The neoliberalization of mass circumcision has, thus, occurred by exactly upsetting such distinctions, representing a rationality that remains beyond the radar of mainstream critique of neoliberalism.

The article also refrained from assuming that being a consumer-like actor would inherently be desirable, as studies have shown that ‘choice’ in healthcare can feel burdensome and unappealing for patients (Mol, 2008; Rapp, 2000). Instead, it explored the historically and structurally conditioned subjective dynamics behind embracing this consumer-like position in the field of mass male circumcisions. Unpleasant memories of circumcision in the pre-reform period marked generational differences in the organisation of mass male circumcisions and served as a basis of comparison between the past and the present, enmeshed with parental obligations and desires about the welfare of their children.

While the article focuses on a particular practice in a particular context, its conceptual breadth and findings are intended to resonate beyond these thematic and geographical limits. In investigating neoliberalism, it urges us not to conflate neoliberalism with commodification or monetisation and see neoliberalism as a specific rationality recrafting the society and the state in the image of the market. From this perspective, neoliberalization designates the dissemination of the market model incentivizing people (and other actors) to think, feel, and act like market subjects in economic and non-economic spheres (e.g. social aids). The task is, then, one of tracing this rationality and its transmutations, limits, and contradictions without adhering to rigid dualistic categories. This can help us better understand the success of neoliberalism in non-conventional areas as well as its failures and limits.

No potential conflict of interest was reported by the author(s).