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Abstract

Investigating maternity tourism to the United States from Russia through the lens of technological mediation, this study foregrounds the geopolitical patterns of human reproduction that shape, and are shaped by, individual choices of maternal healthcare in a neoliberal healthcare market. Following the history of a highly popular Russian-language forum, I demonstrate how this online community gets imbricated into communicative biocapitalism – a neoliberal logic that commodifies the voice of an online user, turning networked publics into markets for medical services. Adding to the literature on data colonialism, I explore a case in which data-driven algorithms effectively alter geographical distribution of reproductive bodies, outsourcing the production of new generations of neoliberal subjects through regimes of technological mediation.

Keywords

Maternity tourism birth citizenship data colonialism Russia United States

Introduction

On an April morning, Anna,¹ a Moscow-based fashion editor, discovered she was expecting. She spent the rest of the day researching local healthcare providers and maternity clinics. Upon entering the query terms and hitting ‘Enter’, her browser yielded a curious set of hits: among its top results was a Florida-based medical group that offered a full spectrum of maternity services to Russian women. Miami was outside of Anna’s definition of ‘local’, but the prospect of leaving the cold, gray, and polluted Moscow to give birth in warm, bright, and sunny Florida beckoned the young woman. Anna could barely wait until the evening to share the important decision with her husband: they were expecting a baby, and their baby would be born in the United States.

Online platforms mediate human interaction: they offer a strategic set of affordances that shape human behavior by structuring, standardizing, enabling or constraining the choices of their users (Bakardjieva, 2015; Graham and Henman, 2018). Through their highly standardized features, online media platforms turn users into rational digital laborers ‘not only producing content…but also producing themselves as profiles organized by marketing standards, a reduced human form that emphasized those features and activities that could be catalogued and sold, or used for selling’ (Bakardjieva, 2015: 247). Consequently, an increasing share of people’s choices are now being technologically mediated, involving the collection and analysis of massive datasets that shape how users learn about and experience their choices. As Anna later recalled in her blog, she had not considered becoming a maternity tourist prior to her online encounters. The search engine algorithm ‘suggested’ the choice of traveling to Miami based on Anna’s data-based profile, effectively shaping the life outcomes for her future child. This scenario is an example of data colonialism: in a digital-age neoliberal economy, constructing data-based profiles for people offers vast opportunities for manipulating their behavior, appropriating the outcomes of their labor, and regulating human life at an unprecedented scale (Couldry and Mejias, 2018).

This article investigates maternity tourism to the United States from Russia through the lens of technological mediation, foregrounding geopolitical patterns of human reproduction that shape, and are shaped by, individual choices of maternal healthcare. Despite the current U.S. President’s allegedly conservative stance on immigration,² Trump properties in Miami annually accommodate hundreds of Russian mothers-to-be (McFadden et al., 2018). Profits received from accommodation of maternity tourists are emblematic of a broader neoliberal logic that, as I demonstrate throughout the paper, contributes to the production of maternity tourism through algorithmic data-based techniques. Used for the purpose of forging and circulating certain types of platform-mediated narratives among expectant parents, digital media channel and mediate the construction of present-day maternity tourism, shaping the geopolitics of reproduction.

This study contributes to an emerging body of literature on data colonialism (Couldry and Mejias, 2018) by investigating the capitalization of human life that occurs at the intersection between data-based technologies and reproductive bodies. Extending the argument proposed by Couldry and Mejias, I explore a case in which data-driven algorithms aim to alter the geographical distribution of medicalized reproductive bodies, outsourcing new generations of U.S. citizens through commodification of user-generated narratives. Following the history of a highly popular Russian-language forum on maternity tourism,³ I demonstrate how this online community gets gradually imbricated into communicative biocapitalism (Banner, 2017)—a neoliberal logic that commodifies the voice of an online user, turning networked publics into markets for medical services. I then adopt an infrastructural perspective to trace an evolving narrative of maternity tourism, which gets commodified for the purpose of creating present and future economic value under the guise of individual choice.

The four sections that follow present and contextualize my argument. I begin by situating maternity tourism within neoliberal healthcare markets, focusing on the role of individual choice and its biopolitical implications. Next, I investigate the convergence of reproductive migration and data-based technologies through the concepts of biomedicalization and data colonialism, theorizing on the role of digital media and their affordances in the construction of patterns of transnational mobility that bear lifelong implications for the children born in these circumstances.

Research design for this study is grounded in studies of digital culture (Rogers, 2017) and critical media theory (Ettlinger, 2018; Manovich, 1999). Drawing on Lev Manovich’s (1999) understanding of technological mediation, I investigate the mediated construction of maternity tourism on the Russian web from two perspectives: representational and computational. In Manovich’s framework, media representation refers to the mediation of various types of discrete objects in the digital format. In this study, I call this the ‘front end’ of technological mediation, documenting the evolving interface along with the content of a popular Russian-language website on maternity tourism. Computation, on the other hand, is a distinctive feature of digital media, which enables new modes of knowledge production at scale, using algorithmic tools to process the vast amounts of digital data (Manovich, 1999). In this study, I call this the ‘back end’ of technological mediation, exploring algorithmic personalization of search engine results by Google in Russia and its neighbor countries. I conclude with the implications of this research for understanding the geopolitics of human reproduction through the prism of data colonialism.

Maternity tourism in a neoliberal healthcare economy

Maternity tourism is a contemporary form of medical migration, which intersects bio-medical treatment of the body with transnational mobility (Roberts and Scheper-Hughes, 2011). In this emergent mobility pattern, expectant persons from developing countries travel internationally to give birth and receive maternity care at medical institutions in the Global North, most notably in the United Kingdom, Canada, and the United States (Kang, 2018; Wang, 2017). Over the past decade, certain U.S. states such as Florida, California, and New York have seen a sharp increase in foreign births. In Florida, a 90% increase has been partially attributed to maternity tourism, most notably from China (Nori, 2016; Wang, 2017) and Russia (Collinson, 2014; McFadden et al., 2018). In this section, I contextualize maternity tourism within the biopolitics of capitalism, keying in on the role of individual choice in a neoliberal healthcare economy.

I start with the concept of biopolitics, which is a twofold process: on one hand, it involves the administration of docile human bodies for the purpose of creating economic value; on the other, it involves population-level management and power over human life (Foucault, 1978). Foucault (1978) connects biopolitics to the development of 18th-century capitalism, which required reproduction and insertion of easily governed human bodies into economic processes. This transformation of management of human life has been made possible through institutions of power that operate through apparatuses of knowledge production. Subsequently, knowledge about individual bodies becomes key in managing and reproducing workforce at the population level. In the next section, we will see the apparatuses of knowledge production change, allowing for the expansion (and outsourcing) of workforce reproduction at scale.

Aside from macro-level biopolitics, Foucault (1997) defines noso-politics—the politics of health, brought about by the emerging medical markets—which led to the subjectification of healthcare to the laws of the market and mechanisms of individual initiative. A prominent feature of noso-politics was the medicalization of the family. It is at this particular juncture that medical interventions have expanded in scope, with the aim of producing optimal conditions to nurture the developing bodies and minds of children on a micro-level, within the family. The 18th century saw a broad expansion of parental responsibilities, and the health and wellbeing of children became a nuclear family’s primary objective (Foucault, 1997). The family–child complex, institutionalized in the 18th century, connects noso-politics, or the politics of medicalization and health, to biopolitics, the politics of labor management in a capitalist mode of production (Foucault, 1997). The family–child complex therefore lies at the core of maternity tourism, mediating the relationship between the ‘private’ individual parental responsibilities of raising a child, and a global-scale demand for docile workforce. Parents bear the responsibility for healthcare choices for their children, including the conditions of their birth, so that these children could grow up to be productive members of society.

Among the factors that drive maternity tourism, scholars point to stark inequalities in maternal and infant healthcare, maintained by national borders (Ji and Bates, 2018; Kang, 2018), as well as increased access to transnational mobility, economic opportunities, and political benefits afforded by citizenship (Yam, 2016). In this context, national borders help produce and enact a neoliberal economy which commercializes maternal healthcare, turning it from an entitlement (available to all citizens of a nation-state) into a commodity (available to those who can pay for it—Roberts and Scheper-Hughes, 2011). These conditions prioritize individual ability to choose from the many options offered by global healthcare markets, allowing medical institutions to compete internationally for patients who can afford their services (Roberts and Scheper-Hughes, 2011). Expectant persons who enter the neoliberal economy in search of better maternal and infant care end up themselves becoming labor reproduction commodities (Lupton, 2012).

In addition to childbirth being viewed through the prism of medicalization (Lupton, 2012), one factor that sets maternity tourism apart from other types of bio-medical travel is an emerging set of legal subjectivities for the future child. Citizenship is a communally generated, but individually held, entitlement that ascribes belonging to a society; asserts national identity; and forges a political tie between an individual and a nation-state based on a paradigm of political legitimacy (Abizadeh, 2012). Birthright citizenship by territory principle (jus soli) delimits nation-states through the imposition of borders, attaching political membership to the territorial presence of an individual at the time of their birth. Citizenship is thus both a legal outcome of maternity tourism and a mechanism with which neoliberal states imagine and construct their national populations (Wang, 2017). In the case of maternity tourism, state borders go through expectant bodies, producing a new set of subjectivities for the future child (Smith, 2012). In neoliberal states, citizenship serves to institutionalize human reproduction, producing new generations of subjects—while at the same time being used by states to regulate reproductive bodies carrying these fetal subjects (Fixmer-Oraiz, 2019). Subject of heated anti-immigration discourses that question the emotional connection between legal status and national belonging (Yam, 2016), citizenship is a lifelong political membership that becomes commodified in the process of maternity tourism.

The acquisition of citizenship at the moment of birth forges a crucial link between the intimate and the geopolitical, through which maternal healthcare becomes a geopolitical strategy (Smith, 2012). Drawing on feminist literature, human reproduction can be understood as a territorializing process that links the small-scale and the intimate to the macro-scale and the geopolitical through the birthing subject (McKinnon, 2016; Smith, 2012). The intimate process of giving birth can be viewed as an assemblage, in which human and non-human actants converge around a birthing body: physical and symbolic attributes of the country and the place of birth, medical providers, healthcare marketplace, and citizenship laws make and contest territorial claims on the new mother and her newborn child (McKinnon, 2016). This complicates understanding of maternity tourism, wherein behind an individual choice of maternal healthcare lies a geopolitical pattern of human reproduction.

This study draws attention to online spaces which mediate the construction and facilitation of territorial claims on expectant women and their newborns. The next section investigates the regimes of technological mediation that territorialize the assemblage of maternity tourism in the digital age.

From biomedicalization to data colonialism: Appropriating patients through data

At the background of geopolitical mobility patterns, including maternity tourism, lies another social transformation known as deep mediatization. Rapid advancements and the proliferation of digital media, combined with increasing reliance on technological affordances for communication, have led to the point where social processes and relationships are no longer simply mediated—they are deeply mediatized (Couldry and Hepp, 2017). This technology-based interdependence has fundamentally restructured the nature of social life: reliance on digital media has profoundly reconfigured both transnational migration (Madianou, 2014) and the provision of healthcare (Banner, 2017; Lupton, 2012). In this section, I investigate the convergence of reproductive migration with data-based technologies through the concepts of biomedicalization and data colonialism, theorizing on the role of digital media and their affordances in the construction of patterns of transnational mobility that bear lifelong implications on the children born in these circumstances. Maternity tourism is a contentious and understudied social phenomenon, which warrants a systematic investigation of the role of digital media in the construction of this mobility pattern among expectant women (Ji and Bates, 2018). This section thus aims to illuminate how processes of datafication and surveillance contribute to creating sociotechnical contexts that frame maternity tourism as an individual choice. These processes are best understood through the concept of biomedicalization.

Biomedicalization is a technologically enabled shift in the provision of health services, where digital data is utilized to construct new categories of patients (Banner, 2017). Essentially, biomedicalization involves aggregating large amounts of data produced by patients online, mostly for the purpose of piloting new types of treatments and large-scale biomedical research in the domain of digital health (Banner, 2017). Cheney-Lippold (2017) calls these data-based profiles measurable types—pattern-based abstractions used for, in Foucauldian terms, the ‘ordering of human multiplicities’ (Foucault, 1978: 218). With biomedicalization, the importance of demographic characteristics in population is diminished in favor of an ever-expanding set of individual parameters that are being used in digital health for the purpose of ‘directing, superintending and adjusting’ individual behaviors (Foucault, 1978: 175). Datafication systems created a laboratory of capitalist power: in the words of Foucault, ‘these are the techniques that make it possible to adjust the multiplicity of men and the multiplication of the apparatuses of production’ (Foucault, 1978: 219).

Biomedicalization makes it so that every patient is a consumer of health services who leaves traces of online behavior, producing textual data for analysis. In these circumstances, the voice of the patient becomes a key rhetorical figure in what Jodi Dean (2009) calls communicative capitalism—namely, the commodification of communication, increasingly prevalent in many social domains, including reproductive health. In Dean’s theorizing, the exchange value of online messages exceeds their use value—consequently, the content of a digital message is less important than its networked circulation. Circulation, in turn, becomes a measure of information utility—in most cases, information diffusion online follows a power-law distribution. This means that, in online spaces, only a small portion of content gets amplified, while the rest of the content is left at the ‘long tail’ of distribution, oftentimes making it invisible to other online users. Virality patterns have a direct impact on digital health communications: as an outcome, some patient voices get amplified to serve the interests of health providers. This commodification and amplification of the patient voice is the essence of communicative biocapitalism, which intersects biomedicalization (collection of data produced by patients online) and communicative capitalism (amplification of certain patient-produced narratives in the interests of private medical institutions) (Banner, 2017), and becomes an essential driver for data colonialism.

By collecting large amounts of human data, biomedicalization enables data colonialism—an emerging form of capitalism that involves the appropriation of human life through data-based knowledge production (Couldry and Mejias, 2018). These broader, macro-level social processes are enabled by the shift to data-based infrastructures that fuel neoliberal economies. This happens through the regimes of technological mediation, which enable the ‘back-end’ production of knowledge about individuals engaging in online interaction, subjecting them to classification and categorization using data from their online behavior and web use (Cheney-Lippold, 2017). A significant implication of such structural dissociation between the front and the back end of online platforms is that it predicates power regimes that operate through digital instruments (Chun, 2006). This is where algorithmically driven online media, often praised as vehicles for freedom in the context of social and geographical mobility, turn into biopolitical tools: algorithms not only assess user-generated information and traces but are also capable of producing calculated publics, using a non-transparent list of criteria to identify potential audiences, often with the aim of commercial benefit (Gillespie, 2014).

Once online users become imbricated within communicative biocapitalism, their textual data and online behavior may get commodified to produce new calculated publics of maternity tourists. In the next sections, I demonstrate how the processes happening in the ‘back-end’ of digital communication, namely the datafication of the users’ online behavior and the commodification of user-generated narratives, serving the interests of power, produce calculated publics of maternity tourists. Like the historical colonialism that predicated the emergence of industrial capitalism, humans’ unprecedented reliance on technological mediation (and datafication that accompanies it) makes them subject to algorithmic control and the appropriation of human data (and as an outcome, life itself) as raw material to serve capitalist purposes (Couldry and Mejias, 2018). In this context, expectant women can be seen as colonized subjects—not only their bodies but also their data becomes commodified and used for profit extraction, which results in the production of new subjects for a neoliberal workforce.

Russian web: Methodological considerations for studying technological mediation

Online spaces constitute an infrastructure to be filled with user-generated content (Rogers, 2013). By offering their users a strategic range of possibilities of action, digital media represent and shape evolving digital narratives of social phenomena (Ettlinger, 2018; Graham and Henman, 2018). In these circumstances, the user emerges as an agent with multiple subjectivities. On one hand, they may engage in information-seeking and information-sharing behaviors as an attempt to de-subjectify themselves from dominant regimes of governmentality (Ettlinger, 2018); on the other, their digital ‘datafied performances’ are being made subject to aggregation and algorithmic computation which produce knowledge about their life, beyond their ability to access or affect their categorization (Cheney-Lippold, 2017: 29). While users make strategic use of the features of digitally mediated environments to negotiate these multiple subjectivities (Ettlinger, 2018; Kang, 2018), digital media, in turn, shape and structure their choices according to the aims and objectives of their creators (Graham and Henman, 2018).

In a neoliberal marketplace, websites constitute design features and affordances to mediate a user’s choice, with potential critical implications on the chooser’s social reality (Graham and Henman, 2018). Furthermore, resorting to commercial search engines, such as Google, for public information, such as that on maternity healthcare, inadvertently prioritizes commercial interests among search results, potentially creating problematic representations of social phenomena (Noble, 2018). By suggesting a potential range of unknown experiences and permitting meaning-making of alternative scenarios, online media evoke affective attunement (Papacharissi, 2016)—in a healthcare setting, these alternative scenarios may be used to profoundly influence the life outcomes of each individual user. Graham and Henman (2018) define two technologies of choice presented to online users through communication affordances: a delimited and objective modality, in which a website uses expert voice and statistical data to produce ‘objective’ knowledge on the user’s choice; and a produsing modality (drawing from Bruns, 2008), in which a website suggests options based on the crowdsourced experience of other users.

Infrastructure ethnography offers a toolkit to study technological mediation by turning platform architecture and affordances into a site of study. Fieldwork in infrastructure ethnography involves analyzing online interaction through historical, linguistic, and structural lens to uncover the ‘master narrative’, and, more importantly, other meanings that get silenced by the dominant, category-based representations of social phenomena (Star, 1999). Infrastructure ethnography also aims to surface invisible, ‘backstage’ components of information systems—a crucial lens for studying online communication, wherein the ‘back-end’ computational processes that facilitate technical mediation do not mirror the ‘front-end’ interfaces that shape user experiences of online environments (Hansen, 2010). This ‘technological unconscious’ (Hansen, 2010: 179), enabled by technological mediation and constructed in the shape of digital traces, remains invisible to the users and subject to algorithmic computational techniques (Gillespie, 2014). While it is hardly possible to access the proprietary algorithms that comprise the ‘technological unconscious’, infrastructure ethnography may be helpful to assess the representations of maternity tourism on the web, as well as interrogate and critique the values and interests embedded in their computational representations online (Noble, 2018).

Screencast documentaries draw from historiographical approach to social research. This involves using the Internet Archive to trace the history of institutions or cultural phenomena through documenting the evolution of their representations(s) on the web (Rogers, 2017). Websites are programmable media objects: they consist of multiple combinations of multi-media objects that can be assembled in various layouts and sequences—a feature known as variability (Manovich, 1999). Querying and retrieving archived versions of a website dedicated to a phenomenon of interest allows a researcher to observe changes in the communicative construction of this phenomenon by studying this variability. In practice, this process involves taking screenshots of a website’s homepage and placing them in chronological order, thereby reconstructing the timeline to discern the patterns and stages of its development across the years (Helmond et al., 2019). This way, screencast documentaries allow foregrounding of the changes in architecture and affordances of a website, linking them to the interests of various actors within that website’s ecosystem. This study borrows from the screencast documentary approach to study the communicative construction of maternity tourism on a highly popular public Russian-language website dedicated to the topic.

In light of the growing popularity of maternity tourism across Russia, as well as throughout the former Soviet Union member states more generally, I situate my inquiry in the Russian web (commonly referred to as runet, the Russian Internet). I bind the object of inquiry along ontological lines suggested by Rogers (2013): expanding the narrow, principled definition of runet as an online space with a domain name of.ru, authored by Russians in Russian language on Russia-related topics, I broaden it based on device cultures that mediate Russian-language users’ engagement with online spaces. Due to historical circumstances that led to runet’s popularity in countries outside Russia (a remaining trace of aggressive Soviet russification policies), the Russian web now encompasses parts of national webs across its neighbor countries, including Belarus, Kazakhstan, the Republic of Moldova, Ukraine, Georgia, Armenia, and Azerbaijan. This turns Runet into a relatively autonomous network of Russian-language content and services reaching users beyond the state borders of the Russian Federation (Barnett, 2011).

Investigating the ‘front end’ of technological mediation of maternity tourism from Russia to the United States, the study traces the history of a popular Russian-language website on maternity tourism. My interest here lies in the change of the website’s interface and affordances over time, and the constellation(s) of actors involved in crafting the narrative of maternity tourism. This website was created in 2011 as a private blog. At the time of data collection (2018) the website’s forum contained hundreds of threads and thousands of posts dedicated to maternity tourism to the United States. Contrary to social media groups that required membership, this website was publicly accessible, and therefore chosen as a point of entry into technologically mediated construction of maternity tourism. In the seven years of its existence, the website transitioned from a journal of one woman’s journey into motherhood into a large crowdsourced database on maternity healthcare and related third-party services in the U.S., as well as a translocal community of parents raising future U.S. citizens.

This analysis proceeds in two parts. I begin by providing a rich historical description of evolution of the narrative of maternity tourism by analyzing the temporal changes in website’s interface and affordances. To do so, I accessed the Internet Archive Wayback Machine⁴ to retrieve a total of eight captures from the website’s landing page. The captures were taken annually, starting from the time when the website was launched (2011), and ending with its configuration at the time this article was being written (2018). In the course of analysis, I paid special attention to the ways in which prominence and obscurity of different features and affordances of the website came to shape narratives around birth tourism as a choice, as well as the involvement of various institutional actors, including medical providers. Taking a systemic historical approach, I then constructed a features matrix of the underlying structure of the website (online supplementary Appendix A), to ease tracking the temporal metamorphosis and understand the change in the website’s interface and affordances, which were used to discursively and visually frame the choice of maternity tourism, while at times obscuring other options for maternal and infant care.

Following the analysis of the ‘front end’, I turn to investigating the ‘back end’ of technological mediation, exploring algorithmic personalization of search engine results by Google in Russia and its neighbor countries. The connection between the ‘front’ and the ‘back’ ends becomes apparent as the website in question gets gradually imbricated into communicative biocapitalism, a neoliberal logic in which the voice and the data of an online user gets commodified to serve in the interests of global healthcare providers. As search engines continue to prioritize business interests in serving information to their users, the collection of personal accounts on maternity tourism becomes part of an algorithmically driven ecosystem aiming to turn the networked publics of Russian-speaking expectant persons into markets for medical services located in the United States. The next section chronicles the website’s gradual integration into the logic of communicative biocapitalism, followed by an analysis of an output of ‘back-end’ computational processes, which further accelerate the loop by producing ‘calculated publics’ of maternity tourists.

Findings and discussion

Undertaking a structured historical approach to study the interface and affordances of a Russian-language forum, I investigate maternity tourism in the context of communicative biocapitalism, a neoliberal logic that commodifies the voice of an online user, turning expectant persons into clients for medical services. I use infrastructure ethnography to trace an evolving technologically mediated narrative of maternity tourism, which intersects digital media with human bodies for the purpose of outsourcing human reproduction, altering its geographical distribution on a global scale. This case thus situates reproductive migration, constructed and mediated through digital communication on online platforms, within biopolitics of communicative capitalism.

Phase 1: A voice of the patient

The website was launched in 2011 as a personal blog, created by a Moscow resident to share her experience of traveling to the United States as a maternity tourist to a (supposedly) narrow audience of people who might be interested in following in her footsteps. Expectantly, the blog occupied a prominent spot on the page (for more detail and the features matrix, please refer to online supplementary Appendix A). Above the main body of the blog, there was an embedded video of Miami beach. The author admitted that Florida climate was an important factor in her decision to give birth in the U.S. (her baby was due in December, when the contrast between Moscow and Miami was particularly stark), so the video was strategically placed to appeal to the potential audience. In support of this presumption, there was also a Yandex weather app on the right-hand side, promising a sunny +28℃ (82 F) in Miami, Florida. At the very bottom of the page, there were photo albums with views of Miami Beach, Sunny Isles Beach, Hollywood, and the Mount Sinai Hospital. The main directory contained the following items: blog, photo, video, legal paperwork, budget, links, children’s goods (the list and where to buy them), and Frequently Asked Questions (at the time of capture, there were six questions, to three of which the author admittedly did not know the answer). The right-hand side contained three useful links (information on pregnancy, breastfeeding, and doctor reviews), money-saving tips, and the list of ‘tricks’ used by intermediary businesses entitled ‘Don’t fall victim to intermediaries’. In general, the website made an impression of a very personalized tourism agency, trying to persuade its audience to take a risk and travel to Miami to give birth (circumventing the intermediaries), which happened to be exactly the situation the website administrator herself was in at the time of the blog’s creation.

In Graham and Henman’s (2018) epistemology, this website design falls within the produsing modality of technologies of choice—the author claims expertise based on her recent experience and frames the choice to give birth in the United States in economic terms. This can be seen from the titles of her ‘most read’ blog posts, such as ‘Why give birth in the United States’ (spoiler: because it is affordable), ‘Why I said no to the intermediaries’ (same reason), ‘How to pick a hospital by price’, and a few others. The right-hand side of the website contained an interesting ‘Husband’s commentary’ title, which offered two articles: ‘How to save money’ and ‘How not to get ripped off by intermediaries’—which might suggest that the website has been targeting potential fathers-to-be, as well as mothers.⁵ At this stage, the user of this website was constructed as a passive reader, whose choice of the place of birth for their future child was delimited to fall between three alternatives: give birth in Russia (pricey and risky), give birth in the U.S. with intermediaries (pricey), give birth in the U.S. without intermediaries (affordable, click here to find out how). No institutional actors were involved at this stage in the website’s development aside from the mention of ‘intermediaries’—medical concierge businesses specializing in maternity tourism. While these businesses are a potentially interesting object of analysis per se, they are outside the scope of this paper’s immediate objective of showing the commodification of the voice of the online user in communicative biocapitalism.

Phase 2: Reconfiguring the (prod)user

A year into its existence (2012–2014), the website was substantially revamped. It received a bright red logo with a rising sun on it that advertised giving birth in the United States without intermediaries, ‘featuring a real story about birth in Miami, doctor and hospital reviews, forum, and lots of helpful information’. The blog was still prominently positioned on the landing page, and its author continued her narrative about making it back to Moscow with her newborn. The menu now offered information on maternity care in different cities across the U.S., and a new interactive communicative affordance—a forum—inviting users to participate in a discussion around six thematic subsections. These subsections were dedicated to maternity and infant care, life in Miami, bringing the baby home to Russia, housing and car rentals in Miami, and different trips and holiday tours that could be taken in Florida. It is important to view these thematic subsections as an attempt by the website administrator to shape the maternity tourism narrative while fostering the creation of an online community. Notably, each subsection had its own strictly formulated bylaws—certain subsections (such as life in Miami, or life in Russia) were closed to the general public and open exclusively to those who were at that particular stage in their journey.

These changes in website’s interface and affordances constituted an epistemological shift—each user had been reconfigured from a passive consumer of content to a produser (Bruns, 2008), which afforded opportunities to contribute to crowdsourced production of the maternity tourism narrative. The choice was no longer framed as an ‘us vs. the intermediaries’—rather, maternity tourism got to encompass a spectrum of activities in the United States as well as in Russia. The users who visited the website were being constructed as produsers and encouraged to further contribute to the narrative of maternity tourism. In this phase, it was mostly the website’s contributors who were sharing external links to other institutional actors such as healthcare providers, accompanied with reviews on the quality of their services. In 2014, towards the end of this phase, the website creators collected and displayed a crowdsourced database for medical providers in Miami and embedded the first commercial content by linking to a car rental company. This was the first step toward the website’s expansion, and the very beginning of the commodification that followed in the next years.

Phase 3: Cross-platform expansion

In 2015, the website started advertising an exclusive club membership—a ‘welcome to the club’ button was prominently positioned, and the club began accepting membership dues through major payment systems. The aim of the club’s creation was community-building, to lower transaction costs due to information asymmetries. Moreover, the contentious nature of maternity tourism both in Russia and in the United States predicated a need to unite and solidify the community. This translocal community was formed for the purpose of forging ties and solidarity between the women who became first-time mothers far away from home, and who found themselves lacking support of a partner and/or family members while abroad.⁶ They organized sightseeing tours and children’s clothes drives, which forged interpersonal bonds as well as reduced the transactional costs of their stay in a foreign country.

As this translocal online community was solidified and regulated by the introduction of a club, the meaning of becoming a maternity tourist had evolved into a lifestyle choice. For this and other reasons, this phase saw a cross-platform expansion—users were encouraged to join the groups on Facebook and other social media (such as vkontakte and Odnoklassniki). There was, however, a note, warning those wanting to join the group to create new social media accounts for this purpose, to avoid disclosing their ‘delicate interests’ to their friendship networks—from which I conclude that the ‘master narrative’ of maternity tourism was predominantly a negative one, which made users seek anonymity in online spaces. At the same time, this desire for privacy and anonymity would do little to prevent these users from being algorithmically surveilled and categorized as potential maternity tourists. On the contrary, cross-platform expansion predicated significant growth in scale that continued for the next few years, using the aggregated data about the users to turn this online community into participants of multi-sided markets.⁷

Phase 4: Biomedicalization

By 2016, the website content had grown in scale, and the forum was strategically placed at the very top of the page. The number of threads in the forum became so large that a ‘search’ button was introduced. The ‘healthcare’ thread was also more prominently placed, which could be interpreted to signify the high importance of the health narrative among other narratives of maternity tourism (such as citizenship). Moreover, both the main content and the right- and left-hand sidebars now featured interviews with medical professionals (OBGYN as well as pediatricians), which might speak to an epistemological transition from crowdsourced expertise (grounded in authentic personal experience of a user) to professional expertise (grounded in the training and credentials of external authorities—per Graham and Henman’s (2018) classification). This is where biomedicalization enters the scene, speaking in the voice of medical professionals who present their authoritative opinion on the state of maternal healthcare in the United States. Graham and Henman (2018) call this modality ‘Delimited and Objective’—while users could still ask and answer each other’s questions in the forum, the types of choice on offer have now shifted to a rational, criteria-based comparison among doctors and clinics in the United States. While more research is required to know how the users were navigating the website following these changes in its interface and affordances, the shifting modality of choice accompanied by biomedicalization is apparent (online supplementary Appendix A).

Growth in scale marked the commodification of user-generated narratives, which turned this particular networked public into a market for medical services. Above the website’s title, the page featured a prominently placed advertisement of a maternity healthcare clinic in Miami presenting ‘the best Russian-speaking medical team’. Bruns (2012) asserts that such intersection between community engagement and commercial interests (i.e. ‘the bees and the trees’) is somewhat inevitable, as it is predicated upon power asymmetries between produsers and the corporations. He also warns against a possible shift from produsage to prosumption (Bruns, 2012)—an arrangement in which not only consumer’s money but also consumer’s knowledge becomes part of the production process. With biomedicalization, this process can be seen happening on the forum—in this technological modality, the primary function of the perceived user is to generate data and traffic to the website, fulfilling the promise of communicative capitalism (Dean, 2009). In technologically mediated environments, the relationship between ‘the bees and the trees’ is not always a symbiotic one—it is at this point that the user-generated narratives start to serve a larger goal of promoting medical providers specializing in maternity care in the United States.

Phase 5: Communicative biocapitalism

Starting in 2017, the website gets further commodified by various parts of a neoliberal marketplace—the users can now receive discounts with a range of local medical professionals, as well as discounted car and accommodation rentals, insurance, and flights. The website now contains a ‘delivery calculator’ to help users calculate their maternity expenses and offers legal support in filling out immigration paperwork in a variety of life circumstances through partner organizations. In 2018, the advertisement at the top of the website offered a ‘unique’ medical deal promising to ‘take care of you and your baby’ in Miami, where each client got a bonus spa treatment. Anyone visiting the website for the first time would be greeted with a large pop-up advertisement: ‘Don’t miss our special offer—ride this SUV, first month FREE’. This technological affordance known as nudging is used to enfold the user into the website’s functionality, prompting them to go for the ‘best’ option based on an economic rationale. The website still tries to present itself as a crowdsourced knowledge repository on maternity tourism—featuring a welcome note from the administrators that reads:

Welcome everyone! We are [names omitted], parents of two energetic boys born in Miami, FL. We created this website to help people like you make the best decision for your child. Please give a shout at [email address] if you’re having a difficulty finding something — I’ll send you the link!

Researching the forum in 2018, when this article was being written, revealed that the forum had 10 topics, only one of which was dedicated to the actual birthing experiences (‘Maternal healthcare in Miami: doctor and hospital reviews and everything birth-related’). This was the second most discussed topic after ‘Welcome to the USA’, in which users exchanged tips on settling in and managing daily life in the United States. Upon closer inspection, the topic contained eight subtopics, such as OB/GYN reviews, hospital reviews, pediatric specialist and immunizations, post-partum experiences, stem cells, miscellaneous discussion on birth in the U.S., glossary of medical terms, and a subtopic dedicated to in vitro fertilization (IVF). Going forward, a systematic content analysis would be beneficial in order to analyze the patterns that emerged in the process of these technologically mediated discussions.

The technologies of choice, afforded through the website’s interface, represent the ‘Delimited and Objective’ modality, in which the user is once again configured as a passive reader, whose choice is constrained to the options presented on the website. From this point onward, the ‘voice of the patient’—in this context, expectant online users—is used to reinforce the neoliberal logic driving capitalist medicine; the rhetoric of freedom and empowerment serves to construct new neoliberal subjects.

At the end of the day, it is still up to the website users whether to use the suggested criteria for selecting a maternity healthcare provider in the U.S. or to leave the website altogether and choose a domestic institution. However, these users might not be able to fully de-subjectify themselves from the workings of the neoliberal logic of maternity tourism—their data was already made to speak for them. As Cheney-Lippold explains,

Everything from plane prices to friends to news content to even whom we might date is determined for us on the basis of how our data is made useful. Rarely in life are we so unknowing of the knowledge that makes us, and our world, in such rarefied ways. (2017: 246)

It might not be possible to find out the ‘black-boxed’ criteria which assign expectant persons into the calculated publics of potential maternity tourists—and yet, following Safiya Noble’s (2018) call, interrogating algorithmic representations of social phenomena does not require deconstructing the code that runs them. The following subsection aims to surface the outcomes of the ‘back-end’ computational processes that facilitate technological mediation of maternity tourism.

Calculated publics of maternity tourists

To investigate agencies that emerge at the intersection of algorithms and genres of online participation, and to demonstrate the role of search engines in the creation of calculated publics of maternity tourists, I conducted a small experiment. Initial exploration of the top two search engines on the Russian web supported my hypotheses (Yandex.ru—57.51%, Google.ru—34.76% of all Russian-language web traffic (Blue Media Consulting, 2016)). Upon entering the query ‘birth’ in the Russian language,⁸ Yandex.ru suggested 10 autocompletion options that start with ‘[giving] birth in USA’ and ‘giving birth in Miami’, whereas Google.ru yielded ‘[giving] birth in USA’ as option #1 and ‘[giving] birth in Miami’ as option #4.⁹

To cross-validate these results, I used the Google Autocomplete tool developed by the Digital Methods Initiative¹⁰ to simulate the top 10 Google Autocomplete suggestions for the query ‘birth’ in Russian language for Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia, and Ukraine—the countries with significant proportions of traffic through the Russian web. The simulation revealed no mentions of maternity tourism in Google Autocomplete options for Armenia, Belarus, and Moldova. In Azerbaijan, ‘[giving] birth in America’ was #7, scoring two points higher than ‘[giving] birth in Baku’, the nation’s capital. In Georgia, ‘[giving] birth in America’ was option #10, with ‘[giving] birth in Georgia’ at #3, and ‘[giving] birth in Tbilisi’, the nation’s capital, at #9. In Kazakhstan, ‘[giving] birth in USA’ came in #8, right after ‘[giving] birth for Kazakhs’. In Russia, ‘[giving] birth in [the] USA’ was option #9. In Ukraine, ‘[giving] birth in [the] USA’ was suggested by autocomplete as option #5 (online supplementary Appendix B). For the majority of Russian speaking users who do have a web browsing history and are signed into their Google devices, these results might differ due to personalization settings and the variability of programmable media. Also, it is important to note that these search results will likely fluctuate over time and are not fully representative of countries outside Russia due to the prevalent use of national languages: Azerbaijan, Georgia, and Ukraine have their own distinct national webs.

Yet, these findings serve to bolster the claims made in this study: when searching for pregnancy clinics online, Russian-speaking users may inadvertently become a ‘calculated public’ of maternity tourists. The ‘front end’ and the ‘back end’ work in tandem to accelerate the logic of communicative biocapitalism—the more user-generated data gets aggregated by these online resources, the more is known about a ‘typical’ maternity tourist, making it possible to algorithmically assign probabilities of each online user becoming a maternity tourist (as mentioned earlier in the paper, Cheney-Lippold calls these probabilistic assessments ‘measurable types’—2017). This, in turn, makes the representation of maternity tourism on the Russian web more visible, increasing the prominence of the results (and, subsequently, their algorithmic autocompletion) by the search engines.

When users click on these autocompletion options, if only out of curiosity, the visibility of the website increases further, as does the visibility of the sponsored content that goes along with those search terms. Unsurprisingly, the top two search results yielded by these autocompletion options on both search engines linked to sponsored content from competing medical concierge businesses that specialized in maternity tourism to the U.S. These two links were followed by approximately 250 other hyperlinks dedicated to the topic, including blogs and discussion forums, as well as links to numerous social media accounts offering users information on a technologically mediated ‘choice’ of maternity tourism ‘without intermediaries’. By assigning this technologically mediated choice to expectant women, search engine algorithms ultimately serve in the interests of communicative biocapitalism, outsourcing future neoliberal subjects through regimes of technological mediation that accompany information seeking behaviors in the digital age.

Conclusions

Data colonialism is a new stage of capitalism that extracts, digitizes, and appropriates human life through data (Couldry and Mejias, 2018). Understanding how people enter these platform-mediated relationships that lead to the capitalization of human life is an important first step in mapping the data-industrial complex that drives biocapitalism. As shown in this article, digital media play an active role in the communicative construction of certain ontologies, where users are much more than digital laborers in communicative capitalism—their online behavior, as well as their reproductive bodies, are being appropriated and redistributed to serve the geopolitical interests of neoliberal economy under the guise of individual choice.

So, what does it mean to claim that expectant persons have been colonized by data? As seen from the analysis above, despite maternity tourism being framed as an individual lifestyle choice, the underlying structures of technological mediation reveal a more systemic nature of reproductive migration. In light of infrastructure being a fundamentally relational phenomenon that emerges in the process of user interaction, the narrative may evolve over time—in the case of the Russian forum, the meaning of maternity tourism gradually shifted from a somewhat risky tourist activity, to a lifestyle choice made by a growing community of Russian-speaking women who traveled to the United States to receive high-quality medical care and provide ‘future options’ for their children. As became evident from the case study, maternity tourism predominantly operates through the prism of economic rationale, regardless of the technologies of choice and their modalities.¹¹

Still, we see the importance of the user-generated narrative diminish with the growth of scale—once the website became imbricated into a larger neoliberal healthcare economy, the types of choice offered to its perceived users have radically changed. Users were no longer making a decision whether or not to receive maternity care in the United States—their constructed agency shifted from being produsers to becoming prosumers, who were offered a rational, criteria-based comparison among U.S.-based doctors and clinics (the question of becoming a maternity tourist got subtly taken off the agenda). This transition from produsage to prosumption is a manifestation of communicative biocapitalism, in which not only consumer’s money but also consumer’s knowledge becomes part of the production process. In communicative biocapitalism, the primary function of the user is to generate data and web traffic, regardless of the meaning of the narrative that gets produced in the process.

Once Russian-speaking web users become imbricated within communicative biocapitalism, their textual data and online behavior could get commodified to produce new calculated publics of maternity tourists. To generate profits for the private healthcare industry, certain expectant persons may get categorized as potential maternity tourists to the United States without their knowledge or will—through a non-transparent list of criteria, their data-based profile might cause search engines to ‘suggest’ an option of becoming a maternity tourist at a very particular moment in their lives, with subsequent implications on the life outcomes of their future children born into the political membership of the United States. When this happens, generations of future neoliberal subjects are constructed and produced through regimes of technological mediation. As I show in this study, the ‘back-end’ computational processes that facilitate technological mediation do not mirror the ‘front-end’ interfaces that shape experiences of maternity tourism—they actively construct future maternity tourists through the commodification and circulation of the user-generated narratives generated by others.

Understanding maternity tourism as a technologically mediated process adds a new perspective on the geopolitical implications of data colonialism: in the case presented in this study, data-driven algorithms were shown attempting to categorize and manipulate behavior of individuals and, consequently, future life outcomes of their children. This technologically mediated manipulation effectively alters geographical distribution of reproductive bodies, outsourcing new generations of U.S. citizens, who also inadvertently end up ‘colonized by data’. Among the many ways in which data colonialism appropriates human life and the outcomes of human labor, this study focused on one: appropriation through altering the geopolitics of human reproduction.

The presented study only scratches the surface of technological mediation that underlies reproductive migration—aside from Google Autocomplete, there are many more ways in which the ‘technological unconscious’ might contribute to manufacturing a social reality, in which maternity tourism is presented as an appealing or, at times, inevitable choice. Another limitation of undertaking the screencast documentary approach is the researcher’s inability to fully experience the ‘look and feel’ of the website beyond the landing page. For instance, it would have been quite beneficial to observe the development of the content on the forum in ‘real time’, tracing the ways in which new and expectant mothers discuss their experiences of giving birth.

Using an ethnographic lens to further investigate this case would help reveal the broader neoliberal logic behind this migration pattern and explore the lived experiences of the persons who were selected/assigned/predicted by the data-industrial complex as possible candidates for maternity tourism. Shifting the focus from technological affordances to power that operates through digital media by interviewing the persons who made the technologically mediated choice to have their children born on the U.S. soil would help glean additional insights regarding the role of technological infrastructures underpinning reproductive migration.

Supplemental Material

BDS868491 Supplemental Material2 - Supplemental material for Geopolitics of reproduction: Investigating technological mediation of maternity tourism on the Russian web

Supplemental material, BDS868491 Supplemental Material2 for Geopolitics of reproduction: Investigating technological mediation of maternity tourism on the Russian web by Olga Boichak in Big Data & Society

Supplemental Material

BDS868491 Supplemental Material1 - Supplemental material for Geopolitics of reproduction: Investigating technological mediation of maternity tourism on the Russian web

Supplemental material, BDS868491 Supplemental Material1 for Geopolitics of reproduction: Investigating technological mediation of maternity tourism on the Russian web by Olga Boichak in Big Data & Society

Footnotes

Acknowledgements

I am grateful to the editors, Agnieszka Leszczynski and Matthew Zook, and to three anonymous reviewers for their excellent suggestions that have been a source of inspiration for revising and completing this article. I also thank the Philosophy, Theory and Critique division of International Communication Association for an opportunity to present an oral version of this study and for recognizing it with an award at the 2019 Annual Conference.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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