Governance and Empowerment in Clinical Encounters: An Ethnography of Toronto's Sexual Health Landscape

This dissertation is an ethnography of the clinic. My fieldsite was a sexual health organization, comprised of what I call The Centre and The Mobile. Created in the 1970s, The Centre was a pioneering force in the history of sexual health care and the womens health movement in Toronto, Ontario, Canada. This organization was created by and for immigrant women with the goal of providing free and accessible sexual health care. However, providing sexual health care to these populations in Canadas public health care system needs to be understood in terms of the increasing emphasis placed on the managerial tasks of reporting as a form of accountability. \nI use the conceptual framework of sexual health governance to examine the delivery of sexual health care in Toronto. Sexual health governance is an assemblage of institutions, social actors, and expert knowledge, which regulates, counts, and fosters sexual health via technologies of care, surveillance, and metrics. In this dissertation, I ask: How is the sexual health landscape organized, and how does the sexual health governance shape everyday practices and experiences of care? I carried out participant observation in The Mobile and The Centre. I interviewed an array of sexual health social actors, including counsellors, physicians, administrative staff, executive directors, volunteers, sexual health promoters, and clients. \nIn this dissertation, I argue that both The Centre and The Mobile were a part of, and were shaped by, sexual health governance. While their funding requirements meant they had to carefully manage their metric data (counting clients and services), they also remained productive spaces for meaningful forms of care. I argue that sexual health social actors were invested in biomedicine while also seeking to do it differently via valuing choice, bodily autonomy, and agency. Clients, too, exercised agency-within-compliance as they accessed sexual health care, both desiring biomedical information and care while also challenging it, revealing nuance in the operations of neoliberal disciplinary power. This is a dissertation about entanglementshighlighting the tension between care and surveillance, empowerment and governancethrough an ethnographic study of sexual health clinical encounters and the meaning this held for the landscapes social actors.

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