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This chapter examines the relationship between health service restructuring and the health care experiences of women from rural and remote areas of Canada. Data were collected from 34 focus groups (237 women), 15 telephone interviews and 346 responses from an online survey. Access to services, care quality and satisfaction are salient themes in these data. Problems include: travel, shortage of providers, turnover in personnel, delays associated in accessing care, lack of knowledge of women's health issues and patronizing attitudes of some health care providers. Health care service restructuring has led to deterioration in service availability and quality. Key areas for policy development need to address health care access and quality improvement issues, including increasing access to more (particularly female) providers who are sensitive to women's health issues.

Purpose – This chapter critically examines the purportedly growing phenomenon of Maternal Request Caesarean Sections (MRCS) and its relative contribution to the rising caesarean section (CS) rates.

Methodology – We apply a decentred comparative methodological approach to this problem by drawing upon and comparatively examining empirical data from Canada, the US, the UK and Finland.

Findings – We find that the general argument that has emerged within the obstetric community, evidenced in particular by a recent “State of the Science” conference, is that the reduced risks and benefits of MRCS are evenly balanced, thus ethically it could be seen as a valid choice for women. This approach, taken in particular in the North American context, negates the problematic nature of accurately measuring, and therefore assessing the importance of maternal request in addressing rising CS rates. Moreover, although some of the blame for rising CS rates has focused on MRCS, we argue that it has a relatively minor influence on rising rates. We show instead how rising CS rates can more appropriately be attributed to obstetrical policies and practices.

Originality – In presenting this argument, we challenge some of the prevailing notions of consumerism in maternity care and its influence on the practice patterns of maternity care professionals.

Practical implications – Our argument also calls into question how successful efforts to address MRCS will be in reducing CS rates given its relatively minor influence.

Purpose – This chapter addresses the transformation of patient into consumer, focusing on the specific population of human egg recipients. This work also analyzes medicine, and reproductive medicine and egg donation specifically, as marketplaces, particularly as they function in the Internet environment.

Methodology – This chapter utilizes a content analysis of egg donation related websites using both inductive and deductive coding schemes.

Findings – Egg donation related websites and their practices do indeed fit the model of a reproductive medicine marketplace, particularly those practices related to marketing strategies and cost.

Originality/value – This work focuses on the Internet as a primary location for a reproductive medicine marketplace, and develops a new understanding of the ways in which consumers are transformed by and operate in this market. It also demonstrates the emerging need for policy to govern this marketplace.