The professional terms for occupations that provide welfare services are changing, and here the introduction of new public management in the Nordic countries since the 1990s is indicative of wider developments. The article explores professional projects in welfare service work from both conceptual and empirical perspectives. The aim is to produce a gendersensitive analysis of the professional projects at the lower levels of the occupational hierarchies in health care. The first part reviews the literature conceptualizing the societal and institutional embeddedness of professional projects. The institutional matrix of welfare states emerges as a key context in shaping the welfare service work performed by womendominated professional groups. The second part examines the case of Finland and suggests that recent reforms have created new inequalities in the system of professions, in which occupational groups in welfare service work are becoming marginalized. This signals a move away from 'democratic professionalism' towards a revival of 'old professionalism'.
Theories of professions and healthcare organisation have difficulty in explaining variation in the organisation of maternity services across developed welfare states. Four countries -the United Kingdom, Finland, the Netherlands and Canada -serve as our case examples. While sharing several features, including political and economic systems, publicly-funded universal healthcare and favourable health outcomes, these countries nevertheless have distinct maternity care systems. We use the profession of midwifery, found in all four countries, as a 'touchstone' for exploring the sources of this diversity. Our analysis focuses on three key dimensions:(1) welfare state approaches to legalising midwifery and negotiating the role of the midwife in the division of labour; (2) professional boundaries in the maternity care domain; and (3) consumer mobilisation in support of midwifery and around maternity issues.
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