As development organizations undertake the task of improving the public health in former socialist states, their interventions are shaped by a particular cultural logic and predetermined frame of possible action. In the context of local encounters, however, they often confront competing interpretations of a society's prevailing needs. How they manage such differences may not only explain the outcomes of a given project, but may also reveal the capacities and limitations of development agencies to engineer post-socialist change. This article examines a recent WHO project in St. Petersburg, Russia, which defined women's "social well-being" as a local health concern. While the project employed a discourse of "democracy" to promote women's empowerment in the clinic, its parameters of intervention neither incorporated local knowledge nor addressed the structural relations underlying clinic-level conflicts. Two kinds of results ensued: the ideology of democracy was rejected, while WHO's recommendations were partially appropriated as profit-making strategies.