In the final days of his administration, President Bush tried to pass a law that makes it more difficult for women to obtain birth control, by allowing health care workers to conscientiously object to filling and prescribing birth control prescriptions. While the ruling will be able to be rescinded during the Obama presidency, it will take 3-6 months.1
Birth control, family planning, abortion, and other related policies are politicized around the world. While considered a personal, religious, and/or ethical decision, issues of family planning are also thoroughly connected to government policy and objectives. Well known examples include the one-child policy in China and the faith-based politics of the U.S. Christian “right.”
Foreign aid and monetary incentives and disincentives are a few of the numerous tools available to policymakers to influence procreation and family-size. This news analysis will examine birth control and U.S. foreign aid; case studies on Tibet, Singapore, and Peru; the role of international organizations, including the United Nations and the World Health Organization (WHO), and NGOs such as Planned Parenthood; and the influence of religion on family planning.
Birth Control and U.S. Foreign Aid
The Bush Administration has often tied family planning to foreign aid policies. Since 2002, the Bush Administration has supported a Global Gag Rule that denies international aid to any group involved in abortion-related activity. Organizations that do not comply are not eligible for U.S.-donated contraceptives, including condoms.
Other administration policies include the 2003 $15 billion pledge to combat AIDS in Africa required that the funds be used for abstinence-only programs. Condom use was only to be promoted amongst high risk individuals, including trucker drivers and sex workers. The impact of the policy was felt worldwide.
For example, Uganda had extensive health education programs, which reduced HIV/AIDs cases in adults from 15 percent in 1992 to six percent in 2004. However, after the pledge was passed, these successful programs were cut back in favor of abstinence-only programs. Condom ads were replaced with virginity ads; some condoms were actually recalled. In the first two years that the program was enacted, rates of HIV infections doubled.2
More recently, in October 2008, USAID ordered six African countries to not accept condoms, birth control pills, IUDs, and other contraceptives, distributed by Marie Stopes International, a British family planning NGO that has offices and clinics worldwide. Marie Stopes estimates that the result of this ban would lead to 157,000 unwanted pregnancies per year, which in turn would lead to 62,000 additional abortions and 660 women dying in childbirth.3
Commentators note that these numbers may be inflated since birth control might still be routed to these communities through other means. Nonetheless, Marie Stopes clinics are often the only family planning clinics available to many isolated African communities.4
Case Studies: Tibet, Singapore, and Peru
Family planning policies can be found worldwide. These three case studies offer examples of its use by China (in Tibet), Singapore, and Peru. These countries actively sought political and economic goals through encouraging or even forcing women to have/or not have children.
While China’s one-child policy is well-known; its use in Tibet is not. Tibet.org, a non-profit website in support of Tibet, documents this issue. The site notes that the one-child policy is supposed to exclude minority nationalities, including Tibetans; however, in practice, it has actively been promoted there since the 1980s, through work units and birth control clinics.
Chinese policies in the TAR (Tibetan Autonomous Region) have included the 1984 2-child policy, which was updated in 1992 allowing two children only if the mother was 22 when she had the first child and 25 when she had the second. Incentives for urban women to have only one child include: priority for goods, jobs promotion, as well as free medical treatment for their child until he or she reaches 18. Those who do not comply are penalized. China’s punitive family planning programs have lead to increased abortions, sterilizations, and infanticide in Tibet.5
Singapore has promoted family planning policies since its independence in 1965; however, these policies have varied from being anti-natalist to selectively pro-natalist. In the 1960’s and 1970’s, Singapore supported anti-natalist policies until fertility rates reached replacement levels in the mid-1970’s. Incentives for smaller families included priority in primary school registration as well as priority in allocation of public housing.6
In the 1980’s, census data revealed that well-educated women had smaller families; singlehood rates amongst the educated were rising as well. Out-of-wedlock births are not viewed favorably within Singapore society; so increasing singlehood contributes significantly to lower birth rates.7 By the mid-80’s, Singapore changed its policies to be pro-natal and it also relaxed its immigration policies to attract workers and make-up for its shortfall in births.8
Pro-natal policies included: priority in primary school registration for students whose mothers had university degrees, enhanced child relief for better-educated women for up to three children, increased paid child leave for educated women, governments-sponsored graduate marriage matchmaking funds, funds to encourage sterilization of lower income women, and hospital accouchement fees making it more expensive for hospital births (thus discouraging large families amongst the poor).9 Similar pro-natalist policies continued in Singapore throughout the past two decades. 10
The Fujimori government (1990-2000), known for human rights abuse and corruption, had a policy of forced sterilizations, encouraged through free food and threats of coercion. More than 300,000 Peruvian women were forced to be sterilized.11 Fujimori’s Plan Verde, planned to get rid of entire social groups, including criminals and poor people. 12
The United States Agency for International Development (USAID) and the United Nations Population Fund (UNFPA) supported Fujimori’s family planning policies. Support included training of military doctors who performed the sterilizations, funding of NGOs involved in the plan, funding for contraceptives to be distributed in areas where there were “sterilization festivals.”13 Fujimori faces criminal charges in Peru for human rights violations; meanwhile in 2007, he has been convicted of ordering an illegal search and seizure and was given a six-year prison-term. While U.S. and UN involvement were known and documented, there has yet to be any repercussions for their involvement.
The Toledo government (2001-2006) supported aggressive policies to increase the birth rate. The government did not support sterilization nor did it allow birth control to be distributed. Abortion was only allowed in cases where the women’s life was at risk. Birth control pills and IUDs were considered to cause “abortion” since they prevented ovulation, fertilization, and/or implantation of the fertilized egg. Condoms distribution stopped as well. The government ruled that life began at conception. The impacts of these policies included increased contraction of HIV amongst women and 350,000 illegal abortions per year.14
Role of International Organizations
International organizations, such as the United Nations, as well as NGOs, play an important role in providing services and funding in support of family planning policies.
The United Nations
The United Nations has a number of mechanisms and organizations that address family planning, including the United Nations Policy Fund which promotes the right of every woman, man, and child to enjoy health and equal opportunity. It helps “ensure every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. “15
The UNPF 1994 conference attended by representatives of 179 countries affirmed the concept that reproductive health is a prerequisite for long-term sustainable development. The UNPF offer services and support to improve maternal health, prevent maternal mortality, support adolescents and youth, prevent the spread of HIV/AIDS, promote gender equality, protect human rights, secure reproductive health supplies, and assist in emergencies.16 While the UNPF has developed many worthwhile programs, its active involvement in Peru, and possibly in other countries, in programs that were forced upon the population, taints the institution.
An additional UN mechanism to address family planning is the UN Millennium Development Goals (MDGs), which were amended to add goals that relate to family planning. These goals include: Goal 5: Improve maternal health, with related targets 5.B To achieve universal access to reproductive health by 2015 and related indicators 5.1 Maternal mortality ratio, 5.2 Proportion of births attended by skilled health personnel, 5.3 Contraceptive prevalence rate (moved from MDG 6), 5.4 Adolescent birth rate , 5.5 Antenatal care coverage (at least one visit and at least four visits), and 5.6 Unmet need for family planning ;Goal 6: Combat HIV/AIDS, malaria and other diseases. All countries who have signed on to the carry out the MDGs are responsible for reporting progress in each of these goals.
World Health Organization (WHO)
The WHO is also very active in helping educate and advocate on issues of family planning. In 1994, it published its first global strategy on reproductive health. The WHO advocates “improving antenatal, delivery, postpartum and newborn care; providing high-quality services for family planning, including infertility services; eliminating unsafe abortion; combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other gynaecological morbidities; and promoting sexual health.” 17
In addition to education, the WHO funds family planning-relating research, such as a 2007 male hormonal contraceptive study. It works with country health ministries to strengthen their capacities to undertake research and carry out family planning programs. It publishes a magazine promoting best practices. It also works with a Scientific and Ethical Review Group for its studies and research grants.
There are many NGOs worldwide, faith-based and secular, who are involved in family planning, from a variety of perspectives. These NGOs provide counseling, education, as well as health services.
One of the largest and most active NGOs on this issue is Planned Parenthood. Planned Parenthood operates in 180 countries, with regional offices in Nairobi, Tunis, Brussels, New Delhi, Kuala Lumpur, and New York. It supports sexual and reproductive rights as a guaranteed human right, encourages women to take control of their reproductive lives, and promotes gender equality and elimination of gender bias.18
It provides “counseling, gynecological care, HIV-related services, diagnosis and treatment of sexually transmitted infections, infertility services, mother and child health, emergency contraception and abortion-related services.” They focus on the Five A’s: Abortion (decrease number of unsafe abortions), Access (information, education, and services to poor and marginalized populations), Adolescents (educational programs and services); Advocacy (lobbying government and international organizations to align with their organizational principles); and AIDs (helping combat the spread of HIV/AIDS through education and services).19
Most of the world’s religions have perspectives on family planning; these views are often translated into policies by countries who identify with a religion or whose leaders rely on their religious values to shape public policy.
In certain cases, such as the Vatican, religious/political leaders try to spread their perspective and influence other country’s family planning policies. The Vatican and other religious groups have tried to influence the outcomes of UN conferences and documents on family planning. Catholic lobbyists are active worldwide; for example, in the Philippines, they worked against the passage of a reproductive health bill that promoted contraceptive use and sex education.20
The official perspective of Catholic Church is that it does not support abortion, oral contraceptives, tubal ligations, vasectomies, sterilization, and condoms (except for medical necessity); it does support the rhythm method as a form of contraception. These views are spread through missionaries and church leaders around the world. As with many contentious issues, there are Catholics who disagree with this stance; groups such as Catholics for a Free Choice work in Latin America and Europe to raise awareness of other perspectives within Catholicism on issues of family planning.
The issues of birth control, abortion, and other related family-planning issues are very controversial. Conflict can be found in any decision-making body, from the international level to the local level, where family planning policies are made and enforced.
It is hard not to pass judgment on countries that support family planning policies such as sterilization. The notion of choice and the right of the individual to make this choice is not universally held. Some societies value the good of the community over the welfare of the individual and it is often within that context that family planning policies are developed.
Nonetheless it is difficult to stand idly by, as women are forced to be sterilized or, on the other extreme, do not have the option to buy birth control. The complicit involvement of the groups whom one would expect to advocate for international human rights, such as United Nations, are not only allowing, but helping finance these operations is abhorrent.
1 “236.com: President Bush Is Making Laws Faster Than President-Elect Obama Can Promise To Rescind Them.” Huffington Post. November 18, 2008.
2 Anastasion. Danielle. “Uganda: The Condom Controversy AIDS and the abstinence debate.” PBS. July 13, 2007.
3 Kristol, Nicholas. “Can This Be Pro-Life?” New York Times. October, 9, 2008.
5 Birth Control Policy in Tibet. http://www.tibet.org/Activism/Rights/birthcontrol.html
6 Yap, Mui Teng. “Fertility and Population Policy: the Singapore Experience.” Journal of Population and Social Security (Population), Supplement to Volume 1.
11 Population Research Institute Weekly Briefing. Volume 5/ Number 27. September 22, 2003.
12 Ruhfus, Juliana. “Peru: Fujimori’s Forced Sterilization Campaign.”
13 Population Research Institute Weekly Briefing. Volume 5/ Number 27. September 22, 2003.
14 Sanger, Alexander. “Birth-Rate Policies Whip-Saw Women in Peru.” WomensNews. July 23, 2003.
20 Catholic Church Expects Defeat Of Philippines Family Planning Bill, Drafts Alternate Measure.” Medical News Today. November 21, 2008.
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