05-02-99: ICPD + 5
Challenging A Hidden Agenda
Reproductive Health or Population Control?

A NEW LANGUAGE
Hardly anyone these days advocates population control. Terms like 'population problem' and 'population programmes' are unfashionable. Even ardent neo-Malthusians have adopted the vocabulary of 'reproductive health', 'maternal health' and 'gender equity'. Conferences like Cairo 1994 and the Hague 1999, which focus on fertility control, distance themselves from the language of demography.

The Cairo conference and the Hague 1999 are conferences about population but their organisers support the view that demographic concerns are more palatable in a different packaging. Programmes aimed at reducing the number of people in the world have been formally outlawed. Now they are served up in a new form.

Concerns relating to women's empowerment, reproductive health and the environment have provided a new legitimacy for population control programmes. Even Non-Governmental Organisations (NGOs), whose mission is undoubtedly to assist women, end up extolling the 'demographic bonus' of slower population growth:

'... promoting safe motherhood, giving access to quality family planning, tackling the problem of Sexually Transmitted Diseases and providing clean water and adequate food and nutrition - are all connected with improving reproductive and family health and reducing family size. Slowing population growth, in turn, will generate social, economic and environmental benefits.'
(IPPF (International Planned Parenthood Federation) and Cairo+5 A Position Paper 1998)

The focus on women's rights and health has, as most NGOs admit, taken the sting out of the North/South conflicts evident at international conferences on population up until 1994. Before then, demographic targets tended to be understood, especially by Southern participants, as anti-third world, population control policies:

'A significant shift in thinking is needed from the concept of population control programme imperative to that of reproductive health. The Family Reproductive Health Programme aims to promote equitable, appropriate access to health and other life opportunities, which influence and affect people's reproductive health. It is not motivated by demographic considerations. Therefore it is important to establish that the Family Reproductive Health Programme is not a population control programme'.
(Save The Children Ghana Appraisal Study Report August 1995)

Many aid workers and NGOs on the ground may be sincere in their concern to distance themselves from explicit population control policies. But, sadly, the motivation of donors and the preoccupation with 'reproductive health' remains trapped in the old Malthusian agenda.

THE SAME CONCERNS
The prejudice that 'too many people' is one of the world's biggest problems has now achieved common sense status in the public mind. Far from being challenged by the Cairo Programme of Action, it has been fortified with the help of NGOs and the reproductive health agenda. The socio-economic development needed to give women real opportunities is no longer a priority but a means to another end - that of reducing fertility:

'Population policy should be integrated with social policies that address a range of poverty reduction and human development objectives. Particular emphasis should be placed on better infant and child health, education of girls, and overall improvements in the status of women. These measures bring important benefits in their own right, and experience now shows that they are more effective in reducing high birth rates than policies that focus narrowly on fertility reduction alone.'
(from Population and Development: Implications for the World Bank, Feb.1995 produced by the Population Reference Bureau in conjunction with the World Bank)

Far from improving women's status, the emphasis of many programmes on gender equity play down the socio economic causes of poverty in the third world, in particular the relationship between North and South. Such programmes relocate the problems facing women to inter-personal relations between men and women in the Third World. But changing personal behaviour and relationships will not solve the continuing poverty and hardship in the developing world.

Discussions about gender equity avoid the unpopular yet crucial question of how the North still calls the shots on the world market at the expense of the South. These are the big issues that have been quietly laid to rest since Cairo 94.

A CHEAP OPTION
The emancipation of women requires far reaching socio-economic change. Population policies, on the other hand, merely require effective targeting. They are seen as more practical and immediate in the 'here and now' but where does that leave women?

Anti-poverty measures, investment and development, all of which could make a significant impact on women's lives, are out of fashion. Cutting back on child-bearing, however, can often seem like a cheap and easy option:

'The provision of reproductive health and family planning services requires modest investments in comparison with countries' other health and development needs.
(taken from Population and Development: Implications for the World Bank, Feb.1995 produced by the Population Reference Bureau in conjunction with the World Bank)

'The cost of family planning programs is relatively modest. More important, family planning investments actually save money. Reduced maternal and child health care costs create short-term savings that often amount to double the cost of the family planning program; additional savings accrue as lower fertility eases the demands on the education system.'
(Family Planning: A Development Success Story, Feb. 1995 Population, Health & Nutrition Department of the World Bank)

Reproductive health is about cost cutting - not about spending more on infrastructure and economic development in the South. 'For every dollar spent on family planning governments save as much as $16 dollars in reduced expenditures in health, education and social services'
(USAID [U.S Agency for International Development] Home Page www.usaid.org 1998)

AN EXCUSE FOR EDUCATION
Empowering women, especially adolescent girls, through education is also high on the Hague agenda. But what kind of education is this? Sex education has never been the key to a good career.

If the real objective of the Hague conference was the improvement of women's education then it would be promoted independently of demographic considerations. Education here is the means to realise another agenda - fertility reduction.

'What are needed are programmatic strategies to target youth in programmes of education about the practice of responsible sexual relations and male participation in family planning. Another strategy might be to include fathers in all programmes that deal with the family'.
(ICPD+5 Years Review and Appraisal 24 March 1998 Economic and Social Commission for Asia and the Pacific)

SELECTIVE HEALTHCARE
Through the medicalisation of population control policies, fertility reduction has been included in a long list of health measures. Endless figures are being paraded in the Hague, from infant mortality to maternal morbidity to unsafe abortions. The answer to these undoubtedly horrific figures is, we are told, quality reproductive health care measures. What does this mean? More major maternity hospitals and children's wards? Unfortunately not.

Reproductive health is above all about the indirect administration of contraception. Because family planning has been redefined as a major contributor towards women's health in general, patients may be excused for failing to grasp that contraception is about reducing the numbers of children.

Maternal mortality has been singled out as the greatest argument for reproductive health care. The figures are indeed horrific. According to USAID, 580,000 women die annually, and one per minute from causes related to pregnancy and childbirth. But if maternal mortality is a real concern, why is it bound up with family planning, rather than a maternity hospital building programme? Would women in the West accept contraception as a palliative for the lack of maternity facilities?

'The first and most obvious step towards reducing the toll of maternal mortality and morbidity is to make high quality family planning services available to all who need them'
(UNICEF, The Progress of Nations 1996)

Reproductive health care has been singled out precisely because it serves the population policy agenda. Yet it is estimated that, each year in the developing world, one million people die from malaria alone and 2 million children under the age of five die from diarrhoea. Dealing with these diseases does not top the Hague agenda. There are numerous discussions on infant mortality at this conference but the solution we are given is more and better reproductive health care.

Of course, if children are not born they cannot die young:

'One way in which lower fertility can promote socio- economic development is by reducing the proportion of dependent children in the population. A lower ratio of children to adults can create a "demographic bonus": With fewer children, families have more disposable income to save or invest. Furthermore, a smaller proportion of children means that a greater percentage of the population is in the working age groups.'
('Family Planning in the Developing World:An Unfinished Success Story' Juli Davanzo, David M. Adamson RAND Labor and Population Program 1998)

Participants in the Hague conference are parading a highly selective concern over health. This will do nothing to improve the level of healthcare in the developing world.

It is estimated that in Africa, for example, 43% of people live below the poverty line. In Ghana only 50% of the population have access to public or private health services at all, only 56% have access to safe water, only 40% have access to electricity, a tiny minority have a telephone. How can the effective healthcare that we take for granted in the West be developed without massive investment in infrastructure, power generation, and building programmes?

Nothing like this is proposed at the Hague. Rather there is talk of 'quality care', community 'health posts', 'outreach workers'. This can only mean supervising local births, dishing out contraception, sex education, low tech quickie abortions - not major surgery or baby incubators.

NO REAL CHOICE
Reproductive rights are promoted in opposition to coercive programmes. These 'rights' are supposed to allow women in the developing world to control their own bodies and freely determine their fertility. Yet new forms of coercion are not challenged, so long as they serve the fertility reduction agenda.

For example, an agricultural credit union in Bangladesh which lends to poor rural women was persuaded by international donors to make borrowers agree to a strict code of conduct, including 'good family planning methods', before loans were approved. Micro-credit or loans tied to family planning methods are a form of blackmail. No Western women would accept or expect obligatory family planning lectures in exchange for a bank loan. Why should Southern women suffer such an imposition?

Outwardly, promoters of reproductive health present their cause as the very opposite of coercion. But most studies of fertility practices do not take the views of their subjects seriously. If their investigation reveals a general preference for large families, they have no hesitation in assuming responsibility for changing people's attitudes. Studies of the levels of 'unmet need' for contraception are often quite open about the fact that their aim is to make people realise that they have this 'need', whether they realise it or not.

It is worth asking the question, who decided that there was an unmet need for family planning and sex education, rather than jobs, houses, hospitals and infrastructure in the developing world?

'Current demand is not being met. Over 100 million couples want family planning services but are not currently using any method largely because of a lack of accurate information and poor access to good quality services'
(USAID Website Homepage 1998)

The very concept of 'unmet need' projects the Western ideal of small family size onto the developing world, and suggests the rest are 'unwanted children' - even in situations where large numbers of children may be seen as essential for survival. The concept of 'unmet need' also assumes that families in the developing world do not know how to prevent pregnancy. Yet for hundreds of years couples have practised abstinence, for example, without a sex education programme. There is also plenty of evidence to suggest that the majority of the population in the developing world do know that getting pregnant involves sex. The presumption of 'unmet need' rests upon an assumption of ignorance and stupidity in the developing world.

There have never been struggles, demonstrations, marches and campaigns for contraceptives in the developing world. But there have been struggles over poverty, land reform and structural adjustment programmes. It is hard to imagine that, for many families experiencing dire poverty, family planning is a priority. Western families do not rush to the nearest family planning clinic when they lose their income - and they would be furious if the job centre directed them there.

According to respected global estimates, 10% of couples world-wide suffer from infertility. Is the South excluded from this problem? Apart from the obvious 'use a condom' family planning message aimed at reducing reproductive tract infections and other diseases that contribute to infertility, there is no such thing as infertility treatment on offer by the proponents of reproductive health care. There are no in-vitro fertilisation clinics, sperm donor clinics or the like on offer. What kind of 'choice' does this provide families in the developing world?

This fact makes it clear that the discussion of 'reproductive rights' for Southern families is only about the 'right' not to reproduce.

WHOSE PRIORITY?
WORLDwrite wants to pose the question: is this conference really about improving the position of women or is it about controlling population growth? The intention of this statement is not intended to question the motives of those involved but to warn of the consequences for health, education and women when the imperative of influencing fertility prevails over other priorities.

Many women writers and feminists have been disturbed by the way their concerns for women have been manipulated and co-opted by the population activists. To challenge the population lobby requires challenging the common assumption that population size and growth matters. Health, education and development must then be separated from the demographic perspective, otherwise these issues will continue to be deployed by the population lobby masquerading as projects about reproductive rights.

WORLDwrite is a UK based youth education charity with an inspiring track record of programmes linking young people North and South. The charity seeks to foster international understanding, oppose all forms of contemporary racism and strives for equality for the developing world. The charity supports the right of women to abortion, contraception on demand and fully supports the objective of women's equality. It is precisely because of our commitment to these objectives, that we are disturbed by the tendency of the population lobby to hijack these issues for their own ends.

10-09-98: British and Ghanaian Ministers join WORLDwrite to launch Internet Youth link with Ghana

Rt. Hon. Paul Boateng and Mr Chris Kpodo, Deputy Ghanaian High Commissioner, join WORLDwrite to launch UK-Ghana Youth Internet Link

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