Women at Conference Decry Focus on Birth Control : Health care: Cairo participants say fixation on family planning detracts from other issues, such as comprehensive medical services for females.
Margaret Ogola, a Kenyan physician, spoke of the clinics she administers in rural Africa, where women are often hard-pressed to find an aspirin or an antibiotic but always have a ready supply of birth control pills.
“You wake up in the morning, and you hear you’re having too many babies. You go to bed at night, and you hear you’re having too many babies,” she sighed. “How come there is money for contraceptive pills and billions more are being poured into the system, and there’s no money for anything else? Isn’t it genocide, really?”
For years, the solution to the world’s population growth was as simple as a tiny metal coil in the uterus or a packet of birth control pills. A huge network of global funding opened family planning clinics in cities and out-of-the-way villages throughout the Third World, with encouraging results.
Fertility rates in nations as diverse as Kenya, Bangladesh, Egypt, Iran and Brazil began dropping. On average, births in developing countries were reduced from six or seven per family in the 1960s to three or four. And researchers worked furiously to develop more innovative contraceptives, ranging from trimonthly injections to hormone implants under the skin.
But a growing chorus of objections from women all over the world--the supposed beneficiaries of this largess--has prompted global planners to rethink their whole approach to birth control and family planning.
The debate is an important basis for understanding this week’s International Conference on Population and Development, which attempts to set a global population-planning strategy for the next 20 years. In its most stark form, it pits outspoken opponents of “contraceptive imperialism” against low-key pharmaceutical salesmen wending their way through the exhibition halls.
While previous international strategies have focused heavily on extending contraceptive services, the draft program of action under discussion in Cairo never even mentions birth control, referring instead to “fertility regulation.”
Indeed, family planning now means much more than birth control. The new plan calls for offering women a wide range of health care services that will help them deal not only with preventing pregnancies but also with sexually transmitted diseases, reproductive tract infections, even prenatal and postnatal care and breast-feeding. The emphasis now is on giving women choices about whether to have children, and how many--on involving women in choosing what birth control options are best for them.
To a great degree, the new talk about empowerment of women and more comprehensive health care services reflects the frustration that women throughout the world have felt with their family planning prescription.
Increasingly, women are asking: Must we--and our bodies--bear the brunt of responsibility for the world’s population and development problems?
In interviews at the conference this week, many women complained, like Margaret Ogola, that Third World public health clinics are often empty of antibiotics or even aspirin--but there’s always a full menu of contraceptives. Increasingly, they complain of health problems brought on by unsupervised use of contraceptives, and call for a new international approach that will give as much attention to women’s health as it does to controlling their reproduction.
“Let’s examine the platter of choices that the U.N. has put before us. What are the choice delicacies that have been prepared for women? We find contraception, sterilization and abortion, and I do not consider that choices, I consider that groveling,” a representative of the International Federation for Womanhood told a cheering gathering of women in Cairo. The crowd included not only conservative anti-abortionists but also representatives of mainstream feminist groups such as the National Organization for Women.
Outside the main conference hall, a member of the Honduras delegation, Marta Casco, complained that the world’s developing countries for too long have had contraception forced on them.
“Our countries need antibiotics, roads, electricity. Our children are dying because they don’t even have rehydration medicine for diarrhea,” she complained. “The only thing to go into my country--and there is plenty of it--is contraceptives.”
Ogola said Third World women are suffering the consequences of undersupervised contraceptive use: Vaginal infections brought on by high-dose oral contraceptives are thought by some to make women more susceptible to AIDS.
“They are being given a form of contraception that cannot be sustained, and it is not right. Not speaking medically, it’s not right, but speaking medically, it’s a disaster,” said Ogola. “If they are going to provide all these things, let them provide at the same time antibiotics, which even the simplest ones we cannot get. . . . It seems that if we are dying from pneumonia, it’s OK. One (person), more or less. But let no other child be born.”
Brian Atwood, administrator of the U.S. Agency for International Development, the world’s largest funder of family planning programs, said emphasis will continue to be placed on making contraceptives available because women want them.
“It’s clear that as we engage in these programs and help women who are demanding these services, we’re not imposing these programs on people,” he said in an interview.
But he said the United States has already expanded its funding focus to look not only at contraception but also at maternal health care, infant survival programs and education for girls.
“Contraception is the factor that has the most immediate impact, but it is not the only factor,” he said. “We want to deal with the living as well.”
