Private Rights, Population Policy: A Tense Debate

June 21, 1992|By JUDY FOREMAN, The Boston Globe

In Brazil, family planners in the 1970s were so eager to curb population growth that they allowed women, who had few other contraceptive options, to get birth control pills in pharmacies without seeing a doctor.

It worked. The average number of children each woman had fell from 5.8 in 1970 to 3.3 in 1990.

The trouble was, nobody warned women that if they smoked while on the pill, risk of a stroke increased. Stroke has now become the leading killer of women of child-bearing age in Brazil, according to the Washington-based Worldwatch Institute.

In Bangladesh, population controllers, backed by the U.S. Agency for International Development, have since the 1970s handed out the pill virtually everywhere, even at roadside cigarette stands, says Betsy Hartmann, director of the Hampshire College Population and Development program.

But women are often not taught the importance of taking the pill every day. If taken erratically while a woman is nursing, some oral contraceptives can actually hasten a new mother`s return to ovulation -- and fertility. Perhaps not surprisingly, the program backfired, and in some areas, births actually increased.

In Indonesia, the government for several years has been pushing another hormonal contraceptive, Norplant, a surgically implanted device developed by the New York-based Population Council that is designed to block pregnancy for five years.

So far, Norplant has been implanted in nearly a million women -- some of whom were alarmed to discover later that health care workers are far more eager to put in the devices than to take them out, as a 1989 Population Council report acknowledges.

Bowing to such criticisms, the Indonesian government belatedly granted women the right to ``removal on request,`` says Judith Bruce, a senior associate at the council.

Balancing an individual`s right to control her own reproduction against the world`s growing need to control population has never been easy in the 30 or more years that national governments and the international ``population establishment`` have been trying to cut birth rates.

But with world attention recently focused on the Earth Summit in Brazil, the long-simmering feud over what is now called family planning burst nastily into the open at a pre-summit meeting in April at the United Nations.

At that session, some feminists, who fear ever-more-desperate population control efforts will again work against women`s health, squared off against environmentalists, who think tough population control is crucial to save the planet.

There is, of course, much overlap between planet-conscious women`s advocates and woman-friendly environmentalists, but acrimony is growing, especially at the extremes.

``It`s like the Bolsheviks-Mensheviks, two groups of revolutionaries with tiny ideological differences,`` fumes Jessica Mathews, vice president of the Washington-based World Resources Institute.

Mathews, a staunch environmentalist, greatly angered women`s groups recently when, in a Washington Post opinion article, she blasted a ``small but noisy`` group of women`s advocates for lining up with the Vatican and other lobbying groups to keep some population control proposals off the Earth Summit agenda.

Indeed, these groups were successful in nearly wiping the phrase ``population control`` off the Earth Summit agenda.

Mathews acknowledges there have been ``outright abuses in population control`` but says the current feminist activism is ``playing into the hands of people who really are the enemies ... people who would like to kill population control programs altogether, like the U.S. government, (Sen.) Jesse Helms and the Vatican.``

Women`s health advocates take quite a different view, calling not for externally imposed, government-instituted population control but for a voluntary ``reproductive health approach, with women at its center,`` as Jane Ordway of the International Women`s Health Coalition in New York puts it.

They want an end to policies that harm women, such as the ``structural adjustment programs`` imposed in the 1960s by the World Bank and the International Monetary Fund, adds Boston activist Norma Swenson. Under these ``carrot-and-stick`` programs, she says, countries could not get foreign aid unless they adopted aggressive population programs developed by U.S. officials.

It is axiomatic in demographic circles that birth rates fall naturally when female literacy and economic status improve. Yet international lenders still impose fiscal austerity programs, Swenson says, in which poor countries seeking loans ``are asked to reduce government spending on education, health and other social programs,`` the very programs that could help cut birth rates.

The irony, she adds, is that when international agencies impose ``programs that attempt to reduce population growth without meeting women`s basic needs, people just don`t use them,`` and the programs fail.

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