When it comes to contraception/birth control/family planning, the ideal would be for a woman to be well informed about her options, then supported in making a choice about a method that will work best for her, has a risk-benefit balance that she finds acceptable, and is in accordance with her personal values.  Under these conditions, women with exactly the same health profile might choose very different methods.  And they might choose to have very different numbers of children, from none to nineteen (or more).  It would help if all of the women had access to education, a living wage, basic healthcare, and individual rights (e.g. ability to divorce, ability to prosecute rape and domestic violence).

Unfortunately, there is a lot of investment in birth control that has more to do with controlling than empowering women.  And it is usually not accompanied by investment in making sure women have access to education, a living wage, basic healthcare, and individual rights.

  1. Some people want to prevent poor women (in the U.S. and internationally) from having children, whether they want them or not.
  2. Some people want to make sure that women they approve have children whether they want them or not.
  3. Some people want God or nature to control how many children a woman has, though sometimes this only applies to women they think should have children (see #1 and #2).
  4. Some people think that women’s male partners should control how many children they have and when.
  5. Some people think the state should control how many children a woman has.
  6. Some people think that all women should have very many or very few children.

Many people are now aware of “Mississippi appendectomies” and other involuntary sterilizations in the United States, and of  the early birth control movement’s ties to eugenics.   Under various guises, these kinds of attitudes and events have continued through the remainder of the twentieth century to today.

When I was growing up in the 1970s and 80s, what we now call  “international family planning” efforts were often bluntly referred to as “population control.”  This nomenclature was accurate; an emphasis on preventing world over-population, poverty, and famine was centered in preventing women–especially poor women–from having children.  Much policy about population was driven by neo-Malthusian theory (Malthus wrote in 1798 that the exponential nature of uncontrolled population growth would ultimately outstrip food production).  Perhaps the most influential text driving the population policies of my childhood was Paul and Anne Ehrlich’s book The Population Bomb (Paul Ehrlich was listed as the sole author as a requirement of the publishing company).  In it, the Ehrlichs argued,

We must rapidly bring the world population under control, reducing the growth rate to zero or making it negative. Conscious regulation of human numbers must be achieved. Simultaneously we must, at least temporarily, greatly increase our food production.

They continue with this line of argument today:

When The Population Bomb was published in 1968, there were 3.5 billion people, and we were called alarmist — technology could feed, house, clothe, educate, and provide great lives to even 5 billion people. Nuclear agro-industrial complexes or growing algae on sewage would feed everyone. Well, they didn’t. Instead, the roughly half-billion hungry people then have increased to about a billion, and a couple billion more are living in misery. Why don’t the growth maniacs stop asserting how many billions more people we could care for and focus first on stopping population growth and giving decent lives to all the people already here?

While their environmental argument has sound points, the policy response was to try to curb the global population through coercive family planning efforts directed toward poor women (often in high-poverty countries, but in the U.S. as well).  John Holdren, the White House science czar, is in the midst of a controversy around Ecoscience, a text he co-wrote in the 1970s with the Ehrlichs that promoted fertility control.  The text indicated that population control efforts were targeted toward women’s fertility in particular:

A program of sterilizing women after their second or third child, despite the relatively greater difficulty of the operation than vasectomy, might be easier to implement than trying to sterilize men.

They also, rather eerily, predicted the misuse of Norplant for coercive fertility control:

The development of a long-term sterilizing capsule that could be implanted under the skin and removed when pregnancy is desired opens additional possibilities for coercive fertility control. The capsule could be implanted at puberty and might be removable, with official permission, for a limited number of births.

Ecoscience also suggested putting sterilizing agents in drinking water; mandating that poor, single mothers give their children up for adoption; and creating laws that set a two-child cap for families, among other outrageous proposals.  Click the link–I am not making this up.

Coercive policies put into effect in the 1970s and beyond included  sterilization quotas in India and the one-child policy in China, among many others.  The average number of children per woman world-wide decreased from 6 in 1960 to  4 in 1999–not necessarily a bad thing, depending on how it was accomplished.  The neo-Malthusian population control movement may have had less effect than it hoped–its abuses and ineffectiveness were documented and criticized in Betsy Hartmann‘s excellent book Reproductive Rights and Wrongs.  Though many family planning efforts now emphasize women’s education and autonomy, which generally do drive down fertility, it is still true that many initiatives are not based around educating and empowering women.   In response to Gates Foundation initiatives in family planning, human rights groups made the following statement:

The Family Planning Summit must ensure that the clocks are not put back on women’s human rights: women’s autonomy and agency to decide freely on matters related to sexual and reproductive health without any discrimination, coercion or violence must be protected under all circumstances.

In a recent piece, Hartmann notes that concerns regarding fertility control efforts are far from over, including in well-intentioned initiatives:

The Gates initiative focuses on India, for example, where the government’s family planning program, supported by international donors including the U.K. government, is forcibly sterilizing poor women from disadvantaged communities, especially in the states of Bihar and Madhya Pradesh….A certain political blindness is at work in the Gates initiative. The assumption is that you can just pour in money and contraceptives to health and family programs that already discriminate against the poor and miraculously they will turn around and help women. Add to this the imperative to drive down birthrates and you get a recipe for coercion.

In the United States, Project Prevention (Formerly known as C.R.A.C.K.) currently offers cash incentives for sterilization or long-acting contraceptives to poor women with addiction.  Evidence emerged this year about an ongoing coercive sterilization program in prisons in California.  A physician I met at a research work group said that she tells her OB/GYN residents that they must give women long-acting contraceptives (IUDs or implants) at their postpartum visit–to give them a Depo shot or a pack of pills  is “like giving them a can of Diet Coke and telling them not to get pregnant.”

Somehow, these policies are never directed toward middle class women–not even those with addiction, unplanned pregnancies, or a history of child abuse, or who already have large families.  Human rights, it seems, are only for certain humans.


Read Part II here