Reproductive Rights and Wrongs: The Global Politics of Population Control

By Betsy Hartmann

“Those involved in women’s health issues, Third World studies, and economic development should find food for thought” (Kirkus Reviews).
 
This is an updated edition of the “influential study” (Publishers Weekly) of issues surrounding childbirth and the history of population control programs.
 
Challenging conventional wisdom about overpopulation, and uncovering the deeper roots of poverty, environmental degradation, and gender inequalities, the author uses data and vivid case studies to explore how population control programs came to be promoted by powerful governments, foundations, and international agencies as an instrument of Cold War development and security policy. Mainly targeting poor women, these programs were designed to drive down birth rates as rapidly and cheaply as possible, with coercion often a matter of course. In the war on population growth, birth control was deployed as a weapon, rather than a tool of reproductive choice.
 
Threaded throughout is the story of how international women’s health activists fought to reform population control and promote a new agenda of sexual and reproductive health and rights for all. While their efforts bore fruit, obstacles remain. On one side is the anti-choice movement that wants to deny women access not only to abortion but to most methods of contraception. On the other is a resurgent, well-funded population control lobby that often obscures its motives with the language of women’s empowerment. Despite declining birth rates worldwide—average global family size is now 2.5 children—overpopulation alarm is on the rise, tied now to the threats of climate change and terrorism.
 
Reproductive Rights and Wrongs reveals how these developments are rooted in the longer history and politics of population control. In this book, a new generation of readers will find knowledge and inspiration for the ongoing struggle to achieve reproductive rights and social, environmental, and gender justice.

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Nov 21, 2016
• ISBN: 9781608467341

Book preview

Praise for the first edition of Reproductive Rights and Wrongs

This is a book of conscience. Shocking, eloquent, carefully researched, it should be read—and acted upon.

—Gena Corea, author,

The Hidden Malpractice and The Mother Machine

Stands out amid the rising tide of books on the population question. Hartman’s critique of global special interests in population and the environment are must reading for students and policy analysts.

—Judy Norsigian and Norma Swenson, coauthors,

The New Our Bodies, Ourselves

If I had time to read just one book to gain an understanding of the population and development link, this one would be it.

—Dianne J. Forte, National Black Women’s Health Project

It is unusual to find such a clear explanation of the complex issues involved in population control in the modern world; Ms. Hartmann’s clarity can have come only from enormous work and deep understanding. This is a modern analysis which gives us hope.

—Jonathan Mann, Director, FXB Center for Health and

Human Rights, Harvard School of Public Health

At this juncture in history when victim blaming has become more blatant and oppressive, there is a need for voices of sanity. This book is such a voice. It reflects conviction, courage, sensitivity, and deep insight.

—Mira Shiva, International Health Activist

REPRODUCTIVE

RIGHTS AND WRONGS

The Global Politics

of Population Control

Third Edition

By

BETSY HARTMANN

Foreword by

Helen Rodriguez-Trias

10335.png

Haymarket Books

Chicago, Illinois

© 1995 and 2016 Betsy Hartmann

Previously published in 1995 by South End Press (Boston).

First published in 1987 by Harper & Row, Publishers, Inc. (New York).

This edition published in 2016 by

Haymarket Books

P.O. Box 180165

Chicago, IL 60618

773-583-7884

www.haymarketbooks.org

[e-mail]

ISBN: 978-1-60846-734-1

Trade distribution:

In the US, Consortium Book Sales and Distribution, www.cbsd.com

In Canada, Publishers Group Canada, www.pgcbooks.ca

In the UK, Turnaround Publisher Services, www.turnaround-uk.com

All other countries, Publishers Group Worldwide, www.pgw.com

This book was published with the generous support of Lannan Foundation

and Wallace Action Fund.

Cover design by Rachel Cohen. Cover image by Andy Maguire.

Printed in Canada by union labor.

Library of Congress Cataloging-in-Publication data is available.

10 9 8 7 6 5 4 3 2 1

To Jim, who gave support

To Jamie and Thomas who gave inspiration

To my grandfather, Henry Bothfield,

who helped teach me the value of giving

Contents

Preface to the Third Edition

Acknowledgments

Foreword

Introduction: Whose Choice?

Part One: THE REAL POPULATION PROBLEM

1. Security and Survival

2. The Malthusian Orthodoxy

3. A Womb of One’s Own

4. The Plan Behind Family Planning

5. The Indonesian Success and the Kenyan Failure

Part Two: POPULATION CONTROL COMES OF AGE

6. Birth of an Ideology

7. The Population Establishment Today

8. Building a Consensus for Cairo and Beyond

9. China—Gold Babies and Disappearing Girls

Part Three: CONTRACEPTIVE CONTROVERSIES

10. Shaping Contraceptive Technology

11. Hormonal Contraceptives and the IUD

12. Bangladesh—Survival of the Richest

13. Sterilization and Abortion

14. Barrier Methods, Natural Family Planning, and Future Directions

Part Four: THE WAY FORWARD

15. The Light at the End of the Demographic Tunnel

16. The Population Framework: Inside or Outside?

Appendix

Notes

About the Author

PREFACE TO THE THIRD EDITION

Overpopulation: A Never-Ending Story

More than two decades have passed since the second edition of Reproductive Rights and Wrongs was published, but the book remains very relevant to the present political moment. While the term population control is out of favor, the practice hasn’t died. The belief that overpopulation is a root cause of poverty, environmental degradation, resource scarcity, migration, violent conflict, and even climate change is pervasive. It influences popular media, environmental education and advocacy, and population, health, development, and security policies at home and abroad. Despite being cloaked in the language of women’s empowerment, population control continues to have a negative impact on women’s health, contraceptive choice, and human rights.

While this book is an important gateway into the population controversy, it is also part of a larger body of critical work that is continually growing as new scholars, writers, and activists take up the task of challenging population control from social, environmental, and gender justice perspectives. I am grateful to the many inspiring people I have met, collaborated with, and learned from in the years since the book’s publication.¹ When you challenge a powerful conventional wisdom like overpopulation, it can feel at times like you’re knocking your head against a brick wall. It’s much more effective to put multiple heads, hands, and hearts together to make change, to dismantle the wall together, brick by brick.

Overpopulation is a particularly stubborn article of faith. It persists despite changing demographic realities. The era of rapid population growth—often dubbed the population explosion—is over. Most countries have undergone a demographic transition to smaller families. Better living standards, improved access to education, health care, and social security, declines in infant and child mortality, rising costs of raising children, and improvements in women’s status, including employment opportunities outside the home, all have encouraged smaller family size.² So has urbanization. Now, more than half the world’s population lives in towns or cities, and this proportion is rising.

When I lived in a Bangladeshi village forty years ago, an experience that inspired this book, the average number of children per family was seven. Today, that figure has plummeted to around two. Average global family size is about 2.5 children, though regional differences remain. Birth rates are still relatively high in sub-Saharan Africa where in nineteen countries women have five or more children. But in that region, too, birth rates are declining, especially in urban areas. A number of countries in East Asia and Europe have birth rates below the replacement level of roughly two children per woman and are concerned about this negative population growth. The UN projects that the current world population of 7.3 billion will reach 9.7 billion in 2050 and 11.2 billion in 2100 before it levels off. However, the 11.2 billion projection may be too high and world population could peak at 9.5 billion instead.³

The main reason we will add two to four billion more people to the world’s population before it stabilizes is not because women are having too many children. Rather, it’s because such a large proportion of the population in developing countries is young and approaching childbearing age. Over time, this baby boom will peter out as the present large generation of young people gets older and birth rates continue to decline. Many demographers now worry about how shrinking numbers of young people will support growing numbers of the elderly.⁴ The challenge that lies ahead is how to plan for these demographic dynamics in socially equitable and environmentally sustainable ways.

Why, then, is overpopulation ideology still so entrenched? One reason is that many people are demographically illiterate. This isn’t their fault. Population education is woefully inadequate in the United States. Many social studies, biology, and environmental studies textbooks are outdated and still teach students that population growth is exploding out of control.⁵ People just don’t know that small families are the global norm.

Another important reason is that the myth of overpopulation is so politically useful to powerful interests. Elites deploy it to explain and legitimize inequality, essentially blaming the poor for causing their own poverty. Inequality is even worse now than when I wrote this book. The gap between rich and poor has become a yawning abyss, the bitter fruit of decades of neoliberal economic policies, financial corruption and speculation, and dispossession of peasants and small farmers. Overpopulation is a convenient smokescreen that obscures the voracious appetites and power grabs of the superrich. Globally, the bottom 50 percent of adults on the wealth scale now own less than 1 percent of the world’s total wealth, while the richest 10 percent own almost 90 percent. The top 1 percent alone owns 50 percent.⁶ The United States is no stranger to this pattern. The top 0.1 percent—approximately 160,000 families—owns almost a quarter of the nation’s wealth, a figure that is almost as high as before the 1929 stock market crash.⁷ These numbers reveal the real problem: too few people control too many resources.

Overpopulation ideology also obscures the root causes of environmental degradation, a theme explored in this book. Today, population and environmental groups like the Sierra Club, the Center for Biological Diversity, and the Worldwatch Institute claim that reducing population growth will magically mitigate climate change. The reasoning behind this view is flawed. Industrialized countries, with only 20 percent of the world’s population, are responsible for 80 percent of the accumulated carbon dioxide in the atmosphere. Overconsumption by the rich has far more to do with climate change than the population growth of the poor. The few countries in the world where birth rates remain relatively high, such as those in sub-Saharan Africa, have among the lowest carbon emissions per capita on the planet. Contraceptives will not solve the climate crisis—only concerted national and international action to take on the fossil fuel industry, reduce carbon emissions and overconsumption, and shift to renewable energies will do so.⁸

Climate change is only one of the many ways poor people, especially poor people of color, get scapegoated for environmental problems.⁹ Take the 2015 coffee table book Overdevelopment, Overpopulation, Overshoot. Lavishly produced by the Foundation for Deep Ecology and the Population Media Center, it blames most every ecological crisis on population growth. The book’s lurid photographs of dark-skinned crowds, starving African children, and close-up pregnant bellies rob people of their identity and dignity. That such images are deemed acceptable—the book was featured in a number of major media outlets—is a testament to how deeply racism, like a major river, continues to carve and shape the population landscape.¹⁰ Misogyny flows close behind. Stanford biologist Paul Ehrlich, famous author of The Population Bomb, told the New York Times in 2015 that letting women have as many babies as they want is like allowing everyone to throw as much of their garbage into their neighbor’s backyard as they want.¹¹

Overpopulation ideology is also very useful to national security interests. In the wake of 9/11, population narratives have come to figure prominently in the US war on terror. The theory that a high proportion of young people in a population causes youth bulges of angry young men who are easy recruits for terrorism, especially of the Islamic variety, is a rationale for racial and ethnic profiling.¹² Analysts in the Pentagon and defense think tanks are now making unsubstantiated claims that population pressure in poor countries is a catalyst for climate conflict and the potential mass migration of climate refugees toward Western borders. This militarization of climate change helps legitimize further US military intervention in Africa and the Middle East and ever-stricter border enforcement.¹³

This book ends in 1994, the year of the pivotal UN conference on population and development in Cairo, Egypt, where the international women’s health movement pushed hard for reform. Hopes were high that the Plan of Action agreed on there by the world’s governments would lead to a new era of population policies, and that coercive, target-driven population control programs would give way to a broader approach to reproductive health, based on women’s empowerment and freedom to choose. I supported that goal, but predicted that achieving it would be difficult.

Dislodging population control from family planning and reproductive health programs has proved an uphill battle. Just two years after the Cairo conference, the Fujimori dictatorship in Peru launched a campaign that sterilized an estimated three hundred thousand indigenous women without their consent.¹⁴ Efforts to reform India’s draconian sterilization program faltered. The country is still rocked by sterilization scandals in which poor women die from botched operations in hastily constructed, unsanitary camps. The majority of Indian women lack access to temporary contraceptive methods and even the most rudimentary reproductive health care.¹⁵ China’s infamous one-child policy wasn’t revoked until October 2015. Its tragic consequences, from forced abortions and sterilizations and skewed sex ratios to the abandonment and hiding of girl children, rank as one of the world’s worst government-sponsored human rights violations of the last thirty years. China experts worry that the new two-child policy will maintain authoritarian state control over people’s reproductive decisions.¹⁶

After the Cairo conference, feminist and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) activists were able to wedge open policy spaces where they could push for a holistic sexual and reproductive health and rights (SRHR) agenda. Progress was made in providing young people with quality health care, sex education and birth control, preventing and treating sexually transmitted diseases, challenging sexual violence and homophobia, and making abortion safe, legal, and accessible. But the backlash has been, and continues to be, fierce.

There are three key oppositional forces. First are conservative anti-abortion and antigay organizations opposed to any progress on the SRHR front. Many of them have roots in religious fundamentalisms of various stripes. Despite Pope Francis’s progressive views on climate change and social justice, for example, the Vatican is still opposed to artificial contraception and abortion as well as LGBTQ rights.

Second, financial, policy, and political commitments on the part of national governments and international agencies haven’t adequately materialized. The decade of the 1990s was a hopeful time. Not only Cairo, but other UN conferences on human rights, women’s rights, the environment, food, and other major international issues were more inclusive and participatory, with activists joining policy makers to hash out new frameworks grounded in the expansion of human rights and social, economic, and gender equality. In 2000, the international development clock turned backward. The UN’s Millennium Development Goals abandoned these frameworks in favor of narrow numerical targets to measure progress. Women’s roles were once again reduced to being child-bearers and caretakers. Social justice was out, social engineering was back in.¹⁷

Third, the population control old guard hardly faded into oblivion. They were never pleased with the Cairo conference outcome and the broader SRHR agenda. They might talk about women’s empowerment, but for them the bottom line remains getting women to use contraceptives in order to reduce population growth.¹⁸

This book tells the story of how beginning in the 1960s, a powerful nexus of population agencies, funders, and pharmaceutical firms distorted the direction of contraceptive development. Health, safety, and freedom of choice concerns took a backseat to the search for the cheapest, most effective methods to reduce population growth, methods that women couldn’t control themselves. This is still the case today, though there are new actors on the scene. Chief among them is the Bill & Melinda Gates Foundation (BMGF), the wealthiest private foundation in the world.

The BMGF is a relative newcomer to the population field, but its influence has been enormous. The present resurgence of population control is due in no small part to its dominant role. The BMGF views contraceptives such as the three-month injectable Depo-Provera and three-year hormonal implants as a win-win technical fix for reducing population growth and empowering women. Never mind that these methods are associated with serious side effects or, in the case of implants, can be difficult to remove. Studies show that Depo-Provera may significantly increase the risk of HIV transmission and acquisition, yet BMGF is promoting it vigorously in African countries with high HIV prevalence rates. The BMGF has powerful partners including the US and British governments, the UN Fund for Population Activities (UNFPA), and the pharmaceutical giants Pfizer and Bayer.¹⁹ In the United States, parallel efforts are targeting young, low-income women and women of color with long-acting reversible contraceptives such as implants and IUDs (called LARC for short). LARC is promoted as a panacea for poverty, a strategy that comes perilously close to eugenics.²⁰

The resurgence of population control policies and programs presents formidable challenges to progressive feminist organizing, especially as the international women’s health movement is no longer such a cohesive force. Professionalization, cooption of women’s empowerment by population interests, and declining funding for radical voices are among the reasons.²¹ Many SRHR activists continue to fight the good fight, but it’s not easy. The fundamentalist offensive against abortion, contraception, and LGBTQ rights, often originating in the United States and exported elsewhere, has also made it increasingly difficult to conduct feminist advocacy on contraceptive safety. Not without cause, activists fear their critiques of specific contraceptives will be used by the Right to brand all contraceptives as bad.²²

More hopeful is the emergence of the reproductive justice (RJ) movement in the United States, founded and led by women of color.²³ The RJ movement promotes bodily integrity, health, and reproductive self-determination within a broad context of gender, racial, social, and environmental justice. While supporting access to contraception and abortion, it has taken a firm stand against population control. In recent years, though, population interests have sought to appropriate reproductive justice language, even coming up with the term population justice.²⁴ Even still, the RJ movement’s original principles provide a solid basis for resisting such efforts.

Attention to the rich histories and legacies of feminist activism against population control is needed now more than ever. The insights gained and strategies used have much to offer contemporary social movements. My great hope is that in the pages of this book a new generation of readers will find knowledge, argumentation, and inspiration that will help in ongoing struggles to achieve reproductive rights and justice.

For making this new edition of Reproductive Rights and Wrongs possible, I would like to thank my agent Richard Balkin, who is there through thick and thin and who is an excellent editor too, and the Haymarket team, especially Anthony Arnove, Dao Tran, and Nisha Bolsey. My colleague and friend Marlene Fried has given me so much support over the years, and working with Anne Hendrixson, director of the PopDev Program at Hampshire College, has given me hope for the future. Thanks to Marlene and Anne for their insightful comments on the preface, and to Kay Johnson for teaching me so much about the effects of the one-child policy in China. I am also indebted to the work of Mohan Rao, Loretta Ross, Jade Sasser, Sarah Sexton, the Sama Resource Group for women and health in New Delhi, and to all the many scholars and activists who continue to challenge population control and work to promote health, reproductive rights and justice for all.

Betsy Hartmann

Amherst, Massachusetts

August 11, 2016

ACKNOWLEDGMENTS

This book was not written in isolation. Throughout the writing of both editions I have benefited enormously from the encouragement, support, and advice of many people. They have helped deepen my analysis and broaden the scope of the book, as well as renew my faith in the possibility of cooperative effort. My greatest pleasure in writing this book has been the valuable friendships and contacts I have made in the process.

For the first edition, thanks must first go to Gretta Goldenman. The book was her idea originally, and her commitment, insight, and endless patience helped carry it through to completion. Marge Berer gave freely of her time to comment extensively on the first two drafts of the manuscript. Her contacts and experience in reproductive rights work were formative in the development of my own thinking. Norma Swenson of the Boston Women’s Health Book Collective played a vital role as book midwife. She not only gave detailed comments on the manuscript, but provided much needed moral support and continually shared her valuable insights on the subject. Judy Norsigian of the Boston Women’s Health Book Collective cast a critical eye on the contraceptive chapters, guided me through the collective’s extensive resource collection, and helped keep me up to date. At the Population Council Judith Bruce gave me excellent comments on two drafts of the manuscript, and I benefited greatly from her expertise in international family planning and women’s issues.

Other people who gave generously of their time to comment on the manuscript are Jim Boyce, Gena Corea, Lynn Duggan, Joan Dunlop, Deborah Eade, Adrienne Germain, Andrew Graham, Keith Griffin, Polly Griffith, Judith Helzner, Jocelyn Knowles, Frances Moore Lappé, Amanda Milligan, and Edward Passerini.

Others who contributed are Jenneke Arens, Kai Bird, Audrey Bronstein, Therese Budoumit, Rebecca Chalker, Elizabeth Coit, Joseph Collins, Judith Condor, Sonia Corrêa, Belita Cowan, Ireen Dubel, Posey Gault, Forrest Greenslade, Teresa Hayter, James Hobbs, Barbara Holland, Tony Jackson, Bernard Kervyn, Loes Keysers, Rodger King, Barbara Klugman, Brian Landers, Stephen Minkin, Ivan Nutbrown, Vivian Orlowski, Richard Palmer-Jones, Paula Park, Cheryl Payer, Sunanda Ray, Paul Rice, Andrew Rutherford, Rashid Shaikh, Weena Silapa-archa, Peter Stalker, Hilary Standing, and Jomo Kwame Sundaram.

Judith Hoffman gave many months to the project as a research assistant. Christopher Glazek also helped do research. At the IPPF Library in London, Graham Peck provided valuable assistance. Hilary Sloin painstakingly word-processed the manuscript in its final stages. Jesse Markham’s advice and support gave peace of mind at a difficult time. My editor at Harper/Collins, Janet Goldstein, shepherded the book along with enthusiasm and insight.

For the second edition I would like to thank Lynn Lu and Loie Hayes at South End Press, who have been incredibly patient and supportive editors. Their enthusiasm for a second edition has helped spur me on—South End is one of the few beacons of light in these dark times of the American publishing industry.

Norma Swenson, who helped me so much on the first edition, has also been a constant source of support and critical insight. She suggested changes for the second edition and encouraged me to do more than I originally intended, which hopefully makes for a better, more up-to-date book.

At Hampshire College Marlene Fried offered much encouragement; in the years I have had the pleasure of working with her, she has taught me a lot about the US reproductive rights movement as well as about political integrity. Also at Hampshire, I am grateful to Clare Lewis for proofing the scanned manuscript, M. J. Maccardini for helping me with research, Mary Sera for logistical support, and Dan Schnurr, social science librarian. I would like to thank Ben Wisner for giving me valuable information, ideas, and friendship, and Kay Johnson for her excellent work on China. Visiting international reproductive rights activists Mere Kisekka, Sundari Ravindran, and Adetoun Ilumoka all had an impact on my thinking, as well as the other activists we have had the privilege to invite to Hampshire for shorter lengths of time. I am grateful to Hampshire College in general for providing a supportive environment in which to work.

There are many other friends and colleagues to whom I am indebted, and I cannot do justice to them all. Following is only a partial list, for it is impossible to list by name all the many people in the international women’s health movement and development community who have given me information and helped shape my views in the years between the two editions of the book. I am grateful to Faye Schrater, not only for sharing her knowledge of contraceptive vaccines, but for her friendship; to Judy Norsigian for continuing to keep me up to date with contraceptive technology and policy; to members of the Committee on Women, Population and the Environment with whom I have actively worked in the past several years, especially H. Patricia Hynes, Jael Silliman, Nalini Visvanathan, Asoka Bandarage, and Gabriela Canepa; to the Women’s Global Network on Reproductive Rights Coordinating Committee, which has helped keep the radical spirit of reproductive rights alive in these difficult years; and to the Boston Women’s Health Book Collective for continuing to be there.

Other individuals I would like to thank for their direct or indirect influence on the book are Adrina, Thais Corral, Dianne Forte, Peter Gillespie, Malini Karkal, Loes Keysers, Vicki Legion, Trine Lynggard, Kalpana Mehta, Fatima Mello, Ranjana Padhi, Rita Parikh, Judith Richter, Helen Rodriguez-Trias, Anna Sax, Ulrike Schaz, Karen Seabrooke, Sarah Sexton, Mira Shiva, and Maria Zuniga. I would also like to thank all my friends in Amherst and environs who helped me keep a sense of humor and perspective, especially Kate Pfister, Neil Stillings, Sam Gladstone, Joyce Duncan, Sonia Kruks, and the members of my writing group.

Last but not least, I must express my gratitude to my family and first of all to my husband, Jim Boyce, who has seen me through all the ups and downs of both editions and continues to be a more than generous source of moral and practical support. Thanks to my children, Jamie and Thomas, who let me work even when they didn’t want me to. Other members of my extended family have also given me much encouragement, particularly Thomas and Martha Hartmann and James and Alice Boyce.

While all these individuals have helped me complete two editions of this book, I alone bear responsibility for the opinions and errors contained herein.

FOREWORD

By Helen Rodriguez-Trias, MD., FAAP

This second, completely updated edition of Betsy Hartmann’s analysis of population policies and their effect on women’s lives offers profound insight, solid research, and vivid case studies from the field to advance our understanding of the origins, development, and actions of the organizations that have espoused population control since the earlier part of this century. Although most such organizations active in the last four decades have helped women to gain desperately needed access to birth control, they have often limited women’s choices by promoting some methods over others. And in their zeal to reduce birth rates, some programs have shown blatant disregard for individual rights.

Whether undemocratic or respectful of individual choices, all population control programs begin with a basic premise, that is: In order to achieve improvement in people’s lives, there is an urgent need to reduce the rate of growth of the world’s population. Most aim at reducing the fertility of women, particularly of women in developing countries, as the means of slowing worldwide population growth toward sustainable and stable numbers. It is this very basic premise that Hartmann questions.

Hartmann argues and substantiates that rapid population growth is a symptom, rather than a cause, of problematic economic and social development, that improvements in the status of women lead to voluntary decreases in family size, and that effective birth control services can only thrive within a comprehensive system of health care delivery responding to people’s needs. Her vision of what people-centered economic and social development may mean includes tackling poverty and inequalities.

Hartmann’s analysis is particularly relevant to the discussions that have just taken place on the international stage as I write this foreword in September 1994. With greater participation of women than ever before in an international forum, representatives of over 170 nations and of thousands of non-governmental organizations met in Cairo at the United Nations Conference on Population and Development. Delegates discussed and reached consensus on an action plan to slow the growth of the world’s population and to promote economic development.

In this book, Hartmann traces the origin of a push for consensus in Cairo back to the 1984 international population conference in Mexico City. In addition to her critique of the centrality of population stabilization to international development deliberations, Hartmann points out the marked discrepancy between the large resource allocation for population activities as compared to pitifully small resources for development. Equally importantly, Hartmann cautions that we not be lulled into obscuring issues of class, race, and inequalities between developed and developing countries. She notes that, In many population publications, women are presented as an undifferentiated mass which needs to be empowered, with little recognition of the many differences between them—poor or rich, rural or urban, Black or white—which in turn impact on their survival and reproductive strategies.

Along with several hundred women from the United States, and as part of the United States delegation, I attended the Cairo conference, representing the American Public Health Association as its immediate past president. I was one of seventeen private sector advisors to the US delegation, many of whom worked for three years drafting documents and organizing preparatory meetings for the conference. Some advisors were longtime feminists, some represented foundations involved in population activities, others were providers of family planning and other reproductive health services, all were advocates of choice. By emphasizing that any agenda for women’s health must advance the political, social, and economic empowerment of women, and providing concrete examples where women have taken leadership, Hartmann’s work helped us prepare for Cairo and beyond.

In this new edition, Hartmann reminds us that discussions on the effect of population growth and environmental degradation pose further pitfalls. Some US environmental organizations are influenced by Malthusian thinking and a few even advocate severe reductions in human populations to restore the wilderness. In urging that women frame environmental issues within an agenda toward social justice, she points out Women’s Action Agenda 21, endorsed by 1,500 women in non-governmental groups in advance of the 1992 United Nations Conference on Environment and Development, or Earth Summit, held in Rio de Janeiro. This document contained a condemnation of suggestions that women’s fertility rates are to blame for environmental degradation and identified structural adjustment, militarism, and wasteful and unjust production and consumption patterns as the key culprits in environmental degradation, not overpopulation.

This book contains examples of activities and programs women have undertaken to improve production, protect the environment, and provide health care in impoverished areas. Out of their experiences as leaders in the field, women are also emerging as leaders in international programs. One effect of their participation has been to broaden the international discussion beyond global population growth to the need to improve women’s status and all people’s quality of life.

At home, violence against the reproductive rights movement continues to escalate, as does the intensity of the Vatican-led movement to delegitimize the Cairo agreement on reproductive choice. In confronting the contradictions and dilemmas that we face in attempting to establish women’s rights to choices, we do well to heed Hartmann: What is needed, she tells us, is a genuinely prowomen alternative, which challenges both the population control and antiabortion positions and which guides family planning, contraceptive reasearch, and health policy.

This book, and my experiences in the reproductive rights movement, lead me to urge caution in how we respond to the current violent attacks. To forge genuine prochoice alternatives, we must guard against the tendency to form too quick alliances when we are confronted by violent opponents. The search for protection from the seemingly powerful forces against women’s rights could lead us to ally with population control advocates who speak of women’s rights only out of opportunism. We need to keep foremost that alliances of women from different nations, ethnic groups, indigenous peoples, races, and social classes must be based on mutual respect, adherence to key principles of democracy, and, most importantly, on a commitment toward eliminating gross inequities among groups and nations.

In the international arena, I believe that we must avoid what to a large extent has happened in the United States: neglect of a social agenda toward equity. Women’s organizations have poured an inordinate amount of energy and resources into the defense of abortion rights and not enough into advancing a broader women’s agenda toward social and economic gains. Greater emphasis on women’s social and economic rights by the reproductive rights movement would bring new forces and vigor to the struggle.

This book provides us with an inspiration and a basis for working on a women’s agenda that pursues the reduction of inequities among us as a requisite for promoting women’s health at home as well as abroad. As Hartmann clearly shows, the contradictions and conflicts will not disappear with the issuance of a consensus document, no matter what process leads to its creation. True consensus must rest on genuine commitments—men with women, white with people of color, rich with poor, landowners with landless, industrialized countries with developing nations—to share power, wealth, and knowledge.

INTRODUCTION:

Whose Choice?

Iarrived at the population issue from two different directions.

Coming of age in the late 1960s, I was a member of the pill generation. While the media extolled the contraceptive revolution as the key to sexual liberation, the college health clinic prescribed the pill with great enthusiasm. Like so many other young women, I soon discovered that the pill made me feel heavy and depressed, and that sexual liberation was often a euphemism for being readily available to men. As feminism began to reshape my view of sexual politics, and politics in general, I abandoned the pill and returned to the safer barrier birth control methods of my mother’s generation. I wondered why the clinic never encouraged their use. Elsewhere some of my friends had far worse experiences, ending up in the hospital with IUD complications and worrying that they would never be able to bear children.

Then in the mid-1970s my long-standing interest in South Asia and international development took me to a village in Bangladesh, one of the poorest and most densely populated countries in the world. Here in the West, Bangladesh is typically thought of as an international basket case, a country whose population growth has already outstripped its resources. In the village, however, I encountered a very different reality. I found fertile land, plentiful water, and a climate warm enough for crops to be grown throughout the year. I met families with six or seven children who ate well and families with only two children who were starving.

The vital difference between them was land ownership. Almost a quarter of the village people owned no land at all and had to work for rich peasants and landlords for pitiful wages. They not only lacked the land on which to grow food, they also did not have enough cash to buy adequate supplies in the market. The real problem was not food scarcity, but land and income distribution.

Up to a point, villagers viewed children as an irreplaceable asset. From an early age, children worked in the home and the fields; instead of draining the family rice bin, they helped fill it. They also provided their parents’ only source of security and support in old age. Because of inadequate nutrition and health care, one out of every four Bangladeshi children dies before the age of five. Thus families had to produce many children in order to ensure that a few would survive. My neighbor’s first five children had all died in infancy. She bore six more and the youngest daughter died too.

Yet once villagers had enough children to meet their needs, they often wanted to limit family size. They complained about lack of living space and the fact that through inheritance, land was being subdivided into smaller and smaller plots. Suffering the burden of repeated pregnancies, women especially were desperate for birth control and repeatedly asked me to help them get it.

This widespread desire for birth control came to me as a surprise. Up to that point, it had been my understanding that the main obstacles to the use of birth control in Bangladesh and elsewhere in the Third World were ignorance and tradition, not the availability of contraception. Now I discovered that many women wanted birth control, but could not get it, even though the U.S. government and other nations were financing multimillion dollar population control programs in Bangladesh.

Later I learned that in other areas of Bangladesh, population control programs were in full force, indiscriminately putting women on the pill, injecting Depo-Provera, or inserting IUDs, without offering adequate medical screening, supervision, or follow-up. Most of the programs only targeted women, ignoring male responsibility for birth control. Due to the poor quality of services, many women experienced negative side effects and became disillusioned with contraception. The government’s response was not to reform the programs to meet the women’s needs, but instead to further intensify its population control efforts by pushing sterilization, even though its irreversibility and risks make it an unsuitable method for many women.

In both instances, whether they lacked access to contraception or had it forced upon them, Bangladeshi women were being denied real control over their own reproduction.

As a woman, I could not help but feel angered and intrigued by the connection between their experience and the experience of many of my peers in the United States. The two directions had converged, and I found myself increasingly absorbed by the population issue. On my return to the United States in 1976, I learned that many people were making the same connection. The women’s health movement was gaining strength, and the campaigns against Depo-Provera, the Daikon Shield IUD, and sterilization abuse of women of color were bringing to public attention the misuses of contraceptive technology occurring both at home and abroad.

I began work on the first edition of this book in the summer of 1983. I naively envisioned a six-month project; instead it took me over three years. My research followed several different lines. At first, I concentrated on reading a wide spectrum of the available population literature. My previous research and writing on international development proved a useful background. Then as I developed a framework for the book, I focused more closely on specific countries and contraceptives. I corresponded with people actively involved in family planning, health, and women’s issues, particularly in the Third World. (I use Third World in this book for lack of a better term, but realize it does not accurately reflect the diversity of nations and cultures, or the fact that in the current global economy Third World conditions exist in many Western countries as well.) In England, where I wrote most of the book, and in the United States I made contact both with people in the population field and with health and reproductive rights activists, who not only guided me to resources, but gave me crucial feedback and support.

For this new edition, I have substantially updated and revised many sections of the book, while preserving its basic organization. Since the first edition was published in 1987, I have become even more involved in population politics, as an activist, writer, and professor. At times this feels less like a personal choice than a political necessity, since population control remains such a powerful force in terms of distorting both development policies and public attitudes. Although the work is often difficult, the rewards are many. It is empowering to be part of a broad international network of women’s health, development, and environmental activists who are not only fighting against population control, but for reproductive freedom and social justice.

In the course of my work, particularly during the Reagan and Bush administrations in the United States, I have sometimes been accused of playing into the hands of the antiabortion movement. Better to remain silent about population control abuses, some liberals say, than to provide any ammunition to antichoice groups which not only oppose abortion, but most forms of birth control.