Family Planning

Modern family-planning programs have provided many poor women with contraceptives and the ability to limit family size; but they have rarely given women genuine choice, control over their bodies, or a sense of self empowerment. The focus of family planning has been on population stabilization and the meeting of targets rather than on the means or the processes to achieve its ends. Although many family planners in the early 2000s call for women's reproductive rights, population-control programs seem to be moving in authoritarian directions.

Article 16 of the Teheran Proclamation issued by the United Nations Conference on Human Rights in 1968 states that "Parents have a basic human right to determine freely and responsibly the number and spacing of their children" (United Nations, 1974). This Article represented a major victory for the population-control movement. Perhaps the term "responsibly" was the real victory because it can be interpreted in a more-or-less coercive way. Indeed, the overwhelming importance given by international donors and local governments to fertility control has led to a relative neglect of other aspects of family planning and reproductive and human rights such as the right of the poor to health and well-being, including the right to bear and sustain children. Indeed, the neglect of the survival issues by the family planners has allowed right-wing fundamentalists to appear as the only ones concerned with family and community.

The emphasis on family planning has undermined public health care and Maternal and Child Health (MCH) in many countries. In 2004, many of the new hormonal and immunological contraceptives did not protect against HIV/AIDS. In many poor communities in Africa ridden with AIDS, modern contraception was widely available while pharmaceutical drugs for AIDS were not. Target pressure and incentives continued to drive interests of health-care personnel toward population control over provision of health care. Population agencies spoke in public of integrating family planning within a broader health-care framework. But in private some have argued that family-planning programs should not be "held hostage" to strict health requirements and that maximum access to contraceptives should override safety and ethical concerns. Even when the population-control organizations have taken efforts to address public-health issues and women's social and economic rights, the population-control objective has continued to be dominant. The Safe Motherhood Initiative is an example.

The Safe Motherhood Initiative was launched by the World Bank, United Nations Development Program, United Nations Children's Fund (UNICEF), United Nations Fund for Population Activities (UNFPA) and the World Health Organization (WHO) to reduce maternal mortality. In many cases, this initiative has aimed simply to reduce childbearing; the assumption being that fewer births will cause fewer maternal deaths. A 1992 World Bank evaluation of its population-sector work admitted that its foray into broader health initiatives had been motivated by the "political sensitivity" of population control and the need to dissipate Third World perception that "population control is really the Bank's strategic objective." The report further notes that many countries that would not accept donor support for population control would nevertheless "accept support for family health and welfare programs with family planning components" and that the likelihood of family planning getting "lost in an MCH program" was less because MCH was better accepted as a "legitimate intervention for both health and demographic reasons" (World Bank, 1992).

As Indian health researcher Malini Karkal has pointed out, the tendency to attribute maternal mortality simply to pregnancy and childbirth by the Safe Motherhood Initiative and other such programs has led to a relative neglect of causes of reproductive mortality that supercede maternal mortality. Deaths due to unsafe sterilization, hazardous contraceptives, deaths associated with sexually transmitted diseases, cancer of the reproductive organs, and unsafe treatment of infertility also account for a large proportion of reproductive mortality. Where births have been "averted" due to family-planning programs, the reproductive choices or conditions of women or of the general population, for that matter, have not increased as a result. In India, although birth rates have declined, infant mortality at about 72 per 1,000 births and maternal mortality at about 460 per 100,000 live births in 1995 continued to be relatively high. As women's-rights advocates argue, improvement of the status of women is not the consequence of family-planning programs as believed by the population planners. Rather it is a more complex outcome resulting from rise of age in marriage, education, employment, better living conditions, and general awareness, as well as family planning. Indeed, everywhere, voluntary acceptance of contraception seems to be correlated with women's access to education.