The Religious Consultation on Population, Reproductive Health & EthicsThis article was first published in:IN/FIRE
Newsletter of the International Network of Feminists Interested in Reproductive Health, Volume 3, Issues 3&4, 1994
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The Cairo International Conference on Population and Development and the Need to Monitor Its Implementation
The United Nations' International Conference on Population and Development (ICPD) held in Cairo in September 1994 produced a Plan of Action which seems to this white US feminist a significant advance over the documents produced at earlier population conferences in Bucharest in 1974 and Mexico City in 1984. Instead of beginning with birth rate targets for individual nations to implement, the cairo Plan of Action commits itself to improvement in the health, welfare, and status of women as the necessary and adequate conditions for women to drastically and voluntarily reduce the number of children they produce. There are, however, a number of troublesome facts which could support other, less hopeful, interpretations.
The dramatic change in US policy from the Reagan/Bush administrations to the Clinton administration supported this shift, as did early financial support, beginning with three billion dollars pledged by Japan and two billion dollars by Germany, to implement the plan in developing nations. But the availability of new research on population was undoubtedly the most decisive factor in producing the new direction in population policy. This research itself depended upon the shift of women into positions of responsibility in governmental social service, in academic research, in foundations funding population and development work, and, perhaps most importantly, in local and regional NGOs involved in both delivery of social services to, and research on the social welfare of, the impoverished peoples of the developing world. Much of the most telling research was only conceived after women at all social levels, including grassroots women, had a role in framing the research questions based on their experience of links between different aspects of reality.
Research indicates that six thousand girls are subject to genital mutilation each day; that forty percent of all women of reproductive age are anemic; that in sub-Saharan Africa one of every twenty-two women of all ages dies from a pregnancy-related causes; that every year seven million infants die in their first week of life; and that over twenty million low birth weight babies are born every year [A new Agenda for Women's Health and Nutrition. (Washington, DC: World Bank, 1994) p. 1].
Such research has convinced many developing nations that fast growing populations are one part of their poverty problem, along with unjust trade, the international debt crisis, and overconsumption of resources by rich nations. Research has also demonstrated to rich nations that birth rates can be lowered and, in fact, have been significantly lowered since the 1960s. In 1950, the average woman in the world had 5.3 children compared to 3.4 today. Nor is this drop limited to the developed world. In the mid-sixties, the average woman in a developing nation had 7.0 children, now she has 3.9 [Frances Fitzgerald, "A Manageable Crowd," The New Yorker, August 1994, pp. 7-8.]
But demographic research not only demonstrated that decreasing the rate of population growth was possible, it also indicated, especially in the last decade and a half, under what conditions couples limited the number of children they produce. The overall condition under which the rate of births decreased was the presence of economic development. While most of the decrease in developing nations' birth rates occurred in places where significant development was taking place, there were some notable exceptions. Bangladesh, for example, alone of the twenty poorest nations in the world, achieved significant decrease without significant development. Between 1975 and 1990 the average number of births per woman of childbearing age (15-49) declined from 7.0 to 4.5 in Bangladesh, while economic growth computed per capita was a low 1.6% [Winthrop P. Carty, Nancy Yinger, and Alicia Rostov, Success in a Challenging Environment: Fertility Decline in Bangladesh, (Washington, DC: Population Reference Bureau, 1993) p.6]. Even in Bangladesh, however, there is some evidence that moving fertility down from present levels toward replacement levels may not be possible without significant economic development.
The most recent demographic research goes beyond indicating development as the required condition for population decrease, and pinpoints those factors within the process of economic development which have the most direct effect on birth rates [See Anastasia J. Gage and Wamucii Njogu, Gender Inequalities and Demographic Behavior in Ghana/Kenya, (New York: Population Council, 1994). p.64] The first of these is infant mortality. It has become clear in the last thirty years that when parents can be made more or less certain that their existing children will live to adulthood, they forgo having more. Today we also know the most important factors affecting infant mortality: the lack of safe drinking water, lack of prenatal and maternal care, lack of immunization against epidemics, and insufficient caloric intake and nutrition.
A second of the primary factors which produce lowering of birth rates, and one much more recently discovered, concerns the status of women in society. In most social systems, even small increases in the number of years of education given girls decreases the number of children per woman, even when economic factors are constant [Nora Guhl Naquib and Cynthia Lloyd, Gender Inequalities and demographic Behavior in Egypt, (New York: Population Council, 1994), p. 49; and Martha Ainsworth, Socioeconomic Determinants of Fertility in Sub-Saharan Africa (Washington, DC: World Bank, 1994), pp. 5-12]. When an increase in education is accomplished by other improvements in the lives of women such as access to credit and training, improved nutrition, access to health care, and increased social status, women have still fewer children.
It was these research discoveries which were responsible for the major shift in the recent U.N. population conference. The research provided a middle ground between conflicting demands of the North and the South at past conferences. Many poor nations of the South had insisted in the sixties and seventies that they had no population problem, that the world's economic and ecological problem was compounded by overconsumption and environmental degradation by the North, along with a basic failure by the North to share technology, to let go of exorbitant debt repayments, and to restructure international trade more justly. The North had argued that overpopulation in the South was not only global ecological disaster on the horizon, but that overpopulation was the cause of poverty in the South, as well as of resulting migration problems affecting the North.
The Cairo Plan of Action -- to pursue reduction of birth rates within a framework of development among poor nations, with recommendations for lowering consumption level among the rich -- provided some possibility of common ground. Neither poor nations nor the Vatican and its allies, however were slow in pointing to the paucity of Plan references to, much less objectives or strategies for, reducing overconsumption among the rich. It is perhaps not necessarily cynical to suggest that the South sees Cairo as an avenue for using the population issue to extract Northern funding and support for development issues, and that the North sees Cairo as an avenue for achieving resolution of population (and migration) issue with minimal redistribution of wealth and power in the world.
How real is the gain for women at Cairo? It is not yet clear. But there is a very real danger that women may continue to be viewed -- and used -- as means, or instruments, in population efforts around the globe. The warning signs are clear to see. The first warning came in the propaganda supporting the Cairo agenda, propaganda which emerged from governments of developed nations, from international foundations and research institutes, and which appeared for months in the media. National Public Radio, The New York Times, The New York, and most mainstream media in rich and poor nations alike all reported in their coverage of preparations for Cairo significant voluntary decreases in birth rates were already accomplished. These reports focused exclusively on the amount of decrease in specific nations and regions and not on specific methods of achieving decreases. Many even stated categorically that they were entirely "voluntary" measures producing the change. But to say this is to ignore a host of different kinds of coercion which contributed to the decreases over the last thirty years. In fact, we have no idea how much of the decreases in births per woman around the world was voluntary; we do not even have standards for assessing voluntariness.
Reproductive coercion has been and still is widespread. The implementation of the one child policy in China is only one example. [For an overview of this policy, see Susan Greenhalgh and Terrence H. Hull, "Regional Report: East and Southeast Asia," in Population Trends and Issues in Developing Countries: Regional reports Number 35, (New York: Population Council, 1992) pp. 24-30]. Forced abortion, though relatively rare, is one aspect of that policy; loss of a variety of housing, education, and economic rights are standard for persons who exceed the designated limit. Women (and men) in nations such as Pakistan have been and continue to be paid to undergo sterilization. [See this depicted in Barbara Crossette, "UN Meeting Facing Angry Debate on Population," The New York Times, September 4, 1994, p. 1. See also Linda Gordon, Woman's Body, Woman's Right, 2nd Ed., (New York: Penguin, 1990) p. 394]. In any society where poverty is so widespread that malnutrition is endemic, the offer of enough money to for a week, much less a month, is severe coercion.
In Northern India during the seventies, the army was used to corral the populations of villages for sterilization campaigns which sterilized thousands a day in make-shift tents, without follow-up care, and often without a pretenses of sterile conditions [For a general survey of reproductive coercion around the globe, see Betsy Hartmann, Reproductive Rights and Wrongs: The Global Politics of Population Control and Reproductive Choice, (New York: Basic, 1987)]. In Bangladesh, women who could not show proof of sterilization were denied access to emergency flood relief during the famines which followed the flooding of 1983-84; consequently, the percentage of Bangladeshi women sterilized rose from 25 percent to 41 percent in those two years. These are only a few examples. Coercion is not limited to the poor nations; poor and minority women in the U.S. are also well-documented victims of reproductive coercion [Gordon, Woman's Body, pp. 431-436].
The failure to admit that coercion has ben a problem in the past and that coercive policies continues in the present raises the question: Does the silence about coercion signal an intention to use coercion in the future? Is the framework of the document -- the need to empower women to make reproductive decisions for themselves -- only rhetoric?
There were other similar disturbing signs at Cairo that caused me to question the woman-focused rhetoric. One was the lack of treatment of domestic violence. The ICPD Plan of Action refers to the need to protect women in abusive relationships, and calls for the elimination of violence in all forms against women and girls. It does not mention domestic violence specifically, though domestic violence is the form of violence most closely connected to population and development policy. At the very least, the document could have called for treating domestic violence as other forms of social violence. For it is the de facto policy of exempting domestic violence from the legal statutes that, more than anything else, makes women vulnerable to domestic violence around the world. Non-specific blanket condemnation of violence against women and girls in the Plan of Action does nothing to advance better understanding of violence against women around the world and even obscures the level of domestic abuse found, which in many nations is experienced by fifty percent or of all women. In many nations there are corresponding surveys of men who respond at similar levels -- or even higher -- to questions about their own violence against wives.
There is a link between contraception/sterilization and domestic violence, and that link is the risk of assault and rape that many women take in proposing contraception or sterilization to their spouses. Women of many cultures report that suggesting contraception/sterilization provokes spousal violence, and that when women who refused to risk violence are discovered by the spouse to have unilaterally resorted to contraception or sterilization, violence is normal. It is also recognized in many areas of the world that when underutilized clinics drop spousal consent rules for contraceptives and sterilization, utilization rates usually soar. Moreover, domestic violence around contraceptive use is one of the principle causes (along with long distances to clinics and lost work time) why long term injectable/implantable chemical contraceptives, such as Depo-Provera and Norplant, are the first choice of many women, despite the fact that they are known to entail both more potential danger and more complications than the safer barrier methods preferred by medical personnel in their own families.
Yet another reason for suspicion and close monitoring of the implementation of the Cairo Plan of Action was brought up time and again by women from developing nations. If, as a doctor from a rural area in East Africa asked, there is so much consensus that control of population increase must take place within a framework of development, and that women must be empowered by greater social attention to the health of women and children and education of women, then why is it still the case that clinic after clinic in the developing world still has closets full of condoms, IUDs, and birth control pills, but no aspirin, antibiotics, or other drugs? If all the funding agencies are truly committed to decreasing infant mortality and increasing maternal health, then why are safe water, immunizations, and prenatal vitamins so scarce? [This situation was not only widely reported at Cairo, but is also well represented in the most recent literature. See, for example, Sonalde Desai, Gender Inequalities and Demographic Behavior in India, (New York: Population Council, 1994), p. 61]. This situation raises the suspicions of many advocates for women from the developing world, and gives some credibility to the charges of the vatican and some vocal Islamic groups: that there is a secular plot by rich nations to preserve the present distribution of wealth by promoting foreign, promiscuous, anti-life attitudes and practices in the developing world.
Finally, a contingent of Japanese women at the NGO Forum of the Cairo Conference raised some disturbing questions. Japan was being touted for its early pledge to contribute three billion dollars over seven years -- a tenfold increase -- to health and population efforts in developing nations. Japan's own birthrate was near replacement level, making it seem a model for Asia. But Japan's Network for Women and Health pointed out that while the U.N. had urged that national preparations for Cairo involve extensive collaboration with NGOs and full discussion at the national level, in Japan there had been no involvement of NGOs and no national discussion at all. The government had not even announced what position it would take at Cairo. [Makiko Arima et al., Japan's Network for women and Health, Cairo 1994, p. 1]. Furthermore, the women noted, while Japan might seem to be a model in some ways, there were some glaring problems that were not being addressed, chief among them the high maternal death rate in Japan. The women brought charts depicting Japan as having one of the lowest infant mortality rates in the world, but a maternal mortality rate at the mid-range of developing nations. Given the state-of the-art status of Japanese medicine, the Network attributed this difference between the high maternal mortality rate and the low infant mortality rate to the low status of women in Japan.
It would be, I think, a mistake to dismiss Cairo and the ICPD Plan of Action as merely a public relations cloak for an anti-feminist agenda. In much of the world, pro-feminist rhetoric is itself a liability. At the same time, it is probably naive to accept at face value all the language of Cairo about empowering women.
It seems clear to me that the pressures of political coalition building had a great deal to do with the lack of critical attention to the issues of coercion in population efforts. The developed nations, international NGOs, and the U.N. leadership at the conference were not willing to focus on any facts which, however important, would certainly be seized by the Vatican-led opposition as evidence of the danger of legitimizing population control measures. For example, to point to sterilization and contraception coercion in Asia would be certain to evoke a comparison with Latin America, where church power has prevented coercive contraception, sterilization, and abortion by governments by ensuring that abortion and often sterilization are illegal, and that contraception is rarely aggressively promoted. Conference planners were not eager to have the Vatican portrayed as the defender of women against government coercion of women in population programs.
Most feminists I know would respond to such concerns by saying: "Let the Vatican claim to defend women. We can always point to their pronatalist coercion of women in Latin America." Because many Latin American women are unable to obtain sterilization, and suffer a lack of reliable, affordable access to contraception, the average rate of illegal abortion in Latin America exceeds twenty-five percent of all pregnancies, and 800,000 women a year experience serious complications from illegal abortion ["Abortion Common Despite Laws," Latinamerica Press, September 1, 1994, p. 6. According to new research by the Alan Guttmacher Institute in Brazil, Chile, Columbia, the Dominican Republic, Mexico, Peru, there are 2.8 million illegal abortions a year in these six nations. 35 percent of pregnancies in Chile end in abortion, 31 percent in Peru, 28 percent in the Dominican Republic, 26 percent in Columbia, and 17 percent in Mexico]. In Brazil, one of the few nations in Latin America where sterilization is legal, over forty percent of women of child-bearing age have chosen to be sterilized, often for lack of access to more temporary means.
In the ongoing debates in individual nations and regions of the world, these feminists are obviously right. The Vatican is unable to maintain a credible stance as defender of the reproductive freedom of women. But Cairo was more like a political World Cup soccer series than a continuing debate in which arguments could be criticized, modified and synthesized. Because the process at Cairo focused on achieving consensus on the ten percent of the draft text to which a few nations dissented (the sections which dealt with abortion, contraception, adolescents, family planning, reproductive health and migrants), the battle lines were drawn before anyone had arrived in Cairo. Adding to the disinclination to engage in extended open discussion were the facts that the debate at Cairo was scheduled to last less than two weeks, and that communications media, largely print media, with some limited television and radio coverage, were generally regarded as the principle interpreters and scorers in the debate. These facts put severe constraints on the type of debate the principals felt capable of mounting.
The media thrives on action and controversy; the lack of background in the field of population made reporters even more susceptible than normal to simple, dramatic arguments and interpretations capable of catching public attention. The thirty second limit to sound bytes determined what arguments could be made. Timing was also crucial. The winner of the debate each day was the side which got in the last word before reporters filed their stories. In such a setting, it could be extremely counterproductive to feed the opposition any argument to which a catchy rebuttal, much less a scathing one, was possible.
The failure of the ICPD to address the issue of violence against women was, I think, due both to an unwillingness to distract attention from what was being touted as the "emerging global consensus" for promoting the welfare and rights of women, and also to a reluctance to undermine that emerging consensus by pointing out too early the various ways in which different societies must break with traditional practices in order to promote the welfare and rights of women. To point out too early in the process the specific ways in which improving the welfare and rights of women will require men to share power with women in the family, in society, and in religion in ways that are entirely foreign to many cultures, would certainly make consensus very difficult. The reigning judgement seems to have been "Let's get them to sign on first, then we will go back and press them to make good on their signature in all these areas."
This may well be as good a strategy as any for promoting global change in the welfare and status of women. What it means, however, is that the agreement of 150 nations of the world to the Cairo ICPD Plan of Action is not yet fully achieved. Support has been pledged but not yet delivered. A major task of the global women's movement in the coming decade will be to monitor the delivery of that support, to call nation after nation to live up to the document they approved.
The first aspect of that monitoring will be to pressure nations to fully implement the 20/20 economic implementation formula at the Copenhagen conference in 1995. Developed nations must be pressed to contribute twenty percent of their foreign aid budgets to implement the social programs of the Cairo ICPD in the developing world, and developing nations to put twenty percent of their national budgets into social spending (health, education, and development). Such a commitment will be extremely difficult for many developing nations within the framework of the neo-liberal austerity plans they have been obliged to adopt in order to deal with their external debt. Commitment of the developed nations to the 20/20 plan will have to include not only earmarking twenty percent of foreign aid for development, but modifying the demands of the International Monetary Fund (IMF) and the World Bank to allow developing nations to allot twenty percent of their budgets to social spending without incurring IMF/World bank wrath.
Once funding is available, women must press to ensure that implementation policies target domestic violence, genital mutilation of females, reproductive coercion of all types, as well as maternal and infant health, education levels of women, and economic discrimination against women, among others.
Christine Gudorf is a professor of religious studies at Florida International University in Miami, Florida, USA. She is the author of Body, Sex, and Pleasure: Reconstructing Christian Social Ethics (Pilgrim Press, 1994). She is currently writing 12 of 18 cases and 9 of 36 commentaries for Religious Ethics: A Casebook on Ethics in World Religions, to be published by Orbis Press in 1998.