In Our Control (50 page)

Even as conference leaders prepared for the massive event, they were getting ready for problems. There was, of course, right-wing opposition to the event, particularly from foes of abortion. The Catholic Church, alarmed by what it saw as a nascent alliance on contraception and abortion issues among the United States, European leaders, and the United Nations, rushed to form coalitions of its own. Approaching Muslim organizations like the World Muslim League, World Muslim Conference, and the Organization of the Islamic Conference and contacting governments in predominantly Islamic countries, the Vatican began to form tenuous alliances. What conservative Muslims and traditional Catholics had in common was their concern over an emerging agenda that placed the rights of individual women—of which reproductive rights were a powerful metonym—over the claims of traditional religious and social power structures. What they did not have in common (and would to some extent undermine the alliance) was a stalwart opposition to birth control and even abortion. While the Catholic Church has consistently opposed both, contraception isn’t illegal in most Muslim countries, and some therapeutic abortions—those conducted to save the life of the mother—are allowed even in Iran and Saudi Arabia.

There were left-wing opponents of the conference and its goals as well. At another massive international meeting—the Earth Summit in Rio de Janeiro in 1992—a group of feminist women condemned population control advocates as coercive imperialists and also criticized contraceptive methods as dangerous drugs.
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These sorts of critiques would lead to an even more dramatic desertion of demographic targets in the Cairo Consensus.

The Consensus, created after ten days of painstaking negotiations, delighted international feminists and enraged traditionalists the world over. The document insisted that reproductive rights were human rights and called for signing nations to work toward universal access to reproductive health care. It also outlined a broad plan that included reducing maternal and infant mortality, increasing life expectancies, and closing educational gaps between male and female students by ensuring that everyone could get at least a primary education. It was an enormous checking of the influence
of powerful religious groups to dictate important global reproductive positions, and it had profound implications on reproductive law and justice. Months later the United Nations International Women’s Conference in Beijing would reaffirm that the official position of the UN was now that women’s reproductive rights were human rights, a stance soon adopted by groups like Amnesty International and Human Rights Watch. Then First Lady Hillary Clinton energized an international crowd in China, proclaiming, “If there is one message that echoes forth from this conference, let it be that human rights are women’s rights and women’s rights are human rights, once and for all.”
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While these agreements were groundbreaking, the next fifteen years would challenge optimism about reproductive justice and globalism. Big ideas take big money, and while many nations made generous promises during Cairo, they weren’t always able or willing to make good on their commitments. The United States always plays an important financial role in any massive international initiative, and this was no exception. But in 2001, with the election of George W. Bush, international reproductive funding faced unprecedented challenges.

With Strings Attached: The Legacy of George W. Bush

First, of course, Bush reinstated the global gag rule, making its revival nearly his first act as president. This came as no surprise to anyone, and yet the effects were dire for many organizations, including Planned Parenthood and Marie Stopes International. Such groups, it should be noted, provide an array of services for underserved women that go beyond contraception and abortion to include Pap smears, prenatal care, childhood vaccinations, and treatment of sexually transmitted infections. Bush’s reinstatement of the gag rule was particularly devastating in light of the global AIDS pandemic. But for a while, it looked as though the bleeding might stop there. Colin Powell, secretary of state and a powerful voice in Bush’s ear, was a friend of UNFPA, and the administration asked Congress to put aside $25 million for the agency. Congress did better, and $34 million was appropriated. Within days, fifty-four Republican congresspeople demanded that the money be frozen, again raising old charges of collusion
with China to commit reproductive coercion. If these accusations had limited traction in the 1980s, they were completely unjustified at this point. Bush set up a State Department investigation of the charges, and they eventually concluded that, in fact, UNFPA was trying to convince the Chinese government to loosen the strictness of their one-child policy and was not engaged in any kind of coercive activity. Despite these findings, Bush bowed to conservative pressure and withheld the $34 million.
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UNFPA estimates that the results of not releasing these funds has been devastating: “$34 million could have been used to prevent 2 million unintended pregnancies, 800,000 induced abortions, 4,700 maternal deaths, and 77,000 infant and child deaths.”
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Such numbers boggle the mind, and it is hard to understand how such losses were justified in the name of
preserving
life.

The Bush administration also began to try to convince other countries not to honor the Cairo agreement because it used language that supported abortion rights. An editorial in the journal
Contraception
notes, “In addition to funding cutbacks, the US has also taken a series of diplomatic actions that have called into question its support for reproductive health and family planning programs.”
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It wasn’t that the United States wasn’t pouring large sums of money into family planning; indeed, America was still the largest international donor to such efforts. It was that they were supporting only certain kinds of work. In other venues, such as large international conferences, they attacked language they felt was too supportive of pro-choice values. Offending phrases included “reproductive health services” (at the UN Special Session on Children) and “reproductive rights” (the UN Population Conference in Bangkok).
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In 2004 the United States was the only dissenter in a resolution to reaffirm the commitments of Cairo.
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Some members of the population movement felt that the fundamental shifts in values within the movement had allowed such things to happen. By taking the focus off things that were easily measured—like demographic targets—they had blurred the focus of their agenda. By removing the crisis mentality they had taken away some of the incentives for powerful governments to assure funds. In this context, as Steven W. Sinding of the Guttmacher Institute argues, “family planning, which had been seen as a global imperative,” had morphed at Cairo and become “one among many desirable but nonessential public services.”
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As evidence, Sinding cites an enormous funding decline for programs since 1995.

Of course there were other reasons that this might have happened. First, in the fifty years since many programs were initiated, fertility rates had declined in most parts of the world—in other words, family planning programs had worked. Second was a shift in interest from preventing births to stopping the spread of HIV/AIDS.

Adrienne Germain argues that whatever changes family planning had undergone in terms of its status in international development work, the evidence of their success spoke for itself. Since Cairo, the percentage of couples using some form of contraception has gone up from 55 to 61 percent, and even Africa, the part of the world with the lowest rates of contraceptive use in the world, had seen rates rise from 15 percent in the early 1990s to 25 percent.
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Other positive changes included reduction in maternal deaths in parts of South America, increased antenatal care in Asia, and a rise in female life expectancy. Reflecting on the conference goals on its ten-year anniversary in 2004, Germain identified four areas for continued work: to provide young women with comprehensive rights-based sexual education, to stop unsafe abortion, to help slow the spread of HIV/AIDS, and to try to align the UN’s Millennium Development Goals (a major statement of international development objectives that did not include reproductive rights) with the Cairo statement.
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The election of Barack Obama was seen by many in the reproductive rights community as a hopeful sign that American funding might return to important programs, and the ambitious agendas of Cairo and Beijing could be put back on track. There are indeed reasons to hope but also signs that caution is necessary. Obama quickly lifted the global gag rule, and in March 2009 released $50 million in UNFPA funds. At the same time, Obama chose to lift the gag rule the day
after
the anniversary of
Roe
, a gesture of goodwill to abortion foes. Given the president’s reluctance to take stands on issues of reproductive justice, this choice is not heartening.

Moving Forward

The future of American funding for international initiatives remains, of course, unwritten. While today programs are able to take advantage of funds to work on behalf of women, it is always possible that a new administration
could again undo these gains. Regardless of the position of politicians on abortion, it is time to stop making international women pawns in nasty domestic battles. It is hypocritical to deny women in the most economically disadvantaged parts of the world essential health services because an organization offers—or simply acknowledges and councils—women on a procedure that is legal in the United States. While it is not surprising that politicians would choose to make statements about issues concerning the bodies of women who cannot vote against them, it is both unfair and unwise.

One of the most astounding facts about international population trends in the twenty-first century is that, according to the United Nations, the use of modern contraceptives in less developed regions of the world is now nearly equal to that of the more developed, around 56 percent.
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More couples in more developed regions use contraception in general, but that greater percentage comes from the use of traditional methods (such as withdrawal, timed abstinence, and fertility awareness). Family planning organizations and proponents of international economic development have both claimed this change as a personal victory, and while certainly both have played a role, it would be reductionary to see the massive global shift in fertility as the product of one movement or social force.

Within the neat average of 56 percent lies a massive diversity of lives and cultures, desires and realities. Around the world, the average number of couples who use modern contraceptives ranges from 3 percent in Chad, where men still say they want close to twenty children, to 90 percent in China, where restrictive government regulation limits families to between one and three children. In defiance of simplistic early attitudes about population control, which assumed that fewer children was better, the past fifty years have seen both coercive governmental and international efforts that forced women through horrifying measures to limit family size, as well as movements within countries all over the world to defend larger families. There has also been profound change both on the national and individual level. When developing nations attended the United Nations population summit in Bucharest in 1974, they articulated concern that population control movements were really Western imperialist efforts to control poor nations. Within a decade, many of these nations had come to believe that limiting population was in their countries’ economic as
well as environmental interest. Beyond government efforts, in nearly every part of the world today expect for Sub-Saharan Africa, couples themselves express the desire for significantly smaller families. In Europe, declining populations have created a new panic, and some worry that such changes will bring new political instability.

In all places, the old debates linger: What is the point of family planning programs? Do they exist to accomplish a larger international goal of driving down population to avoid political and environmental problems? Or are they there to try to provide individuals with options, to help them build better lives on their own terms? And are programs that function on the latter set of principles as successful as those governed by the former? As hunger and resource shortages, temporarily put at bay by agricultural practices of the 1970s and 1980s, return, so do advocates of the former perspective. Without diminishing the true challenges faced by the global community today, the main focus must always be on the latter.

This difference of opinion, though, makes it difficult to measure how many people want contraception and don’t have it. Public health workers use the term “unmet need,” but it is not always clear whose need we are talking about. A pregnancy is not, for many women, an undesired outcome, even when it is unplanned. Generally, “unmet need” refers to women who want to avoid or postpone having a baby but who lack any form of contraception.
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The World Health Organization (WHO) estimates that around 123 million women worldwide want birth control and don’t have access to it.
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Other estimates put the number higher, at around 137 million.
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Approximately 38 percent of all pregnancies around the globe are unplanned and 50 to 60 percent of these end in abortion.
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Unmet need is, according to research, highest in Sub-Saharan Africa (23 percent), followed by Latin America (19.4 percent) and Northern Africa and the Middle East (19.4 percent).
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