My Life So Far (86 page)

I learned that if you want to reduce population growth, you have to increase the supply of contraceptives, but that this must be done in a culturally sensitive, nonjudgmental manner, and women must be offered a
choice
of methods. But more is needed. In some countries, if a woman tries to use contraception, she risks being beaten by her partner. In some cultures she needs all the children she can bear in order to have any status at all or to have enough hands to do the needed work. So if you want to
really
reduce population growth,
try educating girls.
Educated girls marry later, want smaller families, have more power within their marriages to bargain for the use of contraceptives, and practice child spacing. Try helping girls and women start businesses, become wage earners, access financial resources, be recognized and engaged as citizens. Such investments yield great benefits to the individual girls but also give girls a vision of their lives apart from simply marriage and rapid childbearing.

The conference had a special focus on adolescent reproductive health and sexuality. Girls, I discovered, are the strategic focus for reducing world population growth. The earlier a girl begins having children, the more children she will have during her childbearing years and the more generations are compacted. Adolescent pregnancy was of special interest to me because Georgia had the highest rate in the United States.

To do something about this, I learned, meant changing the way things were done. This is never easy. Family-planning clinics often exclude adolescents, formally or informally, through inconvenient hours, the high cost of services, and government- or state-mandated absence of confidentiality. Young people need time to develop trust with a potential service provider. They have lots of questions about feelings and about how to know when a relationship is right. Answering them takes time and attention and sensitivity. I remembered all too well my own positive first experience with a gynecologist and how different my life might have been had that
not
been the case. If young women feel judged by someone on a clinic staff or they are frightened at the prospect of a pelvic exam, they might not come back.

As I listened to the conference speakers, suddenly the “Just Say No” mantra of conservatives back home seemed so simplistic. The problem, I could see, wasn’t the “no” part of it—it was the “just.” It ignores the complex reasons that many women and girls have no choice about when they engage in sex (because of rape, early sexual abuse, low self-esteem, or economic considerations). “Just” makes it seem so easy, so black-and-white.

During the conference I wasn’t just discovering strategies to reduce population growth; I began to see that my own experiences—of vulnerability to pressure from men around
their
sexual pleasure, around acquiescence and needing to be “acceptable”—were universal issues for women: in “developed” as well as “developing” countries! I kept thinking, If
I
am vulnerable to these pressures and fears, how can poor women—with little or no legal recourse, social status, financial independence, education, and knowledge of human rights—possibly stand up and say, “Sorry, I don’t want any more children and I intend to use contraception”?

Then came a serendipitous experience that brought it all together, allowing me to see in practice the layered approach needed to bring girls hope and reduce early parenthood. I was taken to visit a community of impoverished Coptic Christians, the Zabaleen (garbage collectors) people of the Mokattam community, deep in the heart of Cairo at the bottom of a rock quarry. With me were my stepson Rhett Turner and Peter Bahouth, then executive director of the Turner Foundation. We had come to see a project funded by the Egyptian government, several NGOs, and the World Bank that was transforming the lives of the girls in the community through education, employment, and delayed childbirth. As we entered the community, we saw garbage-filled wagons with very young children sitting on them. Directly at the center of the community was a yawning compost pit perhaps sixty feet deep and more than half a football stadium long filled with garbage and pig excrement, which was composted. When the car door opened I was assaulted by a stench thicker and more unbearable than anything I could have imagined. I had to force myself out of the car and had to breathe through my mouth just to keep from getting sick. I could not believe that people lived their whole lives breathing this air.

Marie Assaad, a Catholic sister who chairs the Mokattam Committee for Health and Development, greeted us, and as we walked with her she pointed out the “homes” people lived in—dark, doorless structures with dirt floors, and garbage piled high in some places.

“It’s hard to see all the way through to the back,” Sister Marie explained, “but that’s where each family keeps its pigs. The pigs eat much of the garbage, and then the excrement is taken and dumped into that pit you see over there, where it composts and is sold as fertilizer.”

Children, mostly older girls, were sorting through the garbage, removing anything that wouldn’t compost, and setting aside all paper materials for recycling. Marie Assaad told us that during part of the day some of the boys attended school but that until the project we’d come to visit had been started, girls never did. “There is no reason for parents to invest in the education of their daughters,” Marie told us, and she went on to explain that girls are used, as their mothers were before them, as servants—to sort garbage, take care of siblings, cook food. Though responsible in large part for the family’s health needs, they can’t read prescriptions the doctor might give them and aren’t accustomed to discussing things with (male) doctors.

When girls enter puberty they are married, frequently earlier than Egyptian law permits (age sixteen). A girl may be married off to someone she didn’t choose or to someone many years older who may have numerous partners, putting the girl at risk of HIV/AIDS. Once married, a girl moves to her husband’s house to work as a servant for her mother-in-law and other older women in the new household.

Girls marry, leave home, and begin having babies sometimes right after menarche. Boys marry and bring a new wife (fresh labor) into the family. This was why parents invested in sons but not daughters. And this was how the crippling cycle of deeply ingrained gender bias got repeated generation after generation, driving up fertility rates and poor health.

But, slowly, things were changing. We entered a small new school poised on the edge of the compost pit. There I saw girls as well as boys sitting at desks, studying. Sister Marie explained that to counter the historic parental resistance to sending girls to school, the organizers had taken a more holistic approach—education and salaried work. She then led us to a concrete building on the side of a hill. The rooms were filled with huge looms, sewing machines, and paper-pressing machines. In contrast with the rest of the community, everything here was very clean. The girls were using recycled paper from the garbage and making it into stationery and cards that they embroidered and sold. Other girls were at looms, weaving recycled bits of fabric into rugs. In another room girls sat around a table sorting pieces of colored fabric, leftovers donated by Cairo’s textile shops. They were cutting them into squares, rectangles, triangles, applying what they’d learned in the school—math, fractions—to create symmetrical designs they sewed into beautiful quilts. While they worked they were taught health concepts, including reproductive health, contraception, and the dangers of early marriage and closely spaced births. Some of them were also trained as health outreach workers.

Marie Assaad told us that up to one-sixth of the girls in the community were engaged in these income-generating projects, which paid them (at the time) roughly $17 a month. It may be hard for us to imagine that $17 could be profoundly transformative, but this is the effect it had. Girls had achieved a goal, on their own, and had been rewarded for it; their sense of self was changed: “I
am
somebody.” They could read. They could earn. They could, just maybe, break out of the cycle of servitude and despair.

Mothers and fathers began to view their girls in a new way. Now that the girls had developed income-generating skills, there was less resistance to educating them. Smart enough to read and to earn, they were becoming valuable assets. Mothers often identified with their daughters’ new pride in themselves.

Family health had begun to improve as girls learned to read and grew less timid about moving about in public spaces, seeking information and services, talking with doctors. Another innovative part of this program was the creation of rewards to girls for delaying marriage, which gave them leverage and bargaining power with their families. Girls were offered 500 Egyptian pounds ($80) if they waited until after the age of eighteen and it was known that the marriage was freely chosen.

The example of Mokattam proved to me in the most human terms that in poor countries, if you changed the lives of girls by educating them and allowing them the opportunity to become wage earners, to participate in public life, it meant a twofold gain: You expanded human capital while simultaneously improving reproductive health and slowing population growth. Giving girls the chance to delay marriage until a later age meant that they postponed the first child’s birth, resulting in a smaller family overall.

Standing before a quilt made by girls in the Mokattam community—part of the nonprofit development project I visited while in Cairo, Egypt, at the UN Conference on Population and Development.

(Rhett Turner)

At the 1996 UN Women’s Conference in Beijing, China. Left to right, standing: Tim Wirth, Barbara Pyle, Donna Shalala, Geraldine Ferraro, Sarah Kovner. I am seated next to Bella Abzug.

The Cairo conference was a turning point for me. I returned to Atlanta pondering how I could apply what I had learned.

When Ted was preoccupied with business and wouldn’t mind my absence, Peter Bahouth and I traveled to different parts of the state to meet with America’s frontline workers and to examine the realities of adolescent life at home. Although far less severe, adolescent girls (especially poor girls) in Georgia have things in common with the girls in Mokattam: limited identities apart from their sexuality; no bright future to motivate them to remain pregnancy-free and in school. There are high rates of child sexual abuse and domestic violence and few job opportunities.

I will never forget the day I was touring the maternity ward of a small county hospital near Albany, Georgia, and was taken to a cubicle where a fourteen-year-old girl was in labor with her second child. Before I went in the nurse told me that the girl lived in a shack with no indoor plumbing. I looked down into her dark, expressionless eyes, which were looking straight at me. I prayed she saw no judgment in mine. I wish I had kissed her. She needed someone to take her in their arms and not let go for about twenty years. I wondered if anyone ever had, except for during sex. What could “Just Say No” mean to this girl? It was right about then that I read a quote from Marian Wright Edelman, founder and president of the Children’s Defense Fund: “Hope is the best contraceptive.” That was when I understood that those fifteen years of the Laurel Springs children’s camp, along with what my daughter Lulu had taught me, had provided me with an experiential foundation for understanding what young people need in order to grow up healthy and productive. The Cairo conference had provided the conceptual framework.

I believe Ted and I made a unique and potent duo in the arena of population stabilization. We complemented each other perfectly.
We made it better:
he with his passionate, contagious, macro vision of the problem, his money, and his generosity; and I with my micro, on-the-ground, hands-on view (what specific factors cause individual women in different cultures to have large families). Both views are needed, but evidence shows that unless we address women’s and girls’ specific realities and to deliver high-quality services in a respectful, sensitive manner, all the contraception in the world won’t make enough of a difference.