Reproductive Rights Without Borders
Progressive action on reproductive rights should extend beyond the U.S.
By Rebecca Buckwalter-Poza, Harvard College
Thursday January 4, 2007
American progressives’ fight for reproductive justice doesn’t begin in Tennessee’s state legislature and end in the South Dakota ballot box. Domestic abortion bans are only one part of the ongoing international battle for reproductive freedom. But while American progressives have built an effective movement around our domestic challenges, they have not focused as much on the global reproductive health effects of American international policies.
Right now, one of the greatest threats to reproductive health worldwide is the U.S. Mexico City Policy, also known as the Global Gag Rule. The gag rule is a potent example of how dozens of nations and hundreds of thousands of women can be affected by a single presidential edict. Ronald Reagan introduced the gag rule in 1984 at a population conference in Mexico City. The policy banned funding foreign health agencies and non-governmental organizations that provided abortions or referrals for abortion. Bill Clinton overturned the gag rule when he was president, but George W. Bush reinstated it immediately after taking office in January 2001, adding bans on funding for organizations that are involved with abortion education or political activism in any way.
Alongside this policy, Bush withdrew in 2002 $34 million of foreign aid that had been earmarked for the United Nations Population Fund, the biggest provider of reproductive health services in the developing world. As of 2002, the UNPF had a $274 million budget. Using previous years as a guide, the UNFPA estimated that the funding cut would result in 2 million unwanted pregnancies, 800,000 abortions, 4,700 instances of maternal mortality, and the death of 77,000 children under five. Overturning the UNFPA funding cut and the Mexico City Policy could be the most powerful means of improving women’s health worldwide.
In Kenya, the International Planned Parenthood Federation’s refusal to comply with the Mexico City Policy criteria led to the partial or complete shutdown of five medical centers, many of which were the sole regional providers of prenatal care, mammograms, and pap smears, in addition to contraception and abortion. One such shutdown in Mathare Valley left more than 300,000 Kenyans without medical care. In the midst of the AIDS crisis, Zambian organizations were left unable to distribute contraceptives. And in Nepal, after the loss of $100,000 of funding, the central family planning clinic was forced to dismiss 60 staff members and stop providing mobile clinics. The U.S. Mexico City Policy has proven the vulnerability of international women’s health to U.S. foreign policy and funding changes.
But even if the gag rule remains in place, there is some hope for reproductive health advances in the developing world. Nations that work toward putting basic domestic infrastructure in place have suffered fewer ill effects from the UNFPA cuts than those more dependent on Western, and especially American, aid. Malaysia, for example, has been working to develop and implement initiatives targeting sexual health since 1957. Its National Plan of Action for Prevention, Control, Education, Surveillance, and Care has yielded striking results. From 1957 to 1998, Malaysia’s maternal mortality rate fell from 570 to 20 per 100,000 live births, while the country’s infant mortality rate decreased from 75 to 33 per 1,000 live births, according to the country’s Vital Registration System. In 2001, while other nations were beginning to suffer from the UNFPA funding cuts, Malaysia continued to maintain a low HIV/AIDS rate while improving maternal and infant mortality. HIV/AIDS infection remains at 0.4 percent, manageable in comparison to neighboring Thailand’s 1.4 percentprevalence rate. Overall, from 1990 to 2005, Malaysian women’s contraceptive use rose 6.2 percent to 54.5 percent among women ages 15 to 49, and the population growth rate decreased from 2.6 to 1.9 percent.
U.S. progressives should advocate an approach to foreign aid that increases such domestic capabilities in both the public and private sectors. The United States should direct funding to government programs like Malaysia’s, and throw our weight behind initiatives like the Urban Primary Health Care Project (UPHCP) in Bangladesh, a partnership between the Bengali government, the private sector, and international NGOs. In 1997 the Bengali government, with the support of the Asian Development Bank (ADB), built health clinics in key urban centers for NGO partners. In addition to running the government-owned clinics, the NGOs such as Marie Stopes International (MSI) have provided training and seminars, created fellowships, and built government capacity to manage health care and conduct structural reform. By 2002, 14 NGOs in Bangladesh were providing reproductive health care and training. And their reach is growing. MSI, for example, increased treatment capacity from 1,000 to 600,000 patients a year once its partnership with domestic organizations began. It now operates 23 full reproductive health centers, 46 “mini-centers,” and 150 factory-based centers to serve workers.
The results have been remarkable. Maternal mortality has dropped with increasing speed. In the 12 years before 2002, maternal deaths per 100,000 live births in Bangladesh dropped from 850 to 600; in the following three years, the rate fell to 380. In May 2005, the ADB renewed its support for the strategy by granting $40 million to a second UPHCP. Joining the ADB were the U.K. Department for International Development ($25 million), the Swedish International Development Cooperation Agency ($5 million), and UNFPA ($2 million co-financed).
Progressives in the United States should focus on channeling the immense resources available to us in the form of partnerships and aid to find and nurture grassroots institutions and organizations abroad. Not only will women’s, and, as a natural corollary, men’s and children’s health improve, but the extra support for locally-run clinics and training for health care personnel will create a stable base for continued growth. Four years of well-directed aid for homegrown health services can help a nation sustain programs through eight years of aid cuts, keeping progress alive in the face of policies like the U.S. Mexico City Policy and UNFPA funding cut.
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ThX u soo much for that article. I told them Mexico wasn’t a democracy! There is an all-out assault on women’s rights worldwide by Rich corporate owners and workers. It’s time we fought back and kick some hiney. ThX again and have a great day, Nancy
— Nancy - Jan 5, 01:54 PM - #Birth Control and family planning, sex education that includes frank discussions about STDs, help for victims of rape and other crimes are essential and should be supported. However, abortion is a crime against women and is almost always fatal to the children involved. Can we leave that American feminist “sacrament” out of the funding for women’s global health & move forward?
— Nadya Rossi - Jan 5, 04:46 PM - #Nadya, can’t we support healthcare initiatives in other countries without dictating what they can and cannot do?
— E. Juncal - Jan 5, 11:10 PM - #I find it apalling that this article reveres Planned Parenthood as a champion of women’s rights. When Planned Parenthood was founded by Sanger as the ABCL, its agenda was controlling minority populations. And since its creation, Planned Parenthood has historically failed to combat racist and classist ideologies. For many years, the only available method of birth control PP provided for low income communities was sterilization. Furthermore, many minority women were unknowingly sterilized following an abortion procedure. PP has committed an infinite number of such crimes against humanity. Perhaps that ought to be the focus of our health initiatives.
— Audrey Giampietro - Jan 6, 09:46 AM - #Ms Giampetro’s post is sheer fabrication. PP does not do sterilizations, certainly not after abortions. They are the only source of family planning, as well as primary medical care, for millions of women
— marvin thalenberg md - Jan 6, 10:36 PM - #Family planning, like sex education, prevents abortions
Ms Giampetro hasn’t done her homework. Sanger was arrested and jailed because she published and distributed information to women about birth control and family planning methods. She did this because she was sick of seeing women ruining their health having baby after baby or dying in childbirth in the early 20th century. Women from wealthy families were able to obtain birth control information and get abortions from doctors either in the U.S. or abroad. Although it was technically illegal, there were loop holes that doctors were able to use. Poor women didn’t have that luxury. Sanger was one of many in the medical community that studied and discussed ways to prevent birth defects and mental disorders. At that time, very little was known about the causes and how to treat them. The agenda of the ABCL was to make health and birth control information available to everyone, but to the poor in particular because at that time even a visit to a doctor was a luxury that many could not afford. At that time, sterilization was not the only birth control method available. Although crude by today’s standards, condoms and diaphragms were used. As laws changed and more birth control information and methods became available, Planned Parenthood expanded services. PP staff never performed sterilizations, particularly after abortions.
Planned Parenthood provides a wide range of health services for women in addition to safe abortions. All services are based on the woman’s ability to pay. No one is turned away and everyone is treated with respect and dignity. Additionally, no one is forced to receive any tests or treatment that is not wanted. Information about health issues are made available and it is up to the woman to decide what is best for her.
Planned Parenthood has been my health care provider for 30 years. I have continued to go to PP because I have always received top quality health care. In addition to birth control services, I have received treatment for bladder infections and yeast infections when I couldn’t get in to see my regular doctor right away. Nurse Practitioners have provided me with important health information about tests that PP does not provide, such as mammograms and cholesterol tests. I am now beginning to get information about menopause. Because of the services I have received from PP, I haven’t had to use abortion services.
It is unfortunate that too many people believe the lies of the Religious Right and have demonized Planned Parenthood. I have always received the upmost respect and care from every PP staff member that I have encountered.
— L. Bagdon - Jan 7, 12:48 AM - #Some organizations doing the work on the ground in the developing world include: International Planned Parenthood, Western Hemishpere region (www.ippfwhr.org) which establishes and supports reproductive health care clinics and trains local providers, primarily in Latin America.
Pathfinder International (www.pathfind.org) does much the same thing throughout the developing world, including Asia and Africa.
Population Communications International (www.population.org) trains local people in how to use media effectively to broadcast their own culture specific reproductive health messages.
Center for Development and Population Activities (www.cedpa.org) trains young people in the developing countries, particularly young women, to take leadership roles in promoting the interdependent factors of education, family planning and economic development.
Our government should be funding these and other groups generously, but because it uses the abortion wedge issue as an excuse not to, we private citizens must dig into our own pockets to do it. It’s worth it.
Other comment: Abortion is not a crime against a woman who freely chooses it. To the extent that it is a crime against an incipient human being, the embryo or fetus, it is a ‘crime’ that is outside the jurisdiction of everyone but the pregnant woman. The universal moral principle of personal sovereignty, without which individual liberty is a hollow sham, is “Inside my body is outside your jurisdiction – period. No exceptions”.
If we don’t leave that American minority religious extremist authoritarian “sacrament” of anti-abortionism out of the funding for women’s global health & move forward, we will find out just how sacred human life is not when it’s dying out because overpopulation has pushed the biosphere into collapse.
— G.P. Franck-Weiby - Jan 8, 03:17 AM - #One need not look very far to find that Sanger was a racist and eugenics visionary. In fact, it’s hard to study any research on the eugenics movement without encountering her. In her autobiography, Sanger provides several excerpts from delivered speeches, one of which maintains, “While we close our gates to the so-called “undesirables” from other countries, we make no attempt to discourage or cut down the rapid multiplication of the unfit and the undesirable at home.” As I argued in my earlier post, the message is clear- Sanger’s advocacy of birth control was undoubtedly related to and reliant upon the problem of suppressing minority populations. In fact, she also denoted birth control as “the most constructive and necessary of the means to racial health.” Why else do you think the woman’s recent induction into the Arizona Women’s Hall of Fame was so vehemently protested by the NAACP? As for the sources from which I claim that PP has performed sterilizations- they were not publications of the religious right (of which I am neither, but thank you for speculating) but Lisa Udel’s article from the textbook Gender Through the Prism of Difference, “Revision and Resistence” and Eugenic Nation: Faults and Frontiers of Better Breeding in North America. The latter, for instance, exposes the records of North Carolina’s Eugenic Board to demonstrate that while black women were being disproportionately sterilized in the 1950’s and 1960’s, the number of women requesting such a procedure was marginal- an estimated “6% of the 8,000 total sterilizations in North Carolina were requested. The objective of my initial post was not to contest the author’s claim that the U.S. ought to intervene in the international struggle for reproductive rights. I only wanted to point out that we should be cautious to revere Planned Parenthood has iconic in the global fight for human rights, especially since it has failed its own people here at home through a legacy of racism and eugenics from which it has only recently begun to redeem itself.
— Audrey Giampietro - Jan 8, 10:06 AM - #Audrey, I revere the United States as iconic in the pursuit of free citizenry despite the fact it was founded by white men who forbade women to vote and owned black people.
You really need an intense lesson in how logical correlation works. If your argument is that PP is bad because you ddn’t like what it’s founder did, you still need to provide some kind of proof that her actions are specifically revered or duplicated by the organization. The reality is you know that PP doesn’t actually practice eugenics any more than the Catholic Church actively endorses pedophilia; but nevertheless you like attacking a straw man instead of finding a factual case against the benefits of PP’s current services.
For some strange reason, Planned Parenthood has managed to spend the last 30 years carefully hiding their apparent agenda to eugenically dissolve the American population under the guise of providing safe, quality health care services for millions of women. They’re rather bad evil masterminds, given the circumstances.
— August J. Pollak - Jan 8, 10:36 AM - #It’s articles like this that being so full of lies and outright propaganda for a leftwing agenda to demonize the right, that cause me to strengthen my resolve to counteract their efforts.
My present goal is to use my own personal wealth (and to increase it) to encourage men and women to marry and start families with many children. It is hope for civilisation.
— Joseph Miller - Jan 10, 09:46 PM - #Thank-you Mr Miller for letting us all know that you have amassed personal wealth and intend to increase it like a good american. That’s very nice for you I’m sure. In the meantime, while there are now more billionaires than ever, there are 25,000 people dying of starvation every day. And you say the world needs more people? Fortunately not all wealthy people are of your opinion and Mr Gates recently gave a third of his fortune to help those less “fortunate” than himself – sure, let’s have more people but only when there is not a single soul on the planet who is starving. What do you reckon? The trouble is, that if all 6.6 billion people were to live like rich Americans, we would need about 3 planets to supply the resources. Don’t you REALISE that more than half of the world’s oil has already been used? Don’t you REALISE that fish stocks in many areas have been all but wiped out? Doesn’t the danger of global warming worry you even a tiny bit?
— Tom Gosling - Jan 11, 06:16 AM - #please send this article throug my email number for download copy. i will be greatefull to you.
— Kamal Hossain - Jan 22, 12:58 AM - #Kamal- all our articles have an option at the bottom of the article to send via e-mail or display a printer-friendly version. Hope that helps!
— August J. Pollak - Jan 22, 09:26 AM - #Nadya Rossi, the problem is that those who oppose abortion also oppose contraception, sex education and non procreative sex.
— Mary Smith - May 18, 04:56 AM - #