Feminist Perspectives on Family Planning Programs Research Paper

1.1 Family Planning Programs And The Erstwhile Population Approach

To fully understand the significance of the Cairo accord and the influence feminist thinking had on it, it is necessary to look at the philosophies and practices it replaced. The 1960s, with the advent of new contraceptive technologies and an increase in fears of a population explosion, saw a significant increase in support for family programs in both industrialized and Third World nations. In 1967, the United Nations Fund for Population Activities (later renamed the United Nations Population Fund) was established to support population and family planning programs. At the UN population conference in Bucharest in 1974, many policy makers—mainly from Northern nations—viewed unchecked population growth as the root cause of poverty, environmental degradation, and social unrest. Many developing countries resisted this line of thinking, suggesting instead that economic development was a more straightforward solution to societal ills, than family planning. While womens’ issues gained some attention, they were not seen to be central. Meanwhile, on the ground, family planning programs continued, largely unaffected by the debate at the international forum (Demeny 1985).

At the 1984 Mexico City conference, demographic concerns continued to be the driving force in discussions. However, in a reversal of its previous policy, the powerful US delegation now asserted that population growth had a neutral, not harmful, effect on economic development. Furthermore, anti-abortion politics gained center stage as the US launched an attack on abortion rights (Demeny 1985). Still, family planning programs on the ground continued to be guided by demographic goals and to use mechanistic measures such as reaching target numbers of ‘contraceptive acceptors.’ These programs’ principal strategy was the distribution of contraception, chiefly to married women. Perhaps called population programs more accurately than family planning programs, these efforts usually did not address other health needs, even reproductive health needs.

2. The Feminist Critique Of Population And Family Planning

As these programs proliferated throughout the 1970s and 1980s, women around the world began focusing on the negative effects of family planning programs that were based on demographics. While not denying the benefits of family planning, feminists rejected the depiction of women as targets of programs designed to limit births (Pitanguy 1995). The feminist critique concentrated on several aspects of program practices, including their vulnerability to coercion, their low quality, and their sole concentration on fertility regulation to the exclusion of other womens’ health needs.

The vulnerability to coercion was a major element of the feminist critique. In some countries, health care providers were under pressure to achieve targets or be subject to penalties, and workers pressed people into accepting contraception or sterilization against their will. With success of family planning programs measured in terms of numbers of acceptors, some agencies and governments devised incentive and disincentive schemes to induce couples to participate in family planning programs. For some time, there was a debate about the fine line separating incentives from coercion. Feminists argued that, while milder than sheer force, the incentive practice is coercive; incentives are aimed primarily at the poor, for whom an economic inducement can be a vital necessity, not a free choice (Hartmann 1995). The Cairo Programme of Action later disavowed incentives.

Furthermore, women—and women were the objects of these campaigns in much greater numbers than men—were given little contraceptive choice. The focus was on sterilization or other modern, provider-controlled, methods of contraception such as the injectable Depo-Provera. The risks of these methods, feminists argued, were largely ignored and even exacerbated as a result of poor screening procedures and the lack of follow-up examinations. Safer methods, such as the condom and diaphragm were neglected, even though barrier methods have the ability to help prevent the spread of sexually transmitted diseases. Indeed, apart from fertility regulation, family planning programs provided little else in the way of services. Furthermore, male contraceptive methods were ignored in the research sphere and male participation was neglected in family planning programs, except for sterilization campaigns in some countries (Dixon-Mueller 1993).

Feminists insisted that family planning programs be comprehensive in nature with the limiting of births being only one item in a wide range of women’s reproductive health needs. Other items included skilled care during pregnancy; delivery and postpartum care; prevention of infertility; counseling for sexual dysfunction; safe abortion; prevention and management of sexually transmitted diseases; reproductive tract infections, and reproductive system cancers; and treatment of postmenopausal health problems (HERA n.d.).

Furthermore, feminists demanded that women’s health advocates should be represented at all levels of policy and decision making. They also maintained that men’s responsibilities in the reproductive realm should not be ignored ( Women’s Declaration on Population Policies 1992).

Perhaps most central to the feminist critique is the assertion that women have the ability to make appropriate reproductive choices. In the feminist view, reproductive choices belong at the individual level, not with the health practitioner and especially not with the state. Noncoercive family planning programs aim to prevent unwanted fertility—as defined by couples, not by the government or other outside parties—through the provision of competent services that respect dignity and privacy. The essence of the feminists’ perspective is the view that reproductive rights are human rights.

Another fundamental premise of the feminist perspective on family planning programs, sees women’s empowerment as a desirable goal in its own right, rather than a means to a demographic end. Feminists also emphasize gender equity, including mens’ responsibilities in sexual and reproductive matters (GarcıaMoreno and Claro 1994).

Articulating these views, women in many countries around the globe began advocating wholesale transformation of the approach to population concerns and the basis for family planning programs. By the time of the 1994 ICPD, an international women’s health movement was organized and had developed the expertise and the professional skills needed for influencing policy makers and shaping the paradigm shift on population and family planning (Klugman 2000). ‘The Cairo Programme of Action sums up the agenda of priorities which women from all over the world, through their leadership networks, built gradually during the years of preparation for the conference’ (Berquo 1997).

3. The Cairo Programme Of Action And The ‘Feminist Imprint’

The Cairo conference ushered in a new era of population policy and family planning programming. Its resulting Programme of Action reflects a clear ‘feminist imprint’ (Petchesky 1995). The conference document presents a new perspective, in which high rates of population growth are understood as an interdependent and aggravating factor—rather than the cause—of problems such as poverty and environmental degradation. Even more critically, it places women’s wellbeing at the center of population policy and points to the human rights of individuals to determine and plan family size. Unlike documents from previous population conferences, the ICPD Programme of Action includes chapters on ‘Reproductive Rights and Reproductive Health,’ and ‘Gender Equality, Equity and the Empowerment of Women.’

Echoing the feminist critique, the comprehensive nature of reproductive health is elucidated in section 7.2 of the Programme of Action, as follows:

Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

While previous population conferences had always seen women’s development as a tool for achieving lowered fertility rates, the Cairo Programme of Action places women’s empowerment as a worthy goal in its own right. ‘The empowerment and autonomy of women,’ the agreement reads, ‘and the improvement of their political, social, economic and health status is a highly important end in itself’ (Programme of Action: 4.1). In another clear echo of the feminist critique, the document goes far in its call for gender equality (Programme of Action: 4.1):

The power relations that impede women’s attainment of healthy and fulfilling lives operate at many levels of society, from the most personal to the highly public. Achieving change requires policy and programme actions that will improve women’s access to secure livelihoods and economic resources, alleviate their extreme responsibilities with regard to housework, remove legal impediments to their participation in public life, and raise social awareness through effective programmes of education and mass communication.

4. Critiquing The Critique

The feminist critique has its detractors and the outcome of the Cairo Conference was not universally applauded. Vocal critics were mainly religious fundamentalists, especially the leadership of the Roman Catholic Church (Shannon 1994). A much quieter reaction was registered among some demographers and others whose concerns about high rates of population growth led to their dismay at what they saw as the dismantling of population policies (DixonMueller and Gemain 2000). For example, Malcom Potts maintained that the ‘flaw in the Cairo process was to move from a well-tested middle ground of supplying family planning to adopting a much broader agenda’ (Potts 1995). Jason Finkle and Alison McIntosh claimed that women’s groups ‘co-opted’ the ICPD. The conference, they maintained, was ‘not a step forward for the population movement, which for many years has given primacy to efforts to limit population growth’ (Finkle and McIntosh 1996).

Even some supporters of the reproductive health paradigm adopted in Cairo found some faults in its processes and outcomes. In a review of responses ‘that tend to temper the initial feeling of euphoria surrounding the triumph of the feminist agenda,’ Huda Zurayk writes that while a large number of women from Third World countries were present in the ICPD process, ‘the strings were definitely being pulled by the well-organized Western feminist groups’ (Zurayk 1997). Others, however, point to the significant contribution of Third World—particularly Brazilian, Indian, Egyptian, Nigerian, Mexican, and South African—women to ICPD discourse.

5. Beyond Cairo: The Feminist Critique Moves Forward

After the Cairo Conference, the feminist critique expanded to include a vision of policies, governing not only family planning programs but also the broader panoply of issues related to reproduction and sexuality. One year after the ICPD, in 1995, the United Nations held another of its major international conferences, this time the focus was on women and the venue was Beijing. Again the ensuing conference document, the Beijing Platform for Action, reflected feminist input. While refraining from using the phrase ‘sexual rights,’ the agreement nonetheless endorsed the basic tenets of such rights, and placed them within a human rights framework. ‘The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence,’ reads paragraph 96 of the Plan of Action.

There is little question that feminist analysis has had significant influence on policy worldwide, principally through the actions of women’s nongovernmental organizations. Feminist scholars are now pressing for a similar impact on the discipline of demography, where gender issues have remained marginal. While ideological resistance presents a considerable obstacle, ‘intellectually, the incorporation of gender issues in demography promises to enhance the science by offering a deeper understanding of social process and the application of multilevel methodologies’ (Presser 2000).

Feminists are now focusing on implementation of the ICPD. Even with the advances in international agreements, many observers have pointed out that change on the level of rhetoric is one thing, and change in the everyday lives of women is another. Studies in many countries show varying levels of success in making reality conform to aspirations. Feminists continue to point to reluctant donor nations, recalcitrant cultural conventions, and wayward practitioners as some of the many obstacles to realizing quality family planning programs that are based on the expressed needs and desires of individual women and men.

Bibliography:

1. Berquo E 1997 The ICPD programme of action and reproductive health policy development in Brazil. In: Proceedings of the International Population Conference. International Union for the Scientific Study of Population, Liege, Belgium
2. Bongaarts J, Parker M W, Phillips J F 1990 The demographic impact of family planning programs. Studies in Family Planning 21(6): 299–310
3. Correa S, Petchesky R 1994 Reproductive and sexual rights: A feminist perspective. In: Sen G, Germain A, Chen L (eds.) Population Policies Reconsidered: Health, Empowerment and Rights. Harvard University Press, Boston
4. Demeny P 1985 Bucharest, Mexico City, and beyond. Population and Development Review 11(1): 99–106
5. Dixon-Mueller R 1993 Population Policy and Women’s Rights: Transforming Reproductive Choice. Praeger, Westport, CT
6. Dixon-Mueller R, Germain A 2000 Reproductive health and the demographic imagination. In: Presser H, Sen G (eds.) Women’s Empowerment and Demographic Processes: Moving Beyond Cairo. Oxford University Press, Oxford, UK
7. Finkle J, McIntosh A 1996 Cairo revisited: Some thoughts on the implications of the ICPD. Health Transition Review 6: 110–4
8. Garcia-Moreno C, Claro A 1994 Challenges from the Women’s Health Movement: Women’s rights versus population control. In: Sen G, Germain A, Chen L (eds.) Population Policies Reconsidered: Health, Empowerment, and Rights. Harvard University Press, Boston
9. Hartmann B 1995 Reproductive Rights and Wrongs: The Global Politics of Population Control. South End, Boston
10. HERA: Health, Empowerment, Rights and Accountability. Women’s Sexual and Reproductive Rights and Health Action Sheets. HERA, New York
11. Jain A, Bruce J 1994 Quality: The key to success. In: Mazur L (ed.) Beyond the Numbers. Island, Washington, DC
12. Klugman B 2000 Empowering women through the policy process: The making of health policy in South Africa. In: Presser H, Sen G (eds.) Women’s Empowerment and Demographic Processes: Moving Beyond Cairo. Oxford University Press, Oxford, UK
13. Petchesky R P 1995 From population control to reproductive rights: Feminist fault lines. Reproductive Health Matters 6: 152–61
14. Pitanguy J 1994 Feminist politics and reproductive rights: The case of Brazil. In: Sen G, Snow R (eds.) Power and Decision: The Social Control of Reproduction. Harvard University Press, Boston
15. Pitanguy J 1995 From Mexico to Beijing: A new paradigm. Health and Human Rights 1(4): 454–60
16. Potts M 1995 Cairo’s skewed consensus. Population Today 23(11)
17. Presser H 2000 Demography, feminism, and the science-policy nexus. In: Presser H, Sen G (eds.) Women’s Empowerment and Demographic Processes: Moving Beyond Cairo. Oxford University Press, Oxford, UK
18. Shannon D 1994 All roads led to Cairo. Conscience 15(4): 3–10
19. Women’s Declaration on Population Policies 1992 In: Mazur L (ed.) Beyond the Numbers. Island, Washington, DC
20. Zurayk H 1997 Reproductive health in population policy: A review and a look ahead. In: International Population Conference. International Union for the Scientific Study of Population (IUSSP), Liege, Belgium