by Susan E. Wills
March 20, 1998
A high-stakes game of "chicken" is being played out between Congressional leadership— committed to restore the Mexico City Policy—and President Clinton, who overturned that policy in January 1993. The policy would deny family planning funds to international organizations which perform abortions and promote pro-abortion laws in foreign countries.
Sadly, worldwide access to abortion is high on the President's agenda. In light of this he has threatened to veto any bill containing the Mexico City Policy, including two bills he says are vital to American interests: the back payment of UN dues and payment of about $18 billion to the International Monetary Fund. Congressional leaders plan to use all available leverage to reinstate this quite modest restraint on family planners' hegemony over the developing world's peoples.
The outcome of this stand-off is anyone's guess. What we can expect is no final resolution concerning abortion's role in international family planning as long as such funding is authorized by Congress. Congressional and public support for U.S. funding of international family planning rests on several assumptions:
First, that these family planning programs are voluntary: neither coercion nor serious abuses of human rights are involved.
Second, that funds are exclusively used to provide access to contraceptive methods, not abortion.
Third, that current family planning programs improve the reproductive health of women in developing countries.
Fourth, that voluntary family planning programs are effective in reducing fertility rates.
Fifth, that population growth must be curbed to spur economic development and reduce "overpopulation," with all its perceived threats: mass starvation, environmental degradation, political instability, and natural resource depletion.
Would not most Americans reject a policy that trampled on human rights, violated host country laws against abortion, endangered women's health, that was "effective" only when conducted coercively and, finally, was unnecessary? Evidence continues to mount—from those suffering from these programs, from human rights groups, and from agencies that support, conduct or monitor population control activities—that none of the stated assumptions underlying support for population control remains valid, if ever they were.
Coercion and abuse of human rights: The Population Research Institute recently brought to Congress's notice the coercive nature of Peru's sterilization program, which is supported through USAID (a program of the U.S. State Department). A Peruvian doctor and two victims of coercive sterilization testified about the pressure and incentives on medical personnel to meet monthly quotas of sterilizations, the illnesses and deaths from sterilizations performed in unhygienic settings by poorly trained staff, the lack of knowledge and consent on the part of women who are sterilized, the coercive threats and incentives used to induce women to agree to a procedure they are told is temporary. Peru is one of 38 countries on record as violating human rights in the course of enforcing their population policies. In many countries (including Mexico), women may be sterilized or have IUDs inserted immediately after giving birth without their knowledge or consent, and even against their express wishes.
USAID is not the only channel for funding such coercive programs. The World Bank loans $2.4 billion annually for "health, nutrition, and population" programs. A population sector review issued by the World Bank refers approvingly to an array of family planning incentives and disincentives—for example, promising a new well or irrigation system to a village provided all (or nearly all) villagers accept sterilization or another long-lasting form of contraception. The World Bank has long been accused of having tied lending and disbursement to the adoption of, and compliance with, population measures.
Abortions by any other name: "Contraceptive" methods include oral contraceptive pills, intrauterine devices (IUDs), long-acting injectables like Depo-Provera, and Norplant. Each method has multiple mechanisms of action—and in each, an abortifacient action is a back-up when the contraceptive action fails. Although one cannot possibly calculate the rates of conception and abortion as a consequence of breakthrough ovulation under the various methods, in light of the number of women now using the methods worldwide, the level of non-surgical abortion must be staggering. Girls and women in the developing world who have had "unprotected" sex are encouraged to take "emergency contraceptive" pills or RU-486 or to undergo "menstrual regulation." All three methods constitute abortion.
Health risks: Far from improving their reproductive and general health, these hormonal and surgical methods are inappropriate for women who may be malnourished and in poor health generally and who have no access to competent medical care. Procedures are often performed in unsterile settings by staff with little medical training. Typical short-term side effects of Depo-Provera include: heavy, irregular or interrupted menstrual bleeding, depression, weight gain, headaches, and dizziness. In addition to these symptoms, Norplant may produce nausea/vomiting, mood swings, nervousness, hair loss, acne and more. Long-term effects of Norplant include liver disease, kidney disease, diabetes, and blood clots. Life-threatening ectopic pregnancies can also occur. Sterilization poses a risk of ectopic pregnancy and increases the need for a hysterectomy. Is this the best we can do for women in the developing world?
Mrs. Wills is assistant director for program activities, NCCB Secretariat for Pro-Life Activities.