Why Did National Leaders in India, China, and Peru Impose
Coercive Family Planning Policies?
MALCOLM POTTS
MARTHA CAMPBELL
Bixby Center for Population, Health & Sustainability, University of California, Berkeley.
Venture Strategies for Health and Development, Berkeley.
Abstract
The coercive family planning in India in the 1975, in Peru in 1995, and the one-child
policy in China have certain features in common. They all occurred in countries with rapid
population growth and they all began as genuine efforts to lift people out of abject poverty.
We argue that the national leaders involved in coercive family planning were all making
decisions within a framework that emphasized distal factors, such as education and
income, as driving the demographic transition, rather the proximal factor of unfettered
access to a range of contraceptive methods backed up by safe abortion. The latter emphasis
is entirely free of any implications of coercion, whereas placing all the weight on socioeconomic improvements as drivers of smaller families could make coercion more likely in
the future.
Introduction
Why did the three leaders, Indira Gandhi, Deng Xiao-ping and Alberto Fujimori, in
different parts of the world and at different times in the last half of the twentieth century,
impose coercive family planning policies? Poverty, ignorance, social inequities, religious
teachings and bureaucratic ineptitude have produced many examples where individuals,
primarily women, have been subject to of coercive family planning. The pain of coercive
family planning has been highlighted in the media and academic literature (Alvardo and
Echegaray, 2010). The question that has not been asked is why did these leaders make such
costly decisions? This analysis is concerned exclusively with the context in which national
leaders articulated explicit policies to mandate, or forcefully encourage, individual citizens
to have fewer children. We look for common threads linking these disastrous decisions,
both to reduce the possibility of similar cruel assaults on individual freedom in the future,
and because the shadow of coercive family planning continues to make many
contemporary policy makers reluctant to focus attention on population growth and the need
for family planning.
We suggest that in all three cases the leaders believed that they had inherited a threatening
demographic situation, brought about by prior administrative incompetence, or by frank
hostility to family planning by religious groups. The next step, to interpret the thinking of
these leaders is more difficult and open to genuine debate, but we will suggest that some
progress can be made based on public statements made at the time, along with an effort to
recreate the intellectual frameworks in which these leaders made their decisions.
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The demographic setting
Between the Partition of India in 1947 and prime minister Indira Gandhi’s assumption of
‘Emergency powers in 1975, the population of India almost doubled from under 370
million to about 620 million. The total fertility rate (TFR) for the whole country was 4.9
and still higher in the northern states. The full impact of the ‘green revolution’ had not
been felt and when Gandhi was prime minister the US was shipping millions of tons of
gran to India to avert famine.
Early efforts to slow rapid population growth failed. In 1960, the Vatican delayed WHO
assistance to international on family planning, blocking a seemingly benign resolution
proposing the WHO Director General “collect information from member states as to the
extent to which planned parenthood is regarded and applied as a part of preventive
medicine health programmes.” (Suitters, 1973) The WHO’s first assistance was to offer
advice on periodic abstinence. The Population Council funded the Khanna study in India,
mainly depending on foaming tablets, diaphragms and spermicidal jellies. Predictably, it
showed little or no impact on the birth rate (Wyon and Gordon, 1971). Family planning
was subject to an unfortunate policy mix of western specialists with their bias towards
clinics rather than community empowerment; Indian administrators sometimes looked
down on lower caste villagers; and an overly cautious leadership and administrative system
undermined most of the efforts that might have been made to empower the community to
use modern methods of family planning.10
When the Chinese one-child policy was put in place in 1979, China, like India, had seen
the population grow rapidly from 545 million in 1950 to 980 million in 1980. Unlike India,
however, the TFR had already fallen from 5.5 in 1953 to 2.3 in 1979. We will return to this
seeming paradox below. As in India, prior efforts at family planning had been uneven. A
1953 census showed population growing at 2% a year. Chou En-lai, who was less of an
ideologue than Mao, sought advice on family planning from Pakistani diplomats in Beijing
and in 1956 the government began training family planning workers, set up family
planning clinics and launched a massive promotional campaign (Chen, 1981; Chou, 1959;
Mao, 1949). However, these early efforts fell apart during the Great Leap Forward 1958
and access to family planning was further disrupted when Mao launched the Great
Proletarian Revolution (1966-68). Among other things, Mao closed the universities. In
1970 the government introduced the slogan ‘wan xi shao’ or ‘later, longer, fewer,’ (Chen,
1975), but there was no objective data on which to build evidence-based polices. After
Mao’s death in 1976, the government revised the Constitution (Article 53) to read, “The
state advocates and encourages birth-planning” (Chen, 1975).
Albeto Fujimori was an agricultural engineer, mathematician and physicist who became
rector of Universidad Nacional Agraria in Lima, before becoming a surprise winner of the
1990 Peruvian presidential election. He was faced with national bankruptcy, hyperinflation
and a decade old Maoist guerrilla movement called the Shining Path. The population of
Peru had grown from 7.6 million in 1950 to 21.7 million in 1990. Over the same interval,
the TFR had fallen from 6.9 to 3.7, but, as a result of falling infant mortality, the annual
percentage increase had the population had fallen less from 2.5% per annum in 1950 to
1.85% in 1990). The Catholic Church had consistently and effectively opposed any
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investment in family planning and denied women access to the information and
technologies they needed to limit family size.
To a greater or lesser extent, Gandhi and Deng-Xiao Ping and Fujimori came to power in
nations where prior efforts to offer large scale family planning had failed, stalled or been
actively opposed. Each was in a position where a reasonable and concerned leader could
argue that rapid population growth would have serious adverse effect on the future of the
nation. In India, by the 1970s, the green revolution was taking off, but there were also
genuine memories of famine. Poverty in rural areas and the burgeoning slums remained
pervasive. The population was growing by 3.1 per cent per year and Indira Gandhi had
good reasons to ask how rapid population growth could be slowed. In China, the birth rate
had fallen relatively rapidly but there was still a good deal of demographic momentum
(35.5 per cent of the population was under age 15), and Deng Xiao-ping and those around
him were prudent to review future population projections carefully and consider possible
policy responses. In Peru, if there was no further change in the birth rate, the population
would have doubled in less than 40 years and there were large differences in TFR by socioeconomic status. Fujimori was wise to focus some of his attention on population and
family planning.
The three leaders were confronted by genuine demographic problems, but that does not
explain why, as we see them now, they ended up making such tragically inappropriate
decision.
The intellectual setting
When these three leaders made their decisions, the factors driving the demographic
transition from large to small families had been the subject of academic debate for half a
century. The writings of demographers, economists and sociologists had fed into the
intuitions, prejudices and genuine curiosity of the wider public. In turn, politicians and
decisions makers had transformed such opinions into a variety of fiscal policies, public
health initiatives, patriotic rhetoric and even ethnic or religious hatred. As modern public
health measures in the developing world, such as widespread vaccinations or DDT
spraying to control malaria, brought about spectacular declines in mortality after World
War II, so the pressure to develop policies based on an understanding of the demographic
transition increased.
Simon Szreter (1993) suggests the standard demographic transition model gained traction
in the post-war world because it “appeared to be something of a philosopher’s stone.”
However, the relationship between socioeconomic conditions and fertility decline in
Europe was found to be weaker than expected (Coale and Watkins, 1986) and the success
of organized family planning programs in Asia and Latin America “demonstrated that that
there is no tight link between development indicators and fertility” (Bongaarts and
Watkins, 1996) (p.641). In 1996, Dudley Kirk called the standard social and economic
theory “one of the best generalizations in the social sciences” (Kirk, 1996).
Despite the criticisms, it became more common to adjust explanations of the demographic
than to discard it. For example, having agreed that “the demographic transition itself is
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poorly predicted by customary quantitative measures of development”, Bongaarts and
Watkins (1996) still went on to assert that “the role of socioeconomic development in
accounting for fertility declines remains inherently plausible.” In fact, as Szreter
comments, “In abandoning the more rigorous, unidirectional specification of casual
relationships posited in the classic version of demographic transition theory the model’s
conceptual structure was allowed to become so general and the theoretical relation so
flexible that, as a casual explanation of change, it became an empirically irrefutable
theory” (Szreter, 1993).
In this rather strange situation where policy makers, along with a broad public, were
looking for a promising a single explanation of a complex historical event, the opinions of
demographers, economists, and those working in the field of family planning can be
arranged along a spectrum of opinion. At one end of the spectrum are Pritchett (1994) and
others who assert that couples will want fewer children as socio-economic conditions
improve and they will find a way to limit family size through free market forces because
the costs of fertility regulation are always lower than those of bearing an unintended
pregnancy. At the other end of the spectrum are those who suggest that when women are
given unfettered access to the knowledge and the technology needed to manage whether
and when to have a child, then average family size will fall, even in a poor and illiterate
society (Ravenholt, 1969; Potts, 1976; Campbell et al., 2006; Campbell and Bedford,
2009; Prata, 2009). This latter group highlights the many tangible and intangible barriers
preventing women from accessing the family planning technologies and information and
they usually define access as much wider than government programs, involving all public
and private channels of distribution and communication. They also recognize that induced
abortion (whether safe or unsafe) plays a significant role in fertility limitation. We call this
an opportunity model of the demographic transition.
Whether at one end of the spectrum or the other, everyone recognizes that more education
often correlates with smaller families. However, those emphasizing distal factors often see
this as a causal relationship, while those giving more weight to access suggest it is a
correlation reflecting the fact that it is always easier to disseminate objective information
and distribute contraceptives in an educated society with rising incomes than it is to a poor
and illiterate society. This interpretation in no way diminishes the importance and
significance of investments in education; in fact, achieving lower fertility improves access
to education (Knodel and Wongsith, 1991).
In general and over time, the weight given to distal factors has been more widely
recognized and accepted than the alternative emphasis on family planning per se. For
example, Jeffrey Sachs in The End of Poverty (2005) writes, “One reason for the poverty
trap is the demographic trap, where impoverished families choose to have lots of children.”
He goes on to assert that, ”Because the parents are risk averse, and want to assure with a
high probability of the least one child… they overcompensated in a statistical sense.”
We will argue that national leaders in India, China and Peru, like Sachs, interpreted the
demographic transition in the framework of this model. If, as many demographers and
economists at the time argued in the 1960s and 1970s (Meade, 1967), socioeconomic
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development was a prerequisite for slowing population growth, but rapid population
growth was undermining development, then the socioeconomic model was chasing its own
tail: family size would not fall until social and economic progress occurred. Given this
thinking, a rational policy maker had either to stand by passively and watch as rapidly
growing communities become even poorer, or recommend that the state move in and offer
incentives to use contraception or impose restrictions on the number of children parents
might have.
We recognize that all senior decision makers spend much of their time confronting
unexpected challenges and when they do have time to think about long term strategic
policies, complex issues are necessarily reduced to bullet points and simple alternatives.
We assume that the three had formal and informal discussion with their aides, and perhaps
with political rivals, but we also assume they did not have the time or motivation to follow
any of the detailed academic analyses quoted below, and that they were largely or totally
unaware of the nuances of scholarly writers.
In 1945, Frank Notestein formulated one of the most widely quoted theories of the
demographic transition in 1945 (Notestein, 1945, Notestein, 1953), although it had been
adumbrated by Warren Thompson (1929). Kingsley Davis was an early and forceful
exponent of the assumption that family size falls as social and economic conditions, such
as women's education or family income, improved. The converse, that birth rates would
not fall in the absence of these exogenous changes, was also either implied or explicitly
stated. It was also commonly assumed that “once fertility declines are underway they tend
to continue” (Bongaarts, 2003).
Over his professional career, Notestein’s own thinking evolved in a revealing way.
Initially, he believed that cultural change was both necessary and sufficient for fertility
decline and that family size would fall “with great effectiveness” without the “assistance of
modern contraceptive techniques.” He belittled “the dissemination of contraceptive
knowledge as the sole solution to the problems of population pressure.” (emphasis in the
original) (Notestein, 1944). When Notestein became president of the Population Council in
1959, he began to appreciate that population growth in parts Asia was much more rapid
than it had been during the European demographic transition. Where he had initially
spoken of the he saw a need for “great project of social engineering” if fertility was to fall
(Connelly, 2008), he now placed increasing emphasis on family planning.
Summing up the 1965 International Conference on Family Planning Programs in Geneva,
Notestein began to place greater weight on access to contraception.
“At present three facts impress me: (1) the motivation to practice birth control is shown to
be present in substantial parts of many populations; (2) it is constantly being strengthened
by the whole process of modernization; and (3) it seems likely that the motivation to
practice birth control will be further strengthened by the example of those who practice
birth control successfully.
In the present state of affairs, then, it seems to me more important to provide service to
those already interested than to strive hard for more converts. It is my belief that in the
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securing of new converts, moreover, low-pressure informational services will be more
effective than exhortation.”
Looking back on the US international contribution to international family planning in 1982
Notestein admitted, “I don’t think we did so damn bad” (Donaldson, 1990), yet he never
went back to his academic roots and encapsulated his new thinking in a scholarly journal.
Like the grin on the Cheshire cat, the almost exclusive emphasis as socioeconomic factors
as essential to fertility decline persisted long after a number of the leading thinkers had
abandoned it.
Notestein’s personal intellectual journey captures a broad change which took place
between about 1950 and 1980. As modern contraception and safe abortion became more
widely available from the 1960s onwards, it became apparent that family size could fall,
even in poor and sometimes largely illiterate communities (Potts, 1997, Prata, 2009). Many
of those responsible for implementing family planning programs simply got on with
providing “service to those already interested.” (Potts and Wood, 1972; Potts, 1974).
The two groups at either end of the spectrum of interpretations of the demographic
transition both began to sense the danger of coercion relatively early, but handled it in
different way. At the 1965 meeting quoted earlier, Notestein commented¸
“There is a real danger that sanctions [to encourage smaller families], for example through
taxation, would affect adversely the welfare of children. There is also a danger that
incentives through bonuses will put the whole matter of family planning in a grossly
commercial light. It is quite possible that to poor and harassed people financial
inducements will amount to coercion and not an enlargement of their freedom of choice.”
(Notestein, 1966)
In an influential article in Science in 1967, Kingsley David called the family planning
programs then being launched in a number of developing countries “either quackery or
wishful thinking.” He went on to assert,
“There is no reason to expect that the millions of decisions about family size made by
couples in their interests will automatically control population for the benefit of society.
On the contrary there are good reasons to think it will not.” (Davis, 1967)
Judith Blake, who was married to Kingsley Davis, struggled with implications of the
standard model at the 1972 at a Pugwash Conference. In her presentation titled Fertility
control and the problem of voluntarism, she seems to have recognized that emphasis on
distal factors could imply that coercion might be needed if socioeconomic factors could not
be improved. She seems to have tied herself to this interpretation, even though she did not
like the implications.
“One approach says that voluntarism must be curtailed, the other claims it must be
preserved at all cost. Neither recognizes that it [voluntarism] does not exist right now.
Neither takes into account that at present reproductive behavior is under stringent control,
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and that this control constitutes, in most societies, a coercive pronatalist policy.” (Blake,
1994)
Such a statement could have been an eloquent introduction to reducing the barriers to
fertility regulation. In fact, Blake’s analysis never mentions abortion or contraception but
focuses entirely on such factors as the “cost” of having a child. While obviously
uncomfortable with curtailing voluntarism, she thought it was “naïve to assume that, with
nothing else changing, people will adjust their fertility to below their prior preferences in
response to declining mortality.” (Blake, 1994)
In 1966, Reimert Ravenholt, a physician and epidemiologist, was appointed to lead the
emerging population program at the United States Agency for International Development
(USAID) (Donaldson, 1990). In 1969, Ravenholt responded to Kingsley Davis’ Science
article by writing a letter to the same journal, summarizing (perhaps for the first time) what
he hoped would be the impact of offering women an unfettered opportunity to decide about
childbearing.
“Bearing and rearing children is hard work, and few women have unlimited enthusiasm for
the task. . . It seems reasonable to believe that when millions of women throughout the
world need only reproduce when they choose, then the many intense family and social
problems generated by unplanned, unwanted and poorly cared for children will be greatly
ameliorated and the now acute problems of too rapid population will be reduced to
manageable proportions.” (Ravenholt, 1969)
Donaldson, currently the president of the Population Council, criticizes some of
Ravenholt’s actions but admits, “He focused attention on the problem of rapid population
growth and argued for controlling fertility in a way that more and more people have come
to believe is the most humane and sensible way” (Donaldson, 1990). Connelly (2008) who
frames every aspect of international family planning prior to 1994 as a plot by eugenicists
akin to Nazis, criticizes Ravenholt but actually ends up writing an eloquent exogenesis on
non-coercive family planning policies,
“Ravenholt's office was virtually alone in its policy of refusing support for programs to
create demand for contraception. He argued that supplying ‘unmet need’ would be enough
to solve the problem of population growth, or was at least worth trying before trying
anything else. Many of his superiors and subordinates disagreed, and pressed Ravenholt for
experiments with incentives.” (Connelly, 2008, p.245).
Ravenholt's goal of ensuring that “millions of women throughout the world need only
reproduce when they choose” placed decision-making unambiguously in the hands of
women, while Kingsley Davis (1967) did not trust that women would choose to have fewer
children: “By stressing the right of parents to have the number of children they want, it
evades the basic question of population policy, which is how to give societies the number
of children they need. It was this type of thinking which invited exploration of “beyond
family planning” measures (Berelson, 1969). . Ravenholt’s (1969) little known letter and
Berelson’s (1969) landmark paper “Beyond Family Planning” were both published in
Science one month apart. Ravenholt defines ‘comprehensive family planning’ as raising
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the marriage age, repealing pronatalist laws, access safe abortion and distributing
contraceptives. His goal is to ensure “that women everywhere need reproduce only when
they choose,” and he asks ”where in the world is there a country wherein people truly have
the freedom to control their fertility and where there is a continuing large excess use of
their reproductive powers?”
Probably Berelson had read the letter, although it may have been too late to change his
own text – even if he had accepted the power of the Ravenholt model to make his own
arguments moot. Berelson sees rapid population growth as problem retarding social and
economic development, but argues that “There is no easy way to achieve population
control.” (page 539) Berelson does not recommend any particular strategy, but he wanted
to jolt his readers into accepting the seriousness of the demographic situation and make
sure no strategy is taken off the table just because it might be difficult to implement –
including the ‘establishment of involuntary fertility control” (page 540). The underlying
assumption in ‘Beyond Family Planning’ is that some sort of measurer beyond individual
choice may be needed, although he begins where Ravenholt ended, “What is needed is the
energetic and full implementation of present experience. Much more could be done on the
informational side, on encouraging the commercial distribution of contraceptives, on the
use of paramedical personnel, on logistics and supply….” (Page 539). Like Notstein,
Berelson is more than half way towards giving the greatest weight to the proximal factors,
but relegates the key statement to a footnote. Citing Ansley Cole (1965) he writes,
“Actually, recent research is calling into question some of the received wisdom on the
prior need of such broad institutional factors [education and industrialization] for fertility
decline.”
In the late 1960s and early 1970s, those who emphasized the role of proximal factors saw
the danger that coercion might emerge when too much emphasis was put on distal factors.
One of us (MP) wrote in the Tenth Darwin Lecture in 1970,
“Some writers are asking ‘What is beyond family planning?’ They are talking about
incentives where previously they spoke of motivation. Reports of transistor radios are
becoming tales of compulsory sterilization or hormones in the drinking water. I think this
trend is dangerous and unnecessary. The ideal of voluntary parenthood is an exceptionally
important freedom to preserve. I fear it is threatened with erosion because we are failing to
make a free choice of contraceptive methods available…” (Potts, 1970)
Coercion imposed
Indian Prime Minister Indira Gandhi was a savvy politician and certainly she did not
impose coercive family planning in order to lose the next election – not only did this
happen in the backlash against her coercive family planning policies, but for the first time
since Independence 30 years earlier, the Congress Party lost control of parliament. Deng
Xiao-ping, a chief architect to the Chinese one-child policy commented, “although it is a
difficult task, we must accomplish it.” (Huajiao Ribo, 1980). Peruvian President Alberto
Fujimori was the only head of state who travelled to the 1995 UN World Conference on
Women in Beijing to defend reproductive rights, yet his government went on to implement
coercive sterilizations (Alvarado and Echegaray, 2009). What is behind these seeming
8
contradictions? The evidence seems to be, at least initially, that the coercive family
planning policies being put in place were seen by the leaders as genuinely necessary if
their citizens where to prosper.
India. In the 1960s and 70s there were numerous intellectual links between those working
in family planning in India and in the west. Gandhi was an Oxford graduate. Lady Rama
Rau from India was president of the International Planned Parenthood Federation in
London. The 1971 reform of the Indian abortion law was based on the 1967 English
reform. Indian fellows were trained at the Population Council, New York. Most people
had been taught that socio-economic development was a prerequisite for fertility to
decline.
Connelly, a critic of all aspects of international family planning between the 1950s and
1994, implies that Kingsley Davis (1975) gave explicit support to Indira Gandhi’s coercive
program, (Connelly, 2008), although he does not provide any direct evidence of contact
between the two beyond a paper Davis wrote in the first issue of Population and
Development Review (Davis, 1975). It is, however, a paper that captures the intellectual
turmoil in which good and liberal thinkers found themselves when they tried to follow
their emphasis on distal factors driving the demographic transition. In order to control the
massive rate of urbanization that rapid population growth was producing in Asia, Davis
(1975) saw no alternative to, “… a totalitarian government, highly competent and
rigorously committed, ruling a docile mass of semi-educated but thoroughly indoctrinated
urbanites…” In the face of coercive family planning, urban India did not prove “docile”,
and the government was far from “competent.”
The “great project of social engineering” Notestein had foreseen took on an especially
paternalistic slant in India where most decision-makers were upper caste, while many of
the poor with large families were lower caste. The elite reluctance to trust the decisionmaking of the poor, or to empower them to help themselves, was further aggravated by the
over-medicalization of the family planning delivery systems that Indian and American
advisors were setting up. In the 1950s, Lady Rama Rau resisted task shifting in family
planning delivery, fitting diaphragms required a vaginal examination by a gynecologist
(Gamble papers, 2010), and in the 1970s she resisted community level distribution of oral
contraceptives. (In a corridor discussion at an IPPF meeting, when Ravenholt contrasted
the few deaths from oral contraceptives with the many in India from childbirth, she
retorted angrily, “But, Dr. Ravenholt, those are natural deaths.”) As these various forces
came together in India, family planning turned into something that was done to people for
the benefit of the country, rather than something offered to people to benefit individuals.
Coercive polices became explicit and began to be implemented on a large scale during the
‘Emergency’ declared by Prime Minister Indira Gandhi in June 1975, beginning almost
two years of rule by degree. But politicians, especially experienced and ruthless ones like
Indira Gandhi, do not take deliberate steps which they knew might cause public hostility.
In fact, Indira and her influential son Sanjay (who exerted great influence) wanted to use
the opening they saw in Emergency rule to rid India of several factors which they judged
contributed to poverty and misery among India’s poor. She imposed a moratorium on
9
repaying debts to rural money lenders, who exploited poor farmers by lending money at
usurious rates. Dowries, which are a powerful reason why girls are so disadvantaged in
rural areas and which in the subcontinent can lead to domestic violence, (Dalal et al., 2009)
were formally abolished. Efforts were made to enlarge adult literacy programs, and 1.7
million acres of land were redistributed to the poor (Connelly, 2008). All these ideas, if
they had been implemented successfully, would have been a triumph of humanitarian
government.
It was obvious that even with fewer money lenders, no dowries and better literacy, it would
still be decades, if ever, before India’s poor would begin to get noticeably richer. Given
their frame of reference, the Indian leaders and their Western advisers were trapped. They
did what theory predicted as necessary, contriving a variety of incentives to accelerate the
adoption of modern family planning in a situation where it was self evident that social and
economic progress was not going to get ahead of rapid population growth. And in a poor
country with corruption at many levels together with authoritarian control at the top,
‘incentives’ became increasingly coercive and ugly. Men and women were sterilized
against their will.
[FIGURE 1 NEAR HERE]
Eight million people were sterilized in 1976, compared with 4 million before the
‘Emergency.’ Without denying or diminishing the evil of coercion, it is important to
recognize that some part of this increase was meeting an existing unmet need (Soonawala,
1993). The International Planned Parenthood Federation (IPPF) had always strongly
emphasized voluntary family planning. At the 1967 IPPF conference in Santiago, Chile,
Lord Caradon gave the keynote speech stating, “The need for individual and voluntary
leadership is not less but greater than ever, for this cause [international family planning] is
not imposing anything on the people: it is a matter of setting people free – free from the
prison of ignorance and poverty, and free to choose’ (Suitters, 1973, page 364). At the
same time, IPPF, like some other western agencies, frustrated by the earlier inability of the
Indian government to meet the unmet need for family planning, failed to criticize the
Indian government quickly enough as reports of genuine coercion arose.
China. In some ways the intellectual situation in China was the mirror image of that in
India. It was cut off from Western based technical advice on both methods of fertility
regulation and their delivery, and the Chinese leadership adopted a pragmatic and in the
end highly innovative approach to new methods. Vacuum aspiration abortion, as now used
all over the world, was invented in Shanghai (Wu and Wu, 1958) and they developed ‘noscalpel vasectomy’, ‘paper pills’, and visiting pills.’ IUDs were used widely. Despite their
intellectual isolation, an exclusive emphasis on socio-economic improvement as the driver
of fertility decline also crept into this ideologically driven society. In 1958, Mao himself
declared, “When [people’s] level of education increases, [they] will practice birth control”
(White, 1994). Policy-wise, the Chinese Communist Party planned the economy and it fell
easily into strategies to plan births (Chen, 1979), not dissimilar to those it had for rice or
steel output. Indeed, while taking a neutral stance on government efforts to slow
10
population growth, Mao left no room for private decision making, telling the Supreme
State Council in 1957,
“[We] need planned births. I think humanity is most inept at managing itself. It has plans
for industrial production. . . [but] it does not have plans for the production of humans. This
is anarchism, no government, or organization, no rules. If [we] go this way, I think
humanity will prematurely fall into strife and hasten toward destruction.” (Mao, 1989)
After Mao’s death in 1976, Deng Xiao-ping led the economic reform which was to drive
China’s astonishing economic growth. In 1978 he revived the scientific tradition Mao had
tried to strangle. Addressing the first National Science and Technology Conference, Deng
declared, “science and technology is a productive force.” The Chinese leaders were
critically aware of the growing number of fertile age women and the problem of population
momentum, but they had no data on such items as unmet need. At the Fifth National
Peoples’ Congress, Chairman Hua Guo-feng called for a "crash program over the coming
20 to 30 years calling on each couple ... to have a single child, so that the rate of population
growth can be brought under control” (Chen, 1981). As noted above, Deng Xiao-ping
knew imposing the one child policy would be extremely difficult, but he felt that “we must
accomplish it. Otherwise, we will not be able to develop our economy, and raise the living
standards of our people” (Huajiao Ribo, 1980).
The government revised the Constitution (Article 53) to read, “The state advocates and
encourages birth-planning” (Chen, 1975). The TFR fell from 5.5 in 1953 to 2.3 in 1978,
which despite the interruptions of the Cultural Revolution, to a considerable extent
depended on widespread access to several contraceptive methods, primarily IUDs,
sterilization and safe abortion. At the same time, it is necessary to remember that during
this era Chinese society was regimented rather in the way North Korea is today:
everything, including childbearing, was targeted and overseen by the commune.
FIGURE 2 NEAR HERE
Susan Greenhalgh (2003) posits that “all the key ideas on which China’s one-child policy
were borrowed from the West, and from Western science at that.” It is possible that the
Chinese leadership had seen Ravenholt’s 1969 Science article because Ravenholt’s brother,
Albert Ravenholt, had been a war correspondent in China. He knew Chou En-lai quite well
and had spent time in Mao’s company. If they did read it, they either did not grasp the
implications or they choose the majority path and pressed forward with the one child
family. Greenhalgh suggests that Song Jian, a missile engineer, who also had the freedom
to travel to Europe, was greatly influenced by the 1972 Club of Rome Report, The Limits
of Growth (Meadows et al., 1972). Greenhalgh suggests that an uncritical worship of
‘science’ allowed Song and his colleagues to pose the threat of demographic growth in
such exaggerated terms that they invited a draconian solution. A more pragmatic
interpretation is that the key policies on the one child family were made during the
dizzying time when scientists were trying to recover from the years when Mao had labeled
scientists “feudal” and “bourgeois” and banished them to raise pigs in village communes.
The Song group of missile engineers were one of the few in China in the 1970s with access
11
to a powerful computer, and therefore also able to make reasonably accurate population
projections. Song and his colleagues demonstrated, largely correctly, that relatively small
changes in family size of the order of an average of half a child would alter the population
of China later in the century by a billion.
The Limits of Growth places an explicit and unambiguous emphasis on the role distal
factors in the demographic transition, where couples make a rational choice about the
‘value’ of each child. It cited economic justifications for these assertions (Spengler, 1966),
adopting a strict model of the demographic transition driven solely by economic growth.
“The relation between crude birth rate and GNP per capita of all nations in the world
follows a surprisingly regular pattern. In general, as GNP rises, the birth rate falls. This
appears to be true despite difference in religious, cultural or political factors.” (Spengler,
1966)
In a less revolutionary environment and with more data, China might have developed a less
extreme policy, but in the historical context of the time and the uncontested belief that “as
GNP rises, the birth rate falls,” then the one-child-family became perhaps the most radical
social policy development of the twentieth century. It was motivated by a sincere if
mistaken belief that, difficult as it would be to implement, the one-child policy was
essential for adequately reducing the TFR, in order to lift the people out of poverty. As in
India, China’s coercive policies were politically costly, although the Communist Party had
the good sense to set a nationwide example by imposing the one-child policy with special
vigor on party members. The implementation of the policy varied between provinces.
Usually, couples accepted the benefits of a one-child certificate which made better food
rations available and opened the door to improved education for their child, but people
balked at repaying these benefits when a second child was conceived and they found
themselves driven to have an abortion. Interestingly, the one-child policy did not apply to
the tens of millions of non-Han Chinese minorities. Whether this was a genuine respect for
minorities or a realization that the policy could not be enforced, or a mixture of both, may
never be known.
Peru. Of the three heads of state whose administration were involved in coercive family
planning, President Alberto Fujimori was the one who had begun as the most vocal about
women’s rights. Born of Japanese parents, he was brought up Roman Catholic. As noted
earlier, the nation faced a well documented challenge. Among the indigenous peoples
making up most of the rural population, eight out of 10 lived in extreme poverty and 77%
were illiterate – and those who could read and write were nearly all men (Alvarado &
Echegarry, 2010). In 1985 a National Law on Population made family planning available,
but a combination of Catholic hostility and medical conservatism, which focused on clinics
rather than empowering communities to help themselves, meant that family planning
choices did not reach the rural poor, The Church resisted all efforts to make voluntary
sterilization or safe abortion available. (Boesteb, 2007).
Like Gandhi in India, initially Fujimori showed every sign of genuinely wanting to help
the poor. Like Gandhi he was also impatient with an elected, but in the eyes of many,
12
incompetent congress. While Gandhi had ruled by Emergency Decree, Fujimori and the
military engineered an autogolpe or ‘auto-coup.’ Gaining absolute power, he introduced
legal reforms to help the poor. His economic policies included privatizing state enterprises,
which in the short term raised food, water and energy prices, but in the longer term Peru
became one of the most successful economies in Latin America. Economic progress and
reform policies helped remove the grievances of the disenfranchised and impoverished
people in the Andean highlands which had fed the Shining Path. At the same time,
Fujimori, having sought and finally given himself absolute power, now succumbed to
underscoring Lord Acton’s famous aphorism that “Power tends to corrupt, and absolute
power corrupts absolutely.”
FIGURE 3 NEAR HERE
A free election was held in 1995 and Fujimori won a landslide victory. Instead of building
on this support he became increasingly tyrannical and corrupt. Like Gandhi and Deng
Xiao-ping he declared, “The government cannot reduce poverty efficiently if poor families
continue to have on average seven children” (Aramburú, 2002). A Program Manager in the
Ministry of Health seems to have been expressing Fujimori’s personal views. “The fertility
rate among poor women is 6.9 – they are poor and they are producing more poor people.
The president is aware that the government cannot fight poverty without reducing poor
people's fertility.” (Getgen, 2009)
Genuine improvements in family planning were put in place and attracted initial support
from women’s rights groups in the country (Alvarado & Echegarry, 2010). Outside donors,
including USAID, supported the family planning work. The 1995 Programa Nacional de
Poblacion guaranteed reproductive rights. For the first time voluntary sterilization was
made legal. Legislation “Outlawing Violence Against Women” was passed. Efforts were
set in motion to improve education, although the Catholic Church continued to forbid sex
education in schools. According to Rousseau (2006), the Fujimori regime, despite its
shortcomings, was “positively related to women’s increased opportunities,” and she
suggests that an authoritarian leader may have advanced women’s status more rapidly than
normal democratic processes might have done (Rousseau, 2006). As the only head of state
at the 1995 Beijing Women’s Conference, Fujimori spoke of the suffering of women in
rural areas,
“ . . . a woman carrying a baby wrapped in a blanket on her back, surrounded by an
additional three or four more children. And even more unbelievably, she often carries one
more human being in her womb. Many of these women are single mothers or estranged
from their spouses, or the sole support of their families. These women have a daily double
work load: managing the household and working outside as well.” (United Nations, 1995)
Fujimori considered legalizing abortion but realized Catholic opposition would be
overwhelming. For a while the family planning budget exceeded that of other health
programs (Alvarado & Echegarry, 2010). At Beijing he outlined his government’s family
planning initiative in the following terms,
13
“ . . . my government has decided to carry out, as part of a policy of social development
and the fight against poverty, an integral strategy of family planning that confronts, openly
- for the first time in the history of our country - the serious lack of information and
services available on this matter. Thus, women can have at their disposal with full
autonomy and freedom, the tools necessary to make decisions about their own lives.”
He was explicit – and by any standard justified – in the need to confront the long history of
Catholic opposition to family planning in Peru, saying,
“The Church is trying to prevent the Peruvian State from carrying out a modern and
rational policy of family planning. We have been accused of trying to impose "mutilations"
and "killing poor people" after a recent law was passed by Congress allowing voluntary
vasectomies and Fallopian tube ligation as part of contraceptive methods.” (United
Nations 1995)
Fujimori framed family planning in human rights terms but he failed to prevent the
military from launching a coercive family planning strategy aimed at the Peruvian
indigenous population. The 1989 Plan for a Government of National Reconstruction (Plan
Verde) mandated sterilization of “surplus beings [through a] generalized sterilization use
among those culturally backward and impoverished groups.” (Getgen, 2009). As the
coercive practices became more visible so the media and professional groups began to seek
restraints. The Ombudsman recommended reform in 1998, the targets were dropped in the
same year and a waiting period before operation was imposed (Getgen, 2009). In 2009
Fujimori was sentenced to 25 years in prison on charges of corruption and a range of
human rights atrocities, including kidnapping and assassination. The prosecution used a
series of messages from the US embassy in Lima. One from 1993, before his Beijing
speech, observed,
“An undisclosed source describes the close and complicated relationship between President
Fujimori and his top intelligence aide, Vladimiro Montesinos. The source notes that while
Fujimori understands the importance of human rights, in practice he “is prepared to
sacrifice principles to achieve a quick victory over terrorism.” (U.S. Embassy Cable,
1993)
The Shining Path (Sendero Luminoso) was a Maoist organization that began adopting
increasingly violent tactics in the 1980s, strangling and stoning those who opposed it (US
Department of State, 1996). The group gained control of large indigenous populations in
the Andean highlands. Civil wars are sometimes even more brutal than other conflicts and
the Peruvian military and police resorted to equally barbarous killings and rapes. The 2003
Final Report of the Truth and Reconciliation Commission, set up after Fujimori’s
downfall, concluded almost 70,000 people had been killed or disappeared in the conflict,
about half as a result of the Shining Path and one third as a result of actions by government
forces and the rest slain by various guerilla groups (La Comisión de la Verdad y
Reconciliación, 2003; Human Rights Watch, 2003)
14
As the civil conflict proceeded, the military, who had supported the autogolpe, adopted
increasingly harsh, coercive family planning policy towards the indigenous population. As
in India, so also in Peru, a policy which had been portrayed as a justifiable and humane
emphasis on family planning rapidly degenerated into the cruelest of coercion. While
Fujimori had put family planning in place to help lift people out of poverty, the motivation
of those involved was probably much more hatred of a poverty stricken indigenous
population with a different language than any strategy derived from an esoteric
demographic theory. Targets were set for sterilizations. Incentives to family planning
workers increased substantially. Between 1996 and 2000, surgeons carried out 215,227
sterilizations on women and 16,570 male vasectomies. Given the lack of family planning
choices before 1990, it is likely that many of these operations were wanted, but that does
not excuse those that were coercive. At least 500 men and women from Cuzco and Ancash
told a special commission they had been forcible sterilized (Gamini, 2002).
Rather than seeing coercive family planning in Peru as a strange inexplicable episode in
the history of family planning, it is probably more accurately understood as yet another
example in the history of warfare and conflict of the terrible human ability to dehumanize
an out-group. (Potts and Hayden, 2009) The Shining Path had massacred peasants,
including children aged between four and fifteen (Amnesty International, 1996), and the
security forces razed villages and killed campesinos. The fact that government officials
made it “obligatory for all providers, obstetricians as well as other doctors, to get patient to
undergo [tubal] ligation” (Alvaraod and Echegaray, 2010, page 295) is perhaps best seen
as yet one more human rights abuse in a painful conflict. During the Vietnam conflict,
Nixon/Kissinger decisions led to dropping 539,129 tons of bombs on Cambodia (during
World War II 160,000 tons were dropped on Japan). (Shawcross, 1979 page 297). The
Bush/Cheney decision to invade Iraq also demonstrates that Fujimori was not the only
democratically elected president to “sacrifice principles to achieve a quick victory over
terrorism.”
Coercion avoided?
It is reasonable to ask if, given the technologies then available, could India, China or Peru
have achieved their demographic goals through voluntary means?
To have achieved a rapid decline in fertility in the populous states of northern India would
have required a more flexible and energetic civil administration than existed. The
government would have had to ensure the large scale availability of reversible methods,
including injectables. It would have required the delegation of family planning tasks to
members of the local community, such as auxiliary nurse midwives or carefully selected
and appropriately trained rural health practitioners (RHPs). RHPs are trusted by the
community and available in the poorest communities, where western trained ‘MB, BS'
doctors are usually absent. Unfortunately, the Indian Medical Association denigrates
traditional practitioners and resists the delegation of tasks to community workers. Western
commentators criticized the flamboyant but successful voluntary sterilization programs of
the 1950s and 1960s, which sometimes had a festival-like atmosphere, and they failed to
understand that for many women (and men) voluntary sterilization was a sensible choice,
not unduly different from the popularity of the same method in the US11.
15
In China the greater part of the demographic transition was complete before the one child
policy was established. We will never know if they could have gone the rest of the way by
continuing with a broad access to contraception and abortion combined with promotion
from the central government and at the commune level. Chinese authorities claim that the
one-child policy prevented 250 to 300 million births (Hesketh et al., 2010) A National
Family Planning and Reproductive Health Survey conducted in China in xxx showed that
35 percent of the xxx women questioned wanted one child and 57 percent would have
preferred to have two children. Among urban educated women in wealthy Jiangsu
province, 75 percent wanted only one child whether a boy or a girl. Even in Tibet where
the one-child policy is not applied, 65 percent of women wanted only one or two children
(Hesketh et al., 2010). Probably without the one child policy China’s population would be
somewhat larger today, but if a realistic voluntary family planning program had been
started a decade or so earlier like the South Korea or Taiwan then China might be below
replacement level today but without coercion.
What is clear is that China’s one-child policy was unique and it will never be repeated. In
a review of the Chinese one-child policy, Adair Turner (Chairman of the British Financial
Services Authority) concludes that there are “very good reasons for objecting to the
enforced nature of the Chinese one-child policy,” but also notes, “If China had another 400
million young people, it would undoubtedly have more of the shanty towns, and urban
crime and unemployed young men, we see, for instance, in Brazil or South Africa”
(Turner, 2009, page 2982).
In Peru the 1981 census revealed rapid population growth (2.4% per annum) combined
with the fact that 62% of women, “especially in areas with the highest fertility rates, did
not want any more children.” Boesteb (2007) suggests a humane voluntary programme,
including surgical sterilization, would have brought down family size in Peru without any
trace of coercion. What is clear is that the coercive Fujimori policies set back family
planning in the country and in the US. Conservative groups in Peru used the tragedy of
their country’s coercion to try and restrict access to voluntary family planning, and the
choice of voluntary surgical contraception was almost abolished. The US-based Population
Research Institute and Human Life International used the Peruvian calamity to criticize
USAID and harass organizations working in reproductive rights. A US government
investigation that was put in place by Congressman Chris Smith after conversations with
the ultraconservative Peruvian physician Dr. Hector Chavez Chuchon {accents on first ‘e’
and last ‘o } found no evidence that USIAD had financed any of the coercive abuses
(Cavez and Coe, 2007),
As figures 1 to 3 demonstrate, the coercive episode in India and Peru were brief and had no
impact on the demographic trajectories of these two countries, and in China, much of the
demographic transition was over before the one-child policy was introduced. Nevertheless,
these coercive episodes continue to cast a long dark shadow over international family
planning. Unlike policy making in, say, agricultural development or efforts to reduce infant
mortality, family planning is mired in religious (Donaldson 1988, Wills 2001), social
(Potts and Campbell 2008) , academic and political disputes (Campbell, 1998, Campbell et
16
al., 2007). Religious opposition to so-called “artificial contraception” has been widespread.
Although 80 per cent of American support “US sponsoring voluntary family planning
programs in developing countries” (Adamson et al, 2000), the history of past coercion
weakens support for donor funding. The history of coercion is used to strengthen those
patriarchal groups opposed to family planning per se, and it deters potential allies, such as
environmental groups, from joining an informed dialogue on the role of voluntary family
planning and the population growth factor in development.
The paradox of the 1994 ICPD
The International Conference on Population and Development (ICPD), held in Cairo in
1994, occurred at a time when there seemed to be grounds for optimism: the success of the
focused family planning programs of the 1970s and 80s had created a false assurance that
birthrates would continue to fall; the growth in the food supply had largely kept pace with
the growth in population; the global economy was expanding; and the Cold War had just
ended. The somber forecasts of a world running out of finite resources made in The Limits
of Growth in 1972 (Meadows et al., 1972) seemed unduly pessimistic, and economists had
backed away from asking the sort of questions Noble laureate James Meade (1967) had
explored in the 1960s, whether countries can get out of poverty in the face of high birth
rates.
Nearly all the preparatory meetings leading up to the ICPD were strongly influenced by
women’s groups, who sought to shift attention from population growth to the many other
needs of poor women around the world, including reproductive health, economic
opportunity, property ownership and a reduction in violence (Singh, 2009). At their most
extreme, some women’s groups created what has been called “a myth” (Sinding, 2001) that
everything before Cairo had been a coercive, target-driven effort to control population.
While it was assumed the reproductive health would include family planning, the terms
population and family planning were framed as politically incorrect (Campbell and
Bedford, 2009). Some groups lobbying for the many genuine needs of women worked to
transfer the family planning budgets into more broadly defined goals of reproductive
health. Joan Dunlop described the tactics of women’s groups in the following words,
“What we wanted to do was, rather, simply throw the baby out with the bathwater; we
wanted to redirect the money. We knew there were huge streams of money going into
contraceptive development, and we wanted that money to go in a different direction.”
(Goldberg, 2009)
Dunlop’s assertion “of huge streams of money going into contraceptive development” is
incorrect. Contraceptive development was a small part of foreign aid family planning
budgets, and these budgets rarely amounted to more than one percent of the all the money
flowing from developed to developed countries. In order to achieve the many goals of the
ICPD Programme of Action it would have taken a much larger percentage of foreign aid.
There is no doubt it would have been money well spent, but not having a sense of scale and
trying to “redirect’ the family planning money (which had been better spent than many
other foreign aid programs) merely ended up undermining family planning budgets. The
broad goals set out in the Programme of Action failed to gain political traction among
17
donors, and budgets collapsed. (Spiedel, 2009). While the fertility decline, which had
begun over the preceding decades in countries such as Bangladesh or Kenya, stalled
(Bongaarts, 2008; Ezeh et al, 2009), many token projects were started with the aim of
implementing the broader goal of improving sexual and reproductive health Dunlop and
others wanted. Most were not brought to scale, and in fact many were not scalable.
A year after Cairo, Dirk van de Kaa of the Netherlands commented,
“… the [ICPD conference was ready to deal with everything as long as it did not
relate directly to the mundane issue of population growth and the need to generate
the financial resources necessary to enable people everywhere to plan their families
responsibly.” (Kaa, 1996)
Kaa was right to suggest the eclipse of population concerns might undermine funding. The
policy of making contraception available as part of voluntary family planning in the 1970s
and 80s had been associated with a modest but moderately consistent funding stream from
the U.S., and from the Protestant donor countries of northern Europe. The 1970s and 80s
had seen a marked increase in contraceptive prevalence and a fall in the global total
fertility rate (Cleland et al., 2006). After 1994 there was a precipitous switch from action
to improve family planning to a broader, more holistic approach, aimed at improving the
health and social status of women. It was an ideal that sometimes undermined the
achievable. As a recent World Bank report (2010) pointed out,
“. . . the comprehensive approach to reproductive health, adopted at the 1994 Cairo
Conference, was doubtless too large for many countries in sub-Saharan Africa . . . the
adoption of a comprehensive approach could be considered as a luxury . . . the adoption of
a comprehensive approach to reproductive health pushed family planning . . . to the side.”
The tension between those emphasizing the power of access to family planning and those
who maintain that offering family planning choices, while important is insufficient to
lower family size, continues until today. In 2008 The Bulletin of the Atomic Scientists
sponsored a round table on “Population and Climate Change.” Joseph Chamie, who was
until recently Director of the UN Population Division, emphasized the need for
socioeconomic change, rejecting a primary role for family planning with the statement,
“But reducing national population growth rates involves more than simply reducing
unintended fertility” (Bulletin of the Atomic Scientists, 2008). In a carefully worded
argument Chamie confronted exactly and explicitly the issue that Kingsley Davis had faced
30 years previously, implying that coercion may be needed to slow rapid population
growth in some settings. In Chamie’s words,
“While many may believe that the rights of the individual reign supreme, there are limits
when greater societal well-being is under threat. In the coming years, we'll need policies
and programs to ensure that individual behavior is compatible with sustainable living
standards for the broader world community... For some nations, voluntary behavioral
changes may be sufficient to alter demographic trends and unsustainable, environmentally
damaging practices. However, as Kingsley Davis and then Garrett Hardin forcefully
argued in Science in 1967 and 1968, respectively, voluntary programs to modify individual
18
behavior tend to fall short of intended goals. In such cases, legislation, programs, and
incentives that encourage responsible parenting and sustainable resource use must be
mandated in order to achieve population stabilization and reduce greenhouse gas
emissions.” (Bulletin of the Atomic Scientists, 2009)
Predictably, Chamie’s arguments produced a vigorous and critical response from Betsy
Hartmann of Hampshire College in Amherst, Massachusetts. Paradoxically she also built
on an emphasis on socioeconomic change,
“…with increasing education, urbanization, and women’s work outside the home,
birthrates have fallen in almost every part of the world and will likely continue to do so,
particularly as urbanization accelerates.” (Bulletin of the Atomic Scientists, 2008)
Chamie is a humane person and Hartmann is one of the most eloquent opponents of
coercion, but both have ended up entering the same intellectual trap that fertility decline
can be driven only by socioeconomic improvement. Chamie sees that socioeconomic
improvement cannot get ahead of rapid population growth and advocates mandating
“legislation, programs, and incentives that encourage responsible parenting.” Hartman
simply avoids the issue of scale. Neither recognizes that when women are given options
about their childbearing, then even in a society as conservative, poor and illiterate as
Bangladesh, millions of people can reach replacement level fertility. (Today, in
Bangladesh women aged 15 to 24 want an average of 2.1 children.) (NIPORT, 2007)
Conclusions
The greatest tragedy in the history of international family planning was when some leaders
who wanted to lift people out of poverty ended by closing the door on reproductive
freedom. They did not understand that family planning is listening to what people want,
not telling people what to do.
In India and Peru (Figures 1 and 3) the coercive episodes of family planning were brief and
targeted at vulnerable, low income groups. They had no impact whatsoever on fertility
decline in these two nations. In China (Figure 3) the one-child policy was implemented
when the country was over 85% of the way to replacement level fertility. The pace at
which it might have completed the demographic transition without the one-child policy
will never be known. The political fallout for Gandhi and Fujimori was catastrophic; for
the Chinese leadership internally the one-child policy, as Deng had put it, presented “a
difficult task”, (Huajiao Ribo, 1980) and it has been extremely harmful for the image of the
country in the eyes of the rest of the world. But these architects of coercive family
planning did not start out as evil people, for some arbitrary reason, intent on abusing the
poor. They were all highly intelligent, with a sense of scale and capable of seeing the big
picture. They all inherited demographically threatening situations, with high TFRs and
considerable demographic momentum. In China these problems had been created as the
result of Maoist ideology; in Peru it had been partly driven by Vatican hostility to family
planning; and in India it was the outcome of years of government incompetence and nonevidence based restrictions on family planning, especially in rural areas (Potts and Graff,
2008).
19
All three leaders had the goal of lifting the poor out of poverty. All three had the potential
for greatness. Had Indira Gandhi's efforts to improve the status of women, help poor
farmers and redistribute land not been undermined by coercive family planning, they
would have been hailed as a triumph of humane government. Fujimori had taken Peru
from bankruptcy to the most rapidly growing economy in the world and in the process he
had defeated a major terrorist movement. Deng, by opening up the free market, was
perhaps the chief architect of China’s remarkable economic growth, and for this reason one
of the most important decision makers of the twentieth century. He knew both the
harshness of communist life (his son became a paraplegic as the result of torture during
Mao’s Cultural Revolution). His economic policies helped lift 300 million people out of
abject poverty. The question in the minds of many is whether the one child policy was
needed to achieve this.
So what went wrong?
To quote Szreter (1993) again, “It appears as if the modern international field of study that
addresses large-scale change in fertility behavior is permanently wedded to the conceptual
scheme with which it started ... after World War II.” We suggest that all three national
leaders place excessive weight on the standard conceptual scheme that socio-economic
factors drive fertility decline, and that they gave no, or insufficient, weight to the role of
removing unjustified barriers to the availability of family planning.
We also need to ask, could the obscenity of coercion happen again, and what policies are
likely to might make such a catastrophe least likely to occur again?
If strong, impatient leaders, or powerful international agencies, really believe that
socioeconomic development is a prerequisite for fertility decline, then we may see future
episodes of coercion in family planning.
Poignantly, the most vocal proponents of human rights at the 1994 ICPD remain wedded to
the standard socioeconomic model. Hodgson and Watkins (1997) saw the ICPD having
adopted the paradigm,
“that fertility decline was a consequence of the developmental process and not a catalyst,
as the only way to insure its occurrence was by the indirect route of promoting
development. Such a vision of fertility decline as a necessary consequence, not a cause, of
large societal changes was to provide the frame that feminists would modify for later use at
the 1994 Cairo conference.” (Hodgson and Watkins, 1997)
At its most radical, this vision of reproductive rights even suggests that anyone (the authors
called them neo-Malthusians) “asserting the efficacy of birth control activities at the
societal” level or “lobbying for special funds for family planning” as “an infringement of
reproductive rights (Hodgson and Watkins, 1997). This is a dangerous, extreme philosophy
with unfortunate implications for women. First, in saying that “fertility decline was a
consequence of the developmental process”, the authors were adopting the framework that
20
led to coercive family planning policies in India, China and Peru. Second, it is this
ideology which contributed heavily to the diversion of most of the family planning funds
which has left millions of poor and vulnerable women worse off than they were before
Cairo. In sub-Saharan Africa the number of women living in absolute poverty has grown
and the disparities in TFR between the upper and lower economic quintiles has risen (All
Party Parliamentary Group on Population, 2007; Campbell et al., 2007), with somber
implications for the education and health of the poorest economic quintiles. These
disappointing results, in significant measure, are driven by continuing rapid population
growth.
The growing disparity in TFR between the rich and poor within countries inevitably
translates into sad inequities in education, employment and the life-long pursuit of
happiness. The inequity between rich and poor countries casts a somber shadow over the
coming decades. Ezeh concludes that as a result of the loss of focus on family planning and
stalled fertility decline in Kenya, the projected population in 2050 has been raised from 54
million before Cairo to over 80 million today (Ezeh et al., 2009). Confronted with these
projections, 40 experts from many disciplines and several countries concluded that “an
increase of this magnitude may lead to food scarcity and crumbling infrastructure, and,
potentially, to violent conflicts over scarce resources” (Potts et al., 2009). Taking the
emphasis off family planning inadvertently accelerated, rather than ameliorated, future
demographic growth and by doing so to some extent raises the possibility of future
coercive policies.
Gender equity, elimination of violence against women and facilitating the economic
empowerment of women are unfettered goods. The ICPD Programme of Action was
interpreted by many as taking the focus of family planning, but perhaps there are still
places where common ground can be found. For example, Hodgson and Watkins (1997)
pointed out that “...fertility decline is a necessary consequence of the empowerment of
women” (page 489). This is precisely the motive driving the assumption that once women
have the power to decide if and when to have a child they will exercise that power whether
or not they have benefited yet from improvements in socioeconomic status.
Poor and vulnerable women will benefit most if policy makers, women’s health advocates,
and those seeking to slow rapid population growth all accept that a major goal for the
“empowerment of women” has to be an unambiguous, explicit and enthusiastic
commitment to reducing the barriers to contraception and safe abortion in the context of
accurate information and totally voluntary choice. It is a simple, honorable, achievable
goal offering huge benefits to individual women, their families, the society in which they
live and the future of a unique, finite and fragile planet.
Notes
The authors thank Virginia Gidi for help in preparing the manuscript and especially for
assistance on documentation of events in Peru in the 1990s
21
FIGURES
(Diamond-Smith and Potts, 2010)
22
(Diamond-Smith and Potts, 2010)
23
24
25