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Lancet. 1999 Apr 10; 353(9160):1251.In Andhra Pradesh, India, women's groups have formed a Group Against Targeted Sterilization (GATS) to protest the creation of sterilization camps created by government officials in Hyderabad and Secunderabad, where 20,000 people, mostly women, were sterilized to meet a quota deadline. GATS charges that the women were offered incentives to undergo sterilization and that those who resisted were threatened with disconnection of their household utilities. GATS does not oppose family planning or female sterilization but opposes the dehumanizing use of incentives and threats. The impoverished women who are targeted for mass sterilization undergo the procedures in unhygienic settings. Many are anemic, which is a contraindication to any surgical procedure, and they receive no postoperative care. The targeted sterilizations were performed under the banner of the Indian Population Project (IPP), which is funded by the World Bank. GATS fears that the entire IPP will be diverted from the intention of its donor (the World Bank is committed to a target-free approach) and will become subservient to population control efforts.
Ann Arbor, Michigan, UMI Dissertation Services, 1995. , x, 124 p.The author of this doctoral dissertation states that population control refers to measures undertaken to reduce fertility, which, according to the "population establishment," is currently so high that it endangers planetary survival. A "crisis mentality" exists among advocates of population control, who thus support the use of coercive measures to contain the spectre of overpopulation. Coercion, manifested in the use of targets, incentives, and disincentives, is an inherent part of population control. It is used mainly against women in the Third World; the population establishment defines the "overpopulation problem" in terms of national, racial, class and gender boundaries. Moreover, as the experience of India demonstrates, coercion is ineffective in reducing fertility. Coercion is thus both unethical and ineffective, and must be abandoned. (author's)
PHNFLASH: ELECTRONIC NEWSLETTER ON POPULATION, HEALTH, AND NUTRITION. 1995 Oct 25; (93):1.Many contraceptive implant specialists provided an overview of current contraceptive implant technology and practice to the staff of the World Bank on July 18, 1995. The Director of the UNDP/UNFPA/World Health Organization/World Bank Special Program of Research, Development, and Research Training in Human Reproduction informed the audience about the history of implant technology. The chief investigator of many clinical trials of contraceptive implants in Chile discussed the mechanisms of action of implants and the benefits and disadvantages of the various types of implants that are available or under development. The only contraceptive implant on the market is Norplant, which more than 3 million women currently use. Most Norplant users live in Indonesia, followed by users in the US. Providers insert the 6 progestin-releasing rods in the upper arm, which provides protection from pregnancy for 5 years. Norplant acceptors may request removal of rods at any time. Many people are concerned that Norplant users may not have timely access to removal of the implants when they want them to be removed. Another concern is the potential for coercion since Norplant requires assistance of a medical provider to start and end use. Many women's groups in developing countries share these concerns and have protested against Norplant. As a result, developers of contraceptive implants and representatives of women's groups have met to discuss these concerns. More discussions will be needed to make sure that developers adequately address these concerns.
ANNUAL REVIEW OF POPULATION LAW. 1988; 15:42.In 1988, USAID decided for the fourth year in a row to withhold its contribution to the UN Population Fund (UNFPA). The contribution amounts $25 million. The stated reason for the withholding of funds was the same as in past years: the Agency's objection to UNFPA support for China. It viewed China's family planning program, which emphasized the importance of one child per family, as sanctioning coercive abortions. (full text)
VACCINE WEEKLY. 1995 May 29 - Jun 5; 9-10.A priest, president of Human Life International (HLI) based in Maryland, has asked Congress to investigate reports of women in some developing countries unknowingly receiving a tetanus vaccine laced with the anti-fertility drug human chorionic gonadotropin (hCG). If it is true, he wants Congress to publicly condemn the mass vaccinations and to cut off funding to UN agencies and other involved organizations. The natural hormone hCG is needed to maintain pregnancy. The hormone would produce antibodies against hCG to prevent pregnancy. In the fall of 1994, the Pro Life Committee of Mexico was suspicious of the protocols for the tetanus toxoid campaign because they excluded all males and children and called for multiple injections of the vaccine in only women of reproductive age. Yet, one injection provides protection for at least 10 years. The Committee had vials of the tetanus vaccine analyzed for hCG. It informed HLI about the tetanus toxoid vaccine. HLI then told its World Council members and HLI affiliates in more than 60 countries. Similar tetanus vaccines laced with hCG have been uncovered in the Philippines and in Nicaragua. In addition to the World Health Organization (WHO), other organizations involved in the development of an anti-fertility vaccine using hCG include the UN Population Fund, the UN Development Programme, the World Bank, the Population Council, the Rockefeller Foundation, the US National Institute of Child Health and Human Development, the All India Institute of Medical Sciences, and Uppsala, Helsinki, and Ohio State universities. The priest objects that, if indeed the purpose of the mass vaccinations is to prevent pregnancies, women are uninformed, unsuspecting, and unconsenting victims.
New York, New York, AVSC, 1993 Sep. 8 p.Neither the US Food and Drug Administration nor WHO have yet endorsed intrauterine insertion of quinacrine for tubal occlusion in women. Quinacrine is very inexpensive and easy to produce and insert, which make it open to abuse. Free and informed choice and safety must be upheld as well as quality of care in family planning services. The few studies of quinacrine use for nonsurgical sterilization have small sample sizes and very short-term follow-up. They have largely occurred in Chile, Egypt, and Indonesia. One study suggests that quinacrine increases the risk of cancer. Recently a field trial of 31,781 women undergoing nonsurgical sterilization with quinacrine pellets was conducted in Viet Nam. The pregnancy rate at 1 year was 2.63. At 2 years it was 4.31 for cases with 2 insertions. At 5 years, for women with just 1 insertion, it was 5.15. There were 19 ectopic pregnancies. Major complications included 2 cases of severe bleeding, 2 hysterectomies (severe pain and amenorrhea, adhesions in the cervical canal), 1 case of premenstrual pain and dysmenorrhea, 1 case of pelvic inflammatory disease, and 1 allergic reaction. Only minor side effects occurred. The study methodology was flawed, however. For example, the researchers did not bide by the inclusion criteria they claim to have used. They also extrapolated failure rates and side effects based on subsets to the whole group. Thus, this study cannot be used to conclude that quinacrine pellets are safe and effective. Further, well-designed studies addressing short and long-term safety are warranted. If studies find quinacrine pellets to be safe and effective, their low cost and ease of insertion make it a promising method in areas of high maternal mortality, with low access and availability of family planning services, and great unmet need for permanent methods.
PEOPLE'S PERSPECTIVES. 1994 Jan-Feb; (6-7):27-8.Massive distribution of the contraceptive implant Norplant is the focus of a UN Fund for Population Assistance-supported fertility control project in Indonesia. Although information on the project's activities is limited, there are concerns that Norplant is being used specifically to reduce the East Timor population. Depo-Provera was aggressively promoted in East Timor in a 1987 government campaign, and health care workers dispensing injections were reportedly accompanied by soldiers to enforce compliance. Occupied East Timor has the highest rates of infant and maternal mortality in Indonesia. At present, two-thirds of all Norplant implants produced worldwide are sent to Indonesia, and the national family planning program is phasing out more acceptable methods such as condoms and oral contraceptives that are under the user's control. Indonesia's birth control program has been criticized for its coercive aspects, lack of range of contraceptive options, and failure to provide women with accurate information about procedures performed as part of clinical trials.
TEMAS DE POBLACION. 1991 Jun; 1(2):51-5.This critique of the World Bank's role in developing country population programs begins with a description of a 1987 case in which an 80-year- old Bangladeshi man was persuaded to undergo vasectomy and then robbed of his incentive payment by the health agent. For over 20 years, the World Bank has pressured 3rd World governments to implement population control programs. Although there are divergent opinions within the World Bank, the most dominant is the neomalthusian view that the poor through their high fertility help perpetuate their own poverty. This view hides the real source of poverty in the Third World: the unequal distribution of resources within these countries and between the developed and developing countries. The World Bank has always been blind to the inequalities, and has associated with the elites of developing countries who monopolize the resources of their countries and thereby impede authentic development. Furthermore, the emphasis on population control distorts social policy and hinders the implementation of safe and voluntary family planning services. In many countries the World Bank has required governments to give greater priority to population control than to basic health services. It has pressured them to relax contraceptive prescription norms and has promoted the more effective methods without regard to proper use or side effects. In Bangladesh the World Bank has sponsored sterilization programs that rely on coercion and incentives. In that country of enormous inequities, 10% of landowners control over 50% of lands, while nearly half the population is landless and chronically underemployed. Political power is concentrated in the military government, which annually receives over 1.5 billion dollars in external aid. External aid primarily benefits the wealthy. 3/4 of the population are undernourished and less than 1/3 are literate or have access to basic health care. The poor of Bangladesh, as in many other countries, feel that their only source of security is to have many children, a significant proportion of whom will not survive. In rural Bangladesh, where chronic hunger and unemployment are rife, the incentives and the pressures of family planning and health workers were sufficient to persuade many persons to undergo sterilization. Payment of commissions to workers to promote sterilization has discouraged them from supplying adequate information about sterilization for fear of losing clients. Population from other donors and wide publicity about the abuses in the sterilization program and the high rates of regret among women undergoing sterilization only for the incentives have led to some modifications, but the World Bank has continued to exert pressure on the Bangladeshi government to develop fertility-control programs. The damaging effects of World Bank population programs can also be seen in Indonesia, Nepal, and other developing countries.
In: Population policy: contemporary issues, edited by Godfrey Roberts. New York, New York/London, England, Praeger, 1990. 21-37.On the basis of the orthodox assumption that population growth constitutes an obstacle to economic development, most countries have established programs aimed at reducing fertility through contraception. The methods used by family planning programs, ranging from voluntary acceptance through educational and informational campaigns to financial incentives or disincentives to outright forced sterilization, raise complex ethical issues. Specifically, there are 5 ethical principles--freedom, justice, welfare, truth-telling, and security/survival--that can be used to evaluate deliberate attempts to control human fertility. Such an approach suggests that forced abortion, compulsory sterilization, and all other forms of heavy pressure on clients to accept a given means of fertility control violate human freedom, justice, and welfare. The violations inherent in financial incentives are demonstrated by the fact that they are attractive only to the poor and disadvantaged sectors of the population. Family planning programs that offer incentives to field workers to meet acceptor quotas often lead to a disregard of client health and welfare by subtly encouraging workers to withhold information on medical side effects, outright deceive clients about methods that are not being promoted by the family planning program, and fail to take the time for adequate medical counseling and follow-up. Even programs that provide free choice to clients are illusory if the methods offered include controversial agents such as Depo-Provera and acceptors lack the capacity to make an informed choice about longterm effects. Recommended is the establishment of an international code of ethics for population programs drafted by a broad working group that does not have a vested interest in the code's terms.
ECONOMIC AND POLITICAL WEEKLY. 1987 Jul 11; 22(28):1099.India's family planning program has been restructured from a massive effort, using multimedia promotion and 2 million volunteers and designed to convey the "small family message" directly to the families concerned, to a smaller scale program emphasizing child survival, delayed marriage, village infrastructure, and birth spacing. The change is due to 2 factors: 1) The terminal approach failed to achieve lower birth rates because people will not accept the small family unless they can rely on the survival of the children; and 2) The terminal approach contained an element of coercion which caused the US to reduce support to the US Agency for International Development (USAID) and the UN Fund for Population Activities (UNFPA). The new scaled-down approach should be more effective, since more couples are now practicing family planning and birth spacing, oral contraceptives, IUDs, and longterm hormonal contraceptives are more appropriate than terminal methods to the present demographic picture.
California Western International Law Journal. 1978 Spring; 8(2):342-67.The legislative assembly of the Marharashtra State, India, passed in 1976 a bill for compulsory sterilization which would limit families to a governmentally determined size. Such imposed prescription conflicts with the principle, recognized in 1966 by the UN, of the human right to determine family size, space children, and, most important, to have an awareness of and access to the means necessary to facilitate that decision. This principle accepts the idea that merely providing contraception is an ineffective and deficient method to reduce population. Thus, in order to be permissible, any governmental limitation on individual freedom to determine family size can be imposed only subsequent to the actual and full availability of birth control information and methods. The Marharashtra Family Act requires that if a couple has 3 living children one of the parents be sterilized, unless the children are of the same sex. This Act, as written, exceeds the scope of permissible limitation to family size, since the Act fails to protect the individual's right prior to sterilization. Indeed, there is no provision in the Act to ensure that the government will inform the people of the available methods of family planning prior to the imposition of sterilization. The existing structure of the Act, which has not been implemented yet, must be completed with a scheme for compulsory family planning education and for the provision of birth control methods before compulsory sterilization can be enacted. Without such amendment the Marharashtra Family Act will not be compatible with the human right of family planning, and continued UN funding in support of its population program would no longer be justified. The article includes the full text of bill No. 25 of 1976 for restrictions on the size of certain families in Marharashtra.
New York, Population Council, 1979 Oct. 68 p. (Center for Policy Studies Working Papers No. 48)After outlining various problems posed by the growth or decline of population and the class of feasible means available to governments for dealing with them, the authors pose the question of whether important ethical issues are raised by interventionist policies actually in use today. These policy options are surveyed in detail and shown to fall into 3 categories of government intervention: 1) Limitations imposed on access to modern methods of fertility control. 2) Incentives and disincentives of various kinds. 3) Politically organized peer pressure. With regard to ethical issues raised by these policies, the authors invert the traditional procedure in the ethical literature of first providing an overarching ethical theory and then deducing consequences pertaining to particular issues -- in this case population controversies. Instead, they adopt a contextual and piecemeal approach to the ethical concerns which views ethics as a species of decision making, resting on agreed-upon premises and proceeding to substantive conclusions as to what sort of action should be taken in particular situations. Proceeding to examine the 3 sets of policies from this perspective, they find limitations on access and incentive programs ethically permissible provided certain safeguards and intuitive conditions are satisfied. The 2nd category -- politically organized peer pressure -- is found unethical except under stringent conditions and where other approaches have been tried first. In the final section of the paper, the authors clarify aspects of the ethical framework underlying their judgments on the policy and raise and discuss a number of subsidiary problems. (Author's)
Science. March 25, 1977; 195(4284):1300-1305.India's official advocacy of compulsory sterilization has caused dismay among those who think voluntary birth control services were never provided on a mass scale and that compulsory measures will cause resistance to family planning in general, but it has also brought relief to those who felt India's stand at the World Population Conference in 1972 was not nearly antinatalist enough. The new policy is in effect an admission that education and economic development will not bring about a drop in fertility soon enough. The timing of the policy shift can be explained by the state of emergency declared in June 1975. Prior to that, it would have been politically impossible for Mrs. Gandhi to make any strong statements in favor of birth control. Since the family planning program's inception in 1952 sterilization has been an important part, and incidence increased significantly every year until 1974 when budget cuts did not allow for program expansion. There are various possible explanations for the government's rethinking of its priorities but what was clear was that there was no clamor from the people to reinstate the services. The motivation to have small families seemed to be lacking, perhaps because it is connected to a certain socioeconomic threshhold which had not been reached by the populace when the focus shifted from sterilization to economic development as the best contraceptive. The 5 states that appear to have had a significant decline in fertility have also done well in economic development, while the family planning performance of the poorest states, Bihar and Uttar Pradesh, has been dismal. The problem of motivation is further complicated by a tradition and culture that require large families. The current population contains a huge growth potential for the future; all projections of the population show substantial increases. The Chinese example in family planning cannot be followed without fundamentally changing the structure of the entire economic and political system. Only the most economically prosperous states have the personnel and facilities to enforce a compulsory sterilization law. 1 of those, Maharashtra, is on the point of passing such a law. The experience of the state will be important for future consideration of compulsory sterilization nationwide.