BLOG: Is Consensus Possible on Birth Control?

May 27, 2010 • Family Planning, Daily Email Recap

Nicholas Kristof wrote a column pointing to high desired family size in countries he was visiting in Africa, which you can read here:

Below is his blog on this subject.

BLOG: Is Consensus Possible on Birth Control?
Date: Thursday, May 20, 2010
Source: The New York Times (U.S.)

My column today is about the need for birth control as a key to fighting poverty. In short: let’s make contraception as available as sex. Here are a few extra thoughts I didn’t have space to address.
First, all the numbers on a subject like this are dubious. The U.N. or research groups put out nice reports with figures for all kinds of things, and I sometimes worry that they imply a false precision. The truth is we have very little idea of some of these numbers. For example, the WHO studies have suggested that well over half a million women die each year from pregnancy complications, while a new Lancet study put the number at about 350,000. We don’t know which is right, because nobody really keeps track of women who die in poor parts of the world.

Or there’s a statistic that makes the rounds saying that one quarter of 15-19 year old women in the developing world outside China are married. The problem is that in so many countries, women (and men) have no idea how old they are, and have no birth certificates or I.D.’s.

Likewise, in my column today, I refer to the 215 million women around the world who have “an unmet need for contraception.” That means they want to delay pregnancy for two years or more, are married or sexually active, and are not using modern contraception. I use that figure because it’s the best there is, but in the real world many women are much more ambivalent. They kind of don’t want another pregnancy, unless maybe it’s a boy. Or you ask them if they want to get pregnant, and they reply: “Not really, but I leave it to God.” Or they say that in an ideal world, they’d prefer to wait, but their husband doesn’t want to wait so they want another pregnancy now. So many people answer in those ways, rather than in the neat, crisp “yes” or “no” that the statistics suggest. So all these figures need to be taken with a good deal of salt. We need these kinds of estimates – don’t get me wrong – but we shouldn’t pretend that they are more precise than they are.

Another issue: why did family planning lose steam in the last couple of decades? I think one factor was the coercion that discredited programs in India and China alike. Another was probably that enthusiasts oversold how easy it is to spread family planning. It’s not just a matter of handing out the Pill: it’s a question of comprehensive counselling, multiple choices, aftercare, girls’ education, and a million other things. Contraceptive usage rates can increase even in conservative societies (Iran has actually demonstrated that quite well), but it’s not just a matter of airlifting in pills, condoms and IUD’s.

Perhaps the more important problem, though, is that family planning got caught up in the culture wars. Originally, many Republicans were big backers of family planning programs, and both Richard Nixon and George H.W. Bush supported such efforts. Bush was nicknamed “Rubbers” because of his enthusiasm. But then in the 1980’s, UNFPA, the UN Population agency, was targeted by conservatives because of China’s abortion policies. This was deeply unfair, for UNFPA was trying to get China to stop the coercion. In addition, UNFPA had nudged China to replace the standard Chinese steel ring IUD with a copper T that was far more effective. The result is 500,000 fewer abortions in China every year. Show me any anti-abortion group with that good a record in reducing abortions! But the upshot is that one Republican president after another defunded UNFPA. Indeed, in the last Bush administration, officials didn’t even want to use the term “reproductive health.”

My hope – and maybe it’s unrealistic – is that we can rebuild a consensus behind voluntary family planning, including condoms as one element of a package to fight AIDS. The Vatican clearly won’t join, but many conservatives do recognize that the best way to reduce abortion numbers is to reduce unplanned pregnancies. What do you think? Is that kind of a renewed consensus in favor of family planning realistic? And what are your favorite organizations in this space?

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