After years in the shadows, and under attack from left and right, a campaign to put action into the demand that every woman should have the right to contraception is finally gaining momentum — or regaining the central role it once played in family planning decades ago.
Next week, in Kuala Lumpur, the capital of Malaysia, experts and advocates for women’s health will meet to confront the plight of those estimated 222 million women — the number is probably much higher — around the world who want to limit births but have no access to modern family planning. The conference is third in a series called Women Deliver.
The meeting, from May 28 to 30, follows another international gathering that was held in July 2012 in London to raise awareness and money to narrow this gap. That meeting had the strong support of the Bill and Melinda Gates Foundation, mostly because Melinda Gates, traveling the world from one small village or neighborhood to another in recent years, listened to poor women and became an outspoken advocate for putting contraceptives high on the list of priorities in health care.
“For an idea that is so broadly accepted in private, birth control certainly generates a lot of opposition in public,” Gates told a TEDxChange talk in Germany a year ago in April. “Some people think when we talk about contraception that it’s code for abortion, which it’s not. Some people — let’s be honest — they’re uncomfortable with the topic because it’s about sex. Some people worry that the real goal of family planning is to control population.
“But these are all side issues,” said Gates, who described herself in her talk as a practicing Catholic who saw no contradiction with her faith. “As a result, birth control has almost completely and totally disappeared from the global health agenda, and the victims of this paralysis are the people — the people of sub-Saharan Africa and South Asia.”
Family planning got off to a strong start globally in the 1960s; the United Nations Population Fund (at the time called the UN Fund for Population Activities) was founded in 1969. But some leaders of anticolonial movements were raising the fear that contraception was no more than a Western plot to limit the number of nonwhite people in the world. Meanwhile in the industrial North, especially in northern Europe, there was a strong sense that telling people to limit families was interfering with their cultural preferences.
Then the UN Conference on Population and Development in Cairo came in 1994, by which time the Vatican and elements within the Roman Catholic Church more broadly, mounted a powerful political campaign against contraception on religious grounds. No one felt this pressure more than Nafis Sadik, the frankly combative executive director of the Population Fund at the time. She cajoled and outmaneuvered not only the churches — some Protestant movements joined the fray — but also influential Islamic clerics. It is not well known that Muslim nations had firmly embraced family planning in parts of North Africa and Iran and Indonesia, among other places. By then, it was being challenged by radicalized mullahs. The opposition was strong in Cairo.
“The Vatican was our big, big problem,” Sadik said in an interview recently in New York. It was aided by about five countries, she said: Malta, Nicaragua and Sudan, most prominently. The Vatican chose issues such as the paragraph in the Cairo consensus document asking governments to aid women injured in unsafe abortion, while working to stop the widespread practice, in which tens of thousands of women and girls were dying annually, Sadik said.
“I said they should do whatever they can to limit, to study the causes of unsafe abortion,” she said. “The main thing is, if you don’t have family planning, you’re always going to have unsafe abortions. In all cases, they should be treated properly for the complications. I’m not suggesting legalizing abortion.” She prevailed in Cairo, helping to rewrite international policy on women’s reproductive rights comprehensively before the conference ended. Then, she said, the church regrouped, creating “fake NGOs,” or nongovernmental organizations, to keep the battle against the Cairo consensus alive in relevant UN conferences and other meetings that followed.
Paradoxically, some outspoken advocates for women also chose to downplay if not oppose an emphasis on contraception, still believing that it was using women’s bodies for population control, and that the major emphasis going forward must be on women’s human rights, not family planning. In the United States, the administration of George W. Bush, influenced by the conservative right wing, dealt a serious blow to the Population Fund by cutting off all American donations.
Sadik, a Muslim from Pakistan and the first woman to lead a UN agency, said that she developed her focus on family planning as a young doctor in her country in the 1970s. Now 83 years old, she is retired from the UN but still sought worldwide as a speaker and adviser and will be speaking at the Kuala Lumpur conference next week. She continues to meet women outside official events, wherever she goes. As female reporters soon discover, women are often painfully honest and frank about their lives; men government ministers are often not aware of women’s needs, or choose to deny them.
“I often talked to women,” Sadik said. “When governments say women don’t want family planning, I tell them go to a village and talk to them. I bet you they will ask, Do you know something that can help us prevent the next pregnancy that I can hide from my husband, that I don’t have to take every day? That’s their main preoccupation. All over India, all over Pakistan, all over Africa, go to villages and do the survey.”
For Sadik, making contraceptives available is only part of the equation when looking at the factors that hinder women’s health, or even lead to hundreds of thousands of unnecessary deaths, as the lagging progress on women’s issues among the Millennium Development Goals demonstrate. Local cultures are a big factor, and Sadik can describe many examples in which women themselves reject family planning because the number and gender of children are keys to status in the family and the community. Sadik also believes that strongly entrenched concepts of family honor that often harm women are used to cover up domestic crimes, which become hard to measure.
She recalls one story: “There was this case in Zimbabwe, which I once wanted to talk about in a status of women conference and they wouldn’t let me talk about it,” she said, adding that she was told she would offend the sensitivities of African women. “I said, it’s not a question of African women, it’s a question of something that’s happening that should be condemned,” Sadik said. “This man’s wife wasn’t getting pregnant, and apparently he discovered that she was taking pills. And he killed her because she made him look embarrassed [in front of other men]. Furthermore, that defense was being accepted in the court: that you can’t humiliate the husband.”
“Women have to have control over their own lives, and we have to enable them,” she said. “I mean, they have the right but they can’t exercise it because that is how society is organized. We need to get them away from that. Otherwise they are born under control.”