NO. 233 NOVEMBER 1993.pdf

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ISSN 0911-0755

JOICFP NEWS
Towards Self-reliant FP Programs

CAPRI highlights importance of seeking program self-reliance to promote sustainability
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community service network being set up
by MEXFAM under its community
doctor scheme. Doctors working within
the system are provided initial support
for two years to set up a community­
based practice and are then expected to
attain self-reliance through charging fees.
However, participants were made aware
that MEXFAM still faces the challenge
of coming up with the initial assistance
and providing some additional support in
the form of IEC materials and training
once the two-year period is finished.

Expanding Service Coverage
The second part of the field
observation
activities offered participants
A community doctor explains FP services to CAPRI participants.
a different strategy adopted by MEXFAM
The theme ofself-relianceforfamily the sustainability of FP programs. During to promote self-reliance. MEXFAM
planning (FP) programs proved very the conference, participants were intro­ recently joined hands with Servicios
appropriate for representatives ofLatin duced to the successful approach taken by Integrales de Educacion y Salud (SIES),
American countries attending the 13th the Japan Family Planning Association a private healthcare network that was
American Conference on the Integrated (JFPA) to achieve sustainability. By seeking a partner to promote family health
Family Planning Program (CAPRI), held developing a range of education materials services including FP at the community
in San Cristobal de las Casas, Chiapas, and offering training in such subjects as level. Prior to linking up with MEXFAM,
Mexico, from August 30 - September 1. adolescent health and FP, JFPA has been the activities of SIES were limited to
As awareness grows that donors may able to generate income while promoting clinic-based services. By collaborating,
trim assistance budgets and that funds human resource development in Japan.
however, the two organizations have been
for health projects may shrink in the
To highlight the challenges of FP able to utilize the facilities of SIES and
future, self-reliance is gaining impor­ program self-reliance, the conference the know-how and mobile service
tance as a key factor in determining the included visits to the field where partici­ network of MEXFAM to expand the
survival of FP programs in the region.
pants observed activities being promoted coverage of services on an outreach basis.
The conference was attended by 65 by MEXFAM. In the first area, the Still in its initial stage, the new system is
representatives of government agencies participants were introduced to the expected to generate a profit in the near
and non-governmental organizations
future which can be used to improve and
(NGOs) of the 11 countries of Bolivia,
further expand the services.
Brazil, Colombia, Ecuador, Guatemala,
Insights gained during the field
Japan, Mexico, Paraguay, Peru, U.S. and
observations helped participants to
the Dominican Republic. Represen­
develop a set of recommendations.
tatives of UNFPA, IPPF, UNICEF and
Prominent among these was a call to
PAHO joined other self-funded observ­
promote awareness among NGOs that
ers at the gathering. The meeting was
the fight for self-reliance does not mean
organized by the Mexican Family
abandoning their mission of providing
Planning Foundation (MEXFAM) in
services to the poorest. The participants
cooperation with UNFPA, IPPF and
also stressed that self-reliance of non­
JOICFP.
profit institutions can be achieved with
The conference was an effective
less difficulty if there is adequate
forum for clarifying the concept of selfcoordination among government
reliance for participants and for devel­ Traditional birth attendants demonstrate institutions, the academic sector and
oping practical strategies for promoting delivery procedures for participants.
NGOs.
3]
1
5

Guatemala

A Winning
Approach to
the People
Community-based concept of
IP wins hearts in Guatemala
A landmark decision was made for
the people of Santiago Atitldn at the
National Seminar on the Integrated
Project, held in September inSololdState
in Guatemala. Impressed with the com­
munity-based approach of the project
and the effectiveness of integrating a
range of primary healthcare activities
with family planning (FP), the
representative from Santiago Atitldn
agreed to start the project in his area

from this year. The
IP will be the first
such community
health and devel­
opment project to
be promoted to the
area s 25,000 in­
habitants who have
refused outside
assistance as they
have struggled with
civil war for the
last 30 years.
Expanding the
coverage of the
project was one of
the aims of the
seminar which was
9RIb
attended by 65
representatives
*
from Solola State Women and children of Santa Lucia Utatlan.
including volun­
teers, community health agents and trad­ leaders from both IP and non-IP areas.
itional birth attendants and community With the addition of Santiago Atitlan, the
project will cover a total of 11 areas with
a total population of 113,000.
Despite a very tight schedule, the
seminar provided participants with a deep
understanding of the progress that has
been made in the IP areas during the four
years of implementation. The third of its
kind, the seminar also included a show­
ing of the JOICFP documentary film
Maria, which was filmed in the IP area
of San Lucas Tollman.

Raising the Curtain on Women

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Technical Assistance

(Photo on left) The audience in San Lucas Tolim^n. (Photo on right) In Guatemala
City, (from left) UNFPA Country Director Mirtha Carrera-Halim, APROFAM Vice
Chairperson Blanca de Nicol and Vice Minister of Labor Hilda Morales Trujillo.
JOICFP’s new award-winning docu­
mentary film received a warm welcome
when it was shown to audiences in
Guatemala during the JOICFP mission’s
stay in the country. Maria focuses on the
activities of two women in a small
Guatemalan village who overcome rivalries
and join hands to improve the standard of
health and raise living conditions in their
community, particularly for women. A
moving documentary designed to be used as
an IEC material to raise awareness of
women’s issues, Maria is available in
Spanish, Japanese and English.
At a premier showing in Guatemala City
on September 7, Maria was highly appraised
by the audience of550 guests which included
government officials and representatives of
non-governmental organizations. Among
the officials who joined the showing were
Vice Minister of Labor Hilda Morales
Trujillo, Japanese Ambassador to Guatemala

2

Hirosuke Oshima, and UNFPA Country
Director for Honduras and Guatemala Mirtha
Carrera-Halim. In comments made after the
showing, audience members said that they
were impressed with the film ’ s clear message
of family planning promotion and women’s
participation in healthcare.
The film received the most heartwarming
response from the audience in San Lucas
Tollman, the small IP area in Solola State
which served as the location for the filming
on September 8. Welcomed with a burst of
applause, Maria stunned the audience of IP
personnel, volunteers, traditional birth
attendants and community people with its
scenes of local areas and familiar faces.
Following the film show, a total of 150
reconditioned bicycles donated from the local
governments of Toshima, Arakawa, Tama
and Omiya cities of Japan were distributed by
Katsumasa Harada, counselor, Embassy of
Japan, to IP volunteers in a ceremony.

Following the seminar, a JOICFP
mission including two Japanese experts
visited five project areas where they
monitored progress and provided
technical assistance to improve the
effectiveness of the IP. The opportunity
to visit the IP areas was welcomed by Dr.
Shigeo Hayashi, former director, National
Institute of Health of Japan, and Takaaki
Hara, director. Department of Research
and Study, Japan Association of Parasite
Control, who noted that project activities
had been improved since technical
training was provided in 1991. The
dispatch of the two Japanese experts was
funded under the Voluntary Deposit for
International Aid (VDIA) scheme,
administered by the Japanese Ministry
of Posts and Telecommunications.
While in Guatemala from September
5-16, the JOICFP mission also paid
courtesy calls to government officials
and representatives of concerned
organizations such as UNFPA and
APROFAM to discuss further collab­
oration in the field of family planning
and maternal and child health.
[j]

JO1CFP NEWS, November 1993

Latin America

New Horizons
for Mexico’s
Women
Ramona Pando de Cosio, president
of the Board, Mexican Family Planning
Foundation (MEXFAM), spoke with
JOICFP NEWS on September 27 about
the challenges facing women in Mexico.
Below are highlights of her interview.
In Mexico, there is a very big
difference between the situation of
women in urban and rural areas. The big
cities in Mexico are receiving people in
their thousands from rural areas. These
people come with their rural ideas that
children are necessary for survival. Once
they move to the cities, they realize that
too many children is a problem. It takes
about five to six years for these people to
gain this awareness and start using family
planning (FP), but by this time they
already have too many children.
In the rural areas, the problems of

women are terrible. For example, one of what can you offer a poor rural woman if
our staff members noticed in many towns you want to encourage her not to have
that a great deal of women did not have children and she replies, “What else is
teeth. She initially thought it was lack of here for me to do?” Actually, there is
calcium, but found out that it was really very little we can say in reply, because
caused by the physical abuse of men. Rural for most of these impoverished women,
there is no chance for them
women are very abused,
to study. The only thing to
and unfortunately, this
do is teach them to have
abuse goes from generation
more self-esteem so they
to generation.
can take better care of
One of the obstacles to
themselves and the child­
promoting FP in the rural
ren
that they already have.
areas is the ideas held in
It takes a very long time
communities
about
to build confidence in such
women. It is believed in
women because they tend
rural areas that it is the
to distrust outsiders. But
obligation of the woman to
once you have their trust,
have children — that is her
AI '
then you can start to talk
mission. Therefore, there
about FP, which can give
is this idea that a woman
who uses FP is a bad Ramona Pando de Cosio such women control over
their own lives. With this
woman, and that for a
woman to enjoy sex is bad. It also reflects control, a woman can also have control
badly on the man if a woman cannot have over her relationship with a man. She can
say “no” to more children, even if the
a child. He loses face.
It is essential that we start to change this man threatens to leave. And if a woman
situation by educating the young girls. Our can say a final “no” to such an important
priority with the young girls is to build up part of her life, then she can be in control
[J]
their self-esteem. This is essential, because of so many things.

t. ;

Increasing FP Access in Brazil
Dr. MiltonNakamura,president, Centro
Materno-InfantiUPlanejamento Familiar
(CMHPF) spoke to JOICFP NEWS on
September 22 about the family planning
situation in Brazil and the activities of the
Integrated Project (IP) conducted in Sao
Paulo. Below are highlights of the
interview.
In 1979, we carried out a survey in Sao
Paulo State on the use of contraception.
That survey was the first official document
to demonstrate the impact of FP. Despite
the absence of an official FP program, the
survey showed that an FP program had
already been established and that women
had been using FP effectively.

FP a Key to Development
Of those women polled, 23% between
the ages of 15-45 years were using the pill
and 16% were sterilized. Very few were
using diaphragms, condoms or IUDs. Sao
Paulo State is the most developed of all the
23 states and we know that FP is one of the
keys to the success of development in the
state.
Today, Brazil has an official FP program.
But in reality, it is the people in the middle
to higher classes of society who have ac­
cess to the most sophisticated forms of
contraceptives. Women in the lower classes
have only one chance in FP, and that is to

JOICFP NEWS, November 1993

have a tubal ligation at the time of delivery of a the project in each of these branches co­
child. The reason behind the extremely high ordinates the work schedules of volunteers.
Due to limitations of budget, we have
rate of cesarean sections at many hospitals is
that many poor women have tubal ligations at developed some very innovative approaches
the time of delivery, but want to hide the fact. to expand coverage and increase the
Because of this demand, the cesarean section effectiveness of the project. We started our
work in the slum areas.
rate at some hospitals is
But these are very
as high as 90% of all
dangerous and difficult
deliveries.
to enter, so we worked
So there is a big
out a strategy. The key
demand for FP, but
we found was to use
good FP is really very
the nursery where
difficult to get in Brazil
working women leave
for poor people. Of
their children, and to
course, if you have
utilize the nurse
money, you can get the
working there. By
best. That is our reality.
training this person in
We introduced the IP
our FP program, we
in 1983 in two pilot
were able to enter this
areas with the approval
area.
of the state government.
Dr. Milton Nakamura
A more recent
This was the first
strategy of ours to
official FP program in
Brazil. The IP has increased in coverage ever expand coverage of our project is to link up
since and from our main center we now have 12 with other non-governmental organizations
branches in the southern part of Sao Paulo City. working in different social areas. We
In each of the 12 branches, there is a manager integrate an FP program with their activities
who is chosen by the community as a and introduce to their activities a new IP
representative. Once a month, this person calls strategy. In this way, we can utilize their
a meeting to discuss any problems that the facilities and expand services. If possible,
community might have with the project. All we also try to link up with the government
branches also give classes for the community at different levels such as municipal and
people on FP methods. The nurse in charge of state governments.
3

IPP1

Calling Japanese Women to Action
Mahler urges Japanese women to set a an example for Asian women in reproductive and sexual rights
Dr. Halfdan Mahler, secretary­
general, IPPF, was in Japan from
October 5 - 9 to attend the General
Meeting of the Japan Parliamentarians
Federation for Population (JPFP) on
October 7 and to provide a series of
lectures. He spoke with JOICFP NEWS
on October 7 about population and
family planning (FP), focusing on
issues related to women. Below is an
outline of his interview.
When you speak about the
population problem, you are almost
invariably getting into conflict with
many women’s groups which feel
that starting at the macro-level of
population, you really are not
addressing the true problem — which
is that of the individual woman who
is, after all, the uterus owner. These
women’s groups have very great
difficulties in digesting the oldfashioned notions of too many people
and, by virtue of saying too many
people, you tend to blame the woman
for having produced something.
This is not only a European
problem. I feel from discussions I
have had with women in Japan that
they have the same concern that the
micro-level of the individual woman and
her decision, her right to reproductive
decisions, is easily sacrificed on the altar
of the “population explosion.”
I believe IPPF was a marvelous or­
ganization when brave and angry women
without money ruled it in the 1950s and
1960s and into the beginning of the 1970s.
Then the money started coming in and
with the money, the men came running
in after the money and whatever kind of
prestige always comes with money. It is
only in the last few years that the men in
IPPF have recognized that they had better
watch out, otherwise they might —
hopefully—become endangered species.
When I look at the challenges facing
Japanese women, I can see that when
they truly start to liberate themselves,
the Asian world will tremble. Once
there is a total acceptance of women in
the genuine spirit of equality in Japan,
you will see in the Asian space that
politicians will no longer dare to ignore
women. That is why in Japan we need to
get that message to all women that they
have a historical mission in Asia.
I also believe very sincerely that if
4

we want to have a world where we can live
together, then women are infinitely better
at networking on a horizontal level than
men. We very badly need women’s
perspectives in the field of population and
FP as we move towards the International
Conference on Population and

Dr. Halfdan Mahler
Development (ICPD) in Cairo — not only
from Europe and North America, but also
from this part of Asia. We need badly to
care that women care about what happens
to them and their reproductive rights, their
sexual rights, their rights to be a very
decisive force, as we look at how to
provide sensitive, high-quality FP services.

Hormone Controversy
Looking at the controversy that still
exists in Japan as to whether women like
hormones for contraception or not; it is
clear to me at least, that it is mainly a male
debate and that women have not been
empowered to make what is their decision.
I do not care whether women want hor­
mones or not, but what I am upset about is
that Japanese women have not been
properly informed. So you get emotional
kinds of attitudes. I do not mind these, but
at the same time, you should have arational
attitude based on information. Then you
can say, “I feel I don’t like to have hormones
in my body,” and if that is your decision as
a woman, then that is fine.
This is one area where Japanese women

could set an example. It would be a very
important political stand for women in
Japan to take and would help women in
other parts of Asia if they say, “We insist
that we have quality information that we
can understand. We want to have access
to the higher powers and we do not just
want somebody sitting in the Ministry
of Health and Welfare making
decisions for us based on something
called ‘medical wisdom.’”
I would also like to plead with
Japanese women about another matter.
In Japan at present there is a great deal
of concern about the very low birthrate.
In this situation, male politicians start
wondering how to make women
produce children. First of all, this has
never worked in any country in Europe,
no matter how big the financial
incentives have been to produce more
children. I think it is marvelous that it
did not work. I hope that Japanese
women will decide for themselves in
the light of the way that society treats
them, how many children they have.
Ahead of the conference in Cairo
and the women ’ s conference in Beijing
in 1995,1 plead with Japanese women
to be aware of their responsibility, to
themselves, and then to Asian women at
large. When they draw the battle lines in
favor of women’s equality and develop
their own kinds of strategies of how to
fight, that will send a message to other
Asian women.
Let me add, that there is this idea that
contraception is only a matter of getting
pregnant or not getting pregnant. But I
think in the discussion on contraception,
you must take into account whether it
allows a woman’s sexuality to be realized
in a way that the woman would like to
realize her sexuality. Her choice will
clearly be influenced by that.
You cannot separate sexual and
reproductive health. It is very important
that we have an enlightened discussion
about the relationship between sexual
and reproductive health, and I hope that
Japanese women will not shy away from
that. I am not trying to set off a time
bomb, but I think it is very important,
especially for the younger generations,
that women are able to realize their
sexuality on their own terms and in the
spirit of total equality between the two
sexes.
[T|
JOICFP NEWS, November 1993

United Nations

UN Honors
Efforts in
Population
Sai and Mainichi Shimbun
awarded for spreading
awareness ofpopulation
The UN Population Award was
presented this year to Dr. Fred Sai,
president, IPPF, in the individual
category, and to the Population Problems
Research Council of the Mainichi
Shimbun, in the institution category.
Below are highlights of acceptance
speeches made by Sai and council
president, Tadao Koike, on the occasion
of the awards presentation by UN
Secretary-general Boutros BoutrosGhali in New York on September 16.

Fred Sai
In too many parts of Africa today the
proportion of young girls who are
exposed to even three to five years of
education is quite small. Even today

there are countries where
only 20% of the girls are in
school.
Let us empower our
girls through education,
and transform their lives
through insight, giving
them the tools to embark
on the path of 1 ife on a firm
footing, in equal stride with
their male peers.
In addition to their
education, there is a need
to look at the kinds of
practices which are now
interfering with the lives (From left) Fred Sai, Julia Henderson and Tadao Koike.
and livelihoods of our girls
and women in Africa and making life such more attention to the issues of safer
a drudgery to them. Far too often we are motherhood. This is a field in which we
allowed to hide behind anachronistic must really see the violence we are
traditions and cultural practices, some of committing against our own people, our
which are really morally indefensible, and own kin, and address the needs as
do things to our women which should not quickly as possible.
be permitted. Female circumcision is one
Finally, on the issue of safe
such example. There is no reason at the motherhood, let me say once more that
present time for any child to be coerced nothing has been found to be as effective
into marriage and to be forced to start as the ability for women to control their
having children, deprived of time to enjoy own fertility. Let us make it possible for
her childhood before she becomes a wo­ all women the world over to have full
man and a mother. This we do in the name control of their reproductive rights by
providing them with the quality
of tradition and culture.
Since 1987, we have been calling for information and services to achieve that.
And we must remember that the methods
to control fertility, imperfect though they
may be, are available.

Jane Fonda on Population

Actress Jane Fonda and her husband, population growth is brought into balance
CNN President Ted Turner, were made with available resources.
But, I’m also a woman, and I share the
goodwill ambassadors of UNFPA on
September 21. In a speech at the UN on concern that a crisis mentality, which is
September 20, Fonda provided her views justified and necessary, might cause us to
on population and related issues. Below resort to coercive, insensitive fertility control
measures. Women must not
are highlights ofher address.
be blamed because we bear
It is true that there is no
children. Our health and our
absolute consensus on
whether population growth
bodies must not become the
is a root cause of poverty,
sacrificial altars on which
demographic targets are
hunger, crime, environmental
callously arrived at. If we
destruction, the immigration
have learned one lesson over
crisis, and internal political
the last 30 years, it is that the
conflict. But the one thing
ways that work best to reduce
most of us can surely agree
fertility are the ways that are
on is that unchecked
respectful of women.
population growth exacer­
From a policy standpoint,
bates all of these problems
Jane Fonda
what is to be done? We must
and that it will be extremely
difficult if not impossible to solve any of

first ensure universal access to family

them if we don’t stabilize population
growth.
To improve people’s quality of life,
reduce conflicts and stop environmental
destruction, we need sustained economic
growth carried out in a manner that is
environmentally sustainable and we
absolutely cannot have such development
over the long term unless and until

planning by the end of this decade. We must
alter the conditions that have led historically
to high fertility. Giving women legal status
as full citizens, access to credit, the right to
own and inherit property, education and job
opportunities ar important in and of
themselves. They are also important to
lowering fertility.

JOICFPNEWS, November 1993

Photo courtesy ofICPD Secretariat, UNFPA.

Tadao Koike
The Population Problems Research
Council was established in 1949. From
the beginning, the council has been
engaged in various activities. It has carried
out population and FP surveys, conducted
study groups and seminars and published
what it regarded as useful materials.
The most ambitious activity of the
council is the National Opinion Survey
on FP. It was first conducted in 1950, and
was carried out every other year
thereafter. It has documented the
demographic transition in Japan from
high fertility and mortality rates of the
period after the war to low fertility and
mortality rates of today. It also provides
insight into how Japan was able to emerge
from the difficult conditions just after the
war and overcome its population
problems by formulating and
implementing a national policy on
population growth—enabling it to attain
the economic status it enjoys today.
The council is now striving to go
beyond Japan’s own problems, to address
population and environment on a global
scale.
[j]
5

Views

Banking on Women’s Spirit
Professor Muhammad Yunus, her work, the first beneficiaries are the
managing director, Grameen Bank, spoke children and the next is the household.
to JOICFP NEWS on Septembers about
A woman in Bangladesh has lots of
the activities of Grameen Bank, an skill, which initially she is not aware of
institution hefounded to provide loans to because society has been telling her she is
poor women in Bangladesh. Below are no good because she is a woman. Since she
excerpts from his interview.
was bom she has been told that she has
Grameen Bank started in a small way brought bad luck to the family. And since
in one village as a kind of challenge to the she has always been put on the negative
conventional banking
side of life, she has
practice which dis­
started accepting that
allows poor people
position. She is very
from bonowing mon­
apologetic for being
ey from banks.
the way she is. So to
Banking procedure
get her to believe that
requests that some­
she is something and
can do something takes
body must have
something to offer as
time and preparation.
collateral before the
Grameen operates
with the philosophy
bank will even consi­
der accepting an
that all human beings
application. Since this
are individually a
principle is adopted by
treasure of potential
Muhammad Yunus
the banking system all
possibilities. Given an
over the world it divides the world opportunity, a woman can peel off the
population into two sections: the lucky crust that society has put around her—and
ones who can offer collateral can borrow we have found out that money works in a
from the bank, and the unlucky ones who magical way in peeling off this crust.
In Grameen, to receive a Ioan a woman
the bank will not touch.
has to be a member of a group of five.
Lending to the Poor
When she gets to hold an elected position
in that group, it is a tremendous success for
1 could not accept this. So I tried to her. The first time she earns money she
find out whether what the banks were cannot believe it—she’s somebody. Each
saying was right. I took money from the time she makes weekly installments, it is
bank, offering myself as a guarantor, and self-confidence building.
lent the money to a few people in a
In the beginning the husbands did not
village in 1976. Itworked very well, and like the idea that Grameen should give
people paid back the money. I was trying loans to their wives and not to them. But
to demonstrate to the bank that you can they gradually got used to the idea. Also,
lend to poor people and it is a good in the comer of each husband’s mind there
business. I expanded this experiment, is that knowledge that no matter what,
but nothing changed the bankers’ minds. money is coming to the family.
So in 1983 we became a bank.
The basic principle we tell the woman
By now in 1993, we operate in almost is: “You must prepare yourself to protect
half of Bangladesh — in 33,000 villages the money and at the same time make sure
out of a total of 68,000. We have 1,030 you protect the marriage. Do not give up
branches with a staff of 12,000 and we one for the other.”
offer Ioans to 1.6 million borrowers —
We have also done a tricky thing with
94% of whom are women, all very poor. our housing loans. We only give them out
This bank lends money only to the poorest if the woman owns the land on which the
and gives money to those who have never house will be built. If the husband agrees
had any experience whatsoever of running to transfer the land to the woman’s name,
any business, or using money for any then they can receive a loan. So she builds
a house and the husband is then living in
income-generating purpose.
If I have to summarize, I would say the wife’s house. Over 200,000 housing
that women are much better managers of loans have now been provided, and this
resources, and are much more serious has happened in each case. In a situation
entrepreneurs than men. More than that, where she owns the house and land, the
|T]
any benefits a woman receives through woman feels very secure.
6

Changing the
Agenda
Juliet Richters, lecturer, Department of
Public Health, University of Sydney, visited
JOICFP on August 27 to exchange infor­
mation on women’s health. Below are some
of her views on the issue.
To argue why I don ’ t think women’s health
isj ust gynecology, I need to make a conceptual
distinction between sex and gender. Sex is
the biologically based distinction between
males and females. Gender is the social
construction of male/female identity. It is
both a set of ideas — a way of thinking about
relations, of influencing behavior, a set of
symbols — and a principle of social
organization — allocation to roles, division
of labor. Although many characteristics
associated with masculinity and femininity
give the impression of being “natural” or
biologically founded, they are in fact culturally
constructed and vary from society to society.
The point of having women’s health as a
separate subject is not just to look at the health
of a population subgroup — women — from
the same point of view as has been used all
along for looking at “normal” people, i.e.
men. It is so that we can change the rules of
what we regard as important, in other words
to change the
agenda. The insis­
tent emphasis on
the countable, the
objectively ascer­
tainable, has been
described as a
recurrent problem
in the “male”
scientific tradition.
It has meant that
Juliet Richters
we count deaths.
or pregnancies, or hospital separations, or
numbers of couples discontinuing a
contraceptive method, rather than finding out
about ill health, or reasons for pregnancies, or
what happens to wives when their elderly
husbands are discharged from hospital, or
what women feel when they stop using a
contraceptive they objectively need.
I do not belong to the mystical feminist
tradition: I do not think we should give up
statistics and counting and conducting welldesigned studies that give us unambiguous
answers to clearly stated questions. But we
have to extend the terms of the debate, we
have to be prepared to apply our scientific
logic to personal experience as well as to
“hard events.”
This goes further than what I call “warm­
speculum gynecology,” which is what is often
taught to doctors in the name of women’s
health. It means querying the basis of the
“facts” that we learn from courses and from
medical journals and drug advertisements
and asking “How do they know?” and “Do I
accept the assumptions on which this research
is based?” and “How can I help change it?”
JO1CFP NEWS, November 1993

Japan

Extending
a Helping
Hand

- 24 in Tokyo. An annual
event, the seminar is aimed
at preparing participants for
Ml
overseas service by deep­
ening their understanding
of issues related to inter­
national cooperation and to
broadening
technical
cooperation channels in
-I’ll
Japan for assistance to
Japanese paramedics learn
countries.
ways to assist in international developing
The course included
>
J
■ A
■
cooperation activities
presentations by experts on
topics such as population
“The Japanese experience in family issues, volunteer work, re­
planning and maternal and child health productive health, adoles­ Participants take notes during the seminar.
(FPIMCH) can be utilized to raise the cent health, international
quality of life in developing countries, assistance and communication techniques. the Japan Overseas Cooperation
but a person working in the field should The schedule incorporated an overnight Volunteers (JOCV) in a hospital in
realize that above all else it is essential to brain-storming session at Kanagawa Malawi, was among several participants
be flexible,” saidAtsuko Yoshida, a 33- Women’s Center where participants well-acquainted with the international
cooperation field. Indicating a desire to
year-old midwife. “I think we tend to put engaged in active discussions.
The seminar was subsidized by the share her experiences to further promote
too much emphasis on high-level
Ministry of Foreign Affairs and imple­ international assistance, she commented
techniques in international cooperation
mented by JOICFP. A total of 21 trainees on the importance of making people
activities, and these are not what are
always needed in thefield. It is true that attended this year’s event including nurs­ aware of their own health. “JOICFP’s
we should use our Japanese experience es, public health nurses, midwives and Integrated Project (IP) is very useful for
effectively to assist people, but at the instructors of paramedical students. Course getting people to take action to protect
same time we must consider the culture leader for the seminar was Dr. Minoru their health,” she said.
Muramatsu, former chairman. Population
within which we are working,” she said.
Range of Services
Association of Japan. Launched in 1972,
Yoshida provided her comments
the course has now been attended by a
during the 24th Seminar on International
Masami Nakazawa, a 25-year-old
total of 546 health professionals.
Cooperation in Maternal and Child Health
Yoshida, who served as a member of midwife, also had positive comments to
and Family Planning, held September 13
make about the community-based
approach of the IP, but cautioned that a
mix of clinic- and community-based care
is probably the best approach to serving
all healthcare needs. “Educated people
For the majority of women in Japan, a girl | society in recent years including the
baby is preferable to a boy baby, according I emergence of the nuclear family, later
tend to use services provided by clinics,
marriage, fewerchildren and
but for those people less aware of health
to recent findings of a
population aging.
fertility survey conducted
issues it is very important that there are
The survey also found that
by the Institute of Popu­
people to go out and speak to them,” she
only 15.2% of marriages
lation Problems of the
said. “The only way to meet all the
currently follow the practice
Ministry of Health and
healthcare needs of the people is to
of omiai (arranged mar­
Welfare (MOHW). The
combine
the two in a well-coordinated
riages), a sharp decrease
nationwide survey, carried
manner so that they reinforce each other.”
from the 23.6% of five
out in July 1992, found
Nakazawa who joined the course to
years ago.
that 75.7% of women
learn
about how she can assist people in
Meanwhile,
couples
are
would prefer to have a girl
waiting longer after their first
developing countries, said that she gained
baby if they were to have
encounter before getting
many insights into promotion ofFP/MCH
only one child—a marked
married. According to the
change from 10 years ago
from a variety of viewpoints. “The
survey, couples married
when only 48.5% of
conventional approach to international
during the 1987 -1992 period
women said that they
cooperation may have a tendency of
waited an average of 2.97
would prefer a girl child.
overlooking the needs of the individual
years after their first
Conducted every five
on the receiving end of assistance,” she
years, the survey gained A mother and daughter encounter, a sharp contrast
said. “The type of international
from
the
average
waiting
responses from 8,844 stroll in a Tokyo park.
cooperation
activities I would like to be
period of 1.97 years for
married women under 50
involved in would be tailored to the needs
years of age. In giving reasons for wanting couples married between 1972 - 1977.
of the individual. That is why I think the
The survey also found that while the total
a girl child, many women commented that a
daughter is more likely to remain closer to fertility rate has fallen in Japan to 1.50 in
approach of the IP, which uses parasite
1992 from 1.75 of 1980, fertility for married
parents than a son.
control to raise health conditions and
The findings of the survey reflect the couples has remained virtually unchanged
trigger awareness of health within the
changes that have taken place in Japanese since 1972 at 2.21.
community, is effective.”
[T]

.*J

A Preference for Baby Girls

i

JOICFP NEWS, November 1993

7

Voice of Voices

JOICFP Film Awarded

By Chojiro Kunii

Scenes from Guatemala
In September, a JOICFP mission consisting
of six members including Dr. Shigeo Hayashi,
former director, National Institute of Health
of Japan, traveled to Guatemala. Their visit
camejust after the 13th American Conference
on the Integrated Family Planning Program
(CAPRI), held in Mexico.
The Integrated Project (IP) has met with
considerable success since it was launched in
Guatemala on a pilot basis five years ago. Dr.
Hayashi, a renowned expert in parasite control
and public health, has been involved the
project and has established a great deal of
trust with the Guatemalan people through his
contributions.
JOICFP recently produced the documentary
film Maria, which captures the commitment
of those involved in the IP and contains
breathtaking footage of the scenery around
Guatemala’s Lake Atitlan. The movie begins
by introducing the use of parasite control to
get the community people involved in the
mass examination and treatment exercise.
We learn that by participating in these
activities, the people have gradually over­
come their distrust of IP workers.

Women’s Independence
The film also shows how local women
involved in a cooperative project aimed at
promoting women’s economic independence
have been using reconditioned sewing
machines donated by Japanese people. One
of the people featured in the film is Dr. Jorge
Solorzano, who is in charge of the IP and is a
great enthusiast of the project.
This film and other activities undertaken
by JOICFP have done much to introduce the
local conditions of Guatemala to Japanese
people and motivate them into action. The
Voluntary Deposit for International Aid
(VDIA) and MCCOBA activities are two
such examples of support. The Japan Bicycle
Promotion Institute has also provided some
funds to ship donated reconditioned bicycles
to IP areas in developing countries where
they serve as the main means of transport for
the health volunteers. The Japanese Embassy
in Guatemala, meanwhile, has also been keen
to assist us. Thanks to this support, the
Ministry of Foreign Affairs has been very
cooperative. With all of these activities, there
have been efforts to make sure that they meet
the needs of the communities.
These small movements in Japan have had
a strong impact on the Guatemalan people.
Historically, the people of this country with
deep Catholic roots have resisted family
planning. However, the Japanese IP has been
enjoying a good reputation in Guatemala and
has even sparked the interest of Catholic
priests and the military. Perhaps, this has to
do with a realization that the IP has nothing to
do with religion or politics.
[T|

8

JOICFP’s moving documentary film I indigenous traditional birth attendant
Maria was honored as “Best Short Film” I — who overcome rivalries and work
together to improve the
at the prestigious Asialevel of health in the
Pacific Film Festival, held
in Fukuoka, Japan, from
community. Created in the
International Year of the
September 7-10. A rare
honor for a documentary
World’s
Indigenous
film, the award was
People, Maria presents a
presented by the Federa­
powerful message about
tion of Motion Picture
improving health, par­
ticularly for women, in
Producers in Asia-Pacific at
the federation’s 38th film
indigenous communities.
festival. The educational
The film, ajoint Japanesefilm, shot on location in
Guatemalan effort, is 33
minutes long and available
Guatemala, documents the
in English, Spanish and
struggle of two women — a
young laboratory technician and an older I Japanese languages.

w
k-

DIARY
Sixteen participants and one observer from 15
countries attended the Seminar on FP
Administration for Senior Officers held Aug.
23 - Sept. 10. The seminar was entrusted to
JOICFP by JICA.
*
*
*
JOICFPDeputy Executive Director Yasuo Kon
and Program Officer Kiyoko Ikegami were in
Mexico from Aug. 26 - Sept. 4 to take part in
CAPRI. They traveled to Guatemala on Sept.
4 where they were joined by Dr. Shigeo
Hayashi, former director, National Institute of
Health of Japan; Takaaki Hara, director,
Department of Research and Study, JAPC; and
JOICFP staff member Mariko Honma. The
team took part in the National Seminar on the
IP, technical support activities, the premier
showing of JOICFP’s documentary film
Maria, and VDIA ceremonies. Kon and
Ikegami were later in New York from Sept.
12 - 14 to hold discussions at UNFPA
Headquarters. Ikegami exchanged information
with officials of the Centers for Disease Control
in Atlanta on Sept. 14 and stayed in New York
until Sept. 17 to hold discussions with officials
of IPPF Western Hemisphere Region. The rest
of the JOICFP team remained in Guatemala
until Sept. 16.

*

*

*

JOICFP Program Officer Atsushi Yoshino was
in Indonesia from Sept. 6-21 to produce a
series of educational slides on the activities of
YKB’sFP/MCH clinic.
*
*
*
JOICFP Program Officer Sumie Ishii and staff
member Sono Aibe were in Vietnam from
Sept. 10 - 22 on a project monitoring and
formulation mission.
*
*
*
Dr. Milton Nakamura, president, CMI/PF,
Brazil, was in Tokyo from Sept. 21 - 22, to
exchange information with JOICFP officers,
pay courtesy calls to officials of MCCOBA and
VDIA and visit Morimura Gakuen High School.
*
*
*
Twenty-one paramedics attended the 24th

Seminar on International Cooperation in
MCH/FP, held at JOICFP from Sept. 13-24.
JOICJ-1? Documentary Scries
A New Documentary Film_____

Maria
33 mins., Color; English, Spanish, Japanese

Our latest documentary film features two Marias
from Guatemala — a country over 50 percent of
whose population is comprised of indigenous people.
Nana Maria, a traditional birth attendant and faith
healer who still follows the Moyan tradition closely, strives
to protect the health and decrease the burden of the
women in her village. Citydweller Mario Teresa wishes
to get closer to indigenous women like Nana Mario.
This touching film outlines the awakened women
trying to protect themselves through action.
Distributed by

Sakura Motion Picture Co., Ltd.
Yoyogi Center Bldg., 57-1 Yoycgi l-chome
Shibuyo-ku, Tokyo 151, Jopon
Tel. 81-3-33205311/Fox: 81-3-3320-7666
Telex: J34799ITCINBTH

16mm • VTR (Beta, VHS/NTSC, PAL, SECAM)

JOICFP NEWS is a monthly newsletter
published by the Japanese Organization for
International Cooperation in Family Planning,
Inc. (JOICFP).
JOICFP NEWS welcomes your comments,
suggestions and contributions. Please mail to:

JOICFP NEWS
Hoken Kaikan Bekkan
1-1, Sadohara-cho, Ichigaya
Shinjuku-ku, Tokyo 162 Japan
Phone: 81-3-3268-5875
Facsimile: 81-3-3235-7090
Telex: 2324584 JOICFP J
Cable Address: JOICFP Tokyo

JOICFP NEWS, November 1993

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