FACTS againest MYTHS V0L-VII-7-2001.pdf

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extracted text: VIKAS ADHYAYAN KENDRA

Vol VII # 7/2001

INFORMATION BULLETIN

Over-population as Underdevelopment:
The Myths behind “Population Control”— I
COMMENT

n India population policy is identical with the policy in population control and
is women-targeted. In 1951, it launched the first official family planning
programme, later renamed as the Family Welfare Programme. Subsequently,
the Alma Mata Declaration (1978) of Health for All by 2001 was adopted by
India in 1994 and ‘reproductive’ health rather than family planning was
foregrounded as a new slogan from the Cairo Conference (1994) on Population
and Development. But for all this, birth control continued to be the main
component of the population policy. During the Emergency a policy statement
was issued affirming the priority accorded and commitment to ‘population
problems’. The 1993 National Health Policy stated the long-term demographical
goal of reducing Infant Mortality Rate (IMR) by 2000 but is yet to be achieved!
And since 1991 with the imposition of SAP this Policy began to be steadily
undermined. In fact SAP led to massive injections of foreign assistance in family
planning like the USAID project (1992) worth $325 m. to provide ‘innovations
in family planning services’ in UP and subsequently to the whole of the country.
As a result the dangerous hormonal implant, Norplant, was used on migrant
labour in this State the same year but withdrawn after protests by women’s
groups. In 1992 it again introduced another dangerous drug, Depo Provera,
and then Quinicrine to produce sterility in women. The case was taken to
Supreme Court leading to a ban on Quinicrine. The point, however, is that the
Tiberalisation’ of the drug policy under the SAP regime and foreign aid in family
welfare programme raises such a threat, without fulfilling the urgent need for
safe and cheap contraception.
Since adopting the SAP-induced population policy which is not to improve
demographic balance and well being through greater government investment
in the public sector the government has been implementing the neo-Malthusian
solution that views birth control as the ‘panacea’ for India’s poverty and
underdevelopment. Population policies since have been careful to avoid any
analysis of the impact of SAP on demographic balance and well being.
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For instance the Committee on Population
(Karunakaran Committee) of the National
Development
Council
had
made
objectionable proposals* like the bar on
government recruitment of girls and boys
getting married at an early age, bar on
contesting election for people not following
the small-family norm, and the use of army
and para-miliatary forces to serve the cause
of the health and population stabilisation
though later some of these obnoxious
proposals had been withdrawn. The
government on its part while it conveniently
overlooked the positive recommendations of
the Swaminathan Committee it introduced
the 79th Constitution Amendment Bill to the
Parliament whereby people having more
than two children would be disqualified from
contesting parliamentary election. Such
disincentives/incentive driven coercive
policies and tactics, far from promoting small
families, precipitates pressure on women
and on the poorer classes, who, even if they
are aware of the relevance of small families,
have very little control over their own
reproductive lives. Already, the politics of
population control has become apparent in
some of the States where such a exclusive
and punitive policy at the panchayat and
other levels is preventing democratic
participation of women and the poor.
According to the Indian Express (17-1-2001)
an OBC woman sarpanch in M.P, Shashi
Yadav, has become the first victim of this
legislation. On giving birth to her third child
on September 23,2001, the local District
Magistrate imposed Section 36 of MP
Panchayat Raj Act legislating that any
elected office bearer giving birth to a third
child after January 26,2001 is automatically
debarred. The new law was made effective
after the February 2000 panchayat election
through the amendment bills adopted by the
State Assembly on March 29. Since then the
collector’s office has received other similar
complaints about violation of the 2-child
norm.
In the final analysis, it is not merely issues
like SAP and economic globalism but also the
dominant ideological pattern, which
reinforces changes in the class-biased
approach to the demographic question.
Historically, an important component in the
demographic imbalance was the mass
FACTS against MYTHS

enforced dislocation of population following
communal riots during Partition. The
recrudescence of communalism and today,
fundamentalism, are ideologies that seek in
denying people of their basic rights in the
name of religion. While unconcerned about
providing access to safe contraception and
improved quality of life, the approach seeks
to punish the marginalised through coercive
measures. Hindu communalism specifically
exploits this approach in launching a special
campaign to control the numbers of
‘backward’ minorities. By stressing the
communal divide in mixed areas and fuelling
tensions arising out of limited economic
opportunities in a specific area or region,
such engineered conflicts lead to the exodus
of certain section of the people from specific
localities and States resulting in
demographic imbalances (via riots and
displacements of people from their habitats) ’
ultimately succeeding in ghettoising a
community.
Apart from avoiding any critical evaluation
of the SAP-induced analysis of the
demographic balance, bilateral and
multilateral aid agencies — the World Bank,
USAID, UNFPA,etc. — determined to reduce
“population growth” — employ various
fertility control measures on women in the
South. These methods as Dr. S. Brahme
explains are, firstly, imposing “population
control” as a major condition for development
aid; secondly, dumping hazardous
contraceptives and techniques on women;
and thirdly indulging in an incessant
ideological and .propaganda war. An j
illustration of the last is the US, which has
touted population growth as a threat to its
national security! Quoting the journal, the
Washington Quarterly, (1989) Shiva points
out: “As difficult and uncertain as the task
may be, policy makers and strategic planners
in this country have little choice in the
coming decade but to pay serious attention
to population trends, their causes and their
effects. Already, the US has embarked on era
of constrained resources. It thus becomes
more important than ever to do things that
will provide more bang for every buck spent
on national security. Policy makers must
anticipate events and conditions before they
occur. They must employ all the instruments
of state craft at their disposal (development

assistance and population planning every bit
as much as new weapons systems)”.

These policies and ideologies fail to however
consider an important aspect of religious
fundamentalism viz., the fundamentalism
most women are confronted with but left
largely
unaddressed.
Despite
its
denouncement the Vatican for instance is not
considered the best guarantor of women’s
interest and well being in matters of health
and re-production especially in respect to
women in the South. Lest we forget: the
greatest challenge at the 1994 UN Conference
on Population and Development (ICPD),
Cairo, was - and it was not met - to transcend
the politics of both Washington DC and the
Vatican, and place women of the South at the
centre of the ‘population’ discourse: as
subjects, determining their lives and health,
not as objects of State, or Extra
Constitutional State systems and the
demographic Establishment.
In the circumstances it is hardly surprising
that India’s National Health Policy Draft
introduced in August 2001 has been critiqued
as being highly inadequate. The Draft had
stated nothing significant on the population
question, which the health movement has
long held to constitute a major drain on
primary health care. Moreover, the actual
monetary involvement of these aid agencies
to primary health care has been
correspondingly low yet their influence on
health policies is disproportionally high!
Instead the Draft repeats the usual tautology
that progress in public health has been
nullified by population growth. However, as
Prof. Malini Karakal noted in “One India,
One People” (January 2002) that this mantra
contradicts all evidence available globally
that population stabilisation follows
attainment of certain socio-economic
standards and do not precede them.

MYTH: One of the major goals of India’s
Population Policy is to empower women
by making them free to exercise choice
in the variety of new family planning
methods.

FACT: This myth first emerged in the North
during the 60s, 70s and in the early 80s. It
was later revived into a more refined
package by population “experts” by
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incorporating some of the progressive
language of women’s’ and human rights
groups. The former US Administration under
President Clinton had focussed on the
environment, population and women’s rights
as driving force for its foreign policy in a new
global politics. The underlying motive,
however, was the urgency to control
population growth in the South because its
natural resources must be freed for the
growth of US TNCs. And above all “...the US
economy will require large and increasing
amounts of minerals from abroad especially
from less developed countries. That gives
the US enhanced interest in the political,
economic and social stability of the supplying
countries.”

What this imperialistic view — the link
between resources and population growth —
is conveniently blind to is that population
growth is sparked off by appropriation of
resources from the common people in the
South. Such appropriation — which is
necessary for diverting resources from people
to TNCs - also fuels social and political
instability and unrest, as the Zapatista
uprising in Mexico highlighted on New Year’s
Day, 1994.
Moreover, in the liberalised economy in
particular the language of ‘choice’ becomes a
handy tool for whole variety of “population
control” experts. It makes population control
— the denial of the right of the individual to
freely and responsibly choose to have or not
have children - appear as free choice in the
marketplace of contraceptives. But poor
women in the South as targets of such
programmes are not 'free consumers’.
Coercion rather than choice characterises
their situation in such programmes also a
major component of other global aid
packages. (However, due to popular
resistance to such control measures,
governments have dubbed it 'Family
Planning’ and the World Bank masks it as
'Safe Motherhood’!)
In India, the myth exposes women to the
danger of having hazardous drugs invaded
into her, frequently in a guarded and veiled
manner and without proper information or
monitoring. Since all such drugs target
women, she has to bear the major burden of

this “liberalised” approach. The conventional
sterilisation programmes being already
largely women-oriented (96% tubertomy and
3.5% vasectomy in 1993), these changes,
instead of moving towards a policy that
would protect her, pushes her into further
pain and suffering.

Incidentally,‘right choice* is also being used
by unscrupulous sections of the medical
fraternity to promote certain pre-natal
diagnostic test for foetal sex-determination.
The Pre-Natal Diagnostic Techniqus
(Regulation and Prevention of Misuse). Act
to regulate this and ban sex determination
tests (passed in 1994) is a weak one and not
checking the trend, which would, through
abortion of the female foetus, not only lead
to serious demographic imbalance, but also
jeopardise maternal health. Increase in
female infanticide in some States has already
affected the sex ratio adversely.
Finally, the government by failing to take up
any of the positive recommendations of the
Swaninathan Committee in 1994 exposed
itself as being anti-woman and anti-poor.
Instead it went ahead and introduced the 79th
Constitutent Amendment Bill to the
Parliament, whereby people having more
than two children would be disqualified from
contesting parliamentary elections believing
in the policy of incentives and disincentives.
Undoubtedly, disincentives and indirectly
coercive tactics of this nature, far from
empowering them precipitates pressure on
women and the poorer sections.
MYTH: Women having multiple
deliveries are an important cause in the
high rate of maternal deaths in the
South

FACT: This view is related to the one
commented elsewhere in this issue but takes
into account the particular problem of grand
multiparity. It is a well known fact that
grand multiparity is linked with inflated
maternal mortality figures in the South but
to a very limited extent in the more affluent
North. An illustration is the very low
maternal mortality in the North also in cases
of high parity. Studies in Nigeria had also
shown that high maternal mortality is
associated to high parity only if child
mortality is high. This is a parallel to the
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finding in most countries of the North: what
kills the mother is not the parity but the
poverty.
Even if it is assumed a poor country with
inflated maternal mortality in the high
parity range, it can still be concluded, as have
been shown in various computer simulation
studies, that the elimination of all grand
multiparty (_> parity 5) completely will mean
a less than 5% reduction of maternal deaths.
This and similar findings indicate the limited
value of targeting grand multiparous women
with sterilisation in order to reduce the
overall maternal mortality. It must be
underscored, however, that the vast majority
grand multifarious women actually have an
unmet need, perceived by them, for fertility
control. This important maternal health
aspect of grand multiparty is distinctly
different from one blaming grand multiparity ’
as a major “cause” of maternal mortality.
MYTH: Birth control also efficiently
reduces the maternal mortality ratio.

FACT: It is clear that zero fertility, will
automatically mean zero material mortality.
It is less clear what the impact is of fertility
regulation in the reduction of the mortality
ratio. The latter ratio is defined as the
number of maternal deaths to 100,000 live
births. In a Bangladesh study in the early 80s
it was shown that the impact of fertility
regulation was unexpectedly limited. Two
villages were set up for comparison, in which
one was subject to an intense fertility
regulation drive whilst in the other no
fertility regulation propaganda was made. In I
the first village, the fertility was reduced by
26% in relation to the non-fertility regulation
village. Unexpectedly, the maternal
mortality ratio was identical in the two
villages. The explanation was that the
intensive fertility regulation programme had
not conveyed any increase in the safety at
birth in the village. That is, those
pregnancies being needed did not enjoy any
better protection in the fertility regulation
village than in the other village.
A conclusion is that fertility regulation,
while reducing the actual number of
pregnancies, did not achieve a better safety
at birth or could even have been
counterproductive to better safe mother.
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MYTH: Birth control, after all, was an
important factor in the decline of
maternal mortality in the North.

FACT: In the North the maternal mortality
ratio dropped considerably from levels of
around 1000 to about 5 maternal deaths per
100,000 live births over a period of 300 years.
Much of this decline occurred prior to any
kind of modern contraception was available.
A similar pattern has been found in other
situations. Much more important a factor was
the advent of midwifery, particularly in
remote areas and the recognition of health
and hygiene for the reduction of post
delivery infection. Still further was the
availability of antibiotics and blood
transfusions and when antenatal care and
hospital deliveries were introduced for and
^.utilised by >90% of pregnancies.
Fertility regulation has its own value, which
is indisputable. Health-oriented provision of
contraceptives in order to empower women
(and men) to plan for optimal reproductive
health and voluntary spacing of births do not
need discussion. The controversial point is
when birth control is claimed to be so
efficient in the curbing of the inflated
maternal mortality in the South that it is
given priority ahead of a more
comprehensive and efficient maternal and
reproductive health care. Studies have since
demonstrated conclusively that "efficient
health-care is more effective than fertility
regulation in preventing maternal deaths."

MYTH: By effectively addressing the
) unmet demand for contraception will
result in significantly reducing
population growth rates.
FACT: Proponents of the family planning
approach cite data showing that in many
countries of the South almost half of all
women of child-bearing age want no more
children but (unfortunately) lack easy access
to birth control. Fertility rates would drop
by a third if this unmet need were met.

This argument entails a huge assumption:
without transforming social reality —
especially the powerlessness of women visk-vis men and the meagre access of the poor
to food security and other resources — women
will in fact be able to act on their stated
desire for fewer children. But this begs this
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question whether many women indeed
declare their preference for fewer children
yet lack the power to act on their preference
- even if the technical means of birth control
were available?

In other words, to believe that the mere
provision of contraception will suddenly
allow women to step out of their subordinate
role in the family, or alter the fact that
children still represent a source of security
for many parents in countries of the South,
is to ignore the findings of decades of
fertility-oriented research.

Moreover, if unmet demand were truly as
great as it is assumed, why have population
planners had to and still resort to incentives
and disincentives? In some cases, outright
coercion has been deemed necessary to get
people to accept birth control, suggesting
that people must be made to set aside their
own judgements, about their need for
children!
As part of their single-minded effort to
promote birth control a number of agencies,
globally and nationally along with willing
governments have not only sought to respond
to existing contraceptive demand, but have
actively worked to increase it. While some
strategies are relatively innocuous - TV sit
coms promoting new family size norms — a
wide variety of incentives and disincentives
are used to induce people to undergo family
planning measures or to use contraception

MYTH: Birth control directed towards
‘high risk” women will also be
particularly successful to reduce
maternal mortality.

FACT: Most maternal deaths occur among
women with medium number of children in
the family (parity 2-4) within the 20-35 age
group. This fact is, however, often overlooked
in the risk approach strategy for lowering of
maternal mortality. The consequence is that
interventions in “high risk” pregnancies will
improve conditions in small groups of women
and will have limited overall impact on
maternal mortality. This conclusion is
derived from various findings. A Bangladesh
study (1968-70) was highly revealing. It was
calculated that if all births had been averted
in women i) below age 20, ii) above age 39
and iii) beyond parity 6, the maternal

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MYTH: Islam does not permit family planning.

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FACT: The basis of this myth emanates from the logic that Islam values the family
and encourages procreation. In support of this conclusion, two pieces of evidence
are often cited viz., that the Qur’an prohibited Muslims from killing their children
for fear of want. Second that the Prophet exhorted Muslims to multiply. However,
this argument does not do justice to the complexity of the Islamic position and the
totality of its teachings. Otherwise, it would be impossible to explain the established
fact that the Prophet knew that some of his companions, including his cousin Ali,
practised al-‘azl (coitus interruptus) and yet he did not prohibit the practice.

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The bigger picture of the Islamic position on family planning is its departure point
in encouraging the life principle. Hence, the Prophet’s exhortation to multiply and
the Qur’anic prohibition of infanticide, a wide-spread pre-Islamic practice involving
bom children which was motivated mostly by economic and gender considerations.
But such a basic position does not necessitate the conclusion that contraception,or
even abortion, is prohibited. Indeed, historically, the majority view among Muslim
scholars on contraception has been that it is permissible with the wife’s consent,
though perhaps disliked in certain cases. The wife’s consent is required because
Islam recognises the wife’s right to sexual enjoyment and procreation.

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A leading proponent of this view is Imam al-Ghazali (d.llll) who also notes on
contraception that there are no such prohibitions. In fact, the opposite is true. His
analogical logic is startling in its simplicity. In one part of his argument, he notes
that, despite the prophetic exhortation to multiply, it is nevertheless permissible
for a Muslim to remain single. The effect of remaining single on multiplying, he
reasoned, is no different than the effect of practising al-‘azl. Since the one is
permitted, it follows that the other, without more, is also permitted. He further
argues that although contraception is permissible, it is 'makruh’ (adjective meaning
“disliked or disfavoured”) if practised to avoid, for example, female offspring. One
major justification for this conclusion is that preference for male offspring is frowned
upon in the 'Qur’an’. Al-Ghazali, however, supports contraception for other reasons
such as protecting a woman from the dangers of childbirth, avoiding poverty, and
even preserving a woman’s beauty.
In the case of family planning through contraception, the wisli to avoid poverty does
not infringe on the right to life of a born human being. To the contrary, its goal is to
preserve a dignified quality of life for those already bom. On the other hand, using
contraception to avoid having more females reflects a worldview and a value System
antithetical to that of the Qur’an. It was thus ‘makruh’ and discouraged by scholars
like al-Ghazali.

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Other jurists agreed with al-Ghazali’s basic position on contraception but disagreed
on what constitutes ‘makruh’ behaviour. Such disagreement may very well have
been founded in their disparate historical and cultural experiences. In other words,
these are the kind of differences anticipated and tolerated by the principle, viz., that
laws change with changes in time and place, and perhaps the other principles of
‘ijtihad’.

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Concretely, according to the 1961 and 1981 census reports the number of Muslims in
comparison to the total population of India during the last 20 years (1961-81) has
risen from 10.7 per cent to 11.4 per cent i.e. 0.7 percent only. Additionally, during

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the 1981-89 period Muslims accepted temporary methods of family planning that
was enhanced by 11.4 per cent in comparison to previous period whereas Hindus for
instance such increase was only 10 percent. Family welfare Operation Camps in
various districts of West Bengal during 1980-94 showed that a large number of
Muslim women were getting operated along with Hindu women. Most were from
low-income families and the daily grind of maintaining 3-4 children were their main
driving forces while adopting the permanent method.
MYTH: Artificial contraception is unethical and voluntary abortion may never
be licit and it is against the teaching and doctrines of the Roman Catholic
Church.
FACT: In technical terms of Catholic moral theology, the moral permissibility of
artificial contraception and voluntary abortion is a “solidly probable opinion”, i.e.,
one that all Catholics may follow in good conscience. Contraception is not only licit
but may often be morally mandatory. Likewise, the choice of an abortion - a choice
that, ironically, becomes more necessary when artificial contraception is banned - is
a moral option for women in many circumstances. This is common teaching among
Catholic and Protestant moral theologians.
In this context it must be noted that the problems of over-population, merely dumping
condoms on them cannot solve the death of women from reproductive-related causes,
but they will also not go away without condoms. Furthermore, as some experts and
specialists have maintained, abortion has performed a crucial role in most countries
that has moved from a high fertility rate to replacement levels rates’ Artificial
contraception and abortion are not the final or main solution to these problems, but
they are essential options.

MYTH: The Roman Catholic Church’s position to contraception and other
artificial forms has no negative impact on efforts to provide reproductive
health care services to women and the fight against the AIDS pandemic.
FACT: The Roman Catholic Church under the aegis of the Vatican exerts enormous
power and control to foil any efforts to provide reproductive health care services for
especially poor women in the South and to stop AIDS. To illustrate:

In 1999, the Vatican released an official document stating that providing Catholic
women who had been raped in Kosovo with emergency contraception was
equivalent to promoting abortion. Previously, in reference to women in Bosnia,
theoope went to the extent of stating that raped women should “accept the enemy”
and .3make “flesh of their own flesh”:
4* In 1996, in Nairobi, Kenya, where the AIDS epidemic exploded among young
women, Cardinal Maurice Otunga, Kenya’s leading R.C. church official, burned
boxes of condoms and safe sexual literature. The same year, Kenyan Catholic
Bishop John Njue had even propagated false scientific information by claiming
that condoms are to blame for the spread of AIDS;
4* In 1996, the local R.C. church in Tegucigalpa, Honduras prevented the distribution
of one million condoms by health and election officials at polling stations during a
primary election. Honduras has the highest incidence of AIDS in Central America;

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mortality ratio would have declined from 570
to 430 per 1000.000 live births. Even with
this extremely non-realistic achievement of
virtually cutting off all births from
recognised “risk” groups, a very limited gain
in maternal mortality would have followed.
In spite of the widespread belief that age and
parity are exceptionally important in any
strategy for the reduction of maternal deaths
can be concluded that it is not the age/parity
distribution of births that explains the lower
material mortality in the rich North. Instead,
most maternal deaths occur to women at low
risk. This seemingly paradoxical point can

be explained by the fact that available risk
markers are not very efficient in predicting
maternal death. For instance, there are no
risk markers to predict death from abundant
vaginal bleeding due to a non-contracting
uterus, nor to death causeway post-delivery
infection. But there is one albeit an
inefficient risk marker for eclampsia, that is
pre-eclampsia (high blood pressure
associated with pregnancy). Still, it is known
that a significant number of eclamiptic deaths
appear quite unexpectedly like “out of the
blue.”

Learning the Population Jargon5
Crude Birth Rates: The crude birth rate, or CRB, literally measures the number of live births for
every thousand women. The CRB refers to a country as a whole or to a particular subgroup within a
country. “Crude” refers to the fact that it does not take into account the age structure of a population^
which greatly affects the number of births in any given year. For example, if two countries have the"
same number of people, but one has twice as many women of childbearing age, it will have a much
higher crude birth rate. For this reason, the CBR is not directly comparable across countries, or even
across time. It is often used by demographers when better measures are lacking.
Total Fertility Rates: This rate, or TFR, can be thought of as the average number of children that
a woman will have over her reproductive lifetime. It is hypothetical in the sense that it does not
represent the lifetime experience of any particular woman or group ofwomen, but represent a composite
measure. The TFR is calculated as the sum of birth rates specific to each age group of women and
assumes that each cohort’s fertility will hold during the lifetime of the “hypothetical woman”

Population Growth Rate: The population growth rate is the rate at which a particular population
is growing each year. It is calculated relative to a base population size (say, the population size in the
preceding year), and reflects the effects of births, deaths, and migration.
Replacement Level: A population that is at replacement level will exactly replace itself over the
course of a generation with no growth and no decline. In the industrialised North, replacement level
usually corresponds to a TFR of 2.1; in other words, each woman would bear two children, one to
replace herself and the other to replace her mate (The additional .1 births is necessary to offset a
small number of infant deaths and childless women). In the South, replacement levels are somewhat
higher - about 2.5 - because of the higher infant death rates.

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I Facts Against Myths is a monthly bulletin offactual I
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information on a number ofdevelopment myths and
fallacies, etc, including information against alien
development models, paradigms and false concepts
on caste, creed and gender.
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I
I
I
I
I

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