FATAL MISCONCEPTION :The Struggle to Control World Population.
By Matthew Connelly.
Illustrated. 521 pp. Harvard University Press. $35.
(NYT) – The first large-scale scientific test of family planning took place in Khanna, India, beginning in the early 1950s. Backed by the Rockefeller Foundation and the Harvard School of Public Health, researchers asked 8,000 villagers how often they had sex, whether they wanted to conceive and the details of the women’s menstrual cycles. The researchers met the villagers monthly and provided contraceptives, while closely monitoring another group that was given no contraceptives. After five years, the women given contraceptives had a higher birth rate than those who hadn’t received any assistance.
That initiative was an early warning that population policy can be very difficult to get right. In “Fatal Misconception,” Matthew Connelly, an associate professor of history at Columbia University, carefully assembles a century’s worth of mistakes, arrogance, racism, sexism and incompetence in what the jacket copy calls a “withering critique” of “a humanitarian movement gone terribly awry.”
Efforts to control population have long been ferociously controversial, and the United States under George W. Bush refuses to provide a penny of funding for the United Nations Population Fund because of its supposed (but in fact nonexistent) links to forced abortion in China. Critics of family planning programs will seize gleefully upon this book, and that’s unfortunate, because two propositions are both correct: first, population planners have made grievous mistakes and were inexcusably quiet for too long about forced sterilization in countries like India and China; and second, those same planners have learned from past mistakes and today are fighting poverty and saving vast numbers of lives in developing countries.
“Fatal Misconception” is to population policy what William Easterly’s “White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good” (2006) was to foreign aid: a useful, important but ultimately unbalanced corrective to smug self-satisfaction among humanitarians. Connelly scrupulously displays a hundred years of family planners’ dirty laundry, but without adequately emphasizing that we are far better off for their efforts. One could write a withering history of medicine, focusing on doctors’ infecting patients when they weren’t bleeding them, but doctors are pretty handy people to have around today. And so are family planners.
One of the movement’s early sins was a fondness for eugenics, the belief that contraception was perfect for “dull-minded natives,” as one enthusiast put it, or for curbing the share of melanin in the admixture of humanity. Activists sometimes seem to have had antifreeze in their veins. Connelly cites a crusader named William Vogt, author of a best-selling environmental diatribe called “Road to Survival,” who in 1948 described tropical diseases like sleeping sickness as “advantages” because they helped curb population growth and scolded the medical profession for believing it “continues to have a duty to keep alive as many people” — read: brown and black people — “as possible.” Margaret Sanger, who courageously pioneered the cause of birth control, icily promoted contraception “to be used in poverty-stricken slums, jungles and among the most ignorant people.”
In the 1960s, the United States began to pour money into population control, pushing nations to adopt family planning as a condition of foreign aid. One result was extensive campaigns to insert IUDs, with little or no follow-up care for the many women who developed pelvic inflammatory disease and other problems. When the manufacturer of the Dalkon Shield was hit with lawsuits over dangerous complications, it offered the device at a big discount (and unsterilized) to the United States Agency for International Development, which happily shipped it abroad to be used by less litigious dark-skinned women. As Connelly writes, “Scientists and activists worldwide had agreed that high fertility was to be treated as a disease, and that birth control for nations made individuals expendable.”
In fairness, while IUDs were dangerous, so was pregnancy. The planners reasoned that while many people would suffer or die from botched sterilizations or contraception, tens of thousands fewer women would die in childbirth. Unfortunately, they showed little interest in maternal health care, and they often mixed an admirable impulse to serve humanity with a blithe contempt for individual humans.
It didn’t help that the planners were virtually all Western men who had little understanding of life in the villages. At the 1974 World Population Conference, 127 of the 130 national delegations were led by men. The planners had far too much confidence in their own wisdom. Paul Ehrlich’s best-selling book “The Population Bomb” had warned that the world was on the verge of terrible famines and urged the United States to cut off food aid to areas beyond hope. At the World Bank, Robert McNamara discouraged financing of health care “unless it was very strictly related to population control, because usually health facilities contributed to the decline of the death rate, and thereby to the population explosion.”
Planners always assumed their programs would lower fertility. The reality, however, was more nuanced. Evidence from careful, randomized studies suggests that well-designed, intensive birth control programs can reduce fertility somewhat, but that simply shoveling pills or condoms at peasants has little or no impact. Poor and uneducated people often want lots of children, so to be successful, family planning has to focus as much on reducing desired family size as on curbing ovulation. “Even according to the most favorable contemporary studies,” Connelly writes, “family planning efforts explained less than 5 percent of fertility levels in developing countries.”
In 1983, the United Nations disgraced itself by giving its Population Award gold medal to Qian Xinzhong, head of the Chinese government’s brutal quasi-military campaign of forced sterilizations and abortions as part of a crackdown under its one-child policy. Yet gradually the population movement became aware that women had rights as well as uteruses. This awareness coincided with the rise of women in the movement in the United States and abroad, including the appointment of Nafis Sadik as head of the United Nations Population Fund in 1987. Under Sadik, a Pakistani gynecologist known for promoting women’s rights, the fund expanded its scope to tackling maternal mortality and the spread of AIDS. It has also become a huge positive force in China, taming coercive policies and pushing for replacement of the traditional Chinese IUD, which was ineffective and painful (but which the government favored because it was cheap). More broadly, planners have embraced education for girls — now recognized as the single most effective means of contraception in poor countries — as well as programs like microcredit that empower women and reduce fertility, too. They are also leading the fight to lower maternal mortality, which continues to take more than half a million lives a year.
It’s certainly fair of Connelly to dredge up the forced sterilizations, the casual disregard for injuries caused by IUDs, the racism and sexism and all the rest — but we also need to remember that all that is history. The family planning movement has corrected itself, and today it saves the lives of women in poor countries and is central to efforts to reduce poverty worldwide. If we allow that past to tarnish today’s efforts by family planning organizations, women in poor countries will be doubly hurt.
Just might have to read this book. It’ll probably get my blood pressure up in the dangerous range.
MorganRants 