[Congressional Record Volume 145, Number 46 (Tuesday, March 23, 1999)]
[House]
[Pages H1510-H1525]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SENSE OF HOUSE REGARDING FAMILY PLANNING PROGRAMS
Mr. CHABOT. Mr. Speaker, I move to suspend the rules and agree to the
resolution (H. Res. 118) reaffirming the principles of the Programme of
Action of the International Conference on Population and Development
with respect to the sovereign rights of countries and the right of
voluntary and informed consent in family planning programs.
The Clerk read as follows:
H. Res. 118
Whereas the United Nations General Assembly has decided to
convene a special session from June 30 to July 2, 1999, in
order to review and appraise the implementation of
[[Page H1511]]
the Programme of Action of the International Conference on
Population and Development;
Whereas chapter II of the Programme of Action, which sets
forth the principles of that document, begins: ``The
implementation of the recommendations contained in the
Programme of Action is the sovereign right of each country,
consistent with national laws and development priorities,
with full respect for the various religious and ethical
values and cultural backgrounds of its people, and in
conformity with universally recognized international human
rights.'';
Whereas section 7.12 of the Programme of Action states:
``The principle of informed [consent] is essential to the
long-term success of family-planning programmes. Any form of
coercion has no part to play.'';
Whereas section 7.12 of the Programme of Action further
states: ``Government goals for family planning should be
defined in terms of unmet needs for information and services.
Demographic goals . . . should not be imposed on family-
planning providers in the form of targets or quotas for the
recruitment of clients.''; and
Whereas section 7.17 of the Programme of Action states:
``[g]overnments should secure conformity to human rights and
to ethical and professional standards in the delivery of
family planning and related reproductive health services
aimed at ensuring responsible, voluntary and informed consent
and also regarding service provision'': Now, therefore, be it
Resolved, That it is the sense of the House of
Representatives that--
(1) no bilateral or multilateral assistance or benefit to
any country should be conditioned upon or linked to that
country's adoption or failure to adopt population programs,
or to the relinquishment of that country's sovereign right to
implement the Programme of Action of the International
Conference on Population and Development consistent with its
own national laws and development priorities, with full
respect for the various religious and ethical values and
cultural backgrounds of its people, and in conformity with
universally recognized international human rights;
(2)(A) family planning service providers or referral agents
should not implement or be subject to quotas, or other
numerical targets, of total number of births, number of
family planning acceptors, or acceptors of a particular
method of family planning;
(B) subparagraph (A) should not be construed to preclude
the use of quantitative estimates or indicators for budgeting
and planning purposes;
(3) no family planning project should include payment of
incentives, bribes, gratuities, or financial reward to any
person in exchange for becoming a family planning acceptor or
to program personnel for achieving a numerical target or
quota of total number of births, number of family planning
acceptors, or acceptors of a particular method of family
planning;
(4) no project should deny any right or benefit, including
the right of access to participate in any program of general
welfare or the right of access to health care, as a
consequence of any person's decision not to accept family
planning services;
(5) every family planning project should provide family
planning acceptors with comprehensible information on the
health benefits and risks of the method chosen, including
those conditions that might render the use of the method
inadvisable and those adverse side effects known to be
consequent to the use of the method;
(6) every family planning project should ensure that
experimental contraceptive drugs and devices and medical
procedures are provided only in the context of a scientific
study in which participants are advised of potential risks
and benefits; and
(7) the United States should reaffirm the principles
described in paragraphs (1) through (6) in the special
session of the United Nations General Assembly to be held
between June 30 and July 2, 1999, and in all preparatory
meetings for the special session.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Ohio (Mr. Chabot) and the gentleman from Connecticut (Mr. Gejdenson)
each will control 20 minutes.
The Chair recognizes the gentleman from Ohio (Mr. Chabot).
General Leave
Mr. CHABOT. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks on
the resolution, H. Res. 118.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Ohio?
There was no objection.
Mr. CHABOT. Mr. Speaker, I yield myself such time as I may consume.
This bill reaffirms the principles of the program of action of the
International Conference on Population and Development with respect to
the sovereign rights of countries and the right of voluntary and
informed consent in family planning programs. Mr. Speaker, I want to
commend my good friend and colleague, the gentleman from Kansas (Mr.
Tiahrt), for authoring this sense of the Congress resolution to affirm
the voluntary family planning language that was adopted during House
consideration of the fiscal year 1999 foreign operations appropriations
legislation and later included as part of the Omnibus Appropriation Act
of 1998.
As my colleagues know, the United Nations General Assembly will
convene a special session from June 30 to July 2 of this year in order
to review and appraise the implementation of the program of action of
the International Conference on Population and Development. This
resolution sends a message to that conference that it is the belief of
the United States Congress that all family planning programs should be
completely voluntary, avoid numerical targets and provide recipients
complete information on methods and generally respect individual values
and beliefs as well as national laws and development priorities.
Mr. Speaker, again I want to compliment my colleague from Kansas for
offering this legislation. It is a timely resolution, it is well
drafted, and it deserves the support of this House. I urge adoption of
the resolution.
Mr. Speaker, I reserve the balance of my time.
Mr. GEJDENSON. Mr. Speaker, I yield myself such time as I may
consume.
Over a year ago we had a debate on U.S. funding for family planning.
Frankly, I was sad to see that a number of Members voted against that.
About 17 of the original cosponsors of this resolution today, of the 23
Members who cosponsored this resolution, voted against the funding for
AID to do family planning work. So I am happy to see them here today
moving the abortion debate out of the family planning debate, and what
is happening through the years all too often is people who oppose
abortion end up opposing the funding for family planning, and it always
confused me in the sense that, if we want to reduce the chances of
abortion, make sure good family planning is available.
Mr. Speaker, there is nothing we can do for child survival, for the
quality of life of especially some of the poorest countries, to make
sure we maintain our leadership role in supporting family planning, and
I am, frankly, hopeful by this resolution that we will see more
cooperation on family planning and separate it from the debate on
abortion. Some of us, like myself, are pro-choice and we think that
that is obviously a woman has a right to decide with her doctor. We do
not believe government ought to interfere with that. But if we can get
an agreement on the family planning funds, we could certainly reduce
the need for lots of abortions, and it is an area that we agree on.
Now, frankly, if I had written this resolution, I would have included
other provisions than were included, but this resolution was written by
the Republican majority. But for those of us on our side of the aisle,
I think I speak for most of us that we want to make sure that child
survival is increased and the space and number of children a mother has
has a direct impact on child survival.
Mr. Speaker, voluntary family planning is at the heart of our
program, and the folks at AID have done a great job historically in
trying to lead that effort.
Mr. Speaker, I reserve the balance of my time.
Mr. CHABOT. Mr. Speaker, I yield 5 minutes to the gentleman from
Kansas (Mr. Tiahrt).
Mr. TIAHRT. Mr. Speaker, I rise in support of House Resolution 118,
and I want to thank the gentleman from Ohio (Mr. Chabot) for yielding
to me.
I have introduced this resolution in anticipation of the meetings
being held at the United Nations this week to prepare for the 5-year
review of the progress made since 1994 International Conference on
Population and Development which was held in Cairo. The language of
this resolution represents a compromise between myself and Population
Action International. It is supported by Zero Population Growth, and it
mirrors the language of the amendment I offered last year to the Fiscal
Year 1999 Foreign Operations Appropriations Act. As my colleagues may
recall, that language laid out the definition for ``voluntary'' in a
context of U.S. funded family planning programs. That amendment was
offered in the wake of disturbing news stories that spoke of women
being forced to participate in family planning programs and
[[Page H1512]]
in some instances were sterilized against their will, as my chart
indicates.
Here we have several stories that were covered by the New York Times,
the Wall Street Journal, the Miami Herald and the Sacramento Bee
talking about occurrences in Peru where women were forced into
sterilization.
The voluntary family planning amendment I offered last year was
adopted on a voice vote and later enacted into law as part of last
year's Omnibus Appropriation Act. While the voluntary family planning
amendment enacted into law last year prevents U.S. dollars from being
spent in family programs that are not administered in a voluntary
manner, many programs worldwide still employ these same methods of
coercion, incentives, bribes and quotas. For example, in Indonesia
family planning clinics rely on threats and intimidation to bring women
into their clinics. In Mexico hundreds of forced sterilizations have
been documented, and medical personnel have been fired for their
refusal to perform sterilizations. In addition, women refusing
sterilization have been denied medical treatment. In Peru, as we said
earlier, family planning programs use coercion, misinformation, quotas
and sterilization for food efforts.
These terrible violations of human rights are the reason I have
introduced House Resolution 118. The resolution reaffirms the emphasis
that the U.S. has taken on giving women a choice and stating that it is
Congress' belief that all family planning programs should be completely
voluntary, that they should avoid numerical targets and provide
recipients with complete information on the methods, including telling
recipients whether the methods are experimental, and I think we can all
agree that we should respect individual values and beliefs as well as
national laws and development priorities.
Mr. Speaker, it is my hope that the House will adopt this resolution
and send a strong message to the United Nations that we believe every
family planning program in the world should be carried out in a truly
voluntary manner as described by the definition added to the Omnibus
Appropriations Act last year. I would ask my colleagues to please
support House Resolution 118.
[From the New York Times, Feb. 15, 1999]
Using Gifts as Bait, Peru Sterilizes Poor Women
(By Calvin Sims)
Lima, Peru, Feb. 14--For Magna Morales and Bernadina Alva,
peasant Andean women who could barely afford to feed their
families, it was a troubling offer but one they found hard to
refuse. Shortly before Chirstmas, Government health workers
promised gifts of food and clothing if they underwent a
sterilization procedure called tubal ligation.
The operation went well for Mrs. Alva, 26, who received two
dresses for her daughter and a T-shirt for her son. But Mrs.
Morales, 34, died of complications 10 days after the surgery,
leaving three young children and a husband behind. She was
never well enough to pick up the promised gifts, and the
family was told it could not sue the Government over her
death because she had agreed to the procedure.
``When you don't have anything and they offer you clothes
and food for your kids, then finally you agree to do it,''
said Mrs. Alva, a neighbor of Mrs. Morales in the northern
village of Tocache. ``Magna told them that her husband was
against the idea, but they told her, `Don't worry, we can do
it right now, and tonight you will be back home cooking and
your husband will never realize what happened.' ''
Tales of poor women like Mrs. Morales and Mrs. Alva being
pressed and even forced to submit to sterilization operations
that have left at least two women dead and hundreds injured
have emerged from small towns and villages across Peru in
recent weeks in what women's groups, politicians and church
leaders here say is an ambitious Government family planning
program run amok.
Critics of the program, which was begun in 1995, charge
that state health care workers, in a hurry to meet
Government-imposed sterilization quotes that offer promotions
and cash incentives, are taking advantage of poor rural
women, many of whom are illiterate and speak only indigenous
Indian languages.
The critics, who include many of the program's early
supporters, say the health workers are not telling poor women
about alternative methods of contraception or that tubal
ligation is nearly always irreversible. They also charge that
many state doctors are performing sloppy operations, at times
in unsanitary conditions
``They always look for the poorest women, especially those
who don't understand Spanish,'' said Gregoria Chuquihuancas,
another Tocache resident. ``They make them put their
fingerprint on a sterilization paper they don't understand
because they can't read. If the women refuse, they threaten
to cut off the food and milk programs.''
While it remains unclear whether such actions were
sanctioned by the Government or were the work of overzealous
health workers--the Government denies there are sterilization
quotas, though it acknowledges goals for budgetary purposes--
independent investigations by members of the Peruvian
Congress, the Roman Catholic Church, local journalists and a
United States Congressional committee have chronicled dozens
of cases of abuse.
``The Government's program is morally corrupt because
nurses and doctors are under pressure to find women to
sterilize, and the women are not allowed to make an informed
decision,'' said Luis Solari, a medical doctor who advises
the Peruvian Episcopal Conference, which speaks for the
country's Catholic bishops.
``No one has the right to intervene in people's life this
way,'' Dr. Solari said. ``It's criminal.''
From its inception, Catholic church leaders have vigorously
opposed the family planning campaign because it promotes
artificial forms of birth control, which the church disavows.
Augusto Cardinal Vargas Alzamora of Lima has warned Catholics
that they will be committing a ``grave sin'' if they resort
to sterilization. Tubal ligation is still only the third most
practiced form of contraception in Peru, after abstinence and
the I.U.D., family planning officials say. Abortion is
illegal.
The Government has vehemently rejected charges that it is
conducting a campaign to sterilize poor women and says that
all its sterilization operations are done with the patient's
consent, as required by law.
Health Ministry officials, who spoke on condition of
anonymity, said that in the last year the program had
suffered from ``lapses in judgment'' by individual health
care workers and doctors, who had been reprimanded. But the
officials said that such cases were isolated incidents that
had been blown out of proportion.
Reached on his cellular telephone, Deputy Health Minister
Alejandro Aguinaga, who oversees the program, said he did not
wish to speak with The New York Times.
Three years ago, when President Alberto K. Fujimori
announced plans to promote birth control as a way to reduce
family size and widespread poverty in Peru, family planning
experts, feminists and even many opposition politicians
expressed broad support for the initiative. But the mounting
criticism of the sterilization has tarnished the image of the
family planning program, one of the most ambitious in the
developing world.
In 1997, state doctors in Peru performed 110,000
sterilizations on women, up from 30,000 in 1996 and 10,000 in
1995. Last year they also performed 10,000 free vasectomies
on men, a slight increase over 1996. However, women remain
the main focus of the Government's program because men are
less likely to agree to sterilization, on the mistaken ground
that the procedure could impair their virility.
Health Ministry officials estimate that the 1997
sterilizations will result in 26,000 fewer births in 1998.
This is good news, they say, in a country where the fertility
rate--the average number of children born per woman--is 3.5,
compared with 3.1 for Latin America in general and 2 for the
United States.
The rate is 6.2 children for Peruvian women who have little
or no education and 7 children for those who live in rural
areas. That compares with a rate of 1.7 children for women
who have at least some college education and 2.8 for urban
residents of all educational levels.
Concern over reports of forced sterilization has led to an
investigation by the United States Congressional Subcommittee
on International and Human Rights Operations, which is
seeking to determine if money from the United States Agency
for International Development was used in the Peruvian
Government's campaign.
Officials in Washington said in a telephone interview that
the agency had no role in the Peruvian Government's family
planning program. They said that money and training for
family planning services went directly to nongovernmental
agencies in Peru that have no connection with the
Government's program.
The officials said that they had deliberately taken steps
to disassociate the agency from the Peruvian Government's
family planning program after it became clear that, while
well intentioned, it was too hurried and ambitious to avoid
the pitfalls that it has now encountered.
Joseph Rees, the subcommittee's chief council, said that
after a recent fact-finding mission to Peru he was convinced
that no United States money was directly used to finance the
Peruvian Government's campaign.
But he expressed concern that some money may have trickled
through in the form of infrastructure, management or training
support. Because some United States-sponsored food programs
are operated from the same Peruvian Government medical posts
that administer family planning in rural areas, Mr. Rees said
that it was possible that some of this food could have been
used to bribe women to undergo sterilizations.
``The bottom line here is whether the Peruvian Government
is more interested in doing family planning or population
control and whether the United States wants to risk being
associated with a program where that notion is so far
unclear,'' Mr. Rees said.
[[Page H1513]]
Meanwhile, despite the reported abuses, the number of women
undergoing sterilization in Peru has remained steady.
Preliminary figures for January indicate that at least 10,000
women underwent free tubal ligations by state doctors.
The opposition Renovacion Party, a conservative group that
has always objected to the program, says it has collected
more than 1,000 complaints from women who say they were
either injured by Government sterilization or pressured into
agreeing to the operation.
Arturo Salazar, a Renovacion congressman, said the Fujimori
Government had given no thought to the long-term effect of so
many sterilizations, which if left unchecked, he said, will
severely diminish Peru's rural population, deprive the nation
of security on its frontiers and impede economic development
in the countryside.
But those issues are of little concern to Martha Eras, also
of Tocache, who is struggling to care for her new baby girl,
who was born in August despite the Government-sponsored
sterilization that Mrs. Eras voluntarily underwent eight
months earlier. It appears that the doctor was in such a
hurry that he did not check to see if Mrs. Eras was pregnant.
``My husband joked that it was immaculate conception,'' she
said.
[Excepts from Population Research Institute Review]
PRI Petitions for Norplant Withdrawal
(By David Morrison)
On 24 July 1994 Wyeth-Ayerst itself promulgated a revised
and greatly expanded set of guidelines for doctors and
clinics involved in the sale and insertion of Norplant. These
new guidelines went far beyond those which had originally
been issued, mentioning no fewer than 23 new, separate
adverse health conditions related to Norplant, including
pseudo tumor cerebri, stroke, arm pain and numbness.
Unfortunately this new information on adverse health
conditions is alleged not to have been provided to the
hundreds of thousands of women currently using Norplant, nor,
it is further alleged, were physicians or clinics required to
inform prospective Norplant users of this new information.
____
Sterilization in India
Kathy Rennie, Bloomington, IL
Recently, I was able to spend seven weeks in India and was
so surprised at what I learned. I was able to spend some time
in a small village where the people were very poor and was
appalled to learn that all the women had been sterilized.
These were young women with one or two children. When I
inquired further about this, I was told that the government
had paid them a large sum of money to be sterilized.
These women felt they had no choice but to take the money
because they were so poor and they felt as if they were doing
their duty to lower the population.
____
Norplant Alleged To Cause Blindness--Abuse of Women in Bangladesh and
Haiti Documented
The side effects of having five-cylinders of synthetic
progesterone implanted into one's arm were supposed to be
minimal and to only occur in a few women. While Planned
Parenthood Federation of America, in its fact sheet on
Norplant, mentions ``irregular menstruation . . . headaches,
and mood changes'' as ``possible side effects,'' another PPFA
publication, Norplant and You, suggests that ``bleeding
usually becomes more regular after nine to 12 months'' and
``[u]sually there is less blood loss with Norplant than with
a normal period.''
norplant linked to blindness?
Nothing in the Population Council literature about Norplant
describes the horrors Patsy Smith, a mother in Houston,
Texas, experienced:
``Three months after having Norplant inserted I started
getting horrible headaches . . . like somebody was just
grabbing my head and just squeezing it together as tight as
can be squeezed; like someone had put a bomb in there and it
was going to go off. I'd noticed that [my vision] being kind
of blurry and after the months it got a little bit more
blurry and things started looking like they were on top of
each other.'' \1\
---------------------------------------------------------------------------
\1\ All quotes in this story come from The Human Laboratory,
a documentary produced by the British Broadcasting
Corporation's Horizon series and aired in Britain on 8
November 1995.
---------------------------------------------------------------------------
Although headaches are listed among the possible side
effects for Norplant, the severity of the pain and the
worrisome blurring of her vision led Patsy to visit noted
neuro-opthalmologist Dr. Rosa Tang, who admitted her to a
Texas hospital where she came to understand the seriousness
of her condition
Patsy has a condition called pseudo-tumor cerebri, where
increased fluid pressure in the brain crushes the optic
nerve. The damage in Patsy's case is severe; blindness in one
eye and partial blindness in the other. Another such episode
could take away her sight entirely.
In reviewing Patsy's medical history Tang came to suspect
that Patsy's condition was related to the use of Norplant.
She wrote to all the other eye specialists in Texas to ask if
any of their patients on Norplant had exhibited similar
symptoms. Over 100 cases were brought to her attention,
including 40 women with blurred vision and eight women with
conditions identical to Patsy's. The numbers startled Dr.
Tang:
``It was very surprising for me because I had not seen any
reports in the literature at this time of such a link between
Norplant and pseudo-tumor cerebri and I was surprised of the
fact that there were so many patients that seemed to be
having the condition related to Norplant. I think that there
is enough out there that there is a possibility of a link
between the two [and] that a larger-scale study should be
done if Norplant is to be continued.''
If something as serious as pseudo-tumor cerebri was a
possible side-effect of the implant, why weren't women being
told? Why wasn't Wyeth-Ayerst, the company which produces
Norplant for the Population Council, required to list this
condition among the possible side-effects? Norplant is the
result of almost 25 years of Population Council research. It
has been tested on women in developing countries almost
continuously since 1972. Surely something as serious as
pseudo-tumor cerebri would have shown up during these lengthy
and presumably rigorous trials. But how rigorous were the
trials? Were they scientifically valid at all? Until recently
no one was asking these questions. No one had heard of what
had happened in trial sites such as Bangladesh and Haiti.
* * * * *
the trial of the poor
The Norplant trial carried out in the slum areas near
Dhaka, Bangladesh, according to recent reports, as anything
but objective and rigorous. In fact, women were enrolled in
the trial without their knowledge or consent. Dr. Nasreen
Huq, a physician who works with several non-governmental
organizations in the poorer areas of Bangladesh, states:
``Participation in a clinical trial requires that the
person who is participating in that trial understand that it
is a trial, that the drug they are testing out is still in
experimental stages. This requires informed consent. This was
categorically missing.''
Akhter reported that women who took Norplant ``. . .
fainted quite often, you know, which was not the case
before.'' Other women complained that ``[the family planners]
were telling us we were supposed to be very happy after
taking this Norplant, but why our life is like hell now?''
Not only were these adverse side-effects not noted, desperate
cries from the women to have the implants removed were simply
ignored according to several women:
``In 6 months [I went to the clinic] about 12 times. Yes,
about 12 times, I went to the clinic and pleaded `I'm having
so many problems. I'm confined to bed most of the time.
Please remove it.' My health broke down completely. I was
reduced to skin and bone. I had milk and eggs when I could,
but that did me no good.''
``I felt so bad, my body felt so weak, even my husband told
me it was all very inconvenient . . . [My husband] says he'll
get another wife tomorrow. I told the doctors. `Please take
it out, I'm having so many problems . . . I felt like
throwing myself under the wheels of a car.''
Many women found their way out of the trial blocked for
lack of funds:
``I went to the clinic as often as twice a week. But they
said. `This thing we put in you costs 5,000 takas. We'll not
remove it unless you pay this money.' Of course I feel very
angry. I went to several other doctors and offered them money
to take those things out, but they all refused. I went to
three or four of them and they said these can only be taken
out by those who put them in. They said that if they tried
they might go to jail.''
``One woman, when she begged to remove it, said `I'm dying,
please help me get it out.' They said `OK, when you die you
inform us, we'll get it out of your dead body,' so this is
the way they were treated. In a slum area people are living
in a very small, like 5 feet by 7 feet where at least five
family members are living and these women are working
outside. The most important resource they have is their own
healthy condition.''
``We have . . . information where these women have told us
that they have sold their cow or the goat which was the only
asset they had for treatment because she had to get well,
otherwise the family can't survive, so in order to save her,
they had to, you know, sell the cow or if they didn't want to
treat her then she suffered, so the family was suffering
either way. In every sense these people were totally torn.
Their economic condition was torn, their family happiness was
totally gone.''
``I couldn't see. I couldn't look at things at a distance.
I had trouble focusing. You know in the village we light oil
lamps. I couldn't look at them. They looked like the sun, as
red and large as the sun. If I looked into the distance, my
eyes would water . . . If I went out of doors, my eyes became
absolutely dark. I couldn't see anything at all as if my eyes
had become affected by blindness.''
The 1993 report on the Bangladesh trial contained no hint
of these problems. It blandly stated that: ``Norplant is a
highly effective, safe and acceptable method among
Bangladeshi women,'' claiming that less than 3 percent
reported significant medical problems. The report did not
mention women being denied removal of the implants or the
problems with vision.
Haitian horror detailed similar problems were reported iN
Haiti's Cit, Soleil (City of the Sun) by medical
anthropologist Catherine Maternowska.
[[Page H1514]]
____
Global Monitor: Population Control's Questionable Ethics
(By Ruth Enero)
But what exactly is all the fuss about? To begin with the
so-called anti-pregnancy vaccine, Australia introduced this
type of drug in 1986. The intent was to trigger a given
woman's body into producing antibodies to hCG (human
chorionic gonadotropin), a hormone essential to pregnancy.
Because the drug affects the immune system, it poses health
risks, including damage to pituitary and thyroid glands,
inappropriate immune responses, possible infertility, and
more. Women can't remove this vaccine or stop its effects
once they've been given it. Violations of medical ethics
regarding the use of this drug on Indian women were
documented in 1993, including blatant disregard for informed
consent. The 1992 Nov/Dec issue of Ms. relates that in 1951
India was the first country in the world to launch an
official family planning program. India received a major
component of its anticipated social change by testing
contraceptives that were financed largely by the U.S. Indian
women participated in the testing of (among other drugs)
implants of (two rod) Norplant 2 and (five rod) Norplant.
Most were not aware they were participating in an experiment.
For these women, there were no cautions about Norplant's
carcinogenicity and other side effects. Partly because drug
studies seek long-term data, women who developed medical
problems (hemorrhagic bleeding, dizziness, weight gain, heart
problems) from their implants found that early removal was
not part of their ``free'' care.
____
Quinacrine in India
Dr. Biral Mullick has begun sterilizing women from Calcutta
and surrounding villages with quinacrine, even though the
World Health Organization and female health groups warn that
the method is unapproved and risky. According to the Sunday
Times of India, poor women in Calcutta are initially lured
into trying the procedure because of its afforability--the
paper quotes a price of 35 rupees--and relative ease of use.
``What these women do not know,'' the Times reports, ``is
that they are guinea pigs being used to test the efficacy of
the drug; that they have been subjected a method not approved
by any drug regulatory agency in the world.''
According to Puneet Budim, an Indian gynecologist, none of
these women in Mullick's and other clinics in the country are
told they are part of a trial or what the risks might be. She
alleges that they come into the clinics looking for a Copper
T intrauterine device but walk out burned by the acid the
tablets create when inserted into the womb. ``Scores of
private doctors and NGO's across the country, including a
prominent doctor politician from Delhi, are involved in this
unethical practice,'' Budim said. ``It's a very disturbing
development.'' (The Sunday Times of India, 16 March 1997.)
____
Cutting the Poor: Peruvian Sterilization Program Targets Society's
Weakest
(By David Morrison)
When the first sterilization campaign arrived in their
little town of La Legua, Peru, Celia Durand and her husband
Jaime were unsure they wanted to participate. Although they
had discussed Celia's having the operation in the past, and
had even researched its availability, they had begun to hear
rumors about women damaged and even killed during the
campaigns and Celia had decided she didn't want to be
sterilized that way. Maybe sometime later she would do it;
maybe in a hospital. Certainly not in the little medical post
down one of La Legua's bare earth streets, with its windows
opened wide to the dust, insects, and the smells from the
pigs and other animals rooting and defecating the nearby
streets and yards.
But then the campaign began and the Ministry of Health
``health promoters'' began to work her neighborhood. Going
door to door, house to house, they repeatedly pressed the
sterilization option. Interviewed later, her husband Jaime
would recall the singular nature of the workers' advocacy.
They wouldn't offer Celia any other contraceptive method, he
reported. It was sterilization, nothing else. Many of the
conversations centered around minimizing Celia's fears about
having the procedure during the campaign. ``Do it now,'' they
said. ``You may have to pay [to have it done] later.'' Other
lines of argument included how ``easy,'' ``safe,'' and
``simple'' the procedure would be. And the workers persisted.
Again and again they came to the family's home, refusing to
accept `no' for an answer, until finally Celia gave in and
made an appointment. On the afternoon of July 3, 1997, she
agreed, she would have the procedure.
Her mother, Balasura, worried and the two even quarreled
about it. ``Don't go, daughter, there is always time later.''
Balasura remembers saying. But Celia wanted the daily visits
to end and, besides, the health workers emphasized the
procedure's easy nature. ``Don't worry, mama, I will be back
in a couple of hours,'' she said as she left. That was the
last time her mother saw her alive. Sometime during the
procedure at the medical post, the surgeon caused enough
damage to Celia that she slipped into a coma. Medical staff
put off frantic visits from Celia's brother-in-law, mother
and husband, finally moving her entirely out of the post and
into a larger clinic in nearby Piura. It did no good. Celia
died without every regaining consciousness.
Celia's story is just one of many which have resulted from
a nationwide campaign which aggressively targets poor,
working class and lower middle class women for surgical
sterilization in often filthy circumstances and without
adequately trained medical personnel. Although estimates of
how many women may have been hurt in these campaigns are
difficult to tabulate, a survey of reports about women who
have suffered some injury, indignity, or coercion reveals a
pattern stretching across Peru's length and breadth. Methods
of coercion have included repeated harassing visits until
women consent, verbal insults and threats, offers of food and
other supplies made conditional upon accepting sterilization
and making appointments for women to have the procedure
before they have agreed to do so. Further, none of the
Peruvian women interviewed by a PRI investigator reported
having been adequately informed as to the nature, permanence,
possible side-effects or risks of the procedure. ``All they
told her was how easy it was,'' Jaime said later. ``No
more.''
* * * * *
campaign background
According to both high-and-low level Peruvian sources, the
Ministry of Health's family planning program was a mostly
quiet and somewhat moribund affair prior to 1995. ``It was
just one of those things [the ministry] did,'' recalled one
former high level official who served in the MOH when the
sterilization campaign began. ``They would give their pills,
maybe make some IUD's and give some shots and that was it.''
Everything changed, sources agree, when the Peruvian
legislature changed the National Population Control Law to
allow sterilization as a means of family planning.
According to Peruvian legislators, the Fujimori
administration used a mixture of pressure and dirty tricks to
change the law. Long-standing supporters of Fujimori, even if
they did not want to vote in favor of a broad sterilization
mandate, were told they had to support the administration or
face political reprisal.
2. Using incentives to fill sterilization quotas
As with women in India, Bangladesh and Pakistan, Peruvian
women also reported being offered food, clothing and other
things for themselves or for their children as a condition or
an inducement to sterilization. Ernestina Sandoval, poor and
badly in need of assistance after a string of weather
problems cost first her husband's livelihood and eventually
her home, reported being offered food in a government
hospital but then being told in order to qualify for the food
she would have to accept a sterilization. ``They told me I
had to bring a card from the hospital saying I had been
ligated,'' she told a PRI investigator. ``If I didn't agree
to do this they wouldn't give me anything.'' Maria Emilia
Mulatillo, another woman, reported that her daughter's
participation in a program that supported children of low
birth weight was made conditional upon her acceptance of a
sterilization procedure. Likewise, Peruvian papers like El
Comercio and La Republica have published stories of how
``health promoters'' have been paid or rewarded with special
prizes if they manage to bring more than their quota of women
for the procedure.
3. Lack of informed consent
None of the over thirty sterilized Peruvian women whom a
PRI investigator interviewed, which included a number of
women who said they were happy they had the procedure,
reported having given anything like informed consent. None of
them were told of the procedure's possible side effects,
particularly when performed under the time and other
constraints that mark the campaigns. None were told of the
risks. Universally what the women reported was being told
over and over again about the procedure's eventual benefits,
speediness and ease. But, as critics have pointed out, merely
being told one set of facts about a potential medical
procedure cannot be considered as having been adequately
informed about the procedure.
4. Sterilization the only method offered
Although supposedly committed to offering Peruvian women a
wide-range of family planning choices, including
sterilization, PRI's investigation found that the government
sterilization campaigns were single-minded. None of the women
sterilized in the campaigns that we interviewed (as opposed
to those sterilized, for example, in hospitals) reported
being offered any options other than sterilization. Most were
adamant on that point because, like Celia Durand, they were
unsure if they wanted to be sterilized at all and would have
welcomed a chance to take another option. Several women,
particularly those who had already begun in other government
family planning programs like those using Depo-Provera (which
must be injected every three months), told of being
instructed to have the sterilization procedure because their
current program was being curtailed. Later, when asked
directly about why women were pulled off Depo-Provera and
pressured to accept sterilization, Dr. Eduardo Yong Motta,
former Minister of Health and now President Fujimori's health
advisor, replied that ``Depo costs too much,'' and that the
Ministry had a problem with a method which a ``woman might
forget'' or decide that she no longer wanted.
[[Page H1515]]
5. Medical histories not taken and post-operative care
inadequate
None of the women sterilized in the campaigns that PRI
interviewed reported having had any medical history taken
prior to undergoing the sterilization procedure. This means
that no one sat down with the women before the surgery to
find out if any were experiencing medical conditions that
might, in another circumstance, delay surgery. This is
particularly important in light of the fact that the medical
team was assembled and brought into a local area especially
for the campaign. Familiar medical staff sterilized none of
the women interviewed and thus, in some cases, no one was
able to stop surgeries from proceeding in incidents where
women were pregnant, menopausal or suffering from possibly
complicating conditions. Post-operative care, particularly in
cases leading to serious complications and even death, was
sorely lacking. It was not uncommon for a woman to be rapidly
sterilized in an unhygenic theatre in an afternoon and then
sent home, feverish or still in pain, a few hours later.
____
The Ovrette Program in Honduras: Did USAID Endanger Honduran Children
With an Unapproved Drug?
The Committee carried out an exhaustive investigation and
discovered that the Health Ministry had issued a document
entitled ``Strategy for Introducing Ovrette.'' This document
stated: ``In order to avoid any misunderstandings which might
jeopardize the distribution and harm family planning
objectives, these instructions shall be implemented: 1)
suppression of all literature from the boxes of medication at
the central warehouse (prior to regional distribution) . .
.''
In the Ovrette case in Honduras,USAID has been party to a
flagrant violation of human rights through the imposition of
a coercive and experimental population control program, has
violated several Honduran laws and the constitutional rights
of information, and has acted to the detriment of the health
of Honduran mothers and children. The Ovrette incident should
be thoroughly investigated in order to prevent such an
imposition which can harm future generations not only in
Honduras, but also in many other countries where such
programs are implemented.
____
A Doctor Speaks out: What Happened to Medicine When the Campaign Began?
(Statement of Dr. Hector Chavez Chuchon)
My name is Hector Hugo Chavez Chuchon, and I am the
president of the regional medical federation of Ayacucho,
Andahuaylas, and Huancavelica in the Republic of Peru. This
areas is the poorest in the country. I do not belong to any
political group, and hope that the Peruvian government has as
much success as possible in its enterprises. But, at the same
time, I have the moral obligation to come forward and
denounce wrongs there, where they are done.
I'd like to describe my work since the start of the tubal
ligation and vasectomy sterilization campaign. There are
approximately 200 doctors in my region. Some of them have
come to declare and demand that the federation step forward
to defend and to protest the ``inhumane,'' massive, and
expanding sterilization campaign, a campaign which imposes
quotas on medical personnel. As proof of these quotas, I have
this document which is available in the information packet
that you have. These doctors do not like the way in which
people are brought in for these surgical procedures, where
information is poor, incomplete, and generally deficient.
Also, the places where these operations are performed are,
for the most part, unsuitable, and the personnel often
insufficiently trained.
The Ministry of Health denies that there are campaigns and
quotas referring to sterilizations, and absolves itself of
its responsibility, without taking into account, among other
things, that the doctors work under their orders. Doctors
work under pressure from their superiors, are given quotas
and submitted to other more subtle forms of pressure. It is
also true that doctors work under very unstable employment
conditions, and could easily lose their posts.
I would like to have the people of the United States
understand what their government is doing in Peru. My country
is very large, and we do not have more than 25 million
inhabitants, which in no way calls for a brutal birth control
campaign, especially not one of sterilization. The facts show
that prosperous countries like Japan have a high population
density. Even though they are geographically much smaller,
and lack the natural resources of my country, they live
prosperously. So, we can see that the most important thing
for a country is its human resources, which can generated
wealth and well-being. Therefore, I would like especially to
say that if you want to help my country, do so by investing
in education and job creation, and not using these millions
of dollars for population control programs.
____
``Practically by Force''
(Statement of Avelina Nolberto)
As a poor mother of five underage children and separated
from my husband who also lives in the city of Andahuaylas, I
wash clothes to support myself and the children. During my
work activities I got to know an obstetrician who works in
the Social Security hospital of Ayacucho. I confided in her
about the problems I had run into with my husband. Then she
spoke to me about tubal ligation and, of course, I was
against it, but after so many demands she convinced me,
adding that my husband could come back at any moment and
would once gain fill me with children.
So on 16 October 1996 a worker, the sister of the
obstetrician, arrived at my house telling me that it was free
and I should take advantage of the opportunity since
specialists from the Social Security hospital in Lima had
arrived. I resisted, saying that I had to go to the market to
cook lunch for my small children who were studying in school.
I went to the market and stayed a long time. Upon my return I
found her outside my house and she intercepted me saying that
I was already scheduled for a ligation and that they would
take me by taxi. That is how I arrived at the hospital
practically against my will without any of my girls going in
with me. This lady took charge of all the business in the
hospital. This was the way I had the surgical intervention of
a tubal ligation.
After the operation I was not able to recover. My stomach
swelled and I had the sensation that all my intestines were
burning. I could not expel intestinal gas. It was three in
the afternoon on October 17, 1996. Then I began to worry
because I entered the hospital totally healthy. When I went
to the obstetrician to complain about my state of affairs,
she became very insolent and said that she had nothing to do
with this, and she had the audacity to tell me, ``Don't be
bothering me, as if I had dragged you in.'' After that, my
children came searching for me desperately when they did not
find me home. They found me in the hospital and that is how I
left still very sick.
In the night of October 17, 1996 I had terribly strong
colic and my entire stomach swelled with a terrible burning
sensation that I could not stand. So when I woke up, my
oldest daughter took me back to the Social Security hospital
where they intervened on me again on October 18, 1996. When
my family started to inquire about my health status, what was
the problem I really had, no one could tell them anything
concrete. When I was supposed to be asleep I heard the nurses
whispering among themselves that when they operated to do the
ligation they had cut my intestines. I was not able to
recuperate so they tried again on November 10, 1996, but my
condition kept deteriorating so they decided to send me on
November 15, 1996 to the Social Security hospital of Lima at
my daughter's insistence. There they did a complete cleaning
of my intestines because a greenish liquid had formed and the
doctor told me that I had septicemia. I left there on
December 12, 1996 returning to my city without medicines to
continue my treatment.
The doctors treating me refused to give me medicines when I
asked because I have no insurance.
From that time I have not been able to recover, and given
my precarious financial situation, I had to return to my
husband so that he could look after the children. I still
cannot go back to work like before. Relapsing again, I went
to the hospital Maria Auxiliadora de San Juan de Miraflores
in Lima on November 4, 1997. I stayed there to be treated for
what the doctor said was a perforated intestine. This was
very expensive and I owe the hospital but do not have the
ability to pay them back or to continue my treatment because
of the expensive medicines needed. I am desperate from this
situation. I cannot work to support my younger children. My
oldest daughter, 20 years old, is studying and doing domestic
work and is supporting me as much as she can. Now I am
staying in the house where she works and the lady here has
very kindly agreed to receive me with my young girls of 7 and
11 years old, and I have been given a great deal of help to
recuperate.
____
Family Planning by the Numbers: quotas Haven't Gone Away, They Have
Merely Changed Their Name
(By David Morrison)
Although officials with the US Agency for International
Development deny the practice, current documents and training
programs indicate that the Agency still uses quotas to
evaluate so-called ``family planning program.''
why all this matters
This entire issue can seem like mere numbers on a page
until a situation like that of Peru appears. Then it becomes
clear what USAID's continuing reliance on quotas has wrought.
Hundreds of thousands of women in Peru and elsewhere have had
to confront workers from government and other organizations
who view them not as human being but rather as numbers to be
entered into a report or a means of filling a quota.
____
Refugee Pop Control Advances: Destructive Guidelines Remain in Place
Despite Alterations
(By Kateryna Fedoryka)
As human rights activists and humanitarian aid workers
contend against the tide, the United Nations moves closer to
promulgating guidelines that would subject refugee women to
clinically irresponsible and dangerous procedures of
fertility regulation and abortion. Scheduled for completion
in April, UNHCR guidelines for ``Reproductive Health in
Refugee Situations'' has been the center of a protracted
struggle between the UNHCR, concerned NGOs, and US
Congressman Chris Smith.
Initial drafts of the guidelines called for the
introduction of a specifically reproductive health component
into the emergency
[[Page H1516]]
health care kits for refugee camps. Concern first arose among
NGO participants in the preliminary drafting sessions when it
became evident that the reproductive health kits were to
include the so-called `emergency contraceptive pill' (ECP),
and a manual vacuum aspirator for use in early-term
abortions. Objections centered on poor general hygiene,
unskilled practitioners, and the lack of all but the crudest
of operating facilities, which make safe and responsible
administration and management of such procedures virtually
impossible.
Following promulgation by the UNHCR, there will be a
waiting period before the guidelines are submitted to the
WHO, which has final oversight for medical operations in
refugee camps. If signed into policy by the WHO, the
regulations will go into effect immediately. Conditions in
refugee camps will render impossible any attempt to prevent
abuse. Population control will be imposed on poor refugees.
The aborting of refugee women under the euphemisms of
``emergency contraception'' and ``uterine evacuation,'' as
well as the maternal deaths that are an inevitable result of
carrying out these procedures in unsanitary and inadequate
medical conditions, will undoubtedly reduce the numbers of
``vulnerable peoples'' suffering in refugee camps. If the
present efforts to halt ratification of these guidelines do
not succeed, there will in fact be no more place of refuge
for those who have until now been able to turn to the
international community in their moments of greatest need.
____
Aiding a Holocaust: New UNFPA Program Designed To Tidy up One-Child
Horror
(By Steven W. Mosher)
The United Nations Population Fund's (UNFPA) love affair
with China's ruthless one-child policy continues. Despite
overwhelming evidence of massive human rights violations
stretching back two decades--and in violation of its own
charter--the UNFPA has just quietly embarked upon a new $20
million program in China to assist its so-called ``family
planning program.''
The program, which will be carried out in 32 Chinese
counties, is being billed as an effort to replace direct
coercion with the more subtle forms of pressure that the
UNFPA commonly employs to stop Third World families from
having children. Beijing has signed off on the four-year
experiment. In the delicate phrasing of Kerstin Trone, UNFPA
program director, ``The Government of China is keen to move
away from its administrative approach to family planning to
an integrated, client-centered reproductive health approach .
. .''
As well it might. For except within the population control
movement itself, which continues to celebrate China's
forceful approach, the one-child policy has become a byword
for female infanticide, coerced late-term abortions, forced
sterilization/contraception, not to mention a host of other
horrific abuses that rival in sheer barbarity the worst of
Nazi Germany.
Recent examples of such abuses abound. In the August 1997
edition of Marie Claire magazine, for instance, we find a
report that China has ``implemented [its] harsh birth control
policy'' in Tibet, including ``forced abortions and
sterilizations of Tibetan `minority' women.'' Tibetan
families are allowed one child in urban areas, two in rural
areas. ``Excess births'' are illegal. As throughout China, it
is legal to kill such ``illegal'' Tibetan babies in utero for
the entire nine months of pregnancy, even as they descend in
the birth canal. In sparsely populated Tibet, such a ``family
planning'' program may properly be called genocidal.
Then, as reported in a previous issue of the Review, there
is China's latest weapon in the war it is waging on its own
people: Mobile abortion vans, each of which will be equipped
with operating table, suction pumps, and . . . body clamp.
According to Chinese officials, the government has plans to
make 600 such vans to travel around the countryside doing
abortions. Presumably such vehicles will be banned from the
32 counties in which the UNFPA will be responsible for
keeping the birth rate down with its ``integrated approach,''
but who can be sure?
Nafis Sadik, the Executive Director of the UNFPA, has let
it be known that the Chinese government has agreed to suspend
the one-child policy in the 32 counties during the four-year
experiment. In her words, ``In the project counties couples
will be allowed to have as many children as they want,
whenever they want, without requiring birth permits or being
subject to quotas.''
Whatever the truth of this statement, it is by itself a
remarkable admission. For it has been the steadfast position
of the Chinese government--and the UNFPA itself--that the
one-child policy does not rely upon birth quotas and targets,
nor does it require parents to obtain birth permits prior to
having children. Targets and quotas, it should be noted, were
banned by the Cairo population conference because they always
lead to abuses.
But lest the Chinese people living in these counties take
their newfound freedom to have children seriously, the
Chinese government has retained the right to use economic
pressure. Sadik: ``[T]hey may still be subject to a ``social
compensation fee'' if they decide to have more children that
[sic] recommended by the policy.'' In other words, overly
procreating parents will be fined into submission. That's
hardly reproductive freedom.
And what of the ill-favored people in China's 2000 other
counties? Counties where--we have it on the authority of
Nafis Sadik herself--birth targets and quotas will continue
to be imposed in defiance of world opinions. Counties where
parents, on pain of abortion, must obtain birth permits for
children prior to conceiving them. Counties where mobile
abortion vans roll up and down rural roads, snuffing out the
lives of wanted children while their mothers lie helpless in
body clamps. And counties in oppressed Tibet, whose sparse
populations of nomadic herdsmen are about to be further
depleted by ``family planning.''
The Founding Charter of the UNFPA says ``couples have the
right to decide the number and spacing of their children.''
The Executive Director of that organization has now admitted
that China's population-control dictators deny that right.
Until that changes, until China abandons the whole oppressive
apparatus of targets, quotas, and birth permits, the UNFPA
should get out--and stay out--of China.
____
From the Countries: Aging Japanese; Birth-Control Trains and
Sterilizations Everywhere--Japanese to be World's Oldest
Meanwhile, more than 16,500 handicapped Japanese women were
involuntarily sterilized with government approval during the
period from 1949 to 1995, government officials now have
admitted. However, unlike other nations whose own
sterilization agendas have recently come to light, Japan does
not plan to apologize, offer compensation to the victims, or
conduct an investigation.
Japan legalized sterilization in 1948 (while under American
occupation) as a means of improving the race through control
of hereditary factors. The law, which was revoked only last
year, allowed doctors to sterilize people with mental or
physical handicaps without their consent, after obtaining the
approval of local governments.
(Sources: ``Japan braces for life as world's oldest
nation,'' Associated Press, 11 December and ``Japan
acknowledges sterilizing women,'' The Washington Post, 18
September, A 26.)
* * * * *
Australian sterilizations
Surgeons in Australia's public health system have illegally
sterilized more than 1,000 retarded women and girls since
1992, a government-commissioned report said.
The chief justice of Australia's family court, Alastair
Nicholson said, ``The research points to an irresistible
conclusion that doctors are performing unlawful
sterilizations on girls and young women with disabilities.''
In 1992, Australia's High Court made such sterilizations
illegal if they were not medically required, unless a court
or tribunal granted permission. Since then, such permission
has been granted only 17 times, the report for the federal
Human Rights and Equal Opportunity Commission said. However,
at least 1,045 women and girls were sterilized during that
period, the commission said. The government Health Ministry
called the figure ``overstated,'' claiming that the true
number of cases was only ``one-fourth or one-fifth that.''
(Source: The Washington Post, 16 December, A22.)
* * * * *
Austrian sterilizations
The Austrian Ministry of Justice, following allegations by
member of parliament Theresia Haidlmayr that thousands of
women in mental institutions were being forcibly sterilized,
promised on 28 August to curtail the rights of parents to
authorize the sterilization of their handicapped children.
The judiciary's action was also in response to rumors in
medical circles that Ernst Berger of the Rosenhugel
Psychiatric Hospital for the Young in Vienna, was preparing a
paper which would examine the questionable due process
involved in the forced sterilization of young handicapped
children in Austria. Berger's paper includes a case study of
a 16-year-old mentally handicapped girl who was sterilized 4
years ago on the authority of her father, who was later found
to have been sexually abusing her.
The administrative processing of such sterilizations, said
Berger, ``had a professionally unsound cynical character
differing only superfically from the forced measures
legitimized by the the [Nazi] laws to prevent hereditarily
ill future generations.
(Source: The Lancet, 6 September, 723.)
____
Chinese Unveil ``Mobile Abortion Clinics''
Delegates to the 23rd annual meeting of the International
Union for the Scientific Study of Population (IUSSP) were
treated to a macabre sight during their 11-17 meeting in
Beijing. Chinese government officials drove one of the brand
new ``mobile abortion clinics'' up to the parking lot of the
building where the conference was being held. Delegates
leaving their session were able to stop by the van's open
rear doors and behold its small bed, suction pumps and body
clamps up close.
``We plan to make 600 of these buses to travel around the
countryside,'' said Zhou Zhengxiang,'' the ``vice general
manager'' of the van's manufacturing company.
Human Rights advocates fear that the mobile clinics
represent a further escalation in China's war against its own
people's fertility, a war which has been characterized by
[[Page H1517]]
forced abortion, sterilization and IUD insertion.
``I think the need for body clamps in this thing speaks for
itself,'' said Steven Mosher, President of the Population
Research Institute. ``Women doing something voluntarily do
not need to be held down with clamps.''
Chinese government officials, as usual, denied the practice
of forced abortion in the countryside, but this time their
denials flew in the face of more candid admissions by the
Chinese government from only a few months ago.
The news of 600 mobile abortion clinics may indicate a
split policy on population control in China.
____
The Disassembly Lines, Part II: Indian Women Sterilized Under
Industrial Conditions
(By James A. Miller)
air pumps and errors
The all-too-common primitive conditions at the camps were
reported: air pumps for pneumoperitoneum, bricks to elevate
the operating tables, gowns changed only at rest breaks, the
lack of an anesthetist as part of the surgical team, the
inadequate ``sterilization'' of instruments, the non-
monitoring of patients' pulse and blood pressure during
surgery, and the ignoring of regulations concerning the
number of sterilizations to be performed per surgical team
per day.
The report noted that the ``government sponsored campaign
to meet [quota] targets set for each state by end of the
fiscal year . . . [led to] a uniformly high risk of deaths in
camps [during the] campaign season and a markedly reduced
risk in the balance of the year.'' Another factor
contributing to ``unsatisfactory outcomes'' was the ``speedy
completion of the sterilizations . . . by the surgical teams
who are anxious to return to their home base.''
Although one could go on and on in like vein, perhaps the
best overall summation of what is really going on in India's
sterilization camps was the devastating reply of two Indian
physicians to a glowing Lancet editorial endorsing the camps.
The doctors noted that in some cases ``a bicycle pump [was]
being used to create a pneumoperitoneum'' for laparoscopic
sterilization--a grim symbol of how medical standards have
been lowered in the zeal to meet national sterilization
targets.''
They wrote of laparoscopes being ``reused after a quick
wash,'' of ordinary, non-sterile ``air (not carbon dioxide)''
being used to create a pneumoperitoneum, of the ``high
incidence of uterine perforations,'' of complications which
``are rife'' and a ``case fatality rate as high as 70 per
100,000.'' [See above] They condemned the system in which
``local authorities are under pressure to achieve set targets
and the doctors are paid on a case basis,'' while
``inducements (cash or otherwise) are routinely sanctioned to
candidates for sterilization and the motivator is similarly
rewarded.''
Under such conditions, the doctors declared, ``informed
consent is certainly not obtained.''
____
Post Documents Indian Horror
prizes
In the yard outside the sterilization center were ``tables
of prizes for the government workers who had brought in the
most women. Three patients won the worker a wall clock, 5 a
transistor radio, 10 a bicycle and 25 a black-and-white
television.''
At another camp in neighboring Saharanpur, the reporter
noted that prior to the sterilization, blood samples were
taken by a medical assistant who ``pricked each woman's
finger--using the same needle on all the women. . . .''
But how voluntary have been the individual decisions made
by these millions to submit to being sterilized? During the
1970s, several million Indian men were forcibly vasectimized.
Now, critics of India's sterilization program say it is still
``inhuman because it relies on quotas, targets, bribes and
frequently coercion. . . .''
These critics note that most of the women who are
sterilized are poor and illiterate, and have been ``lured to
the government sterilization clinics and camps with promises
of houses, land or loans by government officials under
intense pressure to meet sterilization quotas.''
V.M. Singh, a legislator from the State of Uttar Paradesh,
declared that ``[e]very single thing in my district leads to
one wretched thing: Will the woman be sterilized?'' Singh
explained that ``[p]eople are told if they want electricity,
they will have to be sterilized. If they want a loan, they
have to be sterilized.''
Singh, who has complained about the situation to the state
government, said that officials in his district and others
along the border with Nepal, in order to meet their quotas,
often ``resort to bribing Nepalese women to travel to India
for sterilizations.''
The Post noted that the pressure for sterilization is
especially acute in India's poor northern states, which
``impose sterilization quotas on virtually every government
employee in the district, from tax collectors to
schoolteachers. If they don't meet the quota, they don't get
paid,'' explained V.M. Singh.
For most village women, months of negotiation precede the
trip from their simple mud huts to the stained sheets of the
makeshift operating table. The discussions do not begin with
medical personnel, however. Rather, it usually begins with a
local government bureaucrat, the ``motivator'' who will be
paid for each woman he can deliver, telling the husband that
``if his wife undergoes a sterilization she will receive 145
rupees (about $4.60) and the family may qualify for materials
for a new house, or a loan for a cow, or a small piece of
land.'' And so another woman is off to a sterilization camp
where she too can wind up on the ``recovery room'' floor.
____
The Disassembly Lines; Indian Women Sterilized Under Industrial
Conditions
(By James A. Miller)
Editor's note: Population control is literally and
figuratively dehumanizing. In India, thousands of women are
being herded into mass sterilization camps, where surgeons
mutilate their reproductive organs in assembly line-fashion
under unsanitary conditions, sometimes using bicycle pumps as
medical instruments, and where mortality rates reach as high
as 500 per 100,000 sterilizations. This article, the first of
two parts, focuses on one such sterilization camp in Kerala,
India.
Written consent was obtained at this time and the women
were seen affixing their signatures to some printed forms.
However, very little about the sterilization procedure was
explained to them, nor were any alternative options offered.
On average, it took just four to five minutes for the
completion of this three-stage procedure. Since three women
were going through the different stages simultaneously, the
total time taken for all 48 women was just 128 minutes--i.e.,
two hours and eight minutes. The surgeon thus spent an
average of only two minutes and 40 seconds per sterilization.
The linen on the three makeshift operating beds was never
changed during the course of the day's surgeries. Moreover,
the surgeon never once changed his gloves during the course
of the 48 surgical procedures he performed. Unfortunately,
this disregard for aseptic conditions is quite common in the
Indian sterilization camps and has been reported often
through the years.
post-operative carelessness
All of women who were sterilized had to walk by themselves
back to hall, which now served as the post-operative ward.
They lay on the nine available cots, usually two per cot. The
rest were accommodated on bed sheets spread out on the
unswept floor, five women per sheet.
As each woman lay down on a cot or a sheet, a nurse sprayed
the area around the abdominal incisions with an antiseptic
and dressed the small wounds. The women were provided with an
antibiotic and a pain killer and were instructed to contact
the local JPHN in case of any problems. No doctor examined or
counseled the women after surgery.
As the number of women of women who had been operated on
increased, the available space in the hall begin to shrink.
The last of the women had to lie on a bed sheet at the
entrance to the bathroom, which was being used extensively by
the women and their attendants. Extensive seepage from this
overused bathroom barely missed the feet of the women lying
on the bed sheet near it.
While the operations were proceeding, the District Medical
Officer (DMO) came to inspect the hospital. He condemned
certain items of equipment which were being used. The JPHNs
and JHIs at the camp took the opportunity to inform the DMO
about the problem of non-payment of incentive money to their
clients during the previous months. (An incentive payment of
145 Rs is paid to sterilization acceptors.) The JPHNs and
JIHIs knew that the people they served were upset that the
incentive payments had not been immediately disbursed, and
they were worried that as word spread in the community they
would find it difficult to ``motivate'' future clients.
The surgeon and his team left the camp by 3:45 p.m.,
shortly after completion of the operations. Most of the JPHNs
and JHIs also left the camp immediately, leaving the women
and their attendants to fend for themselves. By 4:30 p.m.,
many of the women began leaving the premises, although they
could barely walk; none of them were permitted to stay in the
building beyond 5 p.m.
dark and dirty business
As for the operating theatre, sometimes the ``flooring was
dusty and unclean [and] the lighting . . . was very poor. . .
.'' At many places the artificial light which was available
was ``insufficient and uncertain because of drop[s] in
voltage or power out[ages].'' Nonetheless, at some of the
camps the surgeons operated ``round the clock through day and
night with very scanty light--only one torch for two tables
or so.''
Usually there was a shortage of linen required for the
numbers of women to be operated on, and the sterilization of
instruments and linen was inadequate. Often the local nursing
staff who assisted the operations seemed to be ``assisting
for the first time,'' which in fact was the case, as
subsequent inquiry discovered. Moreover, the pre-operative
preparation of the patients was so unsatisfactory that some
of the women had apparently eaten recently and/or had not
properly evacuated themselves, resulting in some even voiding
on the operating table, causing a postponement in their
sterilization.
Although the team of observers found the Kerala camp
conditions ``appalling,'' they
[[Page H1518]]
were ``not as bad as elsewhere in the country.''
In many instances the sterilization camps were conducted in
makeshift locations without even a thought to aseptic
conditions. School classrooms have been used without any
effort to disinfect them, and ``rusted, broken down tables
draped with soiled rubber sheets have been used as operating
tables.'' Surgeries have been performed with ``just one
bucket of water for the surgeons to `disinfect' their hands
before operating.'' The same syringe has been used on all the
clients.
____
With Friends Like These: Fertility Reduction Fails To Make Bangladesh
Rich
(By Jacquelin Kasun)
The government does well to take very seriously what
Messrs. Merrill and Piet say; according to US law, countries
which receive US foreign aid must take steps to reduce their
rate of population growth.
And the evidence suggests that the country is making a good
faith effort in this regard. Fifty-three thousand family
planning workers provide doorstep delivery of birth control
services. Although the law restricts abortion to the saving
of the mother's life, ``menstrual regulation''--removal of
the womb's contents without a prior test for pregnancy--is
widely available, often performed by person with only
``informal'' training. The press also reports that government
doctors perform illegal abortions in clinics without
anesthesia or sanitation.
The government pays women about $3 each, plus a new saree,
to be sterilized. Men receive $4 plus a new lungi. The Sun
reports that the numbers go up just before the rice harvest,
probably because people are hungriest then. The Sun also
reported that women's sterilizations were being performed
with quinacrine, which severely burns the fallopian tubes.
The women are unaware of the risks until they suffer the
consequences.
An aid-dependent poor country whose people are mostly
illiterate, Bangladesh is an ideal place to test birth
control methods. Eager grant seekers in the United States can
support their research and their professional advancement by
doing experiments in Bangladesh. Local women's rights groups,
such as UBINIG and its intrepid leader Fairda Akhter, give
evidence that Norplant providers refuse to remove the implant
even when the women suffer debilitating side effects. Losing
subjects from the sample spoils the results of the research.
Removing implants also uses resources that could be used to
insert them and meet the quotas.
____
Chinese Admit Policy is Coercive
Urban couples generally comply with the policy, the article
reports, because they pay high fines and risk losing
important benefits by having more than one child. In the
countryside, where most Chinese live, enforcement is more
difficult, the article maintains.
Rural officials are responsible for meeting family planning
quotas. Some take bribes to neglect to report births. Some
resort to terror and force to make sure the rules are
followed. `It would be better to have blood flow like a river
than to increase the population by one' reads one rural
slogan, according to a report by the Chinese newspaper
International Trade News.
Women must get regular checkups and certificates to prove
they are not pregnant. Those with unauthorized pregnancies
are ordered to have abortions, the article reported.
The article declared that the highest birth rates are in
China's poorest counties, where farmers still need their
children's labor and rely on their support in old age. Those
who have extra children are fined, but some are unable or
unwilling to pay.
In many areas, the article declared, officials are turning
to economics to help make their arguments. ``If you want to
get rich have fewer kids and raise more pigs,'' says one sign
painted on a wall.
____
From the Countries: Quinacrine in India, Estonians Decline, More
Condoms for Uganda, Quinacrine in India
Thousands of illiterate women in India and Bangladesh have
been used as ``guinea-pigs'' without their knowledge in
unauthorized trials of quinacrine, a derivative of quinine
used to perform chemical sterilization by scaring and burning
a women's fallopian tubes.
Although the ``Q method'' is illegal in India and has ``no
medical sanction'' in Bangladesh, more than 10,000 women have
been sterilized with quinacrine by a single medical
practitioner in India's West Bengal state alone, with similar
trials going on in Mumbai, Bangalore and Baroda; in
Bangladesh's southeastern Chittagong district more than 5,000
women have been sterilized with quinacrine. In a documentary
film on the ``Q Method,'' a doctor at Delhi's Lady Hardinge
Medical College admitted using quinacrine on women in Delhi.
A group of doctors under the aegis of the Contraceptive and
Health Innovations Project (CHIP) in Karnataka, South India,
completed a quinacrine sterilization trial on 600 women in
July 1996, and are currently involved in a 2-year project Ato
sterilize 25,000 women.
Health activists claimed that the U.S. Agency for
International Development has ``funded quinacrine supplies to
India,'' along with a ``zealous population control at any
cost'' international lobby. Since the quinacrine method
requires no surgery or anesthetic, and no real follow-up, and
costs only one dollar per case, it has become a favorite
weapon for such groups.
____
Too Many People? Not by a Long Shot
(By Steven W. Mosher)
The most notorious example is China, where for a decade and
a half the government has mandated the insertion of
intrauterine devices after one child, sterilization after two
children, and abortion for those pregnant without permission.
Btu the use of force in family-planning programs is not
limited to China. Doctors in Mexico's government hospitals
are under orders to insert IUDs in women who have three or
more children. This is often done immediately after
childbirth, without the foreknowledge or consent of the women
violated.
Perhaps the practice in Peru, where women are offered 50
pounds of food in return for submitting to a tubal ligation,
cannot properly be called coercive. Still, there is something
despicable about offering food to poor, hungry Indian women
in return for permission to mutilate their bodies. And the
potential for direct coercion is ever present, given that
Peruvian government doctors mut meet a quota of six certified
sterilizations a month or lose their jobs.
____
Third World Population Growth: First World Burden?
(By Steven W. Mosher)
At the time the NSC report was written, India was in the
middle of its infamous ``compulsuasion'' campaign. Although
this strange word was an amalgam of compulsion and
persuasion, the emphasis was definitely on the former. No
longer was our congenial Indian villager merely to be given
boxes of contraceptives with which to build temples. Instead,
he was to be sterilized. Governments officials were assigned
vasectomy quotas, and denied raises, transfers and even
salaries until they had sterilized the requisite number of
men.
At the same time it was privately commending India's
programs, the NSC strongly cautioned against public praise.
``We recommend that US officials refrain from public comment
on forced-paced measures such as those currently under active
consideration in India . . . [because that] might have an
unfavorable impact on existing voluntary programs.''
____
Statement of M. Graciela Hiliario de Rangel of Mexico
My name is Maria Graciela Hilario de Rangel. I am from the
city of Morelia. I have had IUD's placed into me twice. The
first time was ten years ago, when one was placed in me
before I was released from the clinic. I later had it
removed.
The second one was placed in me eight months ago after the
birth of my baby. On this occasion, I repeatedly told the
doctor that I did not want the device placed in me. He did
not pay any attention to me and ignored my protests. He
placed the device in me anyway.
Afterwards, the chief physician of the clinic told me he
accepted responsibility for this act. I could place a
complaint after I left the clinic, he said, but that his
actions were protected by law. He did not tell me which law
or when it was issued. I asked him for his name and he
replied that he was Doctor Ildefornso Ramos Aguilar and that
his office was in Morelia. He insisted that his doctors were
authorized by law to place the devices and that the reason
was to ``protect'' women.
I had the IUD removed 40 days later, but only after great
difficulty. I went to the clinic several times, asking to
have it removed, but each time I was sent away under the
excuse that they did not thave the proper personnel to do it,
or did not have the right instruments, or they had too many
patients, or some other excuse. I finally told them I would
not leave the clinic until they removed it. Only then did
they remove it. I did not file a complaint against the clinic
because the chief physician had told me that their actions
were protected by law.
____
Family Planning: Population Control in Drag
(By David Morrison)
Later that decade, according to the US Agency for
International Development, the military government of
Bangladesh employed soldiers to round up women for IUD
insertions, besides threatening to withhold schoolteachers'
wages unless they began using contraception.
In the eighties, according to a British Broadcasting
Corporation documentary, another US-funded ``family
planning'' organization used US tax dollars to mislead
Bangladeshi and Haitian women about Norplant's side-effects
prior to insertion. Then, when the women became seriously
ill, removal was refused.
During the same decade targets became common. Twenty-five
countries, ranging from the Philippines to El Salvador, set
monthly quotas for numbers of sterilizations. As they
invariably do, these quotas led to US women being sterilized
without their consent or under false pretenses as workers
scrambled to meet them. In Bangladesh, women whose families
were driven from their homes by flooding were told they would
not receive international humanitarian assistance until they
submitted to sterilization.
During the nineties, right to the present day, some Mexican
government hospitals, according to sworn depositions
collected by
[[Page H1519]]
human rights activist Jorge Serrano, routinely sterilize or
insert IUDs into women delivering their second or third child
without their foreknowledge or consent, and (sometimes) even
over their objections, immediately after giving birth. With
the uterus expanded from childbirth, it is impossible to
correctly size an IUD, which can embed in the uterine walls
as the womb contracts. Then there is the well documented
horror of forced abortion and sterilization promoted by the
Chinese ``one-child'' policy, and supported by ``family
planners'' like the United Nations Population Fund (UNFPA)
and the International Planned Parenthood Federation (IPPF).
____
Sri Lankan Population Atrocities
In the Indian Ocean island state of Sri Lanka, female plant
workers are being forced to undergo sterilization at
government run clinics by health workers who are ``concerned
only with meeting official [population] targets.''
Researcher Padma Kodituwakku of the Colombo-based ``Women
and Media Collective,'' produced the study which discovered
the ``dark side'' to the government's program to keep the
country's birth rate in check. Each of the sterilized women
was paid 500 Rupees--US $12.50--to undergo the surgery,
``ligation and resection of the [fallopian] tube.''
Kodituwakku's research revealed that the predominately
Sinhalese speaking health workers used ``subtle coercions''
to force minority Tamil-speaking women to agree to the
operation to foil the birth of their third child. In every
case investigated the woman was made to feel guilt for having
so many children; they were ``ignorant and irresponsible
breeders'' whose reproduction needed to be curbed.
____
Bad Blood in the Philippines? Possibly Tainted Vaccine May Be Tip of
the Iceburg
(By David Morrison)
Philippine women may have been unwittingly vaccinated
against their own children, a recent study conducted by the
Philippine Medical Association (PMA) has indicated.
The study tested random samples of a tetanus vaccine for
the presence of human chorionic gonadotropin (hCG), a hormone
essential to the establishment and maintenance of pregnancy.
The PMA's positive test results indicate that just such an
abortifacient may have been administered to Philippine women
without their consent.
Individual women who have lost children to miscarriage
after accepting the anti tetanus vaccine have already been
found to have antibodies to hCG. Dr.Vilma Gonzales had two
miscarriages after receiving the tetanus vaccine and became
suspicious. She had her blood tested for anti-hCG antibodies
and found, to her great sorrow, that these were present ``in
high levels.'' As she later told a British Broadcasting
reporter:
``Women should have been told that the injection would
cause miscarriage and, in the end, infertility. The
Department of Health should have asked beforehand, so that
only those who didn't want to have children had the
injection. I really hope and pray to God that I will still
have a baby and get a normal pregnancy. And I am still
hopeful that the Department of Health will find an antidote
to the antibodies as well.''
The possibility that Philippine women were being covertly
dosed with an abortifacient vaccine got widespread attention
after Human Life International, an international pro-life
group, reported on peculiar tetanus vaccination programs in
the Philippines, Mexico and Nicaragua.
Current WHO-funded research in the United States, according
to a leading researcher, has ``moved on'' from tetanus to
diphtheria as the antigen link. For even greater efficiency
and wider reach, the possibility of doing away with the
antigen link altogether is also being explored.
But from the point of view of numerous Filipinas, the most
disturbing allegation against Talwar is that he has, in the
past, tested his abortifacient vaccines on women without
first testing them on animals. Both Indian researchers and
WHO officials are on record as declaring that such abuses
have occurred. Their testimony has helped fire opposition to
the vaccine, especially on the part of women's groups.
____
Mexican Sterilizations
More than 300 Mexican women have documented their
experiences with forced sterilization at the hands of Mexican
population controllers, and an activist group claims to have
gathered evidence of ``thousands'' more.
``Women are being trampled. Their rights are being
trampled,'' said Jorge Serrano Limon, director of Pro-Vida,
the Mexican group which has been investigating the issue.
``Sterilizing our population against its will is a complete
violation of human rights,'' he said. ``We want to make an
anguished appeal to the President to stop this genocide,'' he
said. ``We can't let it happen that after these campaigns we
are going to have a sterile Mexico.''
Pro-Vida held a press conference in Mexico City at which
Rocio Garrido, a woman from the Puebla State, told of how she
had been threatened with sterilization when she went to the
hospital to deliver a baby.
Rocia reported that she later discovered an Intra-Uterine
Device had been inserted into her womb without her consent.
Hospital records back up her account. More than 40 other
women from Puebla state sued the state health institute
earlier this year for allegedly planting IUDs in them without
their consent or knowledge. Some claimed to have been
infected during the unauthorized procedures.
A spokesman for the Mexican Ministry of Health denied any
government campaign to force women to be sterilized. (Mexico
forcibly sterilizing, Reuters, 11 October 1996.)
____
Burn, Baby, Burn: Quinacrine Sterilization Campaign Proceeds Despite
Risks
(By David Morrison)
This interpretation is supported by the coercion and
dissembling that has surrounded quinacrine trials to date.
The largest clinical trial of the drug has taken place in
Vietnam--a nation governed by a one-party dictatorship which
is currently making a concerted push to lower the birth rate.
Did Vietnamese women participate voluntarily in clinical
trials, or were they coerced? There are allegations, made in
a Vietnamese language publication called The Woman, that at
least 100 of the participants in the Vietnamese study had
quinacrine inserted without their knowledge during pelvic
examinations. Faced with these and many other charges this
study was suddenly halted in 1993.
There are also credible reports that ever-growing numbers
of women are being sterilized without any standard drug trial
protocol at all.
In Pakistan, for example, a Dr. Altaf Bashir of the Mother
and Child Welfare Association in Faisalabad has reported
sterilizing women with quinacrine at the rate of 100 a month.
Most of the women were found in ``street camps'' or were
otherwise tracked down and ``motivated'' by Bashir's staff.
Because so many women did not return to the clinics for the
second insertion of the drug Bashir took up a single
insertion approach, even though much of the available
research so far argues against a single insertion being
sufficient to cause complete sterility. An independent nurse
practitioner who observed Bashir's work had this to say about
it:
``Some patients are recruited at `street camps' and given
little information or time to fully understand and think
about the implications of this type of procedure. Patients
receiving treatment at regular clinic facilities receive a
bit more information, but are not informed that this method
has not been formally sanctioned for use in Pakistan.
Insertions are primarily conducted by lady health workers
(not doctors) with limited clinical skills necessary to rule
out any underlying pathology. Essentially no follow up of
these patients is conducted. The patient is told to `return
if she has any problems.' Those that don't return are assumed
to have no problems, no pregnancies, etc. There is no
mechanism established for follow up of these patients.''
____
The Case of the Dalkon Shield
(By James A. Miller)
Government officials, A.H. Robins executives and Pathfinder
Fund administrators (among others) conspired in the early
1970's to dump hundreds of thousands of dangerous
unsterilized contraceptive devices--unmarketable in the
United States--into the developing world, according to a
recent analysis of government and other documents. These
devices were Dalkon Shields.
Robins' international marketing director wrote to USAID to
interest it in placing ``this fine product into population
control programs and family planning clinics throughout the
Third World.'' The deal was sweetened with a special
discount: the company offered USAID the Shield in bulk
packages, unsterilized, at 48 percent off the standard price!
One of the greatest hazards associated with the use of any
IUD is the possibility of introducing bacteria into the
uterus. Accordingly, all IUDs sold in the United States come
in individual sterilized packages, with a sterile, disposable
inserter for each device. The sale of non-sterile IUDs would
be highly irregular in the United States, and would probably
result in product liability suits.
Careful to preserve its image and to protect itself
legally, Robins emphasized that USAID could not distribute
the nonsterile Shields in the United States. A January 1973
Robins memo declared that the nonsterile form of Shields ``is
for the purpose of reducing price . . . [and] is intended for
restricted sale to family planning/support organizations who
will limit their distribution to those countries commonly
referred to as `less developed.'
Robins expected practitioners in such countries to
sterilize the Shields by the old-fashioned method of soaking
them in a disinfectant solution, a procedure which, in the
U.S., would border on malpractice. Moreover, Robins provided
only one inserter for every 10 Shields, thus greatly
increasing the possibility of infection.
Robins included only one set of instructions with every
1,000 Shields, and those were printed in just three
languages, English, French and Spanish. Although the devices
were destined for distribution in 42 countries, many of them
Moslem and Asiatic, it is highly unlikely that they were read
by more than a small number of people.
When USAID officials asked whether Dalkon Shields could be
safely inserted by staff workers of remote family planning
clinics, who would not have had the benefit of an American
medical education, Robins replied
[[Page H1520]]
that was no problem. This was not what the company had argued
in the U.S., where it customarily countered reports of
adverse medical reactions by blaming unqualified personnel,
such as the occasional general practitioner, for inserting
the device.
Ravenholt approved the deal. Hundreds of shoe box-sized
cardboard cartons, each filled with 1,000 unsterilized Dalkon
Shields paid for by the U.S. Treasury, left the America's
shores bound for clinics in Paraguay, El Salvador, Thailand,
Israel and 38 other countries. The big Dalkon dump was on.
Altogether, USAID purchased and shipped more than 700,000
Dalkon Shields for use in the Third World. Slightly more than
half of the Shields went to IPPF. The rest were provided to
the Pathfinder Fund, the Population Council, and Family
Planning International Assistance, all of whom were major
grant recipients of USAID.
Although records are sparse and incomplete, Pathfinder's
annual reports for fiscal years 1973 and 1974 disclose that
it distributed at least 37,602 Dalkon Shield IUDs into the
following countries: Indonesia (500), Kenya (5,000), Nigeria
(1,000), Tunisia (5,200), Dominican Republic (4,000), El
Salvador (2,000), Haiti (350), Jamaica (1,000), and Venezuela
(5,000): Israel (500), Senegal (200), Indonesia (500),
Tunisia (7,500), Mexico (1,152), Brazil (1,200), Chile
(1,500), and Colombia (1,000).
Substantial but unknown quantities of Shields were also
shipped by Pathfinder to India, Paraguay, Egypt, Singapore,
and Thailand. Since the Dalkon dump of the early 1970's
passed without notice, there is reason to be concerned that
similar incidents could happen in the future, perhaps with
Norplant.
____
``Maria Garcia'': I Have Witnessed Many Abuses
I am a medical professional who has worked in Mexican
hospitals for several years. I am here today to tell you
about the devastating results of U.S. family planning funding
sent to Mexico.
Here in the United States, family planning is voluntary.
But in Mexico, it is often literally forced on vulnerable
women. I have witnessed many abuses.
One common practice I have seen is coerced IUD insertion.
This occurs when a woman is about to have a baby. When she
comes to the hospital, she is separated from her husband. She
is not allowed to see him from the time of the initial exam
until she is discharged six hours after delivery.
At the time of her initial exam, doctors ask ``Que vas a
hacer para que no te embarasas otra vez?'' ``What are you
going to do so you don't become pregnant again?'' If she
answers, ``I plan to have more children'' or ``I plan to use
the Billings Ovulation Method,'' this is not acceptable. The
doctors will continue to harass her throughout her labor and
delivery until she says that she agrees to use contraception
or have a tubal ligation.
If she says that she is willing to use contraception or
have a tubal ligation, this is noted in her medical chart so
that medical personnel can reinforce her statement throughout
her stay.
If she says ``I don't know,'' she is offered two choices:
an intrauterine device, known as an IUD, or sterilization. No
other options are given.
None of the risks and complications of these two methods
are explained to her. Therefore the patient who agrees cannot
be said to have given her ``informed consent.''
The patient is also not asked her gynecological history. A
history of repeated Population Research Institute Review 10
March/April 1997 vaginal infections, multiple sex partners,
etc., are contraindications to the use of an IUD. But since
there is no history taken these women are given IUDs
regardless.
If a woman refuses to submit to either an IUD insertion or
a tubal ligation, a steady stream of medical personnel,
including doctors, nurses, and even social workers, pressures
her to choose one of the two options. This pressure steadily
increases as the time of the delivery approaches.
All this pressure occurs at a time when the woman is
extremely vulnerable. The pain of labor she is experiencing
weakens her resistance. I have seen women refuse to accept an
IUD or sterilization four or five times during early stages
of labor, only to give in when the pain and the pressure
becomes too intense. In this way the woman is subjected to a
form of torture, without actually having to torture her.
Any women in the audience who have gone through labor will
agree that this practice is inhuman. Labor is not the time to
be coerced into making possibly irreversible decisions about
childbearing, especially when the husband cannot participate.
The more children a woman has, the more she will be
pressured to submit to sterilization. After the third child,
the pressure to accept tubal ligation is very intense.
Why are the IUD and sterilization the only options offered
to women? Because these are once-and-done procedures. They do
not require the continuing voluntary participation of the
women in question. No further visits to the doctor are
required.
The complaints of Mexican women suffering from IUD side
effects are frequently ignored. Requests for removal are
dismissed. Recently, a woman came to a clinic where I was
working to ask that her IUD be removed. It had been inserted
the previous month after the birth of her baby. The doctor in
charge told her that the pain and abnormal bleeding that she
was experiencing would disappear within several months. He
refused to remove the IUD or even examine her. She came back
the following week, begging to have it removed. I took it
upon myself to remove it. Infection was already apparent.
This woman is now faced with the possibility of further
complications such as adhesions, pelvic inflammatory disease,
or sterility serious side effects that may not be discovered
until later, if ever.
Women have also been refused medical treatment unless they
allow themselves to be sterilized. I recently saw a pregnant
woman with a painful umbilical hernia. When she came to the
hospital to deliver her baby, she wanted her hernia fixed at
the time of delivery. The attending doctor refused to fix the
hernia unless she agreed to have a tubal ligation. In other
words, the threat of withholding medical attention was used
to coerce her assent. The woman insisted that her husband did
not want her to be sterilized. The doctor replied that her
husband would never know. This conversation occurred in the
delivery room just minutes before her baby was born. Can you
imagine her dilemma? Despite her desire for more children,
she agreed to be sterilized in order to receive much needed
medical care.
What makes doctors and other medical personnel willing to
violate women's rights and engage in substandard medical
practices? Because they risk losing their jobs if they don't
conform. Those who refuse to perform tubal ligations or
involuntary IUD insertions are fired.
____
Dr. Stephen Karanja: Health System Collapsed
Our health sector is collapsed. Thousands of the Kenyan
people will die of malaria whose treatment costs a few cents,
in health facilities whose stores are stocked to the roof
with millions of dollars worth of pills, IUDs, Norplant,
Depoprovera, most of which are supplied with American money.
Special operating theatres fully serviced and not lacking
in instruments are opened in hospitals for sterilization of
women and some men. In the same hospitals, emergency surgery
cannot be done for lack of basic operating instruments and
supplies. Most of the women are sterilized without even
knowing it is final. Some with only one child. Some are
induced with financial assistance to accept sterilization.
Horrified sterilized women now trot from hospital to hospital
looking for reversal of the tubal ligation. This is breaking
marriages especially when the single child or two succumb to
the myriad tropical diseases with easy treatment that is not
available.
Millions of dollars are used daily to deceive, manipulate
and misinform the people through the media about the
perceived good of a small family--while the infant mortality
rate skyrockets. Some of this money is not used to educate
people on basic hygiene, proper diet or good farming methods
that would be useful development, but it appears that the aim
of population controllers is to decimate the Kenyan people.
I am a practicing gynecologist in Kenya and I would like to
share with you facts about some of the patients I see daily:
A mother brought a child to me with pneumonia, but I had
not penicillin to give the child. What I have in the stores
are cases of contraceptives.
Malaria is epidemic in Kenya. Mothers die from this disease
every day because there is no chloroquine, when instead we
have huge stockpiles of contraceptives. These mothers come to
me and I am helpless.
I see women coming to my clinic daily with swollen legs--
they cannot climb stairs. They have been injured by
Depoprovera, birthcontrol pills, and Norplant. I look at them
and I am filled with sadness. They have been coerced into
using these drugs. Nobody tells them about the side effects,
and there are no drugs to treat their complications. In Kenya
if you injure the mother, you injure the whole family. Women
are the center of the community. The wellbeing of the family
depends on the wellbeing of the mother.
Why do you not stop this money being used for
contraceptives and use it instead to provide clean water,
good prenatal and postnatal care, good farming methods and
rural electrification. Do the American people know that the
millions of dollars spent for population control are used in
the ways I have described? Why does your government not deal
directly with our government but instead uses a third party
like IPPF, which has no respect for the values of our people
and our laws?
USAID is the single biggest supporter and promoter of
population control in Kenya. The programs it funds are
implemented with an aggressive and elitist ruthlessness. In
Kenya the target are always the poor and the illiterate who
are pressured and tricked into using dangerous drugs which
are often banned in the west, or who are sterilized during
childbirth without either their knowledge or consent.
If the funds you use to kill, maim, subjugate, dominate and
break us to nothingness were used to cultivate our
extraordinary resources, Kenya alone could feed more than
half the African continent. Dear Americans, you cannot build
your own security on the insecurity and degradation of
others. You cannot build your own wealth on the poverty and
destitution of people in the least developed nations.
[[Page H1521]]
____
``Maria Garcia'': I Have Witnessed Many Abuses
I am a medical professional who has worked in Mexican
hospitals for several years. I am here today to tell you
about the devastating results of U.S. family planning funding
sent to Mexico.
Here in the United States, family planning is voluntary.
But in Mexico, it is often literally forced on vulnerable
women. I have witnessed many abuses.
One common practice I have seen is coerced IUD insertion.
This occurs when a woman is about to have a baby. When she
comes to the hospital, she is separated from her husband. She
is not allowed to see him from the time of the initial exam
until she is discharged six hours after delivery.
At the time of her initial exam, doctors ask ``Que vas a
hacer para que no te embarasas otra vez?'' ``What are you
going to do so you don't become pregnant again?'' If she
answers, ``I plan to have more children'' or ``I plan to use
the Billings Ovulation Method,'' this is not acceptable. The
doctors will continue to harass her throughout her labor and
delivery until she says that she agrees to use contraception
or have a tubal ligation.
If she says that she is willing to use contraception or
have a tubal ligation, this is noted in her medical chart so
that the medical personnel can reinforce her statement
throughout her stay.
If she says ``I don't know,'' she is offered two choices:
an intrauterine device, known as an IUD, or sterilization. No
other options are given.
None of the risks and complications of these two methods
are explained to her. Therefore the patient who agrees cannot
be said to have given her ``informed consent.''
The patient is also not asked her gynecological history. A
history of repeated Population Research Institute Review 10
March/April 1997 vaginal infections, multiple sex partners,
etc., are contraindications to the use of an IUD. But since
there is no history taken these women are given IUDs
regardless.
If a woman refuses to submit to either an IUD insertion or
a tubal ligation, a steady stream of medical personnel,
including doctors, nurses, and even social workers, pressures
her to choose one of the two options. This pressure steadily
increases as the time of the delivery approaches.
All this pressure occurs at a time when the woman is
extremely vulnerable. The pain of labor she is experiencing
weakens her resistance. I have seen women refuse to accept an
IUD or sterilization four or five times during early stages
of labor, only to give in when the pain and the pressure
becomes too intense. In this way the woman is subjected to a
form of torture, without actually having to torture her.
Any women in the audience who have gone through labor will
agree that this practice is inhuman. Labor is not the time to
be coerced into making possibly irreversible decisions about
childbearing, especially when the husband cannot participate.
The more children a woman has, the more she will be
pressured to submit to sterilization. After the third child,
the pressure to accept tubal ligation is very intense.
Why are the IUD and sterilization the only options offered
to women? Because these are once-and-done procedures. They do
not require the continuing voluntary participation of the
women in question. No further visits to the doctor are
required.
The complaints of Mexican women suffering from IUD side
effects are frequently ignored. Requests for removal are
dismissed. Recently, a woman came to a clinic where I was
working to ask that her IUD be removed. It had been inserted
the previous month after the birth of her baby. The doctor in
charge told her that the pain and abnormal bleeding that she
was experiencing would disappear within several months. He
refused to remove the IUD or even examine her. She came back
the following week, begging to have it removed. I took it
upon myself to remove it. Infection was already apparent.
This woman is now faced with the possibility of further
complications such as adhesions, pelvic inflammatory disease,
or sterility serious side effects that may not be discovered
until later, if ever.
Women have also been refused medical treatment unless they
allow themselves to be sterilized. I recently saw a pregnant
woman with a painful umbilical hernia. When she came to the
hospital to deliver her baby, she wanted her hernia fixed at
the time of delivery. The attending doctor refused to fix the
hernia unless she agreed to have a tubal ligation. In other
words, the threat of withholding medical attention was used
to coerce her assent. The woman insisted that her husband did
not want her to be sterilized. The doctor replied that her
husband would never know. This conservation occurred in the
delivery room just minutes before her baby was born. Can you
imagine her dilemma? Despite her desire for more children,
she agreed to be sterilized in order to receive much needed
medical care.
What makes doctors and other medical personnel willing to
violate women's rights and engage in substandard medical
practices? Because they risk losing their jobs if they don't
conform. Those who refuse to perform tubal ligations or
involuntary IUD insertions are fired.
____
Dr. Stephen Karanja: Health System Collapsed
Our health sector is collapsed. Thousands of the Kenyan
people will die of malaria whose treatment costs a few cents,
in health facilities whose stores are stocked to the roof
with millions of dollars worth of pills, IUDs, Norplant,
Depoprovera, most of which are supplied with American money.
Special operating theatres fully serviced and not lacking
in instruments are opened in hospitals for sterilization of
women and some men. In the same hospitals, emergency surgery
cannot be done for lack of basic operating instruments and
supplies. Most of the women are sterilized without even
knowing it is final. Some with only one child. Some are
induced with financial assistance to accept sterilization.
Horrified sterilized women now trot from hospital to hospital
looking for reversal of the tubal ligation. This is breaking
marriages especially when the single child or two succumb to
the myriad tropical diseases with easy treatment that is not
available.
Millions of dollars are used daily to deceive, manipulate
and misinform the people through the media about the
perceived good of a small family--while the infant mortality
rate skyrockets. Some of this money is not used to educate
people on basic hygiene, proper diet or good farming methods
that would be useful development, but it appears that the aim
of population controllers is to decimate the Kenyan people.
I am a practicing gynecologist in Kenya and I would like to
share with you facts about some of the patients I see daily:
A mother brought a child to me with pneumonia, but I had no
penicillin to give the child. What I have in the stores are
cases of contraceptives.
Malaria is epidemic in Kenya. Mothers die from this disease
every day because there is no chloroquine, when instead we
have huge stockpiles of contraceptives. These mothers come to
me and I am helpless.
I see women coming to my clinic daily with swollen legs--
they cannot climb stairs. They have been injured by
Depoprovera, birthcontrol pills, and Norplant. I look at them
and I am filled with sadness. They have been coerced into
using these drugs. Nobody tells them about the side effects,
and there are no drugs to treat their complications. In Kenya
if you injure the mother, you injure the whole family. Women
are the center of the community. The wellbeing of the family
depends on the wellbeing of the mother.
Why do you not stop this money being used for
contraceptives and use it instead to provide clean water,
good prenatal and postnatal care, good farming methods and
rural electrification. Do the American people know that the
millions of dollars spent for population control are used in
the ways I have described? Why does your government not deal
directly with our government but instead uses a third party
like IPPF, which has no respect for the values of our people
and our laws?
USAID is the single biggest supporter and promoter of
population control in Kenya. The programs it funds are
implemented with an aggressive and elitist ruthlessness. In
Kenya the target are always the poor and the illiterate who
are pressured and tricked into using dangerous drugs which
are often banned in the west, or who are sterilized during
childbirth without either their knowledge or consent.
If the funds you use to kill, maim, subjugate, dominate and
break us to nothingness were used to cultivate our
extraordinary resources, Kenya alone could feed more than
half the African continent. Dear Americans, you cannot build
your own security on the insecurity and degradation of
others. You cannot build your own wealth on the poverty and
destitution of people in the least developed nations.
____
[From the Wall Street Journal, Feb. 27, 1998]
In Peru, Women Lose the Right to Choose More Children
(By Steven W. Mosher)
When a government team held a ``ligation festival'' to
register women for sterilization in La Legua, Peru, Celia
Durand resisted.
According to Mrs. Durand's now-widowed husband, Jaime, the
31-year-old mother of three was appalled at the pressure
tactics government health workers used to induce women to
have tubal ligations. Not only did they go house-to-house to
round up candidates, but they paid repeated visits to those
who refused to comply. Mr. Durand says they reassured his
wife that the operation was ``simple and quick,'' adding that
she could ``go dancing the same night.''
Even though Mrs. Durand knew that the local health station
was equipped with little more than an examination table,
pressure from government health workers finally wore her
down. On July 4, 1997, she reluctantly underwent surgery. Two
weeks later she died from complications.
Celia Durand was part of a massive sterilization campaign
by the government of President Alberto Fujimori. It is a
classic case of the conflicts of interest and potential for
ethical violations inherent in a government sponsored
``family planning'' program. What was originally sold to
Peruvians as an altruistic program aimed at helping poor
Peruvian women has evolved into an orchestrated attempt to
control reproduction and to meet a goal of fewer Indian
children in the countryside.
In June 1995 Mr. Fujimori announced that his government
would ``disseminate thoroughly the methods of family planning
to everyone'' in order to make ``the women of
[[Page H1522]]
Peru . . . owners of their destiny.'' What has happened since
belies Mr. Fujimori's feminist sentiments.
Until October 1995, even voluntary sterilization was
illegal in Peru. With Mr. Fujimori's backing, the Peruvian
Congress legalized it. Soon the Ministry of Health, then
headed by Eduardo Yong Motta, made sterilization its main
method of ``family planning.''
In a Jan. 29 interview with David Morrison of the
Population Research Institute, Dr. Yong Motta, now President
Fujimori's health adviser, defended the practice of
sterilizing women even if they had previously been using
other contraceptives such as the injectable Depo-Provera.
``Depo costs too much,'' Dr. Yong Motta said. ``In addition.
. . . a women might forget to come in for her shot or might
not want to.'' (emphasis added)
By spring 1996 the Ministry of Health had set national
targets for sterilizations, and health workers were being
given individual quotas. The ministry has been aggressively
targeting poor women in rural areas--which in practice means
those of Indian or mixed descent--for sterilization. The
medical director of the Huancavelica region, for instance,
ordered in a written communique that ``named personnel have
to get 2 persons for voluntary surgical sterilization per
month.'' According to this directive. ``At the end of the
year thee will be rewards for the site that has . . . the
greatest effort to bring in people.''
To meet these targets, mobile sterilization teams travel
throughout the countryside, holding ``ligation festivals''
and practicing the kind of coercion that Celia Durand
experienced. In many areas health workers receive a bonus for
each additional procedure, while they can lose their jobs if
they fail to meet their quotas. As the Huancavelica directive
notes, ``At the end of the year each person will be evaluated
by the numbers of patients captured.''
Dr. Yong Motta openly defends quotas. ``Of course the
campaign has targets. . . . [Success is measured] through
many methods, including numbers of acceptors verus
nonacceptors.'' He admits the dangers of setting targets, but
insists that ``the campaign has been a success.''
That Peruvian medical workers under heavy pressure to meet
sterilization quotas should resort to coercion is hardly
surprising. Knowing full well this danger, the 1994 Cairo
Population Conference condemned the use of quotas or targets
in birth control campaigns, an admonition Mr. Yong Motta and
other Peruvian officials have now admitted ignoring.
Coercion takes various forms. First, there are repeated
visits to the homes of holdouts. As one woman in La Quinta
remarked, the workers came ``day and night, day and night,
day and night to urge me to undergo the operation.''
Various bribes and threats are also employed. According to
interviews in villages and press accounts in El Commercio,
hungry women are offered the opportunity to participate in
food programs, including programs supported by the U.S., if
they agree to sterilization. Women already participating in
food programs have been threatened with expulsion.
Rural women report that no mention is made of
sterilization's health risks. Nor are they given the
opportunity to choose alternative methods of family planning;
indeed, women using contraceptives have been refused
additional supplies. There have even been sterilizations
performed on women without their consent, often during the
course of other medical procedures. Victoria Espinoza of
Piura has testified before a U.S. congressional committee
that doctors at a government hospital told her she was
sterilized--without warning or permission--during a Caesarean
delivery. Her baby later died.
Dr. Yong Motta attempts to defend the pressure tactics.
``If the Ministry of Health did not do the campaign house-to-
house, people would not come,'' he asserts. As far as the
repeat visits are concerned, ``It was a doctor's
responsibility to convince the patient into doing what was
best and having [a tubal ligation]. Women in Peru have many
children.''
The U.S. has some responsibility for all this. It has been
pushing population control in Peru for three decades. As
congressional staffer Joseph Rees remarks, ``We have
enriched, encouraged, and thus emboldened the Ministry of
Health to take decisive action where population growth was
concerned.''
Dr. Yong Motta is more blunt, saying that the U.S. Agency
for International Development ``is disqualified from
objecting [to the sterilization campaign] because they have
been helping in the family planning program from the first.''
To understand how oppressive and intrusive Peru's family-
planning program is, imagine how you'd feel if someone from
the Department of Health and Human Service showed up on your
doorstep bearing contraceptives--let alone an order to report
for sterilization. Not all government-sponsored family
planning programs are this coercive. But there is an element
of intrusiveness common to them all. Instead of making poor
women in Peru ``owners of their destiny,'' Mr. Fujimori's
birth control campaign paternalistically decides their
reproductive destiny for all time.
Sterilization Horror Stories
Bangladesh--Women receiving sterilization and contraception
were offered payment incentives of $3 each, plus a new saree.
The government also pays incentives to providers for signing
up women. Women consent to sterilization out of desperation
for food. USAID endorses coercive incentives.
Honduras--USAID funds help implement coercive program for
experiments with Ovrette, an unapproved contraceptive bill.
Warnings about the experimental drug's side effects on
nursing mothers were hidden from the women in the program.
India--Family planning programs depend on quotas, targets,
bribes and coercion. USAID funds sterilizations using
Quinacrine which is illegal in India and scars/burns the
fallopian tubes. Conditions are miserable at the USAID funded
sterilization camps, there are primitive, unsanitary
conditions and appalling mortality rates.
Indonesia--Family planning clinics rely on threats and
intimidation to bring women into the clinics. Studies have
shown that IUDs are inserted at gunpoint. The programs employ
life-threatening denials of treatment and follow up care and
offer an informed consent.
Kenya--Women are coerced into Norplant implantation and
sterilization. Sterilized women are denied health care for
debilitating complications. USAID is the biggest supporter of
population control in Kenya.
Mexico--Hundreds of forced sterilizations are documented.
Medical personnel are fired for their refusal to perform
sterilizations. Women refusing sterilization are denied
medical treatment.
Peru--Family planning programs are coercion, misinformation
and quotas and sterilization-for-food efforts. Medical
personnel must meet sterilization quotas and surgical staff
are insufficiently trained and work under poor conditions.
USAID sponsors family planning billboards signaling to
Peruvian women that the family planning methods employed are
U.S. sanctioned.
Phillipines--USAID targets local governments with quotas as
a condition for funding and encourages pharmaceutical
companies to push contraceptives on unsuspecting Filipinos.
Women are secretly injected with abortifacient while
receiving tetanus vaccines.
Text From Emailed Articles and Other Textual Excerpts
[From the Latin American Alliance for the Family--Press Release, Feb.
11, 1998]
U.S. Government Asked to Withdraw Population Control Funds From Peru
Following Reports of Massive Human Rights Abuse
Amid ever-increasing evidence documenting coercive
government population control efforts and sterilization
campaigns in Peru, the Latin American Alliance for the Family
(ALAFA) has called for the U.S. government to withdraw its
financial support for Peru's population control efforts which
have resulted in the deaths and injury of numbers of Peruvian
women, mostly in very poor areas of the country.
Daniel Zeidler, director of the U.S. office of the Latin
American Alliance for the Family, an international advocacy
organization, following its own investigative efforts in
Peru, said ``Peru's population program is seriously violating
human rights by pressuring and coercing poor women to be
sterilized. Reports and testimonies abound of women being
offered food in exchange for agreeing to be sterilized,
health workers being pressured to reach government
sterilization goals, women being sterilized without their
consent or without full knowledge of the implications.''
Numbers of women have died following sterilization
procedures. Many women complain that after receiving a free
sterilization they suffer serious medical complications and
many times are not treated or are told by representatives of
the same health system that gave them a free sterilization
that the women must buy expensive medications that they
cannot afford.
Medical experts have stated that the deaths and
complications are due primarily to the poor sanitary and
medical conditions under which these operations are
performed.
Feminist and campesino leaders as well as Church and human
rights leaders within Peru have denounced these campaigns.
Recently, a prestigious independent Peruvian human rights
watchdog organization, the ``People's Defender'' recognized
the validity of the human rights abuses and called upon the
government to immediately reform the program.
The Peruvian government has denied the existence of a
sterilization campaign and has minimized the complications,
but has indicated it will make changes if necessary.
The involvement of US funds in Peru's population control
programs is currently being investigated by Congress. The
chief staff person of the U.S. House of Representtives
subcommittee on International Operations and Human Rights,
Joseph Rees, recently returned from Peru following a fact-
finding mission in January. Rees met with feminist, human
rights, religious and governemnt leaders as well as
interviewing numbers of victims. His official report to the
subcommittee, issued February 10, 1998, was critical of
USAID's involvement in Peru's family planning programming and
recommends that the U.S. ``discontinue all direct monetary
assistance to the Government of Peru family planning programs
until it is clear that the sterilization goals and related
abuses have stopped and will not resume.''
[[Page H1523]]
The report also calls for the U.S. to ``discontinue in-kind
assistance'' which might directly or indirectly facilitate
the sterilization campaigns, and to ``publicly'' disassociate
itself from the campaigns.
Zidler called on all those interested in human rights to
contact both Congress and the President to urge them to
publicly denounce these abuses to the government of Peru and
to immediately suspend US populatin funds to Peru.
____
Fact Sheet No. 1
Some of the Deaths resulting from sterilizations
Case of Juana Gutierrez Chero (La Quinta, Piura, Peru)--
died at home approximately 10 hours after being sterilized;
according to her husband she did not want to be sterilized,
but the health workers kept coming to their house repeatedly
to encourage her to be sterilized. Once she even hid from
them. They came for her one day after her husband had left
for work. They sent her home shortly after the operation.
When her husband returned from work he found her very ill and
in bed; he went off to the clinic to see if he could get
help, but no one was there; Juana died that night at home
about 2 am. (Testimony on video)
Case of Celia Ramos Durand (La Legua)--died about two weeks
after undergoing a sterilization to which both she and her
husband consented after being told it was a simple operation.
According to the family, when she didn't return home from the
clinic, the family went to look for her and were told she had
been transferred to a hospital. They later found out she had
gone into a coma as a result of the operation. (Testimony on
video.)
Case of Magna Morales Canduelas (Tocache)--died 12 days
after being sterilized. (El Comercio, Dec. 19, 1997)
Case of Alejandrina Tapia Cruz (Cajacay)--died one week
after a sterilization operation. (La Republica, Dec. 7, 1997)
Case of Reynalda Betalleluz (Huamanga)--died day after
sterilization (La Republica, Dec. 30, 1997)
Case of Josefina Vasquez Rivera (Paimas)--died day after
sterilization (La Republica, Dec. 30, 1997)
sterilization without knowledge or consent
Example: Case of Victoria Espinoza (Piura). Sterilized
following a C-section. Baby also died. (Testimony on video)
free sterilizations, but patient must pay for complications
Numbers of newspaper articles reported that women who
suffered physical complications were required to pay for
their medications. Many reported there was no follow-up by
health workers.
food in exchange for sterilizations
Example: Case of Ernestina Sandoval (Sullana). She had been
told by health workers that she could get free food by going
to the local hospital. When she got there, she was told she
had to be sterilized in order to receive the food. She
refused. She was told she could get the food this month, but
that next month she should not come back unless she was
sterilized. (Testimony on video) Similar accounts of offering
food in exchange for sterilizations have been reported in
press accounts.
underweight child withdrawn from govt. food program because mother
refused to be sterilized
Example: Case of Maria Emilia Mulatillo (Sullana). Her 2
year-old daughter was participating in a government food
program, but after about two months, Maria was told she
should be sterilized. She said she didn't want to be, yet the
pressure on her continued, till finally she was told if she
didn't get sterilized her child would be withdrawn from the
program. She still refused to be sterilized and her child was
then withdrawn from the program. (Testimony on video)
In order to get women to accept sterilization, health
workers told women their contraceptive would no longer be
available and they should get sterilized. (La Quinta)
you can't leave the hospital unless you're on birth control
Example: Case of Blanca Zapata Aguirre (Sullana). After
giving birth she was told she had to have some type of birth
control. She said she didn't want anything, but she was given
a shot when she was sleeping. She was later told it was for
birth control. (Testimony on video) Peru's government manual
``Reproductive Health and Family Planning 1996-2000'' calls
for 100% birth control usage by women who have just given
birth.
Charges of health workers go house to house, and then back,
and back again pushing sterilization are common.
Health workers are reportedly pressured to meet their
goals.
Some Health workers received 15-30 soles per sterilized
woman (US $6-$12) according to Giulia Tamayo of Flora Tristan
feminist organization. (La Republica, Dec. 30, 1997)
____
Fact Sheet No. 2
Lots of News Coverage in Peru
16 major newspaper articles including numbers of
investigative reports over a period of about one month (mid-
Dec '97 to mid Jan '98) in the major newspaper EL COMERCIO.
Other major newspapers also had significant coverage.) ALAFA
has copies of many of these articles. It is impressive just
to see the quantity of articles written.
Selected Newspaper Headlines from El Comercio, Dec., '97-Jan., '98
``Nurses Deceived Women in Order to Sterilize Them'' (El
Comercio, Jan. 26, 1998).
``Widowers Were Paid Not to Denounce Deaths of Sterilized
Wives'' (El Comercio, Jan. 24, 1998).
``Woman hospitalized for 3 months due to infection caused
by sterilization'' (El Comercio, Dec. 24, 1997).
``They sterilized woman who was one month pregnant'' (El
Comercio, Dec. 23, 1997).
``Woman received clothes for her children in exchange for
sterilization'' (El Comercio, Dec. 23, 1997).
``Food Programs Used to Get Women to be Sterilized'' (El
Comercio, Dec. 20, 1997).
``They Deceived Me'' (Nurse comes to woman's house after
husband had left for work and told the woman that her husband
had said she should be sterilized; woman refused to believe
it, and refused to go; when her husband returned he denied he
had told the nurse that.) (El Comercio, Dec. 20, 1997).
``Children of Woman Who Died Following a Tubal Ligation Are
in Total Abandon'' (El Comercio, Dec. 19, 1997).
``Magna Morales Wasn't Sure, But the Donated Food Convinced
Her'' (El Comercio, Dec. 19, 1997) (Magna Morales died 12
days later following her sterilization.)
Some of the international coverage
LeMonde.
Miami Herald,
Assoc. Press.
France Press(?).
Radio Nederland.
BBC.
[From World, Feb. 20, 1999]
It Takes More Than a Village To Depopulate One
special report from inside kenya's two-child policy: contraceptive
family planning and abortion advocacy mark the kind of ``relief''
international relief organizations energetically import to east africa
(By Mindy Belz)
A large, dusty sign hovering over the used-clothing stalls
of Kenyatta Market reads, ``Marie Stopes International--
family planning/laboratory services, maternal health,
counseling services, curative services, gynecological
consultation.'' Steps beckon to a second-floor clinic. It
offers extended hours, six days a week, and the door is
always open.
Inside, an American woman can inquire about receiving an
abortion, if she will be discreet. ``Do you have all forms of
family planning here, or do you refer patients to a hospital
or somewhere else?''
``Yes, all forms,'' replies a friendly African
receptionist.
``If a person were pregnant, but wasn't sure she could go
through with it . . .''
``You have to just say what it is you want,'' the
receptionist interjects, leaning into the counter and
lowering her voice.
``Could a pregnancy be terminated or would that have to be
done somewhere else?''
``It can be done here.''
Never mind that abortion in Kenya is illegal. Overseas
charity organizations like the British organization Marie
Stopes are the van-guard in changing Kenya's cultural
reticence to killing unborn babies and limiting family size.
They use enticing come-ons promoting ``maternal health'' and
``comprehensive family planning.'' In East Africa and other
developing regions of the world, they receive outsized
budgets from multilateral agencies in the name of empowering
women, improving health conditions, and preserving the
environment.
At the behest of the UN Family Planning Association (UNFPA)
and international groups including Marie Stopes, the
International Planned Parenthood Federation (IPPF), and
others, Kenya is embarking on an aggressive family planning
program. The UNFPA was denied funding by the United States
from 1985 until 1993 for support of China's coercive one-
child policy. Its allocation from Washington restored in 1993
by the Clinton administration, the UNFPA is in the middle of
a five-year, $20 million program to control Kenya's
population. Not content with the dramatic reduction in
Kenya's birth rate--which modern contraceptives already have
achieved (from 8 children per woman in 1979 to just over 4
children per woman today)--the UNFPA and others are looking
to reduce fertility further, to 2 children per woman by 2010.
``We have a two-child policy except in law,'' said Margaret
Ogola, a Nairobi physician. ``Practically the only kind of
health care you get in this country centers on reproductive
health and family planning.''
UNFPA papers refer to a ``decentralized'' national
population policy driven by the Kenyan government's National
Council for Population and Development. But local direction
is not the case, according to Dr. Ogola, who, as a
representative for Kenya's Catholic Secretariat, is involved
in regular consultations with NCPD. Funding for the NCPD, as
for all Kenya's population projects, begins with funding from
UNFPA, the World Bank, the World Health Organization, and
overseas developers like the State Department's U.S. Agency
for International Development (USAID).
From those sources also flow grant and contract awards to
groups like Marie Stopes
[[Page H1524]]
and to Kenya's IPPF affiliate, Family Planning Association of
Kenya (FPAK). USAID does not list Marie Stopes as one of its
beneficiaries, but FPAK received direct funding by USAID
until 1997, according to FPAK director Stephen K. Mucheke.
Mr. Mucheke told WORLD, ``We work in collaboration with other
organizations, and sometimes we may be funded by the same
donor that is funded by USAID. We share the same implicit
plans.''
A little noticed amendment to last year's congressional
budget bill should have put U.S. funding for UNFPA's quota-
based program out of bounds. The Tiahrt amendment forbids
U.S.-funded family planning programs from setting targets or
quotas for number of births, sterilizations, or contraceptive
prevalence.
Abortion, according to Mr. Mucheke, ``is happening down the
street. . . . From an official point of view, I am not
supposed to say that there are groups like Marie Stopes
performing abortions. What I would say is, if you want to
know about products and procedures, ask a consumer.''
In the UN lexicon, so-called private groups like FPAK are
referred to as NGOs, or non-governmental organizations. The
NGO consensus holds that most of the problems in the
developing world can be solved with more contraceptives.
Private pharmaceutical companies also get a piece of the
action by contracting with NGOs and government agencies to
supply the contraceptives. Groups like IPPF, which cried foul
when U.S. judges tried to force Norplant on convicted drug
users and child abusers, don't have a problem when it is
women in the developing world under not government coercion,
but their persuasion.
Common among NGOs, particularly in controversial issues
involving family planning, is a practice of ``stripping off''
portions of a large grant to other organizations, in effect
subcontracting services in a way that makes following the
money a challenge. More common, contraceptive programs reside
in programs with blander names.
Thus, even when the Christian relief organization World
Vision surveyed its health officers worldwide on family
planning issues last year, it found: ``All responding NOs
[national offices] are engaged in some type of family
planning--related activity, either as a straightforward
family planning or reproductive health project or buried
within child survival, maternal health or women's health
activities.''
As a result of the contraceptive campaign, Nairobi
residents are streetwise about birth control. Women who wear
Norplant are teased on city buses for the ``battery pack'';
the six-capsule implant, just inside a women's upper arm, is
revealed when a woman reaches for an overhead strap during
crowded commutes.
Shoppers at Kenyatta, a busy nexus between the slum area of
Kibera and lower-to-middle class neighborhoods near the
downtown area, know where to go for an abortion. They know
about the ``copper T'' and ``the loop,'' two different kinds
of IUDs. And, like people everywhere, they dismiss much-
touted condoms as impractical.
Even Christian women looking for inexepensive, safe, and
acceptable contraceptives may be unknowingly referred to
Marie Stopes, because it has been known to do some
procedures, like tubal ligation, free of charge. The London-
based organization gained a reputation for increasing the
availability of both sterilization and abortion services in
Bosnia and Croatia, countries that now report negative
fertility rates.
In addition to performing actual abortions, Marie Stopes
and other clinics, along with up to 90 percent of private OB-
GYNs, peddle an abortifacient procedure called ``menstrual
regulation.'' Similar to what is known in the United States
as dilation and curettage (D&C), in Kenya menstrual
regulation can be performed as an office or clinic procedure.
It is done when a woman misses a menstrual period but without
benefit of a pregnancy test. No one knows how many abortions
result from menstrual regulation. Even without that tally, in
Kenya, according to UN statistics, ``40 percent of all
documented schoolgirl pregnancies terminate in abortion.''
But none of it means that women who need help are well
informed, according to Stephen Karanja, a long-time Nairobi
gynecologist. Dr. Karanja, a Roman Catholic, served as
secretary of the Kenya Medical Association and has practiced
obstetrics and gynecology at Kenyatta National Hospital,
Nairobi's largest public facility, as well as at Mather
Hospital, a smaller, private, and Catholic facility. Dr.
Keranja helped organize the city's Family Life Counseling
Center and has been an activist in upholding Kenya's law
banning abortion. In 1992 he opened a clinic at Kenyatta
Market--50 yards from the entrance to Marie Stopes. He named
it St. Michael's, in honor of the patron saint that does
battle with forces of evil.
Most of the women Dr. Karanja sees at St. Michael's have
been given no information and little follow-up in connection
with the methods of birth control they are using. Last year
at the clinic, he removed approximately 200 IUDs.
``Word of mouth has spread, and when women begin to have
problems with IUDs, someone tells them to go to `that crazy
man on the hill and he will remove it,' '' he said.
He keeps a sampling of those reclamations in a screwtop
jar, and when he wants to give a graphic depiction of how
women are served by Nairobi birth control providers, he
spills the jar's contents across his desk. To a trained
medical eye, the devices are throwbacks, copper coiled or
loop-shaped IUDs that were taken off the U.S. market at least
five years ago. The T-shaped devices had an extremely high
failure rate; another IUD, copper 385, contained enough
copper wire to be deadly toxic to a developing, tiny unborn
child.
Dr. Karanja's patients tell him, in most cases, that the
birth-control clinics that inserted the devices are not
willing to remove them. ``The services encouraged for poor
women are those that are not repetitive,'' he said. ``They
are not something the women can decide themselves to
change.''
Catholics and evangelical Protestants disagree on where to
draw the line on contraceptives. Both, however, see the
pitfalls of a national family planning plan. ``In our
culture, that is why the message and the messenger have to go
together. The church is still custodian of morality in
Africa. These are deep-seated issues, and people need to be
able to trust the messenger,'' said Peter Okaalet, Africa
director of MAP International, a Christian medical relief
group based in Brunswick, Ga.
``NGO work has come into acceptance because the government
has let us down,'' Mr. Okaalet told WORLD. ``We talk about
Kenya as a country with 10 millionaires and 10 million
beggars. With half the population living below the poverty
line, NGOs are perceived as an answer.''
Dr. Ogola agrees: ``No individual, not even combined force
of the churches--and it is a force to be reckoned with in
this country--can compete with the massive propaganda and
funding. The government has to wake up to the fact that its
people are important and its policies have to be home-grown.
``We have to tell the government to resist. That is very
hard when the government is broke and the donors are offering
millions for family planning.''
{time} 1330
Mr. CHABOT. Mr. Speaker, I yield 4 minutes to the gentleman from
Pennsylvania (Mr. Pitts).
Mr. PITTS. Mr. Speaker, I rise today in support of House Resolution
118, a resolution to reaffirm that this Congress is committed to the
principle that all family planning, both in the United States and, as
we are addressing in this resolution, abroad should be voluntary.
It is critical that we affirm this commitment to voluntary family
planning because even this week there is a gathering at the United
Nations to discuss a 5-year review of family planning and population
development progress since the same Cairo conference 5 years ago.
Since this conference 5 years ago, we have heard some disturbing
accounts of women around the world becoming victims of coercion by
agents of the United Nations. These women's choices are being limited
against their will.
Is this what so-called population control advocates really want, to
tell these women, many of whom are poor and scared, that they can never
again bear more children? Well, we have seen the evidence, and that is
why it is important for Congress to speak up about this today.
For instance, in Peru, what has population control come to mean?
Education? Money to buy clean sanitary medical conditions? Even lessons
about potential contraception?
No. Instead, population control and family planning has come to mean
forced, mandatory and coerced sterilization of poor Peruvian women.
Have these women chosen such paths for their reproductive futures?
Have they been able to discuss options with their husbands and
families?
No. Without notification and without consent, the international
community has strayed from voluntary family planning and is instead
actively pursuing targets and quotas and deciding for poor women what
is best for them.
In Peru, as in many other locations around the globe, this has
resulted in sterilizations, sterilizations in filthy, primitive
conditions, just to meet a mandated quota.
Similarly, in the BBC documentary ``The Human Laboratory,'' women
told their stories about how U.S. taxpayer dollars were being used for
family planning in Bangladesh, in Haiti. One woman begged to have a
Norplant removed. She said, quote, ``I am having so many problems. I am
confined to bed most of the time. Please remove it. My health broke
down completely.'' She eventually resorted to pleading, ``I am dying,
please help me get it out.''
Here was the response. The clinic worker told her, quote, okay, when
you die, you inform us and we will get it out of your dead body, end
quote.
Many other women have complained of severe bleeding, blindness,
migraine
[[Page H1525]]
headaches. According to Farida Akhter, executive director of the
Research for Development Alternatives in Bangladesh, quote, it is
cheaper to use Third World women for such birth control experimental
devices and methods than to use an animal in the laboratory in the
West, end quote.
Through such grossly unjust experimentation, poor women have been
robbed of the most important resource they have, their own healthy
bodies. A woman's health is key to the survival of her entire family in
many of these countries, and this must come to an end.
In the name of population control and under the guise of family
planning, America and the United Nations have exported horror to women
abroad. And our family planning advocates call this progress?
Mr. Speaker, we should be calling it by the most descriptive and
accurate term that it is: Slavery.
I urge my colleagues to join in support of the Tiahrt resolution
today. Reaffirm that all family planning programs should be completely
voluntary. Help maintain the dignity of women around the world.
Mr. GEJDENSON. Mr. Speaker, I yield back the balance of my time.
Mr. CHABOT. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, we would urge adoption of the resolution. I think it is
a very good resolution. I want to again thank the gentleman from Kansas
(Mr. Tiahrt) for proposing it.
Ms. JACKSON-LEE of Texas. Mr. Speaker, today I join my colleagues in
support of House Resolution 118, which reaffirms the principles of the
Programme of Action of the International Conference on Population and
Development. This Programme of Action addresses the sovereign rights of
countries and the rights of informed consent in family planning
programs.
This resolution states that all family planning programs should be
voluntary and completely informative on the various planning methods.
Informed consent and voluntary participation are essential to the long-
term success of any family planning program.
Family planning programs are an essential part of reproductive health
care. Each year an estimated 600,000 women die as a result of pregnancy
and childbirth most in developing countries, where pregnancy and giving
birth are among leading causes of death for women of childbearing age.
With the current world population at over 5 billion and growing, we
must support international family planning programs. Women in under-
developed countries must have access to information that will allow
them to make informed reproductive health decisions concerning
contraception and the spacing of their children.
In supporting this Programme of Action, we support international
reproductive health services and the sovereign right of other countries
to make decisions concerning the well-being of their citizens.
Mrs. LOWEY. Mr. Speaker, I am pleased that the resolution we are
debating today quotes from the Programme of Action of the International
Conference on Population and Development. As many of my colleagues
know, the ICPD met in 1994 and reached a consensus on a 20-year
Programme of Action that makes an unprecedented commitment to women's
rights and concerns in international population and development
activities.
I applaud my colleagues for supporting the implementation of the
Programme of Action. But since the authors of this resolution left out
a good portion of the Programme. I'd like to fill in our colleagues
about the rest of it, because it also deserves our strong support.
The Programme of Action calls for universal access to a full range of
basic reproductive health services. It also calls for specific measures
to foster human development, with particular attention to the social,
economic, and health status of women. It supports integrating voluntary
family planning activities with other efforts to improve maternal and
child health to make the most effective use of our limited resources.
The resolution we are debating here today discusses the need to
respect the religious and cultural realities of the countries in which
we fund family planning activities. I agree. I also believed that we
need to respect the rights of women around the world to make free and
informed choices about their own reproductive health. And we need to
help educate women and men to ensure that they have the information and
resources they need to stay strong and healthy and to nurture healthy
children.
In addition to supporting the portions of the Programme of Action
included in the resolution we are debating today, the United States
also must live up to the financial commitments it made at the ICPD.
To reach the Programme's year 2000 goal of providing $17 billion for
international family programs worldwide--one-third of which would come
from donor countries like the United States--the United States would
have to triple its international family planning assistance.
Mr. Speaker, I am pleased that the authors of this resolution support
the ICPD's Programme of Action. Now I look forward to working with them
to implement all aspects of the Programme.
Mr. CHABOT. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Bass). The question is on the motion
offered by the gentleman from Ohio (Mr. Chabot) that the House suspend
the rules and agree to the resolution, House Resolution 118.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the resolution was agreed to.
A motion to reconsider was laid on the table.
____________________