[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.

                          ____________________