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THE MILLENNIUM SERIES
Women and Population
BY ERLA ZWINGLE PHOTOGRAPHS BY KAREN KASMAUSKI
"Don't look at people like an ant heap,"
N A CERTAIN NOVEMBER DAY an
bluntly paraphrased the common fear, "if those
obscure woman in Iowa gives
people don't stop breeding."
birth to seven babies; we marvel
True, the numbers give pause. Today there
and rejoice. On the same day an
are almost six billion people in the world. For
obscure woman in Nigeria gives
the next 15 years annual increases will proba-
birth to her seventh child in a
bly remain just over 80 million (or one billion
row; we are distressed and appalled.
every 12 to 13 years). The United Nations esti-
In Brazil a mayor sees his town shrink by
mates that by the year 2050 there could be from
two-thirds. Determined not to lose subsidies
7.7 billion to 11.2 billion people in the world.
tied to population, he bans all contraceptives.
Will this be too many? It is difficult to pre-
In Bangladesh the government, determined to
dict, as even Malthus would have seen by now.
stem the tide of births, offers to sterilize women
Predictions often impel changes in the very
for free and throws in a new sari as a gift.
behavior that inspired the prediction. Provid-
In Kenya a woman keeps trying for a son
ing enough food, of course, is paramount.
because her husband asks, "Who will hold my
But what about fresh water? Forty percent of
head for me when I die?" In the United States
the world population faces water shortages at
an unmarried teenager looks at her infant
daughter and says, "I don't really know what I
was doing. I thought I was in love. I thought it
was this great thing, but it was stupid."
Population: We know it's a problem. In fact
most of the problems facing individuals, fami-
lies, communities, and nations are affected by
the quantity of humans sharing the planet.
But if the problem were only numbers, these
stories would have no power to touch or per-
plex us. Nor would we race to bring food to
famine-stricken countries, or blanch to read of
newborn babies being thrown into trash bins,
or fall silent upon hearing of the pregnant
mother who refused cancer treatments that
could damage her baby, gave birth, and died.
Even as some fear for our species' survival, we
instinctively sense mysteries that transcend sta-
tistics. "Don't look at people like an ant heap,"
one expert urged. "These are individuals."
Two hundred years ago Thomas Malthus
predicted mass catastrophe as a result of over-
population. So far, events have not turned out
quite as he supposed they would, yet the brutal
probabilities he described continue to darken
some views of the future. Today 98 percent of
population growth is in the developing world.
"The world is going to hell," as one observer
Freelance writer ERLA ZWINGLE lives in Venice, Italy, a
country in which the falling birthrate is a serious con-
cern. Photographer KAREN KASMAUSKI, a mother of
two children and a veteran of 16 GEOGRAPHIC assign-
ments, also focused on human migration for this issue.
38
heap,"
one expert urged. "These are individuals."
n fear, "if those
some time during the year. What about jobs?
culture, the strongbox in which our sense of
There is already an increasing shortage of those
what we can do is locked.
e. Today there
too, and according to the Population Reference
Contraception has been the key. The num-
the world. For
Bureau masses of unemployed people form
ber of women in some developing countries
ses will proba-
"a social and political time bomb."
using contraceptives has risen to more than 50
(or one billion
But there has been dramatic progress over
percent. "There isn't any place where women
d Nations esti-
the past 30 years. Birthrates have dropped in
have had the choice that they haven't chosen
could be from
many developing countries (including China
to have fewer children," says Beverly Winikoff
e in the world.
and India), and the number of children born to
at the Population Council in New York City.
lifficult to pre-
each woman has fallen on average from six to
"Governments don't need to resort to force."
e seen by now.
three. This is the result of remarkable changes
Yet some 200 million women become preg-
es in the very
on three fronts: contraception, health care, and
nant each year. Half of these pregnancies are
iction. Provid-
is paramount.
Soon to have a sibling, an only child nestles in her mother's sari at a clinic in Bangladesh.
orty percent of
Nurses provide checkups and offer advice-starting with "space your children." Longer
er shortages at
gaps between births mean healthier mothers and babies and slower population growth.
unplanned, and a quarter are unwanted. Un-
obvious. Bangladesh is the ninth most popu-
Chamurk
wanted children are often neglected, abused,
lous nation on Earth, and, with only 52,000
from the 68
or abandoned. They receive less food, medical
square miles of land, it is one of the densest. It
an assortm
care, and education than wanted children.
is also one of the poorest.
with corrug
More than half a million women die each
Today Bangladesh is praised as a population
matting, clu
year from causes related to pregnancy, often
success story. In 1990 its birthrate was an
of beaten e
the result of poor health, lack of medical care,
unbridled 4.9 children per woman (which, if
to spread 11
and having babies too close together. Seven
unchanged, would have doubled its population
a baby give
million infants die each year because their
by the year 2015). The rate is now 3.3, a fact
Someone n
mothers were not physiologically ready for
that has astonished those who believed the
phone rings
pregnancy or lacked obstetric care. Millions
country's population would drop only after
Anowara
of women and men resign themselves to this
chronic poverty and illiteracy were overcome.
village; it's
reality. But with the chance to plan their
Much of the credit goes to two of the many
it with a l
families, they are beginning to see a way to
organizations that help the poor: the Dhaka-
she makes
re-imagine their future. "People are desperate,"
based Grameen Bank, with its innovative pro-
milk or egg
one woman said, "to control their own destiny."
gram of "microcredit," or small loans, and the
sells telep!
Bangladesh Rural Advancement Committee
cents) a m
N BANGLADESH dawn rises over banana
(BRAC), with its nationwide network of village
phone bill
I
groves and palm trees, the emerald
clinics. The work of BRAC and Grameen has
keep some
expanse of rice fields, and pools where
made it possible for millions of women and
"Every \
women in vivid saris immerse them-
children who once could hope only for sur-
the phone,
selves, drenched in the golden light. Here
vival to begin to dream of progress. Mosammat
three years
the problem of overwhelming numbers seems
Anowara Begum is one of them.
parts of B
40
NATIONAL GEOGRAPHIC, OCTOBER 1998
WOMEN AN
Woman to woman
Pledged to bear no more children, a volunteer with the Bangladesh
Rural Advancement Committee counsels a pregnant woman in
Shoal village (left) and dispenses antibiotics for a mother's sick
baby (below). She also discusses family planning. Contraceptives
distributed by such workers helped lower Bangladesh's birthrate
from seven children per woman in 1975 to fewer than four in 1995.
ninth most popu-
Chamurkhan village isn't very different
several children could be destined to beg or
with only 52,000
from the 68,000 other villages in Bangladesh:
even turn to prostitution. But once the loan is
e of the densest. It
an assortment of one- or two-room houses
paid off, Anowara Begum stands to net an
with corrugated metal roofs and walls of palm
average of $2 a day-more than $700 a year-
ed as a population
matting, clustered around small common areas
in a country with an average annual per capita
birthrate was an
of beaten earth. As the morning light begins
income of about $250.
woman (which, if
to spread through the trees, a rooster crows;
Since its launching in 1976, the Grameen
led its population
a baby gives a small, fretful cry; a dog barks.
program has loaned more than two billion
is now 3.3, a fact
Someone nearby hawks and spits. Then the
dollars, in amounts averaging only $180, to
who believed the
phone rings.
more than 2.1 million destitute women.
I drop only after
Anowara Begum has the only phone in the
"We find that when women start borrowing,
y were overcome.
village; it's a Nokia cellular phone. She bought
it benefits the whole family," Mohammed Abul
two of the many
it with a loan from the Grameen Bank, and
Hossain, a senior officer at Grameen, tells me.
poor: the Dhaka-
she makes money with it. Instead of selling
"Her children become important, the family's
ts innovative pro-
milk or eggs, as many of her neighbors do, she
welfare becomes important." One recent study
all loans, and the
sells telephone calls at 4.6 taka (about ten
in Brazil showed that income controlled by the
ment Committee
cents) a minute. At this rate, she can pay the
mother had a benefit on her children's health
network of village
phone bill and weekly loan installment and
that was almost 20 times greater than income
and Grameen has
keep some profit too.
controlled by the father.
IS of women and
"Every week I make 300 taka [$6.50] from
Sharifa Akhtar Shikha, Anowara's 20-year-
pe only for sur-
the phone," she says, "and I repay 160 taka. In
old daughter, studies Islamic history at Dhaka's
gress. Mosammat
three years the loan will be repaid." In some
Jagannath University. "If my mother hadn't
m.
parts of Bangladesh an illiterate widow with
gotten the loan," Shikha says, "it would have
C, OCTOBER 1998
WOMEN AND POPULATION
41
been impossible for me to go to the university.
But she wanted me to have a higher education."
Why? Anowara smiles. "For the future," she
answers. "She will be independent and have
more income. And she'll be happy also."
NORTH
When people can start making decisions
AMERICA
about their lives, they also start making deci-
sions about the size of their families and vice
versa; family planning within Grameen fami-
2.0 (5
lies is twice as common as the national average.
57.2
Surveys have also found a strong link between
1.2
education and family planning.
Mexico
But Bangladesh still has a high death rate of
95.8-154
babies and mothers. Here females die earlier
3.1
7
than males (the opposite of the biological
Nicaragua
$4.5-9.9
11.8->
norm), due in part to severe malnutrition and
4.6
16
46
6.7
19
risky pregnancies, often too close together.
To help improve health care, BRAC has
Colombia
37.7-62.3
founded clinics throughout the country.
&SOUTH
3.0
9
28
"Many more women want contraceptives
AMERICA
now," said Mergina Khatun, a village health
Brazil
165.2-243.3
worker in Mymensingh district. "They see that
2.5
9
if a mother has fewer children, she can give
them better care. And her health will be better."
What if a conservative Muslim leader tells
8.20 billion
2050
UN medium
Mergina that contraception is against the will
population
of God? "I say that God also told us to be
projection
responsible for our families."
/ In the BRAC health center in the town of
Mymensingh, the nurse is counseling a few of
the 800 women who visit every month. A thin
young woman, three months pregnant, sits list-
lessly by the desk. She tells the nurse that she
has been suffering from morning sickness and
has an intermittent fever. She is 20 years old
pla
and has been married three and a half years.
This is her third pregnancy; she has already
bil
suffered one stillbirth and one miscarriage.
1998
4.75 billion
ch
Contraceptives could have helped her delay
these pregnancies until her health improved.
The nurse advises her to take full bed rest,
Diverging futures
eat extra food, and do no heavy work. None
Virtually all of the projected pop-
de
of this will be possible for her. The nurse pre-
ulation increase by 2050 will
N
scribes an antihistamine spray and an analgesic
occur in developing countries
ni
(light gray column). The popu-
for the pain and fever. The girl's gray-haired
bi
lation of the developed world
mother-in-law crouches on the floor, leaning
(dark gray) will fall, as women
against the wall, waiting silently.
there continue to average fewer
than two children each.
Loans and contraceptives continue to
improve the lives of Bangladeshi women and
S
their children. But sadness still inflects the
1998
lives of even healthy families.
1.18 billion
"I have three daughters; the youngest is just
2050
a year and three months old," says Firoza in
1.16 billion
UN medium
population
projection
42
1
1
1
1.2 5 17
1.7
3
6
TH
CA
ASIA
2.6 5 42
EUROPE
1.8
1
31
China
1.4
<1
4
1,255.1 > 1,516.7
Antran
1.2
1
6
73.1
170.3
(Com
Egypt
3.0
6
35
65.7-115.5
India
3.6 6 63
975.8
Nicaragua
7.99
36.
20
3.4
7
72
3.3 15 82 )
4.6 16 46
6.7 19 123
6.4
12
29
4.5 9 62
SOUTH :
AMERICA
21.8 338.5
an
ACORD
Brazil
6.5 15 84
165.2-243.3
2.5
9
4.8 8 77
1.8 2 5
on
Developed
4.3 8 60
countries
Developing
countries)
Health wealth, and population
In what experts calla virtuous sycle, family
if() treatment OF WORKER on mants aquale
planninglleads to healthier STATES
According in the Payable
mother avoid early,late, of elegaly Specifical
in
NEW
You
Gity
smallar
births. Healthier women have neathler
work 97 : were!
children. And fewer child deaths 1:1:101 is)
births as women stop,believing THE they
must have many babies or a BW (i) survive
I futures
In the past.many concluded that economic
Wealther
:I of the projected pop-
development was the best contraceptive
fir
developed
rease by 2050 will
Now, backed.by studies showing family plan
HAVE couminst
eveloping countries
column). The popu-
ning is the most effective.means Ti lowering
ream
better.
e developed world
births worldwide, experts say Contraceo
ower righters 10:00
will fall, as women
tives are the:besticontraceptiva. I Yet devel
nue to average fewer
opment RAHE and its benefits especially better
8
hildren each.
education and health care, remain.es sential
000
Such ances raise demand or family plant
Voman
ning, persuade young couples in poor.coun-
tries to postpone childbearing, and encourage
3.3
3
BASE MAP AND POPULATION DATA: UNITED NATIONS
1.6
STATES CENSUS BUREAU: HEALTH ISSUES DATA: POPULATION
MAP. AND GRAPHS BY, STEPHEN ROUNTREI
Army of entrepreneurs
Saluting the future, women meeting
near Dhaka to repay loans acknowl-
edge the loan officer from Grameen
Bank, who freed them from lives of
powerlessness and isolation. "We
shall plan to keep our families small.
We shall keep free from the curse
of dowry. We shall not practice child
marriage"-so runs the creed Gra-
meen clients, who are 95 percent
female and 100 percent poor, recite
as a promise to break from traditions
of poverty. Launched into business
with a small loan, a woman travels
from door to door selling cookware
(below). Anowara Begum (below
right) used a loan of $390 to buy a
cellular phone, which fellow villagers
pay to use. Soon after the death of
her husband, Anowara hears from
her brother in Malaysia while their
mother weeps. For birthrates to keep
falling, experts say women must be
offered opportunities beyond moth-
erhood and given the authority to
choose whether to bear children.
Taldighi village. "My husband is disappointed.
in large part to massive education campaigns,
make the
Now he is saying he didn't want any more chil-
more clinics, and inexpensive contraceptives.
Philip
dren. Two would have been better, he says,
But Africa, which still has the highest birth-
vary Ten
since the third one was a girl."
rates in the world, remains profoundly child
neighboi
"I had twin baby boys," her neighbor, Alef-
centered. "A person who doesn't have children is
man wit
jan, tells me. "They died of a respiratory infec-
looked down on," a woman explained, "because
first me
tion, one when he was seven days old and the
that person is incomplete in the society."
Marie St
other when he was 14 days old. My husband
In much of the world men have often
The n
told me, 'We don't need to go to the hospital-
been the major objectors to family planning.
children
they don't have drugs for children this small.'
Some do so on the basis of religious beliefs;
azines. ]
And I believed him."
others want to demonstrate their virility. Many
The yell-
believe that only the fear of becoming preg-
"Plan yc
OMEN AND POPULATION," repeated
nant will keep their wives faithful. And there
depends
W
Beverly Winikoff at the Popula-
are misunderstandings: "I used to hate family
world h
tion Council when I told her my
planning," a man told me, "because I thought
"My
topic. "It sounds like you're treating
it meant that people shouldn't have children."
me. "It
women as the disease vector." What about men?
Yet as men struggle to provide for their
for 13 ci
The sun rises over Nairobi, gilding the dusty
families, some admit that smaller families are
cup of 1
parks, the battered streets, the chaotic, make-
better. To help them become more involved in
"Wh:
shift markets. Kenya used to have one of the
family planning, male-only clinics have begun
was th:
highest birthrates in the world, but in the past
to appear in Kenya, Ghana, and some South
raise,"l
20 years it has shown one of the steepest de-
American countries. And a few pioneers, over-
and she
clines in all Africa. As in Bangladesh this is due
coming the common fear that sterilization will
my wife
46
NATIONAL GEOGRAPHIC, OCTOBER 1998
WOME
Early parenthood
Seven months a mother, Jill Crisler, 16, fixes a bottle for her son,
Trenton, before leaving for Northeast High in Lincoln, Nebraska.
Like many teenage births, this one was unplanned. "It's not a mis-
take," says Jill. "I call it a surprise." Unlike most unwed fathers,
Luke Smith stays in his son's life, hurrying from his job to his new
role as Trenton's playmate at the school day care (below).
on
campaigns,
make them impotent, are choosing vasectomy.
That's what the Bible says. So I read about
contraceptives.
Philip Njuguna is pastor of the Nairobi Cal-
vasectomy. The only side effect is that you can't
highest birth-
vary Temple, a Pentecostal church in a poor
have children anymore"-he smiles-"and
foundly child
neighborhood. At 37 he is a small, compact
that's the side effect I wanted."
lave children is
man with a friendly, intelligent expression. I
To their credit many men worry about the
"because
first meet him in the male-only suite of the
possible side effects some contraceptive meth-
ociety."
Marie Stopes Clinic downtown.
ods may have on their wives. Then again,
have often
The main waiting room is full of women and
studies show that men are generally reluctant
planning.
children watching television and reading mag-
to use methods that directly involve them-
igious beliefs;
azines. The rooms next door are for men only.
withdrawal, abstinence, condoms, and the
virility. Many
The yellowish walls bear a few modest posters:
rhythm method. As for vasectomy, says clinic
coming preg-
"Plan your family now-your children's future
counselor Patrick Musyoka in his gentle voice,
And there
depends on you." '45 million men around the
"The stigma is still there."
hate family
world have had a vasectomy."
Men are the point at which family planning
I thought
"My father had just eight acres," Philip tells
leaves the realm of mechanics and enters the
children."
me. "It was an average-size farm but not enough
mysterious territory of behavior. Contracep-
for their
for 13 children. In the morning there was just a
tives themselves are simple-it's the users that
families are
cup of tea. No lunch. Poverty eats you every day.
are complicated, caught up in the volatile
involved in
"What made me decide to have a vasectomy
dynamics of human relationships. "Family
have begun
was that I wanted to have a family I could
planning came to Kenya through health
some South
raise," he continues. "My wife was taking pills,
programs for women," Godwin Mzenge, a pro-
oneers, over-
and she had high blood pressure. Who am I to
gram director, tells me. "The assumption was
rilization will
my wife? I'm her partner. I'm there to help her.
that women would discuss with their husbands
CTOBER
1998
WOMEN AND POPULATION
47
Premature parents, mothers at Lincoln High School gather at lunch as part of a student-child
growtl
program that helps them graduate. The U.S. has the highest teenage birthrate in the industrial-
progra
ized world. Adolescent births endanger mothers and their babies while accelerating population
birth C
dent-child
growth. Rather than stressing either abstinence or contraceptives alone, successful prevention
e industrial-
programs also emphasize setting and achieving goals. "Hope is the most important method of
g population
birth control," says Susan Powers-Alexander, of Lincoln's Planned Parenthood.
what they learned. But now we know that com-
it is, but not always in the way we mean. "I'd
overcom
munication between them isn't that common."
like to have a baby," said Tonya, a pert 12th
on a bod
"We encourage the women to keep discuss-
grader, "but not now. Too many of my friends
a myth
ing," says Rose Ngahu, a nurse. "It takes a lot of
have babies: Mindy, Janet, Penny, Becky, Sue
healthier
force of character to resist the husband."
Ann, April.
"
you knov
This is bad news, for a number of reasons.
Her b;
N LINCOLN, NEBRASKA, a crisp autumn
First, there is sheer quantity: By the year 2000
Infants I:
I
morning spreads across the prairie, over
there will be more adolescent girls in the world
risk of lo
the flags snapping in front of the state
than there have ever been: 400 million poised
birth tha
capitol, over the football fields ready for
to begin having children. If they were to delay
24. They
marching-band practice after school. In the
their first baby by five years, it would mean 1.2
and high
half-light students are arriving for class at Lin-
billion fewer people by the year 2100.
problem:
coln High School. They carry the usual teenage
Second, there is the quality of those lives. Of
likely to
stuff: books, musical instruments, backpacks.
the nearly four million babies born each year
found tl
Some of the girls are also carrying their babies.
in the U.S., nearly one out of eight is born
mother
The U.S. has the highest teenage birthrate of
to a teenage mother. When a girl under 20
social CO:
any industrialized nation. Since 1960 the rate
has a baby, problems mount for everyone.
many of
has tripled among unmarried females age 15 to
She may well drop out of school, in which case
whelmed
19. According to the Alan Guttmacher Insti-
she is likely to go on welfare. (In 1995 the gov-
said. "I fc
tute, four in ten American girls become preg-
ernment spent 37 billion dollars on welfare,
In 199
nant at least once before they reach 20; most
food stamps, and Medicaid for families begun
opened a
of these pregnancies are unintended.
by a teenage mother.) Emotional immaturity
school. T
We think of Lincoln as the real America. And
can lead her to abuse her baby; it can be hard to
east Higl:
50
NATIONAL GEOGRAPHIC, OCTOBER 1998
WOMEN
Smaller is b
Dressed in school uniforms their mothers struggled to buy, Masai
children drink a breakfast of tea in the doorway of a house in rural
Kenya. In Nairobi, Philip Njuguna, a pastor, watches his third child
and only son (below). Njuguna underwent a vasectomy after the
boy was born. "When the family is small, whatever little they have
they are able to share," he says. "There is peace."
we mean. "I'd
overcome the stresses of pregnancy and labor
make sure the girls graduate. "We want the girls
'a, a pert 12th
on a body that hasn't finished developing. "It's
to be successful," says Karen Poore, a teacher at
of my friends
a myth that because they're younger, they're
Northeast. "Whatever will help them complete
ny, Becky, Sue
healthier," one woman told me. "What teen do
their education, we advocate."
you know who eats right?"
There was resistance. "Some people didn't
ber of reasons.
Her baby also may very well have difficulty:
want Lincoln High to be known as 'the preg-
the year 2000
Infants born to teenage mothers are at higher
nant school,' says Ann Irvine at the public
rls in the world
risk of low birth weight, prematurity, and still-
school district office. "There was still the
million poised
birth than children born to women age 20 to
shame factor. We had to get over that." And
y were to delay
24. They also tend to have lower test scores
objections came from those who were con-
ould mean 1.2
and higher rates of physical and psychological
vinced that a day-care center would be seen as
2100.
problems. Sons of teenage mothers are more
encouragement to be promiscuous. "The girls
those lives. Of
likely to serve time in prison. The state of Utah
just laugh," says JoAnn Bartek, who teaches
orn each year
found that every $400 spent on a teenage
family and consumer sciences. "They say, 'Oh
eight is born
mother saved the state $400,000 in various
yeah, that's really what we were thinking:
girl under 20
social costs over the lifetime of her child. But
They've got this really neat day-care center; I
for everyone.
many of the girls only know that they are over-
think I'll go get pregnant."
in which case
whelmed. "I didn't feel shame," one of them
As for those who maintain that the girls
1995 the gov-
said. "I felt fear."
shouldn't be in school, according to Bartek, the
rs on welfare,
In 1993 some of the staff at Lincoln High
girls say, "Well, where should we be? If we don't
families begun
opened a child-care and learning center at the
get our high school diplomas, we're going to
al immaturity
school. They-and their colleagues at North-
be on welfare. We're going to be homeless."
can be hard to
east High-avow that their first priority is to
One study found that almost 60 percent of
OCTOBER 1998
WOMEN AND POPU
51
1
Masai children gather for opening ceremonies at Kimuka Primary School in Kenya's Rift Valley.
birthrat
Adapting to a shrinking supply of cattle land, Masai herders are bearing fewer children in
plannin
hopes of sending all their sons and daughters to school. Africa has the world's highest
provide
t Valley.
birthrates, but they are starting to fall with better health care and education, stronger family-
in
planning programs, and-in countries such as Kenya-weak economies that make it hard to
provide for many children. Even so, the continent's human numbers will double in 30 years.
teens who became pregnant dropped out of
high school. At Northeast and Lincoln High 80
percent of pregnant teens are graduating.
I meet some of these teens at the child-care
center at Lincoln High. The room is spacious
and cheerful, full of toys and cots and intensely
clean. Several girls are here on their lunch
break, crouched on the floor playing with their
babies or talking with the assistants and each
other. A few sit quietly, nursing. The mothers
look more like older sisters.
At 3 p.m. Mandy Brehm comes to pick
up her eight-month-old daughter, Juliana.
Mandy is 16; she has long brown hair, green
eyes, and a pretty, round face. She's named in
Who's Who Among American High School Stu-
dents. When we get home, her mother, Diane,
and her younger brother, Jared, are there.
There is pizza for dinner. As we eat, Diane
recalls the day she learned her daughter was
pregnant. Mandy couldn't find the courage to
tell her; instead she left a note on her mother's
bed. "It said, 'I'll never be the daughter you
wanted. This is the worst day of my life. But I
don't want to kill the baby.' I cried for about
two hours. Then I called her at school and
asked if she wanted to come home."
Many girls do not have the support or the
determination that Mandy did. Fifty percent of
abortions in the U.S. are sought by women
younger than 25.
"My own thought," says Beverly Winikoff at
the Population Council, "is that most people
wouldn't use abortion as a first choice. But
they're pregnant, and they need not be."
make clear decisions. Older boys can dazzle or
Married
What will Mandy tell Juliana when she
dominate: Over half the males responsible for
While m
grows up? "Not to have sex," she replies." 'Cause
teen births are 20 or older. Early sexual abuse
choices.
it's not worth it."
cripples the capacity to say no; one study
Mandy will probably be the only person tell-
reported that 48 percent of high school stu-
discussio
ing her that. "We bombard kids with sexual
dents who had been pregnant were once sex-
The V
messages, but we don't teach them how to
ually abused. And there is fear of losing love.
that sext.
process them," says Susan Powers-Alexander,
"Part of the reason I was so reckless was
lion time
a director at Planned Parenthood in Lincoln.
I didn't like myself at all," Mindy Latzel, 18,
the past
"We don't teach kids to decipher that they're
tells me. "He was 22 at the time. He made me
want to
using sex to sell cars, perfume, pineapple."
feel good about myself, telling me how pretty
to it. M;
The influences on adolescents are powerful
I was. But I guess it was a bunch of lies."
economi
and pervasive: movies, advertising, music, peer
shrinkin;
pressure. The girls face life with a wild assort-
OW MANY CHILDREN should we have?
program
ment of mismatched traits: ignorance, bra-
H
How far apart?" Stan Bernstein,
back on
vado, curiosity, delusions of invulnerability.
senior research adviser at the UN
In Ken
The reasons for teen pregnancy go on. Many
Population Fund, asks rhetorically.
want to
teen mothers are children of teen mothers.
"How should we educate them-concentrate on
mother 1.
Alcohol and drugs undermine the ability to
a few and hope they'll take care of us?" These
In Ban
54
NATIONAL GEOGRAPHIC, OCTOBER 1998
WOMEN /
ys can dazzle or
Married but without children, a Masai teenage bride looks forward to her first pregnancy.
; responsible for
While many women's lives are still dictated by circumstance, more and more now enjoy
rly sexual abuse
choices. In their hopes, fed by new possibilities, the future is born.
no; one study
high school stu-
discussions are happening more and more.
are enough. Because if you have more, you
were once sex-
The World Health Organization estimates
can't raise them as human beings."
r of losing love.
that sexual intercourse occurs a hundred mil-
In the U.S. a 16-year-old father looks at his
so reckless was
lion times a day. Yet despite the great strides of
infant son and says, "I'd probably be locked up
indy Latzel, 18,
the past three decades, millions of couples who
in some juvenile hall if he wasn't here. He's
ie. He made me
want to use contraception don't have access
changed me for the better."
me how pretty
to it. Many developing countries, faced with
The sun rises every morning on more than a
h of lies."
economic crisis and political uncertainty, are
quarter of a million newborn babies. A few of
shrinking their financing of family-planning
them may change the world; all of them will
hould we have?
programs. Some foreign donors have also cut
change their mothers and fathers. They don't
Stan Bernstein,
back on aid-the U.S. by one-third.
belong to the ant heap. They belong, for better
iser at the UN
In Kenya a man says, "When my wife didn't
or for worse, to us all.
iks rhetorically.
want to have more than three children, my
Erla Zwingle reports further on teenagers and preg-
-concentrate on
mother told her, 'You're just lazy.'
nancy at www.nationalgcographic.com/features/2000/
e of us?" These
In Bangladesh a woman says, "Two children
population/women.
OCTOBER 1998
WOMEN AND POPULATION
55
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
Catholics and Cairo: A Common Language
One of the most daunting tasks in international
inflammatory language, such as "population
discourse is the discovery and crafting of a common
explosion" and "zero population growth." This
language. This imperative becomes all the more
demographic approach emphasized reduction of
difficult and demanding when the issues seeking
population and neglected women's human rights.
expression are charged with intense feelings,
emotions, and differences in worldview.
The Programme of Action represents a
refreshing step forward. It recognized the
The United Nations 1994 International
importance of ethics, values, interrelationships,
Conference on Population and Development and its
sustainability, poverty eradication, and especially the
Programme of Action adopted in Cairo constitute a
connection between the empowerment of women
pivotal moment in the articulation of a common
and lower fertility rates. The document articulates a
language of conscience. Furthermore, Cairo
broad vision that puts human dignity above
provided the Catholic church with an unprecedented
demographic goals; women's equality and men's
opportunity to enter the world dialogue in terms not
responsibility over mandated family planning. It
unfamiliar to its own traditions and mission.
crafted language on reproductive and sexual health
and rights.
THE CAIRO CONFERENCE
AND THE PROGRAMME OF ACTION
This year, the five-year assessment of Cairo will
be conducted through a series of regional, national,
Every ten years since 1974, the United Nations has
and international meetings. This assessment is
convened an international conference on population
enhanced considerably by religious voices reflecting
and development. Past conferences have been held
on the principles and goals of Cairo and its
in Bucharest (1974) and Mexico City (1984). In
Programme of Action. Among these religious
1994, 180 governments came to Cairo, Egypt, to
groups, a Catholic reflection is especially crucial
attend the third United Nations International
because of the strong and sometimes controversial
Conference on Population and Development
role played by the Vatican and the Holy See during
(hereafter, Cairo or the Cairo Conference).
the Cairo process.
At Cairo, the governments of the world agreed
THE VATICAN AT CAIRO
to a list of proposed actions for the future - these
are contained in a Programme of Action, which
Cairo sought to deal with some of the most volatile
spans over 100 pages and comprises sixteen
issues in our personal, political, and religious lives:
chapters. Chapters three through sixteen develop
reproduction, sexuality, development, and women's
the qualitative and quantitative goals agreed to at
human rights. Remarkably, it chose to link these
Cairo. Of particular interest to Catholics and other
themes together and to deal with them in the
people of faith are the principles in chapter two that
overarching categories of rights and responsibilities.
provide the ethical framework for the Cairo
approach to population and development.
Rights emerge from the individual, innate, and
inviolable core of each person. Responsibilities are
Earlier population conferences were rightly
grounded, for the most part, in the community, in
criticized for focusing solely on limiting family size
the demand to treat others with equal dignity and
and reaching demographic targets, often using
rights, and in the insistence that the consequences of
CATHOLICS FOR A FREE CHOICE
2
all our actions be measured by more than our own
or to propose language that could win the support of
advantage and identity. The dialogue and tension
the world. This difficulty was compounded by the
between rights and responsibilities, between
Vatican's reluctance to affirm the revolutionary
individual and community, between belief and
character of the Cairo Conference as it put issues of
conscience, between wealth and poverty, indeed
population in an overall ethical framework fortified
between men and women were addressed in Cairo to
by insistence on women's rights and health.
an unheard-of level of agreement. To find the
words and consensus to express the world's
Furthermore, the Vatican's actions at Cairo
conscience on such controversial matters is
weakened Cairo's message, particularly for the
extraordinary. One might have supposed that the
Catholic observer. While there are many Catholics
Holy See would be gratified by the serious purpose,
who do not agree with the positions taken by the
religious resonance, Catholic language, and moral
Vatican at Cairo, more still do not realize how
tone with which Cairo went about its work.
consistent the Programme of Action is with Catholic
teachings. In reality, Cairo and the Vatican had
The field of agreement between the Catholic
more areas of concurrence than disagreement. The
church and the Programme of Action is large and
Vatican came to Cairo with deep suspicions and an
impressive. Nonetheless, sharp differences emerged
apparent unwillingness to trust the global process of
(these are dealt with in part 2 of this paper).
reaching agreement on ethical issues, and, therefore,
its message at Cairo was often inconsistent with
Unique among religious bodies of the world,
church teachings. In particular, the Vatican's actions
the Catholic church enjoys a privileged status as a
distorted what Cairo actually said on women's
Non-Member State Permanent Observer at the
human rights, health, and family.
United Nations through its governmental entity, the
Holy See. In this capacity, the Holy See takes part in
Reproductive rights are dealt with in the
United Nations conferences and can exercise, as it
Programme of Action under the larger rubric of
did at Cairo, voting rights.
human rights for women. The same strategy is
followed in addressing reproductive health through
However, any government will not necessarily
the more expansive issue of a right to health. This is
reflect the beliefs and practices of the people it
one of the great contributions of Cairo. It
purports to represent. There is a distinction between
constantly seeks a larger context, one in which there
the Catholic church and its tradition as a whole (i.e.
is universal agreement, before it deals with
the entire body of believers) and the administration
controversial specifics. Thus, all of the world agree
of that church as it is represented by the Holy See at
on human rights for women even if they may
the United Nations. This distinction is especially
disagree on reproductive rights. The same is true of
important to keep in mind because the laity,
a right to health and the more difficult issues of
theologians, and the bishops at large have no
reproductive health, safe motherhood, abortion, and
meaningful voice or vote on the selection of the
sexual health.
pope and the policies of the Holy See. Therefore, a
truly Catholic position on a particular issue must
One of these difficult issues turned on the
take into account not only the official position of the
definition of "family." As Cairo sought a
Holy See, but also the way this position is received
comprehensive definition, the Vatican feared that a
and lived out in the body of believers. This widely
consequence of so broad a definition would be the
accepted approach insists that Catholic teaching is
validation of homosexual unions.
made up of two entities: the teaching hierarchy
(pope, cardinals, and bishops) and the teaching of
The Vatican became most adamant over the
the laity - the sensus fidelium.
issue of abortion. It finds abortion and
contraception immoral in every circumstance. It
rightly opposes coercive use of these methods.
For all these reasons, the strong Vatican
Delegates at Cairo agreed with the need to end
rejection of major items in the Cairo document was
coercion but also believed that people should be
puzzling and disappointing. The Vatican has every
informed of all these choices. The Programme of
right to state its reservations. The difficulty many
Action leaves to religions and conscience the
experienced with the Vatican's position derived from
dialogue about whether particular individuals or
its unwillingness to enter the process of discussion
traditions should choose among the options they are
CATHOLICS FOR A FREE CHOICE
3
given. In a world climate in which choices seen as
While it is written from a Catholic perspective,
moral by one side are branded as immoral by the
we hope this article will be of use and interest to
other, the Cairo Conference had no other way to
readers from other religious, ethical, or philosophical
proceed.
traditions. And by no means does our analysis
pretend to be exclusive: Cairo's vision reflects the
The articulation of moral choices should never
values of many belief systems.
be so absolute that they have no reference to the real
situations in which people live. Catholic theology
PART 1
and teaching have always affirmed the right of
AREAS OF AGREEMENT: SHARED
conscience and contextualized moral choices. Cairo
PRINCIPLES
did insist that where reproductive health is
concerned, all legal options open to the individual
The Vatican claimed that the Programme of Action
should be safe and people should be informed fully
lacked an ethical framework and was the work of
about the consequences of deciding one way or the
aggressive Western feminists: "One of the principal
other.
concerns of the Delegation of the Holy See
regarding the Draft Final Document is its lack of a
CATHOLICS AND CAIRO
clear ethical vision."i The document that the
Vatican so soundly excoriated, however, is actually
Cairo, in many ways, is a universal declaration of
remarkable for its principles and values values
human rights applied to population, sexuality, and
forged and agreed to by over 180 nations from
women's lives. Had the document been cast in the
around the world and clearly articulated in chapter
narrow terms the Vatican demanded, it would have
two of the Programme of Action.
divided and splintered the world community. A new
language of shared values needed to be formulated, a
The principles, the foundation for the
language of universal rights and responsibilities. The
Programme of Action, are consistent with Catholic
agency to speak that language, the United Nations,
values especially as they relate to population and
gained the world's confidence more readily than the
development reflecting how much the Catholic
respected but sometimes ideological voice of the
church has in common with the global community.
Vatican.
These principles are the legacy of Cairo. Regardless
of what happens with regard to proposed actions or
The debates at Cairo made it clear that in many
financial commitments, the principles are critical to
moments, the Vatican and the global community
the development of a common language of values.
frequently spoke with the same voice. The Vatican,
And despite initial appearances to the contrary, the
however, often declared its position on the more
Vatican and those supporting reproductive rights do
controversial issues as definitive, neither inviting nor
agree on these values.
allowing participation or nuance in order to achieve
consensus. The United Nations cannot adopt a
PRINCIPLE 1:
language of ethics and values that the human family
UNIVERSALITY OF HUMAN RIGHTS
at large neither understands nor accepts. If people
Following the United Nations tradition of support
are fundamentally reliable, then open debate,
for human rights, the Programme of Action includes
accommodation, and global consensus may offer us
strong support for individual rights. Catholic
our best hope for choices that are moral, profoundly
endorsement of the fundamental vocabulary of
human, and irresistibly fair.
human rights moved forward dramatically as social
justice documents and the Declaration on Religious
For the purposes of this article and to help
Freedom from Vatican II were adopted in the 1960s.
clarify the distinction between the official and the
Since then, the church has become an international
living church, the terms "Holy See," "Vatican," and
advocate for human rights, even though, like many
"delegation" are used to represent church
other political and religious bodies, it has a mixed
governance. The terms "church," "church
record in this area.
teachings," and "church tradition" are used to
represent a broader definition of Catholicism, to
Catholic support for human rights such as
include the laity, theologians, and the hierarchy.
bodily integrity, right to life, and right to health - is
linked to the value placed on human dignity by the
church, biblically grounded in the creation of human
CATHOLICS FOR A FREE CHOICE
4
beings in the image of God (Gn 1:26) and the spirit
of resisting development is incalculable and
of Christ (Jn 1). These rights are human, therefore
unconscionable.
universal, and transcend boundaries of gender, race,
religion, and nations. However, while the church
The Catholic social justice tradition and
upholds the universality of human rights, its record
preferential option for the poor provide a basis for
on women's rights is varied.
the church's teaching on development. The church
maintains that industrialized nations should assist,
Within the international community there is a
through technology transfer and debt forgiveness,
debate over the universality of human rights. In this
the developing world's ability to use its resources for
debate, the Vatican agrees with human rights
its own development. In particular, John Paul II has
organizations that a core group of human rights are
criticized both capitalism and socialism for
universal because of our common human dignity
neglecting to put human needs and the common
and should be freely exercised independent of the
good above material profit.
current political, cultural, or economic atmosphere
of a particular location. The other side of the debate
PRINCIPLE 5: POPULATION-RELATED GOALS
argues that human rights are not necessarily
Although often perceived as unwilling to
universal and indeed are culturally conditioned. In
acknowledge problems caused by rates of population
this way "culture" has often been used to defend
growth, the church does consider hunger and other
human rights abuses and to prevent the
developmental problems to be exacerbated by
implementation of development programs.
population growth. Indeed, the Second Vatican
While the church teaches that preservation of
Council insisted that parenthood be exercised
culture is an important consideration in any global
responsibly. Parents who bring children into the
mandate, it insists that culture is not an absolute
world recklessly and thoughtlessly are censured. At
value that justifies everything from the oppression of
issue is not limiting births or determining family size,
women to the bondage of children and genocide.
which the Vatican accepts, but the means by which
The Jewish prophets and Jesus himself exemplified
this limitation is achieved.
the Christian belief that people of good will often
resist aspects of their own cultural heritage.
PRINCIPLE 6: SUSTAINABLE DEVELOPMENT
Because developing countries were able to voice
PRINCIPLE 2: PEOPLE AS CENTRAL
their concerns over sustainable development at
CONCERN OF DEVELOPMENT
Cairo, a larger recognition of the overconsumption
The true measure of development, according to both
of developed countries was written into the
the Programme of Action and the church, is whether
Programme of Action. This principle is also seen in
it meets people's human needs and aspirations and
the church belief that developed countries must
whether it does so in accord with their human dignity.
eliminate their overconsumption as a way to
maintain sustainability and to achieve responsible
Development policies have at times been the
stewardship.
subject of serious criticism by faith-based
organizations, including both official and
The Catholic church supports consideration of
independent Catholic groups. Development policy
environmental concerns in development policy. For
has often been focused solely on economic rather
many centuries, the church, prompted by Scripture,
than human development. In contrast, delegates at
principally Genesis, believed that domination of the
Cairo reaffirmed the emerging global consensus that
earth by people was God's will. To its credit, the
people's lives, not markets or production, should be
church has begun to appreciate the vital
the central concern of all development policies.
interrelationship among human beings, other forms
of life on the planet, and the planet itself. Now the
PRINCIPLE 3: RIGHT TO DEVELOPMENT
church sees the world itself as a sacrament, namely a
The United States President's Council on Sustainable
reality endowed with the presence of God and with
Development notes that people in developed
grace. There remain those in the Catholic
countries only 20 percent of the world's
community who fear that ecological spirituality may
population consume 85 percent of the world's
lead to pantheism. This hesitancy has not prevented
resources.¹i In light of this observation, we are made
popes from speaking bravely about an ecological
aware that we can do better and that the human cost
crisis, our common environmental responsibility,
CATHOLICS FOR A FREE CHOICE
5
and the need to impose limits on human domination
experts prior to Cairo to address this subject:
and overconsumption of natural resources.
prostitution of children in Bangkok, Thailand (1992);
child labor in Manila, Philippines (1993); and street
PRINCIPLE 7: ERADICATING POVERTY
children in Rio de Janeiro, Brazil (1994).
The Programme of Action's focus on eradicating
poverty and the special attention it gives to the
However, it is important not to overstate the
neediest of poor countries is an important aspect of
hierarchy's support of children's rights. While the
the Cairo consensus for Catholics. Cairo is
church often speaks and acts on behalf of the well-
consistent with church teachings on the preferential
being of children, it defines children's rights as
option for the poor and economic justice for all in
almost exclusively derivative of parental rights.
insisting that "special priority" be given to the least
Furthermore, the Vatican is more likely to support
developed nations of the world.
parental rights over children's rights, as further
recognition of the patriarchal family unit. Parents
It has been observed that poverty imposes
have a primary right to educate and raise their
imperatives on the affluent. Jesus makes it quite
children, but it is not an absolute or exclusive right,
clear that neglect of the poor is neglect of God. The
such as prevails in some cultures where children are
Catholic tradition resonates with this teaching, from
defined as property. Society at large and the church
the medieval legends of the poor as saints and of
must establish and affirm children's rights when
God disguised in poverty to modern proclamations
parents violate or neglect them.
of a preferential option for the poor. Indeed, the
Catholic church is often seen as the church of the
PRINCIPLE 12: MIGRANT RIGHTS
masses, the poor, and the workers.
The Programme of Action acknowledges that
migrants often have the least access to resources and
There are different ways of addressing poverty;
services provided in development plans and calls on
sometimes the least effective, but by no means
countries to guarantee fundamental human rights to
inconsequential, is charity and alms giving. On a
all migrants. The church's record here has been
deeper level, however, the church calls for the
impressive and effective. The church has organized
transformation of structures that create poverty. On
and spoken on behalf of migrants. It has often
the deepest level of all, the poor must be addressed
demanded that nations support immigrant and
as equal in dignity to those who are affluent. On
migrant populations by not only considering them as
this, the church and Cairo agree.
workers, but also respecting their cultural identity.
The church has offered migrants pastoral service,
PRINCIPLE 10: RIGHT TO EDUCATION
and through the pope and national conferences of
In Cairo, education was emphasized as the means to
bishops has acted as their advocate before the world
the full development of human resources.
community. In fact, on the issue of migrant rights,
Traditionally, girls and women have not been given
the church and United Nations are more in
equal access to educational opportunities.
agreement with each other than with developed
Investment in education is critical to the
nations.
empowerment of women and the achievement of
their human rights.
PRINCIPLE 13: RIGHT TO ASYLUM
Cairo explicitly calls on nations to grant protection
Catholic teachings support the importance of
for refugees escaping persecution. This stance is
education. From monasteries to universities, the
well in line with church tradition, which condemns
church has been a pioneer in educating people in
political and religious persecution and urges nations
their spiritual and social responsibilities.
to provide asylum for those in exile as a duty of the
common good. In fact, church buildings have
PRINCIPLE 11: CHILDREN AS A PRIORITY
traditionally been sanctuaries for the persecuted.
Cairo maintained children's rights to standards of
The church at large, sometimes selectively, has
living and adequate health care, as well as the right to
offered protection to the vulnerable.
be protected from injury and exploitation. The
church protects children as innocents. The church
PRINCIPLE 14: INDIGENOUS RIGHTS
was so concerned with the injustices perpetrated
In the past, the church has in many instances
against children that the Pontifical Council for the
favored evangelization and cultural transformation
Family organized three international meetings of
over the preservation of indigenous identities.
CATHOLICS FOR A FREE CHOICE
6
History tells how colonization of indigenous people
proposing language or lending force to the many
by Western powers was often accompanied by the
other issues discussed at the Cairo Conference and
imposition of Christianity. The church, however,
important to Catholics.
has recently been more sensitive to indigenous
traditions. Nonetheless, it is disappointing that
In the end the Vatican joined the global
national church leaders, speaking on behalf of their
consensus on the Programme of Action as a whole,
own people, have not been sufficiently heard by the
but placed reservations on the following list of
Vatican. Indigenous rights are not only the rights of
specific phrases:
indigenous minorities. The church cannot be truly
incarnated in a culture unless it takes on the
contraception
character of that culture. If the church appears as an
couples and individuals
alien presence in the culture, it will not reach the
family planning
people there on a profound level or in an authentic
reproductive health
way.
reproductive rights
PRINCIPLE 15:
sexual health
DEVELOPMENT RESPONSIBILITIES
sexual rights
The final principle agreed to in Cairo addresses the
widest range of family-planning services
need for all nations to take responsibility in assisting
women's ability to control their own fertility
global development while acknowledging that each
nation has its own needs, capabilities, and
The Holy See also placed general reservations
responsibilities. It also states a special obligation of
on eight of the sixteen chapters: "Reproductive
more developed countries to advance set agendas
Rights and Reproductive Health"; "Health,
and to maintain sustainable levels of growth. The
Morbidity, and Mortality"; "Population,
church has historically been sensitive to the diversity
Development, and Education"; "Technology,
of nations in regard to population and development
Research, and Development"; "National Action";
strategy, and it has put pressure on the North to
"International Cooperation"; "Partnership with the
contribute to the equitable development of the
Non-Governmental Sector"; and "Follow-up to the
South.
Conference."
PART 2
Cairo, of course, did not detail ethical values as
AREAS OF DEBATE: WOMEN,
a religious tradition would detail them. It could not
HEALTH, AND FAMILY
do this, given the diversity of its constituency. It did,
however, search for a common, global ethic based
When the United Nations produces an international
on human rights and responsibilities. Cairo afforded
document such as Cairo's Programme of Action, its
an opportunity for the Holy See to make its points
goal is to secure the support of as many nations as
regarding the importance of human dignity in
possible. Thus, it provides an extensive drafting
population policy. The Holy See might have done
process aimed at achieving consensus, with many
this more convincingly by affirming more forcefully
versions of a document and numerous preparatory
the many positive features in this document and by
meetings with considerable input by
engaging in a constructive dialogue with the world
nongovernmental organizations -- to discuss
on the complex issues of reproduction and sexuality.
objectives. A government delegation objecting to
any part of the document may have a section,
The Holy See delegation's concerns over three
phrase, or word placed in brackets for further debate
principles in the Programme of Action - women's
and possible deletion. During the Cairo process the
human rights, the right to health, and the definition
Holy See and a handful of other nations- including
of family -- led to reservations on a number of Cairo
Argentina, Benin, Guatemala, Honduras, Malta,
objectives. Disagreement was over application, as
Morocco, and Nicaragua- bracketed most language
the church has historically supported all three of
referring to reproductive rights, sexuality education,
these principles. However, a gap exists between
abortion, contraception, the definition of family, and
what the Vatican said at Cairo and what Catholic
safe motherhood. In fact, the Vatican focused most
tradition allowed the Vatican to say. In reality,
of its energy at Cairo on objecting to the existing
official church statements could have been brought
consensus on reproduction and sexuality rather than
CATHOLICS FOR A FREE CHOICE
7
to bear to support the United Nations positions on
Catholic support for women's rights comes
women, health, and family.
from the biblical tradition of gender equality.
Theologians, men and women, working within the
PRINCIPLE 4: WOMEN'S HUMAN RIGHTS
Catholic tradition have rediscovered the role of
As part of the new development paradigm created at
women in Scripture and early tradition and have
Cairo, women's human rights were supported as a
found it to be more open, creative, and decisive than
principal goal. Prior to Cairo, women's lives were
current Vatican policy. Scripture begins, in the first
not always treated with dignity and respect in
chapter of Genesis, with the grand theme of gender
population policies; women were often considered
equality in the creation account. Not only is there
only in terms of their reproductive capacity, and
no subordination of women, there is indeed a radical
their aspirations and needs were made secondary to
gender equality. The Christian Scriptures present to
demographic outcomes.
us the startling ease that Jesus has in bringing
women into a discipleship of equals. The greatest of
While the church has a strong record of
all messages about Christ, the Easter experience, is
speaking in support of human dignity and objecting
borne by a woman who becomes the apostle to the
to human rights abuses, its record on women's
apostles and, indeed, their teacher. Paul readily
human rights is ambiguous. It is not that church
speaks of the prominent role women play in the
teachings do not support gender equity or the dignity
creation of the early church: Women are appointed
of women, but that the Vatican has shown itself to
as deacons, coworkers, and even apostles (Romans
hold a limited understanding of women's human
16).
rights, and in particular, the ability of women to
control their own fertility.
This discrepancy between the statements of the
Holy See delegation at Cairo and church teachings is
The Holy See is careful never to assert
illuminated by the delegation's criticism of two areas
women's equality with men without a qualifier,
of the Programme of Action: empowerment of
usually the notion of "women's special dignity." In
women and reproductive rights.
the Vatican's worldview, men are the normative
human beings and women are understood primarily
EMPOWERMENT Of Women
in terms of their reproductive and mothering
Cairo's focus on the empowerment of women is a
capacities. What seems to be a laudable principle -
culmination of decades of progress in the field of
women's dignity -- actually circumscribes women's
population and development, accelerated as women
options and equality. No such assumption is ever
entered the international dialogue and research
made with regard to men, whose dignity is presumed
showed that women's status was a factor in family
simply to stem from their humanity.iii
size and efficacy of development programs. The
Programme of Action was the first United Nations
When the Vatican addresses rights for women,
document on population that explicitly recognized
they are more often rights to be protected through
the importance of women's rights as a crucial factor
the agency of others. They are not political, social,
in development and indeed, as a worthy goal in itself.
or economic rights through which women
Cairo declared that development policies should not
themselves exercise power as autonomous moral
center on controlling women's fertility, but on
agents. And while the Vatican does support the
empowering women to make decisions about their
universality of human rights, a division exists
own reproduction. This empowerment could be
between the Vatican and women's human rights
advanced by ensuring access to information and
advocates over the question of what a human right
resources and providing social, political, and
is. In the case of human rights dealing with
economic conditions that favor autonomous
reproductive health, sexuality, and women's
decision making.
empowerment, the Vatican holds that Western
feminists, among others, are attempting to establish
The Vatican and even Pope John Paul II
"new" rights. In reality, Cairo sought not so much
himself have spoken of women's empowerment and
an expansion of human rights but an expansion of
call for the support of women in their dual roles as
what the global community means when it says
mother and part of the labor force. But this very
human rights.
positive view of women in the public sphere is
presented with an emphasis on the woman's role as
mother: "The true advancement of women requires
CATHOLICS FOR A FREE CHOICE
8
that labour should be structured in such a way that
rights as an integral aspect of human rights.
women do not have to pay for their advancement by
According to the Programme of Action,
abandoning what is specific to them and at the
reproductive rights are grounded in previously
expense of the family, in which women as mothers
recognized human rights, such as the right to bodily
have an irreplaceable role."iv
integrity and nondiscrimination, and specifically the
right to decide freely the number and spacing of
Vatican support of the economic
children and reproductive autonomy - a right first
empowerment of women demurs when this
recognized in 1968 at the International Conference
empowerment leads women to a sense of their
on Human Rights in Teheran, Iran.V
sexual and reproductive options. As the Catholic
tradition developed, men were made the norm for
The Vatican objected at Cairo to the
human experience, and women far too readily were
Programme of Action's treatment of reproductive
defined in church teachings in terms of their
rights, choosing this moment to invoke the
reproductive and maternal capacities. In this
preservation of culture and tradition and proclaiming
scenario, little accrues to women simply because they
the danger of establishing "new fundamental human
are human. More often, women are praised when
rights."vi However, Catholic teachings supply many
they are submissive, when they are mothers, and
elements that support reproductive rights, primarily
when they serve the needs of men or their children.
the church tradition advocating for the universality
Within this framework, the Vatican sees the exercise
of human rights. The Vatican recognizes that human
of women's human rights as threatening the
dignity is tied to the ability to exercise free will and
traditional family unit.
individual conscience. In the contemporary world,
religions gain credibility and become persuasive
And although the church has spoken of the
when they recognize the importance of free will,
contributions women can make in the public forum,
allow alternatives, and then guide or persuade people
this belief does not extend to the role of women in
by appealing to their highest motives.
the church. Actions speak more clearly than words.
No woman is ordained in the Catholic church. The
There is something demeaning and morally
governing structure of the Holy See includes no
offensive about putting burdens on women without
women in decision- or policy-making roles and no
allowing them a voice and a vote about their own
women in the church's pivotal electoral body, the
lives and the consequences they may be asked to
College of Cardinals. There is no requirement that
endure. Women at large must be trusted to be
women be consulted regarding the development or
concerned about life issues and to make responsible
content of Vatican documents and no indication that
decisions. Political participation, equality in the
such consultation occurs voluntarily except in very
workplace, protection from violence all rights
limited and rare examples. Official church policies
supported by the Vatican cannot be addressed
prohibiting important forms of women's
without first affirming women's moral capacity and
participation in the church make it difficult for
integrity. Women cannot be expected to make
people to believe that the church is committed to
decisions freely outside the home if society or the
gender equality. The fact that these policies of
church preempts their personal decision making
exclusion are difficult, if not impossible, to derive
concerning the reproductive activity of their bodies.
from Scripture or tradition further weakens the
Vatican's position.
Church teachings on the common good and
justice show us that we cannot achieve moral order
We cannot expect an all-too-human church to
if individuals are coerced or repressed. Because
be centuries ahead of the cultural development of
women in the church have been excluded from
gender equality. It is unpardonable, however, when
defining elements of the common good,
the church seems to be behind, or worse, when it
reproductive rights have not been adequately
resists such development.
addressed in the Catholic church. Women, indeed
all people, do best in dialogue, not when they are
REPRODUCTIVE Rights
asked only to take dictation.
The Vatican has recently been supportive of rights
of women in society, but it continues to try to deny
It is telling that the Vatican chose this moment
women reproductive rights. Cairo went beyond
in the Cairo negotiations to argue for cultural
defining reproductive health to affirm reproductive
preservation. It argued, for example, that access to
CATHOLICS FOR A FREE CHOICE
9
contraception and legal abortion are staunchly
and sexual health is noncontroversial, such as
opposed in other cultures and that democracy does
prenatal, postnatal, and maternal health care and
not suit the culture of the Vatican. This may be true,
treatment for those affected with HIV. However,
but it raises the question of who defines this culture.
even this section of the Programme of Action
Such "sensitivity" to culture is not evident when the
provoked numerous objections on the part of the
culture of women, for example, is at issue or when
Vatican.
cultures that strongly support contraception and
legal abortion are denied these options because they
In addition to the church's strong support of
do not adhere to the Vatican view of acceptable
health as a fundamental human right, Catholic health
public policy.
care is guided by the tradition of treating the whole
person, recognizing that separating the body from
There is a tendency to criticize Western culture
the soul or treating only one aspect is not the best
as too feminist and to favor more traditional
method of promoting overall health. Yet church
alternatives. However, when African and Asian
leadership over and again singles out reproductive
bishops ask for different attitudes on the position of
health and attempts to limit services and information
the Vatican, as they did in recent synods at Rome,
available for this aspect of health. For women,
they are not heard. When women of the South and
reproductive health is central to overall health. At
East spoke to delegates on the importance of
some point, women are placed in bondage to
reproductive rights and health, their positions were
reproduction and biology if only periodic abstinence
dismissed. Culture has been invoked to silence the
("natural family planning") is tolerated.
voices of women in the dialogue on reproductive
rights. Surely those who have most at stake in every
To tell the world that "natural family planning"
pregnancy should be allowed a decisive voice and
is the only means by which pregnancies may be
choice on their own behalf.
avoided as the Vatican does is to speak with an
ineffective voice. The world knows that such
PRINCIPLE 8: RIGHT TO HEALTH
teaching is rejected by a virtual unanimity of Catholic
The church's support of the right to health has
couples and by the vast majority of Catholic
biblical grounding in the healing tradition of Christ.
theologians. The historical record shows that all the
A "right to medical care" is established in the 1963
cardinalatial and episcopal committees formed by
encyclical Pacem in Terris, and the Catechism of the
the popes to deal with this issue recommended a
Catholic Church places the burden of respecting health
change in church teaching and the acceptance of
on all of society. Pope John Paul II often calls upon
artificial contraception as a moral option. The
nations to provide health care to all citizens as a
prohibition of artificial contraception is not so much
basic economic right necessary for human dignity.
church teaching as it is papal teaching.
By acknowledging the universality of the right to
health care, the Catholic church is acknowledging
Furthermore, Catholic teaching on responsible
the need for health care to be independent of
parenthood strongly rejects coercion by any group or
geography, language, ethnicity, gender, or religion.
individual attempting to restrain couples from
making responsible decisions about procreation.
While the church asserts the right to health as a
Denying access to information about certain options
fundamental right, absolutely necessary for human
was perceived by many in the global community as
dignity, the Vatican does not support health when
morally and practically coercive, especially when
applied to reproduction and sexuality, as clearly
access and information are denied to those who are
demonstrated in the Holy See's objections to the
not Catholic or those whose consciences tell them
sections on reproductive health, safe motherhood,
that contraception is a moral choice. In any case,
abortion, sexual health, and sexuality education for
even according to church teachings, without options
adolescents as agreed to at Cairo. At issue was how
one cannot act morally. The Vatican remains free to
to specify and define health.
address and influence the consciences of people by
moral suasion. The world community objects,
REPRODUCTIVE HEALTH
however, to efforts to eliminate access to artificial
Cairo's Programme of Action was the first United
contraception, sterilization, and abortion completely
Nations document to explicitly define reproductive
with legal force and punishment.
health. Much of the language included in the
recommended actions for obtaining reproductive
CATHOLICS FOR A FREE CHOICE
10
SAFE MOTHERHOOD
contraceptives became more available over a thirty-
The Vatican bracketed the term "safe motherhood"
year period, abortion rates fell from over 60 per
in the Draft Programme of Action and objected to
1,000 women aged 15 to 44 in the 1950s to under 40
its use at the Cairo Conference. Its opposition to
per 1,000 in the 1980s.x One of the best ways to
the term, the Vatican delegation said, was based on a
reduce recourse to abortion is through access to a
fear that inclusion of the term would open the door
range of effective contraceptive options.
for abortion. vii But "safe motherhood," by
definition, covers many services and programs that
Even taking into account Vatican opposition to
the church unequivocally supports, including efforts
abortion, we remain puzzled about why the Vatican
to improve women's health in pregnancy through
objects to abortion being safe where legal. "There is
prenatal care and nutrition.
no such thing as a 'safe' abortion: Whether legal or
not, abortion is lethal for the child and destructive of
All women face risks in pregnancy and
the mother and society," declared the US cardinals
childbearing. Poor women face especially high risks.
before the Cairo Conference.xi This dismissal of safe
For example, Bolivia, the poorest country in South
abortion by the hierarchy is insensitive to the
America, has a maternal mortality rate of 600 per
realities women face and to the number of women
100,000 live births,vi compared with 12 per 100,000
who die from unsafe abortions every day.
in the United States.ix
Because women everywhere resort to abortion,
The Vatican delegation's decision to reject the
the alternative to safe abortion, of course, is unsafe
term "safe motherhood" outright, without any
abortion. Again, it is the hierarchy's preoccupation
attempt to make a distinction between its acceptance
with eliminating abortion from the world that
of the components it supports and its resistance to
prevents the real issues of justice and health for
abortion without exception, led to an inconsistent
women from being addressed. Such an absolutist
position on motherhood. All women's lives are
position fails to acknowledge the ambiguity and
defensible, and it is disingenuous for the church to
doubt regarding fetal life and ignores the moral
claim to defend life while simultaneously opposing
complexities surrounding each situation.
measures necessary to save women's lives. The
Vatican's refusal to support safe motherhood at
While the legal status of abortion appears to
Cairo gave the impression that a woman's health is
have relatively little connection to its overall
secondary to her reproductive functions.
pervasiveness in a country, it does influence the
safety of conditions under which the procedure must
ABORTION
be performed. Illegal abortion is associated with a
Despite much talk about the issue, the Programme
high incidence of maternal death and disability. For
of Action principally deals with abortion in one
example, while Mexico and United States have
paragraph, which makes four major statements:
similar abortion rates, maternal deaths per 100,000
abortion should not be promoted as a
live births are almost ten times higher in Mexico,
method of family planning;
where abortion is illegal.xi
incidence of abortion should be reduced
through access to family planning services;
In countries where abortion is illegal, it is the
abortion should be safe where legal; and
poor who are left to face abortions under the worst
where illegal, the consequences of
types of conditions. And in countries where
illegal/unsafe abortions should be addressed.
abortion is legal, but safe abortions are costly, it is
During Cairo, the Vatican objected to all but
again poor women who shoulder the burden. The
the first.
church tradition of a preferential option for the poor
has been interpreted by many Catholics to support
Abortion is a complex moral and social issue -
the safety of abortion and to oppose unsafe
potential mothers know this best. However, the
abortions when safe options are available. It is
Vatican's position on abortion is compromised by its
possible to be opposed to abortion without
unwillingness to accept contraceptive services and
supporting unsafe procedures; concern for public
devices even though they reduce abortions by
safety is not the same as moral endorsement.
diminishing the number of unwanted pregnancies.
For example, according to the Alan Guttmacher
Despite Vatican disapproval, the Cairo
Institute, data from Hungary show that as
Conference was right to address the catastrophic
CATHOLICS FOR A FREE CHOICE
11
health consequences for women of unsafe abortion.
temptresses. Celibacy is protected, admired, and
Mercy requires that we eliminate pain whenever
rewarded by special privileges in the church.
possible; justice demands that we do not abandon
Holiness is equated with abstinence. In the Council
poor women or women in need of help.
of Trent (1545-1563), the church at its highest level
of authority condemned and censured anyone who
SEXUAL HEALTH
dared to say celibacy is not superior to marriage.
Cairo acknowledged the link between sexuality and
gender relations, affirming that relationships
The Vatican's views on sexuality translate into
between partners have profound consequences for
an isolation in church policy of sexual health from
sexual health and behavior. The Vatican, in
other forms of mental and physical health, which has
response, accused the Programme of Action of
real impact on human lives. This impact is most
"promoting a self-centered and casual view of
conspicuous in the Vatican's treatment of
human sexuality, an approach so destructive of
HIV/AIDS. Forbidding the use of condoms when
family life and the moral fiber of society."xiii In
one partner is already infected is an irresponsible
Catholicism, a long tradition of aversion to sexuality
application of church teachings on contraception.
is the root of current Vatican conservatism on
reproduction and women. Despite recent attempts
Realizing the impracticality of the Vatican's
to expunge this historical antipathy, church teachings
position on condoms, the French bishops in 1996
often continue to reflect its influence.
presented a 235-page document on AIDS
acknowledging the usefulness of condoms in
Until Vatican II, pleasure was rarely, if ever,
preventing the spread of HIV. The use of a
linked to sex in a positive way by the church. Sex
condom, the bishops said, "can be understood in the
was often presented as a necessary evil and is termed
case of people for whom sexual activity is an
such by church teachers such as St. Augustine. The
ingrained part of their lifestyle and for whom [that
purpose of sex was procreation, not pleasure or even
activity] represents a serious risk. "xiv
relationship. For more than a thousand years, the
church taught the superiority of sexless marriages
An escalating chorus of voices from recent
and urged all married priests to reject sex with their
official church teachings, theologians, and laity
wives and to refuse to conceive children.
supports positive views of human sexuality.
Spirituality and sexuality are seen today as linked.
Today, the Vatican's suspicion of sexuality
The celebration of our bodies and sexuality brings us
persists. Part of this mistrust is based on amnesia
spiritual awareness and even love itself. Human
concerning biblical references to sexual pleasure as a
sexuality is seen as committing each person to
value in its own right. A preeminent example of this
concern for the other or else it forfeits its human
tradition is the Song of Songs. In this most frank
and virtuous content. Sexuality, like love, should be
and erotic of all biblical books, sexual pleasure
sensitive, considerate, generous, compassionate, and
between lovers and spouses is celebrated. In
concerned. Christianity insists that we love our
addition, one of the overriding images of God's love
neighbors as ourselves. This principle is expected to
for the human family in both testaments is the
govern our sexual relationships.
relationship between the bridegroom and bride.
Jesus has been misinterpreted by some as hostile to
Furthermore, in the sometimes less-than-ideal
pleasure. In reality, Jesus says little about sex but is
lives people must live, differing levels of tolerance,
deeply troubled by power and authoritarianism. The
compassion, and resiliency matter. By denying the
church's suspicions of sexual pleasure and its
sexual or reproductive realities and needs of people,
negative judgment about it do not derive from the
the church cannot effectively heal lives.
Bible. They emerge from second- and third-century
Greco-Roman ideas about pleasure and pain, ideas
ADOLESCENTS AND SEXUALITY EDUCATION
that the mind needs to control the body and that
During the Cairo Conference, the Vatican accused
pleasure or emotions are less human or less
the Programme of Action of accepting "almost as an
acceptable than cognitive life.
unrestricted right, that each individual including
adolescents from an early age, may be 'sexually
Female sexuality, in particular, was and is often
active."xv In reality, the Programme of Action
viewed negatively by the church. Women are blamed
balances the needs of adolescents for access to
for men's sexual desires and presented as
services and information on sexuality and
CATHOLICS FOR A FREE CHOICE
12
reproduction with the rights and duties of parents
as a "domestic church," a "privileged community,"
and other adults to provide needed guidance and
and "the original cell of social life. Indeed,
direction to maturing young people, calling on
society is always most stable when families are secure
societies to promote mutually respectful and
and when governments invest resources in them.
equitable gender relations and to provide education
But while both the Vatican and the Programme of
and services in order to deal with sexuality positively
Action concur that family is important, their
and responsibly.
definitions of what constitutes a family differ.
Instruction in sexuality must, of course, fit with
Cairo acknowledged a wide spectrum of
the age and condition of the person to be instructed.
families, reflecting the global reality of diverse family
The intent should not be information only but
structures. In contrast, the Vatican objected to the
formation of a responsible conscience and sensitivity
diverse characterization of families in the
to the lives of others.
Programme of Action out of fear that this diversity
would threaten the patriarchal system that the
Paralleling the Vatican's difficulty in affirming
church has supported and encouraged throughout
women as moral agents, there is only limited support
the twentieth century. By using "families" instead of
of adolescent sexuality in Catholic teaching. When it
"family," the Holy See delegation believed Cairo
is mentioned, the duty of educating adolescents on
would establish "a formula which would recognize
the issue of sexuality rests with the parents.
all free unions, homosexual couples, etc. as
equiparated with the family.' "xviii Envisioning a "real
The Vatican is concerned that too much
family"xix as only a husband, a wife, and children, the
knowledge too soon, sexual information offered
Vatican lobbied to include language giving special
with no value orientation, and contraceptives made
protection to this configuration of a family and in
too readily available will be seen as tacit
the end officially entered a reservation to the use of
endorsement for irresponsible sexual behavior.
"couples and individuals."
These points could be made without discouraging
the benefits of sexuality education. Adolescents deal
In reality, family diversity has existed
with issues of sexuality every day. The church's
throughout human and biblical history. In biblical
policy of abstinence before marriage does not
times, there were several perspectives on the family,
address the realities of adolescent lives or respect
none of which readily corresponds to the modern
their capacity to make meaningful decisions about
nuclear family. In the Hebrew Scriptures, patriarchy
their sexuality. Abstinence should be encouraged,
prevailed as well as polygamy, men were allowed
but not without information about alternatives, even
concubines, and wives could be dismissed for even
if they are less than ideal.
trivial reasons. In Matthew 19, Jesus objects strongly
to this patriarchal model, especially when it allows a
While Cairo was concerned with the possible
man to divorce a woman because she is property and
and the practical, the Vatican insisted on abstract
forbids a woman to divorce a man on the same
moral imperatives, which led it once again to
grounds.
become an obstacle to the global community's
consensus.
Family structure is not set by nature but reflects
the culture and economy in which it is embedded. A
PRINCIPLE 9: DEFINING FAMILY
male-dominated nuclear family, consisting of a
During the Cairo drafting process, John Paul II told
working husband, a wife who works in the home,
pilgrims in Vatican City that the United Nations was
and several completely dependent children, is a
attempting to destroy families: "I am going back to
relatively recent development in history. Cairo, in
the Vatican to combat a project prepared by the
suggesting that diversity reflects current realities and
United Nations, which want to destroy the
aspirations, is making a statement that has always
family."xvi Despite the pope's early characterization
been true. Out of fear that the Programme of
of the Cairo Conference, the Programme of Action
Action would be interpreted as endorsing same-sex
clearly supports families in significant ways.
marriage, the Vatican failed to acknowledge that
Catholic tradition supports and affirms diverse
Principle 9 names the family as the basic unit of
family forms such as extended families,
society and calls for its protection on these grounds.
multigenerational families, families without children,
The Catechism of the Catholic Church refers to the family
CATHOLICS FOR A FREE CHOICE
13
and other constructs of family that embody love and
We are amazed at how impressive church
acceptance.
rhetoric is and how often it resonates with the global
consensus. There is no reason not to conclude that
There are some who observe that the Holy See
the rhetoric is genuine and that it springs from a
has not always matched its performance on family
profound belief in what is being said.
life with its rhetoric. Marriages were dissolved in the
Nonetheless, the consequences and practice
past so that one partner might enter formal religious
that the world community expect to flow from such
life. Annulments are granted today to one spouse or
rhetoric do not follow in the Catholic church. The
parent over the staunch objections of the other.
strong statements on the equality of women are
And although the Holy See speaks beautifully of
difficult to reconcile with the marginalization of
marriage, it continues to insist that celibacy is a
women in decision-making structures in the Catholic
superior state of life. It punishes priests who marry
church and their absence from key Vatican offices
with exclusion from ministry; it does not, as a matter
and, of course, from the priesthood. The ringing
of course, allow married people to be ordained.
words about parents rather than the state
determining the number of their children and the
REFLECTION: CONSCIENCE AND CONSENSUS
appeal that parents should follow their consciences
Catholicism, despite appearances to the contrary,
in doing so do not fit in easily with the rejection by
has a profound sense that rules are not rigid. Some
the official church of the overwhelming number of
of this sense comes from the New Testament
Catholic parents who believe in conscience that
resistance to law; some comes from the dynamics of
artificial contraception can be a moral choice in
canon law, which readily builds exceptions into the
structuring their families. The statements about the
system; and some comes from a strong investment
sacredness and sacramental character of sexual love
in forgiveness and reconciliation. All this protects
are inconsistent with the denial of sexual love to
church teaching and practice from many of the
church leaders.
rigidities of fundamentalism and biblical literalism.
This inconsistency happens, we believe,
One of the hallmarks of Catholic moral
because the Vatican has been unwilling to admit that
teaching has been its capacity for nuance. Catholic
it sometimes makes mistakes, that it has sometimes
tradition speaks with vigor about principles in the
misled, and that substantive change is possible in the
public forum but encourages latitude in pastoral
system. The Vatican and the Catholic church have
practice. To appreciate the full range of Catholic
impressive power and resources. An admission of
teaching one must take into account not only the
errors made in good faith in the past cannot
articulation of the principle but also the way the
destabilize the credibility of such an institution. A
principle is lived out in practice.
willingness to state, furthermore, that the world has
impressive moral wisdom of its own in no way
For Catholics, conscience is always the court of
makes the Catholic church a less welcome
last appeal in moral decisions. According to the
participant in the global dialogue.
Catechism of the Catholic Church, "a human being must
Morality can at times become the tool of a
always obey the certain judgement of his
political program rather than a principle of rights
conscience."x Even though the official church
and truth. Sexual norms are sometimes formulated
seeks to qualify conscience with such words as
not to illuminate the ethical content of the choices
"informed" or "right," it nonetheless allows that an
people make but to legitimate the denial or
objectively wrong action is a virtue if those who
restriction of personhood for those who defy a
perform it are convinced in conscience they are
convention. To sanction torture in the rooting out
doing good. One of the most influential church
of heresy is to establish the overriding claims of
thinkers, St. Thomas Aquinas, said that it would be
orthodoxy. To forbid all sexual activity to
better to be excommunicated than to act in a way
homosexuals is to promote the exclusive claims and
that contradicted conscience.xxi
value of heterosexuality. To deny all contraception is
to insist that pleasure and relationship must always
Given this tradition, why does the official
be subordinate to reproduction. All these have been
church so often become rigid and ideological? More
taught by the Vatican.
specifically, why were resiliency and consensus so
difficult for the Vatican during Cairo?
The Vatican declares that access to abortion,
contraception, or the use of condoms is never
CATHOLICS FOR A FREE CHOICE
14
permissible. These positions are rigidly held and
For example, the Universal Declaration of
admit no exceptions. Thus abortion is not permitted
Human Rights declared, in 1948, that adult men and
even in cases of incest, rape, a seriously deformed
women had a right to marry and to found a family
fetus, or risk to the life of the mother.
and, indeed, that they had equal rights in entering
Contraception is prohibited even for women who
and dissolving a marriage. There was tension
have had so many births that another would imperil
between the world community and the Catholic
their health or lives. Condom use is condemned
church on the question of divorce. Yet then, as
even to save one's partner from AIDS. Assisted
now, there was a basis for dialogue. Article 16 of the
reproduction is rejected even if done to correct a
Declaration goes on to use language echoing
biological defect. At Cairo, such positions dominated
Catholic documents that the "family is the natural
the Vatican's diplomacy and eclipsed all other
and fundamental" basis of society and that it is
manner of church teaching and discourse.
"entitled to protection by society and the State."
The Catholic community at large and indeed
In the past fifty years, Catholics and sometimes
the pastoral and theological communities take
the official church as well have moved closer to the
different positions on all these issues. One finds
United Nations' position. In 1948, for example, the
substantial latitude in the behavior and beliefs of
church taught that celibacy was superior to marriage
Catholics, in the pastoral practice of priests, and in
and asked many of its members to give up their right
the teachings and analysis of Catholic theologians.
to marry and found a family. In 1948, Catholics
responded favorably; now, they do not. Fifty years
The Vatican position at Cairo reflected papal
ago, virtually no Catholic marriages were officially
rather than necessarily Catholic thinking and
dissolved; now, annulments are frequent, and many
tradition. Its position was narrowly focused rather
Catholics divorce and remarry without annulments.
than comprehensive, diplomatic rather than
magisterial, political rather than morally
An openness to sexual and reproductive ethics
conscientious. The Holy See delegation sought to
and rights is gaining ground in the Catholic church.
bring the Cairo document as close as possible to the
Despite the vehement opposition of the Vatican,
pope's thinking without expecting full concurrence
Catholics in many countries favor access to legal
from the world community, and yet the Vatican was
abortion and contraception and civil rights for
at the same time convinced that it would withhold
homosexuals unthinkable even fifty years ago.
endorsement of the document if it did not receive
Catholics support legal options even when they are
complete concurrence. This stance did not reflect
not convinced that people have the moral authority
the flexibility that exists in the Catholic tradition.
to exercise them well.
The Vatican repeatedly expressed its concern at
At Cairo, it is relevant to note that, although
Cairo that the rest of the world does not affirm an
the Vatican was a fully active and engaged
impressive ethic on life, reproduction, sexuality, and
participant, its sexual and reproductive agenda did
family. The global community is aware that it faces
not prevail. This fact was instructive for the both
life and death decisions regarding abortion,
Vatican and the world. In the grand human
contraception, HIV/AIDS, and sexuality education.
dialogue, the church sometimes teaches the world (as
The Vatican, despite being a sovereign state, is
the Vatican has done brilliantly on the evils of
immune from these concerns because of the
coercion and self-indulgence and on the sacred
character of its population and the purpose of its
character of sexual experience and marital
existence. Aware of this dilemma, the Vatican
commitments), and sometimes the world teaches the
might have been resilient and flexible at Cairo on
church (as Cairo and the United Nations may be
how its moral principles are applied to the world's
doing on human rights, women's human rights, and
governments as they confront concrete realities and
reproductive and sexual rights)
diverse belief and ethical systems.
The church is always less than the truth it
Yet there is reason for hope. History contains
proclaims. It does not control this truth but serves it
examples of church flexibility and growth, as well as
and searches for it. The church sometimes advances
Catholic teachings informed by global values.
because of a reflection on its own traditions; very
Substantive changes have occurred.
often it grows, however, because it hears and learns
from the world. The Reformation and the
CATHOLICS FOR A FREE CHOICE
15
Enlightenment not only benefited the global
community, they also enriched the church.
One of the more encouraging results of Cairo
is an awareness of how the United Nations heard the
church and respected its voice. It is now time for the
church to hear the world community as it speaks
with responsibility and consensus. When the church
possesses truth, it is always a truth the world
possesses in some way. The Creator does not love
and enlighten only a few and leave all the others to
their own devices. And so humility is always in order
and hope is always justified.
NOTES
i Msgr. Diarmuid Martin, Statement at the Beginning of the
III Session of the PrepCom, April 4, 1994: para. 7.
ii The President's Council on Sustainable Development,
Population and Consumption Task Force Report, US GPO,
Washington, DC: 1996: p. 33.
iii Women-Church Convergence, Equal is as Equal Does:
Challenging Vatican Views on Women, Washington, DC:
Women-Church Convergence, 1995: p. 2-3.
iv Pope John Paul II, Laborem Exercens, 1981: para. 19.
V The Proclamation of Teheran said the following about
reproductive rights: "Parents have a basic human right to
determine freely and responsibly the number and the
spacing of their children." United Nations International
Conference on Human Rights, Proclamation of Teheran
(Teheran, Iran), May 13, 1968.
vi Statement at the Beginning of the III Session of the
PrepCom: para. 12.
vii Dennis Poust, "No Consensus," Catholic New York,
April 28, 1994.
viii United Nations Population Fund, The State of World
Population 1997 New York: UNFPA 1996, p. 86.
ix Alan Guttmacher Institute, "The Role of Contraception in
Reducing Abortion," Issues in Brief, 1997: p. 4.
x "The Role of Contraception in Reducing Abortion": pp.
2-3.
xi US Cardinals Conference, Concerns Expressed to Clinton
on Cairo Conference, May 29, 1994.
xii "The Role of Contraception in Reducing Abortion": p. 4.
xiii US Cardinals Conference, Concerns Expressed to
Clinton on Cairo Conference, May 29, 1994.
xiv French Bishops Council, AIDS: Society in Question,
February 12, 1996.
XV Statement at the Beginning of the III Session of the
PrepCom: para. 7.
xvi Philip William, UPI, April 17, 1994.
xvii Catechism of the Catholic Church: 2204-2207.
xviii Notes on the Draft Final Document of the ICPD: p. 2.
xix Gravissimum Educationis Momentum: para. 3.
xx Catechism of the Catholic Church: 1800.
xxi As quoted in T. O'Connell, Principles for a Catholic
Morality, Crossroad, 1978/1990, chapter 8.
CATHOLICS FOR A FREE CHOICE
The Rome Declaration
On the International Conference
On Population and Development
January 5, 1999
Religion Counts
Religion Counts representatives met in Rome in January 1999 to draft and
issue this statement, articulating religious support for ethical approaches to
population and development, and specifically demonstrating solidarity with
groundbreaking agreements made at the 1994 International Conference on
Population and Development.
THE ROME DECLARATION
ON THE INTERNATIONAL CONFERENCE
ON POPULATION AND DEVELOPMENT
January 5, 1999
RELIGION COUNTS
Religion counts. Religious values and thought have helped to build the
foundation for human well-being and they continue to inspire and guide billions of
the world's people. Religions have maintained a sense of the sacred and sustained
humanity in times of trial. They have nurtured spiritual growth, spurred intellectual
inquiry, and provided moral guidance.
The world's faiths have developed in different cultures and historical contexts.
They nonetheless share common moral sensibilities. The different traditions
highlight complimentary values. In many indigenous faiths there is a comprehensive
understanding of the relationship of human beings to the earth; in Hinduism a great
appreciation of diversity and tolerance; in Buddhism a deep understanding of
suffering and compassion; in Confucianism a powerful awareness of reciprocity and
duty in human relationships; in Taoism an enduring emphasis on harmony and
balance; in Judaism a profound regard for the sanctity of life; in Christianity a rich
understanding of charity and mercy; in Islam a boundless devotion to equality and
justice. These attributions have not been exclusive but are embraced across religious
boundaries. They are religion's shared gifts to the world community.
These values are splendidly expressed in the Programme of Action adopted in Cairo
in 1994 at the International Conference on Population and Development (ICPD).
The conference articulated a new approach to population and development issues in
which development policies focus on people rather than markets and population
policies treat women not as receptors of family planning but as directors of their
own reproductive decisions. The Programme's positioning of health and education as
central components of human development replace a prior concentration on fertility
regulation and population control. Finally, the ICPD acknowledged over-
consumption in the developed world as both socially unjust and ecologically
damaging. These developments represent a fundamental transformation in the way
the world community and its policy makers address concerns related to population
and development.
-2-
The ICPD's PRINCIPLES
The ICPD grounded these advances in a set of principles put forth in the second
chapter of its Programme of Action. These principles are consistent with four moral
norms that reflect core affirmations of the world's religions:
Equality, evidenced in the ICPD's assertions that women and men,
whatever their difference, are equal in dignity and rights, and that
education and comprehensive physical and mental health services are
prerequisites for full participation in human societies.
Justice, which the ICPD states is violated in poverty and great
disparities of wealth, and which is at the foundation of its assertion
that families, in their diverse expression and as a basic unit of society,
deserve defense and support.
Freedom, embodied in the ICPD's rejection of coercion in
reproductive decision-making and its recognition that all women and
men are meant to be free moral agents.
Respect, embodied in its call for public policies that are sensitive to
cultural identities, and its insistence that nations not marginalize
migrants and refugees.
RELIGIOUS INSIGHTS INTO THE PROGRAMME OF ACTION
People of faith readily recognize many of the values and principles in the
concepts and commitments in the Programme of Action because they resonate with
moral convictions that are deeply rooted in the heart of religious traditions. These
principles provide the foundation in the document for addressing the interrelated
issues of population and development, including those that require fundamental
social transformation.
The Programme of Action establishes the elimination of poverty as a crucial means
for achieving full human rights and for meeting the objectives of humane population
policies and sustainable development. The recommendations challenge economic
systems that cause and perpetuate poverty, exacerbate disparities in wealth among
people and nations, and recklessly degrade the environment. These
recommendations reflect historic teachings of the world's religions, giving a clear
mandate to people of faith to advance the Programme of Action.
Religion Counts
3 -
At the heart of the document is a challenge to patriarchal societies. Male
dominance bears significant responsibility for women's illiteracy, sexual and physical
violence to women, and women's lack of educational and economic opportunity and
inadequate access to health care. Religions through history and even today are
complicit in sustaining male domination in the societies of which they are part. In
recent decades, religious traditions have begun to recognize that their integrity
compels them to advance towards full gender equality, including within the religious
communities themselves. Both traditional sources and findings of modern religious
scholarship are fully in keeping with the ICPD recommendations on women's rights
and political participation, education, reproductive health and rights, and socio-
economic opportunity in the public and private spheres. Eradication of male
dominance is imperative for the sanctity of all creation.
Reciprocity and mutuality in relationships is the appropriate moral and ethical
foundation for policies related to sexuality. Prompted by the personal articulation of
people's experiences, a reexamination of traditional teaching on sexuality is taking
place within most religious communities.
Sexual and reproductive health are of significant religious concern as integral
components of human well-being. Both women and men must exercise
responsibility in their sexual behavior. Most faith communities accept modern forms
of contraception and family planning, and even where there is official religious
condemnation the evidence suggests that a great many adherents make use of
artificial contraception without a sense of being unfaithful to their traditions. Sexual
and reproductive health care, including education and access to comprehensive
health services, should be available to all women and men.
The challenge is to provide reproductive and sexual health services to those
women and men for whom it is still inaccessible. Religious communities should be
advocates for the recommendations for the Programme of Action in these areas.
People with HIV/AIDS have human dignity that must be respected. There is no
justification for stigmatizing them. Religious leaders and teachers have a particular
duty to dispel the myth that AIDS is a punishment from God. In many countries,
this devastating disease is killing millions of people, leaving children orphans,
partners bereft, and communities crippled. Those who value life should support
access to services that prevent the transmission of HIV. The world's religions are
compelled to assert their most fundamental teachings on the sanctity of life by
advancing comprehensive sexuality education, assertive positions on the use of
condoms, confidential HIV/AIDS testing, and support for those affected by the
disease.
Religion Counts
4
Abortion continues to be a divisive and complex issue. The Programme of Action
addresses the question of abortion in a very limited way. It notes that abortion
should not be a method of family planning; that abortion can and should be reduced
through access to family planning services; it should be safe wherever it is legal, and,
where illegal, the consequences of unsafe abortion should be addressed as a public
health issue.
Certain realities should be made clear. Where there is a full range of family
planning services, the incidence of abortion decreases. In the absence of provisions
for safe abortions, even when legal, the rate of maternal death is increased. When
abortion is illegal it is poor women who suffer the greatest consequences in the loss
of life and health. Children who are the result of unwanted pregnancy can suffer
abuse or abandonment. Those who oppose even the modest provisions of the
ICPD language on abortion need to be accountable for these realities.
Reflection on these hard truths has caused many people of faith, even those
personally opposed to abortion, to conclude that provisions for legal, safe, and
accessible abortions are defensible on religious and moral grounds. While the
religious traditions differ on the issue of abortion, the Programme of Action's limited
statements on abortion do not violate the teachings of any of our traditions.
Therefore religious leaders and communities can and should support the ICPD on
this issue.
CALL FOR ACTION
As Religion Counts joins with others in the five-year review of the Programme of
Action, the following considerations demand our commitment:
1. Principles count. The principles articulated in chapter two of the
Programme of Action must serve as the benchmark against which
implementation of specific actions laid out at the ICPD are evaluated.
For example, a comprehensive review of family planning programs
must not only address their efficacy, but also the extent to which they
embody the ICPD's principles.
2. Partnerships count. Governments and non-governmental
organizations have the opportunity to enlist the support and
participation of religions as large and powerful allies for the
implementation of the Programme of Action. It would be tragic for
both religious communities and advocates of the ICPD consensus if
this opportunity for collaboration and cooperation were not realized.
Religion Counts
5
3. Commitments count. As a matter of moral integrity, nations
must keep their financial and programmatic commitments as
signatories to the Programme of Action. Religious communities and
other non-governmental organizations must insist that their
governments meet these obligations.
4. Religions count. Religions must commit themselves to the
realization of the ICPD's goals and assume an active role in the
implementation of the Programme of Action, including empowering
women, eliminating poverty, making provisions for comprehensive
health care, and promoting a sustainable environment.
Religion Counts affirms the powerful message of the Programme of Action. All
nations, all peoples, and all religions share this world in relationships of
interdependence. The immense challenges taken on in Cairo five years ago by the
countries of the United Nations can only be addressed in an environment of mutual
respect.
Religion counts. This is a moment to make it count for the common good of all
humanity and the whole of creation.
Religion Counts
RELIGION COUNTS
MEMBERS
Rev. Rose Teteki Abbey
Rev. Julian Cruzalta
Beverly Harrison
Ghanaian
Mexican
USA
Pastor
Lecturer, Universidad Colonia
Professor of Christian Ethics,
Presbyterian Church of Ghana
Copilco
Union Theological Seminary
in Accra
Mexico City, DF, Mexico
New York, New York, USA
Accra, Ghana
Roman Catholic
Protestant
Protestant
Musa W. Dube
Elfriede Harth
Denise M. Ackermann
Botswanan
German, Colombian
South African
Professor, University of
Coordinator, International
Professor of Religion and
Botswana
Movement We Are Church
Theology, University of Western
Gaborone, Botswana
Member
Cape
Protestant
Versailles, France
Belleville, South Africa
Roman Catholic
Anglican
Asghar Ali Engineer
Indian
Riffat Hassan
Michio Araki
Director, Institute of Islamic
USA
Japanese
Studies
Professor of Religious Studies
Professor of Religion,
Mumbai, India
and Humanities,
University of Tsukuba
Muslim
University of Louisville
Tsukuba Ibaraki, Japan
Louisville, Kentucky, USA
Buddhist
Rev. Walter Fauntroy
Muslim
USA
Mehmet Aydin
Pastor, New Bethel Baptist
Teresia Hinga
Turkish
Church, Former Member,
Kenyan
Philosophy Department Head,
United State Congress
Professor of Religion, DePaul
Dokuz Eylul University
Washington, DC, USA
University
Turkey
Protestant
USA
Muslion
Roman Catholic
Rev. Larry Greenfield
Sheila Briggs
USA
Shamsul Islam
USA
Research Scholar, The Park
Indian
Professor, School of Religion,
Ridge Center for Health, Faith,
Senior Reader, Political Science
University of Southern
and Ethics
Department, University of
California
Chicago, Illinois, USA
New Delhi
Claremont, California, USA
Protestant
Delhi, India
Roman Catholic
Muslim
Sahar Hafez
Dina Cormick
Egyptian
June Jacobs
South African
General Secretary, Arab
British
Leadership, Women's
Women's Solidarity
President, International
Ordination of South
Association
Council of Jewish Women
Africa/We Are Church
Cairo, Egypt
London, England
KwaZulu-Natal, Republic of
Muslim
Jewish
South Africa
Roman Catholic
Sandha Jain
Joanna Manning
Rev. Gustavo A. Parajon
Indian
Canadian
Nicaraguan
Columnist, the Times of India
Founder, Coalition of
President, Nicaraguan Council
and political/religious
Concerned Canadian Catholics
of Churches
commentator
Toronto, Ontario, Canada
Managua, Nicaragua
New Delhi, India
Roman Catholic
Protestant
Hindu
Rev. James Martin-Schramm
Rosemary Radford Ruether
Madhu Khanna
USA
USA
Indian
Assistant Professor,
Georgia Harkness Professor,
Associate Professor, Indira
Department of Religion and
Garrett-Evangelical Seminary
Ghandi National Centre
Philosophy, Luther College
Evanston, Illinois, USA
for the Arts
Decorah, Iowa, USA
Roman Catholic
New Dehli, India
Protestant
Hindu
Arvind Sharma
Maria Consuelo Mejia
Indian
Gabi Kienesberger
Mexican
Birks Professor of
Austrian
Director, Catolicas por el
Comparative Religion,
Theologian, member,
Derecho a Decidir
McGill University
European Women's Synod
Mexico D.F., Mexico
Montreal, Quebec, Canada
Vienna, Austria
Roman Catholic
Hindu
Roman Catholic
Rev. Myosei Midorikawa
Sheikh Gamal Solaiman
Frances Kissling
Japanese
British
USA
Chaplain, Jindai Temple
Council Member, Institute of
President,
Tokyo, Japan
Business Ethics
Catholics for a Free Choice
Buddlist
Ottawa, Ontario, Canada
Washington, DC, USA
Muslim
Roman Catholic
Philomena Mwaura
Kenyan
Rev. Gordon Sommers
Manfred Kulessa
Lecturer, Department of
USA
German
Religious Studies, Kenyatta
Former President, National
Leadership,
University
Council of Churches
Association of Churches'
Nairobi, Kenya
Bethlehem, Pennsylvania, USA
Development Service
Roman Catholic
Protestant
Bonn, Germany
Protestant
Maria Jose Rosado Nunes
Ven. Haeju Sunim
Brazilian
Korean
Chung Hyun Kyung
Coordinator, Catolicas pelo el
Professor of Philosophy,
Korean
Direito de Decidir, Brazil,
Dongguk University
Professor,
Professor, Catholic University
Seoul, Republic of Korea
Union Theological Seminary
of Sao Paulo
Buddlnst
New York, New York, USA
Sao Paulo, Brazil
Protestant
Roman Catholic
Ven. Karma Lekshe Tsomo
USA
Rabbi Amy Levin
Anthony Padovano
Secretary, Sakyadhita:
Israeli
USA
International Association of
Treasurer, Rabbinical Assembly
Director, CORPUS, a national
Buddhist Women
of Israel
association for married priests
Honolulu, Hawaii, USA
Jerusalem, Israel
Morris Plains, New Jersey,
Buddlrist
Jewish
USA
Roman Catholic
Rev. Carlton Veazey
USA
Executive Director, Religious
Coalition for Reproductive
Choice
Washington, DC, USA
Protestant
Isaac Wüst
Dutch
Member, International
Movement We Are Church
Amsterdam, the Netherlands
Roman Catholic
RELIGION COUNTS
Religion Counts is an inter-religious group of religious scholars, experts, and leaders from
around the world. An initiative of the Park Ridge Center for Health, Faith, and Ethics and
Catholics for a Free Choice, Religion Counts provides a positive, ethically sensitive religious
contribution to discourse on issues surrounding population, reproductive health, and
development policies.
The Park Ridge Center
Catholics for a Free Choice
211 East Ontario
1436 U Street, NW
Suite 800
Suite 301
Chicago, IL 60611
Washington, DC 20009
Attention: Larry Greenfield
Attention: Frances Kissling
(p) 312-266-2222
(p) 202-986-6093
(f) 312-266-6086
(f) 202-332-7995
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
Catholic Voices: Reflections from the Paseo de la Reforma
Mexico City, December, 1998
INTRODUCTION
formal meetings sponsored by the United Nations,
The Hague Forum in February, 1999. The Hague
Over the past decade, the United Nations has,
Forum will evaluate the progress in implementation
through a series of international conferences and
of agreements made at the International Conference
plans of action, addressed a number of serious
on Population and Development held in the Cairo
problems facing the world and its people: human
Programme of Action since its completion in
rights, the environment, population and
September 1994. One of the remarkable aspects of
development, social development, housing, and
the Cairo conference was the partnership forged
women's rights. Few areas have been more
between governments and civil society in the crafting
contentious or difficult than the question of
of international policies. In the spirit of that
population and development, which embody
partnership and with an eye toward the five-year
differing deeply embedded political and religious
review, the United Nations invited non-
views of women's rights, gender, sexuality, and
governmental organizations to share their
reproduction.
perspectives with the UN on the themes and actions
outlined in the Cairo Programme of Action.
At the UN International Conference on
Catholic Voices has taken up this invitation with
Population and Development, held in Cairo in 1994,
enthusiasm, and thus we gathered in Mexico to
these different perspectives collided. The Vatican
reflect upon the issues of population and
and its Holy See delegation occupied substantial
development.
public space, serving as an obstacle to a growing
international consensus on population. This
We are not experts in service delivery or
consensus resulted in a remarkable, socially
program evaluators. Rather, we review the
transformative document called the Programme of
Programme of Action from the perspective of values
Action, which was adopted by the world's
and principles enlightened by the Catholic social
governments. The past five years have marked the
justice tradition. The agreements reached at the
beginning of realizing the world view represented in
Cairo conference represented what has been called
that document and implementing its outlined
by many a "paradigm shift" in the world's approach
actions. These matters were the basis for discussion
to population and development. In this shift, an
of Catholic Voices, a forum of Catholic leaders,
emphasis on demographic targets gives way to an
theologians, activists, and scholars who came
emphasis on human needs and the common good.
together in Mexico City in December 1998.
In the new paradigm, we see hope, a reverence for
life, health, and well being, and an impulse toward
With Catholic Voices' work for women's rights,
respect for human dignity, social justice, and equality
human development, and church reform, it was
among all people. Especially evident in the
fitting that the meeting took place on Mexico City's
Programme of Action is a new-found respect for the
Paseo de la Reforma, the Reform Promenade. This
moral agency of women.
wide, grand boulevard with its stirring name became
a symbol of our hopes for the human community's
Particularly because the views of many
progress toward justice and the common good.
Catholics were not represented by the Holy See at
the Cairo Conference, we present this report of our
The gathering on the Paseo de la Reforma
reflections on issues related to population and
came just two months before the first of a series of
development.
CATHOLICS FOR A FREE CHOICE
2
Reflection: Eradicating Poverty
enable people to "seek to do more, know more and
We are rooted in the principle of the preferential
have more in order to be more," as Pope Paul VI's
option for the poor and economic justice for all in
1967 encyclical Populonan Progressio (On the
insisting that special priority be given to the least
Development of Peoples) put it.
developed nations of the world and to the poorest
individuals everywhere. Profound concern for the
As part of development, Cairo specifically
poor is a refrain throughout the Hebrew Scriptures,
emphasized the right to education and noted that
where the community is urged time and again to care
investment in education is critical to the
for the widow, the orphan, and the stranger. In the
empowerment of women and the achievement of
Christian Scriptures, neglect of the poor leads to
their human rights. Cairo also underscored
exclusion from the Reign of God (Mt. 25), which
everyone's right to "the enjoyment of the highest
embraces not just life after death, but also the here
attainable standard of physical and mental health."
and now, indeed, the totality of human experience.
Cairo recognized development as an integral part of
fundamental human rights and said it must be
Poverty imposes imperatives on the affluent.
fulfilled so as to equitably meet the needs of present
Neglect of the poor is neglect of God. We support
and future generations.
ways of helping the poor such as charity, but we also
call for the transformation of domestic and world
Reflection: Human Rights and the Poor and the
structures that create and maintain poverty. On the
Marginalized
deepest level, it must be recognized that the poor
Our Catholic tradition calls us to stand with the poor
and the affluent are equal in dignity and rights.
and the marginalized. Marginalization of the "other"
Furthermore, the privileged must acknowledge and
leads to corruptions such as racism and nationalism.
reform their habits of over consumption. The
Common human dignity argues for the free exercise
world's resources belong to all of us, rich and poor
of rights by those who are marginalized, including
alike.
the impoverished, migrants, threatened indigenous
populations, the disabled, the elderly, the persecuted,
As population and development policies are
homosexuals, and other disempowered groups.
created and implemented, it is important to note that
World history reveals an often repeated record of
poverty cannot be blamed on population growth.
maltreatment of these groups. It also shows us that
Poverty arises from injustice, and slowing fertility
women and children are the world's poorest and
rates is not a single or simple solution to poverty.
most marginalized
We applaud Cairo's call for nations to cooperate to
eradicate poverty "in order to decrease the disparities
Cairo calls on countries to do better. For
in standards of living and better meet the needs of
example, the Programme of Action acknowledges
the majority of the people of the world."
that migrants often have the least access to resources
provided in development plans. It entreats countries
Reflection: People-Centered Development
to guarantee fundamental human rights to all
People's lives, not markets or production, should be
migrants. It also explicitly calls on nations to grant
the central concern of development policies. The
protection for refugees escaping persecution and to
true measure of development is whether it meets
recognize and support the identity, culture and
people's human needs and aspirations and whether it
interests of indigenous peoples, and to enable them
does this in accord with their human dignity. In the
to participate fully in the nation's life.
past, the Catholic church as a whole has seriously
criticized development policies for focusing solely
Reflection: Women's Human Rights
on economic rather than human development.
To put it concisely: women's rights are human rights.
Ethical population and development policies must
Women and men are entitled to the same rights and
be focused on people, not numbers; on rights, not
privileges; both also share the same responsibilities
demographics; on serving human needs, not denying
and duties. Universal acceptance of women's human
human desires.
rights remain unsettled. However, throughout the
last several decades, women's rights have been
Every person has the right to development.
increasingly recognized in the world, in both the
The cost of the world community's failure to
secular and religious fields. Unfortunately, the
support development is incalculable and
Vatican's actions at Cairo did not reflect the richness
unconscionable. Development policies should
CATHOLICS FOR A FREE CHOICE
3
of the Catholic tradition in support of women's
reproductive health services. Cairo called for
human rights.
adolescents to have information and services "to
help them understand their sexuality and protect
Cairo's Programme of Action was the first
them from unwanted pregnancies, sexually
United Nations document on population that
transmitted diseases and subsequent risk of
explicitly recognized the importance of women's
infertility." Cairo also correctly called on
rights as a worthy goal in itself and as a crucial factor
governments to safeguard the rights of adolescents
in development. Prior to Cairo, women's lives were
to privacy, confidentiality, respect and informed
not always treated with dignity and respect in
consent. It said countries should remove legal,
population policies; women were often considered
regulatory and social barriers to reproductive health
only in terms of their reproductive capacity, and
information and care for adolescents. The
their aspirations and needs were made secondary to
Programme of Action also acknowledged that
demographic outcomes. Cairo noted the exceptional
adolescents must be fully involved in the planning
importance of the "empowerment and autonomy of
and implementation of these educational
women and the improvement of their political,
programmes.
social, economic and health status."
Reflection: Sexuality
We stand with Cairo's groundbreaking calls for
Sexuality is a gift of God and is integral to our
gender equality, the empowerment of women, and
humanity. The celebration of our bodies through
the recognition of women's moral agency. We
sexuality brings us spiritual awareness. Human
endorse its outlined actions aimed at advancing
sexuality commits each person to concern for the
women's status, including promoting education for
other or else it forfeits its human and virtuous
women, eliminating economic and other
content. Sexuality, like love, should be sensitive,
discrimination against women, enhancing women's
considerate, generous, compassionate, and
employment opportunities, and ending violence
concerned. The same standards apply to men and
against women.
women equally. The principle that insists that we
love our neighbors as ourselves is expected to
Reflection: Adolescents' Human Rights
govern our sexual relationships. Ethical expressions
Adolescence is a passage in the human journey
of sexuality based on equality, mutual respect, and
toward maturity. It is an age in which people
concern are found in many kinds of relationships
appropriately begin to explore and discover
and unions.
experiences related to adult life, including social,
spiritual, and personal growth. Given this search,
These perspectives reflect a broader
adolescents must have adequate reliable information
understanding of sexuality than the ones put forth by
to light their way. Adolescents must also be
the Vatican at Cairo. Indeed, a persistent tradition
recognized as more than recipients of adult
of aversion to sexuality within Catholicism is the
knowledge and advice. They have much to draw
root of current Vatican conservatism on
from and to offer as a result of their own insights
reproduction and women. Sex has often been
and experience.
presented as a necessary evil by churchmen,
reflecting a kind of amnesia concerning biblical
The intent of sexuality education for
references to sexual pleasure as a value in its own
adolescents should not be information only; it
right.
should rather be aimed toward the formation of a
Sexual expression is multi-facted and serves
responsible conscience and sensitivity to the lives of
many good purposes. It is a way of communicating
others. The responsibility for these kinds of
intimately with another, of giving and receiving
messages are shared by many, including parents,
pleasure, and of creating new life. It is morally
schools, the media, and other social institutions.
separable from its reproductive function. To its
Sexuality education must respond to the expressed
credit, Cairo addressed "sexual health" in the context
and unexpressed needs of young persons
of "enhancement of life and personal relations, and
themselves.
not merely counseling and care related to
reproduction and sexually transmitted diseases."
One of Cairo's achievements was its recognition
The Cairo agenda should be informed by agreements
that the reproductive health needs of adolescents as
made by nations at the 1995 Fourth World
a group have been largely ignored by existing
Conference on Women, which declared that "the
CATHOLICS FOR A FREE CHOICE
4
human rights of women include their right to have
responsible procreation more possible, it also allows
control over and decide freely and responsibly on
for a satisfying, pleasurable sexual life with
matters related to their sexuality free of coercion,
diminished fear of unintended pregnancy.
discrimination and violence."
Furthermore, the control over fertility that
contraception offers has allowed women to develop
Reflection: Reproductive Health and Rights
aspects of their lives beyond motherhood.
Reproduction is one of the most important and
profound aspects of human life and relationships.
The Vatican supports, in fact encourages, the
Through reproduction, we express our hope in the
practice of family planning, for it recognizes the
future of the human family. Reproduction is both
moral imperative of responsible parenthood.
private and public. It has undeniable consequences
However, only "natural family planning," a set of
for the community and society at large. It is also a
methods that involve periodic abstinence, is allowed.
matter of public health, religious teachings, and
Making only one method available and one that
government policy. It is an area in which women are
does nothing to protect against sexually transmitted
the central protagonists, for it is women who bear
diseases - cruelly ignores the reality of people's lives.
the risks and consequences of childbearing and the
Women and men must freely decide not only
greater responsibility for child rearing. In the just
whether they wish to use contraception, but which
world we work toward, these risks and
method is best for them.
responsibilities will be equally shared by men and
better supported by society.
Couples worldwide have indicated that they
need and want to use contraception. We endorse
An ethically based approach to reproductive
Cairo's commitment to voluntary family planning
health and rights has several underlying principles.
programs that include a full range of safe, effective,
First, it must be voluntary rather than coercive.
and affordable contraceptive choices.
Imposition of external limits on family size are
unacceptable. Couples must have the right to decide
Reflection: HIV/AIDS
when, whether, and how to bring new life into the
Society's and individuals' responses to AIDS must
world. Second, it must be comprehensive rather
be rooted in compassion, responsibility, and a
than focused on family planning alone. Women's
commitment to life. These principles require that
reproductive health cannot be extricated from their
efforts to prevent the spread of HIV must include
health, and programs must provide a wide range of
condoms and condom instruction. Couples should
services. Third, it must be seen as an integral aspect
be encouraged to use them to prevent transmission
of human rights. Reproductive rights are grounded
of HIV. We reject the Vatican's opposition to
in previously recognized human rights. This right
condom use, and we stand with Cairo's approach to
was first recognized in 1968 at the International
treating and preventing this tragic disease.
Conference on Human Rights in Teheran, Iran.
Fourth, it must be tied irrevocably to respect for the
Reflection: Safe Abortion
rights of conscience and free will. Couples consider
Abortion is a complex moral and social issue -
a range of concerns in making the decision whether
potential mothers know this best. The Vatican's
to have a child. The community, family, religious
position on abortion is compromised by its
teachings, social conventions will play a role in
unwillingness to accept contraceptive services and
reproductive decisions, but in each decision, the
devices even though they reduce the need for
individual conscience has the ultimate say.
abortion. Even taking into account Vatican
opposition to abortion, we remain puzzled by
Cairo's approach to reproductive health and
Vatican objections to abortion being safe where
rights is grounded in these principles. Its rejection
legal. This dismissal of safe abortion by the church
of coercion and its support of comprehensive safe
hierarchy is insensitive to the realities women face
motherhood programs are to be commended.
and to the number of women who die from unsafe
abortions every day. Because women everywhere
Reflection: Contraception
resort to abortion, the alternative to safe abortion is,
Catholics around the world have come to believe
of course, unsafe abortion. Again, it is the
that contraception is a moral option. Bringing
hierarchy's preoccupation with eliminating abortion
children into the world is a sacred responsibility.
from the world that prevents the real issues of justice
Safe and effective contraception not only makes
and health for women being addressed. Such an
CATHOLICS FOR A FREE CHOICE
5
absolutist position fails to acknowledge the
Cairo honored families in the Programme of
ambiguity and doubt regarding fetal life and ignores
Action, saying, "The family is the basic unit of
the range of moral complexities surrounding each
society and as such should be strengthened." And it
situation.
recognized diversity. "In different cultural, political
and social systems, various forms of the family
Despite charges that it did, Cairo did not call
exist."
for universal legal abortion. In fact, it based a large
measure of its support for comprehensive family
Reflection: The Role of Religion
planning programs on the imperative to reduce the
Religious thought has an important role to play
need for abortion. It did call for abortions to be safe
within the civil society and its cultures. The values
where legal and for the public health issues of unsafe
and principles at the core of all the major religious
abortion to be addressed. The Holy See opposed
traditions - respect for human dignity, care for the
even these points.
poor and marginalized, a striving for the common
good are important touchstones for civil society.
In countries where abortion is illegal, it is the
Where religion is rooted in community and
poor who are left to face abortions under the worst
experience, religious stories and traditions serve as
types of conditions. And in countries where
important teaching tools. Religious insights often
abortion is legal, but safe abortions are costly, it is
form the framework for the most fundamental and
again poor women who shoulder the burden. The
profound human inquiries.
church tradition of a preferential option for the poor
has been interpreted by many Catholics to support
Many of the issues at the heart of population
the safety of abortion and to oppose unsafe
and development concerns- not least among them
abortions. Within the Cairo context, concern for
issues of sexuality and reproduction, women's rights,
public safety is not the same as moral endorsement.
gender roles and responsibilities- call for massive
social change. They center on transforming
Despite Vatican disapproval, Cairo was right to
relationships, between men and women, between
address the catastrophic health consequences for
government and citizens, and between and among
women of unsafe abortion. Justice demands that we
family members. This kind of social reform and
do not abandon poor women or women in need of
reorganization will be difficult and will take a long
help.
time. Participation by religious institutions,
organizations, and individuals can promote, enhance,
Reflection: Families
and accelerate this transformation.
A broad, fluid vision of families is reflected by Jesus
himself in the Gospel of Mark. As his mother and
However, there is not one religious model that
brothers one day approached Jesus and a group
applies to the whole world. There must be constant
encircled around him, Jesus asked, "Who is my
dialogue among religious and spiritual movements so
mother, or my brothers?" He gestured toward the
that we can become more aware of how to
circle and said, "Here are my mother and my
accommodate difference as well as reach shared
brothers!" (Mk. 3:31-35)
values. As Catholics, we are called by the Second
Vatican Council to "recognize the legitimacy of
We do not agree with the parsimonious view of
differing points of view," and show respect for our
family espoused by the Vatican.
fellow citizens. (Gaudium et Spes, 75). Moreover,
while religions have a place at the policy table, it is
In the fragile world in which we live, it seems
not a privileged place. Rather, they are equal voices
to us that we do better as a human community to
among many.
embrace extended and varied definitions of families.
Why decry people's bonds of solidarity and
EPILOGUE
willingness to take responsibility for another?
As Catholics who support the ethical approach
However, whatever structure the family has
to population and development articulated in the
taken, it has often been the site of violence against
Cairo Programme of Action, we call on nations to
women and children. As we look to a more
strengthen their commitment to the principles and
generous vision of families, violence has no place.
actions outlined therein. We further call on people
who gather themselves in religious communities to
CATHOLICS FOR A FREE CHOICE
6
dedicate themselves to addressing the challenges and
problems related to these issues. We look forward
with hope to a future in which poverty and its roots
are eliminated, men and women enjoy equal rights,
children have what they need to grow and develop,
and the rights of conscience are protected.
CATHOLICS FOR A FREE CHOICE
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
Acting Against the Grain
A Chronology of Church Action to Block Cairo's Implementation
At the September 1994 International Conference on
informed choice. In fact, the agreement says that
Population and Development held in Cairo, Egypt,
governments should remove "unnecessary legal,
the overwhelming majority of nations agreed to a
medical, clinical and regulatory barriers to
Programme of Action - a set of actions and
information and to access to family-planning
policies intended to address "the critical challenges
services and methods." But church officials around
and interrelationships between population and
the globe have acted as barriers themselves, taking
sustained economic growth in the context of
steps to restrict access to any method of family
sustainable development." The Holy See joined the
planning officially banned by the church. (Official
consensus on all of the principles articulated in the
teaching forbids the use of any method except
conference Programme of Action, while expressing
periodic abstinence.)
reservations on most of the document's other
chapters, including those dealing with sexual and
Since Cairo, church officials have obstructed
reproductive health and rights.
efforts to implement many other Cairo agreements,
including efforts to broaden sexuality education
The Vatican's opposition to agreements
programs, to improve and expand prevention
reached in these areas did not end with the
programs on HIV/AIDS and other sexually
conference's conclusion. In the ensuing four and a
transmitted diseases, and even to end discrimination
half years, church officials, from the Vatican to
of disabled persons with regard to reproductive
bishops' conferences and beyond, have conducted a
rights and family formation.
campaign of obstruction to implementation of these
parts of the Cairo agenda. Many of these instances
The following chronology enumerates incidents
have taken the form of direct incursions into the
in this campaign of obstruction. It is by no means
formation of public policy; some are more oblique
comprehensive, and in fact presents only a portion
efforts to vilify those implementing the Cairo
of what is likely a high number of such actions. The
agreement, as when the pope maintained that
entries in this chronology have been gleaned
international institutions providing voluntary
principally from church documents that have been
contraceptives to couples who want them are
made public and from news reports of public actions
involved in a "conspiracy against life." All of their
by church officials. There is no way to identify or
efforts, however, affect not only Catholics, but
quantify nonpublic efforts of the Roman Catholic
citizens of all faiths and no faith all across the world.
church as an institution in the crafting of public
policy and the shaping of individual behavior.
The Cairo Programme of Action stresses the
Appearing at the end of each chronology entry is a
"right of all couples and individuals to decide freely
citation of the relevant section from the Cairo
and responsibly the number, spacing and timing of
Programme of Action.
their children, and to have the information and
means to do so," and it called for expanded access to
In chapter 11 of the Programme of Action,
primary and reproductive health care. Cairo called
delegations at Cairo agreed that those in "influential
for family planning programs to "ensure that women
positions," including religious leaders, should
and men have information and access to the widest
"mobilize public opinion in support of the actions
possible range of safe and effective family planning
proposed" (11.17). Sadly, officials of the Roman
methods in order to enable them to exercise free and
Catholic church have tried to do just the opposite.
CATHOLICS FOR A FREE CHOICE
2
Chapter 11 was among those on which the Holy See
insist that the only reliable remedy to the spread of
did not join the consensus, and indeed, church
AIDS is fidelity within marriage and chastity outside
representatives have worked, often in the public
marriage." In their statement, the bishops also insist
policy arena, to make it harder for the Cairo vision
that periodic abstinence is the only acceptable
to be realized.
method of family planning. 5 PROGRAMME OF
ACTION 7.2, 7.3, 7.6, 7.15, 7.23, 8.31, 8.35
December 1994
The US bishops approve updates and revisions to
August 1995
the Ethical and Religious Directives for Catholic Health
The Peruvian bishops' conference issues a news
Care Services. The Directives bar Catholic health care
release upholding the pope's new encyclical,
facilities from providing or condoning contraceptive
Evangelium Vitae, which condemns contraception and
practices, from providing condoms or condom
criticizes family planning programs. The bishops
counseling, even for disease protection, and from
assert that the church's ban on contraception is not
performing voluntary sterilizations for men and
just an opinion, but is a truth, taught by the church,
women.¹ PROGRAMME OF ACTION 7.2, 7.3, 7.6,
"in the name of God." Moreover, they assert, this
7.15, 7.23, 8.17
church doctrine is not only directed at Catholics, but
is directed to all people of good will.6 PROGRAMME
December 1994
OF ACTION 7.2, 7.3, 7.6, 7.15, 7.23, 8.31, 8.35
US Archbishop Francis Schulte of New Orleans,
Louisiana, issues a pastoral letter entitled "Pastoral
September 1995
Action for Families," in which he denounces the use
Brazilian Roman Catholic officials publicly criticize
of contraceptives. "To many," he writes, "the ability
the government's new AIDS prevention campaign.
to control conception seems to be accompanied by
The campaign advocates the use of condoms to
the right to separate the procreative and unitive
prevent the spread of HIV and AIDS. Bishop
functions of marriage."2 PROGRAMME OF ACTION
Dadeus Grings states that "a sickness isn't fought by
7.2, 7.3, 7.6, 7.15, 7.23, 8.17
degrading morals and hurling people to hell. The
church preaches chastity and is opposed to the use
March 1995
of prophylactics
The church is highly concerned
Pope John Paul II issues his encyclical letter,
about preserving human dignity and can't agree with
Evangelium Vitae (The Gospel of Life), in which he
the methods adopted to fight AIDS."
condemns, among other things, contraception and
PROGRAMME OF ACTION 7.23(b), 8.31, 8.35
treatment of infertility. The pope claims that
international institutions are involved in a
September 1995
"conspiracy against life" because they are engaged in
In its reservations and statements of interpretation
campaigns to make contraception available.³
of the UN World Conference on Women in Beijing,
PROGRAMME OF ACTION 7.2, 7.3, 7.6, 7.15, 7.23,
the Vatican says, "The Holy See in no way endorses
8.17
contraception or the use of condoms, either as a
family planning measure or in HIV/AIDS
June 1995
prevention programs."8 The Vatican also criticizes
The Catholic church in Kenya VOWS to fight a new
the platform of the Conference for the document's
program of Family Life Education in schools. The
focus on sexual and reproductive health, and wants
new program would give young people access to
that all references to sexuality in the document be
information to equip them with the ability to say
interpreted to mean sex within marriage. Joined by
"no" to sex and to help them avoid unwanted
Latin American, Islamic countries, and conservative
pregnancies and sexually transmitted diseases,
nongovernmental organizations (NGOs), the
including HIV/AIDS.4 PROGRAMME OF ACTION
Vatican opposes language that it claims denigrates
7.46, 8.31, 8.35, 11.9
the two-parent (mother and father) family, belittles
motherhood and diminishes the rights of parents to
June 1995
decide if their children should receive sex education
Fifteen bishops from the Middle East and Asia meet
and reproductive health care, including contraceptive
at the Vatican to discuss goals in the pastoral care of
services.⁹ PROGRAMME OF ACTION 7.2, 7.3, 7.6,
families. In their statement, "Serving the Needs of
7.15, 7.23, 7.37, 7.46, 8.31, 8.35, 11.9
the Family," the bishops call upon all men and
women to reject "safe sex" programs, saying, "We
CATHOLICS FOR A FREE CHOICE
3
September 1995
March 1996
Catholic groups oppose Ireland's move to institute
A Brazilian Roman Catholic bishop rejects the
sex education programs in schools, accusing the Stay
marriage application of a Brazilian couple because
Safe program of "confusing moral judgments and
the man is "paraplegic and therefore impotent,"
personal feeling." Although there persists a debate
according to the bishops' letter to the couple. The
among Catholics in Ireland over the sex education
man had applied to the Catholic church to marry a
program, Stay Safe continues - but it is closely
widow who had two children from a previous
monitored by the church. 10 PROGRAMME OF
marriage. A couple "needs to be in perfect physical
ACTION 7.23(b), 7.37, 7.46, 8.31, 8.35, 11.9
condition to be married," the bishop says.¹⁵
PROGRAMME OF ACTION 6.30
January 1996
Church leaders and Catholic conservatives fight
August 1996
against a New York City AIDS education curriculum
As 250 people watch, Kenya's top Catholic bishop,
that includes condom distribution and textbooks
Cardinal Maurice Otunga, ceremoniously burns
that teach respect and tolerance for diverse sexual
several boxes of condoms and one hundred copies
orientations. Consequently, the Board of Education
of pamphlets promoting safe sex. According to the
adopts a revised curriculum on AIDS education that
World Health Organization, one million of Kenya's
no longer includes classroom demonstrations of
twenty-six million people are infected with the virus
condom use.¹¹ PROGRAMME OF ACTION 7.23(b),
that causes AIDS.16 PROGRAMME OF ACTION 7.6,
7.37, 7.46, 8.31, 8.35, 11.9
7.23, 7.37, 8.31, 8.35
February 1996
August 1996
The Vatican advises parents to "reject the promotion
Experiencing pressure from Catholic and other
of 'safe sex' or 'safer sex,' a dangerous and immoral
religious groups, Kenya's President Daniel Arap Moi
policy based on the deluded theory that the condom
rules out sex education in primary schools. Moi
can provide adequate protection against AIDS."¹
states that, "Our religions are against such
PROGRAMME OF ACTION 7.3, 7.23(b), 7.37, 7.46,
immorality [sex education] and my government will
8.31, 8.35, 11.9
reject calls for it to be debated in parliament." The
Catholic church has persistently opposed the
February 1996
teaching of sex education because the proposed
The Peruvian bishops' conference releases a letter,
curriculum included information about
"Building a Culture of Life," that criticizes the
contraception.¹⁷ PROGRAMME OF ACTION 7.23(b),
government's promotion of a sex education program
7.46, 8.31, 8.35, 11.9
geared toward adolescents. They claim the program
is devoid of moral values and social responsibility.
August 1996
They assert that the program is limited to education
The Catholic bishops of Nicaragua release a
on prophylactics and condoms, and thus encourages
statement saying the country is suffering under a
recreational sex that does not take into account
campaign of "antireproductive colonialism." The
responsibility for consequences.¹³ PROGRAMME OF
bishops call for Catholics to not be confused by
ACTION 7.23(b), 7.37, 7.46, 8.31, 8.35, 11.9
those who speak of "reproductive rights,"
"reproductive health," and "safe sex," arguing that
March 1996
these terms disguise "abortionists, promiscuity, and
The Vatican orders Scottish Archbishop Keith
the arbitrary use of sex."18 PROGRAMME OF ACTION
O'Brien to remove his imprimatur (official
7.2, 7.3, 7.6, 7.23, 8.25
permission to print) from an AIDS education
package that includes information and advice on
November 1996
using condoms. The most important inadequacy of
The Holy See announces at the Pledging Conference
the package, according to one churchman involved,
for Development Activities, held at the United
is the attitude towards condoms, "that if you have
Nations in New York, that it will not offer its usual
got HIV and you are having pre-marital sex, or sex
symbolic contribution to United Nations Children's
in any situation, you should use a condom."14
Fund (UNICEF) for 1997 and calls on others,
PROGRAMME OF ACTION 7.23(b), 7.37, 7.46, 8.31,
especially Catholic institutions and individuals, to
8.35, 11.9
reconsider their support for the agency. The attack
is based on charges-unequivocally denied by
CATHOLICS FOR A FREE CHOICE
4
UNICEF - that the agency is engaged in
contraception. The pope asks that the bishops
distributing contraception and promoting abortion,
"support the teaching of natural methods of
and on UNICEF's endorsement of a UN manual
regulating fertility." PROGRAMME OF ACTION 7.6,
dealing with women's needs in emergency situations
7.15, 7.23(b), 8.31, 8.35
and in refugee camps. Produced at the height of the
Bosnian conflict, the manual states that women -
February 1997
including the victims of rape as an instrument of war
The US National Conference of Catholic Bishops
- "have the same rights as others to have access, on
decries the congressional approval of a bill providing
the basis of free and voluntary choice, to
additional international family planning assistance.
comprehensive information and services for
The bishops claim that the money would support
reproductive health," including emergency post-
abortion activities, even though US law prohibits the
coital contraception for raped women.¹⁹
use of US funds for any abortion-related activities
PROGRAMME OF ACTION 4.17, 4.18, 4.19, 7.46,
overseas.²⁴ PROGRAMME OF ACTION 7.2, 7.3, 7.6,
11.8, 11.9
7.15, 7.23, 8.17, 8.25, 8.31
November 1996
March 1997
The Roman Catholic church in Honduras uses its
The Pontifical Council for the Family issues a
influence to prevent the distribution of condoms at
reference document entitled, "Vade Meam for
polling stations during primary elections. The
Confessors Concerning Some Aspects of Morality of
Honduran Ministry of Health had planned to
Conjugal Life," in which contraception is referred to
distribute more than one million condoms at polling
as an "evil." The document states, "The church has
places where voters from the country's two major
always taught the intrinsic evil of contraception, that
parties were choosing candidates for the presidency
is, of every marital act intentionally rendered
and other offices. Government officials say they
unfruitful. This teaching is to be held definitive and
cancelled the plans largely because of church
irreformable. Contraception is gravely opposed to
objections.²⁰ PROGRAMME OF ACTION 7.2, 7.3, 7.6,
marital chastity; it is contrary to the good of
7.15, 7.23, 8.31, 8.35
transmission of life
; it harms true love
"25
PROGRAMME OF ACTION 7.2, 7.3, 7.6, 7.15, 7.23,
December 1996
8.35
Addressing participants in a course to prepare
teachers of natural family planning, the pope
April 1997
reiterates that natural family planning is the only
The Catholic bishops of the United States urge the
method permitted by the church for married couples
US Congress to vote against aid for family planning
to use to space pregnancies. A month prior to his
programs overseas. PROGRAMME OF ACTION 7.2,
statement, the pope urged doctors to adhere to the
7.3, 7.6, 7.15, 7.23, 8.17, 8.25, 8.31
church's sanctioned method of family planning, and
he condemned contraceptives as a form of
June 1997
"hedonism." PROGRAMME OF ACTION 7.2, 7.3,
In a letter to US Bishop John McCarthy of Austin,
7.6, 7.15, 7.23, 8.35
Texas, the Vatican's Congregation for the Doctrine
of the Faith instructs the bishop to terminate all
January 1997
access to contraception and sterilization at
In a letter to the US Congress, Cardinal Bernard Law
Brackenridge Hospital. The letter is part of a series
of Boston, Massachusetts urges members of
of correspondence regarding the leasing arrangement
Congress to vote against the US Administration's
between Seton (a Catholic health care system) and
proposal to spend an additional $123 million for
Brackenridge Hospital (a public medical facility) in
international family planning assistance.
Austin, Texas. "This Congregation," the letter reads,
PROGRAMME OF ACTION 7.2, 7.3, 7.6, 7.15, 7.23,
"directs Your Excellency to ensure that direct
8.17, 8.25, 8.31
sterilizations, as well as any other contraceptive
programs, immediately and permanently cease at
February 1997
Brackenridge Hospital."2 PROGRAMME OF ACTION
In an address to members of the Philippine bishops'
7.2, 7.3, 7.6, 7.15, 7.23
conference during their ad limina visit to Rome, Pope
John Paul II instructs the bishops to defend the
family by publicly opposing sterilization and
CATHOLICS FOR A FREE CHOICE
5
July 1997
November 1997
L Osservatore Romano, the Vatican newspaper, gives its
The Vatican nuncio to the United Nations protests
support to a report which calls on people with
medical aid in refugee camps, saying it is "sometimes
mental and physical disabilities to abstain from sex.
almost exclusively in the form of reproductive health
Dr. Maria Cristina Baldacci, a surgeon and
measures." PROGRAMME OF ACTION 7.2, 7.3, 7.6,
consultant in bioethics, wrote an article for Medical
7.15, 7.23, 10.25
Morality ,saying the disabled should "collaborate with
God to avoid creating further pain and sorrow" by
January 1998
expressing their sexual urges as "friendship or
The German bishops' conference concedes to Pope
something more transcendental." PROGRAMME OF
John Paul II's "urgent request" that Catholic church-
ACTION 6.30
sponsored counseling centers stop issuing
counseling certificates to pregnant women who need
July 1997
abortions. The bishops agree to withhold counseling
Catholic and Muslim groups form Citizens for a
certificates that are key in Germany's legal
Healthier Kenya to campaign against the
procedures for abortion.34 PROGRAMME OF
government's sex education programs and
ACTION 7.6, 7.24, 8.19, 8.25
distribution of contraceptives. The group seeks to
gain support for "traditional family life" and in its
January 1998
literature states that the planned sex education will
The local Catholic church in Zambia opposes a
be dangerous "killing all sense of morality, opening
proposed regulation that would allow unmarried
the way to free sex, to contraception and
pregnant girls to continue in school, claiming the
abortion."29 PROGRAMME OF ACTION 5.9, 5.13,
regulation sanctions immorality. The church says
7.15, 7.23, 8.31, 8.25, 8.35, 11.9
that only students with potential should have the
opportunity to continue their education, and argues
August 1997
that pregnant unmarried girls do not have
The archbishop of Mexico, Norberto Rivera Carrera,
potential.35 PROGRAMME OF ACTION 4.17, 4.18,
demands that all condoms distributed through
4.19, 11.8
Mexico's AIDS prevention program carry warning
labels that state, "Use of this product is harmful to
February 1998
health." In his homily in Mexico City's cathedral, the
On the thirtieth anniversary of Humanae Vitae - the
archbishop praises the Mexican government officials
1968 encyclical letter issued by Paul VI that reiterates
for placing warning labels on alcoholic beverages
the church ban on the use of artificial contraception
that say, "this product is harmful to your health,"
- Pope John Paul II tells Catholics that the
and laments how the government does not do the
church's ban on contraception is the law. In his
same for contraceptives.30 PROGRAMME OF ACTION
letter addressed to Anna Cappella, director of the
7.6, 7.15, 7.23, 8.31, 8.35
Center for Research and Study on the Natural
Regulation of Fertility at Rome's Catholic University
September 1997
of the Sacred Heart, Pope John Paul states that "in
With the support of PROVIDA, a conservative
the act that expresses their love, spouses are called to
prolife group in Mexico, Mexico's Archbishop
make a reciprocal gift to themselves to each other in
Norberto Rivera Carrera rejects the use of
the totality of their person. This is the reason for
contraceptives in marriage. In his homily, Rivera
the intrinsic unlawfulness of contraception: It
Carrera instructs parishioners not to use intrauterine
introduces a substantial limitation into this reciprocal
devices and condoms, arguing that they are methods
giving
"36 PROGRAMME OF ACTION 7.2, 7.3,
that destroy the sexual unity between spouses.31
7.6, 7.15, 7.23, 7.24
PROGRAMME OF ACTION 7.2, 7.3, 7.6, 715, 7.23,
8.17
April 1998
The New York State Catholic Conference and the
October 1997
Connecticut Catholic Conference lobby against US
Fr. Jacque Suaudeau, a medical doctor who is a
legislation that would require health insurance
member of the Vatican Council for the Family
policies to provide prescription drug coverage for
claims that using condoms during sexual intercourse
contraceptive drugs and devices. Women of low-
will not protect against transmission of the HIV
virus.³² PROGRAMME OF ACTION 7.23(b), 8.31, 8.35
CATHOLICS FOR A FREE CHOICE
6
incomes would especially benefit from the
sponsored insurance plans.⁴² PROGRAMME OF
legislation.3 PROGRAMME OF ACTION 7.2, 7.3, 7.15,
ACTION 7.2, 7.3, 7.15, 7.23, 7.24
7.23, 7.24
April 1998
NOTES
The archbishop of Lima, Peru, Cardinal Augusto
]
Vargas Alzamora, protests sex education for eleven-
US Bishops, "Ethical and Religious Directives for Catholic
and twelve-year-olds in secondary school, calling it a
Health Care Services," Origins 24:27 (December 15, 1994).
450-460.
sacrilege and a crime. He criticizes the program for
2 Archbishop Francis Schulte, "Pastoral Action for Families."
teaching students to prevent pregnancies by using
Origins 24:30 (January 12, 1995), 506.
artificial contraception. The minister of education,
3 Pope John Paul 11, The Gospel of Life Evangelium Vitae
Domingo Palermo, explains the program addresses
(New York: Random House, 1995), 23-30.
the country's problem of teen pregnancy and the aim
4 Open File, June 1995.
5 Asian, Middle Eastern Bishops, "Serving the Needs of the
is to bring information not only to the students, but
Family," Origins 25:6 (June 22, 1995), 100.
also to parents and teachers.³⁸ PROGRAMME OF
6 "Al Servicio del Evangelio de la Vida," comunicado de los
ACTION 7.23(b), 7.37, 7.46, 8.31, 8.35, 11.9
Obispos de Perú, 4 de agosto de 1995.
7 UPI wire service. September 19, 1995.
May 1998
S Mary Ann Glendon. "Vatican Stance: Women's Conference
Final Document," Origins 25:15 (September 28. 1995). 235.
Cardinal Augusto Vargas Alzamora of Lima, Peru,
9
'Vatican Criticizes Women's Platform," UPI. September 15,
calls upon parishioners to boycott artificial methods
1995.
of contraception. The archbishop states that, "the
10 The Catholic World Report. August-September 1995.
11
church condemns these methods because they
"Best for Kids," Catholic New York, January 4, 1996.
compromise and affect health, dignity and the
12 Pontifical Council for the Family. "The Truth and Meaning
of Human Sexuality," Origins 25:32 (February 1. 1996).
economy of families."39 PROGRAMME OF ACTION
13 Carta de los Obispos de Perú a los fieles creyentes.
7.2, 7.3, 7.6, 715, 7.23, 8.17
"Construyamos una Cultura de Fe," 2 de febrero de 1996: The
Catholic World Report, March 1996.
June 1998
14 The Catholic World Report, March 1996; PA News wire
In the process of instituting the International
service, November 11. 1995.
15
"Brazil Bishop Bans Marriage Because of Impotence,"
Criminal Court, the Vatican opposes the inclusion of
Reuter wire service, March 26. 1996.
"forced" or "enforced" pregnancy among the court's
16 AP wire service, August 31, 1996.
17
list of war crimes, in fear of women being able to use
The Catholic World Report, August-September 1996.
IS
the ICC to obtain abortions in countries where
"Obispos Católicos condenan 'Colonialismo
abortions are illegal. PROGRAMME OF ACTION
anticonceptivo`," La Tribuna. August 15. 1996.
19 "Vatican Shelves UNICEF Support," AP wire service.
7.35, 7.39
November 5, 1996: "The Holy See Suspends Its Annual
Symbolic Contribution to UNICEF," Holy See press release,
July 1998
November 4, 1996.
US residents of Enid, Oklahoma, face the loss of
20 "Honduran Church Blasted For Halting Condom Giveaway,"
Reuter wire service, November 28. 1996.
tubal ligation services. The city's two hospitals, one
21 'Pope-Birth Control." AP wire service, December 7, 1996.
Catholic and the other Baptist, plan to build a
22 Cardinal Law. letter to Members of Congress, January 30,
Medical Plaza for Women and Infants. The new
1997. See www.nccbuscc.org.
facility will not offer the choice of tubal ligations at
23 "Filipino Families Are Seeking Sound Doctrine, Grace and
delivery for women because it will operate under the
Human Empathy," L Osservatore Romano. February 19. 1997.
24 "Official Expresses Dismay on Vote for Funds for Abortion
Ethical and Religious Directives for Catholic Health Care
Groups," National Conference of Catholic Bishops news
Services, the Catholic church's national guidelines
release. February 13, 1997.
barring most reproductive services.⁴¹ PROGRAMME
25 Pontifical Council for the Family, "Vade Mecum for
OF ACTION 7.2, 7.3, 7.6, 7.15, 7.23
Confessors Concerning Some Aspects of Conjugal Life,"
Origins 26:38 (March 13, 1997), 621.
26 Most Reverend Theodore E. McCarrick and Most Reverend
August 1998
John Ricard, letter to Senator/Representative. April 22. 1997.
The US Catholic bishops lobby against the US
27 Congregation of the Doctrine of Faith, letter to the Most
Congress bill that would require federal employees'
Reverend John McCarthy, June 9, 1997.
health insurance to cover prescription
2S Disabled Protest to Vatican on Avoid Sex' Call," Irish
contraceptives. The bill passes, but the bishops
Times, July 2, 1997.
29 The Wanderer, July 17. 1997.
succeed in securing exemptions for Catholic-
30 "El condón no es totalmente seguro, dice el arzobispo Rivera
Carrera," Crónica. 25 de agosto de 1997.
CATHOLICS FOR A FREE CHOICE
7
31 "Rivera Carrera rechaza los métodos anticonceptivos dentro
del matrimonio." Crónica. 1 de septiembre de 1997.
32 The Tablet. October 18, 1997.
33 Catholic New York, November 13. 1997.
34 "Obeying Pope. German Bishops End Role in Abortion
System," New York Times, January 28, 1998; "German
Catholics to end abortion certificates," Reuter wire service,
January 27, 1998.
35 Von Zarina Geloo. "Zambia's Young Mothers Should be
Allowed to go to School Again," DPA wire service. January
12, 1998.
³"Pope John Paul II. "Why Natural Family Planning Differs
from Contraception," Origins 27:40 (March 26. 1998), 680-
681; "Pope Reminds Catholics Contraception Not Allowed,"
Reuter wire service, March 2, 1998.
37 New York State Catholic Conference, letter to New York
State Assembly, 3 April 1998; Connecticut Catholic
Conference, letter to state legislators, 30 April 1998.
3S "Cardenal Vargas Alzamora critica contenido de educación
sexual." El Comercio, 10 de abril de 1998; "Ministerio de
Educación no imparte planificación familiar a adolescentes,"
El Comercio, 15 de abril de 1998.
39 "Cardenal pide a los feligreses boicotear métodos artificiales
para control natal," Expreso, 12 de mayo de 1998.
40 "New Struggle for Life," The Catholic World Report.
August-September 1998; "The Holy See's Statement on
Criminal Court," L Osservatore Romano. July 22. 1998;
"Semantics Stalls Pact Labeling Rape a War Crime.' New
York Times, July 9, 1998.
41 "Religion, Medicine, Collide on Birth Care," Chicago
Tribune, July 7. 1998.
42 "Political and health issues dominate 'pill bill' debate," Our
Sunday Visitor, August 30, 1998; "Women's Groups Eye
Insurance Bill," AP wire service, August 31, 1998; "Federal
Coverage for Birth Control Gives Pro-Abortion Forces a
Boost," National Catholic Register, August 16-22, 1998.
CÁTHOLICS FOR A FREE CHOICE
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
The Holy See and Cairo
The 1994 International Conference on Population
family," John Paul said. It is the "snare of the devil,"
and Development gave rise to unprecedented
promulgates a "culture of death," and represents a
attention by the Vatican to a United Nations
"serious setback for humanity." On one visit to a
meeting. "No issue has affected John Paul II in a
neighborhood church in Rome, the pope told
more profound way throughout his fifteen-year
parishioners, "I am going back to the Vatican to
papacy than the Cairo conference," observed
combat a project prepared by the United Nations,
Raymond Flynn, then US ambassador to the
which want to destroy the family. I say simply no,
Vatican. Five months before the ICPD convened,
no. Think again. Convert your hearts. If you are
Reuters reported that the pope had "pulled out all
the United Nations, you must not destroy."
the stops in an attempt to influence the conference."
Other senior church officials joined in.
Throughout the year leading up to the
Cardinal Alfonso Lopez Trujillo, president of the
conference, Pope John Paul II and other top Roman
Pontifical Council for the Family, said the ICPD
Catholic church officials campaigned with a
could cause "the most disastrous massacre in
vengeance against the consensus taking shape
history." Trujillo accused the United States and
around the UN conference. John Paul met in March
other Western countries of "biological colonialism"
1994 with Nafis Sadik, executive director of the
for advocating family planning methods the Vatican
United Nations Population fund and secretary
opposes- that is, any methods other than those
general of the ICPD. Face to face, he upbraided
relying on periodic abstinence, or "natural family
Sadik and criticized the draft Programme of Action
planning."
as formulating "population issues in terms of
individual and 'sexual and reproductive rights,' or
A gathering of 114 of the church's 139
even in terms of 'women's rights'."
cardinals in June endorsed the Vatican's fight with a
statement charging that the Cairo document would
Then came his letter to every head of state,
legitimize "abortion on demand, sexual promiscuity
claiming that the document promotes a "lifestyle"
and distorted notions of the family."
that is "totally individualistic, to such an extent that
marriage now appears as something outmoded."
At the final preparatory meeting in April in
This lifestyle, the pope wrote, is "typical of certain
New York, Holy See Delegate Diarmuid Martin
fringes within developed societies, societies which
infuriated participants when he accused conference
are materially rich and secularized."
leaders of flouting the "cultural, ethical, spiritual, and
religious values" of people in developing nations and
In late March, John Paul summoned all
of indulging in "reticence towards a coherent moral
ambassadors assigned to the Vatican for a papal
vision." NGO representatives jeered his remarks,
lesson on population. A month later, he spoke by
and in a curt response, the chairman of the session,
telephone and in person with President Clinton on
Fred Sai of Ghana, turned the charge of ethical
the matter.
shortcomings back against the Holy See.
Through the spring and summer, the pope took
Unbowed, the Vatican attempted to secure
every opportunity in general audiences and other
allies for its crusade, but months of diplomatic
public appearances to attack the conference with
efforts netted few recruits. After one staunch
fiery rhetoric. The conference aims to "destroy the
soldier, President Carlos Menem of Argentina, failed
CATHOLICS FOR A FREE CHOICE
2
to rally Latin American heads of state to adopt a
Indeed, the Vatican's vision of civilization did
joint "right to life" platform for the Cairo
seem to be at stake. The conference became a
conference, it seemed that the pope began turning
debate "between modernity and tradition, between
over stones to find comrades. In August the Vatican
dogma and reason," the Italian daily La Repubblica
reached out to Islamic fundamentalists, paying calls
observed. What the Vatican decried, others
on repressive regimes such as Libya. A Libyan news
acclaimed. The overwhelming majority of world
agency reported that, in return for Libya's support in
governments, religious leaders, and a broad array of
condemning the Cairo conference, Vatican
public interest organizations with historically diverse
diplomats were supporting Libyan efforts to resolve
views on population issues had come to a consensus
differences with Western governments around the
on humane population policies and sustainable
1988 bombing of a Pan Am jet over Lockerbie,
development; the Vatican dug in its heels, crying that
Scotland
the new views of sexuality, reproduction, and
families meant the end of civilization.
During their campaign against the conference,
Roman Catholic church leaders were especially
With the preponderance of governments in
critical of the US government and its positions on
strong support of the plan- a sign that it was no
issues related to the Cairo conference. The US
manifesto of radical liberalism- the Vatican made
bishops issued a statement calling on the US
efforts to cloak its disapproval in acceptable terms.
government to "reverse its efforts" on the
But, crowded with straw men, Vatican criticisms
conference.
often had a ring of absurdity: "The conference's
themes," Navarro-Valls asserted in his op-ed,
Higher up the hierarchy, the US cardinals wrote
"include coerced family planning, abortion,
a letter to President Clinton that distorted the
homosexuality and versions of women's rights that
emerging Programme of Action in order to attack it.
are harmful to women." Readers would have to do
They claimed, for example, that the document
their own research to learn that the document clearly
advocated increased use of sterilization, even though
and repeatedly condemned coercive measures, did
neither the draft document nor its final articulation
not mention homosexuality, and enjoyed the support
promoted particular methods of regulating fertility
of women's advocates the world over.
and never used the words "sterilization," "ligation,"
"vasectomy," or "surgical contraception."
When the conference began on September 5,
Vatican diplomats were undeterred by their lack of
Meanwhile, the US administration, in the
success to date. As soon as delegates set to work on
person of Vice President Al Gore, made
the document, of which 10 percent had been marked
extraordinary efforts not to offend the Vatican while
for continued debate at Cairo, the Holy See seized
defending the conference agenda. For Gore's
upon the paragraph on abortion and, for five days,
trouble, a top Vatican official, papal spokesman
would not let go. To some extent, the Holy See held
Joaquin Navarro-Valls, publicly insulted him by
the conference hostage to the high value the UN
name, suggesting that the Vice President was lying
placed on achieving consensus. The Vatican also
about US intentions.
took advantage of its own vestigial aura of authority
in international circles; with as little support as the
The Vatican also courted US opinion with an
Vatican had mustered, few countries would have
op-ed article written by Navarro-Valls and published
been able to win such a long hearing for their
by the Wall Street Journal a few days before the ICPD
particular agendas.
opened. The conference, Navarro-Valls wrote,
would be "a crucial challenge to Christianity's most
Even after delegates had reworded sections to
fundamental doctrine on the sanctity of life as it has
appease the Holy See, the pope's envoys forced
to come to be and exist in the family. The Holy
delay. So exasperated were delegates that at one
Father is not merely defending a sort of odd
session they booed a Holy See representative.
Catholic view about life and family. He is in fact
pointing to the key issue on which future humanity
"Does the Vatican rule the world?" asked
must make a choice. This issue of human life and
Egyptian population minister Maher Mahran. "If
population undergirds all others. A false step here
they are not going to negotiate, why did they come?"
leads to a general disorder of civilization itself."
CATHOLICS FOR A FREE CHOICE
3
Delegates and NGO representatives grumbled
Cairo. But in reality, Cairo's statements about
about the Holy See's obstructionist behavior, and at
abortion account for only a tiny portion of its
least two petitions circulated calling for a change in
remarkable 20-year plan for the world's future. To
the Vatican's status at the United Nations. While the
be sure, Cairo explicitly addressed the public health
movement to repeal the Holy See's status was
problem of unsafe abortion for the first time in a
limited, frustration with the delegation ran deep. It
UN document. But the document also says "in no
was exacerbated by the widespread understanding
case should abortion be promoted as a method of
that the Pope's positions on reproductive matters do
family planning."
not reflect the attitudes and practices of Catholics
around the world. "The bottom line is the credibility
As evidenced by the Vatican's statements
of the papacy," one government delegate told
decrying the broad themes of the conference, the
Reuters. "If no one follows him, for whom does he
Holy See's conflicts centered not only on abortion,
speak?"
but on the notion that couples and individuals
should have access to a range of contraception,
The Holy See had refused to endorse the two
including but not limited to natural family planning,
previous UN population conference documents, in
on the prominence of women's rights and women's
1974 and 1984, and no one expected anything
equality, and on the recognition of the centrality of
different in Cairo. But in the end, the Holy See
reproductive and sexual health in ethical population
surprised most observers by joining the consensus
policies. The Vatican's differences with the world
on about half the Programme of Action.
consensus on these issues has not changed, and can
be expected to arise again during the five-year review
From news reports of the ICPD, many might
of the implementation of the ICPD.
have been led to believe that the single issue of
abortion accounted for the conflict between the
Holy See and the majority of the delegations in
CATHOLICS FOR A FREE CHOICE
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
The Church at the United Nations
Through an entity called the Holy See, the Roman
the adherents as well- "it exists and operates within
Catholic church enjoys unique governmental status
the international community as the juridical
at the United Nations, where the Holy See is a Non-
personification of the Church."⁴
Member State Permanent Observer. While there are
numerous UN observers (intergovernmental
Legally, the Holy See and Vatican City are
organizations, liberation movements, and specialized
distinct entities with a relationship unique in
agencies of the UN system), the Holy See and
international law. The Vatican city-state exists to
Switzerland are the only two currently holding that
administer the properties belonging to the Holy See
status as "states."
and to insure the ecclesial independence of the Holy
See. The Holy See holds sovereign authority over
THE HOLY SEE, VATICAN CITY, THE
Vatican City and carries out international relations
ROMAN CATHOLIC CHURCH-ARE
on the city-state's behalf as well as on behalf of the
THERE DIFFERENCES AMONG THEM?
Roman Catholic church.⁵ While Vatican City does
not enter into diplomatic relations, the Holy See is
The Roman Catholic church is a religious society
active in the United Nations and maintains full
without a political identity under the law. Vatican
diplomatic relations with 157 countries.⁶
City is an independent city-state within Rome that
serves as the site of the church's government and is
IS THE HOLY SEE CONSIDERED A
itself governed by the head of the church, the pope.
STATE?
The Holy See is "the supreme organ [of
government] of both the Catholic church and the
No, despite its designation as a non-member "state"
Vatican City State," according to the authoritative
permanent observer, "the Holy See is not a state,"
work on the Holy See's international relations,
according to Cardinale.⁷ It is a religious entity
written by Archbishop Hyginus Eugene Cardinale,
without defined temporal territory.⁸ Diplomatically,
who was a Vatican diplomat.¹ Vatican City is
however, many countries treat the Holy See "as
temporal and territorial; the Holy See, a more
being on the same footing as a state" because of the
nebulous construct, is religious.
influence of the pope, as leader of Catholics
worldwide.⁹ According to its Permanent Observer
The term Holy See has multiple meanings. In
Mission, the Holy See can enter into treaties as the
one sense it is simply the pope's "see," or diocese
"juridical equal of a state."¹⁰
(the authority and jurisdiction of a bishop), including
not just Vatican City but also Rome. In another
In international law, statehood traditionally
sense, as the "central government" of the church, it
rests on four criteria: a permanent population; a
refers to the pope, the Roman Curia, and the College
defined territory; a government; and the capacity to
of Cardinals together.² Also called the Apostolic See,
enter into relations with other states. 11 The United
the Holy See refers to the pope's "authority,
Nations Charter, while requiring statehood for
jurisdiction, and sovereignty" in both the "spiritual
membership, does not define a "state."
and temporal governance and guidance" of the
church, including Vatican City.3
Unlike the Holy See, Vatican City is considered
a state. At less than half a square kilometer and with
Although the Holy See is not the same thing as
fewer than 1000 residents- only about half of those
the Roman Catholic church- which encompasses
being citizens- it is the smallest entity in the world
CATHOLICS FOR A FREE CHOICE
2
claiming statehood.¹² In order to administer and
must apply to the UN secretary general for the
safeguard the property of the Holy See, the State of
status.¹⁷
Vatican City was established by the 1929 Lateran
Treaty, between the papacy and Italy, which had
Permanent Observers cannot vote in the
seized the Papal States during the Italian unification.
General Assembly, but as a matter of custom they
have full access to meetings and documents.
WHY IS THE HOLY SEE, A RELIGIOUS
Permanent Observers may address the General
NON-STATE-AND NOT VATICAN CITY-
Assembly and participate in its debates. 18 (The
ACTIVE IN THE UNITED NATIONS?
Vatican's observer status in the World Health
Organization is similar- a voice but no vote.)
There was confusion over Vatican/Holy See
terminology at the United Nations during the 1950s.
Observers can take part in UN conferences,
Official UN documents referred to UN relations
such as the Fourth World Conference on Women.
with the "State of the Vatican City," but in an
The UN agency organizing each meeting decides
exchange of letters with the UN secretary-general in
what level of participation to allow observers, and
1957, the church sought and secured the agreement
non-member states typically are granted the full
that it was the Holy See that maintained relations
status enjoyed by UN member states, including a
with the United Nations."13
vote on any question that is put to a vote. The
United Nations works hard, especially in
The decision, according to Cardinale, was
conferences, to avoid relying upon votes, preferring
based on the church's desire to stress the pope's
to operate by consensus in adopting documents such
spiritual leadership rather than his temporal
as the programs of action by which UN conferences
sovereignty.¹⁴ "This opportune classification
address global issues. The practice of operating by
immensely broadened the perimeter of the papacy's
consensus gives states with minority views- even
interest" in the United Nations' many activities.
lone dissenters- a stronger voice in proceedings
than they would have otherwise.
At the same time, the Permanent Observer
Mission sees to the interests of Vatican City as well
Additionally, recent General Assembly
as those of the Holy See. "It is up to the Holy See to
resolutions have called for all "states" participating
decide whether, in actual fact, the representatives
in conferences to be accorded "full voting rights."19
it sends to international Organisations and meetings
are to act in its own name, or in that of the State of
Taken together, these factors have enabled the
the Vatican City, or even in both at once, according
Holy See to exercise a presence equal to that of any
to the subject matter. In any event the sending
UN member state- including some power to block
authority is the Holy See and not the Vatican City
consensus- at recent conferences such as the 1992
State."15
Conference on the Environment and Development,
in Rio de Janeiro; the 1994 International Conference
WHAT DOES PERMANENT OBSERVER
on Population and Development, in Cairo; and the
STATUS MEAN?
1995 World Summit for Social Development, in
Copenhagen. The same will be the case at the 1995
Permanent Observer status is a matter of custom;
Fourth World Conference on Women, in Beijing.
there is no provision for it in the United Nations
Charter. The custom originated in 1946, when
HOW DID THE VATICAN GET INVOLVED
Switzerland named a "permanent observer" to the
IN THE UNITED NATIONS?
United Nations and the UN secretary-general
accepted the designation. 16 To become a Permanent
The Holy See owes its participation in the United
Observer, a state must be a member of at least one
Nations to the membership of Vatican City in the
specialized agency of the UN system (such as the
Universal Postal Union (UPU) and the International
International Atomic Energy Agency), must be
Telecommunication Union (ITU), which the city-
"generally recognized" by UN member states, and
state joined because of its operation of postal and
radio services. The United Nations, soon after its
CATHOLICS FOR A FREE CHOICE
3
formation, invited these organizations and their
extends over one billion persons scattered throughout
members to attend UN sessions on an ad hoc
the world and belonging to the most diverse ethnic
basis.² 20 The Holy See began attending the General
groups and geographic regions. Its strength
Assembly, the World Health Organization, and the
consists in the respect that its words, its teaching,
UN Educational, Scientific, and Cultural
and its policies enjoy in the conscience of the
Organization in 1951 as an ad hoc observer.²¹ In
Catholic world- a respect that is widely shared by
1956, the Holy See was elected a member of the UN
many people who do not belong to the Church. The
Economic and Social Council and also became a full
real and only realm of the Holy See is the realm of
member of the International Atomic Energy
conscience.²⁷
Agency.22
When Pope Paul VI arrived in New York in
HOW DID THE VATICAN BECOME A
1965 to address the United Nations, he told the
NON-MEMBER STATE PERMANENT
crowd at Kennedy Airport that he offered "to your
OBSERVER?
terrestrial city of peace the greetings and good
wishes of our spiritual city of peace." Addressing the
While the Holy See was an ad hoc observer, the
General Assembly, he presented the church as an
pope's representative at UN meetings was an
"expert in humanity," and in asking nations to work
auxiliary bishop of New York, who also carried out
together as equals, he referred to himself "as a
other duties in the archdiocese. The relationship
representative of a religion that believes salvation is
between the Vatican and the United Nations was
achieved through the humility of its divine
one of "mutual experimentation," a Catholic
Founder."28
periodical said at the time.23 Pope John XXIII
moved toward closer relations in 1963 when he
In a papal address to the General Assembly in
endorsed the United Nations in his encyclical Pacem
1979, John Paul II also claimed a special role. "The
in Terris (Peace on Earth) and, as he was dying, sent
nature and aims of the spiritual mission of the
Cardinal Leon-Joseph Suenens to summarize the
Apostolic See and the church make their
encyclical in an address to the General Assembly.
participation" in UN activities "very different from
that of the states, which are communities in the
In 1964, Pope Paul VI named a permanent
political and temporal sense," he said.29
observer, following Switzerland's precedent. UN
Secretary-General U Thant accepted the designation
Monsignor Diarmuid Martin, a leader of the
and announced it within three weeks.²⁴
Vatican delegations to Cairo and Copenhagen,
referred to "the social teaching of the church" as
Paul VI did not pursue full membership. Under
"the principal inspiration of the positions taken by
the UN Charter, membership entails a state's
the Holy See at the conferences."³⁰
acceptance that it may be required to commit
military power in collective measures to suppress
Archbishop Renato R. Martino, the Vatican's
acts of aggression "or other breaches of the
"Permanent Observer" to the United Nations- as
peace."25 By Lateran Treaty and by choice, the Holy
the ambassador for a Permanent Observer state is
See and Vatican City are committed to neutrality.26
called- also speaks of a religious mission. Asked
about the Vatican role in the United Nations, when
FOR WHOM DOES THE VATICAN SPEAK
there is no "voice" for Protestant religion, Islam, or
AT THE UNITED NATIONS?
Judaism, Martino quoted a Moslem supporter: "The
Vatican has a right to be present" partly because, 'if
Church officials describe their role in the United
you would ask the Moslem to come forward and
Nations as being unique:
speak, we would not know who would be the one to
speak," whereas there is "one voice" for the
As a full member of the international community,
Catholic church. Martino added that the Catholic
the Holy See finds itself in a very particular
church's "one voice is a message of salvation, found
situation, because it is spiritual in nature Its
in the Scriptures and lived in the tradition of the
authority-which is religious and not political-
Church over the centuries. It is an objective truth
CATHOLICS FOR A FREE CHOICE
4
that remains changeless. During the month
11. Cardinale, P. 81; CRLP, citing Restatement (Third) of the
preceding the Cairo Conference, Pope John Paul II
Foreign Relations Lawof the United States, §201 (1986).
and the world episcopate have applied these eternal
12. Schabas; Cardinale, p. 104.
13. Cardinale, PP. 256-57.
truths to the topics addressed by the conference."31
14. Cardinale, p. 256.
15. Cardinale, P. 257.
What place does a religious body- claiming to
16. UN Public Inquiries Unit, "Information on the Status of
Permanent Observer Missions to the United
possess the universal "objective truth" and to speak
Nations, "Oct. 1994.
infallibly on moral matters- have in an
17.
"Legal Opinions of the Secretariat of the United Nations,"
intergovernmental institution like the United
United Nations Juridical Yearbook, 1962, pp. 236-37; United
Nations?
Nations Public Inquiries Unit "Image and Reality," April
1993.
18. United Nations Public Inquiries Unit, Image & Reality:
NOTES
Questions and Answers about the United Nations, How It Works,
1.
Hyginus Eugene Cardinale, The Holy See and the International
and Who Pays for It, Apr. 30, 1993.
Order (Gerrards Cross, England: Colin Smythe, 1976),
19. CRLP (above, note 8).
PP- 257-59.
20. Cardinale, P. 256.
2.
The Official Catholic Directory, 1995 (New Providence, NJ:
21. Schabas.
P.J. Kenedy & Sons with R.R. Bowker, 1995), p.xix.
22. Cardinale, P. 233.
3.
The Catholic Encydopedia, (New York: Thomas Nelson
23. "Vatican UN Observer," America, Apr. 25, 1964, PP.
Publishers, 1987), P. 268; Cardinale.
560-61.
4.
Cardinale, PP 81-83.
24. Tablet (London), Apr, 18, 1964, p. 447; New York Times,
5.
Cardinale, PP. 82-85; Tryanjana Maluwa, "The Holy See
Apr. 7, 1964; Cardinale, p.232.
and the concept of international legal personality: some
25.
United Nations Charter, Articles 1, 4, 43, 45 & 49.
reflections," Comparative and International Law Journal of
26. Schabas; Cardinale, PP. 259-60; Permanent Observer
Southern Africa, Mar. 1986, pp.24-25.
Mission of the Holy See (above, note 6).
6.
Permanent Observer Mission of the Holy See, "The Holy
27. Permanent Observer Mission of the Holy See
See and the United Nations," undated article, in
(above, note 6).
distribution, June 1995.
28. Peter Hebblethwaite, Paul VI: The First Modern Pope (New
7.
Cardinale, P. 259.
York: Paulist Press, 1993), p. 437-39.
8.
Cardinale, pp. 256-59, William Schabas, "Notes on the
29. Origins, vol. 9 (1979-80), PP. 257-259.
Legal Status of the Vatican City and the Holy See," 1994;
30. Msgr. Diarmuid Martin, "What the Church Tries to Do at
diplomatic sources; Center for Reproductive Law and
International Conferences," Origins, vol. 25, no 6 (June 22,
Policy (CRLP) (New York), "Church or State? The Holy
1995), PP. 94-98.
See at the United Nations," July 3, 1994.
31. Dialogue, National Catholic Register, Feb. 5, 1995.
9.
Cardinale, P. 259.
10. Permanent Observer Mission of the Holy See
(above, note 6).
CATHOLICS FOR A FREE CHOICE
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
Catholics and Contraception: A Struggle for Control
"If anyone says that it is not better and more godly to live in virginity or in the unmarried state than to marry, let him be
anathema. (From a declaration of the drunch, Council of Trent, 1545-1563)
Sincere people worldwide are baffled by the Roman
procreation; contraception was implicitly evil.
Catholic prohibition of all contraceptives from
Augustine strongly opposed periodic abstinence, the
condoms to pills. The hierarchy's vehement and
method today's Vatican extols.
absolute opposition to abortion would seemingly
lead it to champion contraception to reduce the need
Medieval Years: Monks Put
for abortion. The church also accepts that
Their Stamp On Sexuality
population pressures exacerbate poverty and
From Augustine's death to the twelfth century,
contribute to human suffering; contraceptives could
writings on sexuality were codified by monks and
help alleviate those pressures as well. Instead, some
monk-bishops. They gave the prohibition of
church leaders, especially Pope John Paul II, have
contraception more of a "corporate stamp.
"1
intensified the opposition to contraception.
Popes and bishops, in turn, promoted monasticism
and clerical celibacy to prevent the clergy from
The above quote exalting chastity points to the
having heirs with claims to church property.
reason: in a church in which all officials are male and
celibate, power and control is maintained when the
1140: First Code Says Contraception a Sin
sexual and reproductive functions are resisted.
Gratian, a monk, compiled the first collection of
Throughout church history, fear of women and
canon law that was accepted as authoritative within
sexuality runs deep. Sexual intercourse, Catholics are
the church. It declared contraception a sin, but not a
told, is not a good if engaged in for pleasure or love
grave one.
alone- it must carry an openness to pregnancy and
childbearing. These "goals" redeem sexuality from
1230-34: A Pope Calls Contraception Murder
time honored notions of evil. More importantly,
The first papal injunction against birth control came
these limits serve to keep distance between the
when Pope Gregory IX, the creator of the
priestly elite and the ordinary Catholic. They serve as
Inquisition, compiled existing authoritative decrees
a form of control over the lives of all, but most
into the universally binding Decretals. The Decretals
tragically of women, who bear the brunt of avoidable
condemned contraception as murder.
mortality and morbidity.
1588: Pope Sixtus V Adopts a Population Policy
St. Augustine (354-430): Sexual Pleasure = Sin
Pope Sixtus V issued the bull Effraenatam (Without
A zealous convert after a lustful youth, Augustine
Restraint), which used the rhetoric of birth control
dominated moral theology for more than a
as murder; the bull applied to contraception the
millennium and has recently re-emerged as a
penalties designated for homicide. The bull was
principal influence on ultraconservative theology.
directed partly against the sexual activity of the
Augustine linked original sin, lust, and sex: he
clergy and served Sixtus's crusade to eradicate
asserted that sexual pleasure was the path by which
adultery and prostitution in Rome. Rome had also
original sin was transmitted from generation to
endured the plague in 1581 and famine in 1578 and
generation. Sexual intercourse, inherently tainted,
1583, providing additional reason for Sixtus's
needed always to be salvaged by the pure motive of
CATHOLICS FOR A FREE CHOICE
2
condemnation of behavior that would restrain
Nineteenth Century:
population growth.
The Birth Control Movement
1853: The human ovum had been discovered, and
Renaissance and the Counter-Reformation:
with it, scientific support of the belief that women
Fresh Thinking
must be infertile on some days during their
The Renaissance and Counter-Reformation brought
menstrual cycles. In this year, the Roman
fresh thinking and new influences to bear on
Penitentiary said couples who had sex only on days
Catholic ideas about marriage and sexuality. The
they believed the wife was infertile did not need to
theology of Thomas Aquinas was dominant. He had
be disturbed by confessors, if the couple had sound
asserted that contraception violates nature's order
reasons for abstaining from sex.
because sex is clearly nature's way of propagating
species. But he set the stage for moderate reform by
The birth control movement grew through the
saying that marital intercourse is good and therefore
early twentieth century. The idea that overpopulation
so is the pleasure in it. Theologians defended sex as
causes famine and war gained currency. But
legitimate when one used sex to pay the "marriage
declining birthrates threatened to weaken the church,
debt"- that is, to meet the sexual demands of one's
as well as individual nations, and nationalism became
partner.
an instrument of propaganda in the churches fight
against the birth control movement.
Council of Trent (1545-1563):
Religious Rivalry Rules the Day
Bastille Day, 1872: Contraception and War
Catholic-Protestant rivalry fueled competition for
Catholic moralists blamed France's military defeat by
strength in numbers and, therefore, support for the
Prussia on waning fertility and predicted the decline
prohibition of contraception. Similarly, in reaction
and fall of an underpopulated France. In a Bastille
against the Protestant rejection of clerical celibacy,
Day speech in 1872, a Swiss cardinal told a French
Catholicism insisted that celibacy is better than
audience. "You have rejected God, and God has
sexual marriage. The bishops declared at the Council
struck you. You have, by hideous calculation, made
of Trent: "If anyone says that it is not better and
tombs instead of filling cradles with children;
more godly to live in virginity or in the unmarried
therefore you have wanted for soldiers."³ World War
state than to marry, let him be anathema."
I aggravated population related fears, and an alliance
of churchmen and politicians enacted laws against
Yet the church's posture toward contraception
contraception in many countries.
eased in two ways during the Counter-Reformation.
Confessors were told to respect penitents' good faith
Late 1800s through 1940s:
and not interrogate them so vigorously as to
Feminism First Seen as a Threat
"disturb" those who were ignorant of the "natural
The birth control movement was seen as part of a
law" and unlikely to mend their ways. Also, it was
broader threat to the church: feminism. Many
deemed lawful for a wife to go along with a husband
Catholic bishops and priests tried to exert influence
who practiced coitus interruptus.
against women's suffrage. In 1944, the chairman of
the US bishops' conference lamented "a new wave
Seventeenth Century:
of perverted feminism that is obviously bent on
Reasons to Limit Births
turning women still more away from the home and
In 1679, Innocent XI renewed the condemnation of
towards extradomestic occupation." Contraception
sex for pleasure, but the condemnation was not
was integral to the problem; the conference
severe. Restricting intercourse to avoid having too
considered planned parenthood a threat to the
many children won theological approval. Poverty
"integrity" of the home.4
and the need to provide for the education of existing
children were accepted as grounds to limit sexual
1930: Pope Attacks "Wicked Childless Parents"
activity, marking new approval for the idea that
Pope Pius XI's 1930 encyclical Casti Connubii
"economic and educational reasons were valid moral
denounced "those wicked parents, who seek to
reasons for not wanting more children."²
remain childless"⁵ or who avoid childbearing "not
through virtuous continence.
but by frustrating
the marriage act."6 "Since.
the
conjugal
act
is
destined primarily by nature for the begetting of
children, those who in exercising it deliberately
CATHOLICS FOR A FREE CHOICE
3
frustrate its natural power and purpose sin against
Human Life), while glorifying the exception made
nature and commit a deed which is shameful and
for rhythm (or periodic abstinence).
intrinsically vicious," the document said.⁷
Dissent loudly greeted the encyclical and
1951: The Church Gets Rhythm
continues more quietly to this day. Theologians note
In 1951, Pope Pius XII declared the rhythm method
that the principle of probabilism gives Catholics the
was available to all couples who for serious motives
right to dissent from doctrine on a moral matter if
- including economic and social ones-wish to
there is a "solid probability" in favor of the
avoid procreation "for a long time, perhaps even for
dissenting opinion. "If after appropriate study,
the duration of the marriage." The overriding
reflection, and prayer, a person is convinced that his
restriction on which Pius insisted (as does John Paul
or her conscience is correct, in spite of a conflict
II) was that rhythm not be used "habitually" for less
with the moral teachings of the Church, the person
than "grave" reasons; in fact, if a woman's health
not only may but must follow the dictates of
demands that she not become pregnant, she must
conscience rather than the teachings of the Church,"
abstain, not simply use rhythm. Abstinence is
theologian Richard McBrien explains.⁸
possible, Pius XII said; otherwise God would not
require it.
1970s: Elements of Dissent
Scholars criticize Humanae Vitae because it reduces
Earlier fears of inadequate population had been
sexuality to biological or physical facts. Theologians
translated into directives against contraception; now
point out that Humanae Vitae fails to see individual
population pressure seems to have contributed to a
sexual acts in the context of the marriage as a whole
reserved acceptance of a contraceptive practice that
and assesses marriage "exclusively in physical
St. Augustine had damned.
terms"- the production of children- without regard
to its other results or products.⁹ Theologians criticize
1953: The Appearance of the Pill
as hypocritical the assertion that one can enjoy sex
It fell to Pius XII to respond to "the pill," which
during the infertile period, while fully intending to
emerged in 1953. In 1958, he forbade the use of the
avoid conception by remaining abstinent on fertile
pill if the aim is contraception. But he confirmed
days.
that the pill can be used for therapeutic,
noncontraceptive
purposes-despite
its
1980s: Eruptions and Reaffirmations
contraceptive side-effect- under the principle of
In large part, Catholics in the pews went their own
double effect. The pill was licit to clear up menstrual
way while priests looked the other way. In 1980, a
pain, but not prevent a pregnancy expected to kill
synod of bishops spoke urgently of the prohibition's
the mother: to cure illness, but not to save lives.
non-reception among the laity and called for new
exploration of the issue. Bishop Patrick Iteka of
1963-1966: The Papal Birth Control Commission
Mahenge, Tanzania, said that for socioeconomic
In 1963, Pope John XXIII convened a commission
reasons, African families had to be planned.
on population and birth control, handing the
Indonesian bishop Sudartanto Hadisumatra said the
question to a panel that ultimately included bishops,
church should help couples reduce the number of
theologians, physicians, demographers, and married
children they bore. Archbishop Angelo Fernandes of
couples.
New Delhi asked for a pastoral statement on
contraception that would respond to his people's
July 29, 1968: Pope Paul VI
situation.¹⁰
Reaffirms Prohibition, Inspires Dissent
In 1966, the birth control commission created by
But the synod's closing statement reaffirmed
John XXIII and continued by his successor, Paul VI,
Humanae Vitae, saying that "the transmission of life
issued a majority report in favor of permitting the
is inseparable from the conjugal union."¹¹ John
use of contraception. A minority dissented, arguing
Paul's closing sermon was even more severe. He said
that to change the teaching- admitting error-
immediate compliance is expected.¹²
would undermine the authority and credibility of the
Vatican. After two years of pondering, Paul
Ever since the 1960s:
categorically reaffirmed the prohibition of
The Challenge of Modern Feminism
contraception in his encyclical Humanae Vitae (Of
Feminism has presented an enormous challenge for
the church in the areas of sexual and marital ethics
CATHOLICS FOR A FREE CHOICE
4
and the exclusively male priesthood. Throughout
supreme interpreter of natural law, his fiat is final in
this century, the church has linked contraception and
expressing the Church's moral viewpoint.¹⁴
feminism as intertwined evils. Members of the
hierarchy continue to make statements that indicate
Journalist Robert Kaiser, who wrote the
that one root of the contraception prohibition is a
authoritative chronicle of the birth control
restrictive view of women.
commission and the aftermath of Humanae Vitae,
makes the point compellingly that the issue is power.
"I want to remind young women that
Referring to Jesuit John Ford, one of the four
motherhood is the vocation of women.
It
is
theologians behind the minority report of the birth
women's eternal vocation," Pope John Paul II said in
control commission, Kaiser wrote this:
his weekly general audience in January 1979.
Unwittingly, Father Ford gave the
"However, a radical feminism which seeks the
game away when he said the
rights of women by attacking and denying
encyclical reaffirmed "the power of
fundamental, clear and constant moral teaching does
the magisterium to bind
not reflect or promote the full reality and true dignity
consciences." For Ford, the point
of women," the pope explained in a 1989 letter to
was not truth. It was power. The
US bishops.
point was not to teach, but to
rule.¹⁵
1988: Motherhood First and Foremost
In his apostolic letter Mulieris Dignitatem (On the
NOTES
Dignity and Vocation of Women), John Paul again
focused on maternity and virginity. Because men
1.
John T. Noonan, Jr., Contraception: A History of Its Treatment
neither bear nor nurse children, "parenthood
is
by the Catholic Theologians and Canonists, enlarged edition
(Cambridge, MA: Belknap Press/Harvard University
realized much more fully in the woman," the pope
Press, 1986; original edition, 1965), PP. 145 and 143.
wrote. "In many ways [a man] has to learn his own
2.
Noonan, p. 336.
'fatherhood' from the mother."
3.
Noonan, P. 414, quoting Cardinal Gaspar Mermillod, via
B. Deppe, "Théologie pastorale," Nouvelle reven théologique
The 1990s: Recent Dissent
31 (1899), 455- 456.
4.
Quoted in Earl Boyea, The National Catholic Welfare
A few brave souls continue to question and even
Conference: An Experience in Episcopal Leadership, 1935-1945,
disagree with Humanae Vitae. At a meeting of the US
doctoral dissertation, Catholic University of America, 1987
National Conference of Catholic Bishops, Bishop
PP. 359-65.
5.
Casti Connubii, 65.
Kenneth Untener of Saginaw, Michigan, told the
6.
Casti Connubii, 53.
assembly that the logic of the birth control position
7. Casti Connubii, 54.
is "not compelling" to Catholics, even priests and
8.
Richard P. McBrien, Catholicism, Study Edition
some bishops. If the church's positions were put to a
(Minneapolis, MN: Winston Press, 1981), P. 1004.
9.
blind vote, he speculated in a 1991 interview, most
Thomas Shannon, 'Ethical Dilemmas in Population
Policy," Conscience, vol. VII, no. 2 (March/April 1986): 1-6,
US bishops would opt to change it.
p.4.
10.
Francis X. Murphy, "Of Sex and the Catholic Church,"
A statement on AIDS by France's bishops in
tlantic Monthly, Feb. 1981, P. 44 ff.
1989 suggested that using a condom may be better
11. Origins 10:323.
12. Francis X. Murphy, "Catholic Perspectives on Population
than death. "The whole population and especially
Issues II," Population Bulletin, Population Reference Bureau,
the young should be informed of the risks," they
Vol. 35, No. 6 (Feb. 1981).
said. "Prophylactic measures exist." And Cardinal
13. Peter Hebblethwaite, "What the French are not saying
Jean-Marie Lustiger, Archbishop of Paris, told a
about condoms," National Catholic Reporter, Feb. 3, 1989,
television audience, "Chastity is possible," but if
and Origins 18:446.
14. Murphy, Population Bulletin, P. 25.
AIDS-virus carriers fail to abstain from sex, they
15. Robert Blair Kaiser, The Politics of Sex and Religion (Kansas
"should use all known means" to protect others
City, MO: Leaven Press, 1985), p. 219.
from the disease.¹ 13
That contraception is an issue of power can be
seen in Humanae Vitae. Historian Francis X. Murphy,
C.SS.R., writes, "Actually, what the document
amounts to is an assertion by the Pope that, as the
CATHOLICS FOR A FREE CHOICE
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
Abortion and Catholic Thought Through History
Most people believe that the Catholic church's
on abortion within the Catholic church in a historical
position on abortion has remained unchanged for
perspective and show the importance of continued
2000 years. Not true. Church teaching on abortion
debate and open hearts and minds.
has varied continually over the course of its history.
There has been no unanimous opinion on abortion at
THE FIRST SIX CHRISTIAN CENTURIES:
any one time. While there has been constant and
BEFORE 600 AD
general agreement that abortion is almost always evil
and sinful, the church has had difficulty in defining
Early Christianity:
the nature of that evil. Church hierarchy has
Moving Away from Paganism
consistently opposed abortion as evidence of sexual
Pagan religions had a calm acceptance of
sin, but they have not always seen early abortion as
contraception and abortion, including the use of
an act of homicide. Though not commonly known,
barrier methods, coitus interruptus, and various
the "right to life" argument is a relatively recent
medicines that prevented conception or caused
development in church teachings. The debate
abortion.
continues today.
Early Christian leaders, to distinguish
Also contrary to popular belief, the prohibition
Christianity from Pagan beliefs, developed ideas
of abortion is not governed by claims of papal
about contraception and abortion, marriage for
infallibility. This fact leaves much more room for
procreation and the unity of body and soul. They
discussion on abortion than is usually thought, with
taught that even sex for reproduction was bad and
opinion among theologians and the laity differing
sex for pleasure was heinous. Chastity became a
widely. In any case, Catholics may follow their own
virtue in its own right.
conscience on moral matters even when it is in
conflict with hierarchical views. The current pope's
100 AD: The Debate Begins
attempt to make his position on abortion the
One of the earliest church documents, the Didache,
defining one at the ICPD in Cairo is only one stop
condemns abortion, but asks two key questions: 1) Is
on a long journey of shifting majority and minority
abortion being used to conceal the sins of
views within the Catholic church.
fornication and adultery? and 2) Does the fetus have
a rational soul from the moment of conception or
In 400 AD, St. Augustine expressed the
does it become an "ensouled human" at a later
mainstream view that early abortion required
point? This idea of "hominization"- the point at
penance only for the sexual aspect of the sin. Eight
which a developing embryo becomes a human being
hundred years later, St. Thomas Aquinas agreed,
- would become one of the cornerstones of the
saying abortion was not homicide unless the fetus
debate about abortion and remains unsolved even
was "ensouled," which he was sure took place well
today.
after conception. Church teaching that abortion is a
serious sin and grounds for excommunication only
Early 400s: St. Augustine
became established 150 years ago.
Says Abortion is Not Homicide
St. Augustine (354-430) condemns abortion because
The following brief chronology cannot do full
it breaks the connection between the conjugal act
justice to the twists and turns of theological thinking
and procreation. However, in the Enchmidion he says,
over the centuries. However, it can put the debate
"But who is not rather disposed to think that
CATHOLICS FOR A FREE CHOICE
2
unformed fetuses perish like seeds which have not
While St. Thomas Aquinas opposed abortion as
fructified," clearly seeing actual human life beginning
a form of contraception and a sin against marriage,
at some point after the fetus has begun to grow. He
he maintained that abortion was not a sin of
held that abortion was not an act of homicide. Most
homicide unless the fetus is ensouled, and thus, a
theologians of his era agreed with him.¹
human being.⁵
The general legislative agreement at this time
PRE-MODERN PERIOD: 1500-1750
said abortion was a sin requiring penance if it was
intended to conceal fornication and adultery.
1588: Making the Penalty for Abortion
Excommunication
THE MIDDLE PERIOD: 600-1500
Concerned about prostitution in Rome, Pope
Sixtus V issued the bull Effraenatum (Without
ca. 675: Illicit Intercourse is the Greater Sin
Restraint) and applied to contraception and abortion,
The Irish Canons place the penance for "destruction
at any stage of pregnancy, the penalties designated
of the embryo of a child in the mother's womb [at]
for a homicide. The prescribed penance was now
three and one half years" while the "penance of one
excommunication. There were no exceptions for
who has intercourse with a woman, seven years on
therapeutic abortion.⁶
bread and water."²
1591: Quickly Relaxing the Rules
ca. 8th Century: Recognizing
Only three years after Pope Sixtus V issued his
Women's Circumstances
Effraenatum, he died and Gregory XIV succeeded
In the Penitential Ascribed by Albers to Bede, the ideal of
him. Gregory felt Sixtus's stand was too harsh and in
delayed hominization is again supported, as well as
conflict with penitential practices and theological
acknowledgment of women's circumstances: "A
views on ensoulment. He issued Sedes apostolica
mother who kills her child before the fortieth day
recommending that, "where no homicide or no
shall do penance for one year. If it is after the child
animated fetus is involved, not to punish more
has become alive, [she shall do penance] as a
strictly than the sacred canons or civil legislation
murderess. But it makes a great difference whether a
does." This papal pronouncement lasted until 1869. 7
poor woman does it on account of the difficulty of
supporting [the child] or a harlot for the sake of
1679: Denying Abortion to Pregnant Girls
concealing her wickedness."3
Facing Murder by Their Families
Abortion had consistently been considered wrong if
1140: Gratian Code Holds Abortion Not
used to conceal sexual sins. Pope Innocent XI
Homicide when Fetus Unformed
attempted to define the "outer limits of permissible
In 1140, Gratian compiled the first collection of
teaching" when he rejected the idea that abortion is
canon law- the Gratian code- that was accepted as
permissible even in situations in which the parents of
authoritative within the church. In the canon
a girl would murder her for becoming pregnant. The
Aliquando, Gratian concluded that, "abortion was
church was still teaching delayed hominization, but
homicide only when the fetus was formed⁴ If the
said hominization occurred some time before the
fetus was not yet a formed human being, abortion
moment of birth.
was not homicide.
THE MODERN ERA: 1750-PRESENT
1312: Council of Vienne Confirms Aquinas On
"Delayed Hominization"
1869: Requiring Excommunication for
The position of this council, still very influential in
All Abortions
Catholic hierarchical teaching, confirmed the
Pope Pius IX's Apostolicae sedis completely ignores
conception of man put forth by St. Thomas
the question of hominization and requires
Aquinas. He said that the fetus is first endowed with
excommunication for abortion at any stage of
a vegetative soul, then an animal soul, and then
pregnancy.9 He said all abortion was homicide. His
when the body is developed, a rational soul. This
statement was the first implicit endorsement of
theory of "delayed hominization" is the most
immediate hominization by the church.
consistent thread throughout church history on
abortion.
CATHOLICS FOR A FREE CHOICE
3
1917: Excommunicating Doctors and Nurses
NOTES
Performing Abortions
1. St. Augustine, De ruptiis et concupiscentia, 15. 17.
In the Code of Canon Law, the first new edition of
(CSEL 42.229-230).
canon law since Gratian's in 1140, excommunication
2.
John T. McNeill and Helena M. Garner, Medieval
Handbooks of Penance (New York: Octagon books, 1974),
was required for both the woman and any others,
PP. 119-120.
such as doctors and nurses, who take part in an
3.
McNeil and Garner, Medieval Handbooks of Penance, p. 225.
abortion.¹⁰
4.
John Noonan, ed., The Morality of Abortion: Legal and
Historical Perspectives, (Cambridge, Mass.: Harvard
University Press, 1970), p. 20.
1930: Condemning
5.
Joseph F. Donceel, S.J. "Immediate Animation and
Therapeutic Abortions
Delayed Hominization," Theological Studies, Vols. 1 and 2,
Pope Pius XI issued the encyclical Casti Connubii (Of
(New York and London: Columbia University Press,
Chaste Spouses), condemning abortion in general,
1970), P. 86.
6.
and specifically in three instances: in the case of
Codicis iuris fontes, ed. P. Gasparri, vol. 1, (Rome, 1927),
p. 308.
therapeutic abortion, which it is killing an innocent;
7.
Codicis iuris fontes, ed. P. Gasparri, PP. 330-331.
in marriage to prevent offspring; and on social and
8.
Actae Sanctae Sedis, 5. 298.
eugenic grounds as practiced by some
9.
Codex iuris canonici, C. 2350.
10.
governments.¹¹ Pius's stance on abortion continues
(AAS 22.539-92).
as the hierarchical view. This document did not
purport to be infallible teaching, but as an address by
the pope to the bishops it carried great moral
authority.
1965: Protecting the Embryo
From the Moment of Conception
Vatican II, Gaudium et Spes, section 51 declared: "Life
must be protected with the utmost care from the
moment of conception; abortion and infanticide are
abominable crimes." Here, abortion is now
condemned on the basis of protecting life, not as a
concealment of sexual sin.
1974: Arguing for the "Right to Life"
The Sacred Congregation for the Doctrine of Faith
issued the "Declaration on Abortion," which argues
against abortion on the grounds that "one can never
claim freedom of opinion as a pretext for attacking
the rights of others, most especially the right to life."
The key to this position is that the fetus is human life
from the moment of conception, if not necessarily a
full human being. The church has now fully changed
the terms of argument.
Today: Abortion Ban is Absolute
The Catholic church hierarchy of today does not
permit abortion in any instance, not even in the case
of rape or to save the life of a pregnant woman.
CATHOLICS FOR A FREE CHOICE
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
Catholics For A Free Choice
An Organizational Summary
Catholics for a Free Choice is the voice of
International Conference on Population and
Catholics worldwide who hold progressive
Development. In partnership with the Park
views on women, reproduction and sexuality.
Ridge Center for Health, Faith and Ethics,
CFFC's work deals with some of today's most
CFFC is also co-sponsor of Religion Counts, an
debated cultural and moral issues in some of the
inter-religious group of scholars, experts, and
most significant forums, including the United
leaders providing a positive, ethically sensitive
Nations conferences on women, the
religious contribution to discourse on issues
environment, and population and development.
surrounding population, reproductive health,
With a skillful and accomplished staff of
and development policies. Its Women, Religion,
researchers, writers, and analysts, CFFC has
and Public Policy project is an effort to extend
become an important source of information and
outreach across faith lines and across national
analysis worldwide on a range of subjects,
borders to examine religion's influence on
including reproductive health and ethics,
public policies related to women.
religious fundamentalism, population policy, and
Catholic church reform. CFFC carries out its
The organization has ECOSOC status at the
work through policy analysis, outreach and
United Nations, and was a prominent NGO
advocacy, and education and communications.
participant in the activities surrounding the 1994
CFFC was established in 1973 and has
ICPD and the 1995 Fourth World Conference
headquarters in Washington, DC, four partner
on Women.
organizations in Latin America, and a US staff
of twenty.
CFFC's positions and activities are backed
by original, accurate research and study of
CFFC articulates sound ethical arguments -
myriad resources, including church documents
based on Catholic teachings that support the
and references. Publications feature a quarterly
right to follow an informed conscience in
magazine, Conscience, A Newsjoumal of Prochoice
making moral decisions about sexual and
Catholic Opinion, and a number of titles including
reproductive matters. CFFC counters the
Catholics and Reproduction: A World View, an
efforts of the Roman Catholic hierarchy to see
unprecedented collection of opinion and
that public policies reflect Vatican positions. In
behavior surveys from around the world; When
one recent campaign, Catholics for
Catholic and Non-Catholic Hospitals Merge:
Contraception, CFFC organized a leadership
Reproductive Health Care Compromised, a
committee of more than 1,000 Catholics in the
groundbreaking study of the loss of
United States to voice support for international
reproductive health services in the United States
family planning assistance.
as a result of consolidations in the health care
industry; Evolution of an Earthly Code, a history of
CFFC creates room in the dialogue on
the changing church position on family planning
reproductive rights for progressive religious
and population; and Catholic Options in the
voices to present their views on an equal footing
Abortion Debate: Reforming Irish Law, a
with religious institutions. A CFFC initiative,
submission to the Irish government's
Catholic Voices, is aimed at lifting up Catholic
Interdepartmental Working Group.
support for the plan of action adopted by the
CATHOLICS FOR A FREE CHOICE
2
CFFC works nationally in the United States
CFFC has been led since 1982 by Frances
and internationally, particularly in Latin America
Kissling, a leader in both the church reform and
and Europe, to provide materials to Catholics,
the women's rights and health movements
policy makers, and the media. We work in
internationally. CFFC's board of directors
close collaboration with four partner
includes theologians, public health experts, and
organizations in Latin America: Católicas por el
women's' rights leaders. The organization's
Derecho a Decidir (Catholics for the Right to
funding comes from some of the world's most
Decide) in Mexico, Argentina, and Bolivia, and
respected philanthropic foundations, such as the
Católicas pelo Direito de Decidir (Catholics for
Ford Foundation and the MacArthur
the Right to Decide) in Brazil. CFFC is a
Foundation, as well as from individual
respected member of the international reform
Catholics.
and renewal movement in the Catholic church.
CATHOLICS FOR A FREE CHOICE
CATHOLIC VOICES
AT ONE WITH THE
CAIRO CONSENSUS
Catholic Voices
Catholic Voices, an initiative of Catholics for a Free
Christianity, nineteenth and twentieth century
Choice, is an international forum on issues of
theology, and modern liberation movements.
population and development. The forum provides
She has been a consultant to the Lily Foundation
a space for progressive Catholic leaders to reflect,
project "What's Left" on the Roman Catholic
research, and participate in national and
left in America. Prof. Briggs is a member of the
international discourse on women's human rights,
steering committee of the Feminist Theology
sexuality, and reproductive health. With special
and Theory Group of the American Academy of
attention to the values and ethics of the Catholic
Religion.
tradition, Catholic Voices supports public policies
and agreements on these issues that promote social
Dina Cormick
justice, respect human dignity, and honor the rights
South Africa
of individual conscience.
Born in Nkana, Zambia, Dina
Cormick is an artist, feminist, and
Begun in 1998, Catholics Voices is in
political activist. She earned a
formation. Membership is in the initial stages;
Masters degree in Feminist
to date, seventeen Catholic leaders, theologians,
Theological Ethics from the University of South
and activists from twelve countries have formed
Africa in 1993. An active participant in the reform
a leadership circle. In December, 1998, Catholic
movement in the Catholic church, Ms. Cormick
Voices issued its first declaration, "Catholic
is a member of the international steering
Voices: Reflections from the Paseo de la Reforma,"
committee of Women's Ordination Worldwide, a
from Mexico City. The declaration examines the
co-founder of Women's Ordination South Africa,
Programme of Action of the International
and a member of the Circle of Concerned African
Conference on Population and Development
Women Theologians.
through a Catholic lens.
Elfriede Harth
Following are brief biographies of the
France
leadership members of Catholic Voices. Each can
Elfriede Harth is a leader in the
be contacted through Catholics for a Free Choice
Roman Catholic church reform
in Washington, DC, at (country
movement. She is spokesperson
code 01) 202/986-6093, or
for the International Movement
email, [email protected].
We Are Church, member of the steering
committee of Women's Ordination Worldwide,
Sheila Briggs
and member of Maria von Magdala, an association
United States
working for women's equal rights in the Catholic
Sheila Briggs is Associate
church. Ms. Harth is currently working on her
Professor in the School of
doctoral dissertation on women, Catholicism, and
Religion at the University of Southern California.
fertility from the Ecoles des Hautes Etudes en
Her feminist theology research interests are early
Sciences Sociales in Paris.
CATHOLICS FOR A FREE CHOICE
2
Teresia Hinga
Anthony Padovano
Kenya
United States
Teresia Mbari Hinga is Assistant Professor in
A well known theologian, author,
the Department of Religious Studies at DePaul
activist, and commentator on
University in Chicago, Illinois. She has written
Catholic church issues, Anthony
extensively on issues surrounding women and
Padovano holds an S.T.D. from the
religion in Africa. Book chapters have included
Gregorian University in Rome and a Ph.D. from
"Christianity and Female Puberty Rites in Africa:
Fordham University. He was president of
The Agikuyu Case," "Between Colonization and
CORPUS, National Association for Married
Inculturation: Feminist Theologies in Africa,"
Priesthood from 1988 to 1998. He is vice-president
and "Gikuyu Theology of Land and
of the International Federation of Married Catholic
Environmental Justice." Under a research grant
Priests, which has members in thirty countries. Dr.
from the Rockefeller Foundation, Dr. Hinga
Padovano is Professor of American Literature and
produced a research report, The Role of Religious
Religious Studies at Ramapo College of New Jersey.
Networks in the Provision of Education to Women
He has been a summer visiting professor at twenty-
in Africa.
four American universities and has lectured
throughout the Americas and in Asia, Europe,
Joanna Manning
Australia, and New Zealand.
Canada
Joanna Manning is an acclaimed
Rosemary Radford Ruether
teacher and writer; in the 1990s she
United States
won the Canadian Church Press
One of the world's leading
award for theological reflection.
Catholic feminist theologians,
Her book, Is the Pope Catholic? will be published
Rosemary Radford Ruether
by Malcolm Lester Books in March 1999. An
teaches courses on the relationship
activist for justice, peace, and women's equality,
of Christian theology and social justice issues at
Ms. Manning started the Rigoberta Menchu
Garrett Theological Seminary and Northwestern
Centre for Justice, Peace, and Creation, and founded
University. The author or editor of twenty-five
the Coalition of Concerned Canadian Catholics. She
books, among them, Contemporary Catholicism:
has a Masters in Theology from Regis College,
Crises and Challenges (1987) and Gaia and God:
University of Toronto.
An Ecofeminist Theology of Earth Healing, she has
also contributed to eighty-five book symposia. She
Philomena Mwaura
writes regularly for the National Catholic Reporter,
Kenya
Christianity and Crisis, and the Religion News
Philomena N. Mwaura is a lecturer in the
Service. Dr. Ruether is a frequent lecturer at
Department of Religious Studies at Kenyatta
conferences and universities; she has lectured
University in Nairobi, Kenya. She has a Masters
throughout the Americas and Europe, as well as
degree in Religious Studies from the University of
Israel, Egypt, Japan, Korea, India, the Philippines
Nairobi and is currently a Ph.D. candidate. She
and South Africa.
has taught courses on the church in Africa, women
in religion and culture, and development of
Valerie Stroud
Christian doctrine.
United Kingdom
Valerie Stroud has served as a
Mrs. Mwaura is deeply involved in the ongoing
catechist and has been employed in
constitutional review process through the Kenya
parish administration and pastoral
Women Political Caucus. She has organized and
care. She served for several years as
facilitated workshops and conferences for the
Secretary to the Deanery Pastoral Council, a worker
Ecumenical Association of Third World
for the Diocesan Liturgy Commission and is
Theologians and the Circle of Concerned African
currently a member of the Diocesan Christian Unity
Women Theologians.
3
Commission. Mrs. Stroud represented her diocese
in philosophy and letters from the Universidad
at the 1996 Council of Churches of Britain and
Central de Barcelona. She has been involved for
Ireland Assembly. A commissioned Eucharistic
several years in a collective, Mujeres y Teologia
Minister, Mrs. Stroud now works full time in the
(Women and Theology), and in 1997 joined with
reform/renewal movement in the Catholic church.
four other women to form the group Católicas por
She is the UK liaison for the International Movement
el Derecho a Decidir (Catholics for the Right to
We Are Church.
Decide) in Spain. Both groups collaborate on
projects with Somos Iglesia de España (We Are
Isaac Wüst
Church in Spain). For the past two decades, Ms.
The Netherlands
Alfonso has taught children and adults, and
Isaac Wüst works full time in the
currently works in a literacy program with women
renewal/reform movement in the
gitanas (gypsies) in Madrid.
Catholic church. He became a
priest in 1956 in Amsterdam, where
Frances Kissling
he was born. He studied Latin American political
United States
and social sciences at the Catholic University of
Writer, advocate, and policy
Louvain, and subsequently lived and worked in
analyst, Frances Kissling has been
Latin America for many years. Mr. Wüst was
President of Catholics for a Free
executive secretary of the education department of
Choice since 1982. An
CELAM, the Latin American bishops' conference,
internationally recognized non-governmental
for five years before leaving the priesthood. In the
organization, CFFC works to advance reproductive
mid-1970s, he worked as an advisor to a UN project
health, women's rights and the strengthening of
that introduced new methods for health education,
civil society through research, education, and
mother and child care, and family planning in remote
policy analysis. Ms. Kissling is a highly regarded
areas. During the next decade, he was involved in
speaker and thinker on issues of religion,
many development and education projects throughout
reproductive health, women's rights, and
Colombia. Since returning to The Netherlands in
population policy. Ms. Kissling's views on
1986, Mr. Wüst has worked at the service of parishes
reproductive health issues combine a deep respect
in Amstelveen and Amsterdam.
for the spiritual aspect of life-giving with a passionate
commitment to the moral agency of women. Ms.
REPRESENTATIVES OF CATHOLICS FOR A FREE CHOICE
Kissling has briefed parliamentarians and
AND CATHOLICS FOR THE RIGHT TO DECIDE IN THE
development professionals in a number of countries,
LEADERSHIP CIRCLE OF CATHOLIC VOICES:
including Brazil, the United Kingdom, Mexico, the
Philippines, Germany, Ireland, Poland, and
Marta Alanís
throughout the United States. A leading voice
Argentina
promoting international public policy that advances
Marta Alanís is coordinator of Católicas por el Derecho
women's health and rights, Ms. Kissling was a
a Decidir (Catholics for the Right to Decide) in
prominent participant in the United Nations
Córdoba, Argentina. Since 1989, Ms. Alanís has
conferences on Population and Development (Cairo,
worked as a teacher in the Archdiocesan Charities of
1994) and on Women (Beijing, 1995).
Córdoba. She has worked in human rights
communities in Bolivia, France, and Nicaragua,
Teresa Lanza Monje
focusing particularly on indigenous women's literacy.
Bolivia
Committed to both liberation and feminist theologies,
Teresa Lanza is coordinator of Católicas por el
Ms. Alanís has studied with liberation theologian
Derecho a Decidir (Catholics for the Right to
Leonardo Boff and feminist theologian Ivone Gebara.
Decide) in Brazil. A lawyer, Ms. Lanza graduated
from the Universidad Mayor de San Andres in
Paloma Alfonso
La Paz, where she conducted research for her
Spain
thesis on sexual and reproductive rights and the
Angeles Paloma Alfonso Aguirre earned her degree
problem of abortion in Bolivia. She is a founder
4
of Género Y Teologia (Gender and Theology),
an ecumenical collective of pastors and
Marysa Navarro-Aranguren
theologians. She has written several opinion
United States
columns on women's rights for major daily
Marysa Navarro is Charles Collis
newspapers. Currently, Ms. Lanza is involved
Professor of History and Chair of
in providing information to legislators, opinion
the Latin American, Latino and
leaders, health providers, and the news media
Caribbean Studies Program of
on the positions of CDD.
Dartmouth College, where she has taught for thirty
years. She is an academic and also an activist. She
María Consuelo Mejía
has been a member of the board of directors of the
Mexico
Ms. Foundation for Women, the Global Fund for
An anthropologist, feminist, and
Women and Catholics for a Free Choice, which
Catholic activist, María
she presently chairs.
Consuelo Mejía directs Católicas
por el Derecho a Decidir
Maria José Rosado Nunes
(Catholics for the Right to Decide) in Mexico.
Brazil
Ms. Mejía was named to Mexico's country
Maria José Nunes is coordinator of
delegation to the International Conference on
Católicas pelo Direito de Decidir
Population and Development in 1994 and
(Catholics for the Right to Decide)
participated in the 1995 Fourth World
in Brazil. She is a graduate Professor
Conference on Women. Born in Bogotá,
in Religious Studies at the Pontifical Catholic
Colombia, she became a naturalized Mexican
University in São Paulo and at the Methodist
citizen in 1984. She received her Masters degree
University of São Paulo. Ms. Nunes is a director and
in Latin American Studies from the National
past vice-president of the Institute for Religious
Autonomous University of Mexico (UNAM) in
Studies in Rio de Janeiro. With a grant from the
1986. Since 1990, she has worked as a researcher
MacArthur Foundation, she managed a research
in the Interdisciplinary Humanities Research
project on the Catholic position on abortion. Ms.
Center and as a consultant for the University
Nunes is an award winning author and frequent
Program on Gender Studies at UNAM.
contributor to national and international magazines.
MILLENNIUM SUPPLEMENT: POPULATION
INSIMPLE w
and as the mo.ru
NO. 4
OCTOBER 1998
NATIONAL
GEO PHIC
POPULATION
HUMAN MIGRATION 6: WOMEN AND POPULATION 36 FEEDING THE PLANET 56
LEWIS AND CLARK 76 PERFUME 94 ANTARCTIC DESERT 120
OFFICIAL JOURNAL OF THE NATIONAL GEOGRAPHIC SOCIETY WASHINGTON D.C.
THE MILLENNIUM SERIES
Women and Population
BY ERLA ZWINGLE PHOTOGRAPHS BY KAREN KASMAUSKI
"Don't loo klat people like an ant heap,"
one exp
N A CERTAIN NOVEMBER DAY an
bluntly paraphrased the common fear, "if those
some time durir
obscure woman in Iowa gives
people don't stop breeding."
There is already a
birth to seven babies; we marvel
True, the numbers give pause. Today there
too, and accordir
and rejoice. On the same day an
are almost six billion people in the world. For
Bureau masses
obscure woman in Nigeria gives
the next 15 years annual increases will proba-
"a social and poli
birth to her seventh child in a
bly remain just over 80 million (or one billion
But there has
row; we are distressed and appalled.
every 12 to 13 years). The United Nations esti-
the past 30 years
In Brazil a mayor sees his town shrink by
mates that by the year 2050 there could be from
many developing
two-thirds. Determined not to lose subsidies
7.7 billion to 11.2 billion people in the world.
and India), and tl
tied to population, he bans all contraceptives.
Will this be too many? It is difficult to pre-
each woman has
In Bangladesh the government, determined to
dict, as even Malthus would have seen by now.
three. This is the
stem the tide of births, offers to sterilize women
Predictions often impel changes in the very
on three fronts: C.
for free and throws in a new sari as a gift.
behavior that inspired the prediction. Provid-
In Kenya a woman keeps trying for a son
ing enough food, of course, is paramount.
Soon to have a si
because her husband asks, "Who will hold my
But what about fresh water? Forty percent of
Nurses provide cl
head for me when I die?" In the United States
the world population faces water shortages at
gaps between bin
an unmarried teenager looks at her infant
daughter and says, "I don't really know what I
was doing. I thought I was in love. I thought it
was this great thing, but it was stupid."
Population: We know it's a problem. In fact
most of the problems facing individuals, fami-
lies, communities, and nations are affected by
the quantity of humans sharing the planet.
But if the problem were only numbers, these
stories would have no power to touch or per-
plex us. Nor would we race to bring food to
famine-stricken countries, or blanch to read of
newborn babies being thrown into trash bins,
or fall silent upon hearing of the pregnant
mother who refused cancer treatments that
could damage her baby, gave birth, and died.
Even as some fear for our species' survival, we
instinctively sense mysteries that transcend sta-
tistics. "Don't look at people like an ant heap,"
one expert urged. "These are individuals."
Two hundred years ago Thomas Malthus
predicted mass catastrophe as a result of over-
population. So far, events have not turned out
quite as he supposed they would, yet the brutal
probabilities he described continue to darken
some views of the future. Today 98 percent of
population growth is in the developing world.
"The world is going to hell," as one observer
Freelance writer ERLA ZWINGLE lives in Venice, Italy, a
country in which the falling birthrate is a serious con-
cern. Photographer KAREN KASMAUSKI, a mother of
two children and a veteran of 16 GEOGRAPHIC assign-
ments, also focused on human migration for this issue.
38
heap,"
one expert urged. "These are individuals."
fear, "if those
some time during the year. What about jobs?
culture, the strongbox in which our sense of
There is already an increasing shortage of those
what we can do is locked.
Today there
too, and according to the Population Reference
Contraception has been the key. The num-
the world. For
Bureau masses of unemployed people form
ber of women in some developing countries
will proba-
"a social and political time bomb."
using contraceptives has risen to more than 50
(or one billion
But there has been dramatic progress over
percent. "There isn't any place where women
Nations esti-
the past 30 years. Birthrates have dropped in
have had the choice that they haven't chosen
could be from
many developing countries (including China
to have fewer children," says Beverly Winikoff
in the world.
and India), and the number of children born to
at the Population Council in New York City.
difficult to pre-
each woman has fallen on average from six to
"Governments don't need to resort to force."
seen by now.
three. This is the result of remarkable changes
Yet some 200 million women become preg-
in the very
on three fronts: contraception, health care, and
nant each year. Half of these pregnancies are
diction. Provid-
is paramount.
Soon to have a sibling, an only child nestles in her mother's sari at a clinic in Bangladesh.
Forty percent of
Nurses provide checkups and offer advice-starting with "space your children." Longer
shortages at
gaps between births mean healthier mothers and babies and slower population growth.
unplanned, and a quarter are unwanted. Un-
obvious. Bangladesh is the ninth most popu-
Cha
wanted children are often neglected, abused,
lous nation on Earth, and, with only 52,000
from t
or abandoned. They receive less food, medical
square miles of land, it is one of the densest. It
an ass
care, and education than wanted children.
is also one of the poorest.
with c
More than half a million women die each
Today Bangladesh is praised as a population
mattin
year from causes related to pregnancy, often
success story. In 1990 its birthrate was an
A
of beat
the result of poor health, lack of medical care,
unbridled 4.9 children per woman (which, if
to spre
and having babies too close together. Seven
unchanged, would have doubled its population
a baby
million infants die each year because their
by the year 2015). The rate is now 3.3, a fact
Someo
mothers were not physiologically ready for
that has astonished those who believed the
phone
pregnancy or lacked obstetric care. Millions
country's population would drop only after
Ano
of women and men resign themselves to this
chronic poverty and illiteracy were overcome.
village;
reality. But with the chance to plan their
Much of the credit goes to two of the many
it with
families, they are beginning to see a way to
organizations that help the poor: the Dhaka-
she ma
re-imagine their future. "People are desperate,"
based Grameen Bank, with its innovative pro-
milk of
one woman said, "to control their own destiny."
gram of "microcredit," or small loans, and the
sells te
Bangladesh Rural Advancement Committee
cents)
N BANGLADESH dawn rises over banana
(BRAC), with its nationwide network of village
I
phone
groves and palm trees, the emerald
clinics. The work of BRAC and Grameen has
keep so
expanse of rice fields, and pools where
made it possible for millions of women and
"Eve
women in vivid saris immerse them-
children who once could hope only for sur-
the ph
selves, drenched in the golden light. Here
vival to begin to dream of progress. Mosammat
three y
the problem of overwhelming numbers seems
Anowara Begum is one of them.
parts o
40
NATIONAL GEOGRAPHIC, OCTOBER 1998
WOMEN
Woman to woman
Pledged to bear no more children, a volunteer with the Bangladesh
Rural Advancement Committee counsels a pregnant woman in
Shoal village (left) and dispenses antibiotics for a mother's sick
baby (below). She also discusses family planning. Contraceptives
distributed by such workers helped lower Bangladesh's birthrate
from seven children per woman in 1975 to fewer than four in 1995.
inth
most
popu-
Chamurkhan village isn't very different
several children could be destined to beg or
with only 52,000
from the 68,000 other villages in Bangladesh:
even turn to prostitution. But once the loan is
of the densest. It
an assortment of one- or two-room houses
paid off, Anowara Begum stands to net an
with corrugated metal roofs and walls of palm
average of $2 a day-more than $700 a year-
as
a
population
matting, clustered around small common areas
in a country with an average annual per capita
irthrate was an
of beaten earth. As the morning light begins
income of about $250.
(which, if
to spread through the trees, a rooster crows;
Since its launching in 1976, the Grameen
its population
a baby gives a small, fretful cry; a dog barks.
program has loaned more than two billion
now 3.3, a fact
Someone nearby hawks and spits. Then the
dollars, in amounts averaging only $180, to
ho believed the
phone rings.
more than 2.1 million destitute women.
drop only after
Anowara Begum has the only phone in the
"We find that when women start borrowing,
were
overcome.
village; it's a Nokia cellular phone. She bought
it benefits the whole family," Mohammed Abul
two of the many
it with a loan from the Grameen Bank, and
Hossain, a senior officer at Grameen, tells me.
the
Dhaka-
she makes money with it. Instead of selling
"Her children become important, the family's
innovative pro-
milk or eggs, as many of her neighbors do, she
welfare becomes important." One recent study
loans, and the
sells telephone calls at 4.6 taka (about ten
in Brazil showed that income controlled by the
Committee
cents) a minute. At this rate, she can pay the
mother had a benefit on her children's health
etwork of village
phone bill and weekly loan installment and
that was almost 20 times greater than income
Grameen has
keep some profit too.
controlled by the father.
of
women
and
"Every week I make 300 taka [$6.50] from
Sharifa Akhtar Shikha, Anowara's 20-year-
only for sur-
the phone," she says, "and I repay 160 taka. In
old daughter, studies Islamic history at Dhaka's
Mosammat
three years the loan will be repaid." In some
Jagannath University. "If my mother hadn't
parts of Bangladesh an illiterate widow with
gotten the loan," Shikha says, "it would have
OCTOBER
1998
WOMEN AND POPULATION
41
been impossible for me to go to the university.
But she wanted me to have a higher education."
Why? Anowara smiles. "For the future," she
answers. "She will be independent and have
more income. And she'll be happy also."
NORTH
When people can start making decisions
AMERICA
about their lives, they also start making deci-
sions about the size of their families and vice
versa; family planning within Grameen fami-
2.0
5
lies is twice as common as the national average.
57.21
Surveys have also found a strong link between
1.2
1
education and family planning.
Mexico
But Bangladesh still has a high death rate of
babies and mothers. Here females die earlier
3.1
7
than males (the opposite of the biological
Nicaragua
Mal
4.5-9.9
11.8-36.8
norm), due in part to severe malnutrition and
4.6
16
46
6.7 19 12
risky pregnancies, often too close together.
To help improve health care, BRAC has
Colombia
37.7-62.3
founded clinics throughout the country.
SOUTH
3.0
9
28
"Many more women want contraceptives
AMERICA
now," said Mergina Khatun, a village health
Brazil
165.2
worker in Mymensingh district. "They see that
2.5
9
43
if a mother has fewer children, she can give
them better care. And her health will be better."
What if a conservative Muslim leader tells
8.20 billion
2050
Mergina that contraception is against the will
UN medium
population
of God? "I say that God also told us to be
projection
responsible for our families."
In the BRAC health center in the town of
Mymensingh, the nurse is counseling a few of
the 800 women who visit every month. A thin
young woman, three months pregnant, sits list-
He
lessly by the desk. She tells the nurse that she
has been suffering from morning sickness and
In wh
has an intermittent fever. She is 20 years old
plann
and has been married three and a half years.
moth
This is her third pregnancy; she has already
birth:
suffered one stillbirth and one miscarriage.
1998
4.75 billion
child
Contraceptives could have helped her delay
birth
these pregnancies until her health improved.
must
The nurse advises her to take full bed rest,
Diverging futures
In th
eat extra food, and do no heavy work. None
Virtually all of the projected pop-
deve
of this will be possible for her. The nurse pre-
ulation increase by 2050 will
Non
scribes an antihistamine spray and an analgesic
occur in developing countries
ning
(light gray column). The popu-
for the pain and fever. The girl's gray-haired
lation of the developed world
birth
mother-in-law crouches on the floor, leaning
(dark gray) will fall, as women
tives
against the wall, waiting silently.
there continue to average fewer
opm
Loans and contraceptives continue to
than two children each.
edu
improve the lives of Bangladeshi women and
Suc
their children. But sadness still inflects the
1998
nin
lives of even healthy families.
1.18 billion
trie:
"I have three daughters; the youngest is just
2050
a year and three months old," says Firoza in
1.16 billion
UN medium
population
projection
42
1
1
1.2 5 17
1.7 3 6
Unite
ASIA
2.6 5 42
-BUROPE
1.8 1 31
China
1.4 <1 4
57.2
T,255.1 1,516.7
Iran
1.2 1
6
73.1
170.3
Egypt
3.0
6
35
65.7.-115.5
(India
3.6 6 63
9751
Nicaragua
Mal)
Si
Arabia
4.5 -9.9
11.8 38.8
20
59
3.4 7 72
3.3 15 #82
4.6
16
46
6.7
19
123
AFRIC
6.4 12 29
4.5 9 62
SOUTH
AMERICA
21.8 338.5
Brazil
6.5 15 84
165.2-243.3
2.5 9 43
4.8 8 77
1.8 2 5
Developed
4.3 8 60
countries
Developing
countries
Health, wealth, and population
In what experts call a virtuous cycle
planning leads to healthier women-
mothers avoid ear Y, late or.closely.
births. Healthier women have health
children And fewer child deaths (ead)
births, as women stop believing.thet.in
must have many babies for Frewito
futures
In the past many concluded that ICORD
of the projected pop-
development was the best contracep
by 2050 will
Now, backed by studies showing amili
veloping countries
ning is the most effective. means
olumn). The popu-
developed world
births worldwide, experts say, Contr
will fall, as women
tives are the best contraceptive.
to average fewer
opment and its benefits, especially
8
ildren each.
education and health care tremaire
Such advances raise demand or
ning, persuade young couples 00 DO
tries to postpone childbearing.and.e.
3.3
3
BASE MAP AND POPULATION DATA: UNITED NATIONS
1.6
STATES CENSUS BUREAU HEALTH ISSUES DATA:
MAP. AND GRAPHS BY STEPHEN ROUNTREE
Army of entrepreneurs
Saluting the future, women meeting
near Dhaka to repay loans acknowl-
edge the loan officer from Grameen
Bank, who freed them from lives of
powerlessness and isolation. "We
shall plan to keep our families small.
We shall keep free from the curse
of dowry. We shall not practice child
marriage" so runs the creed Gra-
meen clients, who are 95 percent
female and 100 percent poor, recite
as a promise to break from traditions
of poverty. Launched into business
with a small loan, a woman travels
from door to door selling cookware
(below). Anowara Begum (below
right) used a loan of $390 to buy a
cellular phone, which fellow villagers
pay to use. Soon after the death of
her husband, Anowara hears from
her brother in Malaysia while their
mother weeps. For birthrates to keep
falling, experts say women must be
offered opportunities beyond moth-
erhood and given the authority to
choose whether to bear children.
Taldighi village. "My husband is disappointed.
in large part to massive education campaigns,
make tl
Now he is saying he didn't want any more chil-
more clinics, and inexpensive contraceptives.
Phili
dren. Two would have been better, he says,
But Africa, which still has the highest birth-
vary Te
since the third one was a girl."
rates in the world, remains profoundly child
neighb
"I had twin baby boys," her neighbor, Alef-
centered. "A person who doesn't have children is
man w
jan, tells me. "They died of a respiratory infec-
looked down on," a woman explained, "because
first m
tion, one when he was seven days old and the
that person is incomplete in the society."
Marie S
other when he was 14 days old. My husband
In much of the world men have often
The i
told me, 'We don't need to go to the hospital-
been the major objectors to family planning.
children
they don't have drugs for children this small.'
Some do so on the basis of religious beliefs;
azines.
And I believed him."
others want to demonstrate their virility. Many
The yel
believe that only the fear of becoming preg-
"Plan y
"
OMEN AND POPULATION," repeated
nant will keep their wives faithful. And there
depend
W
Beverly Winikoff at the Popula-
are misunderstandings: "I used to hate family
world h
tion Council when I told her my
planning," a man told me, "because I thought
"My
topic. "It sounds like you're treating
it meant that people shouldn't have children."
me. "It 1
women as the disease vector." What about men?
Yet as men struggle to provide for their
for 13 d
The sun rises over Nairobi, gilding the dusty
families, some admit that smaller families are
cup of t
parks, the battered streets, the chaotic, make-
better. To help them become more involved in
"Wh
shift markets. Kenya used to have one of the
family planning, male-only clinics have begun
was th
highest birthrates in the world, but in the past
to appear in Kenya, Ghana, and some South
raise," }
20 years it has shown one of the steepest de-
American countries. And a few pioneers, over-
and she
clines in all Africa. As in Bangladesh this is due
coming the common fear that sterilization will
my wif
46
NATIONAL GEOGRAPHIC, OCTOBER 1998
WOMEN
Early parenthood
Seven months a mother, Jill Crisler, 16, fixes a bottle for her son,
Trenton, before leaving for Northeast High in Lincoln, Nebraska.
Like many teenage births, this one was unplanned. "It's not a mis-
take," says Jill. "I call it a surprise." Unlike most unwed fathers,
Luke Smith stays in his son's life, hurrying from his job to his new
role as Trenton's playmate at the school day care (below).
are choosing vasectomy.
That's what the Bible says. So I read about
pastor of the Nairobi Cal-
vasectomy. The only side effect is that you can't
ecostal church in a poor
have children anymore"-he smiles-"and
he is a small, compact
that's the side effect I wanted."
intelligent expression. I
To their credit many men worry about the
male-only suite of the
possible side effects some contraceptive meth-
lowntown.
ods may have on their wives. Then again,
oom is full of women and
studies show that men are generally reluctant
evision and reading mag-
to use methods that directly involve them-
door are for men only.
withdrawal, abstinence, condoms, and the
a few modest posters:
rhythm method. As for vasectomy, says clinic
w-your children's future
counselor Patrick Musyoka in his gentle voice,
million men around the
"The stigma is still there."
ectomy."
Men are the point at which family planning
eight acres," Philip tells
leaves the realm of mechanics and enters the
farm but not enough
mysterious territory of behavior. Contracep-
morning there was just a
tives themselves are simple-it's the users that
Poverty eats you every day.
are complicated, caught up in the volatile
ecide to have a vasectomy
dynamics of human relationships. "Family
have a family I could
planning came to Kenya through health
My wife was taking pills,
programs for women," Godwin Mzenge, a pro-
pressure. Who am I to
gram director, tells me. "The assumption was
I'm there to help her.
that women would discuss with their husbands
47
Premature parents, mothers at Lincoln High School gather at lunch as part of a student-child
gro
program that helps them graduate. The U.S. has the highest teenage birthrate in the industrial-
pro
ized world. Adolescent births endanger mothers and their babies while accelerating population
birt
student-child
growth. Rather than stressing either abstinence or contraceptives alone, successful prevention
in the industrial-
programs also emphasize setting and achieving goals. "Hope is the most important method of
rating population
birth control," says Susan Powers-Alexander, of Lincoln's Planned Parenthood.
what they learned. But now we know that com-
it is, but not always in the way we mean. "I'd
overcome
munication between them isn't that common."
like to have a baby," said Tonya, a pert 12th
on a body 1
"We encourage the women to keep discuss-
grader, "but not now. Too many of my friends
a myth tha
ing," says Rose Ngahu, a nurse. "It takes a lot of
have babies: Mindy, Janet, Penny, Becky, Sue
healthier,"
force of character to resist the husband."
Ann, April.
"
you know \
This is bad news, for a number of reasons.
Her baby
N LINCOLN, NEBRASKA, a crisp autumn
First, there is sheer quantity: By the year 2000
Infants bor
I
morning spreads across the prairie, over
there will be more adolescent girls in the world
risk of low
the flags snapping in front of the state
than there have ever been: 400 million poised
birth than
capitol, over the football fields ready for
to begin having children. If they were to delay
24. They a
marching-band practice after school. In the
their first baby by five years, it would mean 1.2
and higher
half-light students are arriving for class at Lin-
billion fewer people by the year 2100.
problems. :
coln High School. They carry the usual teenage
Second, there is the quality of those lives. Of
likely to ser
stuff: books, musical instruments, backpacks.
the nearly four million babies born each year
found that
Some of the girls are also carrying their babies.
in the U.S., nearly one out of eight is born
mother sav
The U.S. has the highest teenage birthrate of
to a teenage mother. When a girl under 20
social costs
any industrialized nation. Since 1960 the rate
has a baby, problems mount for everyone.
many of the
has tripled among unmarried females age 15 to
She may well drop out of school, in which case
whelmed. :
19. According to the Alan Guttmacher Insti-
she is likely to go on welfare. (In 1995 the gov-
said. "I felt
tute, four in ten American girls become preg-
ernment spent 37 billion dollars on welfare,
In 1993
nant at least once before they reach 20; most
food stamps, and Medicaid for families begun
opened a cl
of these pregnancies are unintended.
by a teenage mother.) Emotional immaturity
school. The
We think of Lincoln as the real America. And
can lead her to abuse her baby; it can be hard to
east High-
50
NATIONAL GEOGRAPHIC, OCTOBER 1998
WOMEN AN
Smaller is better
Dressed in school uniforms their mothers struggled to buy, Masai
children drink a breakfast of tea in the doorway of a house in rural
Kenya. In Nairobi, Philip Njuguna, a pastor, watches his third child
and only son (below). Njuguna underwent a vasectomy after the
boy was born. "When the family is small, whatever little they have
they are able to share," he says. "There is peace."
f pregnancy and labor
make sure the girls graduate. "We want the girls
nished developing. "It's
to be successful," says Karen Poore, a teacher at
hey're younger, they're
Northeast. "Whatever will help them complete
old me. "What teen do
their education, we advocate."
t?"
There was resistance. "Some people didn't
:ry well have difficulty:
want Lincoln High to be known as 'the preg-
mothers are at higher
nant school," says Ann Irvine at the public
prematurity, and still-
school district office. "There was still the
n to women age 20 to
shame factor. We had to get over that." And
have lower test scores
objections came from those who were con-
sical and psychological
vinced that a day-care center would be seen as
age mothers are more
encouragement to be promiscuous. "The girls
ison. The state of Utah
just laugh," says JoAnn Bartek, who teaches
) spent on a teenage
family and consumer sciences. "They say, 'Oh
$400,000 in various
yeah, that's really what we were thinking:
time of her child. But
They've got this really neat day-care center; I
now that they are over-
think I'll go get pregnant."
shame," one of them
As for those who maintain that the girls
shouldn't be in school, according to Bartek, the
staff at Lincoln High
girls say, "Well, where should we be? If we don't
learning center at the
get our high school diplomas, we're going to
r colleagues at North-
be on welfare. We're going to be homeless."
heir first priority is to
One study found that almost 60 percent of
)N
51
Masai children gather for opening ceremonies at Kimuka Primary School in Kenya's Rift Valley.
Adapting to a shrinking supply of cattle land, Masai herders are bearing fewer children in
hopes of sending all their sons and daughters to school. Africa has the world's highest
Valley.
birthrates, but they are starting to fall with better health care and education, stronger family-
in
planning programs, and-in countries such as Kenya-weak economies that make it hard to
provide for many children. Even so, the continent's human numbers will double in 30 years.
teens who became pregnant dropped out of
high school. At Northeast and Lincoln High 80
percent of pregnant teens are graduating.
I meet some of these teens at the child-care
center at Lincoln High. The room is spacious
and cheerful, full of toys and cots and intensely
clean. Several girls are here on their lunch
break, crouched on the floor playing with their
babies or talking with the assistants and each
other. A few sit quietly, nursing. The mothers
look more like older sisters.
At 3 p.m. Mandy Brehm comes to pick
up her eight-month-old daughter, Juliana.
Mandy is 16; she has long brown hair, green
eyes, and a pretty, round face. She's named in
Who's Who Among American High School Stu-
dents. When we get home, her mother, Diane,
and her younger brother, Jared, are there.
There is pizza for dinner. As we eat, Diane
recalls the day she learned her daughter was
pregnant. Mandy couldn't find the courage to
tell her; instead she left a note on her mother's.
bed. "It said, 'I'll never be the daughter you
wanted. This is the worst day of my life. But I
don't want to kill the baby.' I cried for about
two hours. Then I called her at school and
asked if she wanted to come home."
Many girls do not have the support or the
determination that Mandy did. Fifty percent of
abortions in the U.S. are sought by women
younger than 25.
"My own thought," says Beverly Winikoff at
the Population Council, "is that most people
wouldn't use abortion as a first choice. But
they're pregnant, and they need not be."
make clear decisions. Older boys can dazzle or
What will Mandy tell Juliana when she
dominate: Over half the males responsible for
grows up? "Not to have sex," she replies." 'Cause
teen births are 20 or older. Early sexual abuse
it's not worth it."
cripples the capacity to say no; one study
Mandy will probably be the only person tell-
reported that 48 percent of high school stu-
ing her that. "We bombard kids with sexual
dents who had been pregnant were once sex-
messages, but we don't teach them how to
ually abused. And there is fear of losing love.
process them," says Susan Powers-Alexander,
"Part of the reason I was so reckless was
a director at Planned Parenthood in Lincoln.
I didn't like myself at all," Mindy Latzel, 18,
"We don't teach kids to decipher that they're
tells me. "He was 22 at the time. He made me
using sex to sell cars, perfume, pineapple."
feel good about myself, telling me how pretty
The influences on adolescents are powerful
I was. But I guess it was a bunch of lies."
and pervasive: movies, advertising, music, peer
pressure. The girls face life with a wild assort-
"
OW MANY CHILDREN should we have?
ment of mismatched traits: ignorance, bra-
H
How far apart?" Stan Bernstein,
vado, curiosity, delusions of invulnerability.
senior research adviser at the UN
The reasons for teen pregnancy go on. Many
Population Fund, asks rhetorically.
teen mothers are children of teen mothers.
"How should we educate them-concentrate on
Alcohol and drugs undermine the ability to
a few and hope they'll take care of us?" These
54
NATIONAL GEOGRAPHIC, OCTOBER 1998
can dazzle or
Married but without children, a Masai teenage bride looks forward to her first pregnancy.
responsible for
While many women's lives are still dictated by circumstance, more and more now enjoy
sexual abuse
choices. In their hopes, fed by new possibilities, the future is born.
no; one study
high school stu-
discussions are happening more and more.
are enough. Because if you have more, you
were once sex-
The World Health Organization estimates
can't raise them as human beings.
of losing love.
that sexual intercourse occurs a hundred mil-
In the U.S. a 16-year-old father looks at his
so reckless was
lion times a day. Yet despite the great strides of
infant son and says, "I'd probably be locked up
Mindy Latzel, 18,
the past three decades, millions of couples who
in some juvenile hall if he wasn't here. He's
He made me
want to use contraception don't have access
changed me for the better."
me how pretty
to it. Many developing countries, faced with
The sun rises every morning on more than a
of
lies."
economic crisis and political uncertainty, are
quarter of a million newborn babies. A few of
shrinking their financing of family-planning
them may change the world; all of them will
should we have?
programs. Some foreign donors have also cut
change their mothers and fathers. They don't
Stan Bernstein,
back on aid-the U.S. by one-third.
belong to the ant heap. They belong, for better
at the UN
In Kenya a man says, "When my wife didn't
or for worse, to us all.
rhetorically.
want to have more than three children, my
Erla Zwingle reports further on teenagers and preg-
-concentrate
on
mother told her, 'You're just lazy.'
nancy at www.nationalgeographic.com/features/2000.
of us?" These
In Bangladesh a woman says, "Two children
population/women.
OCTOBER 1998
WOMEN AND POPULATION
55
Issues-in Brief Risks and Realities of Early Childbearing Worldwide
http://www.agi-usa.org/pubs/ib10.html
Issues in Brief
Risks and Realities of Early
Childbearing Worldwide
Summary Points
Policy Implications
A10-year-old girl works beside her mother in a remote, rural village. Miles away, in a bustling
metropolis, a boy about the same age gets ready for school. Despite their differences, both are embarking
on one of the most crucial periods in their lives-their adolescence.
Over the next 10 years, these young people will face
vital decisions regarding education, work, sexual
relationships, marriage and having children. Their
decisions will be tempered by social and economic
Terms Used
circumstances and influe nced by family members and
the members of their community.
Adolescents are young people
aged 10-19.
The choices adolescents make will strongly affect their
Marriage includes both legal marriage
educational attainment and employment
opportunities-in fact, the entire direction of their
and cohabiting unions.
lives. Collectively, their choices will ha ve significant
consequences for the future of their communities, their
countries and the rest of the world.
Adolescents, broadly defined as 10-19-year-olds, are a vital population segment, making up one-fifth of
the world's people. The sheer size of the group commands attention: They numbered nearly 1.1 billion in
1995-913 million lived in developing countries and 160 million in developed countries. The world's
two most populous countries, China and India, were each home to approximately 200 million young
people (Table 1, column 1).
table 1
Adolescent Demographics Worldwide
% of
% of
% of
% of
% of
women
women
% of
% o
% of
women
women
women
20-24
40-44
births
Number
birt
Country and
population
15-19
15-19 with
40-44 with
who
who
to
aged 10-19,
wo
survey year
1996
10-19,
in
>=7 years
>=7 year S
gave
gave
women
15-
1996
urban
of
of
birth by
birth by
15-19,
areas
schooling*
schooling*
age
age
1996
unp
20Y
20Y
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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Sub-Saharan Africa
Botswana,
362,000
24
31
75
21
55
50
14
71
1988
Burkina
Faso,
2,335,000
22
26
11
2
62
57
18
23
1992/1993
Burundi,
1,485,000
23
4
1
2
27
39
6
36
1987
Cameroon,
3,163,000
23
42
40
8
67
64
19
24
1991
Cen.
African
752,000
22
48
14
5
61
59
20
23
Rep.,
1994/1995
Ghana,
4,156,000
23
46
63
35
48
50
15
58
1993
Kenya,
7,241,000
25
16
62
26
52
59
18
52
1993
Madagascar,
3,554,000
23
21
19
11
53
60
1
21
1992
Malawi,
2,607,000
23
12
19
8
63
56
18
39
1992
Mali, 1987
2,539,000
23
30
8
1
67
62
20
18
Namibia,
358,000
23
30
44
26
42
38
15
50
1992
Niger, 1992
2,171,000
23
19
5
0
75
63
21
11
Nigeria,
26,099,000
23
29
34
4
54
49
17
10
1990
Rwanda,
2,012,000
25
7
36
3
25
36
7
40
1992
Senegal,
1,966,000
23
46
11
6
52
54
19
26
1992/1993
Tanzania,
7,166,000
23
27
62
10
57
65
16
20
1991/1992
Togo, 1988
970,000
23
41
15
4
56
59
15
44
Uganda,
5,108,000
23
14
22
5
68
69
22
35
1988/1989
Zambia,
2,370,000
24
54
48
23
61
68
17
33
1992
Zimbabwe,
2,708,000
24
27
82
30
50
55
14
47
1994
North Africa & Middle East
Egypt, 1992
14,315,000
22
44
65
23
29
40
13
16
Morocco,
6,160,000
22
45
28
7
19
39
6
22
1992
Sudan,
6,760,000
23
41
58
7
26
61
12
15
1989/1990
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Tunisia,
1,992,000
22
60
39
6
13
36
5
23
1988
Yemen,
3,490,000
23
23
9
1
41
35
11
u
1991/1992
Asia
Bangladesh,
1993/1994
28,919,000
24
13
33
9
66
85
18
23
China, 1988
202,060,000
16
20
51
23
8
22
3
u
India,
197,168,000
21
27
50
25
49
58
9
16
1992/1993
Indonesia,
42,591,000
21
38
84
41
33
51
14
12
1994
Pakistan,
32,452,000
22
36
29
9
31
38
7
9
1990/1991
Philippines,
15,398,000
22
59
81
50
21
26
4
41
1993
Sri Lanka,
1987
3,805,000
21
14
u
u
16
31
8
28
Thailand,
11,565,000
20
26
34
11
24
28
14
31
1987
Turkey,
12,382,000
20
58
90
50
25
42
6
22
1993
Latin America & Caribbean
Bolivia,
1,695,000
22
64
62
26
39
39
13
42
1993/1994
Brazil, 1986
33,510,000
20
74
47
23
31
31
17
50
Colombia,
7,527,000
21
75
63
35
37
36
16
43
1995
Dominican
Republic,
1,680,000
21
68
65
35
33
52
18
36
1991
Ecuador,
2,610,000
22
60
56
26
35
39
15
27
1987
Guatemala,
2,599,000
24
37
21
9
50
48
17
20
1987
Mexico,
20,635,000
22
73
62
17
35
41
15
33
1987
Paraguay,
1,104,000
22
50
42
21
37
34
14
22
1990
Peru,
5,355,000
22
79
69
46
27
36
12
52
1991/1992
Trinidad &
Tobago,
279,000
21
41
90
51
30
40
13
39
1987
Developed Countries
France,
7,719,000
13
1994
80§
84§
82
7
15
2
35§
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Germany,
9,053,000
11
100
100
u
u
4
u
1992
Japan, 1992
15,736,000
13
83
**
100
100
2
4
1
u
United
Kingdom,
7,253,000
12
90
**
100
u
u
и
7
u
1993
United
36,508,000
14
76**
100
98
19
23
14
73
States, 1988
*Except in Central African Republic, Tunisia, Yemen, Indonesia, Pakistan and Thailand, where it is the
percentage of women with secondary or higher education. YIn North Africa and the Middle East and As
never-married women are assumed to have ha d no births. ýBased on all births at ages 15-19 in the previ
five years, except in Burundi, Mali, Togo, Uganda, Sudan and Mexico, where based on the last birth am
women 15-19 in the previous five years. §% for ages 20-24. **% for total population; source, see ref. 1,
A-2. Note: u=unavailable.
Other populous countries included in this report-Bangladesh, Brazil, Indonesia, Mexico, Nigeria,
Pakistan and the United States-each have 20-43 million adolescents. Adolescents are one-quarter of the
total population in most developing countries and about one-seventh in developed countries (Table 1,
column 2).
During adolescence, young people very much need the support and guidance of their parents and
families. This is a time of rapid growth-physically and emotionally. It is a time when adolescents begin
to develop their own standards as well as question the values of their family and community. While
providing guidance has never been a simple task, vast social change makes it even more difficult for
parents to know how to help their children and prepare them for the future.
This report focuses on childbearing during adolescence. Its main purpose is to increase worldwide
awareness of the extent to which adolescents are becoming parents and of the consequences of
pregnancy and childbearing at an early age.
Parents, governments and communities in general are concerned about early childbearing for many
reasons. It can limit educational attainment, restrict the skills young people bring to the work force (and
their capacity to support themselves financially), and reduce their quality of life.
In addition, sexual relationships at an early age put young people at risk of contracting sexually
transmitted diseases (STDs). Some STDs can affect a woman's ability to have children, and others, such
as AIDS, can be life-threatening. Pregnancy may result in serious medical complications when
adolescents give birth or have unsafe, clandestine abortions. And adolescents who give birth before
marriage may be disowned by their families; many are then left with the responsibility of raising the
child by themselves.
This report compiles data about adolescents in 44 developing and five developed countries, covering
75% of the world's total population. The countries included all have comparable data from national
fertility surveys, and in all but six countries, the data are from the Demographic and Health Surveys
(DHS), an international research effort. The developed countries are included to illustrate both
similarities and differences in adolescent behavior worldwide.
Unfortunately, the reproductive behavior of young men has not been studied as much as that of young
women. However, whenever such information is available, it is included.
Changing Living Conditions
One of the most significant factors altering the face of the developing world is the widespread migration
of people from rural areas to cities and towns. In leaving farms and close-knit villages, young people
often experience a weakening of extended family ties and face a diminished social support network.
Nonetheless, the search for better work opportunities and better living conditions has increased the
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proportion of the world's population living in urban areas from about 30% in 1950 to 45% in the
mid-1990s.. 1
Sub-Saharan Africa is less urbanized than many regions of the world, yet the proportion of young
women who live in urban areas ranges from 25-50% in 13 of 20 countries, according to data in Table 1,
column 3. The proportions are believed to be at least as high for young men.
Most countries in Asia have a similar proportion of young women living in urban areas, and those in
North Africa and the Middle East are at the upper end of the 25-50% range. In Latin America and the
Caribbean, the proportions are much higher, a range of 50-75% in all but two of the 10 countries in this
report. In developed countries, most of which have been highly urban for decades, more than 75% of
young people live in urban areas.
Educational Needs
As societies are changing and becoming increasingly urban, young people have greater need for
education; fortunately, more are obtaining at least primary schooling. Young women aged 15-19 are two
to three times more likely than women aged 40-44 to have at least seven years of education (Table 1,
columns 4 and 5). In other words, an increasing proportion of young people are completing primary
school and may have some secondary schooling. In some of the North African and Asian countries,
increases have been especially dramatic.
Chart A illustrates some of the changes. In Kenya, for example, 62% of women aged 15-19 have seven
or more years of education, compared with only 26% of 40-44 year-old women. In Bangladesh, 33% of
15-19-year-olds have at least seven years of schooling, compared with only 9% of 40-44-year-old
women.
chart a
Increased Schooling
The chances of obtaining a primary education have improved dramatically among women.
Ghana
Kenya
Zimbabwe
Bangladesh
Egypt
Indonesia
Philippines
Bolivia
Brazil
Colombia
Mexico
France
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Japan
United States
0
20
40
60
80
100
% with 27 years of schooling
Women aged 40-44
Women aged 15-19
Note: For specific data, see Table 1, columns 4 and 5.
However, in many countries, the actual proportion of young women who have some secondary
schooling is still very low. In most Sub-Saharan African countries, only 40% have attended any
secondary school, and in most North African, Middle Eastern or Asian co untries, no more than half
have done so. In Latin America as well, the proportion of young women who have attained secondary
schooling is 40-70% in eight of the 10 countries in Table 1.
Unfortunately, despite the educational gains that have occurred in the developing countries over the last
30 years, young women still fall behind young men in educational opportunities. By the time they reach
late adolescence (ages 16-20), young women are much less likely to be enrolled in school than young
men, as is the case in seven of the nine countries shown in Chart B.
chart b
Gender Differences
By late adolescence, young women fall behind young men in educational
enrollment.
Ghana
Kenya
Zimbabwe
Bangladesh
Egypt
Indonesia
Females
Philippines
Males
Bolivia
Colombia
0
20
40
60
80
100
% enrolled in school at ages 16-20
Note: Ghana-ages 15-19; Indonesia-ages 16-18. For specific data, see Data
Sources, p. 8.
School enrollment may not mean that the individual is attending classes regularly, but in all nine
countries, 38-54% of young men aged 16-20 are enrolled in school, while in six of these countries,
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27-37% of young women are enrolled. However, gender disparities are less for 11-15-year-olds, an
age-group in which 70-90% of both young men and young women in all but two of these countries are
enrolled in school.
In addition to young women being less likely than young men to attend school, they may face unique
barriers to completion: They are generally expelled from school if they become pregnant, and they rarely
return once they have left.
Sexual Relationships Before Marriage
As young people postpone marriage to later ages, the likelihood of beginning a sexual relationship prior
to marriage increases in both developed and developing countries. Consequently, so does the chance of
unintended pregnancy, abortion or birth among unmarried adolescents. Worldwide, young men and
women are increasingly attending school together, and this increased interaction may also contribute to
the incidence of sexual relationships prior to marriage.
Traditionally, in some parts of Sub-Saharan Africa, premarital sexual relationships are encouraged
because young women are expected to prove their fecundity prior to establishing a union. In most
Sub-Saharan African countries, 40% or more of 20-24-year-old women have sexual intercourse prior to
their first marriage-and before the age of 20.2 In many Latin American countries, as many as 30% of
women report having premarital sex before their 20th birthday. The actual level of premarital sexual
activity may be higher than the reported level because single women may not feel it is acceptable to
acknowledge that they are sexually active.
However, not all adolescent sexual activity is consensual. Sexual abuse, incest and rape are troubling
realities in developing and developed countries alike. In Uganda, nearly half (49%) of sexually active
primary school girls report being forced to have sexual intercourse, and 22% anticipate receiving gifts or
money in exchange for sex.³ In the United States, seven in 10 women who have sex before age 14, and
six in 10 who have sex before they reach age 15, report having had sex involuntarily.4
When Adolescents Have Babies
The number of adolescents giving birth each year is staggering. In fact, slightly more than 10% of all
births worldwide-almost 15 million-are to young mothers.⁵
However, in the past 20-30 years, early childbearing has been declining in many countries of Asia, North
Africa and the Middle East. In seven of these countries in Table 1 (columns 6 and 7), the proportion of
women aged 20-24 who had their first child as an adolescent is 15-35 percentage points lower than that
of women now aged 40-44. For example, in Indonesia, 51% of women aged 40-44 had their first child
during their adolescent years, as compared with 33% of younger women.
By comparison, little change has occurred in Latin America and Sub-Saharan Africa. In most countries
in these regions, declines are small, and in 12 countries, young women are now a little more likely to
have a child during adolescence than were older women (Botswana, Burkina Faso, Cameroon, Central
African Republic, Malawi, Mali, Namibia, Niger, Nigeria, Colombia, Guatemala and Paraguay).
Improvements in general health conditions and nutrition, especially in Sub-Saharan Africa, are
contributing to a lowe r age at menarche and to increased fecundity during adolescence.
Overall, about 35% of young women in Latin America and the Caribbean have their first child before
their 20th birthday, and an even higher proportion (50-60%) do so in most countries in Sub-Saharan
Africa. As Chart C illustrates, the United States has one of the highest levels of adolescent childbearing
in the developed world, with 19% of young women giving birth before age 20. This is almost three times
the level in France and nine times as high as in Japan.
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chart e
Early Childbearing
The proportion of women having their first child at a young age is declining.
Ghana
Kenya
Zimbabwe
Bangladesh
Egypt
Indonesia
Philippines
Bolivia
Brazil
Women aged 40-14
Colombia
Women aged 20-24
Mexico
France
Japan
United States
0
20
-10
60
80
100
%
who had a child by age 20
Note: For specific data, see Table 1, columns 6 and 7.
In most of Sub-Saharan Africa and Latin America, 15-20% of all births are to women aged 15-19 (Table
1, column 8). In Asia, North Africa and the Middle East, however, the proportion of births to adolescents
is much lower, ranging from 3-14% in all but one of these countries. In these regions, recent social
changes have brought about increases in the age at which women begin their first union and have their
first child.
In Latin America and the Caribbean, Sub-Saharan Africa and the developed countries, childbearing
among unmarried young women is more common than in Asia, North Africa and the Middle East. For
example, 5-16% of married women aged 20-24 had their first birth before marriage in most Latin
American countries and in the United States; 13-30% did so in most Sub-Saharan African countries, but
only 2% or fewer did so in North Africa, the Middle East or Asia.6
Early Childbearing
Having a baby is probably one of the most significant events in a person's (or a couple's) life. Having a
baby during adolescence is much more complicated and potentially hazardous than having a baby as an
adult, however.
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Within any society, childbearing among adolescents is most common among the poor. As a result of
poverty, these young mothers may be malnourished, a factor that contributes to poor pregnancy
outcomes. In fact, in some countries, females-young and old alike-receive less food, or less nutritious
food, and lower quality health care than boys and men.
In the United States, and probably most other countries too, pregnant adolescents are less likely than
older pregnant women to obtain adequate prenatal care. A lack of prenatal care means that
pregnancy-related complications, often present among young women, may not be identified and treated.
When a woman becomes pregnant before age 18, birth can be dangerous for both mother and baby. If the
mother's pelvis is undersized because of incomplete skeletal growth, she may suffer prolonged or
obstructed labor. The risk of death during childbirth is 2-4 times higher among mothers aged 17 or
younger than among mothers aged 20 or older.⁷
Mortality and morbidity rates are also higher among infants born to young mothers. The risk of dying in
the first year of life is typically greater by 30% or more among babies whose mothers are aged 15-19
than among those born to mothers aged 20- ;29.8
Do Adolescents Want To Be Parents?
Young women aged 15-19 in most Sub-Saharan African and Latin American countries report that a high
proportion of their births are unplanned-either not wanted at the time the birth occurred or not wanted
at all (Table 1, column 9). Young married women, as well as unmarried women, experience unplanned
and unwanted births-even in countries where early marriage and childbearing are the norm.
One-third or more of all births to adolescents are unplanned in 11 of the 20 Sub-Saharan African
countries and seven of the 10 Latin American countries included in this report. About one-fifth were
unplanned in all but two of the remaining countries in these regions. And in Asian countries with few
adolescent births (the Philippines, Sri Lanka, Thailand and Turkey), 22-41% are unplanned.
Unplanned births among adolescents are also quite common in the developed world. They are especially
high in the United States, where 73% of 15-19-year-old women giving birth report that the pregnancy is
unplanned.
While a substantial proportion of adolescent mothers report that their births are unplanned, more than
half say that the birth is a wanted one. In countries where social change has been slow in coming, where
the desired family size is relatively large, where most childbearing occurs within marriage, or where
Islam is the predominant religion, adolescents are more likely to report that their births are wanted than
in countries where the reverse conditions prevail. These reports may reflect the adolescents' conscious
choice or they may reflect conformity to a common belief in some countries that young women should
have their first child soon after marriage.
Faced with an unplanned pregnancy, some young women turn to abortion-whether legal or illegal in
their country. When the abortion is performed by an untrained person, or under unsanitary conditions,
the procedure can result in illness, infection, infertility and even death. Because young women may have
difficulty locating a provider of safe abortion and paying for such a procedure, they often delay
obtaining an abortion until a later, more difficult, gestational stage. For all these reasons, they are more
likely than older women to be hospitalized with life-threatening complications from the procedure. 9
Education Helps Delay Childbearing
The higher a woman's level of education, the more likely she is to postpone marriage and childbearing.
Adolescents with little schooling are often twice as likely-and sometimes three times as likely-as
those with more education to have a baby before their 20th birthday.
As Chart D shows, 46% of young Colombian women with less than seven years of schooling have their
first child by age 20, compared with 19% of those with more education. The contrast is even greater in
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Egypt, where 51% of less educated women have their first birth before the age of 20 compared with only
9% of better educated women.
chart d
Births by Age 20
Increases in education delay the age at which a woman marries and has her first child.
Ghana
Kenya
Zimbabwe
Bangladesh
Egypt
Indonesia
Philippines
Bolivia
Brazil
≥7 years of schooling
Colombia
7 years of schooling
Mexico
France
Japan
United States
0
20
40
60
80
100
% of women 20-24 who gave birth by 20
Notes: Japan and the United States-women with <12 years of schooling and with
>=12 years of schooling. For specific data, see Data Sources, p. 8. Sources: See
reference 6, Appendix Table 5, cols. 12 and 13. Older DHS surveys than those in Table
1 were used in Ghana (1988), Zimbabwe (1988), Indonesia (1991), Bolivia (1989) and
Colombia (1990).
The link between lack of education and early childbearing is also strong among adolescents in the
United States. Some 58% of young American women who receive less than a high school education give
birth by their 20th birthday, compared with 13% of young women who complete at least 12 years of
schooling.
In some countries, girls and young women may not be given even the opportunity to attend school and
are expected to marry at a young age. Therefore, the average young woman in these countries has little
education and has her first baby during her adolescent years. However, the low level of education is not
the cause of early childbearing; rather, the coincidence of the two is usually a characteristic of living in
impoverished and rural environments.
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Conclusions
The sheer numbers of young people-as well as the values, health, education and productive skills they
attain-will profoundly affect the future of society. This basic fact strongly argues that increased
attention should be given to the well-being of adolescents worldwide.
Some improvements are already occurring. The level of education among young people is much higher
than that of their parents, and the expectation that young people should obtain at least some secondary
schooling is growing. The proportion of women who have a child during their adolescent years is
declining in some parts of the world, and recognizing the impact of childbearing on educational
attainment, parents and communities increasingly discourage sexual activity, marriage and motherhood
at a young age. The growing acceptance by many governments of the need to improve the status and
health of women has focused policymakers' attention on the situation of youth, especially that of girls
and young women.
However, there is need for continued efforts at all levels. Too many young people either do not attend
school or drop out before completing primary school. In many countries, girls are receiving less
education than boys. In some areas, early marriage and early childbearing continue to be accepted-even
encouraged-resulting in a high proportion of women who begin their first union or marriage and have
their first child while still adolescents. Moreover, a substantial proportion of pregnancies and births to
young women in all countries are mistimed or unwanted, and where legal abortion is unavailable,
adolescents may resort to unsafe, clandestine abortion as an alternative.
Some governments do not yet accept the importance of improving the quality and reach of education,
and many do not accept doing so for boys and girls equally. Furthermore, in some communities, parents
may not accept the value or the need for girls to be educated. Even when governments, communities and
families are convinced of the importance of better educational and employment opportunities for young
people, and of working toward greater equality between the sexes, political will is still needed to ensure
that resources are appropriately directed.
The need for policy initiatives that increase educational opportunity is especially great among young
women who are poor, and therefore, are more likely than better-off adolescents to leave school, marry
and begin childbearing at an early age. The difficulty of implementing policies that promote behavior
change and broaden opportunities cannot be underestimated. Yet, it is imperative that governments,
communities and families take responsibility for and actively work toward creating an environment that
will enable and inspire young people to better themselves-and their world.
References
1. United Nations (UN), World Urbanization Prospects: The 1994 Revision, New York, 1995.
2. The Alan Guttmacher Institute (AGI), "Sexual Relationships and Marriage Worldwide," Women,
Families and the Future, New York, 1995.
3. J. Noble, J. Cover and M. Yanagishita, The World's Youth 1996, wall chart, Population Reference
Bureau, Washington, D.C., 1996.
4. AGI, Sex and America's Teenagers, New York, 1994.
5. UN, unpublished tabulations of age-specific fertility rates, 1990-2045; and The Sex and Age
Distribution of the World's Populations: The 1994 Revision, New York, 1995.
6. AGI, Hopes and Realities: Closing the Gap Between Women's Aspirations and Their Reproductive
Experiences, New York, 1995, Table 5, col. 14.
7. A.P. McCauley and C. Salter, "Meeting the Needs of Young Adults," Population Reports, Series J,
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Technology
The New Bork Times
ON
THEWEB
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January 13, 1999
Free Speech Debated in Suit Over Anti-Abortion
Web Site
By SAM HOWE VERHOVEK
P
ORTLAND, Ore. "The Nuremberg Files: Visualize Abortionists on
Trial," proclaims the site on the World Wide Web. With simulated blood
dripping from fetus parts, the site leads a cyber-visitor to the "main
archive," listing the names of dozens of doctors and clinic workers around the
country who provide abortions.
For some of the people the site calls "baby
ALLEGED ABORTIONISTS AND THEIR
butchers," the information includes
ACCOMPLICES
photographs, home addresses, license plate
numbers, the names of their spouses and
...
children. A few doctors, including Barnett
A. Slepian of Amherst, N.Y., near Buffalo,
who was fatally shot by a sniper last fall,
have a line through their names, denoting
ABORTIONISTS: the baby butchers
that they have been killed; those who have
been wounded have their names listed in
A page from an anti-abortion Web site,
gray.
which, with its list of names and
addresses of abortion providers, is at the
For a Federal court jury here, hearing a
heart of a lawsuit.
civil case brought by Planned Parenthood
and several doctors against some of the
most militant abortion opponents in the country, the trial will boil down to this
question: is the Web site constitutionally protected free speech?
The plaintiffs, who are seeking up to $200 million in damages, have brought
their case under the 1994 Federal Freedom of Access to Clinic Entrances Act,
which makes it illegal to use "force or threat of force" against anyone seeking
or providing an abortion, and allows clinics to seek unlimited damages if
workers are harmed or intimidated. But as simple as the question before the
jury sounds, the legal issues are not.
For one thing, this is the first major case brought under the law that does not
involve direct personal threats or an actual physical confrontation. While the
plaintiffs say the Web site amounts to a solicitation of murder, the defendants
contend that it is a legal informational tool.
The Web site, which is named for the German city in which Nazis were put on
trial after World War II, explains: "A coalition of concerned citizens throughout
the U.S.A. is cooperating in collecting dossiers on abortionists in anticipation
that one day we may be able to hold them on trial for crimes against humanity.
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We anticipate the day when these people will be charged in perfectly legal
courts once the tide of this nation's opinion turns against the wanton slaughter
of God's children."
But abortion is legal. And in the climate surrounding the issue -- the National
Abortion Federation says there have been 7 killings, 15 attempted murders, 99
acid attacks, 154 arson incidents and 39 bombings involving abortion clinics or
workers in the last two decades -- the plaintiffs here say that radical
anti-abortion groups are clearly using devices like the Web site to incite more
violence and deny women access to abortion services.
"Just like bounty hunters of the Old West, the defendants want to stop the
doctors by any means -- dead in their tracks," Maria Vullo, a lawyer for the
plaintiffs, told jurors. "It's terrorism."
In testimony here on Monday, Dr. Warren Hern, of Boulder, Colo., said his life
had been turned into a nightmare by the protesters, who have also put his face
on their "Deadly Dozen" flier, which looks like a wanted poster and says he and
other doctors are "Guilty of Crimes Against Humanity."
"It has made me feel a great sense of personal isolation," Dr. Hern told the
jurors, explaining that he now wears a bulletproof vest, covers his windows,
always sits with his back toward the wall and is leery of any contact with
strangers.
But the roster of 14 defendants, which includes the American Coalition of Life
Advocates, an umbrella group that has been described as too extreme by more
mainstream anti-abortion groups, say most of the information they provide
could be found in telephone directories.
Furthermore, they say, nothing in the "Nuremberg Files" advocates violence
against the doctors or clinic workers, although the site does include links to
other Web pages that defend killing abortion workers as legally justifiable
homicide, and to a letter from prison from Paul J. Hill, who murdered a doctor
in Pensacola, Fla., in 1994. In it, he describes "the joy I felt after shooting the
abortionist, and still feel today."
In opening arguments last week, Chris Ferrara, a lawyer for the defendants, said
the case was baseless.
"This is a case about the threat to kill or injure, which is simply not there," he
said. "Opinions? Yes, sometimes harsh. But no violence."
Judge Robert E. Jones of Federal District Court, has turned down requests from
the defendants to dismiss the case outright, in effect ruling that the Web site
was not automatically protected free speech.
In some ways, Judge Jones seems to have signaled that the plaintiffs may have
a valid case.
Quoting an appeals court ruling in another case, Judge Jones wrote that "alleged
threats should be considered in light of their entire factual context, including
the surrounding events and the reaction of the listeners."
Jonathan Entin, a law professor at Case Western Reserve University in
Cleveland, said the case posed a difficult question of where to draw the line
between protected free speech and illegal threats. The basic standard set by the
Supreme Court is that speech is protected unless it is directed toward and likely
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to produce "imminent lawless action," he said.
"The problem for the plaintiffs is, the Web site does not explicitly say, it is your
moral duty to go out and kill these people or maim them or harm their family,"
Professor Entin said. "On the other hand, in the context in which this case is
being litigated, we know there are people who are out there who are willing to
go out and kill people who perform abortions. So the question is, to what extent
will people take seriously the implicit message on this Web site, which is
clearly that all right-thinking people should use whatever means necessary to
stop people from performing abortions?"
Other experts said that if the Web site specifically advocated murder, it would
almost certainly be found to be illegal, and, conversely, if it did not list doctors'
names and addresses, it would almost certainly be considered protected speech.
But the question before the jury, where in the middle does it belong?
"The issues in this case are very tricky," said David J. Fidanque, executive
director of the American Civil Liberties Union of Oregon, which has filed a
friend-of-the-court brief, arguing that the jury must focus not only on the fear
the list may have spurred in the doctors, but also on the intent of the abortion
opponents who contributed to it.
Though the case happens to represent one of the first major jury trials regarding
free speech and threats on the Internet, several legal experts agreed that the core
issue would be the same if the abortion opponents had published the list of
doctors in a newspaper or flier.
In addition to seeking damages, the plaintiffs want an injunction from Judge
Jones that could essentially force the abortion opponents to cease circulating
the files. Among the named defendants are Michael Bray, a minister and author
of a book called "A Time to Kill," which argues that killings of abortion
doctors can be justifiable, and C. Roy McMillan, director of an anti-abortion
group in Mississippi who has said that "it wouldn't bother me if every
abortionist in the country today fell dead from a bullet."
In testimony this afternoon, another defendant, Andrew Burnett, publisher of
Life Advocate Magazine of Portland, defended publishing the names and
addresses of doctors on the Web site with the address
www.christiangallery.com/atrocity. He said his own address had been
published numerous times in The Oregonian, the daily newspaper in Portland,
after he was arrested in abortion protests.
It was a jarring experience, Burnett said, but one that made him realize how
committed he was to his cause. Of the lists, he said: "It's a legitimate way to
have people reconsider what they do for a living."
Related Sites
These sites are not part of The New York Times on the Web, and The Times has no control
over their content or availability.
The Nuremberg Files
Freedom of Access to Clinic Entrances Act, from the Web site of the
National Abortion Federation
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WH/OWIO : Accomplishments and Agenda - Fact Sheet V
http://www.whitehouse.gov/WH/EOP/Women/OWIO/Fact_sheets/V.html
Text version
Fact Sheet V
Promoting Reproductive Health Services for Women
"Certain choices are too personal for politics. President Clinton and Vice
President Gore
The President is committed to ensuring that all women have access to reproductive
health and family planning services, that all women are able to determine the number
and spacing of their children, and that abortion is safe, legal and rare.
Reversed the Gag Rule
During his first week in office, President Clinton reversed the previous administration's
attempts to prevent federally funded family planning clinics from providing full information
on options for resolving unintended pregnancies. A notice of proposed rule making for
permanent reversal has been issued.
Supports Reproductive Health and Family Planning
Under President Clinton, the annual budget for the Title X Family Planning Program has
increased from $173.4 million to $193.3 million. This program is the primary federal
mechanism for direct provision of reproductive health and family planning services to
low-income women. It is estimated that subsidized family planning services, such as those
provided through Title X, prevent more than 1 million unintended pregnancies and 500,000
abortions each year. In addition, the President reversed the ban, instituted in 1987 by the
Reagan Administration, on privately funded abortion services in U.S. military hospitals; and
repealed the Mexico City policy, established in 1984 banning U.S. funding support to
international organizations that include abortion services in their reproductive health and
family planning programs. In 1994, at the International Conference on Population and
Development in Cairo, the United States agreed with more than 150 nations to promote
reproductive health for all women and to address the threat to women's health from unsafe
abortion.
Establishing Clinic Safety
President Clinton signed the Freedom of Access to Clinic Entrances Act to fight the
escalating violence against women and doctors at women's health clinics.
Moved Forward with Reproductive Research
President Clinton ordered that the ban on mifepristonne, a drug that terminates pregnancy
without surgery, be revisited. Currently, the drug is undergoing clinical trials in the U.S.
Establishing Services for Victims of Rape and Incest
Under President Clinton, the Department of Health and Human Services implemented a
congressionally ordered change to Medicaid to include abortion services for women whose
pregnancies result from rape or incest, in addition to saving the life of the woman.
Office of Women's Initiatives and Outreach. Phone: 202 456-7300; Fax: 202 456-7311
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ISSUES IN BRIEF
The U.S. Family Planning Program Faces Challenges and
Change
Although a woman's reproductive years span half of her lifetime, the typical American woman today
wants only two children-a goal that is unrealistic without the use of contraception. In 1990,
approximately 30.5 million women were considered to be at risk of unintended pregnancy (that is, they
were sexually active and fertile, but were neither pregnant nor desiring pregnancy); over 15 million were
low-income women and teenagers in need of subsidized contraceptive services. The nation's organized
family planning program was established to address their needs.
One in three women who made a family planning visit in 1988 - the last year for which comprehensive
data are available - reported going to a publicly funded family planning clinic. These clinics
complement the private health care system in several ways: They serve Medicaid-eligible women when
other providers refuse to accept them; provide subsidized services to low-income women who are not
eligible for Medicaid; offer more extensive counseling on contraceptive methods; provide confidential
services for teenagers and other women who may not be able to discuss reproductive health issues with
their regular physicians; and offer contraceptive supplies at a lower cost than is usually available
elsewhere.
This Issues in Brief describes the current structure and funding of the national family planning program,
and the reproductive health and other preventive services it provides. It examines the impact of the
program on the prevention of unintended pregnancies, births and abortions as well as on the reduction of
low birth weight and infant mortality. It also discusses the central role that Title X of the Public Health
Service Act, the historic core of the federal effort, plays in determining the shape and substance of the
national family planning service delivery system.
Overview
History. Studies conducted during the 1960s showed that rates of unwanted childbearing among
low-income women were at least twice as high as those among the more affluent-a phenomenon that
could be traced in large part to inequalities in access to family planning services. By the end of the
decade, a sizable, bipartisan consensus had emerged favoring government support of voluntary family
planning programs as a means of expanding economic development, alleviating poverty, avoiding
welfare dependency and improving the health of women and their families.
In the meantime, Congress had amended a number of federal laws to allow family planning services to
be provided under certain existing programs. In 1965, as part of the so-called War on Poverty, federal
funds were made available for family planning through the Office of Economic Opportunity. In 1967,
Title IV-A of the Social Security Act was amended to require state welfare agencies to offer and provide
family planning services to women receiving public assistance.
Then, in 1970, with broad bipartisan support, legislation establishing Title X of the Public Health
Service Act was enacted and signed into law by President Richard Nixon, creating for the first time a
comprehensive federal program devoted entirely to the provision of family planning services on a
national basis. In his Message on Population Growth and the American Future, delivered the preceding
year, President Nixon declared that "no American woman should be denied access to family planning
assistance because of her economic condition. I believe, therefore, that we should establish as a national
goal the provision of family planning services to all who want but cannot afford them."
Following the enactment of Title X, public expenditures for family planning grew rapidly in the early
1970s, as the clinics Title X helped to create became established across the country. By fiscal year 1983,
$340 million in public - federal and state - funds were being spent to provide family planning
services to 5 million women at nearly 5200 separate services sites.
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A combination of politics and fiscal pressures during the 1980s, however, forced family planning clinics
to confront both budget cuts and new administrative restrictions. Congress has not formally reauthorized
Title X since 1985. (The authorization process restates congressional support for a program and sets new
funding ceilings.) Congressional appropriations have continued, but in the absence of an authorization,
funding levels have inevitably been lower. Despite these struggles, publicly funded agencies have
continued to provide services to increasing numbers of low- and moderate-income women and
teenagers.
Sources of Funding for Family Planning Services. Public funds to provide family planning services
come from diverse programs with different focuses (see Figure 1). The single largest source of funding
is the federal-state Medicaid program (Title XIX of the Social Security Act). While the large majority of
family planning agencies - 83% - derive at least some income from Medicaid reimbursements, few
rely heavily on it. Medicaid does not fund family planning clinics or provide services directly. Instead, it
is an insurance mechanism whereby federal and state governments reimburse physicians and other health
care professionals for the medical services, including family planning, they have provided to eligible
individuals.
Many poor women are not eligible for Medicaid coverage. To be eligible for Medicaid in most states, a
woman must be single, have already had a child (or be pregnant) and meet income eligibility
requirements that are often extremely low; nationwide, the average income eligibility ceiling is only
about 50% of poverty, or approximately $6000 a year for a family of three.
Poor and low-income women who do not qualify for Medicaid are dependent on clinics for family
planning services. In contrast to Medicaid, Title X is a "categorical" grant program that supports the
establishment and operation of clinics. It is the only federal program dedicated solely to funding family
planning and related reproductive health care services.
Until 1985, Title X constituted the single largest source of public funds for family planning. In 1992,
Title X still helped to support 76% of all family planning agencies, providing more than 20% of the
budgets for over half of them. Thus, Title X continues to provide the underpinnings for the entire
national family planning effort, enabling clinics established with its funds to take fuller advantage of
Medicaid reimbursements and other funding sources.
Clinic services are also partially supported in most states with federal funds from the Maternal and Child
Health and Social Services block grants (Titles V and XX of the Social Security Act), but with a few
exceptions, family planning services are only a small component of these broad programs. In addition,
state contributions to family planning services have grown considerably in recent years. In 1992, only
five states did not use any of their own funds for family planning services; 69% of family planning
agencies received some support from state appropriations.
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Figure I
Several public programs fund
contraceptive services.
State Funds
24.1%
Medicaid
49.6%
Title X
17.1%
Social Services
block grant
Maternal & Child Health
4.6%
block grant
4.5%
Percent Distribution. Fiscal Year 1992
Who Provides Publicly Funded Family Planning Services. In 1992, a total of 2610 agencies provided
organized family planning services --- 1430 health departments, 170 Planned Parenthood affiliates, 260
hospitals and 750 other types of agencies. Together, these agencies operated more than 5400 individual
clinic sites. Of these, 52% were operated by state health departments, 15% by Planned Parenthood
affiliates, 6% by hospitals and 27% by other agencies. Over the last 10 years, there has been a decrease
in the proportion of clinics run by health departments and an increase in those operated by other
agencies, such as independent family planning councils and community and migrant health centers.
The average number of clients served at each clinic site in 1992 was 1010. Planned Parenthood affiliates
had both more clinic sites and larger caseloads, serving 4-8 times as many clients per agency as the other
types of agencies. While Planned Parenthood affiliates reported an average of 2040 clients per clinic site,
health department clinics, many of which are located in rural or sparsely populated areas, served an
average of 760 clients annually.
Who Receives Services at Publicly Funded Family Planning Clinics. Data from the 1988 National
Survey of Family Growth (NSFG), conducted periodically by the National Center for Health Statistics
(NCHS) of the federal Centers for Disease Control and Prevention, show that the number of women who
received their most recent family planning services at a publicly subsidized clinic rose from 6.1 million
in 1982 to 7.1 million in 1988.
The trend toward greater use of family planning clinics is promising. Nonetheless, gaps in the provision
of services remain. According to the 1988 NSFG, only 84% of women in households with incomes
below 200% of poverty who were at risk of unintended pregnancy were using contraception. In contrast,
92% of women with higher incomes were using some form of contraception.
Another indicator of the continuing need is a 1995 NCHS report indicating that, overall, U.S. women
have an average of 3.3 pregnancies over their lifetime, of which only 1.8 are wanted births. White
women average 2.8 pregnancies, 1.6 of which are wanted births; black women average 5.1 pregnancies,
of which 1.8 are wanted births; and Hispanic women average 4.7 pregnancies, of which 2.6 are wanted
births.
Services Provided in Publicly Funded Family Planning Clinics. Besides providing contraceptive
methods and related counseling, family planning clinics conduct many related tests and examinations
(see Table 1). In fact, one study found that women who had obtained family planning services from a
clinic during the previous 12 months were much more likely than women who had not to have received a
pelvic exam and other essential health screening, regardless of the number of visits or source of payment
for the visit.
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The large majority of agencies also provide contraceptive and STD/HIV services to men and have
special programs targeted at teenagers. Over half of the agencies conduct educational programs
emphasizing the postponement of sexual activity, and three-quarters report that their counselors spend
extra time with teenage clients, particularly to provide information and counseling on sexually
transmitted diseases.
The Impact of Publicly Funded Family Planning Services
Publicly funded family planning services have been responsible for preventing large numbers of
unintended pregnancies, abortions and births to low-income women, and especially to unmarried women
and teens.
Publicly subsidized family planning services prevent 1.2 million unintended pregnancies in the
United States each year. By assisting women and families to prevent these unwanted pregnancies,
the national family planning effort prevents 509,000 unintended births and 516,000 abortions each
year. (The remainder would end in miscarriages.)
Each year, publicly subsidized family planning services prevent 798,000 unintended pregnancies
to unmarried women, thereby avoiding 344,000 out-of-wedlock births and 350,000 abortions.
Each year in the United States, publicly funded family planning programs prevent 256,000
unintended pregnancies to teenagers; this avoids 110,000 teenage births and 112,000 abortions.
Because many of the women receiving publicly funded family planning services would be eligible
for other publicly subsidized care if they became pregnant, each public dollar spent to provide
family planning services saves more than $4 that would otherwise be spent to provide medical
care, welfare benefits and other social services. Over $3 is saved in medical costs alone.
Publicly subsidized family planning programs help 281,000 women already enrolled in welfare
avoid becoming pregnant each year; these efforts prevent 123,000 current welfare recipients from
having an additional birth, and 122,000 abortions.
In addition, publicly funded family planning programs prevent 80,000 pregnancies to women who
are not currently enrolled in welfare but who would become welfare recipients if they gave birth;
these efforts prevent 35,000 women from giving birth and becoming dependent on welfare each
year, and prevent 35,000 abortions.
The data also show that public funding of family planning services prevents poor birth outcomes
and improves women's overall health.
Publicly funded family planning services increase the likelihood that pregnant women will obtain
adequate prenatal care. Women who do not obtain sufficient prenatal care are about twice as likely
as those who do to have a low-birth-weight baby, the leading cause of infant mortality in the
United States. A study of 45,000 women who gave birth in North Carolina in 1989 and 1990
found that women who used family planning services in the two years before conception were
more likely to begin prenatal care early and to receive adequate levels of care throughout their
pregnancies. As a result of publicly funded family planning services provided between 1982 and
1988, 107,000 fewer women gave birth after having obtained inadequate prenatal care, according
to a recent national study.
That study also found that publicly funded family planning services provided between 1982 and
1988 prevented 20,000 low-birth-weight deliveries, 6500 infant deaths and 5500 neonatal deaths.
A recently published analysis of Wisconsin's chlamydia prevention program, which includes
family planning clinics as primary screening and treatment sites, found steep declines in the
incidence and complications of the infection. Between 1987 and 1991, the incidence of new
infections in women decreased by 27-50% in clinic populations. Between 1986 and 1991,
hospitalization rates declined by 33% for pelvic inflammatory disease and by 20% for ectopic
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pregnancy, both serious complications of chlamydia.
The benefits of publicly funded family planning services in the United States have long been recognized.
Leading authorities in public health have agreed on its demonstrated effectiveness, not just in preventing
pregnancy, but in improving the health of women and their children (see Table 2).
The Key Role of Title X
While no longer its largest funder, the Title X program continues to be the glue that holds the national
family planning service delivery system together, largely determining both its structure - through its
nationwide network of clinics - and the substance of the services that are provided to low- and
moderate-income women and teenagers. In 1990, 5.3 million family planning clients were served by
clinics administered by Title X-supported agencies.
Women who received services at Title X-supported clinics in 1990 were predominantly young, poor and
had never had a child. Black women, who are more likely than others to be poor, were
disproportionately represented among the clinic population. At the same time, when all clinic clients are
taken into account, about 42% of the women using Title X-funded clinics were married; 69% were 20
years or older; and 63% were non-Hispanic whites.
Title X is administered by the Department of Health and Human Services (DHHS), which is responsible
for allocating the funds appropriated annually by Congress among the 10 federal health regions. In each
region, the health administrator receives applications from, and awards grants on a competitive basis to,
public and nonprofit private agencies that provide contraceptive services as well as training, technical
assistance and other support.
In 1991, there were a total of 85 primary Title X grantees, ranging from 1-4 per state. Fifty Title X
grantees were state and local health departments; 12 were independent family planning councils; eight
were Planned Parenthood affiliates; 15 grantees were other types of agencies.
Some Title X grantees operate family planning clinics directly, distributing grant funds among their
various facilities. Others allocate the money to "delegate agencies," which administer the operation of
individual clinics. Agencies providing family planning services, whether primary Title X grantees or
their delegates, are diverse, community-based organizations. Recipients of Title X funds (in addition to
those listed above) include: university medical centers, community action organizations, community
health centers, nursing service organizations and a wide variety of nonprofit agencies, many of which are
located in places where little or no other reproductive health care is available.
In 1991, 814 separate delegate agencies received Title X funds; Title X grantees and delegate agencies
together administered approximately 4100 clinics that year. Clinics administered by Title X agencies
were located in each state and in at least two-thirds of all counties. Over half of these clinics (58%) were
administered by state and local health departments; 17% by Planned Parenthood affiliates; and the
remaining 25% by hospitals, regional or local family planning councils, Indian nations and community
organizations.
Title X also determines the substance of the services offered to individuals. Each grantee is ultimately
responsible for ensuring that its delegate agencies and the clinics they run meet the program's
requirements. The Title X statute requires that a grantee provide "a broad range of acceptable and
effective methods and services." Both the Title X regulations and official program guidelines outline in
greater detail protocols for the provision of family planning services that comport with nationally
recognized medical standards, including a mandate to offer the full range of contraceptive methods and
related counseling as well as to provide confidential services.
Any woman, regardless of age or whether she has had a child, may go to a Title X-funded clinic for
family planning services. However, the amount each individual pays for the services she receives
depends upon her income. If her income level is at or below 100% of the federal poverty level, by law
she should receive completely subsidized services, including the contraceptive method she chooses. She
will be charged on a sliding fee scale if her income is between 100-250% of poverty; and she will pay
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full fees if her income is above 250%.
The Title X regulations and guidelines serve to ensure that eligible women receive subsidized services
based appropriately on their incomes; low-income women tend to be charged higher fees in family
planning clinics that do not receive Title X funds.
Title X and Politics. As the one federal program devoted to the provision of family planning services,
Title X has also been the focal point for much of the political wrangling over reproductive health issues.
Title X and Teens. From the beginning, Title X has required that services be made available without
regard to age or marital status. Consequently, Title X-supported clinics have always served adolescents
confidentially and without regard for their ability to pay.
In 1981, Congress amended Title X to require that "to the extent practicable, [Title X-funded] entities
shall encourage family participation." Shortly thereafter, the Reagan administration proposed new
regulations - better known as the "squeal rule" - requiring that all parents whose adolescents visited a
family planning clinic be notified by registered mail.
Although over 40,000 letters of protest against the proposals were filed with DHHS from medical, health
and civic groups, the regulations were finalized. Most comments made the argument that the regulations
were trying to mandate open family communication which, although everyone agreed is desirable, is not
always possible.
Two federal appeals court judges eventually barred the regulations' enforcement on constitutional
grounds, and they were withdrawn without ever going into effect. Since that time, Congress has
repeatedly rejected mandatory notification or consent for contraception, and Title X-supported clinics
have maintained the policy of encouraging, but not requiring, parental involvement in minors'
reproductive health decisions.
Title X and Abortion. Since its inception in 1970, the Title X statute has prohibited use of the program's
funds for "abortion as a method of family planning." Repeated, congressionally requested investigations
during the 1980s found that all Title X-funded clinics were operating in full compliance with the law. Of
the more than 4000 Title X-funded clinics nationwide, approximately 80 provide abortions, all with
other than Title X funds. More than half of these clinics are in hospitals.
However, problem pregnancy counseling, and requested referrals for medical and social services that are
not offered under Title X, have been standard practice and are required by Title X guidelines. Even so,
DHHS in 1988 promulgated new regulations (ordered the previous year by President Ronald Reagan)
that, among other changes, would have prohibited doctors and other health professionals in Title
X-funded clinics from providing any abortion-related information or referrals on the grounds that Title X
funds were to be spent only on "pre-pregnancy related services."
The regulations generated more than 75,000 comments. Thirty-six state governments, a host of national
health, medical and civic groups, and all 25 deans of the nation's schools of public health wrote in
opposition, expressing concern that withholding this information would violate their medical ethics and
standards; moreover, they pointed out, many of the women who depend on Title X services often have
no other place to go for the information.
The legality of the so-called gag rule was upheld by the U.S. Supreme Court in 1991. Subsequently,
however, it was roundly rejected in Congress. In 1992, both houses of Congress passed legislation both
to reauthorize Title X and overturn the gag rule. The legislation was vetoed by President George Bush.
The Senate overrode the veto by a vote of 73-26. The House vote was 266-148, only 10 votes short of
the necessary two-thirds. A series of last-minute court orders blocked actual enforcement of the
regulations, and they were ultimately withdrawn in 1993 at the direction of President Bill Clinton.
Looking Ahead
The proportion of public funding for family planning services from different sources has shifted greatly
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over the last period. In 1992, Medicaid expended $319 million - 50% of all public funding-for
contraceptive services, up 81% from its 1981 level. In contrast, Title X, at $110 million, accounted for
only 17%. After adjustment for inflation, Title X expenditures for contraceptive services decreased by
72% between 1980 and 1992. Total public expenditures for contraceptive services dropped by 27%
during that period.
At the same time, the cost of providing family planning services appears to have risen in several areas,
such as contraceptive supplies and related laboratory expenses (between 1991 and 1992, the average
price for oral contraceptives to publicly funded family planning clinics rose 42%) and STD and HIV
counseling, testing and treatment. In 1993, among the agencies that do offer and provide them, these
services constitute, on average, 26% of the agency's contraceptive services budget.
Furthermore, family planning clinics are being called upon to provide care to people with other health
problems. In recent years, for example, the proportion of patients coming to family planning clinics in
need of screening or treatment for STDs has increased dramatically. Forty percent of all medical visits to
one Title X grantee in 1990 involved testing or treatment for STDs, compared with only 10% of visits in
1980. Some providers cannot absorb these additional costs; they are forced to forgo testing and to treat
patients based on their examinations alone.
Moreover, since these clients frequently have no other source of care, Title X-assisted clinics must
address their health needs more comprehensively, by offering such corollary health services as screening
for diabetes or cholesterol levels, prenatal care, programs on smoking cessation and counseling on
substance abuse. All of these efforts consume additional resources, in both staff time and money, usually
without extra funding.
Despite evidence that, in sheer numbers, family planning clinics served more people in 1991 than in
1981, many family planning providers have been forced to cut or change the nature of their services, a
development likely to have an increasingly serious impact on the accessibility of services to their clients.
Some providers report that new clients have to wait longer for an appointment, or that they have been
compelled to require higher fees for their services or to take a higher proportion of clients who can
afford to pay. For poor women seeking to prevent an unintended pregnancy, these changes could present
insurmountable obstacles.
According to a report recently issued by the Institute of Medicine, during the 1980s - when real
(inflation adjusted) spending on publicly subsidized family planning services dropped and Title X went
unauthorized - unintended pregnancy in the United States began to increase, reversing the downward
trend of previous years. Ironically, this situation has led some critics to argue that Title X should be
defunded entirely on the grounds that it has failed to solve our national problems of unintended teenage
pregnancy and out-of-wedlock births. Some critics go so far as to argue that contraception itself is a
failure, and that the provision of family planning services has made these problems worse.
Incontrovertibly, contraception works: While no contraceptive, or contraceptive user, is perfect, the fact
remains that the 10% of American women at risk of unintended pregnancy who do not use contraception
at all account for 53% of all unintended pregnancies. Public support for family planning works, too.
Even its strongest supporters readily admit that the national family planning program will never, by
itself, reduce the nation's unintended pregnancy rate to zero. At the same time, they point out that the
availability of affordable, voluntary family planning services remains the only major programmatic
intervention that - in a cost-effective manner - has been demonstrated to reduce unintended
pregnancy, avert the need for abortion and improve birth outcomes and the overall reproductive health of
the women in the United States.
Table 1
Family planning agencies provide a broad range of services
In the course of a contraceptive visit
And beyond
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Percentage of family planning agencies routinely providing
various services in the course of a woman's contraceptive visit:
Pelvic exam 98
Breast exam
(including self-breast exam) 98
Blood pressure measurement 98
Pap smear 98
Anemia screening 90
Gonorrhea screening 70
Cardiovascular problems 59
Syphilis screening 49
Chlamydia screening 46
Diabetes 45
Urinary tract infection screening 34
Pregnancy tests 30
Herpes screening 10
Percentage of family planning agencies offering various
reproductive health and other services beyond contraception:
Female Clients
HIV testing 82
Well-baby care 71
Postpartum care 70
WIC program 69
Prenatal care 66
Infertility counseling 57
Social services 49
Sports/work physicals 42
Primary health care 40
Colposcopy 32
Genetic counseling 31
Cryotherapy 30
Midlife health program 29
Mental health services 21
Mammography 15
Infertility treatment 11
Abortion 8
Day care 7
Male Clients
Condom distribution 93
STD treatment 86
STD screening 84
HIV testing 79
Sports/work physicals 36
Social services 35
Primary health care 33
Infertility counseling 32
Testicular cancer screening 30
Mental health services 21
Infertility treatment 5
Table 2
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The Importance of Family Planning Is Widely Recognized
Institute of Medicine Committee to Study the Prevention of Low Birthweight: "[I]t is important to
stress that both young teenage status and poverty are major risk factors for low birthweight and that Title
X is specifically targeted at low-income women, including adolescents. As such, the program should be
regarded as an important part of public efforts to prevent low birthweight." Preventing Low Birthweight;
1985
National Commission to Prevent Infant Mortality: "Infant mortality could be reduced by an estimated
10 percent if all women not desiring pregnancy used contraception." Troubling Trends: The Health of
America's Next Generation; 1990
March of Dimes Birth Defects Foundation: "Family planning counseling and services are essential
elements of preconception and interconception care. [We] affirm that family planning should be an
integral part of perinatal care to improve pregnancy outcome." Toward Improving the Outcome of
Pregnancy: The 90s and Beyond; 1993
Institute of Medicine Panel on Adolescent Pregnancy and Childbearing: "The availability of
contraceptive services to adolescents depends heavily on public support, in particular funding through
Title X, Medicaid and other federal and state maternal and child health programs. In light of the
demonstrated effectiveness of contraceptive use in reducing early unintended pregnancy, continued
support of these programs is essential." Risking the Future: Adolescent Sexuality, Pregnancy, and
Childbearing; 1987
Institute of Medicine Committee on Unintended Pregnancy: "Financial barriers [to contraception]
should be reduced by increasing the proportion of all health insurance policies that cover contraceptive
services and supplies extending Medicaid coverage for all postpartum women and continuing to
provide public funding for comprehensive contraceptive services, especially for those low-income
women and adolescents who face major financial barriers in securing such care. This last point speaks to
the major role that public financing programs, such as Title X and Medicaid, have played in helping
millions of people secure contraception It is essential that such public investment be maintained.' The
Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families; 1995
© 1996 by The Alan Guttmacher Institute
Major Sources
D. Daley and R.B. Gold, "Public Funding for Contraceptive, Sterilization and Abortion Services, Fiscal
Year 1992," Family Planning Perspectives, 25:244, 1993.
J.D. Forrest, "Title X Family Planning Clinic Network: Final Analysis," The Alan Guttmacher Institute,
New York, 1992.
J.D. Forrest and S. Singh, "Public Sector Savings Resulting from Expenditures for Contraceptive
Services," Family Planning Perspectives, 22:6, 1990, and special tabulations using data from the 1982
National Survey of Family Growth.
J.D. Forrest and S. Singh, "The Sexual and Reproductive Behavior of American Women, 1982-1988,"
Family Planning Perspectives, 22:206, 1990.
S.K. Henshaw and A. Torres, "Family Planning Agencies: Services, Policies and Funding," Family
Planning Perspectives, 26:52, 1994.
S.D. Hillis, et al., "The Impact of a Comprehensive Chlamydia Prevention Program in Wis-consin,"
Family Planning Perspectives, 27:108, 1995.
D.J. Jamieson and P.A. Buescher, "The Effect of Family Planning Participation on Prenatal Care Use
and Low Birth Weight," Family Planning Perspectives, 24:214, 1992.
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Issues in Brief
Support for Family Planning
Improves Women's Lives
L
ike the use of the telephone, the practice of family planning is so widespread and so
routine in the United States that we almost take for granted its far-reaching benefits.
Because American women using effective modern contraceptives can decide when to have
their children and are able to bear only the number they want, they can plan their
educational careers and their work, family and personal lives with an assurance that would
have been impossible for their grandmothers.
In the developing world, family planning can bring these same benefits to women and do
even more: By helping women prevent ill-timed or unwanted pregnancies, it can also save
their lives and protect their health.
And for couples everywhere, the use of the condom and some other contraceptives helps
protect against the spread of sexually transmitted diseases (STDs), which threaten the
well-being and sometimes the survival of men and women worldwide.
Despite the many ways in which family planning benefits women and their families
throughout the world, the support of developed countries-an essential component of
financing and improving access to these necessary services in developing countries-is
often under threat of being reduced or even eliminated. This Issues in Brief examines, the
advantages for women and society that family planning services bring, and that would be
compromised if these services were curtailed.
High-Risk Childbearing
Every year, 585,000 women-99% of them in developing regions-die from causes related
to pregnancy. These causes include the direct health consequences of high-risk pregnancies,
unsafe abortions and difficult deliveries, as well as problems that arise soon after delivery.
Maternal mortality ratios (representing the number of women who die every year from
pregnancy-related causes per 100,000 live births) in Africa, Asia and Latin America are
10-100 times the ratios in the industrialized world (Table 1, column 1). UNICEF points out
that "no public health problem shows greater disparity between rich and poor countries than
maternal mortality."
table 1
Maternal Health Risks
Country and survey year 100,000 live
Maternal
% of
% of
deaths per
women
women
births
20-24
30-34 with
with at
at least 4
least 1
live births
birth by
age 18
Sub-Saharan Africa
Botswana, 1988
250
26
53
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Burkina Faso, 1992-1993
930
32
80
Burundi, 1987
1,300
8
69
Cameroon, 1991
550
46
68
Central Afr. Rep., 1994-1995
700
38
58
Côte d'Ivoire, 1994
810
44
69
Ghana, 1993
740
25
59
Kenya, 1993
650
28
68
Liberia, 1986
560
44
59
Madagascar, 1992
490
31
67
Malawi, 1992
560
38
74
Mali, 1995-1996
1,200
46
75
Namibia, 1992
370
18
45
Niger, 1992
1,200
53
81
Nigeria, 1990
1,000
35
68
Rwanda, 1992
1,300
8
67
Senegal, 1992-1993
1,200
34
70
Tanzania, 1996
770
25
64
Togo, 1988
640
30
74
Uganda, 1996
1,200
39
77
Zambia, 1992
940
34
72
Zimbabwe, 1994
570
23
58
North Africa & Middle East
Egypt, 1995
170
15
46
Morocco, 1992
610
7
46
Sudan, 1989-1990
660
17
59
Tunisia, 1988
170
3
56
Asia
Bangladesh, 1993-1994
850
47
60
India, 1992-1993
570
28
50
Indonesia, 1994
650
16
31
Pakistan, 1990-1991
340
17
62
Philippines, 1993
280
8
40
Sri Lanka, 1987
140
5
28
Thailand, 1987
200
9
18
Turkey, 1993
180
11
30
Latin America & Caribbean
Bolivia, 1993-1994
650
19
48
Brazil, 1996
220
16
18
Colombia, 1995
100
18
21
Dominican Republic, 1996
110
22
30
Ecuador, 1987
150
16
44
El Salvador, 1985
300
u
47
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Guatemala, 1995
200
26
56
Mexico, 1987
110
19
45
Paraguay, 1990
160
16
37
Peru, 1991-1992
280
12
36
Trinidad & Tobago, 1987
90
13
30
Developed Countries
France, 1994
13*
2
6
Japan, 1992
16*
1
2
United States, 1995
13*
9
7
* Adjusted for underreporting; ratio based on national vital statistics would be
lower. Note: u=unavailable. Sources: Mortality-United Nations Development
Programme, Human Development Report, 1996, New York: Oxford University
Press, 1996, pp. 154-155; births by age 18-The Alan Guttmacher Institute
(AGI), Into a New World: Young Women's Sexual and Reproductive Lives, New
York: AGI, 1998, Appendix Table 4, col. 3, p. 52; at least four births-for
developing countries, special analysis of data from Demographic and Health
Surveys; for France, Lavertu J, Fécondité et calendrier de constitution des
familles: Enquête Famille de 1990, INSEE Résultats 579, Paris: Institut National
de la Statistique et des Etudes Economiques, 1997; for Japan, special tabulations
of the 1992 National Fertility Survey; for the United States, special tabulations of
the 1995 National Survey of Family Growth.
The major causes of maternal deaths are similar throughout the developing world, although
the relative importance of each varies from one region to another. Overall, the leading
causes are hemorrhage, or excessive bleeding (accounting for 24% of all maternal deaths);
preexisting conditions that are complicated by pregnancy (20%); sepsis, or acute infection
with fever (15%); complications of unsafe induced abortions (13%); eclampsia (12%);
obstructed or prolonged labor (8%); and ectopic pregnancy and other conditions (8%).
According to the World Health Organization (WHO), for every maternal death that occurs
worldwide, an estimated 30 additional women suffer pregnancy-related health problems that
can be permanently debilitating. Each year, approximately 17 million women are affected
with such conditions as uterine rupture, uterine prolapse (a displacement from the normal
position), hemorrhage, vaginal damage, urinary incontinence, obstetric fistula (a muscle tear
that allows urine to seep into the vagina) and pelvic inflammatory disease (which can lead
to permanent sterility).
The vast majority of pregnancy-related complications that lead to health problems or death
can be prevented in the first place, or successfully treated, if the right medical care is
available. High-quality and accessible prenatal and maternity care services are the major
reasons for the low levels of death and disability associated with pregnancy and
childbearing in developed countries. In the developing world, unfortunately, services are
often of poor quality, and coverage is inadequate or, in some areas, completely lacking.
Most women in developing countries still give birth at home, helped by a close family
member or traditional birth attendant. Fewer than one in five women obtain assistance from
a trained doctor or nurse when they give birth in Burundi, Niger, Yemen, Bangladesh and
Pakistan; fewer than one-half receive professional medical assistance in Ghana, Kenya,
Mali, Nigeria, Senegal, Uganda, Egypt, Morocco, India, Indonesia, Bolivia and Guatemala.
Even when women deliver in a hospital, the equipment, supplies, drugs, or operating rooms
and trained staff needed to do cesarean sections or manage emergencies may be lacking.
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Who Is Most at Risk?
Young Women and Mothers over 35. The risks of dying during pregnancy or childbirth are
higher for women younger than 20 and for women 35 and older than for other women
(Chart A). Teenagers' physical growth is usually incomplete, and their bodies have not
developed sufficiently for pregnancy and delivery to proceed easily. Chronic
malnutrition-which is widespread in poor countries-exacerbates the problem of
insufficient or stunted physical growth. In addition, very young women are even less likely
than older women to obtain prenatal or delivery care-especially if they are unmarried.
chart a
Maternal Mortality
Both younger and older women face an elevated risk of dying during
pregnancy or childbirth.
Maternal deaths per 100,000 live births
1,000
800
600
400
200
0
Bolivia
Uganda
Matlab. Bangladesh
15-19
20-24
25-29
30-34
35-39
Sources: Bolivia and Uganda-Demographic and Health Surveys, 1993-1994
and 1996, respectively. Bangladesh-Koenig MA et al., Maternal mortality in
Matlab, Bangladesh, 1976-1985, Studies in Family Planning, 1988, 19(2):69-80.
The younger the adolescent, the greater her maternal risk. In Jamaica and Nigeria, for
example, women younger than 15 are 4-8 times as likely to die during pregnancy or
delivery as are women aged 15-19. Although pregnancies at such early ages are common
only in certain parts of the world, many women in all developing regions have their first
child by age 18. In most of Sub-Saharan Africa, in Bangladesh and India, and in one of the
poorest countries of Latin America-Guatemala-25-53% of women aged 20-24 had their
first child before their 18th birthday (Table 1, column 2).
Maternal risk is elevated for older women in part because they frequently have had many
births and have spaced births closely, risk factors discussed next.
Women with Many Children. Women who have had five or more children are about 2-3
times as likely to die during pregnancy or childbirth as are those with two or three children.
Millions of women worldwide face this increased risk, given the large family sizes that are
typical in many regions. For example, the proportion of women aged 30-34 who have
already had four or more children is especially high-ranging from about 40% to
80%-throughout Africa and the Middle East and in some Asian countries (Table 1, column
3).
For women who become pregnant many times, the problem is not just that they are more
often exposed to obstetric risk, but also that frequent pregnancy, childbirth and
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breastfeeding deplete women's physical resources and stamina. This makes it more difficult
for them to fight the effects of heavy blood loss, infection or trauma during childbirth and
after a delivery or abortion.
Women with Closely Spaced Pregnancies. Maternal depletion also threatens safe
childbearing among women who become pregnant again before they have had time to
recover fully from an earlier birth. This problem, too, is common: Births spaced less than
two years apart account for one in 10 of all births in developing countries as varied as
Liberia, Malawi, Senegal, Morocco, Sudan, India, Turkey, Bolivia, Brazil and Peru. They
represent more than one in seven births in Madagascar, Niger, Tunisia, Pakistan, the
Dominican Republic, and Trinidad and Tobago.
Even in developed countries, a short interval between pregnancies is a risk factor,
moderately raising levels of preterm delivery and intrauterine growth retardation.
Women with Unwanted Pregnancies. Every year, an estimated 190 million women
throughout the world become pregnant, and many of them did not want to conceive. In
Latin America, an average of 40% of women of reproductive age who do not want to
become pregnant for at least a couple of years, or ever again, are not using an effective
contraceptive method; in Sub-Saharan Africa, the proportion is 85% (Chart B). Such women
often cannot avoid having an unplanned pregnancy. It should come as no surprise, therefore,
that many women seek abortions, and each year approximately 20 million of them obtain
abortions under conditions in which the procedure is illegal and therefore unsafe, greatly
increasing their risk of maternal morbidity and mortality.
chart b
Nonuse of Effective Methods
Many women who do not want to become pregnant are not using effective
contraceptive methods.
% not using effective contraceptives
100
80
60
40
20
0
Sub-Saharan
Asia
North Africa &
Latin America
Africa
Middle East
Note: Percentages are regional averages, based on women aged 15-44, weighted
by population size. Source: Special analysis of data from Demographic and
Health Surveys.
Lowering Maternal Risk
Family planning reduces the total number of pregnancies among women of childbearing
age. For this reason alone, it can substantially lower levels of maternal mortality and
morbidity. Furthermore, by helping women--especially those at highest risk-to space and
limit their pregnancies, it can do more.
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Even in parts of the world where women customarily marry as adolescents, contraceptive
use to postpone pregnancy until after the teenage years would reduce maternal mortality
associated with very early childbearing. What is more, women who wait to begin
childbearing are less likely to have a large number of children than those who first give birth
at a young age. And those who start practicing family planning early in their married lives
are less likely than those who delay to have closely spaced births.
Finally, the prevention of unwanted pregnancies would mean a reduction in the more than
76,000 maternal deaths that result from unsafe abortions each year in developing
countries-almost 15% of the total number of maternal deaths in these countries. The
associated reduction in maternal morbidity might be even more impressive, given that 30
women suffer pregnancy-related disabilities for every woman who dies.
Offering STD Protection
Millions of men and women throughout the world suffer from STDs. In addition to the
discomfort and embarrassment these diseases cause, some STDs greatly increase the
likelihood of HIV transmission during sexual intercourse, and can have other serious health
consequences.
Worldwide, the most common bacterial STDs (which are curable) are gonorrhea,
trichomoniasis, candidiasis, syphilis, genital ulcers resulting from chancroid, and
chlamydia. The most common viral STDs (which are incurable, though not necessarily
untreatable) are hepatitis, herpes, genital warts and HIV.
An estimated 333 million new infections with curable STDs-or 11 for every 100
adults-occur worldwide every year (Table 2). In absolute numbers, South and Southeast
Asia is the worst affected region. But an individual's risk of contracting one of these STDs
is highest (one in four) in Sub-Saharan Africa.
table 2
Curable STDs
Region
New yearly
Yearly rate
infections
per 100
(millions)
adults
World
333
11
South & Southeast Asia
150
18
Sub-Saharan Africa
65
25
Latin America & Caribbean
36
15
East Asia & Pacific
23
3
Eastern Europe & Central Asia
18
11
Western Europe
16
8
North America
14
9
North Africa & Middle East
10
6
Australasia
1
9
Source: World Health Organization (WHO), An Overview of Selected
Curable Sexually Transmitted Diseases, Geneva: WHO, 1995.
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According to the WHO's most recent global estimate, every year, 5.9 million individuals
become infected with HIV-an increase over previous estimates. The vast majority of new
infections are in Sub-Saharan Africa (four million) and South and Southeast Asia (1.3
million)-the regions with the highest STD rates.
Next to complete sexual abstinence-an impractical goal for most people-the most
effective protection against the spread of both bacterial and viral STDs is the latex condom.
If used correctly, this method-while offering contraceptive protection-can dramatically
reduce the likelihood that an infected man or woman will pass the disease to a sexual
partner.
The female condom, the sponge, and the diaphragm or cervical cap used with a spermicide
also have the potential to reduce STD transmission. What is more, by reducing genital wart
infections, all barrier and spermicidal methods offer some protection against the
development of cervical cancer. However, while the effects of spermicidal methods on
reducing the risk of certain STDs is clear, the evidence on their effects on HIV transmission
remains inconclusive.
Other modern contraceptive methods also confer some health protection. The pill helps
reduce a woman's chance of developing endometrial or ovarian cancer, and the longer it is
used, the lower the risk. What is more, among women with chlamydia and gonorrhea,
hormonal contraceptives reduce the chance of pelvic infection, ectopic pregnancy and
infertility.
Family planning and reproductive health service providers help improve and even save the
lives of both women and men by educating couples about healthy sexual behavior, the
benefits of condom use, and STD prevention and treatment, and by linking clients and their
families to other preventive and curative health services.
Empowering Women
Access to family planning services is affirmed as a universal human right in many United
Nations documents. More concretely, it contributes to the advancement of women and to the
fuller development of society.
Women who are able to defer childbearing until their 20s improve their chances of having
time to obtain adequate schooling, develop work skills and acquire broad life experience.
And women who bear only the number of children they want have increased opportunity
and time to be in the labor market and to build competence and achieve personal fulfillment.
Such participation in society enhances women's sense of self-worth and improves the
well-being of their families.
The relationship between women's empowerment and family planning is often mutually
reinforcing: As women obtain more education and gain the skills and confidence they need
to go out into the world and earn money of their own, their desire and ability to plan their
childbearing also grows. Moreover, women who practice family planning are more likely
than those who do not to seek other types of health care services for their children and
themselves.
Taking Effective Action
Helping women avoid high-risk and unwanted pregnancies remains an urgent health
priority-especially where access to prenatal and emergency obstetric care is inadequate,
and nutrition and overall health are poor. And the use of the latex condom is the only
effective way known to prevent the transmission of STDs-including HIV-among
sexually active couples. What is more, in many parts of the developing world, a woman's
first referral to other important health services is often made through her initial contacts
with a family planning provider, be it a clinic, community-based distributor or outreach
worker.
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In many developing countries, it will be difficult-and will take decades-to improve
overall health and living conditions, and to change deeply entrenched, discriminatory
cultural practices and attitudes that harm women and jeopardize their health. While these
broad goals should continue to be pursued, the more widespread provision of family
planning services is an achievable (and highly cost-effective) way of improving both
women's lives and the well-being of couples and families everywhere.
Sources of Data
The Alan Guttmacher Institute (AGI), Hopes and Realities: Closing the Gap Between
Women's Aspirations and Their Reproductive Experiences, New York: AGI, 1995.
AGI, Preventing Pregnancy, Protecting Health: A New Look at Birth Control Choices in the
United States, New York: AGI, 1991.
National Academy of Sciences, Contraception and Reproduction: Health Consequences for
Women and Children in the Developing World, Washington, DC: National Academy Press,
1989.
Safe Motherhood Initiative, Causes of maternal deaths, , accessed Apr. 9, 1998.
United Nations Children's Fund (UNICEF), The Progress of Nations, 1996, New York:
UNICEF, 1996.
World Health Organization (WHO), Abortion: A Tabulation of Available Data on the
Frequency and Mortality of Unsafe Abortion, Geneva: WHO, 1994.
Credits
Akinrinola Bankole and Susheela Singh oversaw data compilation and analyses used for
this publication, which was written by Deirdre Wulf. This Issues in Brief was made possible
by support from the Andrew W. Mellon Foundation and the Rockefeller Foundation.
© copyright 1998, The Alan Guttmacher Institute.
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CONTACT:
Susan Tew/Beth Frederick
212/248-1111 (phone)
212/248-1952 (fax)
[email protected]
NEGLECTING YOUNG WOMEN'S REPRODUCTIVE
HEALTH NEEDS THREATENS WORLDWIDE PROGRESS
Education, Contraception and Health Services Are Lacking
Adolescent women throughout the world need improved access to education, information about
sexuality and reproduction, and a full range of reproductive health services, regardless of their marital or
childbearing status. Needed services include those for contraception, sexually transmitted diseases
(STD) and pregnant and/or parenting women. The 260 million 15-to-19-year-old women throughout the
world are the next generation of mothers, workers and leaders. For young women to fulfill these roles to
the best of their abilities, their sexual experience must be acknowledged and their educational and
reproductive health needs must be met, according to a new report by The Alan Guttmacher Institute,
Into A New World: Young Women's Sexual and Reproductive Lives. Consider:
Up to 60% of adolescent births throughout the world are unplanned, and about one in nine
adolescents lack the contraceptive protection they need to prevent an unwanted pregnancy;
one-third to two-thirds of young women obtain less than seven years of schooling in most
developing countries; and,
over 300 million cases of curable STDs occur worldwide each year, with young women especially
susceptible to these diseases and bearing the most serious consequences.
"The lives of the young women depicted in this report are to some extent already determined,"
comments the president of The Alan Guttmacher Institute, Jeannie I. Rosoff. "Most are no longer in
school, many are married or mothers, and some have been exploited sexually. But the same fate does not
need to befall their younger sisters, or the next generation of adolescents. Parents, communities and
governments must recognize how quickly the world is changing, and how imperative it is to direct
attention to improving the situation of girls and young women. Indifference, wishful thinking and denial
will not prepare their children, particularly their girls, to take their rightful place in a modernizing
world."
Today, there are more than one billion young men and women between the ages of 10 and 19 around the
world-the largest generation of youth in history. The 541 million young women-281 million of whom
are aged 10-14-are a formidable demographic force, and their pattern of childbearing has major
implications for the size of the world's population.
The new report brings together comparable information from 53 developing and developed countries,
covering five major regions-Asia, Latin America and the Caribbean, North Africa and the Middle East,
Sub-Saharan Africa and Western Europe, the United States and Japan-representing about 75% of the
world's total population. It demonstrates the diversity and commonality of young women's experiences
in the education they receive; their patterns of marriage, sexual activity and childbearing; their
contraceptive and reproductive health care needs; and the risks they confront as they deal with changing
values around sexuality. Further, it identifies the vast individual and societal benefits to be realized in
meeting these needs.
EDUCATION: Girls continue to be disproportionately disadvantaged in their access to education, an
increasingly important prerequisite for the modern world. While more young women today get a basic
education (seven or more years of schooling) than did their mothers, girls in many developing countries
get less schooling than boys and those in rural areas get less than girls in urban communities. In some
cultures, the benefits of equal, higher education for girls clash with traditional patterns of early marriage
and motherhood, or compete with economic realities, such as needing them to work in the home.
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Throughout Latin America and in many African and Asian nations, the proportion of young
women in rural areas who have seven or more years of education is one-half to one-third the
proportion in urban areas and in some countries, educational disparities are even larger.
Gender disparity in secondary education is common throughout North Africa, the Middle East and
Sub-Saharan Africa, where half of the countries studied showed six or fewer young women attend
secondary school for every 10 young men enrolled.
SEXUAL ACTIVITY AND MARRIAGE. In a large part of the world, the majority of women have
their first sexual experience as adolescents.
Eight in 10 young women in Sub-Saharan Africa have had first intercourse before age 20; four in
10 before marriage.
Eight in 10 young women in five developed countries have had intercourse as adolescents; seven
in 10 before marriage.
Six in 10 young women in Latin America and the Caribbean have done so in adolescence; three in
10 before marriage.
A woman who marries as an adolescent may lack the education, the experience and the skills that a
slightly older woman is likely to bring to her marriage and family. Levels of early union and marriage
have typically declined from those a generation ago. Still, adolescent marriage remains common among
women in some regions.
In many countries of Sub-Saharan Africa, 40-60% of adolescent women marry by age 18, and in
others, such as in Mali and Niger, more than three-quarters do so.
In India and Bangladesh, 50-70% marry by age 18.
Some 25-40% of young women form their first union by age 18 in most of Latin America and the
Caribbean.
In contrast, 10-30% of young women marry by age 18 in some North African and some Southeast
Asian countries, and only 5% do so in China.
CONTRACEPTIVE USE. Contraceptive use by married and unmarried adolescents is more common
than in the past, but in most of the world, use is still low. The majority of young women have heard
about modern contraceptive methods, but they may lack access to these methods, lack information on
their proper use or do not use one because they are expected to have a child soon after marriage. Many
adolescents who want to practice modern contraception have little skill in negotiating contraceptive use
with their sexual partners; have limited transportation and meager financial resources; and encounter
services that are geared to older, adult women and that do not offer privacy and confidentiality to
adolescents, especially if unmarried.
About three to five in 10 married adolescents practice contraception in many countries in Latin
America and the Caribbean.
About seven in 10 adolescents practice contraception in developed countries such as the United
States.
Sexually active unmarried adolescents are more likely than married ones to practice contraception
throughout Sub-Saharan Africa, and in the few countries of Latin America and the Caribbean for
which information is available, they are as likely as their married counterparts to do so.
Worldwide, 11% of adolescent women-or 29 million, both married and unmarried— are sexually
active and do not want to have a child soon but lack the necessary protection to prevent an
unwanted pregnancy, either because they are not using a contraceptive method or because they are
using less effective methods.
In Sub-Saharan Africa, North Africa and the Middle East, rates of contraceptive use are low
among married young women-20-30% in Morocco, Namibia and Zimbabwe, and under 10% in
many others.
Nonetheless, in some countries in Sub-Saharan Africa, such as Ghana and Kenya, current levels
are 3-5 times what they were 20 years ago.
In Asia, contraceptive use among married adolescents is very low in India and Pakistan (less than
5%) but more common in Indonesia and Thailand (36% and 43%, respectively), where it has
increased strikingly since the 1970s.
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ADOLESCENT PREGNANCY AND CHILDBEARING. Adolescent childbearing is declining in
countries where it had been common, as access to education increases and as the social, health and
economic advantages of delaying births become more widely recognized. Still, in many parts of the
world, women often have their first child before age 18, rural adolescents and those with little education
are unlikely to delay childbearing, adolescent births are often unplanned, and very young adolescents
experience health risks and problematic pregnancy outcomes more often than older adolescents or adult
women.
Each year, adolescents have more than 14 million births worldwide.
The proportion of women who have their first child by age 18 ranges from 1% in Japan to 53% in
Niger.
One-fourth to one-half of all adolescent births in Latin America and the Caribbean are unplanned,
as are 15-30% of those in North Africa and the Middle East and 40-60% in such Asian and
Sub-Saharan countries as the Philippines, Ghana, Kenya, and Zimbabwe.
In the United States, seven in 10 births to adolescents are unplanned.
Across Sub-Saharan Africa, Asia, Latin America and the Caribbean, a woman who has her first
child before age 18 will have an average of seven children by the time she has completed her
family; however, if she waits until her early 20s, her family will average five or six children, and
if she postpones childbearing until her late 20s, she will typically have three or four children.
If today's young women were to have their first child two-and-one-half years later than is currently
the average age at first birth, population growth by the year 2100 will be 10% lower than if no
change occurs; if they postpone that first birth by five years, it will be 20% lower-a decrease of
1.2 billion people.
REPRODUCTIVE HEALTH SERVICES FOR YOUNG WOMEN. Sexually active adolescents face a
variety of risks, including exposure to unwanted pregnancy, unsafe abortion and sexually transmitted
diseases, that threaten their sexual and reproductive health and may impair their future fertility.
In India, Egypt, Indonesia and the Philippines, 25% or less of adolescent mothers give birth in a
hospital or health facility; in Bangladesh, the proportion is 3%.
Young adolescents are more likely to experience premature labor, spontaneous abortion and
stillbirths than are older women, and they are up to four times as likely as women older than 20 to
die from pregnancy-related causes.
The infants of very young mothers face a risk of death during the first year that is 30% higher than
the risk faced by infants of adult mothers.
Adolescent mothers need health care for themselves and their infants and social support to enable
their continued schooling, for example.
Faced with an unwanted pregnancy, some young women seek clandestine abortions, which endangers
their health-or their very life. Abortion-related infections are especially common in countries where
abortion in legally restricted, and adolescents frequently comprise a large proportion of patients who are
hospitalized for complications from such procedures.
The rate of adolescent abortion varies from country to country, ranging from very low|levels in
Germany (3 abortions per 1,000 women aged 15-19) and Japan (6 per 1,000), to moderately high
levels in Brazil (32 per 1,000) and the United States (36 per 1,000).
In Malawi, Uganda and Zambia, adolescent women represent one-fourth to one-third of patients
suffering from complications of unsafe abortions, and in Kenya and Nigeria, more than half of
women with the most severe abortion complications are adolescents.
In Latin America and the Caribbean, about one-tenth of all women hospitalized after an abortion
are younger than 20, and adolescents comprise one-third of the women with the most serious
infections.
Sexually transmitted diseases, including HIV/AIDS, are a major cause of reproductive tract infections
that threaten the future fertility and lives of young women and affect the health of their newborns,
potentially resulting in low birth weight, prematurity and increased susceptibility to infections and
diseases.
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Newsrelease: Into A New World
http://www.agi-usa.org/new/archive/nr_inw.htm.
Each year, 8-9% of people aged 15-49 are estimated to be infected with a curable STD in North
America and western Europe, and rates as much as three times as high in some regions of the
developing world.
Half of HIV infections occur among people younger than 25, and recent estimates show that some
7,000 15-24-year-olds are infected with HIV each day.
In Botswana, Nigeria and Rwanda, 20% or more of pregnant adolescent women test positive for
HIV.
In some regions of the world, the AIDS epidemic has reached shockingly high proportions among
adolescents; nearly 13% of all urban youth aged 14-20 in Rwanda are infected with HIV.
Sexual relationships that result from force, coercion and abuse, and some cultural practices such as
female genital mutilation, endanger the reproductive health of young people. Young women who are
sexually abused are at risk of infection and unwanted pregnancy, and they may also suffer other trauma
and psychological distress.
In the United States, four in 10 women who have sex before age 15 report their first sexual
experience as involuntary; in Santiago, Chile, nearly 3% of young women who have sex before
age 18 say that rape is their first experience of sexual intercourse.
Female genital mutilation, one cultural practice that endangers reproductive health, often results in
lifelong pain during intercourse, recurrent pelvic infections and prolonged, obstructed labor and
delivery.
Sexual exploitation of children and adolescents for commercial gain is a multi-billion dollar illegal
industry, according to UNICEF.
"Society must prepare young people to face a world far different from that of their parents," notes Into A
New World in summarizing the challenges revealed in the new report. "They need the guidance and
support of their family and their community, and the attention of a government committed to their
development the importance of investing in the lives of young men and women-of rethinking policies
and priorities, committing financial resources and implementing programs-reaches far beyond sheer
numbers. How well communities and nations meet the needs of young people not only will determine
the kinds of lives these young people have, but also has ramifications for the lives of the children they
bring into the world and for the societies they will build and maintain."
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Issues in Brief-- Endangered: U.S. Aid for Family Planning Overseas
http://www.agi-usa.org/pubs/ib11.html
ISSUES IN BRIEF
Endangered: U.S. Aid for Family Planning Overseas
In the wake of groundbreaking international accords calling for greater political and financial attention
to population and development issues, the United States is failing to fulfill its commitments. During the
last two years, ultraconservatives in Congress have doggedly attacked U.S. participation in the
International Conference on Population and Development in Cairo and the Fourth World Conference
on Women in Beijing and have made U.S.-aided family planning programs a favorite target of their
hostility. Cleverly using the divisive issue of abortion, they have attacked family planning efforts as
promoting abortion by encouraging promiscuity, sabotaging parental authority and threatening family
life.
Frustrated in their attempts to restore heavy-handed policies imposed on international family planning
programs during the Reagan years, key members of the U.S. House of Representatives set out, instead,
to undermine these programs through draconian funding restrictions. They succeeded: In 1995, while
funding for most humanitarian aid was reduced by 20%. family planning was singled out for
extra-ordinarily harsh treatment-a far deeper cut and a complicated allocation scheme that reduced
even further the amount of funds actually available. Lawmakers gave no reprieve in 1996, as the
disproportionate funding cut was extended for a second year. Another congressional test of this issue,
however, is already slated for February 1997.
This Issues in Brief explores the political climate confronting family planning assistance. It describes
the human toll that deep funding cuts will take in the form of more unplanned pregnancies and
abortions, more women dying in pregnancy and childbirth, and more infant deaths. Finally, it discusses
why U.S. leadership is critical to the global family planning effort and why it is fully consonant with
American traditions and values.
The congressional elections of 1994 ushered into the House of Representatives a formidable bloc of
antiabortion conservatives. Facing an electorate that is basically prochoice, however, they had few
potential targets within their reach. Foreign assistance became an easy mark and the restoration of the
so-called Mexico City policy became a rallying cry.
The Mexico City policy was first enunciated by the Reagan administration at the 1984 United Nations'
population conference in that city; it was revoked by President Clinton nearly 10 years later. The policy
deemed population growth a "neutral" phenomenon; to the extent it could be considered a problem, it
would be solved by "market forces." The policy also declared that, henceforth, the United States would
no longer "promote" abortion worldwide--something that, in fact, had been prohibited by law since
1973. The latter goal would be achieved by imposing strict new conditions on indigenous, private
organizations abroad-conditions that could not be imposed on similar U.S.-based institutions. Under
the Mexico City policy, these overseas organizations would be disqualified from receiving U.S. family
planning aid if-with their own funds and in accordance with the laws of their own countries-they
provided any abortion-related information or services.
The House endorsed the reimposition of the Mexico City restrictions on several occasions in 1995 but
was rebuffed by the Senate each time. The Senate's refusal to reinstate these discriminatory and
imperialistic restrictions, even after the House countered with varying versions, resulted in a lengthy
showdown between the two chambers. As a consequence, a second-but equally devastating-assault
by family planning opponents began to unfold: to decimate the program's funding.
In January 1996, almost four months into the new fiscal year and under immense pressure to head off a
third governmentwide shutdown, both the Senate and the White House were forced to accept a
self-described "compromise" proffered by the House leadership. As the price for dropping the Mexico
City language, family planning would be stripped of much of its funding. First, an overall funding cut of
35%--a much deeper cut than that sustained by development assistance generally-was imposed.
Second, to punish family planning even further, an unprecedented and complex set of funding rules
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would be imposed. No funds would be made available until July 1-a full nine months into the fiscal
year-and, perhaps most severe of all, the funds, once released, could only be doled out in monthly
installments over the next 15 months.
The fiscal 1997 budget process brought more of the same. Still stymied by Senate and White House
opposition to the Mexico City restrictions, the far-right demanded an extension of the same funding
conditions. However, another test of the issue was built into the equation. The new law requires
Congress to vote-by February 28, 1997-on a presidential "finding" (itself to be delivered by February
1) as to whether the funding limitations are having "a negative impact on the proper functioning" of the
international family planning program. Assuming the president reports that they are, and both the House
and Senate agree, the fiscal 1997 money will be released on March 1 instead of July 1.
A Major Setback
Meanwhile, the impact on the lives of millions of women who are served by these programs, and on
their families, will be profound. As nations head into the 21st century, the largest generation in history is
just reaching adulthood. The choices these young women and men make about family size will depend
greatly on the contraceptive and reproductive health services available to them, and will help shape their
futures and the world's thereafter.
Moreover, given that women are the primary caretakers and household managers throughout much of the
developing world, their health and well-being undeniably determines how their children-especially
their daughters-will fare in life. In the immediate future, the relatively dismal state of women's
reproductive health throughout much of the developing world can be expected to worsen as a direct
result of the severe cutback in U.S. family planning aid.
According to a 1996 report from the United Nations Children's Fund (UNICEF), almost 600,000 women
die during pregnancy and childbirth each year; 75,000 of these women die attempting to abort an
unwanted pregnancy themselves or with the help of an untrained and unsafe provider. All told, these
deaths render at least one million children motherless every year.
UNICEF further estimates that for every woman who dies, "approximately 30 more incur injuries,
infections and disabilities which are usually untreated and unspoken of, and which are often humiliating
and painful, debilitating and lifelong." Improving access to quality family planning services, notes
UNICEF, is paramount to improving maternal and child health in developing countries. It is well
documented that mortality rates for women and children are highest when births are spaced too close
together, when a woman has many children (more than four) and when births occur too early or too late
in a woman's life. Yet the campaign by abortion opponents to decimate government-supported family
planning services only assures that women and their families in the developing world will know more
suffering and death.
Measuring the Impact
In early 1996, a consortium of expert organizations undertook an effort to quantify the impact of the
steep reduction in family planning aid. Their calculations, which take into account only the 35% cut to
the program's overall funding level, are conservative by design (see Methodology). Excluded from the
analysis is the combined effect of the nine-month moratorium and the monthly "metering" of funds,
which only adds to the financial hardship.
Based solely on the one-year, 35% cut, the consortium estimates that:
7 million couples in developing countries who would have used modern contraceptive methods
will not have access to these methods.
As a result, 4 million more women will experience unintended pregnancies, leading in turn to:
1.9 million more unplanned births and 1.6 million more abortions (the remainder of the
unintended pregnancies will end in miscarriages);
8,000 more women dying during pregnancy and childbirth, including from unsafe abortion;
and
134,000 more infant deaths.
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Unmet Needs The devastating cuts to U.S. family planning assistance abroad come at a time when
increased access to family planning and related reproductive health care is crucial. Although progress
has been made, the unmet need for quality contraceptive services remains considerable.
Over the last three decades, the size of the average family has fallen from roughly six children to about
three. By having fewer children, parents are in a better position to provide for them and improve the
family's quality of life overall. However, while women are striving-and succeeding, albeit with great
difficulty-to have smaller families, a gap still exists between the number of children women say they
want and the number they actually have. Many women give birth before they and their partners feel they
are ready to care for a child, and substantial proportions of women-more than 50% in some
countries--say their last birth was mistimed or unwanted. (see Chart1).
Chart 1
Unplanned Births
Many women say their last birth was mistimed or unwanted
Cameroon
22
Nigeria
12
Pakistan
24
Jordan
38
Guatemala
29
Kenya
56
Egypt
42
Indonesia
24
Mexico
5)
Philippines
47
Thailand
33
Colombia
38
Japan
52
United States
39
France
19
0
20
40
60
% of women whose last birth was:
Mistimed
Unwanted
Source: AGI, Hopes and Realities
The use of effective contraceptive methods has increased rapidly over the past 30 years throughout the
developing world. Yet nearly 230 million women worldwide-roughly one in six women of
reproductive age-are still in need of modern contraceptive methods to postpone or avoid future
childbearing (see chart 2).
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Chart 2
Unmet Need
Many women need family planning to postpone or end childbearing
Cameroon
31
Nigeria
28
Pakistan
28
Jordan
22
Guatemala
33
Kenya
38
Egypt
20
Indonesia
19
Mexico
19
Philippines
20
Thailand
11
Colombia
17
Japan
17
United States
10
France
13
0
20
40
60
% of women needing contraception to:
Space births
End Childbearing
Source: AGI, Hopes and Realities
The high level of unmet need for family planning is a key reason why women have great difficulty in
spacing their pregnancies and bearing the number of children they want. Determined to avoid an
unplanned, unwanted birth, many women-in the absence of family planning or following a
contraceptive failure-resort to unsafe abortion. Worldwide, more than one-quarter of
pregnancies-about 52 million annually-end in abortion, often performed clandestinely and under
unsanitary conditions.
Meeting the Challenges
Helping women narrow the gap between their child-bearing desires and what they actually experience is
at the heart of U.S. family planning assistance. Enabling women to have the number of children they
want, and when they want them, is central to the quality of their lives and the well-being of their
families. And women's success in achieving their reproductive goals has important implications for the
social and economic welfare of the communities and nations in which they live and, ultimately, or the
future of the world.
Rapid population growth severely reduces the likelihood that developing societies can move out of
poverty or that women can contribute to development on an equal footing with men. Providing women
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with the means to control their fertility, primarily throu gh improved access to quality family planning
services, is, therefore, fundamental to human progress.
In this light, it is important to recognize that the impact of deep cuts to U.S. family planning aid will
extend well beyond the delivery of contraceptive and reproductive health services to women and
couples. On-going U.S. efforts to improve literacy ra tes and primary school education of girls, promote
good nutrition, improve maternal and child health, and enhance women's participation in the economic
and political spheres of society will feel the sting as well.
On the ground, these programs rarely operate in a vacuum, independent of each other. Rather, over the
years, they have become increasingly integrated, partly to maximize resources but largely because such
efforts naturally complement and reinforce one an other. The extensive cuts to family planning
assistance inevitably will affect other development endeavors.
U.S. Leadership
Currently, about three-quarters of the roughly $4 billion spent to provide family planning services in
developing countries is borne by the countries' own governments and by the women and men who use
these services. The remainder is contributed by developed countries. Financial support from developed
country governments-both to other governments directly and to indigenous nongovernmental
organizations (NGOs) working in those countries-clearly plays a pivotal role in meeting the rapidly
increasing contraceptive needs of couples in the developing world. And, it is no exaggeration to say that
the U.S. program is the anchor of the global family planning effort on which other countries'
contributions depend for stability and direction.
Should U.S. support for international family planning continue to erode, it is unrealistic to expect that
other donor countries will-or could-make up for the loss of U.S. government funds. No other country,
nor international organization for th at matter, has the extensive field presence nor the vast array of
technical resources and experience that the U.S. family planning effort has developed over the decades.
Moreover, American leadership has been crucial to forging alliances among governments and the private
sector so that family planning and related social services are provided in a more integrated manner.
Reflecting American Values
Making family planning services widely available to all who want them is one of the surest ways to
foster self-sufficiency, promote preventive health care and basic education, nurture strong and healthy
families, and enhance the quality of life for all of us. In many ways, family planning reflects the core
values that most social conservatives-indeed, most Americans-hold so dearly. It is ironic that the
strongly held antiabortion views of some conservatives have been extended into the r ealm of family
planning, which has long enjoyed strong bipartisan support in Congress and around the country as a
means to reduce the incidence of abortion.
The American public supports humanitarian assistance-family planning and reproductive health
services, child survival, education, environmental protection-not only as a necessary price for world
leadership but also as the right thing for a weal thy country to do. In a recent nationwide poll conducted
by the University of Maryland, those surveyed felt that 5% of the national budget was an appropriate
level for the U.S. to spend on development assistance. Currently, less than 1% of the federal budget is
earmarked for international aid, and less than half of that amount goes to humanitarian assistance.
Contributing "our fair share" to alleviate poverty and promote better health and nutrition among
developing societies is a strongly held American value, one that has driven U.S. international assistance
for many decades. And making quality family plannin g services available to all who want them has
been a central tenet of American humanitarian aid. Clearly, it must remain so if our efforts are to
succeed in improving the lives of women, supporting families worldwide and benefiting our own lives
here at home.
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Methodology
The potential effect of a 35% cut in U.S. funding for family planning is estimated by gathering and
sometimes reconciling information from a wide variety of sources, ranging from national censuses and
population estimates to country-specific surveys of wo men of reproductive age and special studies of
contraceptive use and of pregnancy outcomes.
The estimates that follow reflect the knowledge and expertise of the following organizations: The Alan
Guttmacher Institute, The Futures Group, Population Action International and the Population Reference
Bureau, in consultation with the Population Counci 1. The basic steps in reaching the estimation are as
follows.
The first step in estimating the impact of the funding cut begins with determining how many of the
couples who depend on U.S. funded family planning programs will lose their access to
contraceptives.
Population censuses and estimates indicate an estimated 829 million women of reproductive age
are living today in developing countries other than China (which receives no U.S. family planning
program support).
Surveys of women in developing countries show that roughly 247.5 million of these women and
their partners use modern methods of contraception to lengthen the time between the births of
their children or to avoid having more children than they already have.
Because of their poverty, 190.5 million, or 77%, of the couples in developing countries outside of
China who are using modern contraceptive methods rely on public-sector family planning
programs.
The United States contributes about 17% of all public funds spent on family planning in
developing countries other than China, accounting for 32.4 million couples using modern
contraceptive methods. [Of these couples, 12.6 million are estimated to be protected by
contraceptive sterilization or long-lasting methods including hormonal implants (such as
Norplant) or intrauterine devices (IUDs).
On an annual basis, 19.8 million couples depend on U.S. supported programs to obtain
contraceptive supplies, such as pills, condoms or injectables, or to start use of a long-term method,
such as voluntary sterilization, hormonal implant or IUDs.
A cut in program resources of 35% means that 12.9 rather than 19.8 million couples will be able to
be served in a year's time, leaving 7 million couples without access to contraceptive supplies or
services.
The second step is estimating what effect losing U.S.-supported family planning services will have
on the couples who are depending on them for contraceptive care.
There are few other contraceptive choices in developing countries for women who lack access to
modern contraceptives. A conservative estimate is that of the 7 million women losing|services
because of U.S. funding cuts 2.8 million will turn to traditi onal methods and 4.2 million will use
no contraceptive.
Because pregnancy rates are so much higher among couples relying on no method or on a
traditional method than if they use a modern contraceptive, 4 million more unwanted pregnancies
are expected in developing countries due to the drop in family planni ng program resources.
About 40% of these unintended pregnancies are likely to end in induced abortion, even though it
is often not legal and performed in unsafe conditions-accounting for 1.6 million abortions among
the expected additional unwanted pregnancies.
Some 47% of the unintended pregnancies are likely to end in unwanted births with the remaining
13% resulting in spontaneous abortions or miscarriages-accounting for 1.9 million unwanted
births among the expected additional unwanted pregnancies.
Maternal mortality rates in developing countries are high, about 4.1 deaths per 1,000 women
giving birth, leading to an estimated 8,000 additional deaths due to pregnancy among the women
facing additional unintentional pregnancies.
Infant mortality rates in developing countries are high, with about 7.2% of all babies born dying
before their first birthday, leading to an estimated 134,000 additional infant deaths among the
women facing additional unintentional pregnancies.
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Abortion in America
49% of pregnancies among American women are unintended; 1/2 of these are
terminated by abortion.
In 1996, 1.37 million abortions took place, down from an estimated 1.61 million in
1990. From 1973 through 1996, more than 34 million legal abortions occurred.
Each year, 2 out of every 100 women aged 15-44 have an abortion; 47% of them have
had at least one previous abortion and 55% have had a previous birth.
An estimated 43% of women will have at least 1 abortion by the time they are 45 years
old.
Each year, an estimated 50 million abortions occur worldwide. Of these, 30 million
procedures are obtained legally, 20 million illegally.
52% of U.S. women obtaining abortions are younger than 25: Women aged 20-24
obtain 32% of all abortions, and teenagers obtain 20%.
2/3 of women having abortions intend to have children in the future.
While white women obtain 60% of all abortions, their abortion rate is well below that of
minority women. Black women are more than 3 times as likely as white women to have
On average, women give at least 3 reasons for choosing abortion: 3/4 say that having a
baby would interfere with work, school or other responsibilities; about 2/3 say they
cannot afford a child; and 1/2 say they do not want to be a single parent or are having
problems with their husband or partner. an abortion, and Hispanic women are roughly 2
times as likely.
Contraception in America
11% of women having abortions have never used a method of birth control; nonuse is
greatest among those who are young, unmarried, poor, black, Hispanic or poorly
educated.
Safety of Abortion in America
1 death occurs in every 150,000 legal abortions, compared with 1 in every 34,000 in
1974.
1
Teen Pregnancy in America
13% of all U.S. births are to teens.
76% of births to teens occur outside of marriage.
1/4 of teenage mothers have a second child within 2 years of their first.
Teens who give birth are much more likely to come from poor or low-income families
(83%) than are teens who have abortions (61%) or teens in general (38%).
In 1993, 3.8 million mothers aged 15-44 received welfare or Aid to Families with
Dependent Children (AFDC); 55% of these women became mothers when they were
teenagers. Only 5% were currently teenage mothers, and 83% of
these-159,000-were aged 18-19; young teens, those aged 15-17 accounted for
32,000 of all mothers receiving AFDC.
7 in 10 teen mothers complete high school, but they are less likely than women who
delay childbearing to go on to college. In part because most teen mothers come from
disadvantaged backgrounds, 28% of them are poor in their 20s and early 30s; only
7% of women who first give birth after adolescence are poor at those ages.
1/3 of pregnant teens receive inadequate prenatal care; babies born to young mothers
are more likely to be low birth weight, to have childhood health problems and to be
hospitalized than are those born to older mothers.
Nearly 4 in 10 teen pregnancies (excluding miscarriages) end in abortion. There were
about 289,000 abortions among teens in 1994.
Since 1980, abortion rates among sexually experienced teens have declined steadily,
because fewer teens are becoming pregnant, and in recent years, fewer pregnant teens
have chosen to have an abortion.
Impact of Publicly Funded Family Planning Services in America
Publicly subsidized family planning services prevent 1.2 million unintended pregnancies
in the United States each year. By assisting women and families to prevent these
unwanted pregnancies, the national family planning effort prevents 509,000 unintended
births and 516,000 abortions each year. (The remainder would end in miscarriages.)
Each year, publicly subsidized family planning services prevent 798,000 unintended
pregnancies to unmarried women, thereby avoiding 344,000 out-of-wedlock births and
350,000 abortions.
2
Each year in the United States, publicly funded family planning programs prevent
256,000 unintended pregnancies to teenagers; this avoids 110,000 teenage births and
112,000 abortions.
Because many of the women receiving publicly funded family planning services would
be eligible for other publicly subsidized care if they became pregnant, each public dollar
spent to provide family planning services saves more than $4 that would otherwise be
spent to provide medical care, welfare benefits and other social services. Over $3 is saved
in medical costs alone.
Publicly subsidized family planning programs help 281,000 women already enrolled in
welfare avoid becoming pregnant each year; these efforts prevent 123,000 current welfare
recipients from having an additional birth, and 122,000 abortions.
In addition, publicly funded family planning programs prevent 80,000 pregnancies to
women who are not currently enrolled in welfare but who would become welfare
recipients if they gave birth; these efforts prevent 35,000 women from giving birth and
becoming dependent on welfare each year, and prevent 35,000 abortions.
The data also show that public funding of family planning services prevents poor birth
outcomes and improves women's overall health.
Publicly funded family planning services increase the likelihood that pregnant women
will obtain adequate prenatal care. Women who do not obtain sufficient prenatal care are
about twice as likely as those who do to have a low-birth-weight baby, the leading cause
of infant mortality in the United States. A study of 45,000 women who gave birth in
North Carolina in 1989 and 1990 found that women who used family planning services in
the two years before conception were more likely to begin prenatal care early and to
receive adequate levels of care throughout their pregnancies. As a result of publicly
funded family planning services provided between 1982 and 1988, 107,000 fewer
women gave birth after having obtained inadequate prenatal care, according to a recent
national study.
That study also found that publicly funded family planning services provided between
1982 and 1988 prevented 20,000 low-birth-weight deliveries, 6500 infant deaths and
5500 neonatal deaths.
A recently published analysis of Wisconsin's chlamydia prevention program, which
includes family planning clinics as primary screening and treatment sites, found steep
declines in the incidence and complications of the infection. Between 1987 and 1991, the
incidence of new infections in women decreased by 27-50% in clinic populations.
Between 1986 and 1991, hospitalization rates declined by 33% for pelvic inflammatory
disease and by 20% for ectopic pregnancy, both serious complications of chlamydia.
3
The Impact of Education on Reducing Adolescent Pregnancy
Young women aged 15-19 are two to three times more likely than women aged 40-44 to
have at least seven years of education. In other words, an increasing proportion of young
people are completing primary school and may have some secondary schooling. In some
of the North African and Asian countries, increases have been especially dramatic.
In Kenya, for example, 62% of women aged 15-19 have seven or more years of
education, compared with only 26% of 40-44 year-old women. In Bangladesh, 33% of
15-19-year-olds have at least seven years of schooling, compared with only 9% of
40-44-year-old women.
The number of adolescents giving birth each year is staggering. In fact, slightly more than
10% of all births worldwide-almost 15 million-are to young mothers.
Overall, about 35% of young women in Latin America and the Caribbean have their first
child before their 20th birthday, and an even higher proportion (50-60%) do so in most
countries in Sub-Saharan Africa. The United States has one of the highest levels of
adolescent childbearing in the developed world, with 19% of young women giving birth
before age 20. This is almost three times the level in France and nine times as high as in
Japan.
46% of young Colombian women with less than seven years of schooling have
their first child by age 20, compared with 19% of those with more education. The contrast
is even greater in Egypt, where 51% of less educated women have their first birth before
the age of 20 compared with only 9% of better educated women.
The link between lack of education and early childbearing is also strong among
adolescents in the United States. Some 58% of young American women who receive less
than a high school education give birth by their 20th birthday, compared with 13% of
young women who complete at least 12 years of schooling.
International Adolescent Pregnancies
Up to 60% of adolescent births throughout the world are unplanned, and about one in
nine adolescents lack the contraceptive protection they need to prevent an unwanted
pregnancy.
One-third to two-thirds of young women obtain less than seven years of schooling in
most developing countries.
Over 300 million cases of curable STDs occur worldwide each year, with young women
4
especially susceptible to these diseases and bearing the most serious consequences.
One-fourth to one-half of all adolescent births in Latin America and the Caribbean are
unplanned, as are 15-30% of those in North Africa and the Middle East and 40-60% in
such Asian and Sub-Saharan countries as the Philippines, Ghana, Kenya, and Zimbabwe.
In the United States, seven in 10 births to adolescents are unplanned.
Across Sub-Saharan Africa, Asia, Latin America and the Caribbean, a woman who has
her first child before age 18 will have an average of seven children by the time she has
completed her family; however, if she waits until her early 20s, her family will average
five or six children, and if she postpones childbearing until her late 20s, she will typically
have three or four children.
If today's young women were to have their first child two-and-one-half years later than is
currently the average age at first birth, population growth by the year 2100 will be 10%
lower than if no change occurs; if they postpone that first birth by five years, it will be
20% lower-a decrease of 1.2 billion people.
International Reproductive Health Services for Young Women
In India, Egypt, Indonesia and the Philippines, 25% or less of adolescent mothers give
birth in a hospital or health facility; in Bangladesh, the proportion is 3%.
Young adolescents are more likely to experience premature labor, spontaneous abortion
and stillbirths than are older women, and they are up to four times as likely as women
older than 20 to die from pregnancy-related causes.
The infants of very young mothers face a risk of death during the first year that is 30%
higher than the risk faced by infants of adult mothers.
Adolescent mothers need health care for themselves and their infants and social support
to enable their continued schooling, for example.
International Adolescent Abortion Rates
The rate of adolescent abortion varies from country to country, ranging from very low
levels in Germany (3 abortions per 1,000 women aged 15-19) and Japan (6 per 1,000), to
moderately high levels in Brazil (32 per 1,000) and the United States (36 per 1,000).
In Malawi, Uganda and Zambia, adolescent women represent one-fourth to one-third of
patients suffering from complications of unsafe abortions, and in Kenya and Nigeria,
more than half of women with the most severe abortion complications are adolescents.
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In Latin America and the Caribbean, about one-tenth of all women hospitalized after an
abortion are younger than 20, and adolescents comprise one-third of the women with the
most serious infections.
Childbirth Related Deaths
Every year, 585,000 women-99% of them in developing regions-die from causes related to
pregnancy. These causes include the direct health consequences of high-risk pregnancies, unsafe
abortions and difficult deliveries, as well as problems that arise soon after delivery. Maternal
mortality ratios (representing the number of women who die every year from pregnancy-related
causes per 100,000 live births) in Africa, Asia and Latin America are 10-100 times the ratios in
the industrialized world UNICEF points out that "no public health problem shows greater
disparity between rich and poor countries than maternal mortality."
Most women in developing countries still give birth at home, helped by a close family member
or traditional birth attendant. Fewer than one in five women obtain assistance from a trained
doctor or nurse when they give birth in Burundi, Niger, Yemen, Bangladesh and Pakistan;
fewer than one-half receive professional medical assistance in Ghana, Kenya, Mali, Nigeria,
Senegal, Uganda, Egypt, Morocco, India, Indonesia, Bolivia and Guatemala. Even when
women deliver in a hospital, the equipment, supplies, drugs, or operating rooms and trained staff
needed to do cesarean sections or manage emergencies may be lacking.
Infant Mortality
Yet some older Americans can remember when infant deaths were as common in the United
States as they are currently in many parts of the developing world (Chart A). In 1920, the U.S.
infant mortality rate was as high as Nigeria's is today (87 infant deaths for every 1,000 live
births); In 1965, it still equaled the current rate of 25 deaths per 1,000 in Sri Lanka, and in
inner-city communities particularly, the rate remains close to that level.
Throughout the developing world, babies born to women younger than 20 are, on average,
one-third more likely to die than infants born to women in their 20s and 30s. This is mostly
because babies born to very young mothers are more likely to be premature, to
below-birth-weight and to suffer from complications at the time of delivery. And many
adolescents do not know how to obtain or cannot afford good prenatal and delivery care. In
addition, teenage births are likely to be first births, and first births always carry a higher risk than
subsequent births.
The link between early childbearing and lower rates of infant survival in developing countries
has serious implications. One in five women aged 20-24 report having had their first child
before their 18th birthday, and two out of five report doing so before they were 20. This
high incidence of teenage childbearing is partly because even when adolescents want to prevent
pregnancy, they often face special problems in obtaining the contraceptive products or services
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that would enable them to do so.
Repercussions of cuts to U.S. AID
Based solely on the one-year, 35% cut, the consortium estimates that:
7 million couples in developing countries who would have used modern contraceptive
methods will not have access to these methods.
As a result, 4 million more women will experience unintended pregnancies, leading in turn to:
1.9 million more unplanned births and 1.6 million more abortions (the remainder of the
unintended pregnancies will end in miscarriages);
8,000 more women dying during pregnancy and childbirth, including from unsafe
abortion; and 134,000 more infant deaths.
There are few other contraceptive choices in developing countries for women who lack
access to modern contraceptives. A conservative estimate is that of the 7 million women
losing services because of U.S. funding cuts 2.8 million will turn to traditi onal methods
and 4.2 million will use no contraceptive.
Because pregnancy rates are so much higher among couples relying on no method or on a
traditional method than if they use a modern contraceptive, 4 million more unwanted
pregnancies are expected in developing countries due to the drop in family planni ng
program resources.
About 40% of these unintended pregnancies are likely to end in induced abortion, even
though it is often not legal and performed in unsafe conditions-accounting for 1.6
million abortions among the expected additional unwanted pregnancies.
Some 47% of the unintended pregnancies are likely to end in unwanted births with the
remaining 13% resulting in spontaneous abortions or miscarriages-accounting for 1.9
million unwanted births among the expected additional unwanted pregnancies.
Maternal mortality rates in developing countries are high, about 4.1 deaths per 1,000
women giving birth, leading to an estimated 8,000 additional deaths due to pregnancy
among the women facing additional unintentional pregnancies.
Infant mortality rates in developing countries are high, with about 7.2% of all babies born
dying before their first birthday, leading to an estimated 134,000 additional infant deaths
among the women facing additional unintentional pregnancies.
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