When the adobe walls of this village's family planning clinic went up a few years ago, medical workers wondered whether the local women would have the courage -- given the value placed on fertility in Kenya and the sometimes violent opposition of their husbands to birth control -- to line up in public for contraceptives.
As it turned out, the nurse from the Family Planning Association of Kenya who visits once a week has all she can do to stock enough birth control pills, intrauterine devices and injectable contraceptive hormones. "Every week there are 10 or 15 new faces," says Jane Kirui, who supervises the village operation. "Now they are even coming from outside the district. We cannot keep up with the demand."
Which is why Erma Craven, a matronly social worker and National Right to Life member from Minnesota, felt she had a moral duty to come to the international women's forum in Nairobi this summer.
"I have relatives in America who bred as many as 23 children to make America rich," she said to women at a crowded seminar sponsored by a group called the International Right to Life Federation. "And I am opposed to people whose only idea is to 'give a peasant a pill.' "
During her speech, Craven exhibited a color poster of aborted fetuses lying in plastic bags and trash cans. Abortion, she said, as well as birth control pills, voluntary sterilization and the intrauterine device, is a tool in a western conspiracy to limit the growth of the world's nonwhite population.
"And I consider it extremely racist when the U.S. Agency for International Development targets the whole Third World for population control!"
A Jamaican woman leaped to her feet. "You are riding on my back, you bloody American! We can make up our own minds!"
"I am a doctor, I am black and you don't know what you are talking about!" shouted a second woman.
"Friends!" cried Craven's colleague, a well-dressed physician from Arizona, "I know you may not agree with us, but at least listen to what we have to say!"
"Please," said Visi Srinivasan, a wizened woman in a sari who rose to calm the crowd. Srinivasan, a Ford Foundation official from New Delhi, spoke quietly. "I have worked with extremely poor Indian women for the past 18 years. These women have their first babies at 12 or 13. They say, 'We don't want to have eight or nine children, we are so poor.' So I say if the U.S. is going to fight about family planning, fine, you fight it out among yourselves. But don't drag us into it."
When she sat down, the women around her stood and cheered.
So it went at workshop after workshop at the women's forum here as a small but vocal group of American right-to-lifers as well as their counterparts from Australia, New Zealand and India clashed with professional family planners, women physicians and feminists from Africa, India and Asia over the appropriate methods of birth control for the developing world and whether such a question was any American's business.
On one side, there were groups like the International Right-to-Life Federation, represented by an Irishman living in Switzerland; the National Right to Life Committee; a New Zealand group known as Women for Life; Women Who Want to Be Women, from Australia; a French group called Laissez les Vivres (let them live); a changing cast of Irish Catholic missionary nuns and a priest from Stafford, Va., whose newsletter, for a Washington-based group called Human Life International, asks, "Did you know Planned Parenthood is killing . . . millions of pagan babies whom our missionaries could otherwise convert?"
Together they constituted a loose federation opposed not only to abortion but to "artificial" contraceptive methods like birth control pills and the intrauterine device. Some opposed voluntary sterilization as well. Instead, they lobbied for so-called natural family planning methods that rely on periods of sexual abstinence and the traditional rhythm method to limit family size.
"We think it's the best way," Sister Mary O'Malley, an Irish missionary in northern Kenya, told a group of sympathizers . "With full cooperation a man and a woman can achieve success rates of 99 percent." Most studies say natural family planning has a success rate lower than most other contraceptive methods, but O'Malley said she had taught the technique at her mission and found it to be practical as well as having the added virtue of "bringing families together."
In the opposite corner were family planning advocates like the International Planned Parenthood Federation and many smaller groups that receive U.S. tax dollars to promote family planning in developing countries. The acrimony at the forum, these groups say, is the sideshow in a larger battle now underway in the United States for control of the millions in foreign aid the U.S. spends on family planning.
Family planning advocates say that conservative political and religious groups in the United States are pushing aggressively to curb all U.S. support for contraceptive family planning. The push comes, they say, just as the demand for family planning, and its promotion by the governments of developing countries, is growing.
"Their goal is to put an end to 20 years of bipartisan support in Congress for family planning," says Kathleen Mazzocco, spokeswoman for the Washington-based Population Crisis Committee, of the right-to-life groups. Members of those groups in Nairobi, however, insist they are simply trying to protect Third World women from what they describe as the scourge of abortionists and rapacious international pharmaceutical companies.
"There are people working at this moment to make abortion legal all over Africa," says William Sherwin, Irish secretary of the Swiss-based International Right-to-Life Federation.
Family planning advocates credit the U.S. right-to-life movement with the U.S. turnaround at the International Conference on Population late last year. At that meeting, the U.S. announced it would no longer support any private family planning group thought to be involved in "abortion-related activities."
Since then, the United States has cut $15 million in support to the International Planned Parenthood Federation, despite the fact that U.S. law has prohibited the use of any foreign aid for abortion since 1973.
The cut amounted to approximately one-third of the federation's budget, and its impact was felt even in countries where abortion is illegal. In Kenya, for example, Maendeleo Ya Wanawake, a Kenyan women's organization with family planning education seminars and contraceptive dispensaries around the country, has had to curtail some of its activities.
In addition the U.S. has cut $10 million of its $46 million contribution to the United Nations Fund for Population Activities, and family planning advocates say the rest of the money is threatened.
Those groups also criticize the U.S. delegation to the United Nations Women's Conference for failing to include family planning on its priority agenda. When asked at a press conference about the omission, Maureen Reagan, head of the delegation, said it was not one of the delegation's priorities.
Earlier this year, according to family planning agencies, White House assistant Faith Ryan Whittlesey asked the Agency for International Development to waive the long-established informed consent regulation that requires any recipient of U.S. funds to fully inform patients about all methods of birth control. The change would make it possible for right-to-life groups to dispense natural family planning information in developing countries without mentioning the availability, and comparative effectiveness, of other contraceptive methods.
The debate at the forum was less a fight over money, however, than a battle for the minds and bodies of Third World women. If the audience reaction here is any indication, though, the right-to-life groups may have a long road ahead. Many developing nations have had family planning strategies on paper for the past 20 years. In recent years, as studies by numerous international organizations have concluded that Africa will face widespread famine unless it manages to get its population under control, those governments have begun to devote substantial resources to the population problem. The Kenyan government is planning a major expansion of its family planning programs with the help of U.S. funds.
"In India we know that effective family planning is not just an option, it is critical to our survival," said Srinivasan. "If the U.S. government will no longer support us, the Indian government is prepared to support family planning on its own."
In Kamathanga, and in villages and cities across sub-Saharan Africa, according to the women physicians and technicians at this conference, the story is much the same. Private citizens, as well as governments, have begun to see the medical, social and economic costs of unchecked population growth. Use of contraceptives in Kenya has increased from 2 1/2 to 10 percent since 1977, according to a U.S. government report.
On Thursdays at the family planning clinic in Kamathanga, the women seem convinced. "The ladies here do not want so many babies," says Rose Muturi, a first grade teacher at the Kamathanga primary school, which has more than a thousand young students. The average family size in Kenya is eight children, but in villages like Kamathanga, families with 12 and 13 children are not uncommon. Kenya's population growth rate is the highest in world history, growing about twice as fast as the country's economy.
"Even men say it cannot be in the next generation," said Kenyan Jane Kirui. "There is not enough land to divide among sons. People know that for their children to have a future they will have to have an education."
Health is also a consideration. Africa has the highest maternal mortality rate in the world, more than 10 times that of the United States.
As recently as two decades ago, traditional practices like breast-feeding and periods of sexual abstinence, as well as higher infant mortality rates, kept family size down and births spaced by two to three years. "If a woman was pregnant before the previous child could carry something, that was really a scandal," says Kirui. Not any more. Women in desperate economic straits, say doctors in Kenya, Sierra Leone, the Philippines and elsewhere, turn to abortion when they have no other choice.
"The women beg, 'Please, I am so tired, I do not want to have any more children, give me the pill.' " says Kulimi Mworia, an official with the Kenyan Family Planning Association. The association also dispenses information about natural family planning, Mworia says, but the women have become skeptical about it. "They say, 'I have already had three babies with this natural family planning. The pope is not going to look after my children. Now I want to be sure.' "
The right-to-life groups say their objection is not only moral. Third World women, they say, are being used as "guinea pigs" by international pharmaceutical companies. They criticize the use of Depo-Provera in Africa when its use has been severely restricted in the United States. )
But Kenyan women say the Kenyan government screens the contraceptives that come into the country, and that for the women it is a matter of weighing risks. "In Kenya we say better to die in 15 years from the pill than die in childbirth next year," says Mworia. "Who will take care of my babies then? At least in 15 years they will be grown." They find the new American attitude odd at best, and at worst, patronizing.
"Do they think we are children?" asks Mworia. "We can take care of ourselves."