"What do you call people who use the natural method of family planning?" goes the old bromide.
That bad joke flashed through my head the other day. In a major policy shift, the Agency for International Development announced that, effective immediately, it would fund groups that promote only "natural" family planning (a combination of watching a woman's bodily signals and abstinence) in underdeveloped countries. The change undercuts the agency's longstanding policy of "informed consent" requiring family planning providers that receive U.S. government funds to offer a range of choices. (AID continues to support other programs that make chemical and barrier contraceptive methods -- but not abortion -- available.) The move was an administration response to high-level lobbying by "pro-life" groups that claim they cannot "in conscience" meet the informed consent policy.
My next thought was of a Malaysian Chinese woman I met over 25 years ago. She was -- as I was -- vastly pregnant. She had come to a shed-like free baby clinic in a village outside Kuala Lumpur where I had volunteered as a clerk. There was a snivelly toddler on her hip; two others, not much older, clung to her pantlegs. Her hair was lank; her skin stretched almost to snapping across her cheekbones. She looked twice my age but, to my surprise, was only two years older: 26. It was her ninth pregnancy. It was my third: a contraceptive failure, thus a surprise, but more of timing than ultimate intention.
"How do I stop them coming?" she pleaded, pointing to the belly. She had nearly died delivering the eighth. Docors had warned her not to have more. Her husband could not stay away.
There was nothing we were permitted to do other than to suggest she go to a government hospital in the city. Out of deference -- it was said -- to some people's consciences, the Malayan government regulations at the time drastically restricted the kinds of information available and who could dispense it.
She adjusted the child on her hip so that one leg pushed less on her belly and left. I do not know if she lived or died. Fortunately, if they choose to, her by-now-grown children have access to contraceptive alternatives.
I thought, too, of a Filipino doctor friend, a devout Catholic woman of conscience. From a socially prominent family, she abandoned a lucrative practice to start a family planning clinic in a poor section of Cebu. In spite of the teachings of a church that was central to her life, she felt women desperately needed information, choices, so they could be good, healthy mothers to the children they had.
In the beginning, believing it was right, she would only prescribe after consultation with both husband and wife. If a husband demanded she remove a wife's IUD, she removed it. Slowly, however, as she got to know the women and the conditions of their lives, she developed a deep respect for their judgment about themselves. Eventually, if a woman returned the next day and wanted the IUD back, she reinserted it, no questions asked.
Sixteen years ago, when we lived on Java, one of the world's most densely populated places, we worked out a rough rule of thumb to make the population density comprehensible to our own children: including volcano tops and rice paddies, each Javanese man, woman and child had about one third of a football field in which to live, work and raise enough food to feed himself. At the rate of population increase at the time, that area would be halved about now.
Shortly after that, as we waited for an airTAKE 240352 PAGE 00003 TIME 11:46 DATE 08-21-85 plane in East Indonesia, several enlisted men, realizing I spoke Indonesian, approached me.
"Where do you come from?"
"Is it true that all Americans use family planning?"
"What method do you use?"
The Indonesian government-sponsored education program providing family planning options had just begun. Its growing acceptance has extended somewhat the time for reaching a sixth of a football field per Javanese.
This does not suggest that "natural" methods of family planning should not be taught. They may be right for some people. Preliminary World Health Organization studies show that illiterate women can, if well taught, learn to use such "natural" methods. But they question whether the strict abstinence demanded during about half of each monthly cycle can be maintained over the long haul. Certainly, in some places, for strong cultural reasons, it would not be. Nor should people's right to act in conscience be questioned.
It is unconscionable, however, that we Americans, who have relatively easy access to a range of contraceptive choices, who proclaim respect for individual choice, permit a few people to force us through our government to force their "conscience" on others. In so doing, we participate in a bad joke that can make people parents more frequently than they might want or can afford to be.