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close this bookUnderstanding Reproductive Health: A Guide for Media (CMFR - UNFPA, 1996, 49 p.)
View the document(introduction...)
View the documentData card
View the documentI. Introduction
View the documentII. Tracing policy shifts from family planning to reproductive health
View the documentIII. Reproductive health: a perspective and an approach
View the documentIV Why reproductive health?
View the documentV. Fundamental principles
View the documentVI. Issues within and beyond the pelvic zone: some reflections
View the documentNotes
View the documentReferences
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II. Tracing policy shifts from family planning to reproductive health


For almost five decades since the birth of the family planning establishment2, most governments the world over have been infusing enormous investments and focusing much of its activity and energy into controlling numbers of people, either in their own countries or elsewhere. The establishment viewed the increasing numbers –especially those in the developing countries – as a threat to national well-being and security. The growth in population in the developing world was a destabilizing force that would hinder the developed countries’ sustained access to material resources.3

During the early 50s to the 70s the establishment pushed governments of developing counties to control their population growth rates, assisting them with funds and programs to achieve this.

Birth control methods and techniques flooded countries of Latin America, Asia, and Africa. Population controllers went to work. India set up its sterilization camps where women and men were sterilized in exchange for a few hundred rupees, a sack of wheat, or a transistor radio. Indonesia started its safari campaigns – which are still going on up to this day – where the military rounded up women in villages and plunged lUDs into them.

But these attempts to control numbers met with resistance in most of the developing world. Furthermore, the establishment also observed that fertility levels did not go down to desired levels.

Thus, in the 70s, the population policy community started to re-think its strategies and shift its focus from population control or how to reduce numbers immediately at the least cost to population planning or how best to reduce numbers by looking at the different influences that made couples decide to have children.

Population planners became more interested in those factors that motivated people to practice family planning. They gave importance to research that studied “determinants”4 of fertility and suggested governments to provide incentives and disincentives to encourage couples to limit or increase the sizes of their families.

The focus was on motivation. Population planners urged governments to integrate family planning into some broader program like Maternal and Child Health or Primary Health Care. They believed that such an integration would attract more clients to resort to birth control methods.

But then again, after a decade or so of motivating and integrating, the population planners observed that their approach failed to achieve dramatic results. Governments, they pointed out, were slow in integrating family planning into broader programs. Motivation and integration, they claimed, were turning out to be very costly, not only for national governments, but for international donor agencies as well.

Throughout the 80s and 90s, the women’s groups5 began to make their presence felt. The women’s groups pointed out that the establishment has blamed women for the world’s teeming populations; thus the focus on controlling women’s fertility. Women advocates argued that population policies, whether based on control or a system of incentives and disincentives, have been disrespectful of women’s bodies and rights. Women had become “targets”, passive recipients of some form of birth control method, often without any recognition of their dignity and their capacity to make rational choices.


Women’s groups have demanded and continue to demand from government and other institutions of society– that since women stand in the center of population policies, they should be able to participate actively in making those decisions that directly affect their lives.

Time and again, they have insisted that they have needs which are not centered solely on the pelvic zone. These needs include food, land, jobs, credit, education, houses, health care for their children as well–basics the government should provide. They said they also needed to be freed from violent and abusive husbands, from customary rules that do not allow them to inherit and own property, from cultural conditions that tend to straitjacket women into a motherhood role, from oppressive laws that restrict their effective access to the means by which to control their bodies and the reproductive function; as well as from institutionalized forms of discrimination and sanctions that prevent them from fully expressing their sexuality.

All these basic needs in life, they said, have more bearing on their health and their desire and ability to control their fertility than the numbers of pills and IUDs distributed or the numbers of hospitals in their communities. These “enabling conditions” have to be fulfilled before they are able to achieve reproductive health and before they can exercise their reproductive rights.

Population controllers and planners, for whatever reasons, have collaborated with several women’s group6. UNFPA has supported feminist conferences and meetings which feature women’s concerns and it has funded women’s groups working on health projects. The Population Council has sponsored meetings to work with feminist leaders on contraceptive technology issues. USAID is strengthening its Women in Development offices which are funding women’s projects.

At the Nairobi Conference in 1985, for instance, population control and planning groups were well represented. At the Cairo (1994) and Beijing (1995) Conferences, population controllers and planners worked closely with women’s groups. Many feminists and women’s groups in these conferences, however, opposed the controllers and planners on ideological grounds (see Table 1) and have proposed a reproductive health approach instead.


Table 1. Comparison of population control and reproductive health population policies7


Population Control

Reproductive Health


Reduction of growth rate; and

Improve women’s and children’s health and family welfare.

Change socio-economic conditions;

Improve women’s and men’s overall and reproductive health;

Increase women’s control over their bodies and lives.

Ethical Principles

Demographic goals are crucial.

Bodily integrity; Personhood; Equality; Diversify

Underlying Assumptions

Population size/growth main determinant of poverty, underdevelopment, and environmental sustainability;

Population control is able to reduce fertility.

Poverty is due to economic growth model; need to meet basic needs;

Improving women’s status and quality reproductive health programs will reduce fertility.



Target oriented with incentives and disincentives

Focuses on individual needs

Service range

Contraception; maternal and child health.

Contraception; maternal health; STDs, RTIs, HIV/AIDS; violence against women; cancer screening- in the context of ender relations

Age of women and marital status

Married women of reproductive age

Women of all ages throughout their life cycle; married or unmarried;

Focus on male responsibility

Service delivery standards

Quality of care not emphasized

Quality of care standards high

Women’s empowerment

No component on women’s status/rights

Increased access and control; women’s empowerment built into all service design and implementation.

Efforts at structural reform of society (e.g. legal reforms, policy reforms, etc. to eliminate discrimination and violence against women) outside the program are supported.

Contraceptive methods

Focus on permanent, long-acting contraceptives requiring medical intervention (e.g. sterilization, injectables, implants); provider preferences dominate.

Emphasis on safe, effective and affordable methods which women control;

Efforts are to increase male responsibility, research into and use of male methods.


User’s feedback

Bureaucratic; little interest in users’ perspectives

Users’ feedback actively sought


Demographic quantitative research related to fertility control

Action research with high degree of participation


Demographic targets

Quantitative and qualitative standards emphasizing users’ satisfaction, well-being, quality of care, and empowerment

Planning and decision-making

Top-down; minimal participation of service providers at all levels.

Community highly involved in conceptualization and review of design and operations; users well-represented in decision-making bodies.