Coercion in family planning. (Letters).

BARBARA HEWSON'S ARTICLE rightly makes the point that the notion of coercion is often ill-defined, and moreover that context makes a difference. For example, financial incentives for sterilization are likely to exert more pressure on poor people than rich. However, I find her argument pitting liberal Western ideas of individual autonomy against communal values problematic. This dichotomy has been used in the past to advance a culturally relativist argument justifying population control abuses in Southern countries (ironically, often undertaken at the behest of 'liberal' Northern population interests). Moreover, the term "communal" often masks profound differences in power between men and women, rich and poor.

Women's health movements in both the North and South have put forward an alternative ethics based on every woman's right to respect for her bodily integrity. As Sonia Correa and Rosalind Petchesky note, this concept involves both a woman's right not to be alienated from her sexual and reproductive capacity and her right to the integrity of her physical person.

Coupled with human rights, this universalist ethics has had a positive impact on population policy, although much still remains to be done to protect women, especially poor women, against coercion in family planning programs in both North and South. The Programme of Action adopted at the 1994 Cairo conference criticized coercion, but did not put in place any concrete mechanisms for the investigation of abuses or redress. In addition, although it discouraged contraceptive acceptance targets at the local level, it did not challenge national level demographic targets which, as in the case of the Peruvian sterilization scandal, often help set the stage for coercion.

BETSY HARTMANN
Director, Population and
Development Program
Hampshire College,
Amherst, MA

IN THE PHILIPPINES, Coercive population policies have oscillated between population control, pushed by government economic technocrats and some aid agencies, and pronatalism, sponsored by fundamentalist Catholic groups, including the hierarchy of the Catholic church.

Family planning programs that included mass sterilizations, scant and biased information, and provider preference for long-acting contraceptives were the norm in the 1970s and 1980s, while the country was under military rule. But the restoration of formal democratic processes, the ascendance of the Catholic church as a major power broker, and the elaboration of a rights-based approach by feminist groups has recently led to the introduction of new approaches to family planning.

What is dominant and disturbing at this time in the Philippines is President Gloria Arroyo's desire to restrict artificial contraception and foist natural methods of family planning into government programs. In just over two years, her administration has de-funded artificial contraceptives and banned an emergency contraceptive permitted for limited use by the preceding administration. Under her regime, the Catholic bishops and antiabortion groups are vociferous in calling for the banning of all artificial contraceptives, on the spurious grounds that they are abortifacient. Meanwhile, the media and some legislators have opposed a bill to institutionalize reproductive health programs, and are whipping up the public persecution of women who have had an abortion.

Coercion in family planning is still a reality in the Philippines. For women here, strengthening individual autonomy will save both our lives and our dignity.

DR. JUNICE MELGAR
Executive Director, Likhaan
Quezon City, The Philippines