The Mexican government, as we have previously reported, is aggressively seeking to drive down the nation's birthrate to below replacement. Young mothers who come to government-run clinics and hospitals to deliver their babies are pressured to accept either sterilization or an IUD. This abusive program was formulated by Mexico's National Population Council (CONAPO) in consultation with the U.N. Population Fund (UNFPA), which continues to fund it today.1
This program, rather disingenuously referred to as "reproductive health care," is arguably the Ministry of Health's top priority. It is more generously funded and vigorously pursued than other forms of health care, such as those addressing HIV/AIDS or sexually transmitted diseases.
The question we asked ourselves was this: How do the health priorities of ordinary Mexican women compare with those of the government? Do women support the government's anti-natal agenda, or do they see other health needs as more pressing?
To answer this question we carried out a survey of the health needs of women -- as they themselves perceived these -- in the Mexican city of Guadalajara. Who wants reproductive health care? Not the women of Mexico, it turns out.
Guadalajara, located in the western part of the central highlands, is Mexico's second city. It is home to some 4 million people. It is a transportation and marketing hub. Several major highways, carrying national and international heavy transport, as well as almost everything else, traverse the city. The residents are small shopowners and tradesmen, mechanics and other service providers. Television and telephones, both conventional and cellular, are widely available. Most of the inhabitants have received some education, and literacy rates are high. Like Mexicans in general, the residents of Guadalajara are religious, with about 90% identifying themselves as Catholics, and the rest adhering to various Protestant sects.
A total of 370 women were interviewed by one of ten trained interviewers in different districts of the city. The interviewers went door-to-door in their respective districts.2 Those interviewed were shown a list of 15 different public health programs, and asked to order the list in terms of their own personal needs, putting their most pressing need first and their least important need last. The health programs listed were Reproductive Health,3 vaccinations, HIV/AIDS, Family and Child Abuse, Natural Family Planning, Sexually Transmitted Diseases, Lifestyle, Maternal and Neonatal, Potable Drinking Water and Sewage, Psychological, Cholera, Diarrhea, Tuberculosis, Malaria, and Leprosy. Other information collected included age, religion, marital status, and prior history of contraception, sterilization, and abortion.
The date on health needs reported by respondents was entered into a database and the mean rank order was calculated for each category of health care. The lower the rank order for a particular kind of health care, the greater the need for such health care expressed by the respondents. The results are shown in Table 1.
Health Need Followed by Mean Rank Order
Vaccinations: 5.13 HIV/AIDS: 5.32 Family & Child Abuse: 5.32 Natural Family Planning (NFP): 5.82 Sexually Transmitted Diseases (STDs): 6.24 Lifestyle: 6.26 Maternal & Neonatal: 7.30 Potable Drinking Water & Sewage: 7.98 Psychological: 8.88 Cholera: 9.18 Diarrhea: 9.44 Tuberculosis: 9.83 Malaria: 10.28 Leprosy: 10.67 Reproductive Health: 12.02
Table 1: Desirability of Health Programs in Mexico: Note that the higher the mean rank order, the more desired the programs are in the view of the respondents.
What do these modern Mexicans have to say about their health care needs? They list their most pressing concerns as Vaccinations, HIV/AIDS Prevention, Child and Family Abuse, and NFP. Now Vaccinations are needed to prevent such diseases as Tuberculosis, Measles, and polio, while HIV/AIDS needs no explanation. Because of Mexico's machismo culture, family and child abuse remains a difficult problem. The only mild surprise in this cluster of top-ranked health needs is the presence of Natural Family Planning, or NFP, which was welcomed by many respondents as a safe and natural means of regulating their fertility, a point to which I will return in a moment.
Second-order health needs listed by the women interviewees include sexually transmitted diseases, or STDs; lifestyle diseases, primarily alcohol- and drug-related problems; maternal and neonatal health care; and potable drinking water and sewage treatment programs. The problems of STDs, alcohol addiction and drug addiction are another aspect of Mexico's culture. The relatively high ranking of maternal and neonatal health care can be read as a cry for help on the part of mothers whose "reproductive health care" consists of a tubal ligation or IUD insertion following delivery. Mexicans are also aware that polluted drinking water, not to mention the lack of proper sewage treatment facilities, is a vector for the transmission of dysentery and other diseases, and so would like to see the water supply made safe. All in all, the Mexican health problems given priority by the women are commonly recognized as such by outside observers, confirming the good judgment of those we surveyed.
The health problems that follow -- Psychological problems, Cholera, Tuberculosis, Malaria, and Leprosy -- although not affecting the large percentage of the population that, say, Family and Child Abuse can, are nonetheless endemic to Mexico. Here again, the views of those we spoke with accord well with Mexico's epidemiological realities.
The single most striking result of the survey was the dismal showing of Reproductive Health. This category of health care, defined as the limitation of childbearing by means of contraception and sterilization, came in dead last. The Mexican women we surveyed would prefer almost any kind of health care to the kind of "either-IUD-or-Ligation" programs that they have been force-fed the past few decades.
Many proponents of family planning will view these results as contradictory. They will ask how the Mexicans can praise Natural Family Planning on the one hand, while condemning reproductive health care on the other. They will maintain that the two family planning methods are merely different means to the same (i.e., anti-natal) end? They will be wrong.
As it turns out, the people of Mexico have a far better understanding of the differences between Natural Family Planning and reproductive health care than the controllers. And they vastly prefer a method over which they have intimate control -- NFP -- to the permanent, or semi-permanent methods imposed by the National Population Council and the U.N. Population Fund.
Those we talked to were not using NFP as shorthand for "family planning." And those who expressed, in the "comments" section, a desire for more education in NFP were not thereby expressing a preference for fewer children. Indeed, in the Mexican context it is just as likely that they would use this additional education in NFP to conceive a child as it is that they would use it to delay conception. Their interest in NFP centered on the fact that they themselves, and not some distant, even foreign, government agency, would determine the number and spacing of their children.
Bear in mind that those with whom we spoke were not backward, tribal people, but highly Westernized and educated residents of one of Mexico's most modernized cities. Note also that their prioritization of their health care needs was highly rational, that is to say, that it accords well with the real diseases and health problems that they and their families must contend with on a daily basis. Why should their views on their own health care needs, including their rejection of so-called reproductive health care, not be taken seriously in planning health care programs?4
Meeting the real health needs of women in the developing world, as they themselves define those needs, would mean funding primary health care. Instead the controllers ignore the views of women, view their fertility as a threat, and act to neutralize that perceived threat by disabling their reproductive systems. To paraphrase pro-life feminist Angela Franks, if women's fertility is causing social, economic, environmental, or health problems, as the controllers believe, and if women refuse to acknowledge this reality, it is for the greater good that they be persuaded, or compelled, or forced to stop having children. Kingsley Davis and other population alarmists have long said that it is necessary, in the interest of reducing population growth, to make it less pleasant for women to do what so many of them enjoy doing, namely, raising children.5
Still, population control organizations find it highly inconvenient that their programs are not greeted with joy by their "targets," and they go to great lengths to disguise or explain away this fact. Overseas, they work overtime to create the impression of robust popular and government support for their anti-natal programs, recruiting local surrogates, suborning government ministries of health and education, launching media blitzes, and sponsoring contraceptive giveaways. This façade falls away in discussions with donors, in which they arrogantly suggest that the women's reluctance to contracept comes about because they either don't know their own minds, or because they simply don't know what's good for them (or their country, or the environment, etc.).
The Mexican women we spoke with knew their own minds, and their views should be respected, both by their government and by the U.N. Population Fund.
1 UNFPA will continue to fund this program with $12 million through 2006. See (http://www.unfpa.org/regions/lac/countries/mexico/4mex0206.pdf). [Back]
2 Randomness was approximated by four factors: 1. the interviewees were sought out at random in their homes. No attempt was made to seek out interviewees on the basis of ethnic group, religious affiliation, or other characteristics. 2. The interviews were conducted at the rate of 20 or 30 per week over a six-month period. 3. The only age restriction imposed on the respondents was that they must be over 18. 4. The influence of language factors on the selection of respondents was minimized by the fact that each interviewer was fluent and literate in Spanish. [Back]
3 "Reproductive health," was explained to respondents as the provision of contraceptives or sterilization, while "Natural Family Planning," or NFP, was described as a natural, i.e., non-surgical and non-chemical, means of conceiving or delaying children. [Back]
4 Similar results were obtained from a survey of Ghanaian women. See "What Do African Women Want," PRI Review (July-August 2001) 11 (3):1-5. [Back]
5 Kingsley Davis, "Population Policy and the Theory of Reproductive Motivation," Economic Development and Cultural Change, Vol. 25, Supplement, 1977, 174-78. [Back]