Where Women Have No Doctor: A Health Guide for Women.
By A. August Burns, et al. Berkley: Hesperian Foundation, 1997.
Reviewed by Eric Retzlaff, RN
There’s a saying you hear from time to time that could apply to this book: rat poison is 99 percent whole wheat. It’s the one percent that kills.
The Hesperian Foundation’s book dispenses at great deal of useful health information but is permeated (much more than 1 percent) and tainted by population control propaganda under the euphemistic banner of “reproductive health.”
Women in traditional, family-oriented societies will get not only western medical information from the book, which they need, but a world view rooted in the West’s rampant individualism and consumerism. The book is an obvious effort to propagandize women and girls in the developing nations into accepting the developed world’s own allegedly superior image. To the degree that the book succeeds, it will bring women and girls in these countries many of the social and developmental evils from which their sisters in almost all developed societies suffer.
In the spirit of Margaret Sanger, an early pusher of “birth control” and the foundress of Planned Parenthood, the book sees children and childbearing not as joys or satisfactions which women might freely choose but as evils from which women, particularly those brown-skinned and poor in the developing world, need to be liberated. Drawings of women with many young children are uniformly presented as sad and tearful. Women with a child or two are depicted as happily pursuing their education, having more food for their children and more time to enjoy themselves and their children, being safe from the “perils of pregnancy.” While no reasonable person would expect a couple to have as many children as they are physically capable of having, the idea that large families can be happy, healthy families does not appear to balance the previous negative views of children and family life.
True perspective denied
Family planning, the text argues, is “much safer than pregnancy and childbirth”: 500 out of 15,000 women die of pregnancy or childbirth while only one of 15,000 dies from family planning, the book asserts. Aside from the difficulty in verifying these statistics on a worldwide basis, the comparison is unfair. Being pregnant is generally more dangerous than not being pregnant, but being naturally non-pregnant (via natural family planning) is safer than being using one of the usual run of drugs or devices so favored by population controllers to keep women non-pregnant. Moreover, the text’s authors aren’t concerned to point out that the safer sex they promote so ardently is, in fact, much more dangerous than abstinence.
In a brief section entitled, Deciding about Boyfriends and Sex, the advice dispensed is no more morally based than what is conveyed in many pragmatic American sex education programs: “Only have sex when you decide that you are ready and know how to protect yourself from harm,” the authors advise. This is typical, as the book often uses the term “partner” rather than “husband” for the person with whom a woman may decide to have sex.
Family and faith attacked
Typical of the book’s elitist First-World view, girls and women are counseled against their family and tradition and religion.
For example, the book advises “talking with your mother and father can be hard sometimes,” and “Your parents want you to live by tradition, but you feel that times are changing.” But this does little to express the reality of lived experience that is probably reflected in a mother’s concern.
In addition, the book openly denigrates people who choose to include faith in their decision making about so-called “family planning.” A drawing showing a woman between another woman in a lab coat holding a contraceptive and a bishop wagging his finger bears the caption: “You have a right to make your own decisions about family planning.”
Marriage and communication in the family are undermined when the book states:
If your husband still [after you’ve talked with him] does not want you to use family planning even after learning about its benefits, you must decide whether you will use family planning anyway. If you do, you may need to choose a method that can be used without your partner knowing about it.
Despite two decades or more of “safe sex” and “safer sex,” an epidemic of sexually transmitted diseases and teenage pregnancies has remained a major social problem in the United States. Yet this book has no qualms about exporting the cause of the problem — extra-marital and promiscuous sexual activity — and then offering a steadily discredited solution.
Besides having its own chapter, “safer sex” is interwoven in other chapters. The authors only perfunctorily mention abstinence as the only completely safe way to avoid pregnancy and illness. Brief qualifying statements, and a small chart that shows contraception failure rates are hardly enough to dispel the sense of safety that continual repetition of the safer-sex mantra has on the reader. In some places, qualifiers such as “safer” are dropped: “latex condoms will protect you from STDs including AIDS/HIV…prevent unwanted pregnancy…” or “learn how to be sexual in a safe way.” The safer-sex message is so frequent and intense this reader felt the authors either believe or want their readers to believe you can play Russian roulette and always hit an empty chamber. Why else would they write this self-contradictory statement: “Although it is risky, if you practice safer sex carefully, you can continue to have sex with an HIV infected partner without becoming infected yourself”?
Studies disagree on how effective condoms are in preventing STDs and HIV/AIDS. One meta-analysis of such studies showed that the failure rate with HIV/AIDS could run as high as 31 percent.1
Mixed message on pregnancy
Promotion of family planning methods in this book downplays the potentially abortifacient effect of several contraceptives: pills, IUDs, injections and implants.
Although the book’s physiology section, entitled Monthly Bleeding, describes fertilization as “the beginning of pregnancy,” its language fails to recognize that what is happening in the womb has anything to do with a human being. This is consistent with the book’s description of miscarriage as “losing a pregnancy” and abortion as the means by which “a pregnancy can be removed from the womb.” However, the book can’t entirely avoid the connection between pregnancy and babies, as in its chapter titled “Pregnancy and Childbirth.”
This kind of verbal engineering continues in the family planning chapter where, at first, the whole implantation issue is avoided. Initially, we’re told “…the IUD prevents the man’s sperm from fertilizing the woman’s egg” and that hormonal methods prevent ovulation and hinder sperm motility. But later, under “emergency methods of family planning,” to be used soon after unprotected sex, we’re told that birth control pills and IUDs can “prevent a fertilized egg from attaching to the womb wall.” Remember that we were told earlier that fertilization is the beginning of pregnancy, not a human life. The word abortion is not used here, but then abortion means only the removal of a pregnancy, not a baby. To further confuse the issue, we’re told in the later abortion chapter that “emergency family planning methods” “may be able to prevent a pregnancy.”
In the abortion chapter, the authors write that “if family planning methods fail, safe and legal abortion is a woman’s safety net” protecting her from “unsafe abortion.” The authors admit that “safe abortion” is not entirely safe, and they spell out the potential complications and how to deal with them. They say the statistics are on their side: out of 100,000 women who get safe abortions, only one dies, compared to 100 to 1,000 deaths per 100,000 100,000 unsafe abortions.
Of course, accurate worldwide statistics for deaths from illegal and legal abortions are hard to gather, and Dr. Brian Clowes, argues persuasively in The Facts of Life that groups that favor abortion have overestimated and continue to overestimate the number of deaths from illegal abortion. Similarly, deaths caused by legal abortion are underreported because the immediate cause of death is not the abortion but a complication, Clowes notes:
The danger of abortion complications doesn’t relate to legalization alone but to a country’s medical infrastructure. Excessive bleeding and systemic infection (sepsis) are medical emergencies that can result in death even in US communities with up-to-date 911 systems and highly trained health professions, but how much greater risk exists for poor, uneducated women in the countryside of developing nations, whether the abortion is legal or not. The same is true for the more serious side effects of hormonal methods of family planning (Norplant is an excellent case in point) and the IUD.
In conclusion, the useful information in this book arrives with a hefty dose of propaganda and misinformation. Women in the developing world need resources to help them confront actual health risks in their lives, not propaganda designed to help them exchange one set of risks for another.
Eric Retzleff, RN, is a registered nurse, author and editor working in New York.
1 Weller, Susan C. “A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted HIV.” Social Science and Medicine, Vol. 36, no. 12, 1640.).