Congress to USAID: stop the abuse! Abusive “family planning” programs disallowed US funds

The Tiahrt amendment, legislation which sets strict limits on the types of family planning activities the United States Agency for International Development (USAID) may fund, passed the 105^th US Congress and was signed into law by President Clinton on 22 October. The amendment declares many of the abuses which have characterized population control programs since their inception to be violations of U.S. law.

“My amendment simply defines the term ‘voluntary’ to ensure that no participants are bribed or otherwise coerced regarding participation in certain family planning methods,” said Representative Todd Tiahrt [R-KS] during the amendment’s floor debate in the House of Representatives. “Furthermore, my amendment requires that all participants are fully informed of the range of options at their disposal. Forced sterilization of some of the most vulnerable classes of women in foreign countries should not be occurring in US-funded family planning programs,” he added.

Congressman Tiahrt then presented a small mountain of evidence which PRI, other human rights advocates and media outlets have accumulated about human rights abuses occurring in population control programs. In addition to 18 separate citations from PRI Review, the Congressman cited reports from major wire services, the New York Times, Washington Post and some environmental groups’ websites.

Surprise support

Perhaps the most surprising moment in the floor debate occurred when Congresswoman Nancy Pelosi [D-CA] rose to argue in favor of the amendment. Pelosi, a long-time opponent of any restrictions on US funding of international family planning programs, called it “thoughtful” and praised the amendment’s focus on making all such programs “voluntary.”

“I do want to use the balance of my time to say that the gentleman’s emphasis on the word ‘voluntary’ is one that I think every person in this body supports,” the Congresswoman said. “It is also helpful for women to determine the size and timing of their families and that should not be a matter of coercion but a matter of conscience and of health and well-being of that particular family,” she added.

Opposition token and predictable

The only Representative rising in opposition to the measure was three-term Congresswoman Lynn Woolsey, whose 6^th District seat in California, which includes Stanford University, may be among the most anti-natal in the United States. But it is unclear whether the Congresswoman had even read the amendment, as most of her comments did not address amendment specifics at all. The amendment passed on a voice vote and was then included in the large omnibus spending bill later signed by President Clinton. The following is the text of the amendment and a brief analysis of each portion:

(1) Any voluntary family planning project shall meet the following requirements: (1) service providers of referral agents in the projects shall not implement or be subject to quotas, or other numerical targets, of total number of births, number of family planning acceptors, or acceptors of a particular method of family planning (this provision shall not be construed to include the use of quantitative estimates or indicators for budgeting and planning purposes);

Quotas, as PRI documented in detail in the March/April edition of this journal,1 remain common in many, if not all, family planning projects which USAID funds around the world. In fact, a USAID contractor, Management Services for Health. runs a program called the Family Planning Management Development Project, whose purpose is to train clinic personnel to achieve targeted increases in the contraceptive prevalence rate in a given region.

(2) The project shall not include payment of incentives, bribes, gratuities, or financial reward to (A) an individual in exchange for becoming a family planning acceptor, or (B) program personnel for achieving a numerical target or quota of total number of births, number of family planning acceptors, acceptors of a particular method of family planning;

The use of bribes or payments either in exchange for participation in population control programs or as incentives for workers in those programs to bring in more “acceptors” is a long standing and well documented abuse. Incentives around the world have included everything from sarees and clothing for children in India to food in Peru, radios and other small electronics in parts of India and Africa, and money in Bangladesh, Pakistan and other places.

(3) The project shall not deny any right or benefit incurring the right of access to participate in any program of general welfare or the right of access to health care, as a consequence of any individual’s decision not to accept family planning services;

Making various types of government benefits and programs available to only those who agree to use a so-called “modern contraceptive method” also has a long and ugly history. In the 1970’s an Indian government program restricted business licenses to those companies in which a given percentage of male employees had agreed to vasectomy. Most recently, the Peruvian government ejected a woman’s daughter from a nutrition program after the mother refused sterilization.

(4) The project shall provide family planning acceptors comprehensible information on the health benefits and risks of the method chosen including those conditions that might render the uses of the method inadvisable and those adverse side effects known to be consequent to the use of the method;

Lack of informed consent is rampant in population control programs around the world. What passes for “informed consent” is often little more than a lengthy (and usually very one-sided) sales pitch for a particular population control method. The most notorious abuses include giving illiterate women reading materials on a method and then asking them to sign a paper which says they agreed to use the method. Others include outright lying about the method or using misleading language to name or describe it. Sterilization procedures in Peru, for example, went by the Orwellian name of Voluntary Surgical Contraception.

(5) The project shall ensure that experimental contraceptive drugs and devices and medical procedures are provided only in the context of a scientific study in which participants are advised of potential risks and benefits;

Women in the developing world have often been used as guinea pigs for particular population control devices, drugs or methods. As documented by the British Broadcasting Corporation and stories in the Wall Street Journal, women in Bangladesh and Haiti were inserted with Norplant as part of a drug “trial,” while women in Vietnam were sterilized with quinacrine, again as part of a “trial.” In neither case were international norms for human involvement in drug trials followed. Results from both allegedly scientific studies are still being cited as justification for an increased use of each method. This portion of the amendment seeks to disallow that particular practice.

And, not less than 60 days after the date on which the Administrator of the United States Agency for International Development determines that there has been a violation of the requirements contained in paragraph (1), (2), (3), or (5) of this proviso, or a pattern or practice of violations of the requirements contained in paragraph (4) of this proviso, the Administrator shall submit to the Committee on International Relations and the Committee on Appropriations of the House of Representatives and to the Committee on Foreign Relations and the Committee on Appropriations of the Senate, a report containing a description of such violation and the corrective action taken by the Agency.

This provides the so-called enforcement portion of the amendment. It is long on requirements for notification but short on penalties. Human rights groups have expressed concern over allowing USAID (the proverbial fox) to guard the correct implementation of these programs (the proverbial chicken coop).

Yet even the relatively weak enforcement provisions cannot take away from the importance of this amendments passage into law. Never before has the US Congress formally attempted a legislative remedy to human rights abuses that have taken place in population control programs. While it remains too early, to be sure, to declare victory in the battle against such abuses, thanks to Congressman Tiahrt advocates for poor women around the world have a new tool to use in their fight.