Unto the least of these: USAID targets Central Asians for population control

Although the Central Asian Republics of the former Soviet Union are among the least tensely populated places on earth, US taxpayers, through the United States Agency for International Development (USAID), have spent tens of millions of dollars over the last five years to contracept and control those populations.

Following the breakup of the Soviet Union in 1991, the five former Soviet Central Asian Republics (CAR) — Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan — achieved their independence after some seven decades of Soviet control.

The United States quickly established diplomatic relations with the new nations, by opening embassies and exchanging ambassadors and turning on the foreign aid spigots. Soon, dozens of U.S. companies and allegedly non-profit organizations were on USAID’s payroll, offering the newly independent states advice on “everything from drafting laws to wearing condoms.”

The “needs assessment”

The introduction of “family planning” into the five “Stans” began with a three-week long trip in November 1992 by a special USAID — assembled “assessment team.” The group traveled to tour of the five Central Asian countries (significantly, a civil war in Tajikistan prevented a visit there), to discover the need for such services and to plan for a future seminar on maternal and child health, family planning and breast feeding for representatives from the CAR.1

Predictably, the assessment team discovered that there was a critical need for birth limitation and large quantities of contraceptive supplies were required throughout the region again, even though it is one of the least densely populated places on the planet.2 Indeed, since USAID officials had already begun planning a seminar on dealing with the alleged deficiencies, what was the purpose of the “assessment” trip. Typically, the basic decisions had already been made as to how to address the “needs” yet to be discovered.3 (See sidebar on page 6).

Besides the gathering of worthwhile information concerning the state of maternal and child health in the CAR, the survey team found that the region suffered from “low contraceptive usage and [a] limited variety of family planning methods.” Not surprisingly, the assessment team recommended that USAID “proceed with [its] plans for a seminar…to be held [in] January 1993, in Alma Ata, Kazakhstan.”

Much of the family planning information collected was anecdotal in nature and of dubious value. For instance, the assessment team reported that in Uzbekistan, which had “been promoting IUDs aggressively, officials report[ed] that more than one million [IUDs] have been inserted in the last year [199l].”4 Inasmuch as the total population of Uzbekistan was some 21 million, subtracting out the half who are males, the girls under age 15, and the women age 49 and older, there were less than five million women of reproductive age in the entire population.5 No matter how “aggressively” they pursued the task, is it credible that health officials could possibly have inserted IUDs in more than 20 percent of the relevant female population in just one year’s time? Such an IUD “success” story was all the more improbable in view of the outdated and creaky health care systems in the CAR, complicated by severe shortages of basic drugs and medical supplies, including IUDs.6

Another factor which mitigated against the validity and relevance of the information gathered by the needs assessment team was the lack of “any substantive conversation with women [patients] about the health care system[s]…although requests were made…to arrange informal meetings with women.7 With all the needs information coming from CAR health care providers, a scarcely disinterested group, an obvious bias permeated the USAID report. Nevertheless, for whatever it was worth, the USAID team found that the “family planning statistics being monitored are impressive,” although it was noted that the “ability to analyze and interpret the data and use [the] statistics for planning purposes is weak.”8

To cure that deficiency, the USAID team recommended that nationally representative surveys, “like the Demographic and Health Surveys (DHS) [US]AID has supported in many other countries” be undertaken in the CAR to validate the existing statistics. The team found that there was an “acute need” for all contraceptives, including “oral contraceptives, Norplant, Depo-provera, IUDs, and minilap kits [for sterilizations].” Generously, the United Nations Fund for Population Activities (UNFPA) would ‘“reportedly supply 60,000–80,000 IUDs per country during the next year [1993].”9

Creating the demand

To “prepare the way for policy and practice changes” in the areas of maternal and child health care (MCH) and family planning, the USAID assessment team recommended that “key research…and Ministry of Health personnel” from the CAR be sent to the United States “to view MCH/family planning care…with particular attention to [the] provision of [a] full range of family planning services.”10 Noting the low level of “contraceptive prevalence rates” throughout the CAR region, the USAID team found a “great need for updating [the] knowledge and skills of health professionals [regarding birth control] and [for] changing their negative attitudes toward oral contraceptives and voluntary surgical contraception.” [emphasis added]11

A recommended “priority response” to the situation, was to provide “method-specific [birth control] information in Russian,” including “key issues of [Johns Hopkins’] Population Reports and the book…Contraceptive Technology.” To remedy the low use of contraceptives, the USAID team proposed “[I]n-country or regional training of trainers in counseling, clinical skills (e. g. Minilap with local anesthesia for female sterilization), and contraceptive technology updates,” who would then go on to train others in a cost-effective manner. Revised curricula emphasizing contraceptive techniques were recommended for the CAR medical and nursing schools. Contraceptive “social marketing” programs were also advocated, as well as “mass media educational campaigns” to drum up demand. “Study tours” to Indonesia for senior health officials to view that country’s national family planning program were recommended.12

USAID’s Kazakhstan Seminar

USAID’s Maternal and Child Health seminar was held in Alma Ata, the capital of Kazakhstan, from 11–15 January 1993. High level representatives of the health care system and parliamentarians from each of the five republics of Central Asia attended. According to a USAID report, the seminar was “[d]esigned to address the most important issues in maternal and child health faced by those republics, as identified in a November 1992 assessment by USAID,” although, as noted above, the seminar had been planned prior to the “assessment”13 [emphasis added].

The USAID report recommended a 3-part program, beginning in fiscal year 1993 and continuing through 1998, for USAID to provide assistance to the Central Asian republics in improving the health of their women and children. Besides the health projects for women and children, one of the three key elements proposed was a large contraceptive project which would expand the availability and variety of contraceptives in the marketplace, introduce new contraceptive technologies, and broaden the range of health professionals and others who offer counseling in child spacing.14

In view of the small populations of the Central Asian republics (see endnote 2, below), “child spacing” rather than population control became the operative phrase for USAID’s agenda, since, as even USAID’s report candidly admitted, “there is no need for reduction in [the] rate of population growth” in the CAR.15

Moreover, CAR seminar participants preferred the term “child spacing” to “family planning” since the very word ‘planning” was a dirty word which reminded the populace of the harsh and rigid systems imposed by the Soviet Union during its seven-decade long occupation of the republics.

William Courtney, the United States Ambassador to Kazakhstan, welcomed seminar participants and a number of “expert” speakers, including Malcolm Potts, the prominent abortion advocate and past president of the International Planned Parenthood Federation, who flew in from the United States. Potts delivered at least five talks, covering such topics as the “Safe Motherhood Initiative,” the “Impact and Benefits of Family Planning on Health,” the “Worldwide Experience & Trends with Contraceptives,” “New Family Planning Methods (Hormonal),” and the conference summary wrap-up.16 Other seminar workshops covered “New Family Planning Methods (Surgical Methods and Intrauterine Devices) and “Educating Families about Family Planning and Contraceptive Marketing.” The latter talk was given by a representative of the Washington-based Futures Group, which soon after would receive a USAID contract to provide contraceptives to the CAR and initiate “contraceptive social marketing” programs in the region.

One of the recommendations arising from the seminar was for a $36 million six-year program for the Central Asian republics, funded by USAID, of which $19 million (53 percent) would go for basic health needs of women and children, $8.3 million (23 percent) for program “management, evaluation and audit” overhead, and 8.7 million (24 percent) for a comprehensive contraceptive agenda.17

Another “assessment team”

To implement its contraceptive project, USAID assembled a team composed of “cooperating agencies”’ [i.e. paid USAID agents] staff to conduct yet another “general assessment of the Central Asian Republics’ (CAR) contraceptive services.”18

The Reproductive Health Services Expansion Program (RHSEP) team included representatives from USAID and a task force from the Newly Independent States, plus such well-known population control groups as The Futures Group (TFG), OPTIONS and Social Marketing for Change (SOMARC) projects; the Johns Hopkins University for International Education in Reproductive Health (JHPIEGO); the Johns Hopkins University Population Communications Services (PCS); the Association for Voluntary Surgical Contraception (AVSC); and Macro Internationals Demographic and Health Survey (DHS) project.

All of these organizations would receive USAID contracts to carry out the contraceptive agenda earmarked for the CAR.

Not surprisingly, the new assessment team found that a “significant [but unmet] demand for fertility regulation exists in the C AR.” Nonetheless, the survey found that there was “limited support for FH [family health, i.e. birth limitation] among the top leadership” in the nations of the CAR. As in the previous assessments, contraceptive supplies were found unavailable or of poor quality, and health personnel lacked training in contraceptive delivery.

To meet these alleged needs, a $9.1 million contraceptive program, exclusive of the cost of a “demographic health survey,” was proposed, to run for three years starting in June 1993. Detailed and specific tasks were outlined for each of the “cooperating agencies” of the assessment team, who now wrote the proposal to USAID.

The Central Asian trough

USAID’s contraceptive agenda in the CAR is being implemented by an “informal consortium” composed most of the organizations active in the effort so far. Among the tasks USAID assigned the “consortium” members were:19

OPTIONS was told to conduct study tours for “key decision makers” in the CAR to Turkey and the United States to observe contraceptive programs in action and thereby increase their awareness of the alleged health benefits of “modern contraception.” USAID budgeted $1,525,000 for this and other projects.

JHPEIGO was to examine and revise national medical guidelines for the delivery of contraceptives and conduct clinical training of medical personnel in contraceptive techniques. USAID paid JHPIEGO $580,000 for these services.

USAID contracted with JHU/PCS to develop a communications program that would include a mass media campaign to develop demand for contraceptives and to conduct at least 10 “focus group discussions” in each of the republics. These “discussions” were to explore knowledge, attitudes, practices and behaviors of potential clients towards birth limitation and contraceptives. USAID will pay JHU/PCS $800,000 for this work.

SOMARC was told to develop commercial marketing networks for the financing and distribution of contraceptives and to train, via seminars and symposia, physicians and pharmacists to provide contraceptives. The organization was also to work with international pharmaceutical companies to secure agreements to sell contraceptives to the CAR at low prices. Sources in Turkey will be the main suppliers although other companies in the United States and Europe will also be contacted.

Through December 1995, USAID paid $6.9 million to SOMARC under five separate contracts for the establishment of contraceptive social marketing networks.

Seminars and deliverables

The USAID population control effort in Central Asia, featuring “needs assessment” studies, lots of seminars, “focus group discussions,” symposia, workshops and “training” sessions, and foreign travel — all implemented by the same old bought and paid for U.S. “cooperating agencies” USAID uses everywhere — is typical of USAID’s modus operandi.20

Unfortunately, in Central Asia, deliverables to USAID will include much more than pounds of useless reports and wasted monies. Permanently sterilized women and victims (including deaths) from Norplant, Depo-Provera, IUDs and birth control pills will also be delivered up by USAID‘s population control henchmen.