USAID targets womens health: Letter rebukes IPPF for ‘unnecessary’ medical care
A letter from the US Agency for International Development (USAID) has lent more support to the conviction that, when it comes to women’s health, USAID cares more about how many women are sterilized or contracepted than about how many are made healthier. Witness USAID’s outrageous action back in the 1970s when it knowingly shipped hundreds of thousands of unsterilized IUDS to third world nations.1
A new instance of USAID’s lack of concern for women’s health has recently come to light in the body of a 1991 letter from USAID’s Office of Population to the International Planned Parenthood Federation (IPPF).2
In that letter, USAID complained that
…All too often, in our view, family-planning programs impose numerous medical barriers to service which we are convinced hinder program effectiveness and impact, especially for hormonal contraceptives. Common examples of what we mean by medical barriers include unnecessary laboratory tests: excessive physical exams (e. g. pelvic and breast); holding the oral contraceptive “hostage “ to other reproductive medical care (e. g. pap smears and STD tests); restrictions on the number of OC [oral contraceptive] cycles dispensed… excessive follow-up schedules ( e. g. every three months, including counseling, weight, blood pressure, breast check, etc.); conservative medical thinking (e.g. taking a woman off the Pill for a while if she develops a headache just to play it “safe,” or denying a postpartum woman with an enlarged thyroid the Pill until the gland becomes smaller); excessive counseling and history-taking in such a way as to include a lot of irrelevant information rather than the important things, the net effect being to increase waiting time and see few[er] clients…
In other words, USAID told its IPPF agent, to cut out all the tests and follow-up and get those women sterilized or fitted with IUDs and Norplant, or provided with the Pill. Recently, following USAID’s “guidelines,” the Planned Parenthood Federation of America (PPFA) changed language in its own guidelines from “must” to “as indicated” for blood tests and laboratory exams for chlamydia and gonorrhea before an IUD is inserted. PPFA explained that the change was “consistent with 1994 US Agency for International Development guidelines for developing countries, which say a routine pre- exam (a separate visit) should not be required, since two visits may be a barrier to IUD use.3
1 See “The Dalkon Shield dump,” PRI Review, Sept./Oct. 1996, 3-5.
2 “International News,” Ms Magazine, Nov./Dec. 1992, 15.
3 “PPFA clinics drop pre-test,” Network, Winter 1997, 2, 7. (Network is a quarterly publication of Family Health International, Research Triangle Park, North Carolina, and is funded in part by USAID.) PRI is attempting to get the 1994 guidelines referred to above.