Pregnant (Again) and Poor

piporiko Lun 6 Avr 2009 - 18:56

NY Times Op-Ed Columnist
Pregnant (Again) and Poor
By NICHOLAS D. KRISTOF
PORT-AU-PRINCE, Haiti

For
all the American and international efforts to fight global poverty, one
thing is clear: Those efforts won't get far as long as women like
Nahomie Nercure continue to have 10 children.

Global
family-planning efforts have stalled over the last couple of decades,
and Nahomie is emblematic both of the lost momentum and of the poverty
that results. She is an intelligent 30-year-old woman who wanted only
two children, yet now she is eight months pregnant with her 10th.

As
we walked through Cité Soleil, the Haitian slum where she lives, her
elementary-school- age children ran stark naked around her. The
$6-a-month rental shack that they live in — four sleep on the bed, six
on the floor beside it — has no food of any kind in it. The family has
difficulty paying the fees to keep the children in school.

There’s
simply no way to elevate Nahomie's family, and millions like it around
the world, unless we help such women have fewer children. And yet
family-planning programs have been shorn of resources and glamour for a
generation now.

Nahomie is one of 200 million women worldwide
who, according to United Nations estimates, have what demographers call
an “unmet need” for safe and effective contraception. That is, they
don’t want to get pregnant but don’t use a modern form of family
planning.

This "unmet need" results in 70 million to 80 million
unwanted pregnancies annually, the United Nations says, along with 19
million abortions and 150,000 maternal deaths.

The push for
contraception was at the center of development efforts in the 1960s and
1970s, but then waned. In part, it was tarnished by its own zealotry,
including coercion in China and India. Another reason was abortion
politics, which led to a cutoff in American financing for the United
Nations Population Fund — even though the upshot was more unwanted
pregnancies and more abortions.

In
addition, family planning turned out to be harder than many enthusiasts
had expected, for it requires far more than condoms or the pill. Haiti
has family-planning clinics, spending on contraception is fairly high,
and women say they want fewer children — yet only one-quarter of
Haitian women use contraceptives.

Nahomie's story helps explain
the enigma. She tried injectables, but she says they caused excess
bleeding that frightened her. The clinic had little counseling to
explain and reassure her, so she stopped after nine months.

A
sexually transmitted infection at the time meant that she couldn’t use
an IUD just then, and a doctor told her that the pill would be
inappropriate because she has vascular problems. Reluctant to return to
a clinic that seemed scornful of poor women, she drifted along with
nothing.

A
couple of babies later, her first husband left her, and her next
husband wanted to have children with her, so she acquiesced. A few
children later, she began to push back, but in Haiti’s social structure
she felt she had to accede to her husband’s whims. "I asked to use
condoms," Nahomie said, "but he refused." Last fall, shortly after she
became pregnant with her 10th child, her husband ran off.

A book
published a few years ago, “Reproducing Inequities,” notes that we are,
painstakingly, learning what does work. The effective strategies go
beyond the contraceptive devices themselves to include better
counseling, more dignity for women in clinics, a greater choice of
methods that are completely free — and a broad effort to raise the
status of women.

The best way to elevate women, by far, is to
educate girls and to give them opportunities to earn income through
micro-loans, factory jobs or vocational training. It is sometimes said
that the best contraceptive isn’t the pill or the IUD, but education
for girls.

(A
side note: Whenever I write about efforts to save children from malaria
or diarrhea, I get cynical letters from neo-Malthusians who argue that
saving children’s lives is pointless until birthrates drop. That’s
incorrect. There’s abundant evidence that when parents are confident
that their children will live, they will have fewer and invest more in
each of them.)

In any case, the mounting academic evidence
underscores what is intuitively obvious in Haiti: unless family
planning is more successful in poor countries, they won’t be able to
overcome poverty. “There’s no other way,” says Tania Patriota, the
representative of the United Nations Population Fund in Haiti. “It’s
indispensable.”

President Obama has already lifted the
ban on aid for the Population Fund, and we now have an opportunity to
lead a global effort to regain lost momentum for family planning. And
while Nahomie’s story shows that this won’t be easy, it also
underscores that there’s simply no alternative.