http://www.salon.com/mwt/excerpt/2009/04/10/means_reproduction/index.html
From a sketchy underground doctor to the American fight against
communism, a look at the unlikely forces that helped spread global
family planning.
Editor's note: The following is excerpted with permission from "The
Means of Reproduction: Sex, Power and the Future of the World" (2009,
the Penguin Press, a member of Penguin Group USA Inc.)
By Michelle Goldberg
April 10, 2009
In the 1950s, before he became notorious, Harvey Karman was a
psychology student at UCLA, attending on the GI bill. Writing a paper
on the emotional impact of abortion led him into the abortion
underground, where he helped a number of desperate coeds find ways to
terminate their pregnancies. "It seemed like every guy who got a
girlfriend pregnant, everyone who had remotely heard about me, said,
'This guy knows about abortion,'" he told Ms. magazine in 1975. Often
he'd help young women make their way to Mexico to end their
pregnancies. Some of them came through the procedures fine, but some
came home sick or injured, and Karman would take them to the school's
medical center for treatment. Frustrated with this system, he
eventually started performing abortions himself.
Much of Karman's early history is hazy, but one horrific incident
stands out. In 1955, one of the women who sought Karman's help died
of an infection, and he was charged with both murder and abortion. A
court rejected his insistence that he was a mere middleman between
the woman and a doctor, finding that he himself had tried to induce a
miscarriage using a speculum and a nutcracker. Nevertheless, he was
convicted only of the lesser charge, and after serving two years in
prison, he emerged unfazed to resume the work that had become, for
him, a kind of crusade.
A man of the nascent counterculture, Karman dabbled in experimental
films and worked with juvenile delinquents and at Head Start, but
abortion remained his consuming passion. A sympathetic doctor told
him that if he could induce just a small bit of bleeding in a
pregnant girl, she could be admitted to the hospital and her abortion
could be completed legally, a technique he adopted. In fact, all
around the world, in countries where abortion is restricted, that's
often how it's done. According to Malcolm Potts, an Oxford-educated
doctor who is one of the world's leading authorities on abortion, the
"extralegal person is usually trying to produce uterine bleeding that
will take the woman to the public hospital where she will be cleaned up."
However standard, this system struck Karman as crazy, and he started
trying to devise something better. Karman "was a very dexterous
person," said Potts, who later became his friend. "He used to make
model airplanes when he was young. I once locked myself out of my
car, and I'd never seen anybody break into a car as quickly as Harvey
did. And he's pretty good at breaking into the uterus." As Potts
recalled, Karman read the medical literature about abortion in
Eastern Europe, where it had been legal since the 1950s. He wanted a
method that was as painless as possible, allowing a woman to get up
and walk away as soon as it was over. So he started experimenting in
his kitchen. Karman cut the end off a large, plastic, handheld
syringe, attached some polyethylene tubing to it, and soon came up
with the prototype for the manual vacuum aspiration (MVA) syringe, a
simple, hand-operated device that today is used all over the
developing world. "It's probably done many millions of abortions
since then," Potts said.
Starting in the 1960s, Karman used his invention to perform illegal
abortions out of a rented room next to a dentist's office in Los
Angeles. Charismatic and swaggering, he was remembered by some in the
nascent abortion rights movement as a hero, by some as a huckster. He
added a Ph.D. to his name, though his degree came from a dubious
Swiss diploma mill. Without a doubt, there were abundant reasons to
be suspicious of him, but he was no mercenary backroom butcher, and
many recall him as more interested in spreading word of his discovery
than in profiting from it, giving free demonstrations to interested
doctors and health care workers. "I was most impressed ... because of
the safety for the women and because [the technique] made it possible
to bring the price way down. And Harvey never charged a cent for his
visits," one San Diego Planned Parenthood official told Ms.
In 1972, the device came to the attention of Reimert Ravenholt, the
head of population affairs at the U.S. Agency for International
Development. Ravenholt, a roguish figure gleefully dismissive of
political sensitivities, had already decided that poor countries
sorely needed abortion equipment that could be run without
electricity. USAID was primarily focused on spreading contraception,
but government officials knew that birth control was always going to
fail for a certain percentage of people, especially in places where
access was sporadic and use inconsistent. As a then classified 1974
government report on overpopulation would conclude, "[I]ncreasing
numbers of women in the developing world have been resorting to
abortion, usually under unsafe and often illegal conditions ...
[A]bortion, legal and illegal, now has become the most widespread
fertility control method in use in the world today." To Ravenholt it
seemed obvious that no comprehensive American program to bring family
planning to the world could ignore abortion. Besides, after Roe v.
Wade was decided at the beginning of 1973, the issue seemed to be
settled. Abortion was legal in America. Why shouldn't American aid
reflect that?
Reimert had USAID contract with the Battelle Corporation to
reengineer Karman's innovation for mass production. It was a modified
50 cc syringe topped with a thin plastic tube, or cannula. When the
plunger was pulled, a thumb-operated valve retained the vacuum. The
abortionist would insert the cannula through the cervix, then
gradually release the valve to suction out the uterus. "This was a
very efficient way of terminating early pregnancies," said Ravenholt.
If there was a risk in putting an illegal abortionist to work, albeit
indirectly, for the U.S. government, it seems not to have occurred to
Ravenholt. "I knew what we needed, and Harvey had done something
along that line, so what the hell?" he said. Through the U.S.
government's General Services Administration, he ordered a thousand
"menstrual regulation kits" that included a syringe, a dozen cannula,
a speculum and a plastic basin, and he supplied them to doctors all
over the world. The feedback was positive, so he ordered ten thousand
more. His staffers would bring suitcases full of them when they went
on trips abroad. The technology has since been introduced in over one
hundred countries.
It's hard to believe now, after years in which the United States has
exported its antiabortion movement all over the globe, that the
American government was once responsible for bringing safe abortion
to great swaths of the developing world. Hard to believe, too, that
support for distributing contraceptives to remote corners of the
planet was once a solidly bipartisan undertaking. As George H. W.
Bush wrote in 1973, "Success in the population field, under United
Nations leadership, may, in turn, determine whether we can resolve
successfully the other great questions of peace, prosperity, and
individual rights that face the world." (As a congressman, Bush
earned the nickname "Rubbers" for his enthusiastic interest in family
planning.)
Today abortion is broadly legal in the vast majority of the developed
world and in Asian countries, including China and India; more than 60
percent of people live in countries with liberal abortion laws.
Another 14 percent or so live in nations like Colombia and Ghana that
allow abortion under certain circumstances. But in many poor
countries, including large parts of Africa and Latin America and
parts of Asia and the Middle East, abortion is either banned entirely
or allowed only to save a woman's life.
Twenty-six percent of the world's women and men live under such laws,
which are largely the relics of colonial constitutions promulgated by
European countries that have since abandoned such restrictions for themselves.
Given that so many abortion bans are artifacts of colonialism, it is
particularly ironic when the contemporary global antiabortion
movement accuses reproductive rights activists of neoimperialism. Yet
it's also true that realpolitik-driven fears of swelling third world
population, more than humanitarianism, drove early efforts by the
United States to bring family planning to poor countries. America's
international commitment to birth control was intended to fight
communism, not to liberate women. If it did the latter, that was at
best a bonus. Eventually, the national security rationale would give
way to a focus on women's rights, leaving birth control programs far
more politically vulnerable to right-wing attacks, since nothing but
women's lives was at stake.
The vicissitudes of the United States' policies on birth control and
abortion have always had at least as much impact abroad as they do
domestically. Americans don't pay much attention to what goes on
beyond their borders, giving those working on issues of sexual health
abroad a freer hand than at home, whether that means blanketing
neighborhoods in other countries with packets of pills or channeling
money to abstinence-promoting, condom-excoriating missionaries.
American officials have introduced safe abortion into foreign
countries, and they've interfered to make abortion more perilous. The
United States pushed to create the United Nations Population Fund,
the world's premier agency promoting reproductive health, in 1969.
Decades later, the United States government tried to destroy it.
By then it was in some ways too late: The family planning
infrastructure that America did so much to build had taken on a life
and a legitimacy of its own. At the same time, the forces of cultural
globalization -- undermining sexual taboos and celebrating individual
rights above community attachments -- continue to be associated with
Americanization. Thus a country like Nicaragua can pass abortion
legislation that mirrors the position of the party then in power in
the United States and still spin it as a blow against Northern imperialism.
The global spread of family planning has vastly changed the world.
Even as the planet's population increased nearly fourfold in the
twentieth century, from 1.6 billion to 6.1 billion people, fertility
rates have declined sharply in most countries, and smaller families
have become the norm. "In the 1950s, women in less developed regions
had an average of six children," wrote UN demographer Joseph Chamie.
"[T]oday's average is closer to three. By mid-century, the global
fertility average is anticipated to be close to replacement levels of
around two children per couple." There are many reasons women are
having fewer children, but many studies show that a substantial part
of the decrease is due to increased access to contraception, now used
by more than half the couples in the world.
In some countries effective family planning programs have been a
great boon to development. Falling birthrates, which for a time
increase the percentage of working adults to dependent children in a
society, create a window where a greater share of the population is
productive. Demographers call this the "demographic dividend," and it
can be a major spur to development. Harvard economists David Bloom,
David Canning, and Jaypee Sevilla have argued that the demographic
dividend created by East Asia's postwar embrace of family planning
"was essential to East Asia's extraordinary economic achievements,
accounting for as much as one-third of its 'economic miracle.'" (The
Philippines, conversely, is the only big East Asian country to eschew
family planning, and the only one whose economy never took off.)
Perhaps most important, the global family planning movement has --
often inadvertently, and in the face of great internal resistance --
given rise to a new vision of universal women's rights that has
changed both international law and individual lives. At the 1994
International Conference on Population and Development in Cairo, more
than 180 countries adopted a program of action proclaiming,
"Advancing gender equality and equity and the empowerment of women,
and the elimination of all kinds of violence against women, and
ensuring women's ability to control their own fertility, are
cornerstones of population and development-related programs. ... The
full and equal participation of women in civil, cultural, economic,
political and social life, at the national, regional and
international levels, and the eradication of all forms of
discrimination on grounds of sex, are priority objectives of the
international community."
This was a remarkable statement (and to some social conservatives an
appalling one). Like most UN declarations it remains more a goal than
a reality. Given the persistence of sexual oppression and even terror
in much of the world, the half a million women who die due to
pregnancy complications each year, the millions more who have their
genitals cut in the name of purity, and the plague of illegal
abortion that fills hospital wards from Nicaragua to Nigeria, the
Cairo program of action can today seem like empty verbiage. But just
as peacekeeping remains a crucial endeavor despite the endurance of
war, and human rights law matters despite constant violations, the
global commitment to reproductive rights represents an important
attempt to unite humankind against an ageless scourge: the wholesale
devaluation of women.
There have been setbacks and backlashes, some caused by right-wing
forces in the United States, others by related movements in countries
such as Nicaragua. In all likelihood there will be more, since
fundamentalism and feminism are both spurred by the upheavals of
globalization. Still, slowly, in frustrating fits and starts, a
relatively new international ideal of women's rights as human rights
is altering laws and societies in subtle but systematic ways, forcing
changes to discriminatory inheritance laws and patterns of education,
draconian abortion bans, child marriages, and other sources of female
misery. The attempt to liberate half the world's people from the
intertwined tyrannies of culture and biology is one of the least
heralded but most ambitious global initiatives in history.
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