The Means of Reproduction In this groundbreaking work of investigative journalism by the author of the New York Times bestseller Kingdom Coming, Michelle Goldberg exposes the global war on womenÂ's reproductive rights and its disastrous and unreported consequences for the future of global development WomenÂ's rights are often treated as mere appendages to great questions of war, peace, poverty, and economic development. Bu... Full description
Table of Contents
Title Page
Copyright Page
Dedication
Introduction
CHAPTER 1: SANDINISTA FAMILY VALUES
CHAPTER 2: THE GREAT POPULATION PANIC, OR FIGHTING COMMUNISM WITH CONTRACEPTION
CHAPTER 3: SISTERHOOD IS INTERNATIONAL
CHAPTER 4 : CAIRO AND BEIJING
CHAPTER 5: RIGHTS VERSUS RITES
CHAPTER 6: THE GLOBALIZATION OF THE CULTURE WARS
CHAPTER 7: MISSING GIRLS
CHAPTER 8 : THE BIRTH STRIKE
CONCLUSION: SEX AND CHAOS
Acknowledgements
NOTES
INDEX
ABOUT THE AUTHOR
ALSO BY MICHELLE GOLDBERG
Kingdom Coming: The Rise of Christian Nationalism
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To Carolyn Goldberg and Binni Ipcar
NOTE TO THE READER
This book is the product of both firsthand reporting and archival research. Often I would interview a person, sometimes several times, and then supplement what he or she told me with information gleaned from oral histories, news stories, journal articles, and books. All secondary sources have endnotes; things that I saw and heard myself do not.
INTRODUCTION: THE GLOBAL BATTLE FOR REPRODUCTIVE RIGHTS
Eunice Brookman-Amissah, the former health minister of Ghana, calls the death of her teenage patient Amina the beginning of her road to Damascus. The stepdaughter of an Anglican archbishop, Brookman-Amissah was brought up in a very conservative home, and those values stayed with her when she went to medical school. In the Accra teaching hospital where she trained in the late 1960s, young women who came in with botched abortions were put in a place called Chenard Ward. There were at least ten of them every day. “They were kept there bleeding and feverish and dirty until all the other cases were done—then it was time to do the evacuations,” she told me. “They were kept on the floor. Even when there were beds, these women were put on the floor. People stepped on them and insulted them and called them names—this is how horrible it was!”
Brookman-Amissah did not, at the time, see all this as particularly outrageous. “We were brought up to think that women who had had unsafe abortions were criminals,” she said. “They were bad women. They were the scum of this earth.”
After graduating, Brookman-Amissah went into private practice. She looked after a poor Muslim family who lived very close by. Their daughter, Amina, was exceptionally bright. “Her parents were illiterate, but she was going to school,” Brookman-Amissah said. Amina called her “Auntie Doctor,” and liked to hang out at her clinic and talk to the nurses, saying she would be one herself one day.
In 1992, when Amina was fourteen, she came to the clinic one Friday. As Brookman-Amissah remembers it, she was agitated and had been crying. A man in her compound, she said, had given her money to give to a doctor to make her period come. “My first reaction was one of outrage,” said Brookman-Amissah. “ ‘Amina, how dare you talk to me about that? Don’t you know we don’t do that here! Naughty girl!’ That sort of thing.” Brookman-Amissah asked Amina to send her mother on Monday so they could talk. “I can still see the look in her eyes,” she said.
But on Monday, no one came. Nor on Tuesday. On Wednesday, she heard drumming and commotion outside. A nurse told Brookman-Amissah what it was. “Doctor,” she said, “that’s Amina. They’ve gone to bury her.” The man who got her pregnant had taken her for an abortion over the weekend, and it had killed her.
“Was Amina really a criminal?” she remembers thinking. “Maybe I’m the criminal. That man, that older man, is a criminal. The whole society is liable for the death of an innocent young girl who didn’t even know what was happening to her.”
Brookman-Amissah began to alter her views. She got involved in training doctors in more humane postabortion care, and eventually became the representative in Ghana of Ipas, an international safe-abortion organization based in Chapel Hill, North Carolina. Ipas distributes manual, handheld abortion kits all over the world, which are also used to treat women whose backstreet abortions have gone wrong. Brookman-Amissah used to sit for hours outside the offices of the Ministry of Health, trying to donate the kits and to offer free training in their use. “I believe I was called the abortion lady,” she said.
Yet while abortion remained illegal, the mood was changing among elites. Brookman-Amissah remembers that when she proposed programs to address complications from unsafe abortions, the woman who headed the government’s office of reproductive health was unsure. Then the official went to a groundbreaking 1994 UN conference in Cairo, during which, much to the chagrin of an international network of religious fundamentalists, most of the world’s countries pledged to commit themselves to reproductive health and rights. She came back clutching the conference’s official program of action, which urged all countries “to deal with the health impact of unsafe abortion as a major public health concern and to reduce the recourse to abortion through expanded and improved family-planning services.”
Soon Ipas and the Ghanaian government were collaborating on a program to train midwives to help women who’d suffered complications from illegal abortions. And then, in 1996, Brookman-Amissah became the minister of health herself. Later she would become Ghana’s ambassador to The Netherlands, before rejoining Ipas as vice president for Africa. Abortion remains broadly illegal in her country, but the government is actively trying to educate workers in health care and law enforcement that there is an exception when a woman’s health is at risk.
Promoting safe abortion in Africa is a monumental job. Thanks to the legal remnants of colonial constitutions, the procedure is severely restricted in most sub-Saharan African countries. According to the World Health Organization, of the forty-two million abortions performed in the world each year, twenty million are unsafe, and nowhere in the world are abortions more dangerous than in Africa. Botched abortions kill 36,000 African women each year, representing more than half of the global total of between 65,000 and 70,000 annual deaths.1
Worldwide, complications from unsafe abortions cause 13 percent of maternal deaths and account for a fifth of the “total mortality and disability burden due to pregnancy and childbirth,” according to the WHO. Twenty-four million women have been rendered infertile by dangerous procedures, an especially crushing debility in parts of the world where childless women are reviled. Again, the toll is worst in Africa.2
The problem of unsafe abortion has been seriously exacerbated by contraceptive shortages caused by American policies hostile to birth control, as well as by the understandable diversion of scarce sexual health resources to fight HIV. Between 1995 and 2003, international donor support for family planning in the developing world fell from $560 million to $460 million, a shortfall that has hit Africa particularly hard. In Kenya, the World Health Organization reports, between 1998 and 2003, the number of births that mothers said were unwanted nearly doubled, from 11 percent to 21 percent.3
But it’s not just the scale of the problem of unsafe abortion and lack of family planning that makes the work of reform so difficult. Cultural conservatism is deeply entrenched across Africa, as it is in most of the poor regions of the world. Religious revivals, Christian and Muslim alike, have caught fire, and they compete to condemn the destabilizing libertinism of the West. (During the American presidential campaign of 2008, the Ghanaian artist Blakk Rasta had a hit with the song “Barack Obama,” which celebrated the candidate even as it promised that judgment would come to America for “legalizing abortion.”)4
Churches in the global South “are by and large much more comfortable than their Northern neighbors in preaching a traditional role for women,” wrote the religion scholar Philip Jenkins in The Next Christendom: The Coming of Global Christianity. “This is especially true in much of Africa, where Muslim notions exercise a powerful cultural influence. Although Christians do not accept the whole Islamic package of mores on this or any issue, they do imbibe a conservatism general to the whole community.”5
The specific religious dynamics differ in other parts of the planet, but the conflation of women’s rights with globalization or Westernization, and the concomitant desire to limit them in the name of national or cultural integrity, is nearly universal. Republicans in the United States, whether in Congress or the White House, have worked to bolster this conservatism by denying aid to groups that have anything to do with abortion, channeling funds to traditionalist faith-based groups, and using the country’s diplomatic weight to thwart international efforts to improve reproductive rights.
American antiabortion pressure, said Brookman-Amissah, “has grown over the years. It started with resistance to the whole Cairo agenda, especially the reference to reproductive health and rights, a word they seem to be very allergic to. The fanaticism that is there about abortion, which is also threatening women in your country, this was translated onto the international scene.”
Even as religious traditionalists in developing countries find support abroad—whether it comes from Saudi Arabia, American evangelicals, or the Vatican—they excoriate feminists and family planners as agents of Western cultural imperialism. Meanwhile, women’s rights activists like Brookman-Amissah find bases for their work in international NGOs (nongovernmental organizations), and backing for their positions in statements of the United Nations and other international bodies. A global culture war is raging, and it’s all about who controls women’s fertility—and, more broadly, women themselves.
That is the subject of this book—the global battle for reproductive rights. It spans five decades and four continents, and it elucidates a multifaceted political and ideological fight that is one of the most important, if unsung, of our time.
All over the planet, conflicts between tradition and modernity are being fought on the terrain of women’s bodies. Globalization is challenging traditional social arrangements. It is upsetting economic stability, bringing women into the workforce, and beaming images of Western individualism into the remotest villages while drawing more and more people into ever growing cities. All this spurs conservative backlashes, as right-wingers promise anxious, disoriented people that the chaos can be contained if only the old sexual order is enforced. Yet the subjugation of women is just making things worse, creating all manner of demographic, economic, and public health problems.
This is not just a story about abortion, though abortion tends to be a flashpoint. It is, rather, about how great international powers have worked to influence the rights of the world’s women, and how, conversely, women’s rights will ultimately shape the future.
The tale is much bigger than it might at first appear. For decades now the countries of the first world have been exporting family planning to the third world, for reasons that combine humanitarianism and national security realpolitik. With the West’s help, governments worldwide concerned with overpopulation have tried to change the sexual and childbearing norms of their peoples. Feminists have fought, with a surprising if unheralded degree of success, to have reproductive rights recognized in international law. The United States has, depending on who is in charge, worked to bring safe abortion to poor countries, and worked with equal zeal to take it away. Imitating the organizing strategies of their opponents, fundamentalists have joined hands across national borders to stave off challenges to traditional gender hierarchies. And remarkably little of this hugely consequential story is understood by the American public, despite the country’s crucial role in shaping the fate of women all over the planet.
Many of the roots of our current battles lie in the cold war, a time of widespread panic that overpopulation was going to lead to Malthusian doom and revolutionary upheavals. Back then, staunch anticommunists saw the mass diffusion of birth control as a key bulwark against anticapitalist chaos. A huge international family planning infrastructure was erected, and the idea that childbearing should be a matter of choice rather than fate spread throughout the world.
Not surprisingly, some countries saw this as a form of neocolonialism, a critique that has gained ever more salience in recent years, when it’s been supported, ironically, by the American right. Nevertheless, in the second half of the twentieth century, a global consensus began emerging that overpopulation hindered development. As the concern grew, some countries started using coercion to bring down birth rates faster, resulting in outcries from both feminists and religious groups.
At certain points there was considerable hostility between those most concerned about women’s rights and t...
