Jewish World Review Feb. 21, 2003 / 19 Adar I, 5763

Eve Tushnet

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Consumer Reports

For her own good: Sterilizing the poor | In the United States, doctors are often viewed as heroes. In a nation that skids erratically from pluralism to relativism, physical health is one of the few values most of us can agree on. Television shows from "Marcus Welby, MD" to "Scrubs" have played on the sympathy and respect we have for doctors. And the doctors generally live up to our expectations--they sacrifice time and rest in order to heal the sick and the injured. They earn the authority we give them.

I wonder what Obdulia thinks of doctors now. Obdulia is a 21-year-old Mexican woman of Tzotzil Indian heritage. One day she went to the nearest health center, complaining of abdominal pain. The doctors recommended surgery; accepting their authority, she assented.

When the surgery was over, she was unable to bear any more children.

Obdulia told the National Catholic Register that her doctors, by performing an unwanted tubal ligation, had snuffed her dreams of having more children. And she is not alone. Throughout the world, women are lied to, pressured, and subtly or not so subtly coerced into unwanted sterilizations and other contraceptive procedures. And just as in the coerced sterilizations that continued in the United States until the 1970s, poor women and members of minority ethnic groups are targeted. Conservative humorist P.J. O'Rourke has described the population-control mentality as, "Just enough of me... way too many of you"; Obdulia's doctors proved him right.

Coerced sterilization happens all over the world. But opponents of the practice got a lucky break when two Mexican human rights organizations--one governmental, one not--released twin reports condemning the sterilizations in that country. The government report, released December 16, charged that more than 400 women had been sterilized against their will, and that coerced sterilizations or contraception (for example, IUD insertion) have occurred in every one of Mexico's 31 states. Mexico's forthright behavior contrasts to the response of the United Nations Population Fund (known as UNFPA), which suppressed a report showing that Brazilian clinics supported by the Fund had pressured women into various contraceptive methods. The report, when leaked to the Register, revealed unprepared health care workers who spoke of their clientele in contemptuous terms, refusing to listen to the women they supposedly served.

In Mexico, too, the UNFPA got its hands dirty; it was involved in the planning of Mexico's birth control program, funded it, and took on responsibility for monitoring and evaluating the program. Yet its evaluations managed to miss Obdulia and all the women like her.

These reports should come as no surprise. The driving force behind the population-control movement is the belief that poverty is best alleviated by reducing the birthrate of the poor; one of the many problems with this diagnosis is that poor women often disagree with it. (Economist Amartya Sen has laid out many of the other flaws of a poverty-fighting strategy that focuses on population control in his 1994 article, "Population: Delusion and Reality." The short version is, focusing on more direct paths to economic growth--like providing people with educational opportunities and better overall health care--is more effective and far less likely to foster coercion.)

When a group that commands both authority and power disagrees with the wishes of a group that commands neither, who do you think will win? Population controllers have won the support--active or tacit--of governments around the world (another reason the Mexico report is so important), and, of course, they have an entire UN fund to play with. In 1961-2, Stanley Milgram ran a now-notorious experiment in which he found that people would obey white-coated instructors even when it violated their own conscience and impulses of kindness: The instructors ordered subjects to administer fake "electric shocks" to actors who writhed in pain, cried out, and even pleaded that they had life-threatening heart conditions.

Two-thirds of Milgram's subjects administered what they were told were 450-volt shocks, even though they could see and hear the "agonized victim." If scientific authority figures could command that much authority over the university-town populace from which Milgram drew his subjects, it is easy to see how educated doctors could pressure peasant women into getting unwanted IUDs, or threaten poor women with cutoff of emergency aid if they do not get sterilized.

Population control, because it so often goes against the preferences of the poor (unlike programs that promote small-scale entrepreneurship, provide poor people with access to technological innovations, help peasants market their goods, or offer a chance at an education), fosters rule by experts rather than self-determination. It tries to alleviate poverty by giving poor people less control over their own futures, not more. This is absolutely backwards, and much more likely to engender the fatalism that keeps people poor than the hope and determination that helps them exit poverty.

In fact, population control is a classic case of the problem with rule by experts. Expertise is distinguished from wisdom in that it concerns knowing a great deal about how to achieve one possible good, whereas wisdom concerns the proper ordering of goods. Experts know a lot about a little thing; but because of their sharp focus on one problem, they can become subject to myopia, and fail to see the ways in which their good conflicts with other, more important goods like liberty and responsibility. This potential problem of expertise is made much, much more likely when the experts are far removed from the consequences of their failures. It is made almost inevitable when the experts have even a hint of contempt for the people whose lives they presume to guide. In population control, all these factors together create a dangerous and deeply sad situation.

The United States government and US human rights supporters must be vocal in their condemnations of any population programs shown to be abusive. More importantly, though, we must approach all population programs with intense skepticism. We must maintain this attitude of mistrust for two reasons: First, because it is only due to that skepticism that programs will be investigated and abuses uncovered (especially since the coerced women are among the segments of the populace least likely to complain of mistreatment). Second, because the structure of the population control movement--its focus on population over poverty, and its designers' distance from the lives of the people they affect--and the vulnerability of the target population make abuse so likely.

The reports from Mexico should not be a surprise. They could have been predicted by anyone who has studied the history, logic, and structure of the population control movement.

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© 2002, Eve Tushnet