This concludes the second chapter dear reader. After this, we will turn to the fourth (1st and 3rd available in archives).
4. The Inquirer Debate: Reducing the “underclass”
In keeping with traditional American attempts to utilize birth control as a means of social, economic and racial “betterment,” the Philadelphia Inquirer published an editorial on December 12, 1990, just two days after the FDA approval of Norplant®. The editorial was entitled: “Poverty and Norplant: Can Contraception Reduce the Underclass?” Donald Kimmelman linked a report by a black research organization on high levels of black poverty (a report that emphasized child poverty) to this new contraceptive. Kimmelman wrote,
Dare we mention them (the two developments) in the same breath? To do so might be considered deplorably insensitive, perhaps raising the specter of eugenics. But it would be worse to avoid drawing the logical conclusion that foolproof contraception could be invaluable in breaking the cycle of inner city poverty...the main reason more black children are living in poverty is that people having the most children are the ones least capable of supporting them...(and)...No one should be compelled to use Norplant...What if welfare mothers were offered an increased benefit for agreeing to use this new, safe, long-term contraceptive....All right, the subject makes us uncomfortable too. But we’re made even more uncomfortable by the impoverishment of black America and its effect on the nation’s future. Think about it (Kimmelman 12/12/90 emphasis mine).
Kimmelman’s piece embodies the problematics of the Norplant® Condition in disciplinary liberalism. Kimmelman draws on a logic independent of the human condition, one which has as its telos the betterment of black America and the nation’s future (as if the two were separate and distinct), but does so without investigating fully the political and ethical ramifications of such a “logical conclusion.” Using this reasoning Kimmelman advocated providing financial incentives to welfare mothers who use Norplant®.
Norplant® was not celebrated in editorials as a means of expanding women’s reproductive freedoms, but as a means of achieving greater social “progress.” By providing cash incentives to welfare mothers, the problem of black poverty would be reduced. Kimmelman’s argument is problematic because it targets black mothers as the primary cause of black poverty, as Roberts and others have noted. The “least capable” mothers need to be encouraged not to reproduce: or as Sanger put it, “less from the unfit.” More complex considerations of the structural causes of poverty (reaching everything from changes in global economy to class, race and gender stratification) are not the reason why people are born into poverty. These problems are “disappeared” with one simple surgical procedure. That Kimmelman’s logic had eugenic overtones was evidenced in part by his conflation of poverty and race, as he used the terms “poor” and “black” interchangeably. Lastly, because white Americans frequently stereotype black mothers as inadequate, Kimmelman’s statements regarding black mothers serve to represent the history of white prejudice.
Dr. Sheldon J. Segal, Norplant’s creator, was deeply offended by the article noting that Norplant® was “developed to improve reproductive freedom, not restrict it” (Roberts 1997, 106). But the largest outcry came from within the Philadelphia Inquirer itself. Black staff members were outraged by the editorial in particular. Steve Lopez shot off an angry rebuttal in the Inquirer on the following Sunday:
What we have, basically, is the Inquirer brain trust looking down from its ivory tower and wondering if black people should be paid to stop having so many damn kids...(and then attacking the editorial-page editor, David Boldt), By combining contraception and race, the voice of the Inquirer calls to mind another David. David Duke (Roberts, citing Lopez 1997, 106-107).
The Inquirer’s recommendation of cash incentives for welfare mothers to use Norplant® directly mirrored David Duke’s proposal of a $500 instant cash benefit for those who “volunteered.” Public criticism was also so sharp that eleven days after the editorial was published, the piece was retracted publicly and an apology was given, a first for the Inquirer (12/23/90, C4). Yet, Boldt did not back down, writing of his dismay at public reaction in his piece, “A “Racist-Pig” Offers Some Final Thoughts” (12/30/90, 7F).
The Inquirer was not alone in its policy recommendations. Newsweek, The New Republic, the Richmond-Times Dispatch, the Washington Post all offered support for Kimmelman’s piece. Moreover, discourse in the national media reflected political discourse at the national and state level. While a detailed consideration of state proposals to tie Norplant® to social welfare is provided below, Roberts’ greatest contributions are in addressing the linkages of race and reproduction. In addition to the basic premise that race and reproduction are necessarily linked in the American context, Roberts puts forth an analysis of the racial politics of welfare discourse. While some (e.g. David Duke and Donald Kimmelman) did explicitly suggest the use of Norplant® to reduce the black population, most politicians, policymakers, and journalists have not suggested this. But, race is significant because a disproportionate percentage of blacks are on welfare: “Black women are only six percent of the population but they represent a third of AFDC recipients” (Roberts 1997, 111).
Roberts concludes the text with a consideration of the meaning of liberty. For Roberts, white academics, white feminist health advocates, and population control advocates have all too often failed to consider the racial repercussions of their proposed policies. That race remains unexamined in a field that is explicitly racialized leads to the question of liberty for whom? Reproductive rights are often white reproductive rights, which may or may not be beneficial to members of black communities. Eugenicists, population control advocates, and white feminists have often worked together on issues of (white) social betterment. Following Patricia Williams’ critique of rights discourse, reproductive rights advocacy fails because it does not contain a sufficient definition of personhood. This (liberal) “neutral” definition of rights works well for those in position of power, i.e. whites. But it fails to address the experiences of black women, which have been characterized by a consistent denial of the power of their personhood. Identity, resistance, empowerment - all are impossible without the fundamental assertion of specific personhood. A social justice perspective on rights recognizes explicitly the connection between humanization of individuals and empowerment of a group (Roberts, 1997, 310). Such a connection, I will argue later, is imparted meaningfully through the communal nature of storytelling and memory, as detailed by thinkers such as Arendt and Benhabib.
In addition to black critiques of American reproductive policy, Native American groups have spoken out against the use of Norplant® and Depo-Provera in their communities by the Indian Health Services. This has resulted in reports such as Lin Krust’s and Charon Asetoyer’s project for the Native American Women’s Health Education Resource Center (NAWHERC), A Study of the Use of Depo-Provera and Norplant by the Indian Health Services. The report expresses “considerable apprehension about the distribution of Depo-Provera and Norplant® to Native American and Alaskan women, given the history of the drugs and of the IHS” (Krust and Asetoyer 1993, 1). While the report is useful as a whole, its importance for this study rests in gaining a sense of Native American and Alaskan women’s experiences with contraceptive policies as well as understanding the role of IHS in facilitating these policies.
As in Islamic cultures, Native American cultures place a particularly strict religious, cultural and social boundary around menstruation: “Sundances, sweats, or other spiritual ceremonies...any place where the pipe is used...meetings of the Native American church,” all of these functions are avoided during menstruation (Krust and Asetoyer, citing Lewry 1993, 10). Sexual activity is also avoided. Ironically, a very significant function of contraception (to have the freedom to have sex without the risk of pregnancy) “becomes a moot point” (ibid.).
According to NAWHERC, “the IHS has a deplorable record when it comes to Native American reproductive rights” (Krust and Asetoyer 1993, 11). Echoing Robert’s accounts of the experiences of many black southern women in the 1970s, the authors report an alarming history of involuntary and/or coercive sterilizations on Indian reservations. In 1975, 25,000 women had been sterilized at IHS facilities alone. GAO investigations uncovered a pattern of coercion and misinformation in these procedures. During the 1980s, mentally challenged Indian women were given Depo-Provera to regulate and/or eliminate their menstrual cycles. While elimination of cycles occurs in approximately fifty percent of recipients, the other half experience the profound menstrual irregularities previously mentioned. Like Roberts, the authors suggest that with this recent historical background, it is hardly surprising that reproductive and racial politics are intertwined (Krust and Asetoyer 1993, 12). It is within this historical context that Norplant® was introduced to Indian reservations.
Once introduced into the IHS system, both Norplant® and Depo-Provera were treated as any other contraceptive. Reflecting a familiar criticism, the IHS is criticized in the report for failing to provide any national tracking system of recipients and for not having any standardized procedures for informed consent. This stands in marked contrast to significantly more rigorous guidelines for sterilization, which emerged from past sterilization abuses. While sterilization is necessarily permanent, are the potential damages from Norplant® and Depo-Provera insignificant enough to not merit rigorous medical follow-up? If a patient does knowledgeably consent to use of the device, then a national registry should not be nearly as significant. But without standards of informed consent, how can anyone be certain how many Indian women have been provided with Norplant® without adequate information or adequate understanding of the given information?
The authors then disclose samples of IHS health care provider responses to their questionnaire. The study found a wide variation in quality of data on Norplant® and Depo-Provera recipients. Some were extremely comprehensive, tracking the number of women requesting and receiving the devices and the number of each reported side effect. Others could (or did) only provide basic figures, such as number of Norplant® recipients at the given clinic. Some clinics tended to “push” either one of these methods over methods with higher “user failure” rates. One provider writes, “I push Depo for all women if they are interested” (Krust and Asetoyer 1993, 19). NAWHERC finds a wide variation in the presence and level of counseling prior to insertion of the device. This leads them to conclude that a national standard procedure for interviewing, counseling, inserting, and removing the Norplant® devices (and Depo-Provera) would benefit further research and recipients. High staff turnover and high patient mobility are complications that merit further tracking of the patients, rather than less. Wyeth-Amherst’s “hands-off” approach may relieve them of services that demand resources, but it does so at the expense of the well-being of thousands of Native American women in the United States. Given the seriousness of some side effects, it is important that rigorous standards be adopted. By ensuring accountability through federal regulation, patients and researchers can benefit.
NAWHERC’s enhanced institutional approach is attractive because it leaves the institutions of liberalism intact, while seeming to add the “safeguard” of federal tracking and data collection systems. This approach is faulty for two reasons: 1) it relies further on the very systems which have compromised Native American women’s well being and 2) It fails to work from the “bottom-up,” an approach which would bring the experiences of Native American women who have been through the IHS health care system into the foreground. What evidence has been provided by the researchers to conclude that the collection of data and provision of federal tracking systems would result in a greater consideration of the well being of individual women? Interestingly, NAWHERC’s “top-down” approach places trust in the very structures of disciplinary liberalism that contributed to the abuses of the 1970s and 1980s. The IHS involuntarily sterilized women during the 1970s, touching off a storm of controversy within reservations and among the public at large. If racial politics and reproductive politics are intertwined, as even the authors suggest, then what are the racial politics of this solution? A social justice perspective on rights would focus upon the personhood of the individuals impacted by the technologies. It is not that further collection of data is necessarily harmful, far from it. Rather, it is harmful to think that this is a sufficient solution. Were this the case, then further data collection on involuntary sterilization could also have been a sufficient solution. Women’s health collectives outside the IHS, women’s groups oriented around the technologies, and groups of Native American women being integrally involved in all “data” collection and policy initiatives – these are definite and real possibilities. Such groups could serve to resist and check any continued abuse of power by the IHS and the federal government.
5. Norplant® as Population Control: The Malthusian Fallacy
Once men begin to feel cramped in their geographical, social, and mental habitat, they are in danger of being tempted by the simple solution of denying one section of the species the right to exist (Hartmann, citing Claude Lévi Strauss 1995, xxii).
While each of the above case studies reveal a pattern of abuses, less attention is paid (with the exception of Roberts’ text) to the issue of why Norplant® has been pushed heavily in Third World countries and in certain sectors of the United States. What are the politics of contraception in the twentieth century? Betsy Hartmann provides a compelling analysis in Reproductive Rights and Wrongs: The Global Politics of Population Control. Norplant® and other contraceptive technologies are being pushed because there is a sense of crisis over recent world population growth. Hartmann states that the “philosophy of population control” has three assumptions:
1. Rapid population growth is a primary cause of the Third World’s development problems, notably hunger, environmental destruction, economic stagnation, and political instability.
2. People must be persuaded – or forced, if necessary – to have fewer children without fundamentally improving the impoverished conditions in which they live.
3. Given the right combination of finance, personnel, technology, and Western management techniques, birth control services can be “delivered” to Third World women in a top-down fashion and in the absence of basic health care systems....efficacy in preventing pregnancy should take precedence over health and safety considerations (Hartmann, 1995, xix).
Hartmann’s text is a comprehensive attempt to refute these basic assumptions, revealing their dangers while showing pragmatic alternatives. It is a fact that the world’s population is growing at an astronomical rate. While the population has more than tripled since 1900, the rate of its increase has also increased noticeably. This is due primarily to an increase in life span resulting from improvements in medicine, food supply, and public health (Hartmann 1995, 5). In industrialized nations, decreasing mortality rates have been met by decreasing birth rates, resulting in “replacement-level fertility.” While the population growth rate is also declining in non-industrialized settings (albeit at a slower rate), the discrepancy in birth rates between Third World countries and industrialized nations is vast.
There are compelling economic, social, and cultural reasons for this discrepancy. Children, in many “Third World” settings, are necessary assets to family income. In industrialized countries, children consume considerably more than they produce while in many Third World countries the reverse is true. “In Bangladesh, for example, boys produce more than they consume by the age of ten to thirteen, and by the age of fifteen their total production has exceeded their cumulative lifetime consumption. Girls likewise perform a number of valuable economic tasks, which include helping their mothers with cooking and the post-harvest processing of crops” (Hartmann 1995, 6-7). For Hartmann, a high birth rate is often an indicator of a people’s endangerment. For many readers in industrialized nations, it may be more difficult to imagine that a high “birth rate” may be resulting from the need for help in the fields, care for the sick, and basic survival through a higher infant mortality into adulthood. According to Hartmann, population control advocates invert this equation (high birth rates result from threats to communities), asserting that high birth rates themselves are the root cause of the very problems that plague many communities. A broader understanding of “Malthusian” and anti-Malthusian arguments is significant because neo-Malthusian ideology influences contraceptive policies implemented by the Population Council, USAID, and other key agencies.
Malthus predicted that barring a major shift in human behavior, human populations would double every twenty-five years. Because the planet has a limited “carrying capacity,” only the misery of “poverty, famine, and pestilence” along with “war and slaughter” would keep overpopulation in check (Hartmann 1995, 14). While this apocalyptic view of human future (Malthus being after all, first a clergyman and then an economist) has a certain pessimistic appeal, Hartmann notes that there are basic flaws in his argument. Malthus failed to acknowledge the possibility of shifts in the need for more or less people in a given community. As societies transform, the need for more or less children will shift with them. Second, to a large extent, he failed to acknowledge human capacity to intervene into nature, thus increasing our productive capacity to match the needs of a rising human population. Neo-Malthusians modify Malthus’ analysis and apply it selectively to Third World nations and in some instances, to minorities in the West. Because there are high birth rates and low living standards in these instances, neo-Malthusians take this correlation to be causal. The reduction of high birth rates will result in higher living standards. Thus, members of the upper and middle classes of the industrialized West are free to reproduce, while members of the “Third World” are only hurting themselves through reproduction and demand radical measures of social intervention.
While Hartmann may be correct in asserting that the appeal of Malthusian ideology lies in its connection to incipient racist, sexist, and classist tendencies in the industrialized West, to some extent its appeal also rests in the fact that it does seem to possess explanatory power. The environmental destruction being visited on the earth has no historical parallel. Could the vast consumption of non-renewable resources, proliferation of famines, deforestation of rain forests, and astronomical pollution rate not be related to the population explosion during the twentieth century? Regardless of the answer, it remains true that social policy needs to be shaped to fit the fragile and finite confines of the earth. While many of the aspirations of ecological neo-Malthusianism remain fundamentally sound, the premises are faulty.
Famines are not a function of lack of food. In many cases, famines are a function of war, or more pointedly, function of a breakdown of political representation and economic stability. The countries of Africa frequently suffer from famine, which may be related to low productivity. As Hartmann notes, between sixty and eighty percent of the rural labor force in Africa has a very low productivity rating. The most common agricultural tool is a hoe. The focal point in Africa’s agricultural economy is the production of cash crops for export. This lack of focus on food crops has a long history in Africa directly connected to Western colonization. World Bank dependency in Third World regions has resulted in this continued focus, with the need to re-pay debts in order to re-finance loans from the World Bank.
For Hartmann, what is needed in Africa is not a draconian population control policy, but the implementation of widespread agricultural reforms. Paul Ehrlich, the author of the landmark The Population Explosion and avowed neo-Malthusian, operates his logic from a simple equation. The impact (I) of a population on the environment is equivalent to its size (P) times its affluence (A) times the index of the environmental disruption caused by the technologies that produce consumable goods (T). The I = PAT equation is ironically, an equation (like 2+2 = 4) that stands independent of the human condition. It places the pluralistic dynamism of reproductivity into the “straitjacket of logic,” a logic that stands at the center of disciplinary liberalism.
Hartmann’s trenchant critique offers a significant response. First, there are compelling reasons to believe that of the three, technological development has the greatest impact. To take an extreme example, whether the earth’s population is six, ten, or twenty billion, a nuclear exchange could induce a nuclear winter in a relatively short period of time. The example of the nuclear exchange carries over to her second point, which is that Ehrlich fails to address the role of social and political power. Power constructs P, A, and T as well as the relationship between these variables. Moreover, each of these variables reduces diverse and specific cultures to one group: the world population. Different cultures have different rates of consumption, but they also have different rates of contribution to the world’s well being. Inquiring into the inappropriate uses of technology (such as for the increase of affluence) will yield a more capacious understanding of the world’s ecological crises. An understanding of postindustrial dependence upon the automobile instead of mass transit, upon contraception instead of fundamental social reform – these dependencies (and many others) are part and parcel of the world ecological crisis. The population “bomb” serves as a means by which western middle and upper class elites can displace the problems generated by their lifestyle choices onto m/Others in the Third World.
Is the World Bank correct to assert then that population growth is “a serious brake on development” involving “lost opportunities for raising living standards, particularly among the large numbers of the world’s poor” (Hartmann 1995, 30)? Sub-Saharan Africa’s ten poorest and ten richest countries have nearly the same population growth rate. If population growth explains economic well being, then it would vary between the richest and poorest countries (Hartmann 1995, 31). Poverty, in many instances, is a function of a lack of public resources devoted to the well being of its people. As public expenditures move away from education and health care and into military budgets, it is unsurprising that poverty will increase. Neo-Malthusians ask the wrong questions:
They do not ask who owns the land, who fells the forests, who draws up the government budget, who steals the international bank loans, who were the colonialists, and who were the colonized. By a wave of some magic wand, they deny the role of the rich and powerful in creating and perpetuating the poverty of the powerless. Their ideological fervor masks a profound fatalism: The poor are born to their lot, and the only way out is for them to not be born (Hartmann 1995, 34).
Even political instability and revolution are attributed to a crisis in population growth (ibid.). Like Sanger, Malthusians are quick to “solve” public crises of poverty and social welfare through population control policy changes.
In a drive to reduce population at any cost, effectivity of contraceptive devices takes precedence over the safety of the devices. Provider-controlled contraceptives have emerged in light of the user “failure” rate among user-controlled contraceptives. Women’s and men’s choices to reproduce are then read as “failures” by population control advocates. It is within this ideological context that IUDs, Norplant®, and Depo-Provera have emerged. Ironically, population control advocates have contributed to women’s lack of reproductive control. Population control policies work hand-in-glove with patriarchal power relations, inhibiting women’s reproductive autonomy.
According to some critics, family planning programs in the Third World function in part as conduits for neo-Malthusian ideology, emphasizing the reduction of birth rates, rather than the provision of fully informed reproductive services to women and men. Family Planning clinics in the Third World are discouraged by their funding sources (e.g. U.S. Agency for International Development or AID) from providing condoms and encouraged to “install” provider-controlled technologies of contraception. An AID leaflet distributed to the Philippines agencies reads: “Discourage condom acceptors and encourage more IUDs and pills. The clinic is evaluated on the method accepted by the clients. There will be no more supply of condoms: so convince your condom acceptors to shift to pills and IUDs” (Hartmann 1995, 65).
Family planning agencies also provide a variety of economic incentives for forms of contraception both in and out of the United States. Frequently, “acceptors” are provided with a one-time cash incentive for sterilization or IUD insertion. On a significantly smaller scale, Planned Parenthood clinics have offered teenage girls funds that accumulate while they retain Norplant® in their bodies. Aside from biasing poorer women and girls against forms of birth control that do not “pay,” such programs can carry the added dilemma of encouraging users to retain the devices despite deleterious side effects. Other women are paid with animals that serve as capital within their social framework. In Thailand, women were given pigs by the Community Based Family Planning Services (CBFPS) for spacing their pregnancies (Hartmann 1995, 68). Other countries offer stringent disincentives to further pregnancies. Hartmann quotes Singapore’s Prime Minister, Lee Kuan Yew’s assessment of reproductive rights:
Free education and subsidized housing lead to a situation where the less economically productive people in the community are reproducing themselves at rates higher than the rest. This will increase the total population of less productive people (Hartmann 1995, 70 emphasis mine).
The fusion of neo-Malthusian and social Darwinist ideologies has produced policies that hold populations with higher birth rates accountable for structural economic problems such as underemployment and poverty.
It is through such an ideological fusion that reproductive policy has become critical not only to “health” concerns but to a broad array of social welfare issues. In Indonesia, the World Bank, UNFPA, and AID have pushed for stringent contraceptive policies (involving Norplant®, sterilization, and IUDs) through massive campaigns. In 1995, roughly 1.5 million Indonesian women have received Norplant®. Just as in Brazil and Bangladesh, critics question whether these insertions were performed with informed consent. Of equal importance, removal on demand is not guaranteed in Indonesia, the world’s largest Norplant® consumer (Hartmann 1995, 77).
Without a doubt, the Indonesian family planning program is a “success” story, marking dramatic drops in birth rates since the implementation of the long-term contraceptive policy. Yet, the success of this policy is rooted in both coercive and manipulative methods as well as hierarchic structuring. According to AID, “The most ready explanation given for the success of the Indonesian family planning program is the strong hierarchical power structure, by which central commands produced compliant behavior all down the administrative line to the individual peasant” (Hartmann 1995, 78). Family planning counselors engage in “safaris” to “educate” the people of Indonesia. In the late 1970s in East Java, the military accompanied family planning counselors to ensure adequate insertion rates. In 1990, police and army officials went house to house, taking women and men to IUD insertion sites. In Lombok, a family planning worker disclosed their method: “If the target is still high and has not yet been reached and the people are difficult to reach, the army makes them a little bit afraid so that they are willing to come together for a family planning session” (Hartmann 1995, 79). Community rewards and recognition for the best positive attitude are also provided by the Indonesian government.
These practices gain credence in the international community because the population “bomb” is seen by many to be more dangerous than the threat of nuclear catastrophe (Cadbury 1994; Hartmann 1995, 93-112). By 1958, President Eisenhower had established the Draper Committee. While this committee was not designed to examine population crises, Draper made the “population problem” the focal point of his career in and out of government. Draper’s 1959 mapping of the explosion earned worldwide press coverage and helped to establish population as a critical world crisis. By the 1960s, the U.S. Agency for International Development (AID) began allocating funds for international “family planning” programs. With the exclusion of John D. Rockefeller III, western leaders in political and business communities strongly advocated a “top-down” approach to “family-planning” by 1974 at the World Population Conference at Bucharest. This approach has come to fruition in the 1980s and 1990s and is central to the Norplant® “problem.” As policymakers and health care advocates increasingly have sought out contraceptives as a corrective to social problems such as poverty, the underlying structural foundations of unequal distribution of wealth are ignored. Moreover, the “acceptor” of the device is held accountable for systemic economic and political transformations that exist well beyond any individual.
Hartmann tirelessly develops her thesis on the impact of neo-Malthusian forms of birth control. For her, technology is not neutral, but reflects the values of its creators. The sense of urgency generated by the “population explosion” thesis led to the prioritization of efficacy over safety, as in IUDs, Norplant® and Depo-Provera. These same concerns led to minimizing “user failure” through the development of non-removable birth control devices. This occurred at the expense of women’s autonomy and health. Barrier methods are usually safer and can also serve to inhibit the spread of HIV. This bias has been exacerbated by the fact that the bulk of contraceptive research has been devoted towards controlling women’s fertility. Hartmann’s thesis carries the implication that the lack of attention to women’s health and well being on a specific level has been generated from focusing strictly upon “population” as the object of analysis. To the extent that a device can effectively reduce a population, particularly a population of the “unfit,” it is a good device – without regard to its specific impact on women and men.
In response to neo-Malthusian efforts, Hartmann provides a summary of policies aimed at stemming population growth, while improving the distribution of economic, social and political power. South Korea, Cuba, Sri Lanka, and Kerala all have experienced massive demographic transitions independent of personally invasive population control policies. She sites the following “ingredients” for the success of a more humanized population “control” program:
1) Income and land redistribution;
2) Employment opportunities and social security;
3) Improvements in the position of women, including a later marriage
4) Reductions in infant mortality;
5) Accessible health care and education (Hartmann 1995, 300).
Through an emphasis on social justice, it is possible for population concerns to be addressed while emphasizing the specific needs, the very personhood of women and men around the globe. Even if one takes the most adamant population control position, education (specifically, literacy), economic opportunity, and increasing women’s status are greater predictors of birth rates than the level of distribution of contraceptives.
6. Conclusion
In Indonesia, the abuses of Norplant® are so common that grim pronouncements of technological determinism may seem appropriate. Yet, in Brazil the device has been mediated by a stronger civil society, democratic citizen-state relations, and has resulted in resistance to the seemingly inexorable forces of technological development and political hegemony. In the United States, the political framework enables the possibility of stronger monitoring of reproductive policy. But such monitoring is less likely in the very settings where abuse of Norplant® is most common. While Norplant® may be less likely to be abused in some settings than others, the device and the discourse that surrounds it is also a production of a certain problematic in liberalism, one that is bound up with an instrumental relationship to rationality – if not the very notion of rationality itself. Foucault’s genealogical and archaeological models are utilized to unearth the instrumental rationality that inheres in disciplinary liberalism. It is to these topics that Chapter Three is directed.
