Population Policy: Will Coercion Come Back in Vogue?

Betsy Hartmann

In February of this year the Indian government announced a new population policy based on a two-child norm. While social activists have welcomed certain elements of the policy, such as free and compulsory elementary education and improvements in health infrastructure, other proposals are raising serious alarm.

After the 1994 UN Population Conference in Cairo, India started to experiment with dismantling its oppressive sterilization program which targets poor women. Under this program women are not only offered cash incentives to be sterilized, but family planning workers' salaries are tied to how many "acceptors" they recruit. The Indian government claimed it was abandoning this strategy in favor of a more voluntary, reproductive health approach toward family planning. Now it appears the pendulum may be swinging backwards.

Among the new measures proposed by the government are incentive schemes which would give health insurance to those below the poverty line who agree to be sterilized after two children and special rewards to local government units which achieve an 'exemplary performance' in universalizing the small family norm. Prominent Indian feminists such as Kalpana Sharma and Gita Sen warn that such policies could have a harmful effect on women. According to Sen, rewards to local government bodies "should not translate into ground-level coercion of (especially) poor women towards unwanted and unsafe sterilizations or IUD insertions."

Furthermore, she writes, "The ethics of rewarding those 'below the poverty line,' whether through health insurance or anything else provided they accept sterilization, is highly questionable. Poor people and especially poor women and girls need access to safe and good quality health services on a priority basis. Placing conditionalities on this reinforces a mindset among providers and politicians that poor people deserve nothing better. Such measures should be dropped from policy."

The international women's health movement has long fought against such incentive schemes because they undermine the health and human rights of poor women, making a mockery of the idea of reproductive choice. They also set the stage for even worse coercion.

For example, in Bangladesh in the mid 1980s certain local governments withheld food aid from poor women unless they agreed to be sterilized in order to meet or exceed their population targets. Emboldened by India's new population policy, the Chief Minister of Uttar Pradesh, a supporter of the fundamentalist Hindu BJP party, recently announced a state population policy which will target "specific groups and communities," read Muslims, with higher rates of population growth. Those with more than two children will be barred from contesting local elections so "the menace could be controlled."

The Plan of Action adopted by the Cairo population conference came out firmly against family planning incentive and disincentive schemes. Why then do they remain in place, or worse yet, are being reintroduced in a country like India?

Part of the reason lies in the uneven development between international, national and local population policies. Change at the top does not translate easily into change at the bottom; top-down, demographically-driven programs are firmly embedded in institutional culture in a number of countries, not to mention international agencies. Furthermore, while the Cairo Plan of Action endorsed important family planning reforms, it did not challenge traditional neo-Malthusian thinking. The pressure is still on countries like India to reduce birth rates as fast as possible. Improving the health and status of women takes time and resources and is politically risky for elites; sterilization incentives seem the 'easier' option.

And then there is the phenomenon of Chinese exceptionalism. While some members of the international population community have spoken out against China's coercive population control policies, many others have remained silent. The Chinese population problem is so big, the logic goes, that maybe just in this one case coercion is a lesser evil. And look, many urban Chinese accept the one-child policy as necessary (never mind what the rural people think).

There is too much silence about the Chinese policy on the left too. China is a socialist country, some progressives argue, it puts collective interests before individual interests, you can't judge China by the same standards, and besides we don't want to play into the hands of red-baiting, anti-abortion politicians like Jesse Helms...

True, we don't want to play into their hands, but there is an alternative perspective. The work of feminist scholars such as Kay Johnson and Susan Greenhalgh points to the devastating effects the policy has had on the health and rights of women and girls -- its gendered consequences belie the image of an ideal collective. Moreover, there are plenty of reasons to challenge the necessity of the program. Not only doesn't China face an imminent Malthusian crisis (on the contrary the economy is booming and people are better nourished than ever), but a number of other Asian countries, including Taiwan, Thailand, Sri Lanka and South Korea, accomplished the transition from high to low birth rates without recourse to coercion. Chinese exceptionalism is in fact the flip side of the yellow peril, the 'othering' of the world's biggest country, especially its women.

Family planning incentive and disincentive schemes need to be soundly criticized wherever they may be -- India, China or the United States. Yes, we have our own versions here, in public welfare 'reform' child exclusion policies and private efforts like the organization CRACK's payments to poor drug users to be sterilized. These schemes are no substitute for investments in health, education and improvements in the status of women. They set back the clock of social and gender justice.

Betsy Hartmann is the Director of the Population and Development Program at Hampshire College.