Blanca Ruth Rodriguez's barrio lives, literally and figuratively, on garbage. Most of the people in her neighborhood, Comuneros, get up at dawn to ride bicycle carts to a nearby garbage dump. They bring heaps of refuse back to their wood and cardboard houses where they pick them over, looking for items to sell or use. Some rooms are piled high with cartons, bags, strips of plastic, and rusted metal; many floors are thick with slime. Today, as it rains, garbage streams flood the shacks.
The nearest health clinic for the 197 families of Comuneros is a bus ride away; patients must bring their own syringes and gloves. No one boils drinking water. Children have constant diarrhea. Yet outside the small store that Blanca Ruth and her father manage is a sign: "Information Post: Family Planning," and the green flag of Profamilia. Amid the bread, eggs, and cigarettes inside is a display of condoms and pills, with brochures explaining how to use them. Another condoms display bears a banner: "Nothing can cure AIDS, but this can prevent it."
"I sell about 25 cycles of pills a month, and God knows how many condoms," says Blanca Ruth, who is 25 and has two children. "But most women here already have their families and preferred to have their tubes tied. Profamilia came to pick them up, took them into the clinic, did the operations, and brought them back the same day."
Next door in a day care center, 15 wet and dirty kids are jammed into a small, smelly room. One baby swings in a hammock, another perches atop a roll of cardboard. I conduct a poll: Most have one or two brothers and sisters. Blanca Ruth beams. "Here, we are planificadas," she says-we use family planning.
Twenty-six years ago, when Dr. Fernando Tamayo, gynecologist to some of Colombia's most prominent women, contemplated establishing a family planning center to serve the poor, few nations in the world seemed less hospitable to such an enterprise. While Colombia had one of the highest birthrates in the world, the Catholic Church was more influential and conservative there than anywhere else on the continent. The left, radical and armed, saw contraception as "imperialist genocide." Most Colombian men, hopelessly machista, thought contraception would encourage their wives to cheat; most Colombian women, more machista still, deferred to their men. Even the medical establishment considered family planning a sin.
Today in Latin America, only Cuba, Uruguay, and Chile have significantly lower …