Q: Why did you start your work in family planning?
A: During the 1970s and 80s I spent a lot of time with women in Africa, Asia and Latin America. Fear of death in childbirth, child marriage, family violence, pain, poverty and resignation were common themes. Health information and services were woefully inadequate. I chose to work in family planning because it is a vital reproductive health resource and the only one that was available to poor women in developing countries.
Q: Why were reproductive health services so poor in developing countries back then?
A: Governments did not feel that reproductive health other than family planning was worth investing in. Data about women's reproductive health were sparse and maternal deaths were estimated, not counted, while morbidity was ignored. This neglect was based on the argument that preventing pregnancy was a better way to prevent these deaths than providing obstetric services. Sexually transmitted infections in females and induced abortion were subjects people refused to deal with, even though abortion, nearly always unsafe or fatal, was being used as a means of birth control. This was evident from the few statistics that were available and from my experience working with these women.
Q: Can you recall an incident that illustrates the consequences of this neglect?
A: One strong image illustrates the lack of services and basic human rights for women who had abortions. In Cameroon I visited a sparkling new maternity hospital on a hill. Down below, in what was often a sea of red mud, was a dilapidated building where women with complications of "backyard" abortions were often left lying by the door by family members too ashamed to be seen with them. Only one doctor worked there, in terrible conditions with almost no equipment or drugs. The women were put on rusty gurneys with a dirty sheet and, after treatment, housed in "rooms" the size of closets, each with three tiers of wooden shelves, not beds. In one I saw one woman, "Rose", dying. The fancy maternity hospital on the hill could have saved her but refused to serve women who had had unsafe abortions.
Q: In Asia in the 1970s, many countries had strong population control programmes that provided family planning services. Didn't women in these countries receive better care than women in countries where contraception was not supported by the government?
A: While contraception was an essential and desired service, too little attention was given to service quality because the goal was to promote acceptance of contraceptives. In India, for example, a lot of intrauterine devices (IUDs) inserted during periodic "camps" were not fitted properly and led to unwanted pregnancies. The women involved often ended up having unsafe abortions because abortions were rarely available in health-care facilities, especially in rural areas, even though it had been legalized in 1972 for pregnancies up to 10 weeks. This is still the case in rural areas. Although abortion services are now more widely available in urban areas, especially from private, for-profit providers, low-income urban women must still resort to unsafe procedures. IUDs remain unpopular in India. Other contraceptive choices were very limited and services then, as now, were often poor, yet women were blamed for not wanting to use them. In Indonesia, contraceptive services were often delivered to villages by the military. Women were given no choice in contraceptionrelated matters; they were not offered support or information on dealing with its side-effects or guidance in choosing alternative methods. Again, the drive to increase acceptors trumped interest in service quality.
Q: During the late 1980s, you witnessed a feminist revolution that differed from one in high-income countries during the 1960s and 1970s. What were these activists fighting for?
A: This movement in developing countries had its roots in the fight for broader social justice. …