A Postscript to Our Forum of Volume 6(1):71-122. We received two further contributions to the debate featured in the Forum in our last issue. The papers speak for themselves and I will not attempt any further synthesis, except to note that each brings up important issues not fully covered in the previous Forum. John C. Caldwel

Basu, Alaka Malwade

Klugman, Barbara

The Australian National University

Forum: Health Transition Review 6, 1996, 95-99The International Conference on Population andDevelopment, Cairo, 1994. Is its Plan of Action  important,desirable and feasible?A Postscript to Our Forum of Volume 6(1):71-122We received two further contributions to the debate featured in the Forum in our last issue.The papers speak for themselves and I will not attempt any further synthesis, except to notethat each brings up important issues not fully covered in the previous Forum.John C. CaldwellICPD: What about men’s rights and women’s responsibilities?Alaka Malwade BasuCornell University, Ithaca NYThe ordinary everyday feminist is content to suggest that men and women should beequals, but the thoroughgoing feminist holds that women should have the position hithertoenjoyed by men and men should have the position hitherto endured by women. (Russell1931)The general tone of the ICPD document is very much that of Russell’s thoroughgoingfeminist even if its vocabulary makes some cursory concessions to a more ordinary feminism.Indeed, this latter factor, the plethora of concessions, is one of the major problems with thedocument. It plays safe by anticipating every possible criticism through the expedient ofsaying a little bit about everything that anyone might consider important. One must thereforejudge it by its tone and not by its specific recommendations. And, while the document doesoften use the language of gender equality and never once explicitly recommends a completereversal of the status quo, its spirit is so decisively in favour of the latter that it is being readby feminists as well as by the establishment as the landmark in the otherwise agonizinglyslow progress of the women’s movement.Perhaps this heavy emphasis on women’s issues in an official document is warranted fornational policies to move even a little in the direction of reducing discrimination againstwomen within and outside the household and there really is no fear that the status quo willever be reversed. But the one-sided rhetoric, besides being possibly negative for strategicreasons, also has a few crucial aspects which make it particularly bad for gender equality.The thoroughgoing feminist stand of the ICPD is most evident in the overwhelmingreference throughout the document to women’s rights and men’s responsibilities. Whenevermen are mentioned separately, as they are in a whole section in Chapter 4 for example, it isalways in the context of the responsibilities that they should be more encouraged to assume.The concept of reproductive health itself starts off being defined as a human or individualright, but soon confines itself in longer discussions to the rights and needs of women. Andfrom this near-exclusive demand for female reproductive health, the document goes on toconnect every aspect of the population and development question to gender issues. Page 86,96 ForumHealth Transition Reviewfor example, which is part of a chapter on the need for more research, has the word ‘women’five times.But what about men’s rights and women’s responsibilities? By representing tensions asbeing almost entirely gender-based, the ICPD served an important symbolic function butfailed to address the larger socio-economic and cultural issues important to the populationand development debate. It is no use pointing to the document’s obligatory references topoverty, environmental degradation, North-South relations, and such. These are seen byreaders of the document as mere sideshows to the main event. More starkly, even thoughhuman rights are the major issue in the deliberations, men and boys get short shrift in theconference document. Thus, the gender difference in child mortality is seen as much morecrucial than the high level of child mortality, male and female, in poor societies across theworld.This overriding concern with women as a central category means that no nationalpopulation and development policy is going to feel worried about international opprobriumwhen it fails to pay even lip service to men’s issues. In fact the new draft population policy ofthe government of India went as far as to recommend that a new Commission on Populationshould present annual reports to parliament and state legislatures on Population, GenderEquality and Quality of Life Improvement.This new bias is grossly inegalitarian. Poor, illiterate, unskilled men may exploit theirwomen at home, but at the hands of the state, the employer, the family planning program (onehas only to recall India’s sterilization program during the Emergency) and society at large,their situation can be described as advantageous only in very relative terms. Indeed, genderdisparities are the smallest at these lower socio-economic levels as many Third World studiesindicate, and the neglect of male reproductive health, male empowerment and male autonomycan only make things worse for them in a way that even their women are not likely to laud.The ‘errant’ male who gives his wife or girlfriend or commercial sex partner an STD oreven HIV infection must be infected himself to be able to pass on the infection. And hisinfection merits identification and treatment and prevention as much as his partner’s, not onlybecause this will reduce the chances of his partner’s infection, but also because his ownreproductive health should matter in a truly gender-blind policy. Thus the economic, culturaland public health constraints which lead to his practice of unsafe sex need a sympatheticanalysis even if it is far easier today to focus on the patriarchy that allows him greater sexualfreedom. That is, there is a case for comparing men with men and dealing with intra-maledifferentials (whether by class, caste, region or occupation) in the same way that male-femalecomparisons call for greater attention to female disadvantages.The psychological strains of impotence and infertility are similarly great among men,even when they have access to the social mores and authority to acquit themselves and heapall the blame on barren wives. In any case these social mores cannot deal with the barrennessof subsequent wives and cannot deal with the local derision that sexually or reproductivelyinadequate (the latter is usually taken to imply the former) men continue to face and thatoften leads to their abuse of women in the first place. The sexually able, fertile male is muchless likely to exploit his male prerogative to abandon or ill-treat his wife, just as he is lesslikely to suffer general insecurity in other spheres of life.Quite apart from ethical considerations, there are too many operational difficulties in the‘men’s responsibilities and women’s rights’ framework. How can one make men moreresponsible for their own fertility if one denies them rights in reproductive decision-making,which is what ICPD’s female autonomy and empowerment model in effect implies? For themoment at least, pregnancy requires the collaboration of both sexes and the fertility outcomeis common to both partners. Each partner acting on his or her own in the matter ofreproductive choice can only heighten the conflict and decrease the co-operation inherent inThe International Conference on Population and Development, Cairo, 1994    97Health Transition Reviewthe ‘co-operative-conflict’ situation that characterizes interpersonal relations to the detrimentof all — men, women and children.The language of contraceptive methods is similarly confusingly antagonistic. When malemethods are called for, it is so that men can take greater reponsibility for family planninginstead of leaving it all to women. In the same breath, female-controlled methods are calledfor so that women have the freedom and the means to exercise reproductive choice andautonomy. What then is policy to do? Whom should it encourage more to take upcontraception: men or women?In any case, field data indicate that reproductive decision-making is more of a jointenterprise than the ICPD tone implies and there is little evidence that high fertility(or, for thatmatter, the fertility decline that several parts of the world are currently experiencing) isimposed on the unwilling woman by an overpowering male. First of all, other householdmembers, often female, often override the views of the actual reproductive unit. Secondly, theconditions which increase the demand for children among men (such as economic insecurity,social insecurity, crisis insecurity, few alternatives to childbearing) usually go hand in handwith parallel conditions that increase the demand for children among women (such as loweconomic worth, low crisis security, few alternatives to childbearing); so that there is usuallylittle theoretical or empirical justification for male-female differentials in desired family size.As for the concept of female responsibility, the ICPD statements do not go far enough. Ifthe conference document’s censure of male irresponsibility has any basis (and I think it does),then it would appear that rights and responsibilities do not necessarily go together and thatresponsibility and accountability are not very much coveted attributes. In that case, there is noreason to expect that increased female autonomy and empowerment will automatically lead toincreased female responsibility and the document should have made separate mention ofpolicies designed to encourage the latter.The cause of gender equality and human rights is better served by an idology thatacknowledges that many men and boys all over the world continue to face acutedisadvantages compared to better-off males, disadvantages that may often be greater than thedisparities between men and women within a group, and that these disadvantaged mendeserve to be included in the ICPD kind of discourse on reproductive health and reproductiverights.Russell, Bertrand. 1978 [1931]. Dangers of feminism. In Mortals and Others: Bertrand Russell’sAmerican Essays 1931-1935, ed. H. Ruja. London: George Allen and Unwin.98 ForumHealth Transition ReviewICDP Plan of Action: Its ideological effectsBarbara KlugmanWomen’s Health Project, Department of Community Health, University of the WitwatersrandThe forum opened up a number of essential debates in the aftermath of the ICPD. First, anumber of authors commented on the ideological nature of the ICPD Programme of Action,arguing that while it marks a step forward in putting women’s rights and needs on the globalagenda, in doing so it fails to assess, in realistic terms, the resources available for health,reproductive health, and family planning in particular.The ideological effect of the ICPD cannot be underplayed. In the past, the overwhelmingacceptance of population growth as the primary cause of poverty has allowed governments,aided and abetted by the international community, to frame their understanding of healthpriorities in population terms. Placing on the agenda questions of development, inequities inNorth-South economic relationships, and inequities in production and consumption patternsbetween and within countries, lays bare the underlying causes of resource shortages. Inaddition, placing the question of choice on the agenda, and asserting the powerful linkages ona health level between sexually transmitted diseases, family planning, maternal health, andinformation services, has issued a challenge. The scandal that family planning services areusually given higher priority than other services which are crucial to people’s health andsurvival, ranging from water supply to prevention of AIDS, is highlighted. This priority is notbased on an assessment of women’s and men’s perceptions of their needs and priorities, buton the assessment of the international community, through its funding mandates, and by andlarge undemocratic governments which accept this process. This challenge to theconventional wisdoms in the population field asks, were there a zero-budgeting exercise,what could be achieved? It challenges practitioners in the population field not to take the easyroute, by focusing exclusively on family planning.It cannot be denied that this challenge comes at a time of decreasing resources in thepopulation field. But the role of an international conference of this kind is to create consensuson an international vision; something to strive for. In this, the conference was highlysuccessful, for it put population pressures in the context of broader questions of equity andethics, and afforded a critique of existing family planning programs, from the perspective ofwomen, who have been at the receiving end of most of these programs, without havingplayed a decision-making role in relation to their conceptualization, implementation ormonitoring.There is no doubt that the practical implications of the goal to shift from family planningto integrated reproductive health services, within primary health care, will be taken up moreor less by different nations. The different forms of existing services, and the logistical andfinancial implications, are different in different countries. Those countries which are alreadyexpending resources on primary health care, and various components of reproductive health,will be in a better position to take on the challenges. If all the ICPD Programme does is causefunding agencies and governments to reflect on their options, this will have been a stepforward. If it gives women’s and community groups confidence to challenge unacceptablepractices, this too will be significant. There are many examples where family planningprograms could be improved, without any or substantial cost implications. In many cases, auseful start would be such simple interventions as an increased range of contraceptives, clearprotocols to ensure that appropriate contraceptives are offered, training of health workers orThe International Conference on Population and Development, Cairo, 1994    99Health Transition Reviewlay providers in listening skills, and clear protocols to identify sexually transmitted diseases.In the case of family planning providers, it can only be understood as outrageous that they arenot in a position to advise pregnant women to go for an antenatal check-up or, better, toprovide basic antenatal support in order to identify women at risk who require assistance indelivery. That in many parts of the world, delivery services are not available, does not meanthat this essential goal should not be tabled, and all efforts directed towards achieving it.Already the challenges offered by the ICPD Programme have supported researchers andNGOs from such countries as India, Peru and South Africa, in working with governments todevelop broader and better services. The perspective of the ICPD has facilitated theinvolvement of donor agencies in these processes.Another question arising from the women-centred approach of the ICPD is the role ofmen. It is striking how, when for the first time in history, a population document manages toreflect the values and aspirations of women, who have been the targets of such documents,there is a backlash towards asserting men’s centrality in the area of reproductive health. Thefact, however, remains, that it is women’s health which is most directly at risk from lack ofaccess to contraception and maternal health services, and they are even more vulnerable inrelation to HIV. It is also women who are lowest in the economic ranks, with least access toemployment and other alternatives to childbearing; and women who are most vulnerable toviolence and other controls which limit their ability to make or implement their ownreproductive choices. For all these reasons, it is cost-efficient to focus what limited resourcesthere are on meeting women’s needs. Doing so also recognizes the unequal power relationsbetween men and women, and seeks to bolster the power of women. Those in power, do not,after all, make a habit of giving it away. In no way does the ICPD program suggest ignoringmen’s needs, but these are not given equal priority.The location of population pressure as one of many problems facing society, and theunravelling of the many and complex causes of such pressure, mark the ICPD program as apositive step forward in international thinking about global sustainability. That it cannot, ofitself, alter the international order, does not negate its value in placing both equity, andwomen’s concerns, centrally on the agenda.

The International Conference on Population and Development, Cairo, 1994. Is its Plan of Action important, desirable and feasible?

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