POPULATION CONTROL

Population control, the catch word of the 1950s and 1960s, is the silent reality of the 1970s and 1980s. Predictably, Third World populations have borne the brunt of new drug experimentation and resulting population control policies. Experimental contraceptives was sponsored by SEATO in Bangladesh. Women in Puerto Rico and Mexico were used to test contraceptives without their consent. Depo-Provera was used experimentally on 8000 women in San Pablo, Mexico; 120,000 in Sri Lanka; and 250,000 in Bangladesh. Policies of sterilization of native people have been pursued throughout the world. Since 1960 US AID has been a major funder of Third World population control, providing half of the money for internationally funded birth control programs and family planning services, including the Pill, IUD, and sterilization.

BIRTH CONTROL (BC) PILLS -

The physiological effects produced by oral contraceptives resemble changes that occur during pregnancy. As in pregnancy, hormones alter not only the reproductive system but also many other body functions as well. Thus a simulated pregnancy which continues for more than 9 months extends long-term physiological risks beyond the normal duration of pregnancy.

The risk of dying from blood clots is 7 times greater for women on Birth Control pills. Women over 30 are especially prone to this complication. In the Third World, the combination of long-term pill use into late life and the rise of cigarette smoking among women will predispose large numbers of women to severe clotting disorders. Clotting may result in strokes, blindness, heart attacks, and pulmonary embolism. People who have experienced even mild clotting tendencies prior to BC pill use should avoid the drug altogether. In order to determine a patient's medical history, a close questioning and physical examination by qualified health personnel is required. It is unlikely that all Third World women receive this individualized, time consuming screening.

Blood pressure elevations into the abnormal range occur in more than 5 percent of pill users and some increase is found in the majority of women. Hypertension associated with BC pill use carries the same well established mortality as high blood pressure from any cause. Blood pressure should always be checked two months after BC pill use is started. When elevations occur, the contraceptives should be contra-indicated. In reality, BC pills are dispensed without any provision for blood pressure monitoring.

Many other problems are associated with BC pills. There is a doubling of the risk of gall bladder disease, which is already high in women of childbearing age and can be a fatal disorder in areas where sterile surgical conditions are not always available. A formerly rare liver cancer is found much more frequently in BC pill-user: precisely the setting for pill use in much of the Third World. BC pills also cause an increase in blood sugar in up 25 percent of users, who develop criteria for diabetes.

BC pills should never be given to women with breast cancer. Rates of this disease are not known in the Third World, but in the US about 1 in 20 women develop breast cancer at some point in their life. In areas where periodic medical care or patient education are not available, this disease could easily be overlooked.

Many women fail to resume menstruation promptly after pills are stopped. For some it may take months or years to become fertile, while others are permanently sterile. Predisposition factors include low body weight, late onset BC pill use - conditions which are quite common among Third World women.

BC pills also deplete the body of vitamin B6 and folate. Usual dietary sources for these vitamins cannot compensate for these losses, so that some doctors in the US recommended routine supplementation. Given marginal Third World diets, severe deficiency could result, producing anemia and seizures.

Erratic use of BC pills has the paradoxical effect of increasing fertility. When women are not properly informed about this consequence not only is pregnancy more likely to result, it is less likely to be suspected. Continued exposure of the fetus to BC pills results in a higher incidence of cardiovascular and other birth defects.

BC pills should not be used after delivery because they inhibit the quantity of breast milk produced and decrease its content of protein, fat, sodium, calcium, potassium, and magnesium. This effect is greater with the higher dose pills used in LDCs. Although it is now well established that breast milk is the preferred source of infant nutrition, family planning programs providing BC pills to lactating mothers necessitate a dependence on supplemental formula feedings which may be dangerous to infants.

BC pills also are considered ill advised for women with undiagnosed abnormal vaginal bleeding and sickle cell disease, conditions which again are prevalent in the Third World. Moreover, use of BC pills in combination with such common medications as ampicillin, some major anti-TB medicines, and many antiseizure drugs, may lead to bleeding or pregnancy.

As more experience is gained about the hazards of these drugs, especially in their most potent forms, it has become clear that their use should be limited to cases with minimum risk, not as population-wide methods. Thus BC pills may be appropriate for closely supervised individual cases, but unsupervised mass distribution campaigns may be extremely dangerous to women and children.

DEPO-PROVERA (Medroxy Progesterone Acetate) -

This drug, developed some 20 years ago, provides sustained infertility for periods of three to six months per injection. Although used in 82 countries from West Germany to Bangladesh, it is manufactured for export only as a birth control substance in the US (it is used, however, for treatment of inoperable cancer of the uterus). In laboratory tests it caused cervical cancer in monkeys and breast cancer in beagle dogs. It is thought to cause irregular menstrual disturbances, long-term or permanent sterility, a reduction in the body's resistance to infection, and progressive weight gain. In addition, Depo-Provera may be harmful to the children of nursing mothers who are given the shots, and may interfere with immunoglobulins in human milk as well. "Side effects may include congenital heart defects, abnormal development of the penis or vagina, and the possibility of genital cancers later in life".

According to Upjohn, Depo-Provera has been given to 10 million women and accounts for one percent of the company's annual sales. From 1971-76, Upjohn admitted spending $4 million to secure contracts for the sale of its drugs in 29 Third World countries; the sale of Depo-Provera increased dramatically. Today, however, the International Planned Parenthood Federation (IPPF) and the UN Fund for Population Activities (UNFPA) are the two largest buyers of the drug. The US has been the major source of funds for both programs. While the US, due to FDA regulations, cannot buy Depo-Provera as a birth control device and send it abroad, US AID can support the IPPF in London, which in turn buys the drug from Upjohn's subsidiary in Belgium. Yet, when confronted with the reality of US funds. In 1979, AID, through the IPPF, supplied Depo-Provera to 378,000 women in Mexico, Sri Lanka, and Bangladesh in experimental research projects. AID directed the UNFPA to purchase 600,000 doses for Bangladesh and 1 million for Thailand. Now, AID is reportedly set to support the widespread distribution of Depo-Provera to developing countries.

Dr. Malcolm Potts, medical director of the IPPF (1969-78) and now director of the International Fertility Research Program, spearheads the "Depo-Provera for the masses" campaign. He insists that the drug must be given to millions of women over the course of decades before its carcinogenic effects can be judged. "We are not going to know whether Depo-Provera is safe," he explains, "until a large number of women use it for a very long time...You cannot prove a drug is safe until you use it".

The agencies conducting these population control programs assert that the women who receive Depo-Provera do so of their own free will. When there is no consensus of opinion among the experts and when little accompanying information is passed on to women in these programs, it is difficult to believe that the women truly understand the possible immediate and long-term consequences of the drug.

At an IPPF-sponsored clinic in Thailand, 60,000 women received injections. Each woman was given the time to make her "free choice" and have the injection - 60 to 90 seconds. At the Khao I Dang refugee camp in Thailand, women who agreed to be injected with Depo-Provera were promised a chicken - a powerful inducement in a camp where refugees are fed about 4 ounces of meat a week. The International Committee of the Red Cross (ICRC) reported that at the Kamput refugee camp, the injections were simply compulsory.

Women are under pressure to participate. For example, in many areas receive 6 kg of wheat a month, plus oil, powdered milk and fish meal. These 'rewards' are taken from the UN World Food Program's 'Vulnerable Group Feeding Program,' which is supposed to go to mothers of small children without condition. But part of the international cooperation at a local level is that somehow no one ever officially tells World Food Program Headquarters in Rome that the rules are being bent.

Recent studies, including a confidential WHO report, have shown that there is a marked increase of breast and cervical cancer among young women in Thailand, particularly at Chiang Mai, where Depo-Provera is or has been used by 56 percent of the women. Complications can take 30 years to develop, either in the women or their children. But, as Depo-Provera has generally been used in areas where follow-up is difficult, these complications have been ignored.

In many Thai refugee camps, according to ICRC personnel, Cambodian women, often members of hill tribes, are required by the authorities to have an injection before they marry. A member of the delegation of the ICRC in Thailand claims that 59 percent of the women who received Depo-Provera had no idea what the shot was for, and only 15 percent were asked beforehand if they were pregnant. In one camp, a volunteer reports, individuals were given bounties for each woman they brought in for injections. Often young boys were slipped through program, and women were processed more than once. When questioned about the possible negative effects of Depo-Provera on refugee women, Thai authorities say that they have been using it for years and see no reason why refugee women should be treated differently than Thai women.

It is commonly accepted that Depo-Provera belongs to the class of drugs which can cause birth defects as well as serious medical problems for women. However, the drug is often given to pregnant women, and Upjohn even promotes it for nursing mothers.

The effects of Depo-Provera can be insidious. In Thailand researchers found that nearly 15 percent of the lactating mothers receiving injections had a reduced milk supply. If we consider that Depo-Provera is often given to the poorest groups in most countries, those already nutritionally at risk, the implications of such findings are grave indeed.

Nor do the social effects stop there. In Bangladesh, after 1 year of use, 60 percent of Depo-Provera users experienced side effects described in The Lancet as "menstrual chaos." Abnormal bleeding is a potential health problem and this is significant in cultures where women are excluded from important areas of social life as long as they show signs of menstrual bleeding.

STERILIZATION

As with other forms of population control, the poor, those politically less powerful, such as those from ethnic minorities or tribal groups, are often considered the prime sources of unwanted population growth. In fact, they may simply be the easiest or most expedient populations to control. Statistics on sterilization are difficult to find and even harder to confirm.

In the mid-1970s the President of United Native Americans estimated that of the total US Indian population of 800,000 as many as 42 percent of the women of childbearing age and 10 percent of the men were sterilized. Another spokesman believes that there are only 100,000 American Indian women of childbearing age still able to have children.

One of four US Indian children will not be raised by its parents. Only one of ten adopted or foster Indian children is raised by Indian parents.

Other sources estimate that as many as 32 percent of all Black women in the US are sterilized by the age of 30.

In the US most women are sterilized just after giving birth. They consent while heavily sedated. They are not given the 72 hours, required by US law, between consent and the operation.

The Committee to End Sterilization Abuse reports that Peace Corps programs sterilized Quechua women in Bolivia without their knowledge or consent. From 1963-65 a Rockefeller Foundation grant funded the sterilization of 40,000 Colombian women. US AID funds indirectly supported the sterilization of a million Brazilian women between 1965 and 1971. Today, sterilization programs are underway in Manaus, Brazil.

SILASTIC IMPLANTATION -

This birth control device is a solid, time-release substance that is injected under the skin through a large hypodermic needle. The implant, a time-released synthetic progesterone, can make a woman infertile for periods of from three to five years. There have been no long-term animal studies of this substance. In 1980, WHO began to experiment with the drug on women in Chiang Mai Province, Thailand.

Article copyright Cultural Survival, Inc.

CSQ Issue:

5-4 Winter 1981

December 1981
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