Reproductive Health Care, the "Demographic Imperative," and the Real Health Needs of Women in the Developing World (Part One)

Proponents of "reproductive health care" assert that the 1994 population conference in Cairo marked a watershed between two radically different approaches to reducing the fertility of women in the developing world. They concede that, prior to Cairo, population-control programs were driven solely by a narrow demographic imperative. Following Cairo, however, they maintain that a broad approach to improving reproductive health was adopted that not only encouraged smaller families, but also did so in the context of providing "client-centered" programs that conferred significant health and welfare benefits to their target population. In this two-part article, I will show that these several claims are misleading, if not altogether false. In the first article, which follows, I document the failure of population- control programs to address women's health needs, as they themselves perceive them. The rationalizations used to support an exclusive focus on contraception and sterilization ("latent demand," and "unmet need") are examined, as well as the harm done to women's health by the careless administration of such drugs and devices. In the second article, I will discuss the post-Cairo conference rhetorical shift to "reproductive health," and the claims that such programs have reduced maternal mortality, infant mortality, and the absolute number of abortions. I will conclude with a discussion of how the health needs of women in the developing world could be better met by redirecting existing resources to primary health care, including obstetric care.