Editor’s note: Given the enormous controversy between President Obama and the US Catholic Bishops now underway, this article by R.T. Ravenholt, M.D., MPH, Former Director, Office of Population (1966-79) of the United States Agency for International Development (USAID), on the seizing of the control of the USAID population programme by the Catholic Bishops in the late 1970s is highly relevant to today’s discussion in the press. It was first published by Stephen D. Mumford, DrPH, founder and President of the North Carolina-based Center for Research on Population and Security.

Pronatalist Zealotry and Population Pressure Conflicts: How Catholics Seized Control of U.S. Family Planning Programs by R.T. Ravenholt, M.D., MPH, Former Director, Office of Population (1966-79) at the United States Agency for International Development chronicles his fourteen year effort to establish a population program within USAID, his eventual removal and dilution of the project.

And how “…‘Right-to-Life’ adversaries invoked the assistance of two Roman Catholics, Congressman Clement Zablocki of the House Foreign Affairs Committee and his assistant, John H. Sullivan, to attack AID’s population program…

And how “…another Catholic, then Deputy Administrator, John H. Murphy, and others, when they created a task force for the purpose of reorganizing and thereby decapitating the Office of Population.

And how “…with the help of Jimmy Carter and his political appointees, religious zealots finally managed to degrade AID’s population program by placing the two Federal agencies with family planning programs under Catholic control.”

Concluding with a statement by President George Bush, written while he was the U.S. Representative to the United Nations and published as the foreword to Phyllis Piotrow’s book, World Population Crisis: The United States Response. This document reveals the political costs of taking a stand against the Vatican and, when seen through lens of history, provides some insight on why Bush turned against the needs of the world and supported the Vatican during his presidency.

Pronatalist Zealotry and Population Pressure Conflicts: How Catholics Seized Control of U.S. Family Planning Programs

By R.T. Ravenholt, M.D., MPH

Director, World Health Surveys, Inc.

3156 E. Laurelhurst Drive

NE, Seattle, Washington 98105

Former Director,

Office of Population (1966-79)

United States Agency for International Development

Department of State, Washington, D.C.

Presented to the Annual Meeting of the Washington State Chapter of Zero Population Growth, Inc., at Seattle, March 4, 1991

Introduction

Dr. Ravenholt directed the global population program of the U.S. Agency for International Development in the Department of State from 1966 to 1979. During this time it became the world’s foremost program in the field, providing more than half of all international population program assistance ($1.3 billion) in those years. In 1971 he originated the World Fertility Survey, the largest international social science research project ever undertaken. He has also researched extensively and published more than 140 scientific reports in the fields of epidemiology, preventive medicine, population and family planning, smoking and health.

R.T. Ravenholt was born in Wisconsin, received his Medical Doctorate from the University of Minnesota and a Master of Public Health degree from the University of California. After epidemiological positions with the Communicable Disease Center in Atlanta and the Seattle-King County Health Department, he was Epidemiological Consultant in Europe for the U.S. Public Health Service. After directing AID’s population program, he served successively as Director of World Health Surveys for the Centers for Disease Control, Assistant Director for Epidemiology and Research, National Institute of Drug Abuse, and Chief, Epidemiological Branch, Food and Drug Administration.

In 1972, Dr. Ravenholt was awarded AID’s Distinguished Honor Award, “In recognition of his distinguished leadership in the development of worldwide assistance programs to deal with the challenge of excessive population growth.” Other awards he has received include the Hugh Moore Memorial Award from the Population Crisis Committee, the International Planned Parenthood Federation Award for “innovation and vision in the population field,” and the Carl S. Schultz Award of the American Public Health Association for “distinguished service in the field of population and family planning.” He is Board Certified in Preventive Medicine, and a fellow of the American College of Epidemiology and of the American Public Health Association.

The Address Presented to the Annual Meeting of the Washington State Chapter of Zero Population Growth, Inc., at Seattle, March 4, 1991

Some three decades ago, I was director of Epidemiology and Communicable Disease Control for the Seattle-King County Public Health Department during seven years. Among my responsibilities was the annual school immunization program; and the last time I was here in University Heights School I came to immunize several hundred children for smallpox, DPT and polio. Thus, Seattle has been close to my heart for many years.

Following this in 1961, I ventured to Europe as epidemiology consultant for the European region for the U.S. Public Health Service, attached to the American Embassy in Paris. Whenever there was an important epidemic in Europe I could investigate it—smallpox epidemics in West Germany, Yorkshire, Wales and Stockholm; typhoid at Zermatt; thalidomide-induced malformations in many countries, and so forth. After two adventurous years, I returned to Seattle, as a full-time faculty member in preventive medicine at the University of Washington, focusing mainly upon the research and teaching of the epidemiology and prevention of cancer and tobaccosis.

Then I was offered the ultimate job of directing the development of a global population/family planning program for the U. S. Agency for International Development (AID). There are many epidemics in the world: tobaccosis, AIDS, and of course all the old infectious diseases, but I think this audience would agree that the global epidemic of people is a fundamental cause of a wide range of other world problems. However, the problem is so deep, it is very difficult to approach. Most people are concerned with the surface manifestations of disease epidemics, poverty and armed conflicts. A great deal of time and money is often wasted worrying about the surface waves and not recognizing the deep population tide flowing beneath.

I wrote down and have distributed much of what I will be speaking about tonight, and I have appended several documents which you may wish to read later. As we commenced development of AID’s far-flung population/family planning program, I wrote out rather carefully what the strategy of AID’s family planning program would be. This strategy was published in the January 10, 1969 issue of Science, and is presented as Appendix A (not shown on this site).

While the overall program was designed to bring the most effective means of fertility control to villagers and house holders throughout the less developed world, AID’s population/family planning program consisted of hundreds of individual projects, each one crafted to accomplish a specific task—to develop new or improved fertility control technology, to train a wide range of population/family planning workers, to provide financial, commodity and personnel support of family planning services, to perform surveys of the availability, use and results of contraceptive programs, etc. Appendix B presents the “Foremost Achievements of AID’s Population Program, 1966-1979.”

During the fourteen years I directed the population/family planning program of AID, I had many exciting and gratifying experiences. Among the most memorable was working with outstanding pioneers in the global population/family planning field. I think particularly of General William H. Draper Jr., who was, in my estimation, the most remarkable activist in the 60’s and 70’s until his death at the age of 80 in 1974. Even in his seventies, no one could match Bill Draper’s tremendous pace and accomplishments. He was just an extraordinary person in raising and mobilizing private and government resources. And we thrived on the fruits of his labors.

Also, I enjoyed the special satisfaction of leading a band of most intensely motivated population warriors who often worked themselves to exhaustion in overcoming omnipresent bureaucratic inertia while implementing vitally needed population program actions.

The third Appendix (C) is a statement by President George Bush, written almost 20 years ago when he was the U.S. Representative to the United Nations and published as the foreword to Phyllis Piotrow’s book, World Population Crisis: The United States Response. As you will perceive, George Bush is not entirely ignorant of the importance of the population variable. While in the Congress he chaired the Republican Task Force on Population and Earth Resources, and was enthusiastically supportive of AID’s population program when I presented it to the Task Force.

His current equivocal or negative stance on population/family planning issues is clearly a pragmatic political stance, fashioned to keep malignant Far Right zealots at bay, and thus avoid the political oblivion which befell his father when he demonstrated forthright commitment to family planning.

But now that President Bush is riding a crest of acclaim following the swift conclusion of the Iraqi War, perhaps he will be more responsive to voices of light and reason. Perhaps he will concern himself more with deep population tides and ultimate historical recognition rather than simply transient political popularity.

Starting the Aid Population Program

The 1960’s were turbulent, challenging, frustrating years, beset with many uncertainties concerning how best to curb the increasingly evident world population explosion.

President Lyndon Johnson understood the population imperative, and spoke forth eloquently on how $5 invested in fertility control would yield more developmental benefit than $100 invested in traditional development assistance.

In Seattle, having listened to the President’s rhetoric, and having been invited to take a key role in curbing world population growth, I assumed resources would be forthcoming sufficient to make rapid program progress. But upon moving to Washington and beginning to wrestle with the incredibly resistant bureaucracies of AID and the Department of State, I soon became aware of my naivete.

As Director of the Population Branch of the Health Service of the Bureau for Technical Cooperation and Research, the resources initially put at my disposal were: an office, a secretary, and no earmarked funds. With this I was supposed to commence curbing the world birth rate!

Furthermore, adding to my woes, outgoing AID Administrator, David Bell, had testified to the Congress on April 8, 1966 (3 days before my arrival) that no special legislation nor earmarked funds were needed for AID’s population program, and “AID will not consider requests for contraceptive devices or equipment for manufacture of contraceptives.”

Thus constrained by Bell’s testimony, his deputy, William Gaud, who became AID Administrator, continued the “no contraceptives” policy of the Agency for another year before overturning it and giving his strong support to contraceptive distribution.

Without personnel, earmarked funds, or appropriate policies, throughout 1966 the prospects of effective population program development seemed hopeless.

Despite my utmost pleadings for additional secretarial staff, none was made available during 1966; though in Bert Johnson, I did gain a shrewd, dedicated, bureaucratically-experienced assistant that summer, who provided vital help in keeping the idea of an AID population program alive “until the wind changed.”

This happened in January 1967 when AID, upon the urging of Vice-President Hubert Humphrey, reorganized and created the Office of War on Hunger. Thereupon the population function was raised one echelon in AID’s bureaucracy and I became Director of the Population Service, with 28 personnel positions at my disposal.

But when I asked my new boss, Herb Waters, “How much money is available to the population program?” he pondered a moment and then said, “Well, you can have those U.S. owned Indian rupees!” However, by then I had learned that the U.S. owned Indian rupees were a mirage. They did not actually exist but were merely entries in account books. The Government of India had its own set of priorities, and did not need to go to a bin marked “U.S. Owned” for whatever rupees it wished to expend.

By then I was well aware that if we were ever to succeed in building a program to impact world fertility, substantial dollar resources were essential. Hence, I made it clear to General William Draper, Chairman of the Population Crisis Committee (PCC), that without large dollar resources, no effective AID population program was possible. Furthermore, unless such funds were securely set aside (earmarked) for this purpose, the older, always predatory, programs of AID would usurp the funds. He then went to Senator William Fulbright, Chairman, Senate Foreign Relations Committee, and with vital help from Phyllis Piotrow, Executive Director of the PCC, the Title X Amendment to the 1968 Foreign Assistance Act was created. It was short, sweet, and effective—saying, in effect, that of all funds appropriated for foreign assistance in fiscal 1968 not less than $35 million could be used only for population/family planning purposes. That action, contrary to David Bell’s testimony the previous year, was indispensable for the creation of the AID population program.

In 1969 the earmarking for the population program was raised to $50 million, in 1970 to $75 million, in 1971 to $100 million, and in 1972 to $125 million. Thus, with vital help from the Congress, we gained the resources that fueled a global surge in family planning.

And as the program grew, with crucial help from AID Administrator John Hannah and Deputy Administrator Maurice Williams, by 1972 I directed a unified staff of 110 in the Office of Population, of the Population and Humanitarian Assistance Bureau, enabling us to drive a carefully crafted program forward with remarkable vigor, in close alliance with numerous cooperating agencies and AID’s country missions, as detailed in Appendix B.

Now I will read my prepared remarks and subsequently respond to your questions.

Population Pressures and War

In the past few months, once again during this fateful 20th Century, the United States and many allied nations have engaged in the momentous task of constraining an aggressive tyrant whose territorial ambitions violated the security of neighboring countries and the world.

A door to the dark room of murderous human conflict was opened, and no one yet knows the ultimate consequences of that war. Officially the war is ended, and the cost in dead Coalition Force soldiers seems light, but the ultimate cost of the Iraqi war may nevertheless be huge.

When considered along with the Vietnam and Cambodian wars, the ongoing fratricide in Lebanon and Israel, and the incessant wars in Central America, it is obvious that the world remains a bubbling cauldron of sectarian hate and strife—and that a fundamental coolant must be applied if the world is ever to enjoy prolonged peace.

To this audience of ZPG members it is no secret that a common ingredient in virtually all modern wars is burgeoning tribal, racial or national populations—with the inevitable collision of their interests with those of neighboring populations. It would be naive for country leaders and the United Nations to expect durable peace among the nations of Asia, the Middle East, Africa and Central America unless and until annual population growth rates are reduced to less than 1 percent, as in Europe and North America, from current disastrous levels of 2, 3, and even 4 percent. Ultimately, of course, zero population growth should become a universal goal.

With world population now at 5.3 billion and increasing 90 million (1.7 percent) annually, the pressure on available resources is implacable.

Rapidly growing populations are usually impoverished, dissatisfied, and aggressive populations, mainly because of the heavy burden of child acquisition costs they must bear. Africa’s population of 670 million is increasing 3 percent, or 20 million, annually. Child acquisition costs (the cost of raising a child from birth to independence) are ordinarily about ten times the per capita Gross National Product. Hence, Africa is loading on more than $100 billion annually in excessive child acquisition costs (20 million excess African births annually X $500.00 average African per capita GNP X 10 = $100 billion excess Africa child acquisition costs annually)—which obliterates all developmental assistance received, and locks Africa ever more deeply into its own “Demographic Trap.” With starvation already prevalent in a dozen African countries, the outlook is dismal. Furthermore, well intended but foolishly naive death control programs devoid of birth control elements are aggravating the African population crisis.

In clinical medicine we strive to abide by the ancient precept: “First, do the patient no harm!” Likewise, in development assistance and public health assistance, we must strive to abide by the precept: “First, do the community no harm!” But by the singular act of a further reduction in death rates without a balancing reduction in birth rates, a number of international assistance agencies are harming the quality of life and developmental progress of many desperately poor countries. Findings of the World Fertility Survey and numerous other studies have abundantly demonstrated that the surest way to rapidly and durably cut infant and maternal disease and death rates is to enable women and couples to limit their reproduction to those children they truly want and are able to care for.

The “Economic Development First” Fallacy

To the “armchair strategists” who still insist that in peasant societies the child death rate must be cut and the women must be educated and their poverty reduced before they will practice family planning, I recount experiences such as that in the Howrah District slum outside of Calcutta in 1970. Through the Pathfinder Fund and the Humanity Association, free oral contraceptives had been supplied to all women in the Howrah slum who wished to use them. A year later, when the Government of India blocked distribution of free oral contraceptives (OCs), many of these women somehow scraped together enough money to continue using OCs they purchased for one dollar per cycle. With the help of the Humanity Association 50 such poor women still using OCs were assembled in a Howrah slum street for General Draper, myself and others, and I ascertained how many live births and dead children each woman had experienced. It was a revealing fact that most of these women had lost children—some as many as five!

Likewise, when visiting a voluntary sterilization clinic in Bangladesh, I encountered a woman undergoing tubal ligation who had experienced 19 pregnancies but had only two living children. No one knows better than such a woman the agony of excessive childbearing and child loss.

At the “bottom of the barrel” there are many desperately poor illiterate women who through bitter experience know that another pregnancy will mean another death—of the newborn, of another child, or of the mother herself.

Such women will walk for days to obtain tubal ligation or abortion. Because they are poor and illiterate does not mean they are stupid and unable to understand what is best for themselves and their families. Beginning in 1973 in Egypt, and then in dozens of countries, we were able to demonstrate that when oral contraceptives were offered at every abode, the majority of households accepted them, and a large proportion of non-pregnant women began using them and soon taught other women to do the same. By making all the most effective means of fertility control readily available to peasant populations, one could rapidly achieve use rates comparable to those seen in much more developed societies.

I take lasting satisfaction from the fact that when developing AID’s global population/family planning program, we did our utmost to put the “Family Planning Horse” in front of the “Development Cart”, as set forth in my 1969 Science article. The final paragraph in that article reads, “Regardless of what special social measures may ultimately be needed for optimal regulation of fertility, it is clear that the main element initially in any population planning and control program should be the extension of family planning information and means to all elements of the population. It seems reasonable to believe that when women throughout the world need reproduce only if and when they choose, then the many intense family and social problems generated by unplanned, unwanted, and poorly cared for children, will be rapidly ameliorated and the now acute problem of too rapid population growth will be reduced to manageable proportions.”

Thus, to start a “family planning blaze”, we emphasized all those actions needed to improve the immediate availability of the more effective means of fertility control: country supply and village, clinic and household availability. Just to divert from my text a bit. Back in the Sixties a number of countries had begun family planning programs by introducing IUDs into their maternal and child health centers. In these countries, typically, a few hundred maternal and child health centers ostensibly offered family planning services and a limited number of women used them. Popular wisdom was that, yes, some people would practice family planning, but general educational and economic levels must be raised before most women would practice family planning.

And there was an element of truth in this assumption: If poor peasant women live ten miles or more from the nearest clinic, which provides services at irregular hours, and they must learn precisely when it is open, then, indeed, to obtain that service the woman almost has to know how to read. She also has to have a little money to hire someone to look after her children while gaining transportation to the clinic. She also must have a very high level of motivation before coming out of a traditional village to go to a clinic for a pelvic examination and an IUD insertion—thus announcing to all her neighbors that she is sexually active and breaking age-old social taboos.

Of course, under those circumstances, extraordinary motivation, considerable knowledge and some money are essential.

Well, I was determined to break that barrier if I possibly could. And I saw a way that we might do it. IUD’s, of course, require clinical application. But oral contraceptives and condoms do not. There is no compelling reason why a woman must go to a clinic for these contraceptives. They can be distributed to every home for individual use.

Trailblazing in Egypt: Contraceptive Home Delivery

The first place we were able to do this was in Egypt in 1973. We arranged to have several outstanding investigators at the University of Cairo actually offer three monthly cycles of oral contraceptives in an attractive package to every household in a population of 15,000 people at Shanawan. At first, Drs. Saad Gadalla and Leila Hammamsy were reluctant to undertake this task, but when confronted with the realization that continued research support indeed depended on household distribution of contraceptives, they went ahead with the project and soon learned to their surprise that no one was killed, nobody set the dogs on them, and many poor peasants were very appreciative of this novel service.

Picture what happens in a peasant village which has had virtually no previous experience with family planning when, on a certain day, a team of field workers, a man and a woman, go to each household, offering a package of three monthly cycles of OCs and discuss family planning and contraception with the householder. Imagine the impact of this!

I have long maintained that the most important information one can give a woman about oral contraceptives is some oral contraceptives. Give them to her! Then she can see them, feel them, and realistically think about them. Likewise with condoms, the most important information one can have about condoms is a supply of condoms.

The tobacco companies long ago learned that giving away free cigarettes was a powerful way to recruit new addicts. And they’re still trying to do it. Recently, they wanted to give them to the forces in Iraq but they were forestalled by intense criticism. In World War I, General Pershing distributed free cigarettes in all the soldiers’ rations. Out of that effort came several million cigarette-addicted young men who then returned home and communicated their addiction to their wives and children and neighbors (see Ravenholt R.T. “Tobacco’s Global Death March” Population & Development Review Vol 16, June 1990, pages 213-240). Sheer availability is powerful determinant of human behavior. We must always keep that in mind. The sheer availability of contraceptives is highly determinative of human behavior, and when trying to move peasant populations from their traditional non-use of contraceptives to use, the act of contraceptive distribution to every household is a powerful accelerant of acceptance.

Peasant households ordinarily contain no chests with drawers, but simply a dirt floor with poles supporting the roof. And storage of miscellaneous articles is usually done in string bags suspended from the poles. When three cycles of oral contraceptives are delivered into a household, the woman is likely to immediately discuss with neighbors: “What in the world is this that the government has given us!” Then she will probably put them in string bag hung on the wall. When her husband comes home from the fields in the evening, a vital communication occurs between the husband and his wife who has something to tell him. Even if she forgets to tell him, he’ll ask, “What is that object hanging on the wall?” So, inescapably, there is communication and discussion of this new and important matter of contraception.

We found in Egypt, as we did later in dozens of countries where we used the same approach, that ordinarily about two-thirds of the households would accept the offered present of three monthly cycles of OCs, and about half of those acceptees would begin using the pills. They wouldn’t all succeed, of course, because some of them didn’t have enough information and confidence initially. But many succeeded.

One of the first things we did in 1967, when AID’s policy was changed so we could provide contraceptives, was to create a special package of OCs-21 contraceptive tablets packaged with 7 iron tablets—so these women would not need to have a calendar. They could just start at the beginning of a package, take 28 pills and then start the next package, with the menses occurring while they were taking the iron tablets. Iron is very much needed in some of these societies that do not eat much meat. This regimen has worked very well. And AID’s standardized, nonproprietary “Blue Lady” package enabled us to purchase OCs at the record low price of about 15 cents per monthly cycle.

We found that we could leapfrog many obstacles if we could get the oral contraceptives right into the household—in Egypt, then in Bangladesh and then in many others of the poorest countries of the world. It is still being done.

In taking contraceptives to the world’s poor and delivering them to villages and households, we were extending the reach of the planned parenthood movement begun in this country early in this century. The rapid success of such family planning programs in decreasing fertility wherever they have been implemented has been well documented (1).

Accomplishments of Aid’s Population Program (See Appendix B)

Building and improving the effectiveness of AID’s population program was my daily occupation during 14 intensive years. Beginning in 1966, it was my privilege to serve under 4 presidents, 6 AID administrators, and 11 assistant administrators, in directing the evolution of an extraordinary global enterprise—one that provided a broad range of assistance to population and family planning programs throughout the developing world. By the end of fiscal 1979 this program had provided $1.3 billion in assistance to population programs in Asia, Africa, and Latin America—comprising more than half of all international population program assistance during those years.

I vividly recall the challenge of breaking new ground in this sensitive field during the 1960’s; the special opportunity of working with inspirational leaders such as General Draper, Dr. Alan Guttmacher and Senator Ernest Gruening; the occasional desperation of those difficult and precarious early years when likewise dedicated colleagues and I struggled mightily to pull together the personnel, policies, resources, and operations needed to build a powerful global program; and then our growing pleasure as programs we helped develop and support began to rapidly decrease fertility and population growth rates in many poor countries.

“Success has many parents” and this was certainly true in the population field where many talented individuals and organizations contributed to our common endeavor. Yet the nature and magnitude of AID’s contributions during those years was such that a considerable portion of the burgeoning success of population and family planning programs in East Asia and Latin America could justly be credited to the AID program, and especially to its Office of Population. The creative and dedicated staff of the office worked tenaciously, often under most difficult circumstances, to fuel and guide the work of many other organizations and country programs overseas (2-4).

The nature and strength of the actions in which we engaged to the zenith of the program in the mid-1970’s was sketched in Washington Post article of February 27, 1976 (5).

Judging by the pace of our progress during the early and mid-70’s, we projected even more rapid progress during ensuing years. But action begets action, and the very fact that we were implementing a program with unusual strength caused our adversaries, with whom many of you are familiar, to mobilize against us. We underestimated the growing strength of these adversarial forces.

Reproduction and its control, a controversial issue for centuries, became even more of a public issue in the 1950’s and 1960’s with the growing movement to launch population/family planning programs aimed at solving a broad range of social problems in the United States and the developing world. Publication of Phyllis Piotrow’s well-researched book with its foreword by George Bush tells the story of how fundamental changes in U.S. foreign policy were made leading to initiation of population program assistance in 1965 (2).

Controversy both within and outside of AID attended virtually every move toward creation of the population program. Especially, controversy whirled about all those actions aimed at making the most effective means of fertility control—oral contraceptives, condoms, intrauterine devices, surgical sterilization, and abortion—readily available to entire populations in developing countries.

When authority for this action was dispersed in AID during the first 6 years of the program, reaction to diverse initiatives was diffused. But with the reorganization of 1972 which created a unified Office of Population in the Bureau for Population and Humanitarian Assistance, and with accelerated implementation of a central strategy, adversarial activities became progressively more intensely polarized, and focused on me as the main target. Many program actions, later taken for granted, such as the annual purchase and delivery of huge quantities of contraceptives, household distribution of contraceptives, and extensive support for voluntary sterilization, were initially intensely resisted by religious zealots, though later well accepted by AID and many other countries.

Repeatedly, “Right-to-Life” adversaries invoked the assistance of two Roman Catholics, Congressman Clement Zablocki of the House Foreign Affairs Committee and his assistant, John H. Sullivan, to attack AID’s population program. When I spoke at the ZPG annual meeting at Estes Park in Colorado one year, Jack Sullivan challenged our contraceptive availability strategy. Congressman Zablocki insistently demanded that AID administrators “fire Dr. Ravenholt.”

A determined attempt at my removal was made in 1975 by another Catholic, then Deputy Administrator, John H. Murphy, and others, when they created a task force for the purpose of reorganizing and thereby decapitating the Office of Population. However, this action was abandoned after six months when the relevant committee chairmen, Senator Hubert Humphrey, Senator Daniel Inouye, and Congressman Otto Passman, all registered strong support for me.

But with the help of Jimmy Carter and his political appointees, religious zealots finally managed to degrade AID’s population program.

How Catholics Seized Control

Following a meeting of Presidential candidate Jimmy Carter and his campaign staff with fifteen Catholic leaders at the Mayflower Hotel in Washington, D.C., on August 31, 1976, on which occasion they pressed Carter to deemphasize federal support for family planning in exchange for a modicum of Catholic support for his presidential race, President-elect Carter proceeded to put the two Federal agencies with family planning programs under Catholic control.

Joseph Califano became Secretary of Health, Education and Welfare, and the first one to whom President-elect Carter offered the U.S. AID Administrator position was Father Theodore Hesburgh, President of Notre Dame University.1 When Father Hesburgh declined the role of AID Administrator, the appointment was given to John J. Gilligan, a Notre Dame graduate and a former governor of Ohio.

Also, a long-time Catholic adversary of AID’s family planning program, John H. Sullivan, moved from Congressman Clement Zablocki’s office into AID during the Presidential transition and was given a key role in selecting Carter’s political appointees. During previous years, Congressman Zablocki and Jack Sullivan had persistently worked to curb AID’s high powered family planning program. In 1973, Jack Sullivan and allied zealots helped Senator Jesse Helms develop the Helms Amendment to the Foreign Assistance Act. Since then, this amendment has prevented AID from providing assistance for the termination of unwanted pregnancies.

In hearings of the House Foreign Affairs Committee on July 18, 1975, Mr. Zablocki stated for the record his antipathy to contraceptives and discussed with a Right-to-Life representative, Randy Engel the removal of Dr. Ravenholt. “I would hope that we could find a way of removing him.”

Among the Carter political appointees selected by Jack Sullivan was Sander Levin, newly defeated Democratic candidate for governor of Michigan. Not a Catholic, but an opportunistic lawyer without family planning program experience, Levin immediately upon entry to AID proceeded to maul and discombobulate AID’s population program, as desired by his political superiors. He became the Assistant Administrator with direct responsibility for disorganizing and dispersing Office of Population personnel and for the removal of Ravenholt. This was accomplished after several years of wrangling before the Merit System Protection Board, when Ravenholt accepted transfer to the role of Director, World Health Surveys, Centers for Disease Control. Since then, AID’s dismembered and otherwise crippled family planning program has been sustained to the extent possible by dedicated staff and likewise dedicated Members of Congress and other supporters. It has continued many operations, though certainly not all, despite continued harassment from the Reagan-Bush administrations and anti-birth control zealots.

Carter’s political appointees took other actions to curb birth control initiatives and obstruct family planning programs. According to members of the Food and Drug Administration (FDA) Committee on Obstetrics, in 1978 after the FDA already had informed the Upjohn Company that its product, Depo-Provera, was “approvable”, it was HEW Secretary Joseph Califano who specifically directed that FDA disapprove Depo-Provera for marketing as a contraceptive—a disapproval that has endured until now despite overwhelming evidence that Depo-Provera is one of the safest and most effective of all contraceptives. It has been approved for marketing in more than 90 other countries, and has been safely used by more than 12 million women. But because of the religious objections documented here, Depo-Provera is not yet available to American women and AID cannot purchase it for supplying desperately poor and needy women in less developed countries.

Thus Califano, an otherwise able Secretary of HEW, “paid his appointment dues to the Catholic Church.”

Ironically, however, Califano himself became a victim of another political deal in 1979—this one between Carter and the tobacco industry. As Secretary of HEW, Califano fought hard and effectively against tobacco; and industry leaders insisted on his ouster in exchange for support of Carter’s 1980 re-election campaign.

Politics is often highly determinative of family planning program progress. With dependable support from Presidents Johnson, Nixon, and Ford, and from Senators Fulbright, Humphrey, Inouye, and others, AID during the 1960’s and 1970’s became the world leader in development and support of action programs aimed at resolving the world population crisis; whereas, under Presidents Carter, Reagan and Bush, family planning programs have been greatly hamstrung by “voodoo” policy decisions—much to the detriment of American taxpayers, economic development, global health and peace.

Although it is appropriate for Catholic and other religious leaders to exhort adherents and others not to use contraceptives and other means of birth control, it is surely unacceptable to the majority of Americans that religious minorities dictate what means of fertility control may be used by persons of other faiths—by denying them access to valuable products of scientific research through covert political deals and “dirty tricks”. Currently, Catholic and other religious opponents are excluding from the United States the very safe and effective drug, RU486, which comes close to fulfilling my definition of an ideal birth control substance: “A non-toxic and completely effective substance, which when self-administered on a single occasion would ensure the non-pregnant state at completion of a monthly cycle.”

Because RU486 can be administered by the woman herself, as needed on the basis of hindsight, it has unique potential for helping curb unwanted, irresponsible childbearing in the United States and throughout the world. Humanity cannot afford to have it embargoed by religious zealotry. If current religious-political barriers to full availability and use of Depo-Provera and RU486 were removed and domestic and international family planning programs given the strong financial support they deserve, then rapid slowing of population growth and improvement of health and well being in the Middle-East, Africa and Latin America would follow. All this is essential for progress toward a kinder more peaceful world.

Back in 1968, in defining the ideal contraceptive, I aimed for something a woman could use at the end of a monthly cycle if her period was late—to assure the onset of her period and her non-pregnant state. We put tens of millions of dollars into research on this, especially on prostaglandins, which had emerged in 1969 as a means of pregnancy termination. We also strongly supported antiprogesterone research, especially by Dr. Arpad Csapo at Washington University in St. Louis, one of the foremost experts in the world. His work contributed to the development of RU486, the last stage of which was done in France; and now RU486, an antiprogesterone, combined with prostaglandins, is working very well indeed.

In France, more than 85,000 women have used RU486 with outstanding success and minimal difficulty, and it is about to go into production in Britain. But it has been kept out of the U.S. until now by religious opponents, who seek to deny American women access to this extraordinary product. Likewise, Depo-Provera, an excellent contraceptive, is being denied to American women and poor women dependent on foreign assistance, because AID can only buy for overseas distribution to less developed countries those contraceptives which are approved for use in the United States.

To ease Roman Catholic adversarial pressure upon AID’s family planning program during the Reagan Era, many millions of dollars were lavished upon “natural” family planning methods—an antithetical diversion from the fundamental task of taking contraceptives to the world’s poor.

If the population crisis in the Middle East and in Africa is going to be resolved, the general availability and use of RU486 or its equivalent is essential. During the years I directed AID’s population program, great progress was made in curbing excess fertility in East Asia and in Latin America. Because of deep rooted religious and other cultural barriers, little headway has yet been made in the control of excess fertility in the Middle East and in Africa. A very best effort is needed to solve these most difficult fertility control problems.

This meeting is now open for discussion and questions.

Discussion

Q: I think Depo-Provera is available in the U.S. Is it true that it is approved for purposes other than use as a contraceptive?

Ravenholt: Right.

Q: But it can be used as a contraceptive?

Ravenholt: Well, it can be, but because it is not approved for such use by the Food and Drug Administration, many physicians are reluctant to prescribe it for this purpose. Hence, most women are denied the choice of this excellent contraceptive.

During the 1980’s, repeated attempts were made to obtain FDA approval of Depo-Provera for contraceptive use. But until now the religious-political barrier to such use has endured. A powerful groundswell of protest against religious constraint of freedom of contraceptive choice is needed.

Q: Dr. Ravenholt, do I understand correctly that the perception of Norplant is that it is not an abortifacient, whereas RU486 and Depo-Provera may be?

Ravenholt: Norplant and Depo-Provera are both contraceptives; whereas RU486 is an abortifacient.

Q: So there would be less resistance to them compared with RU486?

Ravenholt: Yes, Norplant doesn’t threaten the religious opposition the way RU486 does. They can foresee if RU486 becomes generally available in the United States, most women will have a few of these in their purse or in their medicine cabinet.

Remember what happened when the oral contraceptive appeared. Religious defenses were not greatly mobilized against the pill, and it was licensed for marketing in the United States in June, 1960. Women began using oral contraceptives very rapidly. Until oral contraceptives became available, there was a considerable difference in family planning/birth control activities by Protestants and Catholics in the United States.

But as soon as the pill was available, it could be taken quietly, by the woman herself. Soon Catholic women in the U.S. began behaving just like Protestant women in the U.S., as far as use of oral contraceptives was concerned. By 1965, 5 million American women were using oral contraceptives, a decade later 10 million, and now 13 million. And Catholic women are using them equally as Protestant women.

Now Catholic and other religious leaders realize that when RU486 becomes generally available, women will control their fertility just as they please, with little heed to priestly authority. The fertility control promise of RU486 is revolutionary and will ultimately overturn an obsolete Papal tenet. With full availability of all contraceptives and contraceptive services to villagers and householders in the developing world, much reduction in excess fertility would be achieved. But because all contraceptives depend upon the exercise of foresight, contraceptives alone can never suffice in the struggle to reach the goal that unwanted, irresponsible childbearing be reduced to a tolerable minimum. For that goal to be achieved, women must be able to exercise hindsight in controlling their fertility: they must be able to terminate unwanted, improvident pregnancies; most efficiently achieved by the availability of RU486 with backup medical services.

Unfortunately, the Helms Amendment to the Foreign Assistance Act has since 1973 prevented the U.S. from helping poor women in the less developed world achieve the precious freedom of choice now enjoyed by women in this country.

Q: The most illiterate farmer knows that he cannot put 100 head of cattle on an 8-acre farm. What is it in the collective human psyche that does not recognize this is applicable to the human situation too?

Ravenholt: Well, I’ll answer that from personal experience.

I grew up as the middle child of nine children on a small Wisconsin dairy farm. You might think that my father, a well-educated man—a couple of years at University of Wisconsin—and my mother too—would have had sense enough to know that our small farm could not support nine children. But I can remember back then, during the Depression, my father expressing utmost indignation about the federal programs. He ascribed our poverty to the weather, the Federal Land Bank, and many other scapegoats, rather than excessive fertility. I doubt if he ever grappled with the fact that he simply had more children than he could afford. And I can assure you that around the other side of the world, it is the same.

When actually immersed in an overabundance of children, it is very hard to understand just what they are doing to a family’s living standard. But still there are ways of going forward. A woman thinks from month to month. She’s not so concerned about the ultimate number of children, thinking about whether she wants to be pregnant that month. And if we make it possible for her not to be pregnant whenever she does not wish to be pregnant—lo and behold, instead of ending up with nine children she’ll generally end up with two or three.

Many spot surveys and the massive findings of the World Fertility Survey have abundantly demonstrated that a large proportion of fecund women in every culture wish to delay and prevent pregnancy.

Q: You addressed a little bit about what we can do. I get a certain sense of it being out of our hands if the people who have the power to make decisions are being influenced by other forces. But what can we do most effectively to bring effective contraceptives to the market and to affect the policies which would enable the United States to provide the full range of contraceptives?

Ravenholt: We must come back to the fact that it is simply intolerable in this country that a minority religious sect dictates to the entire citizenry that they not have access to fertility control means which would be highly beneficial to them. Depo-Provera and RU486 are urgently needed in this country and throughout the world. The current constraints on availability are intolerable. ZPG must help lead the movement to remove the present barriers to their use.

Q: A young woman in the audience here, if I may speak to her, asked what we might do to help strengthen worldwide family planning. What we must do is write our legislators. It’s very important that they know what is going on so please try to correspond with them. And now there’s a petition being circulated on RU486. It is sponsored by The Fund for a Feminist Majority. The petition is being sent to France, to the makers of RU486 and hopefully will have tens of thousands of American signatures on it.

Ravenholt: The American Public Health Association sponsored a delegation of members who visited France last year seeking to expedite movement of RU486 to this country. In California and other States there are determined attempts to somehow gain access to RU486, even if FDA continues to procrastinate.

There is a need for militancy by ZPG and other proponents of rational population policies and freedom of choice.

The task before us is not an easy one. Since 1973 the Roman Catholic Church has organized a powerful, coordinated and pervasive program aimed at imposing their anti-birth control dogma on everyone.

Currently, they not only, in large measure on birth control issues, control the White House, the Congress, the Supreme Court[4-5] and many state legislatures, but effectively block virtually all potent media criticism; and even intimidate and inhibit Planned Parenthood leaders from frank identification of the main religious force now obstructing reproductive freedom in this country and the world.

Personally, I have begun speaking out more frankly on the matter of unfair religious obstruction to freedom of choice, and I hope all of you will do likewise. We have some good legislators. But they need to be instructed; as does George Bush. He needs to be brought back to his better senses. Ongoing warfare in Central America and the Middle East may have transient political appeal for some. But most of us would no doubt prefer that a fundamental coolant be applied to these hot spots—by improved fertility control.

Thank you.

Endnote

1. On January 3, 1977, at the Yankee Peddlar Inn in Holyoke, Massachusetts, U.S. Secretary of State Designate, Cyrus Vance, responded to my query:

“Who’s going to become the new AID Administrator?” saying, “Well, we’ve offered the job to Father Hesburgh of Notre Dame, but we’re not sure that he will accept.”

References

(1) Ravenholt, RT, Chao J. “World Fertility Trends”, 1974. Population Reports, August, 1974. J-25.

(2) Piotrow PT. World Population Crisis: The United States Response. Praeger, New York, 1973.

(3) Population Program Assistance Aid to Developing Countries by the United States, Other Nations, and International and Private Agencies. Agency for International Development, Bureau for Technical Assistance, Office of Population, 1967-75.

(4) Ravenholt RT. “Population Program Assistance.” U.S. Agency for International Development, Presentation to the Select Committee on Population, House of Representatives, James Scheuer, Chairman, April 25, 1978.

(5) Rosenfeld SS. “Do Family Planning Programs Work?” Washington Post 1976 Feb 7; Sect. A:25 (col.1).

Appendix B

Foremost Achievements of Aid’s Population Program, 1966-1979

—Creative, careful and consistent programing and monitoring of $l.3 billion of population funds provided by the U.S. Congress, for hundreds of projects and country programs aimed especially at enabling hundreds of millions of poor people to enjoy their fundamental human right of having the knowledge and means for controlling their fertility.

—Applied research, development, testing and dissemination of improved means of fertility control. The most important technological accomplishments of A.I.D.’s Office of Population during the last decade have been:

* Development of the 28 tablet oral contraceptive package, including 21 hormone tablets and seven iron (ferrous fumarate) tablets, which facilitates use of this method by illiterate women without calendars. These oral contraceptives are packaged in standardized non-proprietary packages which have been indispensable for maintaining maximum commercial competition and lowest prices for A.I.D. purchases.

* Development of the Menstrual Regulation Kit in 1973, a safe, simple and inexpensive means of uterine aspiration, through research contract with the Bettelle Memorial Institute. Eleven thousand M.R. Kits were purchased and rapidly disseminated in 1973, mainly by the mechanism of the International Conference on Menstrual Regulation held at Hawaii that December. But action to purchase 100,000 M.R. Kits was blocked by passage of the Helms Amendment to the Foreign Assistance Act. Nevertheless, since then private and multilateral organizations have distributed more than 150,000 M.R. Kits to requesting family planning organizations and the M.R. Kit has abundantly proved its unique utility.

* Support for and assistance in the development of the Voon Band (Falope Ring) and Hulka Clip for non-thermal laparoscopic tubal occlusion; and development of simplified and much less expensive laparoscope based upon the Falope Ring technique rather than electro cautery.

Wide dissemination of laparoscopic equipment to specially trained surgeons in more than 70 developing countries including Korea, Indonesia, India, Pakistan, Nepal, Tunisia, Colombia and Mexico has greatly motivated surgeons there to provide high quality voluntary sterilization services, usually on an outpatient basis.

Because of these developments laparoscopic sterilization is now simpler, safer, less costly and much more generally available.

* Support for and assistance in development of mini-laparotomy equipment and techniques, now extensively used by gynecologic and general surgeons to provide voluntary sterilization services as an outpatient procedure in developing countries.

* Strong support for research and development of “a non-toxic and completely effective substance which when self-administered on a single occasion would ensure the non-pregnant state at the completion of a monthly cycle”:

From 1970 to 1979 the Office of Population applied $7 million for support of research and development of prostaglandins, which are increasingly becoming used and accepted as an important new means of fertility control; and $4 million for antiprogesterone research, contributive toward RU486 development.

And from 1970 to 1979 the Office of Population applied $4.5 million toward the identification, synthesis and testing of Latinizing Hormone-Releasing Hormone and analogs and antagonists thereto. Dr. Roger Goleman of the Salk Biological Institute, Project Director for most of this research supported by A.I.D., received the Nobel Prize in 1977 for discoveries largely achieved under this contract; and LH-RH synthetic analogs are currently very promising new means of fertility control.

—Purchase and delivery of huge quantities of contraceptives and surgical equipment to family planning programs in distant lands, so that these programs could have adequate contraceptive supplies. Through fiscal 1979 AID applied approximately $215 million for:

* 780 million monthly cycles of oral contraceptives, purchased at the world’s lowest prices of about 15 cents per cycle and delivered throughout the developing world to become the leading means of fertility control in many countries.

* 2.3 billion condoms, improved by coloring and lubrication, and promoted through advertising to become an important means of family planning in developing countries as they long have been in developed countries; plus large quantities of other barrier contraceptives which individuals can use without medical supervision.

* 10 million intrauterine devices which are an important means of fertility control in most countries.

* 2000 improved laparoscope and 36,000 minilap and vasectomy kits, now used in more than 75 developing countries; which have helped to make voluntary sterilization the world’s most popular means of fertility control—both in developed and less developed countries.

—Initiating and continued strong support for the United Nations Fund for Population Activities. In 1969, the initial year of the UNFPA, the $2.5 million provided from A.I.D.’s 0ffice of Population account constituted 85 percent of UNFPA resources; and through fiscal 1979, A.I.D. contributions to the UNFPA totaled $204 million or 35 percent of UNFPA income.

—Strong support for the International Planned Parenthood Federation (IPPF). Beginning with a grant of $2.7 million in fiscal 1968, A.I.D. provided 40 percent of IPPF funds for a number of years; end through fiscal 1979, A.I.D. support to IPPF totaled $126 million.

—Origination, development and major support of Family Planning International Assistance/PPFA ($69 million from A.I.D.), and of the International Project of the Association for Voluntary Sterilization ($29 million from A.I.D.); and extensive support to the Pathfinder Fund ($50 million through fiscal 1979). Through hundreds of innovative projects, these three organizations have provided support for incipient and burgeoning family planning activities in more than 100 developing countries. A.I.D. support for these three family planning organizations through fiscal 1979 totals $148 million.

—Creative and coordinated support for a broad set of initiatives, including research, training, equipment, surgical services, and development of national associations for voluntary sterilization which has helped voluntary sterilization surge ahead during the seventies to become the world’s most popular means of fertility control, with more than 90 million couples now using this method. During the last decade A.I.D. has provided $100 million in support of voluntary sterilization.

—Origination, design, development and support of the World Fertility Survey (WFS), in partnership with the United Nations Fund for Population Activities (UNFPA), the international Statistical Institute (ISI), and the International Union for the Scientific Study of Population (IUSSP). The WFS has rapidly become “the world’s largest international social science research project ever undertaken,” and is providing large quantities of high quality data on fertility and many related developmental variables from more than 40 developing countries by means of nationally representative sample surveys of households using standardized data collection methods. Through fiscal 1979 WFS received $17 million from A.I.D. and $13 million from the UNFPA.

—Development and major support for training programs in the United States and numerous developing countries. More than 12,000 population and family planning personnel, including program managers, surgeons, nurses and other paramedical personnel, specialists in information, education, and communication, demographers, economists, and sociologists have been trained in the United States in appropriate skills, including the most advanced techniques of fertility management. In addition many tens of thousands of family planning personnel have been trained in the developing countries with A.I.D. support. For population and family planning training A.I.D. has provided $153 million.

—Origination (with Dr. Phyllis Piotrow), development and strong support of the Population Information Program, first at George Washington University, and now at Johns Hopkins University, which has published and widely distributed comprehensive and authoritative Population Reports on many priority issues relative to population and family planning programs. PIP Reports, published in five languages, are among the ten most widely read medical publications in the developing world ($11 million from A.I.D.).

—Origination (with Dr. Elton Kessel), development and major support of the International Fertility Research Program (IFRP) for comparative testing and rapid dissemination of improved technologies. With AID support the IFRP has measured the comparative performances of each means of fertility control in many developing countries. By this action latest technologies have been widely introduced in the developing world, with careful measurement of results by indigenous investigators. IFRP, now operating in more than 50 countries, has developed a Maternity Care Monitoring Program which collects salient facts on reproductive health, delivery, and contraceptive use before and after each pregnancy from hundreds of thousands of women delivering in selected hospitals in many developing countries ($18 million to IFRP from A.I.D. through fiscal 1979).

—Origination, development and support of Contraceptive Prevalence Surveys (by Westinghouse, Inc.), which also use standard data collection methods to survey nationally representative samples of households in many developing countries (Colombia, Mexico, Costa Rica, Korea, Thai land, Bangladesh, Tunisia and Egypt). These are being done in record time to provide the reliable information on current contraceptive availability and use needed for management of family planning programs. ($2.5 million for Contraceptive Prevalence Surveys from A.I.D.)

—Origination, design, development, and support of Operations Research Projects (Intensive Service Projects) in 19 countries, testing the practicality and measuring the efficiency of various family planning program configurations, including household distribution of contraceptives. The findings of these projects contribute directly to improvement of national programs ($14 million for these action research projects from A.I.D. through fiscal 1979).

—Origination, development and support of Contraceptive Retail Sales (CRS) Projects (with contraceptive advertising campaigns) in six countries Jamaica, Bangladesh, Nepal, Ghana, Mexico and El Salvador. These projects have achieved greatly increased availability of non-surgical contraceptives by sales at low prices through many thousands of neighborhood shops. In Bangladesh the Contraceptive Retail Sales program currently accounts for one-third of all contraceptives distributed in that country. (A.I.D. support of CRS projects, including contraceptives, totals $15 million through fiscal 1979).

—Support for University Population Centers and diverse research, training, technical assistance and evaluation activities by universities, e.g. Johns Hopkins University, University of Hawaii and the East-West Center, University of North Carolina, Columbia University, George Washington University, University of Michigan, University of California, University of Chicago, State University of New York, Meharry Medical College, University of Minnesota, Washington University, Harvard University, California Institute of Technology. ($156 million support from A.I.D.).

—Support for collaborative activities by non-university educational and professional associations such as the Population Council, the National Academy of Sciences, Salk Institute, Smithsonian Institution, American Public Health Association, Battelle Memorial Institute, American Home Economics Association, Airlie Foundation, and the International Confederation of Midwives. ($88 million support from A.I.D. through fiscal 1979).

—Support for allied U.S. Government agencies: The international activities of the Family Planning Evaluation Division of the National Center for Disease Control; the International Demographic Statistics Center, U.S. Bureau of the Census; and the National Center for Health Statistics ($33 million support from A.I.D.).

—Major support for national family planning programs on a bilateral basis in 46 countries including: Indonesia ($72 million), Philippines ($63 million), Pakistan ($38 million), India ($30 million), Bangladesh ($30 million, Thailand ($24 million), Tunisia ($14 million), Nepal ($13 million), Tanzania ($10 million), Ghana ($9 million). ($415 million bilateral support for population and family planning programs from A.I.D. through fiscal 1979).

Country Programs

The efficiency with which developing countries have applied international population program assistance, along with indigenous resources, varies greatly. Most successful have been South Korea, Taiwan, Thailand, Indonesia, Columbia, Costa Rica, Chile, Dominican Republic, Panama and Mexico.

Countries which have made substantial headway toward reducing birth and growth rates, but whose family planning programs have been seriously flawed and less effective than they might have been, include India, the Philippines, Egypt, Tunisia, Brazil and Jamaica.

Countries which have received considerable international population program assistance but have not yet made substantial progress toward controlling birth and growth rates, include Pakistan, Bangladesh, Nepal, Ecuador, Guatemala, Honduras, Nicaragua, Kenya, Ghana and Tanzania. Due to political and bureaucratic disabilities these countries have not yet achieved general availability of effective means of fertility control.

Countries which have received little international population program assistance and made little if any progress toward control of excessive fertility include Burma, and most countries in Africa, and the Middle East.

International population program assistance is a high risk enterprise. For successful results, all essential links in the action chain must be of adequate strength: international assistance must be timely, appropriate in nature, of adequate magnitude, be made readily available, and be well used by indigenous program personnel operating under strong leadership.

If one or more of these links is weak or missing the entire enterprise may fail.

Appendix C

World Population Crisis: The United States Response

by Phyllis Tilson Piotrow

Praeger Publishers

New York Washington London

Foreword by George H. Bush, Jr.

U.S. Representative to the United Nations, 1973

Few issues in the world have undergone such a rapid shift in public attitudes and government policies over the last decade as the problems of population growth and fertility control.

My own first awareness of birth control as a public policy issue came with a jolt in 1950 when my father was running for the United States Senate in Connecticut. Drew Pearson, on the Sunday before Election Day, “revealed” that my father was involved with Planned Parenthood. My father lost that election by a few hundred out of close to a million votes. Many political observers felt a sufficient number of voters were swayed by his alleged contacts with the birth controllers to cost him the election. The subject was taboo—not only because of religious opposition but because at that time a lot of people were unwilling to discuss in public what they considered a private matter.

Today, the population problem is no longer a private matter. In a world of nearly 4 billion people increasing by 2 percent, or 80 million more, every year, population growth and how to restrain it are public concerns that command the attention of national and international leaders. The per capita income gap between the developed and the developing countries is increasing, in large part the result of higher birth rates in the poorer countries.

World Population Crisis: The United States Response recounts and analyzes the events which mobilized the United States leaders to action. Dr. Piotrow presents a story of determined and sometimes disruptive advocates, of conscientious, careful scientists, of political leaders striving to reach a new consensus, of vigorous officials building action programs. It is above all, a story of individuals and institutions struggling to solve a new kind of worldwide problem within the framework of individual choice and responsible government.

The population problem does not have easy answers. As a member of the U.S. House of Representatives in the late 1960s, I remember very well how disturbed and perplexed my colleagues and I were by this issue. Famine in India, unwanted babies in the United States, poverty that seemed to form an unbreakable chain for millions of people—how should we tackle these problems? I served on the House Ways and Means Committee. As we amended and updated the Social Security Act 1967 I was impressed by the sensible approach of Alan Guttmacher, the obstetrician who served as president of Planned Parenthood. It was ridiculous, he told the committee, to blame mothers on welfare for having too many children when the clinics and hospitals they used were absolutely prohibited from saying a word about birth control. So we took the lead in Congress in providing money and urging—in fact, even requiring—that in the United States family planning services be available for every woman, not just the private patient with her own gynecologist.

I remember another bill before the Ways and Means Committee. This one successfully repealed the prohibition against mailing information about birth control devices or sending the devices themselves through the mails. Until 1970 the mailing of this information had been heaped in with the mailing of “pornographic” material.

As chairman of the special Republican Task Force on Population and Earth Resources, I was impressed by the arguments of William H. Draper, Jr. that economic development overseas would be a miserable failure unless the developing counties had the knowledge and supplies their families needed to control fertility. Congress constantly pressed the rather nervous federal agencies to get on with the job. General Draper continues to lead through his tireless work for the UN Population Fund.

Congressional interest and support in population problems was remarkably bipartisan—including Jim Scheuer, Ernest Gruening, Bob Taft, Bill Fulbright, Joe Tydings, Bob Packwood, Alan Cranston, and many others from both parties and every section of the country. Presidents Johnson and Nixon both were seriously concerned about the problem, too. In fact, early in 1969 President Nixon delivered an official Message on Population to Congress. In the federal agencies there were at first only a few determined individuals like R.T. Ravenholt in AID and Philander P. Claxton, Jr. in the State Department who were willing to urge their superiors ahead. Now the recommendations of the Commission on Population Growth and the American Future, chaired by John D. Rockefeller 3rd, have urged many agencies to take on a larger role and have called for the U.S. government to adopt a national population policy.

When I moved to the United Nations in 1971 as United States Ambassador, I found that the population problem was high on the international agenda, though lacking some of the urgency the matter deserves. The General Assembly had designated 1974 as World Population Year with a major conference of government scheduled. The UN Fund for Population Activities, which has raised some $50 million, now stands ready to help agencies and governments develop appropriate programs. It is quite clear that one of the major challenges of the 1970s, the Second United Nations Development Decade, will be to curb the world’s fertility.

The United Nations population program, including the Fund and specialized agenda, stands today at the threshold of international impact. The problem has been recognized; the organizations exist; the resources are at hand. But policy making on the international level no-less than on the national one is an educational process. In developing the programs needed, the public as well as government leaders learn from one another. New technologies lead to new policies and laws, new public and private values, new insights into our own problems as well as those of others. We all proceed by trial and error. Will we learn fast enough from one another and with one another how to defuse the population bomb?

One fact is clear: in a world of nearly 4 billion people, with some 150 independent governments, myriad races, religions, tribes and other organizations, major world problems like population and environmental protection will have to be handled by large and complex organizations representing many nations and many different points of view. How well we and the rest of the world can make the policies and programs of the United Nations responsive to the needs of the people will be the test success in the population field. Success in the population field, under United Nations leadership, may, in turn, determine whether we can resolve successfully the other great questions of peace, prosperity, and individual rights that face the world.

Dr. Piotrow’s study of evolving population policy, in the United States and in the United Nations, is necessarily a sway without an ending. It is not a blueprint for the future, but rather a search for the meaning of the past, an exploration of the means, the arguments, the individuals and the events which did, in fact, influence U.S. policy making over the last decade and a half. But the lessons suggested here—about leadership, about innovation, about national and international organizations—surely have continuing application for the future. Dr. Piotrow was in a unique position to observe and even participate in many of the actions taken.

I worked with Phyllis Piotrow on some of these issues. This book is far too modest about her own efforts, for she has contributed significantly herself to public understanding and support of population activities through her work with the Population Crisis Committee. Certainly the private organizations, like the Population Crisis Committee, Planned Parenthood-national and international, the Population Council, the Population Reference Bureau, the Population Institute, Zero Population Growth, and others, have played a major role in assisting government policy makers and in mobilizing the United States response to the world population challenge that is described in this volume.

George Bush

U.S. Representative to the United Nations

Pronatalist Zealotry and Population Pressure Conflicts: How Catholics Seized Control Of U.S. Family Planning Programs

By R.T. Ravenholt, M.D., MPH

Published by

Center for Research on Population and Security

P.O. Box 13067

Research Triangle Park, N.C. 27709

(919) 933-7491

First printing, May 1991

Second printing, May 1991

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