“Reproductive Health Care,” the “Demographic Imperative,” and the Real Health Needs of Women in the Developing World (Part Two)

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 did so in the context of providing “client-centered” programs that conferred significant health and welfare benefits to their target population. This two-part article will show that these several claims are misleading, if not altogether false. In the first article, which was published in the previous issue, the failure of population control programs to address women's health needs was documented, as the women themselves perceive them. The rationalizations used to support an exclusive focus on contraception and sterilization (“latent demand” and “unmet need”) were examined, as well as the harm that has been done to women's health by such drugs and devices. In this, the second, article the post-Cairo conference rhetorical shift to “reproductive health” is discussed, and the claims that such programs have reduced maternal mortality, infant mortality, and the absolute number of abortions are analyzed. A discussion ensues 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.