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Gagged: the politics of reproduction and U.S. foreign aid, 1961-2009

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Gagged: the politics of reproduction and U.S. foreign aid, 1961-2009

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Content GAGGED: The Politics of Reproduction and U.S. Foreign Aid, 1961-2009 By Allison Lauterbach Dale A Dissertation Presented to the FACULTY OF THE USC GRADUATE SCHOOL DORNSIFE COLLEGE OF LETTERS, ARTS AND SCIENCES UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (HISTORY) May 2014 Copyright 2014 Allison Lauterbach Dale ii For Grampa, My first history teacher iii Acknowledgments I often tell people that when grad students daydream, they dream of what they’ll say in their dissertation acknowledgments. Now that the time has finally arrived, I realize that words can never express how thankful I am for the support I have received from my teachers, colleagues, friends, and family. That said, I’ll do my best. Generous financial support from the following archives and organizations made this dissertation possible: the Lyndon Baines Johnson Presidential Library; the Society for Historians of American Foreign Relations; the Arthur and Elizabeth Schlesinger Library on the History of Women in America, Radcliffe Institute for Advanced Study at Harvard University; the Center for the United States and the Cold War at NYU; the Gerald R. Ford Presidential Foundation; the Boalt Hall Women’s Association; the Center for Law, History and Culture at USC’s Gould School of Law; and USC’s Department of History. USC’s Wallis Annenberg Fellowship allowed me to spend a year focused entirely on researching and writing my dissertation. Archivists and library administrators around the country helped me wade through thousands of pages of history. In particular, I would like to thank Lynda Leahy and Susan Landry at the Schlesinger Library, Kelly Wooten at Duke, Mark Updegrove and Allen Fisher at the LBJ Library, William McNitt at the Ford Library, Zuzanna Kobrzynski at NYU, Stephen Plotkin at the JFK Library, and Kelly D. Barton at the Reagan Library. Betty and Rei Ravenholt and Charles Hemmer kindly answered my many questions, despite having never met me. I have been spoiled by an amazing group of teachers whose commitment to their students extends long after graduation. At Brown, Michael Vorenberg introduced me to my love of legal history and Maud Mandel became my role model. Elliott Gorn, who has kept me sane with his iv humor and cynical wisdom, is a wonderful teacher, a generous collaborator, and a dear friend. At Berkeley Law, Kristen Holmquist, John Yoo, Ken Bamberger, Kathleen Vanden Heuvel, Michael Levy, and Herma Hill Kay were incredible professors whose encouragement and support allowed me to work on this dissertation throughout law school. Kristin Luker is the reason I went to Berkeley and I can only hope to have made her proud. Rickie Solinger, Sarah Dubow, and Reva Siegel gave me valuable feedback throughout the course of my research. Their work inspires me to be a better scholar. At USC, Lori Rogers and Sandra Hopwood kept me on track and were my very own cheering section. Ariela Gross is responsible for my decision to pursue a law degree and is also the reason I met my husband. To say that she has been a transformative presence in my life is an understatement. Mary Dudziak provided invaluable support and guidance in the early years of this dissertation. Peter Mancall and Alison Renteln made me a more well-rounded scholar and a happier grad student. Karen Halttunen is one of the finest teachers I know and I am a better writer and historian because of her. I have been incredibly lucky to call Steve Ross my dissertation adviser, mentor, and friend. I will forever be grateful for his patience, loyalty, and compassion. He always knew when all I needed was a hug. I valued every moment I spent learning with and from my colleagues at USC, in particular Julia Ornelas-Higgdon, Jessica Kim, Jennifer Black, Sarah Fried-Gintis, Shayna Kessel, Catherine Clark, Matthew Amato, Elizabeth Logan, Annie Johnson, and Sarah Goodrum. They asked insightful questions, read my terrible chapter drafts, and provided friendship and laughter along the way. Sarah Keyes and Raphaelle Steinzig have been my USC family in Berkeley and helped me get to the finish line. v Nicole, Annie, Katie, and my other friends at Berkeley Law empowered me to complete my dissertation and celebrated my accomplishments as though they were their own. I am especially grateful to Marienna for voluntarily proof-reading my entire manuscript and providing such helpful suggestions. Ilana and Sharona have become my sisters and I wish I could live near them forever. Maxine, Amanda, Wes, Neil, Jessica, and Jon have been by my side through every setback and every victory. The Dales welcomed me into their lives and treated me like family from the moment we met. I have asked around and it turns out that Jon and Mary are in fact the best in-laws ever. Grammy and Grampa always stressed the importance of education and provided me with unparalleled support and inspiration. I strive to make them proud. Abby and David are driven, ambitious, and insanely talented—I only try to keep up. I am so lucky to be their sister. Our parents taught us the value of hard work and raised us to believe we could achieve our loftiest goals. My dad is a super hero without a cape. My mother is the most courageous, selfless, and giving person I know. I would have never finished this dissertation were it not for Conor’s love, support, and homemade cocktails. I am the best version of myself when I am with him and am so proud to call him my husband, partner, and best friend. And thank you, Rory, for sitting by my side—or on my lap—as I typed every word of the dissertation and for forcing me to take breaks to enjoy the sunshine. Or to put it in a way you understand, woof-woof-woof, want a treat? Finally, thank you, Vin Scully, for keeping me company all of these years. vi Table of Contents Acknowledgments iii Introduction Abortion and the Transnational Implications of Domestic Change 1 Chapter 1 Prophylactic Diplomacy: Population Bombs, Foreign Aid, and Public Opinion 8 Chapter 2 Sex, Drugs, Population Control: USAID’s Dissemination of Contraceptives 57 Chapter 3 Roe v. World: The U.S. Pro-Life Forces Take on the World 113 Chapter 4 Grassroots to Gagged: The Rise of the Religious Right and the Decline of Family Planning Funding 158 Epilogue 210 Bibliography 215 1 Introduction Abortion and the Transnational Implications of Domestic Change The words “Baby killer!” echoed throughout the chamber, piercing the civil decorum of the evening’s events. Such character assassinations were common outside abortion clinics, but this was the U.S. Congress. And it was one congressman charging another with murder—a fellow pro-lifer at that—during a debate over health care legislation. Inflammatory rhetoric was of course not new to the halls of Congress in 2010. A century-and-a-half ago, the battle over slavery resulted in an out-and-out brawl on the House floor. Just as slavery proponents and abolitionists once did, pro-life and pro-choice advocates today believe they are fighting the ultimate fight and any compromise is unacceptable. 1 As the “baby killer” encounter indicates, the debate over abortion infiltrates every corner of our society. Individual women and their families can be forever changed by abortion–whether obtained and how. Churches take stands on both sides, and, as in the 2009 murder of late-term abortion practitioner, Dr. George Tiller, the violence of the debate even infiltrates the confines of church walls. Political candidates must take unequivocal stances on abortion. Supreme Court nominees live and die by Roe v. Wade. Less recognized, however, are the ways in which such domestic battles over abortion, and reproductive rights more broadly, have influenced U.S. foreign aid policies and, in turn, have shaped the lives of people around the world. The battles surrounding U.S. foreign aid for family planning programs make for a valuable case study on the international ramifications of American social and legal change. Since the establishment of the United States Agency for International Development in 1961, the 1 I call the two sides the pro-life and the pro-choice movements because those are the terms the two sides use to describe themselves. I refer to individuals or smaller groups not necessarily 2 diplomatic, ideological, and humanitarian objectives of foreign assistance have competed for primacy. In no other area has this been more apparent than in U.S. foreign aid programs for family planning and population control. --- Speaking to Congress in March 1961, President John F. Kennedy described new threats to national security and prosperity. Failure by the Congress to act, he explained, “would be disastrous . . . for widespread poverty and chaos lead to a collapse of existing political and social structures which would inevitably invite the advance of totalitarianism.” 2 Kennedy spoke not of nuclear weapons, espionage, or military conflict but of the problems endemic to U.S. foreign aid programs. Outdated and inefficient, such programs only provided short-term relief and left recipient countries vulnerable. The future of free market capitalism and democratic governments depended on a new approach concentrated on the sustained economic growth and independence of developing nations. Emphasizing the consequences of inaction, Kennedy highlighted the Soviet Union’s success in using foreign aid to spread communism. Focused on long-term development, the Soviets strategically dispersed aid to make developing nations financially dependent. Foreign assistance was another Cold War weapon, one the United States had yet to wield effectively. Responding to Kennedy’s plea, Congress passed the 1961 Foreign Assistance Act, reorganizing and separating military and non-military assistance programs and mandating the creation of a new agency to oversee the latter. That November, Kennedy established the United 2 John F. Kennedy, “Special Message to the Congress on Foreign Aid,” Message to Congress, March 22, 1961, Online by Gerhard Peters and John T. Woolley, The American Presidency Project, accessed April 3, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=8545. 3 States Agency of International Development (USAID), ushering in a new era in American foreign aid. The late 1950s and early 1960s also marked the inauguration of a global effort to slow population growth. It had taken the human race until 1650 to reach a population of half-a-billion people. By 1850, that total was up to 1 billion. By 1930, 2 billion. Only 30 years later, by 1960, 3 billion populated the planet. Today, over 7 billion people inhabit the globe. 3 Led by John Rockefeller III, a small group of white, wealthy, politically connected elites effectively lobbied the Kennedy and Johnson administrations to take up the cause of population growth, particularly in developing nations. According to these advocates, developed nations could no longer ignore the needs of their underdeveloped neighbors. Appealing to concerns of national security, Rockefeller and this “population establishment” insisted that rapid population growth destabilized developing nations and made them more vulnerable to communism. Rockefeller and his similarly well-situated friends used every political and financial tool at their disposal to spread the message of population control. Congress soon, too, started to pressure the White House. Worried that endeavoring into population and family planning programs would enrage the Catholic Church, President Johnson would only commit the United States to engaging in demographic research. His administration and officials at USAID instead encouraged the United Nations, private foundations, and nongovernmental organizations to take the lead in actually administering family planning programs. 3 As of March 24, 2014, the world population stood at approximately 7.15 billion. “U.S. & World Population Clock,” United States Census Bureau, December 30, 2010. http://www.census.gov/popclock/; “The Population Issue – Time for Action,” Planned Parenthood World Population, n.d., 2–3, Emily Hartshorne Mudd Papers, 1873–1990, 73-143- 90-M103, box 12, folder 540, Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA. 4 Despite the growing public acceptance for limiting population growth, at every stage the U.S. government needed to navigate public backlash when determining what USAID would and would not fund. Even when it became apparent that the public outrage Johnson so feared was not going to come, the president and many in Congress still hesitated to commit. Indeed, Americans’ comfort with the idea and use of birth control had evolved in ways the administration did not fully realize. But Johnson and USAID could only avoid the issue of birth control for so long. With the introduction of the first hormonal birth control pill in 1960, and the Supreme Court ruling in Griswold v. Connecticut recognizing the right of married couples to use contraception in 1965, family planning was becoming part of the public discourse. The United States could not on the one hand espouse the need for controlling population growth while also refusing to offer the most effective means for doing so. Members of both parties in Congress and officials at USAID insisted on the need to incorporate family planning programs into the growing U.S. foreign assistance program. When it became clear that the small number of Congressmen opposing birth control would not object, USAID finally entered the field. In 1967, the Agency sent $1.3 million worth of contraceptives to India, including enough birth control pills for 100,000 women. 4 Foreign aid programs continued without much change until 1973 when the Supreme Court’s holding in Roe v. Wade effectively legalized abortion. Although the U.S. experience with decriminalizing abortion came at a time when most countries in Western Europe were also liberalizing their laws, changes to the U.S. foreign aid program would begin to set the American experience apart. Three years before the Hyde Amendment banned the use of Medicaid and other 4 Luther J. Carter, “Population Control: U.S. Aid Program Leaps Forward,” Science 159 (February 8, 1968): 614. 5 federal funds for abortions, Congress passed the 1973 Helms Amendment to the Foreign Assistance Act prohibiting the use of USAID funds for abortions, the first such restriction on foreign aid programs. The history of the Helms Amendment sheds light on the vast bureaucracy behind U.S. foreign aid programs. Just because Senator Jesse Helms (R-NC) and a few of his colleagues were able to get the amendment passed did not mean that they had the oversight to see that it was implemented properly. The ability of USAID officials and funding recipients to subvert the law’s intentions reveals the power that individual personalities had in shaping foreign aid programs on the ground. Just whose vision of family planning was most effective, appropriate, or even moral depended on the circumstances and personnel associated with each project. Initially part of a staunch minority that opposed abortion, Helms himself was a harbinger of things to come. Throughout the late 1970s and into the early 1980s, conservative political operatives reframed the abortion debate to draw Catholics and Evangelical Protestants away from the Democratic Party. To Catholics and Evangelicals alike, the Equal Rights Amendment and abortion both embodied a significantly dangerous theme: the breakdown of traditional family values. This interpretation gained momentum as the backlash to the feminist women’s liberation movement continued to grow. Motivated to protect traditional family values and gender roles, Catholics and Evangelicals, long divergent from one another, came together to fight against abortion. The Republican Party successfully crafted abortion into a powerful, polarizing wedge issue that was sure to garner attention. Still, the first few years of Ronald Reagan’s presidential administration went by without much change. To the dismay of his loyal electorate, Reagan even originally expressed support for continuing family planning programs. Reagan’s administration, 6 however, did not lose sight of the effectiveness of using the issues of contraception and abortion to galvanize conservative voters. In the summer of 1983, just weeks before the Republican National Convention, Reagan upended decades of foreign aid policy and programming when he announced that population growth did not threaten the planet or its inhabitants. Until then, U.S. foreign aid for population programs had been based on two key assumptions. First, population growth was threatening the stability of developing nations, not to mention impairing their populations’ quality of life. Second, the United States would not dictate what family planning methods should be used in developing nations, though it refused to support coercive programs. The U.S. delegation to the United Nations Population Conference in Mexico City, on Reagan’s behalf, announced new terms of U.S. foreign aid. According to the new “Mexico City Policy,” the U.S. government took the position that population growth was in fact a neutral phenomenon and that free market economies, and not government intervention, would slow growth rates. Moreover, the United States would no longer give aid to international nongovernmental organizations that used their own funds to provide abortions, lobbied for liberalized abortion laws, or worked with other organizations and hospitals engaged in such activities. An organization could get U.S. family planning funding or it could provide abortions. It could not do both, no matter who was paying for it. The policy was exactly what the increasingly powerful pro-life movement had wanted. --- This historical narrative is about more than population growth and family planning. Rather, it is also about the complexities of policy history, from how a policy is conceived, to how it is passed into law and ultimately administered on the ground. At every stage of this process, 7 politicians, government officials, and civilians, each with different perspectives and objectives, shapes a given policy’s fate. The Helms Amendment, for example, came out of Congress with the goal of preventing U.S. money from funding abortion services. However, those at USAID charged with putting the funding restrictions into place disagreed with those stated objectives. Their ambivalence in turn allowed funding recipients, at times, to ignore the restrictions all together. A Republican fear of this exact type of subversion in turn motivated the construction of more onerous restrictions. This dynamic exists amidst the backdrop of broader, large-scale proliferation of major changes in U.S. policy. While the Mexico City Policy was in part a response to concerns over subversion of the Helms Amendment, it also represented a new articulation of U.S. population policy. While population control had previously received bipartisan support, the Reagan administration reframed the issue, using opposition to population programs as a tool to recruit conservative voters previously outside the reach of the Republican Party. Electoral politics dictated the terms of U.S. foreign aid policy. From the establishment of USAID in 1961 to the Mexico City Policy in 1984, domestic cultural and legal transformations shaped U.S. foreign aid policies and with them, the lives of men, women, and children around the world. This historical narrative demonstrates that foreign policy is not just a creation of Foggy Bottom diplomats working in ivory tower isolation; it is born of domestic politics and culture and reveals the transnational implications of America’s unrelenting battle over reproductive rights. 8 Chapter 1 Prophylactic Diplomacy: Population Bombs, Foreign Aid, and Public Opinion During the late 1950s, hunger plagued the Third World. Poverty rates soared. Infant mortality reached shocking levels. Demographic expansion outpaced economic growth. Developing economies could not keep up with their growing populations. Population control advocates tried desperately to convince industrialized nations of the correlation between such staggering population growth and the devastating living conditions in the developing world. A reporter publicly confronted President Dwight D. Eisenhower about the issue at a press conference in 1959. When asked if the U.S. government would help other nations formulate plans to address population growth, and by extension, if he thought the United States would deliver birth control information on request, Eisenhower did not hesitate to distance himself from the proposition. Under no uncertain terms would the United States fund the distribution of birth control at home or abroad. “I cannot imagine anything more emphatically a subject that is not a proper political or government activity or function or responsibility,” he declared. “The government will not, so long as I am here, have a positive political doctrine in its program that has to do with the problem of birth control. That’s not our business.” 5 Six years later, Eisenhower just as emphatically supported the advent of such programs. In June 1965, as an honorary co-chair of Planned Parenthood-World Population with former President Harry Truman, Eisenhower urged Congress to approve foreign aid for population control programs. Claiming that the “facts changed my mind,” Eisenhower explained, “If we 5 Dwight D. Eisenhower, “The President’s News Conference,” December 2, 1959, Online by Gerhard Peters and John T. Woolley, The American Presidency Project (hereafter “APP”), accessed April 1, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=11587&st=birth+control&st1=. 9 now ignore the plight of those unborn generations which, because of our unreadiness to take constructive action in controlling population growth, will be denied any expectations beyond abject poverty and suffering, then history will rightly condemn us.” 6 The following year, he announced that he would “personally support all programs, public or private, that carefully respect the freedom and rights of the individual family and which aim at providing to the family all necessary information and, where necessary, facilities to help eliminate the worldwide dangers posed by rapid increase in population.” 7 As historian Elaine Tyler May points out, “Eisenhower’s change of heart indicates the extent to which expert and official opinion had accepted the imperative of population control.” 8 In the time between Eisenhower’s admonition and subsequent support for government- sponsored population programs, a new era in foreign policy had begun, one which now included the distribution of foreign aid. The creation of the United States Agency for International Development and the commencement of U.S. assistance for population control embodied both a new emphasis on aid and the growing concern over population growth. How the United States maneuvered through the Cold War significantly shaped the evolution of this symbiosis. According to many advocates of population control and later to U.S. government officials, rampant population growth made developing nations especially vulnerable to communism and thus merited intervention by the federal government. American officials also 6 Marshall Green, “Evolution of U.S. Population Policy,” January 14, 1993, 5, Robin Chandler Duke Papers, 19980-0350, 1998-0372, box 3, folder “Duke, Robyn C. – Subject Files – Population Int’l Misc. 1997,” Robin Chandler Lynn Duke Papers, Rare Book, Manuscript, and Special Collections Library, Duke University, Durham, NC. 7 Dwight D. Eisenhower, “Statement given to the press by Dwight D. Eisenhower in response to Catholic Bishops’ statement on birth control,” Gettysburg, Pennsylvania, November 28, 1966, Files of S. Douglass Cater, box 66, folder “Cater, Douglass: Population -- Birth Control (4),” Lyndon Baines Johnson Presidential Library, Austin, TX (hereafter “LBJ”). 8 Elaine Tyler May, America and the Pill: A History of Promise, Peril, and Liberation (Philadelphia: Basic Books, 2010), 43. 10 “foresaw that overpopulation could lead to human misery, unrest, violence, and war.” As a result, diplomatic and humanitarian objectives competed for primacy as the United States endeavored into the population field. 9 Importantly, the advent of U.S. international population and family planning programs in the 1960s was not the first time the federal government entered into the field of population control. Cold War-era foreign policy interests and the philanthropic concern with Third World living conditions were only the most recent motivations for such involvement. From the time theorists first recognized the dangers of overpopulation in the late eighteenth century through the rise of the eugenics movement in the late nineteenth and early twentieth centuries, racism and paternalism informed the U.S. government’s initial population policies. Further influenced by American imperialist aspirations, such racist and sexist motivations left an indelible imprint on U.S. foreign and domestic population control. Whether population policies emerged out of nativist resistance to growing immigrant populations, the advent of the pseudo-science of eugenics, or the fear of communist expansion, U.S. cultural trends shaped the direction such programs would take. Still, questions remain as to how the priorities of select interest groups transformed into federal policy, how the government juggled its altruistic concerns and national security objectives, and whether such dynamics actually affected the rates and ramifications of population growth. Population Theory in Gestation The modern global concern with overpopulation was born amidst the Reign of Terror of the French Revolution. Nicolas de Caritat, marquis de Condorcet, a French philosopher, political 9 Ibid., vii. 11 scientist, and mathematician, had written on topics ranging from integral calculus to Voltaire. His observations on the threats of population growth, however, came while he was attempting to evade arrest as a “refugee republican suspected of conspiracy after the regicide of Louis XVI in 1793.” Published posthumously three years later, Condorcet’s Sketch for a Historical Picture of the Progress of the Human Mind examined a perceived disequilibrium between population expansion and the food supply. Overall happiness would decline, Condorcet argued, when humankind surpassed its means of subsistence. Though he acknowledged that scientific discovery would boost agricultural productivity, Condorcet underscored the role of reproductive behavior in helping society transition to smaller families, and in turn, a smaller population. Expanding on Enlightenment themes, he believed that reason would triumph and prompt a targeted, voluntary change in reproductive patterns. He emphasized the positive role that female education could play and suggested that sexuality be treated separately from reproduction in order to prevent overpopulation. Though a radical notion at the time, his hypothesis eventually gained traction, later inspiring feminist views on population control in the mid-twentieth century. 10 Responding to Condorcet in 1798, Reverend Thomas Robert Malthus similarly expanded on the dangers of overpopulation. In “An Essay on the Principle of Population,” Malthus argued that as long as food was available, the population would increase. Though he rejected contraception as unnatural, Malthus believed that individual responsibility for family size could 10 Lloyd S. Swenson, Jr., “A Civilizational Classic,” review of Sketch for a Historical Picture of the Progress of the Human Mind, by Marquis de Condorcet, Comparative Civilizations Review, No. 22 (Fall 1990): 7; Shalini Randeria, “Malthus versus Condorcet – Population Policy, Gender and Culture from an Ethnological Perspective,” in Between Life and Death: Governing Populations in the Era of Human Rights, eds. Sabine Berking and Magdalena Zolkos (Frankfurt am Main: Peter Lang, 2009), 26–27. 12 solve overpopulation. 11 For example, couples could choose to marry later in life to postpone procreation. Malthus also examined the role government could play, suggesting that marriage be restricted to propertied men and vehemently opposing any form of assistance to the poor. Writing in Great Britain, he claimed that the English Poor Laws only propelled population growth. While Condorcet focused on reducing fertility rates, Malthus sought instead to “absolve owners of private property of any social duty to alleviate poverty.” His moral righteousness and his explicit political agenda collectively inspired his population theories. 12 Half a century later, Karl Marx offered an economic interpretation of population growth. Observing that specific laws of population accompany every different mode of production, Marx attributed the negative consequences of overpopulation to capitalism and to its demands for an abundance of cheap labor. 13 According to Marx, high fertility was symptomatic of poverty, not its cause. Socialism, he argued, would quell the population problem “by bringing about a radical transformation in the underlying causes of poverty.” 14 Eugenics as an Answer to Social Dislocation While another hundred years would pass before any nation would officially acknowledge and confront the problem of population growth, the advent of eugenics in the 1880s signaled a 11 Judith R. Seltzer, The Origins and Evolution of Family Planning Programs in Developing Countries (Santa Monica, CA: Rand, 2002), 45. 12 It appears that Malthus thought that only married couples had sex. Randeria, “Malthus versus Condorcet,” 27; John Sharpless, “World Population Growth, Family Planning, and American Foreign Policy,” in The Politics of Birth Control and Abortion in Historical Perspective, ed. Donald T. Critchlow (University Park, PA: Pennsylvania State University Press, 1996), 81. 13 Seltzer, The Origins and Evolution of Family Planning Programs in Developing Countries, 45–46; Mohan Rao, From Population Control to Reproductive Health (New Delhi: Sage Publications, 2004), 89. 14 Seltzer, The Origins and Evolution of Family Planning Programs in Developing Countries, 45–46; Steven W. Sinding, “Population, poverty and economic development,” Philosophical Transactions of the Royal Society: Biological Sciences 364 (October 2009): 3024. 13 new way to analyze population demographics and prompted new government policies for population regulation. Francis Galton, a cousin of Charles Darwin and himself a pioneer in the field of human population statistics, first coined the term “eugenics” in 1883 to describe his proposal to regulate reproductive patterns for racial improvement. 15 Believing that only the best and brightest should be encouraged to reproduce, Galton founded the Eugenics Education Society and published the journal Eugenics Review. Jane Hume Clapperton’s 1885 Scientific Meliorism introduced the theory of “racial blood” and soon became the principal text of the burgeoning eugenics movement. Such organizations as the American Breeders Association, established in 1903, and the American Eugenics Society, founded in 1922, institutionalized and proselytized the eugenics doctrine. 16 The eugenics movement emerged during a period of “social dislocation” in the United States that included a rapidly growing immigrant population, urbanization, and transforming gender roles. Amidst such a “bewildering array of social problems . . . observers struggled to make sense of new social conditions and offered their remedies for social ills.” 17 Professor Edward A. Ross, a sociologist, eugenicist, and criminologist, became a movement leader. While at Stanford in 1901, Ross introduced the notion of “race suicide” in his article, “The Causes of Race Superiority.” “There is no bloodshed, no violence, no assault of the race that waxes upon the race that wanes,” Ross wrote. “The higher race quietly and unmurmuringly eliminates itself rather than endure individually the bitter competition it has failed to ward off from itself by 15 Christine Rosen, Preaching Eugenics: Religious Leaders and the American Eugenics Movement (Oxford: Oxford University Press, 2004), 5. 16 Rao, From Population Control to Reproductive Health, 93. 17 Rosen, Preaching Eugenics, 12. 14 collective action.” 18 Immigration, industrialization, and urbanization, he argued, not only threatened living standards but also caused birth rates of the native-born white population to decline. Believing the state should intervene to save the white race, Ross suggested that a return to the rural family and the governmental regulation of birthrates would realign society into the natural order. 19 Ross’s theories gained traction, reaching as far as the White House. President Theodore Roosevelt often alluded to the threat of race suicide in his appeals to “racialized agrarianism.” Like Ross, Roosevelt believed that the American family needed to be managed in order to preserve the quality of the white race. 20 While Ross focused on the roles of urbanization and immigration in the “decline” of the white race, Roosevelt blamed the rise of “new women.” Women who worked outside the home and sought better access to higher education, Roosevelt contended, neglected their civic obligation of motherhood. Such poor choices jeopardized the viability of the patriarchal family model. One Harvard professor similarly lamented that a higher education for women contributed to racial deterioration by “divert[ing] blood from the reproductive apparatus to the head.” 21 Eugenics was based on the premise that although reproductive behavior is a social act, it necessitated state intervention and regulation. Otherwise, men and women could not be trusted to reproduce responsibly. The control of reproductive decisions for the preservation of traditional 18 Edward A. Ross, “The Causes of Race Superiority,” Annals of the American Academy of Political and Social Science 18 (1901): 88. 19 Laura A. Lovett, Conceiving the Future: Pronatalism, Reproduction, and the Family in the United States, 1890–1938 (Chapel Hill: University of North Carolina Press, 2007), 79. 20 Ibid., 91, 110. 21 Edward Hammond Clarke, Sex in Education (Boston: Houghton, Mifflin and Co., 1873), 126– 27. 15 constructions of motherhood would continue to characterize debates over family planning and population programs for decades to come. 22 A History of Governing Reproduction Eugenics was only the most recent chapter in the history of local, state, and federal regulation of the U.S. population. In 1664, the Maryland colonial assembly passed the first criminal law on interracial marriage, mandating punishment for any “freeborn English women” engaged in “shamefull Matches” with “Negro slaves.” 23 Shortly after the American Revolution, states began responding to a spike in rates of premarital sex by instituting laws prohibiting fornication and pregnancy out of wedlock. Reflecting the professionalization of American law, these statutes attempted to preserve a semblance of Puritan morality and to protect towns’ financial stability. The first such law, Massachusetts’ 1786 “Act for the Punishment of Fornication, and for the Maintenance of Bastard Children,” delineated the punishment process for any two people engaging in premarital sex and outlined the procedures for procuring child support from a child’s father. 24 Many states went on to follow the Massachusetts example. Over time, paternity suits had less to do with regulating sexual morality than with protecting the fiscal health of towns and the welfare of children. 25 22 Rebecca M. Kluchin, Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950– 1980 (New Brunswick, NJ: Rutgers University Press, 2009), 8. 23 Quoted in Nancy Cott, Public Vows: A History of Marriage and the Nation (Cambridge, MA: Harvard University Press, 2000), 44. 24 John C. B. Davis, The Massachusetts justice: a treatise upon the powers and duties of justices of the peace: with copious forms (Worcester, 1847). 25 Michael Grossberg, Governing the Hearth: law and the family in nineteenth-century America (Chapel Hill: University of North Carolina Press, 1985), 216. 16 Throughout the nineteenth century, due to religious and increasingly “racial” reasons, as many as twelve states declared null and void any marriages between whites and Indians. 26 American ethnologists proposed the theory of “polygenesis,” arguing that the black and white races were, by their very nature, separate and unequal with distinct physical and mental characteristics. Throughout the Civil War, Democrats and abolitionist Republicans in Congress traded regular accusations “as to whether slaveholders’ lust or the process of turning slaves into citizens was more to blame for fostering ‘amalgamation.’” Building on this theory, in 1863 opponents of the Republican abolitionists coined the term “miscegenation,” the mixing of species, contending that a biological integration of races would produce inferior, if not sterile, offspring. Following the Civil War, as the possibility of white women’s accessibility to black men became an escalating reality, states hurried to pass, solidify, or refine legislation criminalizing interracial marriage. 27 The next stage in this narrative began in 1907 when the Indiana state legislature passed a eugenics-inspired sterilization law. Thirty-two other states eventually followed suit. These laws provided for compulsory sterilization of a range of such “unfit” individuals as “habitual criminals, confirmed rapists, epileptics, the insane, drug addicts, idiots and the feeble-minded.” 28 At the federal level, the Department of Public Welfare carried out a program of eugenic sterilization during the Great Depression. 29 26 Cott, Public Vows, 28. 27 While many states went on to repeal these laws after World War II, the Supreme Court did not find such prohibitions unconstitutional until it overturned Virginia’s anti-miscegenation law in Loving v. Virginia, 388 U.S. 1 (1967). Ibid., 98–99. 28 Rao, From Population Control to Reproductive Health, 97; Alexandra Minna Stern, Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America (Berkeley: University of California Press, 2005), 2. 29 Johanna Schoen, Choice & Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare (Chapel Hill: University of North Carolina Press, 2005), 12. 17 The Supreme Court’s holding in Buck v. Bell in 1927 effectively sanctioned eugenic sterilization laws throughout the country. Carrie Buck, a “feeble-minded” woman committed to the Virginia State Colony for Epileptics and Feedbleminded, was the daughter of a “feeble- minded” mother and was herself the mother of an “illegitimate feeble-minded child.” The Court concluded that Buck was “the probable potential parent of socially inadequate offspring, likewise afflicted, that she may be sexually sterilized without detriment to her general health, and that her welfare and that of society will be promoted by her sterilization.” Writing for the majority, Associate Justice Oliver Wendell Holmes explained that the state’s interest in a genetically pure population outweighed an individual’s interest in bodily integrity. “It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind,” Holmes reasoned. “Three generations of imbeciles are enough.” 30 Laws prohibiting the marriage of “undesireables,” restricting immigration, and promoting voluntary and compulsory sterilization all aimed to prevent the reproduction of the “unfit,” an umbrella term that could incorporate everything from alcoholism and pauperism to sexual perversion, syphilis, and mental retardation. 31 These statutes were also tools to impose heteronormative models of the family, sexuality, and procreation. While they followed the legacy of earlier fornication bans and anti-miscegenation laws, there was one important difference. Whereas the earlier anti-fornication laws tried to discourage certain behaviors, these new eugenic policies marked the first time that the U.S. government directly and physically intervened in the reproductive lives of its inhabitants. Segregating the mentally retarded from the 30 Buck v. Bell, 274 U.S. 200, 205, 207 (1927). 31 Rachel Iredale, “Eugenics and its Relevance to Contemporary Health Care,” Nursing Ethics 7 (May 2000): 207–08. 18 rest of the population or even forcing vasectomies and tubal ligations on unwilling patients represented a new, more extreme form of state intrusion. Eugenic Imperialism The first half of the twentieth century was replete with foreign policies shaped, at least in part, by eugenics. According to Mohan Rao, a scholar and physician who specializes in public health, the eugenics message of racial purity, though not always explicitly invoked, offered “an efficient way of ensuring that [a nation’s] population was kept fresh, energetic, efficient, and productive by ensuring that its fresh flow of population was mainly recruited from ‘the better stock.’” 32 Hannah Arendt offered another interpretation of the connection between imperialism and race. “Imperialism would have necessitated the invention of racism as the only possible ‘explanation’ and excuse for its deeds even if no race-thinking had ever existed.” 33 Eugenics fueled the imperialistic adventures of several countries. The German suppression of the native Herero revolt in southwest Africa from 1904 until 1907, for example, resulted in the almost complete annihilation of the native population. Several German officers described the events as a “race war.” 34 During and after World War I, the Ottoman Empire targeted Armenians, Greeks, and Syrians for destruction. Enver Pasha and Mehmed Talaat, the leaders of the Ottoman Empire, claimed publicly that they were only trying to suppress subversion. Their German allies knew otherwise. Reporting to Berlin in 1915, German ambassador Baron Hans Freiherr von Wangenheim wrote that “military considerations” were not 32 Rao, From Population Control to Reproductive Health, 93. 33 Quoted in Isabel V. Hull, Absolute Destruction: military culture and the practices of war in Imperial Germany (Ithaca, NY: Cornell University Press, 2006), 330. 34 Ibid., 59, 64. 19 the only motivation for the deportation of Armenians. Instead, he said, the Ottomans were attempting to “exterminate the Armenian race in the Turkish Empire.” 35 Beginning in the 1920s, the United States implemented directed sterilization programs in Puerto Rico and parts of Latin America. 36 When reflecting on these efforts, one U.S.-appointed governor noted that Puerto Rico’s problem was not only overpopulation but that it was a population of poor quality. Many Puerto Ricans condemned the sterilization programs, arguing that it was both a form of eugenics and a weapon of colonialism. 37 Nazi Germany carried out the most notorious eugenics crusade. Alongside a military campaign to expand Germany’s borders, the Nazis instituted what became known as the Final Solution: the systematic, deliberate slaughtering of anyone thought to defile the Aryan race. From the time Adolf Hitler came to power and began persecuting and exiling Germany’s Jews in 1933 through the end of World War II in 1945, the Nazis exterminated more than 11 million Jews, Roma, homosexuals, mentally and physically handicapped individuals, political dissidents, and others deemed genetically inferior. The events of World War II, the Nazi atrocities in particular, prompted an international reevaluation of the ways countries viewed and managed populations. However, even though social policy would no longer explicitly revolve around eugenics, the movement’s racist and classist ghosts continued to haunt population policy around the world. For example, while the American public began rejecting eugenics, many states’ sterilization laws remained on the books. Moreover, according to historian Linda Gordon, a renewed concern with overpopulation in the 35 Quoted in David Fromkin, A Peace to End All Peace: the fall of the Ottoman Empire and the creation of the modern Middle East (New York: Macmillan, 2009), 213. 36 Linda Gordon, Woman’s Body, Woman’s Right: Birth Control in America (New York: Penguin Books, 1990), 481–82. 37 Linda Gordon, The Moral Property of Women: A History of Birth Control Politics in America (Champagne, IL: University of Illinois Press, 2007), 343. 20 1950s motivated several industrialized nations to once again repeat “on an international scale the motifs of the eugenics sensibility, the distinction between the moderate, restrained ‘us’ and the teeming, profligate ‘them.’” 38 In the United States, a reconceptualization of foreign relations and the advent of modern foreign aid programs provided the vehicle to disseminate such attitudes. The Conception of U.S. Foreign Aid The Second World War literally and figuratively redrew the global map. The United States occupied Japan. Significant chunks of Europe lay in shambles. Refugees around the world sought new homes. Formerly allies, the United States and the Soviet Union threatened humankind with nuclear destruction. The United States sought to control such chaos through military assistance and economic aid. In March 1947 President Harry Truman announced a new approach to foreign relations when he told a joint session of Congress: “[I]t must be the policy of the United States to support free peoples who are resisting attempted subjugation by armed minorities or by outside pressures.” He added, “I believe that our help should be primarily through economic and financial aid which is essential to economic stability and orderly political processes.” 39 The Truman Doctrine, which was “facilitated by the allocation and distribution of military and economic aid to weak nations susceptible to Soviet aggression,” was the first of several U.S. containment efforts. 40 38 Gordon, Woman’s Body, Woman’s Right, 387. 39 Harry S. Truman, “Special Message to the Congress on Greece and Turkey: The Truman Doctrine,” March 12, 1947, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/?pid=12846. 40 Rhonda L. Callaway and Elizabeth G. Matthews, Strategic US Foreign Assistance: The Battle Between Human Rights and National Security (Burlington, VT: Ashgate Publishing Company, 2008), 38. 21 The European Recovery Program, also known as the Marshall Plan, likewise focused on providing economic assistance to weakened European countries both to aid in their recovery and to prevent “communist victories in these nations.” Director of Central Intelligence Allan Dulles was candid about the purposes of the effort. It was “not a philanthropic enterprise . . . . It is based on our views of the requirements of American security . . . . It is the only peaceful avenue now open to us which may answer the communist challenge to our way of life and our national security.” 41 At his second inauguration in January 1949, Truman again addressed foreign assistance when he outlined four key aspects of his foreign policy: U.S. support for the new United Nations; the reconstruction of Europe through the Marshall Plan; the creation of a joint defense organization (NATO) to meet the emergent Soviet threat; and the allocation of technical assistance to Latin America and other poor countries. While this last objective, “Point Four,” was originally added as a public relations gimmick, it laid the foundations for U.S. foreign assistance programs that continue today. 42 Appealing to the United States and the world to solve the problems of the globe’s “underdeveloped areas,” Truman introduced the modern distinction between developed and developing nations. Helping such countries, Truman explained, was an American responsibility. We must embark on a bold new program for making the benefits of our scientific advances and industrial progress available for the improvement and growth of underdeveloped areas . . . . The old imperialism—exploitation for foreign profit— has no place in our plans. What we envisage is a program of development based on the concepts of democratic fair-dealing . . . . Only by helping the least fortunate of its members to help themselves can the human family achieve the decent, satisfying life that is the right of all people. Democracy alone can supply the vitalizing force to stir the peoples of the world into triumphant action, not only 41 Quoted in ibid., 38–39. 42 Gilbert Rist, The History of Development: From Western Origins to Global Faith, 3rd ed. (London: Zed Books, 2008), 70–71. 22 against the human oppressor, but also against their ancient enemies—hunger, misery, and despair. 43 As Gilbert Rist, a scholar of development studies, points out, the word “underdeveloped” essentially operated as a synonym for “economically backward.” 44 Truman’s categorization of nations embodied the modernization of poverty: the poor became the assisted, an international problem in need of intervention. 45 The “development age” had begun. 46 Uncertain Foreign Aid Policy Under Eisenhower National security began gradually replacing post-war relief and reconstruction as the dominant concern shaping U.S. foreign assistance efforts, especially following the onset of the Korean War in 1952. Indicative of this dynamic, the U.S. government increasingly separated military and development assistance. Military and political aid had been one-sixth of U.S. foreign assistance from 1949 to 1953 but comprised half of the program between 1953 and 1961. Political scientists Rhonda L. Callaway and Elizabeth G. Matthews argue that such change was “unquestionably a response to a serious security issue: when North Korea invaded the South and drew the US into a war, a natural desire to prevent that from happening again occurred. As a consequence, strengthening the defensive capabilities of US allies seemed prudent.” 47 43 Harry S. Truman, “Inaugural Address,” Washington, D.C., January 20, 1949, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=13282&st=bold+new+program&st1=#axzz1 GFFqYTuM. 44 Rist, The History of Development, 72. 45 As of 1945, this globalization of poverty identified two-thirds of the world population as poor. Arturo Escobar, Encountering Development: The Making and Unmaking of the Third World (Princeton, NJ: Princeton University Press, 1995), 22–23. 46 Rist, The History of Development, 70–71. 47 Callaway and Matthews, Strategic US Foreign Assistance, 40. 23 After Eisenhower took office in 1953, U.S. foreign policy continued to reflect a “military and anti-Communist” orientation. With Eisenhower in the Oval Office and slight Republican majorities in both houses of Congress, a “growing conservatism” informed the country’s approach to foreign assistance. This conservative ideology supported a foreign policy of “containing communism with a ring of military alliances, nuclear deterrence, and the strengthening of foreign forces in strategic areas . . . . [A]ny economic development of less developed countries was thought to be best handled by the private sector.” 48 Foreign aid was thus justified as “a relatively inexpensive way to reinforce [U.S.] security.” 49 In 1954, Eisenhower asked Congress for $2.1 billion less in foreign assistance than Truman had previously requested. John Foster Dulles, Eisenhower’s Secretary of State, said the budget decrease was the most that could be “reconciled with the essential security of the U.S.” Harold Stassen, who oversaw Eisenhower’s foreign aid programs, explained, “We are seeking more defense, more rapidly, with less dollars, lasting longer.” 50 The administration’s approach was in line with public perceptions of foreign assistance at the time. A Gallup Poll from August 1959 indicated that 39 percent of Americans thought the amount of money the United States devoted to foreign aid should be decreased, while 36 percent wanted it maintained at existing levels and only six percent wanted to see it increased. Twenty percent of those polled did not have an opinion. 51 48 James A. Hagen and Vernon W. Ruth, “Development Policy Under Eisenhower and Kennedy,” The Journal of Development Areas 23 (October 1988): 4. 49 Jeanne Kuebler, “Foreign Aid Overhaul,” Editorial Research Reports 2 (December 1962): 917. 50 Quoted in Hagen and Ruth, “Development Policy Under Eisenhower and Kennedy,” 4. 51 Hopes And Fears: Happiness Survey, August 1959, retrieved February 16, 2014 from the iPOLL Databank, The Roper Center for Public Opinion Research, University of Connecticut, http://www.ropercenter.uconn.edu/data_access/ipoll/ipoll.html (hereafter “iPOLL”). 24 The Soviet Union’s economic assistance initiatives, however, forced Dulles, Stassen, and the rest of the Eisenhower administration to change their tune. Most notably, after Soviet Premier Nikolai A. Bulganin and head of the Communist Party Nikita Khrushchev toured Asia in 1955, the Soviet Union offered India technical assistance for the construction of a steel mill, among other projects. Khrushchev challenged his American critics: “perhaps you wish to compete with us in establishing friendship with the Indians? Let us compete.” 52 In the era of the Red Scare and the House Un-American Activities Committee, Dulles and his colleagues knew they had to take some sort of action. As economists James A. Hagen and Vernon W. Ruth have noted, with Soviet economic aid “increasing sharply in the name of economic development programs . . . U.S. policy makers took the Soviet challenge to heart but were very uncertain of where to take it.” 53 The multiplicity of approaches to aid administration throughout the 1950s reflects that indecisiveness. In October 1951, two years before Eisenhower took office, Congress passed the first Mutual Security Act and created the Mutual Security Administration, an umbrella organization for military and economic aid. 54 In 1953, the Foreign Operations Administration (FOA) was created as an independent government agency to combine economic and technical assistance programs on a worldwide basis. The FOA merged into the International Cooperation Administration (ICA) in the Department of State the following year. The Mutual Security Act of 1954 next “introduced the concepts of development assistance, security assistance, a discretionary contingency fund, and guarantees for private investments.” The Food for Peace 52 Quoted in Hagen and Ruth, “Development Policy Under Eisenhower and Kennedy,” 5. 53 Ibid. 54 United States Agency for International Development, “A History of Foreign Assistance,” Other USAID Supported Study/Document (April 3, 2002), USAID Development Clearinghouse, 2, accessed March 25, 2014, http://pdf.usaid.gov/pdf_docs/PNACP064.pdf. 25 program went into effect later that year. The Development Loan Fund, created following the Mutual Security Act of 1957, served as the ICA’s lending arm, extending loans “of a kind that the Export-Import Bank and other donors were not interested in or prepared to underwrite— those repayable in local currencies.” 55 In his 1956 State of the Union address, Eisenhower “asked Congress for limited authority to make longer term commitments on aid projects” to assure their continuity. Stassen had made a similar proposal a year-and-a-half earlier only to be denied by the State Department. Lacking confidence in the State Department, a bipartisan coalition in Congress successfully opposed the long-term funding proposal. 56 Kennedy Overhauls Foreign Aid Upon taking office in 1961, President John F. Kennedy sought to streamline U.S. foreign aid and make it more effective. Speaking to a joint session of Congress that March, Kennedy described the existing aid program as “[b]ureaucratically fragmented, awkward and slow, its administration is diffused over a haphazard and irrational structure covering at least four departments and several other agencies.” Existing programs only provided short-term relief and left recipient countries economically unstable and vulnerable. Emphasizing the consequences of inaction, he noted how successful the Soviets had been in using foreign aid “to make developing nations dependent on Russian support—thus advancing the aims of world communism.” The United States needed to follow suit. 57 Kennedy advocated more than long-term commitments, however. The future of free market capitalism and democratic governments, he argued, depended on a new approach to 55 Ibid. 56 Hagen and Ruth, “Development Policy Under Eisenhower and Kennedy,” 6. 57 John F. Kennedy, “Special Message to the Congress on Foreign Aid,” March 22, 1961, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=8545. 26 foreign aid, one that “would shift emphasis from mutual security to a coordinated free world effort to help the underdeveloped nations attain self-sustaining growth and economic stability.” “[T]he fundamental task of our foreign aid program,” he explained, “is not negatively to fight Communism: Its fundamental task is to help make a historical demonstration that in the twentieth century . . . economic growth and political democracy can develop hand in hand.” 58 Historian Michael Latham has argued that although many doubted that the Soviets would risk a direct military confrontation in the 1950s, “they were certain that the Kremlin was determined to chip away at the ‘underdeveloped periphery,’ destroy America’s international credibility, and steadily undermine the system of political and economic alliances the United States had attempted to construct.” 59 Indeed, only two months before Kennedy’s message to Congress, Soviet premier Nikita Khrushchev gave a speech in which he threatened just that. Pledging support for the “sacred struggles of colonial peoples,” Khrushchev said the Soviets would “defend wars of national liberation.” 60 Debating Aid Most of the debate over what shape the new foreign aid program would take concerned the duration of any U.S. commitment. While Kennedy wanted five years of Treasury borrowing authority, such an approach would have “enable[d] future expenditures without Congressional appropriation.” Though a “lesser objection,” many in Congress speculated that the guarantee of continued aid “would reduce the recipients’ incentives to help themselves.” As a compromise, 58 Kuebler, “Foreign Aid Overhaul,” 916. 59 Michael E. Latham, Modernization as Ideology: American Social Science and “Nation Building” in the Kennedy Era (Chapel Hill: University of North Carolina Press, 2000), 2; Kennedy, “Special Message to the Congress on Foreign Aid.” 60 Latham, Modernization as Ideology, 3. 27 the final Foreign Assistance Act authorized five years of funding with annual congressional appropriations. 61 The terms of U.S. aid were also a site of controversy. Secretary of State Dean Rusk maintained that recipients “would not be pressed into indicating alliances or special commitments to the U.S.” However, he said, their aid would “be conditional on the adequacy of their performance in the process of development.” When asked by Senator Homer Capehart (R- IN) if the United States would “have no concern whether a country that we help goes communistic,” Rusk responded, “[W]e affirm the world of choice . . . and I know of no country which has on its own volition, by the vote of its people, deliberately accepted a communist regime.” 62 Speaking to a joint session of Congress in July 1961, Ayub Khan, Pakistan’s president, put a face on the issue when he made a personal appeal for Congress to pass the then-pending Foreign Assistance Act. “[U]nless Pakistan is able to meet the economic needs of its people, in another 15-20 years we shall be overtaken by communism . . . . If we go under communism, then we shall still press against you, but not as friends.” 63 While not everyone agreed on how to go about providing aid, there was basic agreement on the need for such assistance. Moreover, “[r]egardless of whether the aid program would be successful or not, there seemed to be a consensus that the economic development of less- developed countries would help forestall the expansion of communism.” 64 As Senator Hubert Humphrey (D-MN) explained, “As far as I am concerned I am probably going to support the 61 Hagen and Ruth, “Development Policy Under Eisenhower and Kennedy,” 9–10. 62 Quoted in ibid., 10. 63 Ibid., 9. 64 Ibid., 10. 28 foreign aid program. However, I do it just like I go to see the dentist; I am just not happy about it.” 65 Though not all agreed on the terms of the new foreign aid program, Congress did agree on its necessity and on August 4, 1961, passed the Foreign Assistance Act of 1961 (FAA). 66 The FAA reorganized U.S. foreign aid programs, separating military from non-military assistance and mandated the creation of a new agency to oversee the latter. On November 3, two months after signing the FAA into law, Kennedy issued Executive Order 10973, establishing the United States Agency for International Development (USAID or the “Agency”) in the State Department. 67 Unencumbered by “political and military functions that plagued its predecessor organizations,” USAID integrated pre-existing U.S. assistance efforts, “combining the economic and technical assistance operations of the International Cooperation Agency, the loan activities of the Development Loan Fund, the local currency functions of the Export-Import Bank, and the agricultural surplus distribution activities of the Food for Peace program of the Department of Agriculture.” The Agency, however, was more than just a “bureaucratic reshuffling.” It was the first U.S. foreign aid organization focused primarily on long-range economic and social development. 68 65 Quoted in ibid., 11. 66 The bill passed in the Senate with a vote of 69 to 24, and in the House 260 to 132. Ibid.,10. 67 John F. Kennedy, “Executive Order 10973,” November 3, 1961, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/?pid=58911. 68 United States Agency for International Development, “A History of Foreign Assistance,” 1. 29 Domestic Reception The FAA met resistance from several major industries. The National Foreign Trade Council, for example, strongly opposed the use of funds for the “direct promotion of industrial development of underdeveloped nations” on grounds that it could stunt domestic development. 69 A.G. Heinshohn, a manager of two cotton mills with over 1,000 employees, likewise “blamed foreign aid for substantial loss of business in the textile industry to foreign competition.” Robert T. Stevens, president of J.P. Stevens and Company, one of the country’s oldest textile companies, believed that the textile industry was carrying “too much of the load of our foreign policy.” 70 Similarly fearing competition, the mining industry successfully lobbied against an aid provision that would have authorized the president “to encourage production of strategic materials in friendly nations.” 71 Several congressmen echoed the “concern that the aid program was setting up competition against American business.” Representative Gordon Canfied (R-NJ), for example, wanted to prohibit the use of U.S. aid to establish textile-processing plants abroad. Representative Robert Griffin (R-MI) likewise moved to prevent funds from going to the establishment “of any kind of plant which might compete with U.S. industries.” Both efforts failed, though the Congressional Record does not indicate as to why. 72 Not all sectors opposed U.S. foreign assistance programs. Emilio G. Collado, Director of Standard Oil Company of New Jersey, dismissed concerns over the effect aid would have on U.S.-based companies. “I do not think there is any evidence that, in the aggregate, U.S. investment abroad has affected adversely the level of investment and employment in the United 69 Hagen and Ruth, “Development Policy Under Eisenhower and Kennedy,” 25–26. 70 Quoted in ibid., 28. 71 Ibid., 25. 72 Ibid., 25–26. 30 States,” he said. To the contrary, Collado claimed, “U.S. foreign investment helps protect our share of the world market and creates substantial employment opportunities in the U.S. by helping to maintain and increase foreign demand for US goods.” 73 Some industries had already been profiting from U.S. foreign assistance programs. G. Peter Grace, president of chemical conglomerate W.R. Grace and Company, testified before Congress in 1957, “recommend[ing] loans, investments and technical assistance to Latin America, an area in which his company had interests.” The shipping industry had also long benefited from aid. Per the Mutual Security Act of 1953, at least 50 percent of aid commodities had to be shipped on U.S. flag vessels. 74 Organized labor had consistently supported foreign aid efforts. Andrew J. Biemiller, the legislative director of AFL-CIO and a former congressman (D-WI), testified to Congress in 1961 on the benefits of assistance programs to domestic labor. Labor supported passage of the FAA in part because of the threat of communism and, as Biemiller said, because “it is right.” Still, Biemiller acknowledged ulterior motives. “Labor has a tremendous interest in the foreign market. If we were to cut off foreign trade, then you would really have an unemployment problem in the United States.” 75 Viewing foreign aid as a source of employment for their members, unions also saw international assistance as building new markets more quickly than it was promoting foreign 73 Aid policy was often tailored to facilitate such demand. In 1959, Eisenhower applied a “Buy American” policy to projects underwritten by the Development Loan Fund, and later extended it to U.S. military and other economic assistance. Kennedy continued the policy. In 1962, 78 percent of procurement was carried out domestically. Ibid., 27; Kuebler, “Foreign Aid Overhaul,” 925. 74 Hagen and Ruth, “Development Policy Under Eisenhower and Kennedy,” 13. 75 The International Development and Security Act of 1961: Hearings on H.R. 7372, July 6, 1961, Before the House Committee on Foreign Affairs, 87th Cong. 1410 (1961) (Statement of Hon. Andrew J. Biemiller, Director, Department of Legislation, AFL-CIO). 31 competition. Unions also had a “direct stake in the aid program.” Such programs as the American Institute of Free Labor Development helped domestic labor secure “appropriations to facilitate noncommunist trade union organization in developing countries.” 76 Many religious and volunteer organizations supported foreign assistance for humanitarian reasons. Presbyterian leader Clifford Earle tried to reconcile the altruistic and political purposes of foreign aid. “We recognize . . . that a government and the Congress have to act in terms of national interest,” he told the House Committee on Foreign Affairs in June 1961. “[W]e would remind ourselves and the American people in whatever way we can that American interest is served when we help others to help themselves in the way [U.S. foreign aid] is designed to do.” 77 Barbara Stuhler, Director of the League of Women Voters, likewise acknowledged the multiple objectives of foreign aid. When asked if the League “was supporting the program on its merits without regard to communism,” Stuhler responded, “I wouldn’t want the league to appear that unrealistic . . . . [Y]ou can argue for the program on its own merits, but we live in a bipolar world where the struggle is between communism and democracy.” The impact of the foreign aid program, she said, could not be evaluated fully “without considering this background of the struggle between the U.S. and the U.S.S.R.” 78 Public opinion data shows that the majority of Americans supported at least the idea of foreign aid. According to a Gallup Poll conducted two months after Congress passed the FAA, 52 percent of Americans believed that the U.S. foreign aid program had actually advanced the interests of the United States during the previous five years. Twenty-seven percent of respondents did not believe the assistance efforts had helped while 21 percent reported no 76 Hagen and Ruth, “Development Policy Under Eisenhower and Kennedy,” 13. 77 Quoted in ibid., 16. 78 Quoted in ibid., 30. 32 opinion. 79 A year-and-a-half later, 59 percent of Americans were “for” foreign aid compared to 30 percent who were “against it” and 11 percent who held no opinion. 80 Polling data consistently indicated that those favoring foreign aid did so because of humanitarian concerns, rather than the security benefits or political advantages. Those opposing aid programs typically reasoned that the money could be better spent domestically. 81 Mixed Motivations Born out of the Cold War, USAID served the dual purposes of providing humanitarian assistance and stymieing the spread of communism. The Agency offered one way to modernize developing nations and to make them more receptive to the liberal social values of capitalism and democracy. 82 Despite the political uses of such assistance, Kennedy’s administration and USAID both chose to highlight the altruistic purposes of foreign aid. An early USAID brochure, for instance, announced: To those people in the huts and villages of half the globe struggling to break the bonds of mass misery, we pledge our best efforts to help them help themselves, for whatever period is required—not because the Communists may be doing it, not because we seek their votes, but because it is right. If a free society cannot help the many who are poor, it cannot save the few who are rich. 83 79 Gallup Poll (AIPO), November 1961, retrieved February 16, 2014, iPOLL. 80 Gallup Poll (AIPO), January 1963, retrieved February 16, 2014, iPOLL. 81 “Chapter IV: Public Attitudes Toward Foreign Aid,” in The Agency for International Development During the Administration of President Lyndon B. Johnson November 1963– January 1969, Administrative History, Administrative Histories (Washington, D.C.: Agency for International Development, September 30, 1968), 83, Papers of Lyndon Baines Johnson President, 1963–1969, Administrative History Agency for International Development Volume I, box 1, folder “Administrative History of the Agency for International Development Volume I, Part I, Introduction and Chapter I thru IV,” LBJ. 82 For more on the role of the modernization ideology, see Latham, Modernization as Ideology. 83 The Story of A.I.D. (Washington, D.C.: Agency of International Development, United States Department of State, n.d.), 29, Edwin R. Bayley (#20) Personal Papers, Series 1 Subject Files, box 1, folder “Agency for International Development 1961–1962 (2 of 3),” John F. Kennedy Presidential Library, Boston, MA (hereafter “JFK”). 33 Still, critics at home and abroad repeatedly questioned American motives. The United States surely had economic and ideological objectives. Third World social and economic turmoil jeopardized what many saw as the American financial exploitation of the “underdeveloped” countries. That same chaos threatened U.S. political and military supremacy. 84 Kennedy himself acknowledged Congress that international unrest, especially in nations seeking independence and economic progress through nationalist or socialist reorganization, threatened the health of international capitalism and needed to be avoided. 85 The competing goals driving foreign assistance are explicitly enumerated in the FAA itself: “To promote the foreign policy, security, and general welfare of the United States by assisting peoples of the world in their efforts toward economic development and internal and external security, and for other purposes.” 86 While they sometimes complemented each other, these objectives often competed for primacy. This was especially evident in the history of USAID’s population programs. The Population Bomb The rising Cold War tensions combined with the state of the world economy at the end of World War II prompted strategic planners to address a range of military, economic, and political questions, many of which touched upon population growth. As such, many of the same motivations behind the creation of USAID compelled the federal government to commit to population control efforts. Cold War politics were in fact central to “bringing [the] population growth issue into the realm of public policy and diplomacy.” “The success of communism 84 Gordon, Woman’s Body, Woman’s Right, 392–93. 85 Kennedy, “Special Message to the Congress on Foreign Aid.” 86 Foreign Assistance Act of 1961, Pub. L. 87-195, 75 Stat. 424 (1961). 34 seemed inevitable,” the theory went, if underdeveloped nations “continued to be plagued by poverty, disease, and starvation.” 87 Private foundations and nongovernmental organizations first led the charge for population control. Religious organizations also encouraged federal engagement. In late 1961, for example, the National Council of Churches, the main voice of Protestantism, called on the U.S. government to help other countries requesting family planning assistance. 88 The Ford Foundation took a research-based approach to population control. The Foundation’s first grants in the field went to the Population Council and the Population Reference Bureau for demographic research and training. In 1963, the Foundation created a separate population program focused on “medical, biological, social, and public-health research and training in the United States and Europe.” By the 1960s, the Foundation’s Overseas Development program helped fund government-run family planning programs in developing countries. 89 The Population Reference Bureau, the Pathfinder Fund, and the Milbank Memorial Fund likewise advocated—and funded—demography projects and medical and scientific research in fertility. A small group of primarily wealthy, well-connected white men and women also used their money and political sway to lobby the cause of population control into the realm of public 87 Sharpless, “World Population Growth, Family Planning, and American Foreign Policy,” 84. 88 “National Council of Churches Backs Family Planning,” Planned Parenthood News, No. 29 (Winter 1961), Alan Frank Guttmacher Papers (H MS c155), box 5, folder 65, Harvard Medical Library in the Francis A. Countway Library of Medicine, Harvard University, Cambridge, MA. 89 Leona Baumgartner to Walt W. Rostow, “Outline of current U.S. private and governmental technical assistance in the population field available to requesting countries,” April 16, 1965, 2, Administrative History, Agency for International Development Volume II, Part I, box 2, folder “Part I Documentary Supplement [2 of 4],” LBJ. 35 policy. 90 John Rockefeller III, for instance, had “decided to make birth control his cause” in the 1930s, after his travels in Asia and Africa “convinced him of the need for population control.” 91 When the Rockefeller Foundation declined to create a program in the area, Rockefeller established his own organization in 1952, the Population Council (the “Council”), “to support medical research in reproduction and to train demographers and population experts.” 92 However, the organization’s “unofficial purpose was to promote a consensus among academic, governmental, and cultural elites that population problems were not only pressing but were reaching crisis proportions.” 93 The Council “reshaped the field of demography into a social science and a policy science” through its grant, fellowship, and research programs. Throughout the 1960s, the Council played an increasingly large role in technical assistance programs designed to implement population control both domestically and in developing countries. Although a “relatively small organization,” the Council was “the leading world source of technical assistance, governmental or non-governmental” in the population field and served as a “clearinghouse for information about population and family planning.” 94 Rockefeller and his science-focused colleagues distanced themselves from the “extreme and hysterical proponents of population control,” including Hugh Moore, the wealthy founder of the Dixie Cup Company. Moore had self-published a pamphlet called The Population Bomb in 1954, which circulated to around 1.5 million people. Under the heading of “War, Communism 90 Donald Critchlow, “Birth Control, Population Control, and Family Planning,” Critchlow, Politics of Abortion and Birth Control in Historical Perspective, 9–10; Marshall Green, “The Evolution of US International Population Policy, 1965–92: A Chronological Account,” Population and Development Review 19 (June 1993), 305. 91 Critchlow, “Birth Control, Population Control, and Family Planning,” 8. 92 Rockefeller also founded the Council on Economic and Cultural Affairs, an organization dedicated to promoting farm management in developing nations. Ibid. 93 Sharpless, “World Population Growth, Family Planning, and American Foreign Policy, 80. 94 Baumgartner to Rostow, “Outline of current U.S. private and governmental technical assistance in the population field available to requesting countries,” 1–2. 36 and World Population,” Moore wrote, “Hundreds of millions of people in the world are hungry. In their desperation they are increasingly susceptible to Communist propaganda and may be enticed into violent action.” 95 Moore and his allies invoked arguments similar to those Kennedy later employed when urging Congress to reconfigure U.S. foreign aid efforts in 1961. They appealed to national security interests by insisting that over-crowding, poverty, and poor health made developing nations especially vulnerable to communist influences. Democracy, they contended, could not thrive in overcrowded, underdeveloped countries. 96 Rockefeller considered Moore’s pamphlet “sensationalist” and Moore an alarmist. The two men and their respective organizations approached the population problem from different perspectives. Rockefeller wanted to “place population control on a scientific and humanitarian basis.” Moore, however, emphasized the communist threat. In a letter to Rockefeller, Moore explained, “we are not primarily interested in the sociological or humanitarian aspects of birth control. We are interested in the use which the Communists make of hungry people in their drive to conquer the earth.” 97 Ultimately, Cold War political and security concerns convinced several presidential administrations and Congresses of the need for population programs in developing nations, but the programs themselves revolved around scientific research and new contraceptive technologies. 95 Quoted in Michelle Goldberg, The Means of Reproduction: Sex, Power, and the Future of the World (New York: Penguin Books, 2010), 44; Matthew Connelly, Fatal Misconception: The Struggle to Control World Population. (Cambridge, MA: Belknap Press, 2008), 162. 96 Sharpless, “World Population Growth, Family Planning, and American Foreign Policy,” 84; Rickie Solinger, Pregnancy and Power: A Short History of Reproductive Politics in America (New York: NYU Press, 2007), 164. 97 Critchlow, “Birth Control, Population Control, and Family Planning,” 9. 37 The Birth of U.S. Family Planning Efforts Advocates of population control had their first major breakthrough in 1958 when Eisenhower appointed a presidential committee to study and report to him on foreign aid programs. Upon hearing news of the committee, Moore contacted the committee’s chair, General William H. Draper, Jr., telling him, “If your committee does not look into the impact and implications of the population explosion, you will be derelict in your duty.” 98 Draper and his colleagues apparently listened. On August 17, 1959, the committee issued its third of four reports, The Composite Report of the President’s Committee to Study the U.S. Military Assistance Program, also known as the Draper Report. Among other suggestions, the committee concluded that the U.S. government should assist countries requesting help with the population problem, increase its support of population related programs, and fund appropriate research to meet the challenge of population growth. 99 The Draper Report marked the first time a federal body officially identified population growth as a national security threat. Birth control had become an issue of national defense. 100 Without commenting on the population suggestions, Eisenhower passed the report on to the Senate Foreign Relations Committee for review. However, after news of the Draper Report broke, the Catholic Church worked to prevent its recommendations from becoming policy. Even though the report never used the words family planning, birth control, or abortion, the National Conference of Catholic Bishops issued a statement opposing any public assistance for birth 98 Quoted in Goldberg, The Means of Reproduction, 48. 99 People in Crisis; Foreign Aid and Population Control: What Should be the Policy of the United States? (Washington, D.C.: Population Crisis Committee, n.d.), 13, Papers of Elizabeth Smith Gatov, Planned Parenthood, box 16, folder “Planned Parenthood, Population Education 1966–1968,” JFK. 100 Connelly, Fatal Misconceptions, 186. 38 control, abortion, or sterilization. 101 Meanwhile, the Senate committee reported that it largely agreed with the Draper Report’s findings and even recommended that the United States assist with contraceptive development for Third World nations. 102 Ultimately, though, the political pressure exerted by the Church proved the more influential force. Fearing public backlash, Eisenhower came out against population programs, issuing his infamous declaration against federal funding for contraceptives. 103 It should be noted that at the time, contraception was simply not a subject of public conversation. The word “pregnant” had not even been mentioned on television. In fact, the decision to include Lucille Ball’s real-life pregnancy into a storyline for I Love Lucy was considered a big risk in 1952. In such a climate, it is unsurprising that Eisenhower was so skittish about the topic of birth control. 104 The Draper Report, the Catholic bishops’ response, and Eisenhower’s reaction prompted a surge in publicity on population growth. Newspapers and magazines clamored to cover the problem. In 1960, “The Population Explosion,” an hour-long CBS TV documentary on India, drew 9 million viewers during its first airing and another 9.5 million for its second. In a series of columns for The New York Times, Arthur Krock received national notoriety for advocating a different interpretation of the problem. Invoking arguments previously levied by eugenics advocates in the early twentieth century, Krock warned that the danger of population growth lie not in the susceptibility of developing nations to communism, but in the potential influx of immigrants. If population growth remained unchecked, Krock warned, there would be “forcible 101 People in Crisis, 13. 102 Ruth Dixon-Mueller, Population Policy & Women’s Rights: Transforming Reproductive Choice (Westport, CT: Praeger, 1993), 61. 103 Critchlow, “Birth Control, Population Control, and Family Planning,” 10. 104 Thomas Doherty, Cold War, Cool Medium: Television, McCarthyism, and American Culture (New York: Columbia University Press, 2003), 51. 39 invasions of national borders by hordes of human beings who cannot subsist within their own.” 105 Baby Steps to Overturning the Status Quo As a senator and presidential candidate, Kennedy, like Eisenhower, publicly doubted the appropriateness of foreign assistance for birth control, abortion, and sterilization. “I think it would be a mistake for the U.S. Government to attempt to advocate the limitation of the population of underdeveloped countries,” Kennedy said in 1960, reflecting upon concerns of cultural imperialism. “For the United States to intervene on this basis would involve a kind of mean patriotism, which I think they would find most objectionable . . . . I think it would be the greatest psychological mistake for us to appear to advocate the limitation of the black or brown or yellow peoples whose population is increasing no faster than in the United States.” 106 By focusing on potential foreign criticism, Kennedy sidestepped any Catholic resistance at home. 107 Kennedy also doubted that any such population programs would ever come to fruition. Telling reporters that he would make decisions free from his personal religious views, he insisted, “The prospects of any President ever receiving for his signature a bill providing foreign aid funds for birth control are very remote indeed. It is hardly the major issue some have suggested.” 108 105 Quoted in Connelly, Fatal Misconceptions, 187. 106 “John F. Kennedy: Background Memorandum Prepared by Democratic National Committee,” September 8, 1960, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=25702&st=birth+control&st1=. 107 Connelly, Fatal Misconception, 187. 108 John F. Kennedy, “The Religion Issue in American Politics,” Remarks of Senator John F. Kennedy at American Society of Newspaper Editors, Washington, D.C., April 21, 1960, accessed March 25, 2014, http://www.jfklibrary.org/Research/Research-Aids/JFK- Speeches/American-Society-of-Newspaper-Editors_19600421.aspx. 40 Members of his administration, however, pushed for government action. George McGhee, who had served on the Draper Commission and whose wife volunteered for Planned Parenthood, led the State Department’s Policy Planning Council and made several recommendations for ways to engage the issue. Secretary of State Dean Rusk, who himself had been “long concerned about population control,” approved several of McGhee’s suggestions. For example, USAID could now give information “on the various aspects of human reproduction,” or advice about establishing family planning programs to countries requesting it. Additionally, Robert Barnett, a State Department official, was assigned to the population issue full-time. 109 The initial public indication of federal involvement came in December 1962 when Assistant Secretary of State Richard Gardner delivered the first broad statement on U.S. population policy to the U.N. 110 Refraining from any personal declarations on the subject for fear of alienating the Catholic Church, Kennedy likely used Gardner as a test balloon. In his speech, Gardner welcomed further attention to the population problem, an issue of “transcendent importance.” 111 According to the policy statement, “the U.S. wanted to know more, and help others know more about population trends . . . [and] would help other countries, upon request, to find potential sources of information and assistance on ways and means of dealing with their population problems . . . .” 112 U.S. missions and embassies around the world received a copy of the policy statement. 113 109 Connelly, Fatal Misconception, 198. 110 Critchlow, “Birth Control, Population Control, and Family Planning,” 10–11. 111 Richard N. Gardner, “Population Growth: A World Problem,” Statement of U.S. Policy, December 10, 1962, 1, Emily Hartshorne Mudd Papers, 1873–1990, 73-143--90-M103, box 11, folder 519, Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA. 112 Dean Rusk to AIDTO Circ. A 280, “Population Programs,” February 25, 1965, 2, Administrative History, Agency for International Development Volume II, Part I, box 2, folder “Part I Documentary Supplement [2 of 4],” LBJ. 113 Connelly, Fatal Misconception, 199. 41 Not everyone in the administration agreed with the approach, however. George Ball, an undersecretary for economic affairs, described population control as “a field which is pre- eminently suited to private activity.” Kennedy seemed to agree with Ball’s analysis, in part because he did not want his administration to take on the Catholic Church. Responding to a briefing on population growth and poverty in South America, Kennedy asked, “Why doesn’t the Ford Foundation . . . concentrate all of its resources on the population problem around the world?” 114 The line between public and private activity, however, had become increasingly blurred. Historian Matthew Connelly detailed the extent of such overlap: Barnett owed his State Department job to the Ford Foundation and Planned Parenthood staff that had helped McGhee draft his recommendations. Gardner’s UN statement was based on a form letter Barnett wrote to people provoked by Hugh Moore’s full-page newspaper advertisements. Barnett circulated the statement to AID missions and embassies all over the world to encourage requests for U.S. help. Foundations and family planning associations then set about drumming up such requests to prove the demand for more such assistance. 115 In early 1963, the National Academy of Sciences (NAS) and Harvard Professor John Rock issued recommendations that the United States participate in international birth control studies. 116 While the National Institutes of Health already provided assistance for research on fertility and reproduction, the NAS and Rock insisted on the need for a more active approach to addressing population growth. That April, a reporter asked Kennedy how he felt “about the recommendations . . . that the Federal Government should participate actively in an attack on uncontrolled population growth.” Barnett and Planned Parenthood staff had planted the 114 Quoted in ibid., 198–99. 115 Ibid., 199. 116 Rock was the leading scientist responsible for the development of the first hormonal birth control pill. 42 question. 117 In his answer, Kennedy echoed the sentiments expressed in Gardner’s speech to the U.N. “[I]f your question is: Can we do more, should we know more about the whole reproduction cycle, and should this information be made more available to the world so that everyone can make their own judgment, I would think that it would be a matter which we could certainly support.” 118 Though a subtle indication of approval, it was a turning point for how the American presidency viewed and treated contraception. From then on, USAID “encouraged the collection and analysis of population growth data [and of] attitudes about family planning,” but referred requests for information and financial and technical assistance to private agencies and foundations. 119 A turning point came in 1963 when, urged by Draper and frustrated by USAID’s persistent refusal to treat population growth as a developmental problem, Senator J. William Fulbright (D-AK) included an amendment to the FAA that explicitly authorized USAID to research population growth and to provide technical assistance. The bill passed with the amendment attached. 120 Though the Act permitted the Agency to provide family planning information to couples requesting it, Congress explicitly barred USAID from using funds for the purchase and distribution of contraceptives. That same year, Secretary of State Rusk sent a memorandum to USAID missions announcing that the “United States would assist family planning programs.” 121 By the end of 1963, USAID actively helped developing countries generate official demographic statistics and 117 Connelly, Fatal Misconception, 199. 118 John F. Kennedy, “The President’s News Conference,” Washington, D.C., April 24, 1963, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=9165&st=National&st1=Academy. 119 Rusk to AIDTO Circ. A 280, “Population Programs,” 5. 120 Connelly, Fatal Misconception, 199; Robert A. Pastor, Congress and the Politics of U.S. Economic Policy, 1929–1976 (Berkeley: University of California Press, 1982), 273; Dixon- Mueller, Population Policy & Women’s Rights, 61. 121 Critchlow, “Birth Control, Population Control, and Family Planning,” 10–11. 43 began informally discussing the establishment of international family planning programs. Agency officials claimed that population was now its first priority. 122 Global Action Of course, this was not a uniquely American issue or concern. Family planning organizations in Europe and North America had been holding international meetings since the 1880s. However, the 1960s became the key decade of international consensus building. The first World Population Conference in Rome in 1954 and the second in Belgrade in 1965 marked the convergence of modern foreign aid programs with the international emphasis on population growth. 123 At the 1965 International Conference on Family Planning Programs in Geneva, thirty- five countries congregated to discuss approaches to population growth. That same year, eighty participants from a variety of countries met in Cali, Colombia at the First Pan-American Assembly on Population. Calling for responsible parenthood, the Assembly encouraged couples to make sure they could provide the possibilities for education and care that their kids deserved. 124 The following year, twelve heads of state signed the Declaration on Population by World Leaders. One of the earliest international documents on family planning, the Declaration defined family planning as a means of “assuring greater opportunity to each person” and of 122 Connelly, Fatal Misconception,199; Part I, Chapters V thru VIII, Agency for International Development During the Administration of President Lyndon B. Johnson November 1963– January 1969, Administrative History, (Washington, D.C.: Agency for International Development, September 30, 1968), 124, Papers of Lyndon Baines Johnson President, 1963– 1969, Administrative History Agency for International Development Volume I, box 1, folder “Administrative History of the Agency for International Development Volume I,” LBJ. 123 ICPD Secretariat, “Background Document on the Population Programme of the UN,” United Nations, March 24, 1994, accessed March 25, 2014, http://www.un.org/popin/icpd/conference/bkg/unpop.html. 124 Dixon-Mueller, Population Policy & Women’s Rights, 58; Seltzer, The Origins and Evolution of Family Planning Programs in Developing Countries, 9–10n1. 44 “free[ing] man to attain his individual dignity and reach his full potential.” 125 In 1961, only two developing countries had programs to reduce birth rates. By 1967, there were twenty-six. 126 As of December 1969, over 70 percent of the world’s population lived in countries offering official support for birth control. 127 The U.N. also began tackling the population problem. When the General Assembly first sanctioned U.N. involvement in population programs in December 1966, every relevant U.N. agency echoed the endorsement. 128 Once the Secretary General set up the U.N. Trust Fund for Population Activities (UNFPA) to administer the organization’s population programs in 1967, other U.N. agencies quickly requested roughly $25 million so that they, too, could build their population programs. 129 All of these developments occurred despite strong resistance from the Catholic and communist member nations. Johnson Gets on Board Notwithstanding these early gestures and global trends, the United States maintained a non-interventionist position throughout Kennedy’s presidency and the early years of President Lyndon B. Johnson’s administration. While USAID would help other governments and NGOs run population and family planning programs, the Agency would not administer its own. Despite the increasing social, legal, and cultural acceptance of contraception, Johnson considered 125 Quoted in Dixon-Mueller, Population Policy & Women’s Rights, 12. 126 Green, “The Evolution of US International Population Policy, 1965–92,” 307. 127 The Carolina Population Center, “Cracking the World Population Problem: A U.S. Goal for the ‘70s,” Working Paper, University of North Carolina at Chapel Hill, December 1969, 6, White House Central Files, Subject Files: Task Forces; box 6, folder “EX FG 221-30 International Development 1/1/71-[12/31/72],” Richard Nixon Presidential Library, Yorba Linda, CA. 128 Ibid.; Sharpless, “World Population Growth, Family Planning, and American Foreign Policy,” 87. 129 In 1987, the General Assembly renamed the Fund the United Nations Population Fund. The Carolina Population Center, “Cracking the World Population Problem,” 17. 45 population control to be “like a tar baby,” and avoided speaking on the issue for the first two years of his administration. According to one close aide, expanding population programs was “not a matter that the President want[ed] to visibly touch at th[e] time.” 130 Fearful of a negative public reaction to the still socially taboo subject of contraception, Johnson pursued a strategy that downplayed attention to any federal involvement in the population problem. A meeting of key White House officials to discuss the subject in 1965 was even known as the “Never-Never Committee.” 131 Despite believing in the dangers of population growth, administration officials at the meeting “expressed deep anxiety about the volatility of the issue.” Any population-related developments, they agreed, “should be carefully thought out to avoid misunderstanding by civil rights, religious and other groups.” 132 This hesitancy frustrated population activists. Mary Calderone, president of Planned Parenthood Federation of America (PPFA), for example, accused the federal government, though sympathetic to family planning, of “pussyfoot[ing] around, afraid to offend any group.” 133 Like Kennedy before him, Johnson relied on private organizations including the Population Council and PPFA to plead the case of population control to the American public but was careful to keep them at arms’ length. 134 Rockefeller tried to arrange a personal meeting with the president, to encourage him to sign the World Leaders’ Declaration on Population. 135 Johnson initially rebuffed his efforts, telling his staff, “I want to encourage Rockefeller, but that 130 Jack Valenti, quoted in ibid., 210. 131 Ibid. 132 Ibid. 133 Quoted in Donald T. Critchlow, Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America (New York: Oxford University Press, 1999), 46. 134 Department of State to Circular (See Posts listed on pages 6 & 7), “AID Population Programs,” Airgram, March 8, 1965, 4, Papers of Lyndon Baines Johnson President, 1963–1969, Confidential File Oversize Attachments 6/18/68 #2, box 190, folder “C.F. Oversize Attachments: 6/18/68 [from 3-ring binder #1: Cater AID/Population],” LBJ. 135 Critchlow, Intended Consequences, 54. 46 doesn’t mean that Rockefeller encourages me. There’s a difference.” Only after Rockefeller secured support of other world leaders did Johnson sign the Declaration. 136 Johnson finally publicly committed to population programs in his State of the Union in 1965. He announced that the United States would “seek new ways to use our knowledge to help deal with the explosion in world population and the growing scarcity in world resources.” 137 The one sentence, a result of pressure from population control activists and personal outreach from Rockefeller, reflected both the increasing concern with overpopulation as well as Johnson’s own hesitancy to become involved. Johnson more directly confronted the issue and the need for related aid in an address to the U.N. later that year. “Let us in all our lands—including this land—face forthrightly the multiplying problems of our multiplying populations and seek the answers to the most profound challenge to the future of the world,” he said. “Let us act on the fact that less than $5 invested in population control is worth $100 invested in economic growth.” 138 Not only was stemming the effects of population growth morally responsible, it was economically prudent; it was a political, economic, and a moral issue all at once. His State of the Union and U.N. address collectively marked a new era in U.S. foreign assistance. 139 136 Quoted in Critchlow, “Birth Control, Population Control, and Family Planning,” 11. 137 Lyndon B. Johnson, “Annual Message to the Congress on the State of the Union,” Washington, D.C., January 4, 1965, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=26907&st=state+of+the+union&st1=. 138 Lyndon B. Johnson, “Address in San Francisco at the 20th Anniversary Commemorative Session of the United Nations,” Speech presented at the 20th Anniversary Commemorative Session of the United Nations, San Francisco, CA, June 25, 1965, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=27054&st=United&st1=Nations. 139 It is unclear what accounted for Johnson’s shift away from using Cold War security justifications for population programs. John W. Finney, “Birth Control Now a Major Part of U.S. Aid,” The New York Times, December 26, 1965. 47 (Sort of) Going All the Way The United States soon began the transition from simply collecting and analyzing demographic data and training and supporting other organizations to a more aggressive approach in which USAID implemented actual programs on a bilateral and multilateral basis. 140 While a new USAID policy directive authorized Agency missions to provide direct assistance themselves, missions were not allowed to advocate a specific program or dictate population policies of other countries. Every family was to have “complete freedom of choice in accordance with its conscience.” At least on the surface, population programs would not be prerequisites for receiving other forms of U.S. aid . 141 Any population assistance that USAID provided “would, in any case, merely be additive to the host country’s own efforts and assistance from other sources.” USAID would consider requests for technical assistance on a case-by-case basis and would continue to refer requests to private agencies where appropriate. 142 Rather than promoting population control itself, the United States simply aided those countries already engaged in the endeavor. USAID missions around the world received “general reference materials and technical publications” on a range of population-related topics, including family planning. The missions were also encouraged to assign one of their officers to familiarize themselves “with the problems of population dynamics and program developments in the country and to keep the Mission Director, Country Team personnel, and [USAID in Washington] appropriately advised.” The 140 Volume I, The Agency for International Development During the Administration of President Lyndon B. Johnson November 1963–January 1969 (Washington, D.C.: Agency for International Development, September 30, 1968), 120, Papers of Lyndon Baines Johnson President, 1963– 1969, Administrative History Agency for International Development Volume I, box 1, folder “Part I, Chapters V–VIII,” LBJ. 141 Ibid., 125. 142 Rusk to AIDTO Circ. A 280, “Population Programs,” 6. 48 new Population Reference and Research Bureau became the Agency’s “focal point for information and coordination in the population field.” 143 Johnson allowed USAID to include a population line in its budget for the first time in 1965. 144 According to one Agency official, “after that, once the dam had been breached, an enthusiastic Congress pumped money into the program quite quickly.” 145 Seven years after President Eisenhower had announced that the United States would not have international birth control programs, Congress authorized USAID to do just that when it passed the Foreign Assistance Act of 1966 and the Agricultural Trade Development and Assistance Act of 1966, also known as PL-480 or Food for Peace. Both bills provided that any money generated from PL-480 sales of agricultural commodities could be used for family planning programs in requesting countries. 146 There was, however, a stick accompanying the carrot. The Food for Peace Act required that a country’s family planning efforts be considered before granting food aid, even while Johnson himself kept insisting publicly that population programs be voluntarily initiated. 143 Ibid. 144 Steven W. Sinding, Interview by W. Haven North, The Foreign Affairs Oral History Collection of the Association for Diplomatic Studies and Training, February 27, 2001, accessed March 27, 2014, http://www.loc.gov/item/mfdipbib001070/. 145 Ibid. 146 The Agricultural Trade Development and Assistance Act of 1954 originally established the Food for Peace program. Pursuant to Title I of the Act, “developing countries receive credit to purchase American agricultural commodities on concessional terms. The recipient government sells the food on its domestic market, accruing local currency as a source of revenue.” Richard Ball and Christopher Johnson, “Political, Economic, and Humanitarian Motivations for PL 480 Food Aid: Evidence from Africa,” Economic Development and Cultural Change 44 (April 1996): 516; Guidelines for Population Program Assistance, Manual Order (Agency for International Development, April 25, 1967), 3–4, Papers of Lyndon Baines Johnson President, 1963–1969, Confidential File Oversize Attachments 6/18/68 #2, box 190, folder “C.F. Oversize Attachments: 6/18/68 [from 3-ring binder #2: Cater AID/Population],” LBJ. 49 Thereafter, Johnson insisted on personally signing off on every food shipment to India, a policy that came to be known as “the short leash.” 147 So Why the Change? By the end of 1966, USAID operated population programs in more than twenty countries. 148 Foreign aid for family planning was underway. Several factors likely combined to push Johnson towards action. In December 1965, the White House Conference on International Cooperation gave the final push needed to compel more expansive government action. The Conference suggested that the United States provide up to $100 million each year over the next three years to facilitate family planning programs abroad. Political insiders indicated that Johnson had been waiting for such a “grassroots” proposal as a “springboard” for larger government commitment. 149 Congress also shifted gears. Beginning in 1965 and lasting on and off until February 1968, Senator Ernest Gruening (D-AK), chairman of the Government Operations Subcommittee and himself a physician, used a series of hearings on the population crisis to compel the White House into allotting more funds for foreign family planning and to generate public attention on the problems of population growth. During the hearings, several government witnesses were attacked for being too “skittish” or too ignorant about the population problem. 150 The hearings “provided a Washington forum of fairly high visibility for leading population advocates to make 147 Connelly, Fatal Misconception, 213, 225. 148 Technical Cooperation and Research, Health Service, Population Branch of Agency for International Development, January 1967, 5, Confidential File, Oversize Attachments, 6/18/68 #2, box 190, folder “C.F. Oversize Attachments: 6/18/68 [from 3-ring binder #1: Cater AID/Population],” LBJ. 149 Finney, “Birth Control Now a Major Part of U.S. Aid.” 150 Green, “The Evolution of US International Population Policy, 1965–92,” 305–06. 50 the point that this was a pressing global problem.” 151 In its July 1966 report on the year’s foreign assistance bill, the Senate Foreign Relations Committee criticized USAID for being too conservative on the population problem. Republican leaders even drafted a statement calling for bipartisan support for population and family planning efforts. Eisenhower, who had famously declared that the government should not get involved in birth control, even showed his approval for population programs. 152 According to Robert Komer, a senior National Security Council staffer, the “hard dollar and cents argument for taking a more serious view of birth control in the [less developed countries]” ultimately won over Johnson. 153 Economists within the State Department and domestic interest groups appealed to Johnson’s “political instincts” with economic arguments in favor of linking food aid policies to population control. 154 Self-described as “one of the nasty economists,” Deputy Assistant Secretary of Defense Stephen Enke insisted that preventing births could increase the gross national product of developing countries. 155 Komer thought Enke’s research might provide “a little flank attack that . . . might just penetrate LBJ’s defenses.” 156 He wrote to Johnson about a “fascinating statistic.” “A recent study,” Komer said, “claims that if economic resources in many [less developed countries] were devoted to retarding population growth rather than accelerating production growth, these resources could be 100 times more effective in raising output per capita!” 157 Johnson appears to have taken Komer—and Enke’s—arguments to heart. 151 Sinding Interview. 152 Green, “Evolution of US Population Policy,” 5, 6; Critchlow, Intended Consequences, 74. 153 Quoted in Connelly, Fatal Misconception, 210. 154 Ibid; Kristin L. Ahlberg, Transplanting the Great Society: Lyndon Johnson and Food for Peace (Columbia, Missouri: University of Missouri Press, 2008), 84–85. 155 Connelly, Fatal Misconception, 207. 156 Quoted in ibid., 210. 157 Quoted in ibid., 212–13. 51 When he began backing domestic and international family planning, Johnson presented such programs as part of a global war on poverty. He explained that his vision of a great society “did no stop at our boundary.” 158 Introduced by representatives George Bush (R-TX) and Herman Schneebeli (R-PA), the 1967 Social Security Amendments authorized federal support for domestic family planning programs. The bill mandated that part of maternal and child health funds in the Social Security budget be allocated to family planning. 159 One journalist noted that domestic population programs reflected “a belief by officials that the United States could not afford to tell other countries what they should do on a national level while little was being done on a Federal level in this country.” 160 Governmental and nongovernmental organizations alike concluded that, “they had to shore up the home front, if only to continue making advances abroad.” 161 It is significant, however, that what limited federal programming did take place targeted racial and ethnic minorities. 162 Still, the amount of funding Congress allocated for international family planning programs far exceeded that for domestic programs. In 1968, for instance, USAID planned to spend $20 million on family planning but Congress was “impatient to see faster progress” and “force[d] the pace.” Congress authorized $35 million and gave the Agency an ultimatum: “either spend the full amount or have the unspent part cut from its budget and lost.” USAID had spent just $4.2 million on such programs the previous year. 163 158 Quoted in ibid., 247. 159 Ibid., 251. 160 William M. Blair, “Udall Offers Help On Family Planning,” The New York Times, June 20, 1965. 161 Connelly, Fatal Misconceptions, 252. 162 Connelly argues that family planning programs at home and abroad “often meant helping Planned Parenthood provide services in poor neighborhoods.” Ibid., 247. 163 Luther J. Carter, “Population Control: U.S. Aid Program Leaps Forward,” Science 159 (February 8, 1968): 611–12. 52 And Yet… And yet, there was still hesitation. As late as 1967, Johnson’s administration resisted calls for a White House conference on population for fear that it might “polarize pubic opinion, particularly at any time prior to the Pope’s final decision on birth control.” 164 Johnson maintained close contact with bishops on the Catholic Welfare Council for the duration of his administration. The president also refused to meet with Senator Gruening, who had introduced legislation to establish Offices of Population Problems in the Department of Health, Education, and Welfare and in the State Department. The administration feared that the legislation might “actually set us back in the administrative efforts at family planning.” 165 The fear of public outcry appears to have been pure speculation. In fact, the majority of Americans supported the notion of the U.S. government “helping other nations who ask our aid in their birth control programs.” 166 In 1965, 77 percent of adults in the United States favored the distribution of birth control information. Only 15 percent opposed it and 9 percent were unsure. 167 As the Wall Street Journal astutely observed in 1964, although government officials’ “fear of frankness probably is not entirely unfounded in popular feelings against providing birth- control information, the abundance of discussion in newspapers and magazines suggests that public attitudes may be changing. It will be easier to tell for sure when political leaders start talking about the subject” directly. 168 164 In his 1968 encyclical, Humanae Vitae, Pope Paul VI reaffirmed the Catholic Church’s opposition to all forms of birth control. 165 Quoted in Crtichlow, “Birth Control, Population Control, and Family Planning,” 11. 166 According to a Gallup Poll conducted in August 1967, 71 percent of Americans were in favor of the proposition, 22 percent opposed it, and 7 percent had no opinion. Gallup Poll (AIPO), August 1967, retrieved February 21, 2014, iPOLL. 167 America’s Mood In The Mid-sixties, February 1965, retrieved February 21, 2014, iPOLL. 168 “An Old Woman Who Lives in a Shoe,” Wall Street Journal, December 22, 1964. 53 It appears the concern with how Catholics would respond was also somewhat misplaced. Reverend John A. O’Brien of Notre Dame, for instance, issued a “call for an end to the war on birth control” in November 1963. While he did not “claim to speak on behalf of his faith,” Father O’Brien noted “the acceptance by other major faiths of birth control techniques that are not approved of by Roman Catholics means that new multilateral solutions must be sought.” He even advocated the White House holding a conference “to explore methods to control the rapid increase in births.” 169 O’Brien was not alone. Parish priests around the country were “beginning to speak openly of ‘pastoral dilemma’ in their obligation to teach that artificial birth control is always a grave sin.” 170 Cardinal Richard Cushing, the Archbishop of Boston, expressed a similar sentiment in speaking about laws prohibiting the use of contraceptives. “In the present case, especially in the light of the position taken by other religious groups in our plural society,” he said, “it does not seem reasonable to me to forbid in civil law a practice that can be considered a matter of private morality.” 171 As early as 1950, almost half of Catholic wives approved of fertility control. Moreover, two-thirds of those women said they had used or would use contraception. 172 In 1964, 52 percent 169 “A Catholic on Birth Control,” The New York Times, November 9, 1963. 170 Dorothy Dunbar Bromley, “Catholic Church and Birth Control,” Los Angeles Times, February 12, 1965. 171 Quoted in Morris K. Udall, “Text of Remarks by Congressman Morris K. Udall, Arizona, delivered at Planned Parenthood-World Population Symposium – ‘Population and Poverty in the United States,’ 9:30 a.m. Friday, May 7, Coach Hose Motor Inn, Milwaukee, Wisconsin,” Remarks presented at the Planned Parenthood-World Population Symposium – Population and Poverty in the United States, Milwaukee, WI, May 7, 1965, 4, Planned Parenthood Federation of America Files, Accession #88S-35, box 27, folder “PPFA National – BD. of Directors Out-of- Town Meetings Milwaukee, Wis. May 1965, Press Releases,” Sophia Smith Collection, Women’s History Archives at Smith College, Northampton, MA (hereafter “Smith”). 172 Frederick S. Jaffe, “Knowledge, Perception, and Change: Notes on a Fragment of Social History,” 291, reprinted from The Mount Sinai Journal of Medicine 42 (July–August 1975), Planned Parenthood Federation of America Files, Accession #88S-35, box 25, folder “PPWP 54 of all Catholics thought the Church should allow the use of “artificial birth control devices,” compared to 15 percent who did not want the Church to change its position and 33 percent who were unsure. 173 Saying No to Contraceptives While Johnson and USAID officials felt comfortable committing the Agency to population programs, contraceptives were still out of the question. Other countries could use USAID funds for contraceptives but the Agency itself could still not distribute prophylactics. Contraceptives had been on the prohibited list for commodity assistance since 1948. Worried about the very salacious nature of contraceptives, Congress deliberately and explicitly prohibited USAID funds from going to such supplies when it first authorized research on population control and technical assistance. 174 U.S. News & World Report articulated the anxieties likely behind those decisions: “What is ‘the pill’ doing to the moral patterns of the nation? . . . . Is the pill regarded as a license for promiscuity? Can its availability to all women of childbearing age lead to sexual anarchy?” 175 A month after Johnson’s 1965 State of the Union, Secretary of State Rusk wrote to USAID personnel to update them on recent developments in the population field. While the Agency would entertain requests for commodity assistance, it would not “consider requests for contraceptive devices or equipment for manufacture of contraceptives.” Rusk explained the policy as a financial decision: “Experience has made it clear that the cost of these latter items is The Fifties & Sixties History; Knowledge, Perception & Change: Notes on a Fragment Social History. Jaffe,” Smith. 173 Harris Survey, February 1964, retrieved February 21, 2014, iPOLL. 174 Dixon-Mueller, Population Policy & Women’s Rights, 61. 175 Quoted in May, American and the Pill, 80–81. 55 not a stumbling block in countries that are developing effective programs.” Moreover, he added, USAID could provide other materials, “such as vehicles and education equipment for use in maternal and child health and family planning programs.” 176 A.H. Moseman, USAID’s assistant director, attributed the policy to “a sensitive concern for avoidance of possible crippling criticism and opposition, both domestically and in the less developed countries.” 177 As one senator noted, “it would be improper for the U.S. Government to go to the governments of aided countries and explain to them that, in the opinion of AID, their birth rates were too high to make effective the economic aid they were receiving.” 178 Such prohibitions might have been necessary to give hesitant politicians the political cover needed to allow them to commit to early population programs. Indeed, many suspected politics as informing the decision on contraceptives. As a New York Times editorial aptly noted in 1965, “This plan to provide propaganda on ways without supplying the means is an obvious attempt to appease foreign and domestic critics of birth control. The critics are unlikely to be silenced by this show of timidity.” The government “is not meeting the [population] problem by limiting its assistance to mere advice.” 179 In 1967, USAID Administrator David Bell and a Department of State circular both reinforced the ban on funding contraceptives. 180 Already concerned with provoking the ire of 176 Rusk to AIDTO Circ. A 280, “Population Programs,” 6–7. 177 A.H. Moseman, “Action Memorandum for the Administrator,” Memorandum, September 23, 1966, 1, Administrative History, Agency for International Development Volume II, Part 1, box 2, folder “Part 1 Documentary Supplement [2 of 4],” LBJ. 178 A Bill to Reorganize the Department of State and the Department of Health, Education, and Welfare, Hearings on S. 1676, Before the Subcommittee on Foreign Aid Expenditures of the Senate Committee on Government Operations, 89th Cong. 79 (1965) (Statement of Senator Joseph S. Clark). 179 “Timidity on Birth Control,” The New York Times, March 7, 1965. 180 John Maffre, “AID to Offer Birth Curbs for First Time,” The Washington Post, April 6, 1967. 56 Catholic leaders, Johnson did not intervene. 181 Under attack over U.S. involvement in Vietnam, he could not afford to draw more negative publicity. 182 Population experts within USAID disagreed with the policy, arguing that family planning programs would fail without contraceptives. 183 Moseman, USAID’s assistant director, observed in September 1966 that the ban on contraceptives made the Agency vulnerable to criticism that it “wish[ed] to give the impression of providing assistance for family planning ‘without getting our hands dirty:’ . . . [and of] providing less than maximal assistance to countries . . . while claiming to be dedicated to assisting them maximally with the solution of their critical population problems.” 184 Even at their height, USAID’s population programs were severely limited by American politics of sexual morality. USAID Administrator William Gaud did not see what all the fuss was about when it came to birth control. “I am not convinced that it really matters,” he told Moseman in October 1967. Just six months later, however, Gaud had changed his mind and even made a personal appeal to Johnson to lift the aid restriction. Soon thereafter, the Agency prepared to send $1.3 million worth of contraceptives to India, including enough birth control pills for 100,000 women. 185 It turned out that contraceptives did matter and the Agency would spend the next two decades trying to get them into as many hands as possible. 181 May has noted that concerns about alienating the Catholic Church, “added to the aura of illegality and immorality that still surrounded contraception” and “kept investment in population control efforts at low levels.” May, America and the Pill, 43. 182 Reimert Thorolf Ravenholt, World Population Crisis and Resolution: Taking Contraceptives to the World’s Poor - Creation of USAID’s Population Program, 1965–1980, 6, accessed February 22, 2014, www.ravenholt.com. 183 Ravenholt, World Population Crisis and Resolution, 4. 184 Moseman, “Action Memorandum for the Administrator,” 3. 185 Carter, “Population Control,” 614. 57 Chapter 2 Sex, Drugs, Population Control: USAID’s Dissemination of Contraceptives A Nepali cigarette manufacturer might seem an unlikely alliance for USAID’s population programs. However, in Nepal, a country where the main mode of transportation in the 1970s was by foot, USAID project managers found themselves relying on such retailers and other local companies to get the products, Dhaal and Gulaf, to poor, rural consumers. The Janakpur Cigarette Factory (JCF), for example, had provided advice and development support during the early stages of the U.S.-funded venture. JCF’s trucks would deliver cigarettes to Kathmandu and would return, at no charge, to Janakpur with batches of Dhaal and Gulaf for local dealers to sell. 186 During one meeting with the cigarette monopoly in 1978, an American project manager passed Dhaal around the room for the Nepali staffers to examine. He wanted them to see what it was they would be transporting around the country. One young salesman called out to the manager: “I don’t see how you are going to get a woman to swallow one of these.” The item, Dhaal, was just a brand name for what the manager went on to explain were also called condoms. 187 The project manager worked for the Nepali arm of USAID’s Contraceptive Retail Sales (CRS) project, which used nonclinical, commercial outlets to distribute contraceptives into 186 S.J. Thapa to Badri Raj Pande, “Commercial contraceptive marketing program in Nepal the Nepal Contraceptive Retail Sales (CRS) Project,” Attachment to letter, June 20, 1979, 2, Lot 85- 45, Accession 286-85-056, box 1, folder “Nepal Contract Correspondence 1979,” National Archives, College Park, MD (hereafter “NACP”). 187 “Contraceptive Retail Sales,” 1979, 4–5, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Contract Correspondence 1980[3],” NACP. 58 “virtually all areas of a developing nation.” 188 Each CRS program tailored marketing campaigns based on how much local populations knew and understood about contraceptives. The brand name “Dhaal,” or shield, was itself chosen through a national contest. 189 The project manager’s interaction with the JCF employee appeared in a 1978 independent assessment of USAID’s CRS program in Nepal. In conveying the story, the manager attributed the young staffer’s ignorance to the “puritanical conservatism among the Nepalese populace.” 190 His report, and the program it addresses, exemplifies the attitudes and problems imbedded in both USAID’s efforts to distribute contraceptives in developing nations and in U.S. international population programs as a whole. --- In 1967, just two years after the Supreme Court overturned a state law forbidding the use of contraceptives by married couples, the United States announced it would be giving $1.3 million in contraceptives to India. 191 In an effort to slow population growth, USAID’s Office of Population began bombarding developing nations with “enormous quantities of pills and condoms, training a cadre of young field officers—young men and young women—who would work as teams going village by village to introduce contraception.” 192 The Agency sought to 188 L.W. Gregory and Gerald P. Gold, “Cost Reimbursement Type Contract,” Westinghouse Electric Corp. to Agency for International Development, June 30, 1976, 1–2, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Contract,” NACP. 189 Thapa to Pande, “Commercial contraceptive marketing program in Nepal the Nepal Contraceptive Retail Sales (CRS) Project,” 2. 190 “Contraceptive Retail Sales,” 4. 191 381 U.S. 479 (1965); Luther J. Carter, “Population Control: U.S. Aid Program Leaps Forward,” Science 159 (February 8, 1968): 614. 192 Steven W. Sinding, Interview by W. Haven North, The Foreign Affairs Oral History Collection of the Association for Diplomatic Studies and Training, February 27, 2001, accessed March 27, 2014, http://www.loc.gov/item/mfdipbib001070/. 59 make contraceptives “as easily accessible as tea, flour, salt, soap or aspirin.” 193 The CRS program was just such an effort. Despite emphasizing its benevolent intentions, the U.S. government readily used foreign assistance, including that for family planning, as a tool to advance political objectives, including stymying the spread of communism. Less acknowledged, though, is the role these aid programs played in channeling U.S. political conflict and worldviews abroad. The process by which the domestic embrace of contraception eventually translated into foreign aid is just one example of this dynamic. What began as a tentative acceptance of the legality of birth control evolved into a U.S. program of “contraceptive inundation” in developing countries. 194 The various programs and policies for distributing contraceptives thus reflect more than the population theories of the era. They also offer insight into the way Americans viewed sex, fertility control, power, and their relationship with developing nations. Several objectives drove U.S. distribution efforts: the reduction of population growth and unwanted high fertility as a means of improving living standards; the improvement of women’s lives by helping them avoid unwanted pregnancies and abortion; and the advancement of couples’ and women’s rights to plan their families. 195 Meanwhile, the Johnson administration quietly saw additional rationales for throwing its support behind these programs. Unchecked population growth in developing nations made countries politically and economically less stable, 193 Parmilla Senanayake, “Applying Family Planning in Rural Communities,” Proceedings of the Royal Society London, Series B 199 (October 1977): 118. 194 Ibid. 195 Judith R. Seltzer, The Origins and Evolution of Family Planning Programs in Developing Countries (Santa Monica, CA: Rand, 2002), xii. 60 and accordingly, more vulnerable to communism. Moreover, decreased fertility rates, several economists believed, would have the inverse effect of increased economic productivity. 196 USAID’s contraceptives programs were based on three key assumptions. First, population control advocates and government officials believed that while population growth slows economic development, lower fertility rates produce higher living standards and improve human welfare. Second, the Agency’s population officials, and by extension the U.S. government, presupposed that the men and women in developing nations actually wanted smaller families and fertility regulation. Finally, with the modernization and popularization of contraceptives, USAID’s Office of Population assumed that the mere availability of prophylactics would satisfy couples’ desire for reproductive control and would accordingly lower fertility rates. 197 USAID faced challenges of external implementation at the local level. The local recipient governments, however, were no less fraught with opposition and problems related to family planning than the U.S. government had been. Additionally, USAID programs often came into conflict or competed with host nation population programs. The process was further complicated by such factors as high rates of illiteracy, cultural opposition towards family planning, and a social premium placed on large families. 196 See Philander P. Claxton, Jr. to The Secretary, “Statement of Policy on Population Matters ACTION MEMORANDUM,” November 2, 1966, Confidential File, Oversize Attachments, 6/18/68 #2, box 190, folder “[from 3-ring binder #1: Cater AID/Population],” Lyndon Baines Johnson Presidential Library, Austin, TX (hereafter “LBJ”); Matthew Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge, MA: The Belknap Press, 2008), 212–13. 197 Seltzer, The Origins and Evolution of Family Planning Programs in Developing Countries, xiv; see also Marshall Green, Interview by Charles Stuart Kennedy, March 3, 1989, The Foreign Affairs Oral History Collection of the Association for Diplomatic Studies and Training, accessed March 27, 2014, http://lcweb2.loc.gov/service/mss/mfdip/2004/2004gre06/2004gre06.pdf. 61 Despite the best—and some not so benevolent—intentions of USAID officials, Congress, and several presidential administrations, the history of the CRS program, in operation from 1976 until 1983, reveals a whole series of problems around family planning that go far beyond just birth control. While previous scholarship has addressed the broader arc of U.S. family planning programs abroad, the CRS project provides a new lens through which to examine the way those programs ultimately played out on the ground. Domestic Attitudes Towards Contraceptives Americans have long practiced contraception. Colonists for instance, tried regulating their fertility using early forms of condoms as well as herbal remedies, douches, withdrawal, and the rhythm method. 198 By the nineteenth century, Victorian morality and the ambitions of U.S. Postal Inspector and politician Anthony Comstock compelled every state in the union to pass laws prohibiting the sale of prophylactic devices. Despite the ban, contraceptives remained attainable for the wealthy and by way of underground networks. While the subject of contraception remained socially taboo throughout most of these developments, several trends helped legitimize discussion about and use of birth control following World War II. In the 1940s and 1950s, family planning allowed for better parenting since the spacing of births allowed parents to be mentally, financially, and emotionally prepared for such responsibility. Many families saw birth control as providing greater chances for social mobility. The notion of “family planning” also offered a technical solution to larger social problems. The nuclear family became a key defense against social, political, and diplomatic 198 See Janet Farrell Brodie, Contraception and Abortion in Nineteenth-Century America (Ithaca, NY: Cornell University Press, 1997). 62 chaos. Concern over rapid population growth, poverty, welfare costs, urban overcrowding, and out-of-wedlock births further drove efforts to find more efficient means of birth control. 199 The federal government first endeavored into funding contraceptives in an unofficial, indirect way in 1935. When welfare agencies in several southern states began using federal money for birth control programs, federal officials did not intervene. In 1942, the Children’s Bureau very quietly and without any publicity began distributing family planning funds through its Maternal and Child Health program. Local health departments had to know to ask for the money. 200 By 1965, two federal agencies began taking more public action. First, as part of its anti- poverty program, the Office of Economic Opportunity started issuing family planning grants. The inaugural grant went to Corpus Christi, Texas to assist in a community birth control program. 201 Then, following Johnson’s 1965 State of the Union directive to seek new ways to tackle population growth, the Department of the Interior became the first federal organization to directly provide birth control information, services, and devices. 202 The Department directed three of its agencies to distribute the supplies to American Indians on reservations, natives of the Pacific Trust Territory, and Indians, Eskimos, and Aleuts in Alaska. Each under the Interior’s 199 Donald T. Critchlow, Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America. (New York: Oxford University Press, 1999), 4, 16; Elaine Tyler May, Homeward Bound: American Families in the Cold War Era, rev. ed. (New York: Basic Books, 2008). 200 George Dugan, “Catholic Bishops Say U.S. Coerces Poor Over Births,” The New York Times, November 15, 1966. 201 Evert Clark, “Catholics Reaffirm Birth-Control Bans In Reply to Johnson,” The New York Times, January 9, 1965. 202 Lyndon B. Johnson, “Annual Message to the Congress on the State of the Union,” January 4, 1965, Online by Gerhard Peters and John T. Woolley, The American Presidency Project (hereafter “APP”), accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/?pid=26907. 63 jurisdiction, these groups all had birth rates well above the national average. 203 It should be noted that each of these early efforts targeted low income and minority populations, not unlike the eugenics programs earlier in the century. Going All the Way By April 1966, USAID operated population programs in more than twenty countries. 204 Most Agency and administration officials appeared satisfied with the state of U.S. population programs. Testifying before Congress in one of Senator Ernest Gruening’s hearings on population, USAID Administrator David Bell explained that “[l]ooking ahead to AID’s expanding work in this field, we do not consider that we need additional legislation.” He added, “[f]urthermore, we do not believe the earmarking of funds is necessary to ensure effective action in the field.” Incidentally, Bell left his post at USAID a mere three days after appearing before Congress. 205 The status quo remained unchallenged until 1966 when Dr. Reimart T. Ravenholt became the Director of USAID’s Office of Population. Having worked for the Center for Disease Control and as an epidemiology consultant for the U.S. Public Health Service, the forty-year-old Ravenholt was an expert in the field of public health and population growth. Described by colleagues as “energetic and pushy” and “very able and dynamic,” Ravenholt was known for 203 William M. Blair, “Udall Offers Help On Family Planning,” The New York Times, June 20, 1965. 204 Technical Cooperation and Research, Health Service, Population Branch of Agency for International Development, January 1967, 5, Confidential File, Oversize Attachments, 6/18/68 #2, box 190, folder “C.F. Oversize Attachments: 6/18/68 [from 3-ring binder #1: Cater AID/Population],” LBJ. 205 Quoted in Reimert Thorolf Ravenholt, World Population Crisis and Resolution: Taking Contraceptives to the World’s Poor - Creation of USAID’s Population Program, 1965–1980, 4, 13, accessed February 22, 2014, www.ravenholt.com. 64 having “a strong personality, a rather domineering personality.” 206 He had a reputation, for instance, for “personally demonstrating USAID’s pump-action abortion kits and handing out condoms with his business card printed on the wrapper.” 207 Ravenholt saw the issue of overpopulation in “very narrow, family-planning terms.” Specifically, he promoted the idea “that spreading the use and acceptance of contraceptives would be adequate in dealing with [the] problem” of rapid population growth. 208 Ravenholt learned quickly of the various obstacles his small staff would face in expanding the Agency’s population portfolio. The entire foreign aid budget was at its lowest level in a decade. USAID’s programs, including those for population control, took a back seat to the increasing U.S. military presence in Vietnam. 209 As Ravenholt recalled years later, “I had naively assumed that the President’s strongly-stated support for a population/family planning program would readily translate into USAID having the personnel and budget needed to create a powerful [population/family planning] program.” However, Ravenholt concluded, “It’s not a [Population] Branch; it’s a twig.” 210 In July 1966, several months after he took over the Office of Population, Ravenholt sent an action memo to the Agency’s new administrator, William Gaud, urging that USAID should reverse its policy banning the provision of contraceptives. A lawyer by training, Gaud joined USAID by happenstance. When Kennedy took office, Gaud reached out to his longtime colleague, new Secretary of State Dean Rusk, telling him that he would like to join the administration in some capacity. Shortly after Labor Day in 1961, Rusk suggested Gaud join 206 Carl Hemmer, e-mail message to author, June 23, 2011; Green, Interview. 207 “Pump-action” refers to a specific method of abortion. Connelly, Fatal Misconception, 241. 208 Green, Interview. 209 Carter, “Population Control,” 612; Ravenholt, World Population Crisis and Resolution, 6. 210 Ravenholt, World Population Crisis and Resolution, 6, 9. 65 USAID. As Gaud recalls, “inasmuch as I had served in South Asia during the war and knew something about it, [Rusk] thought I might be interested in coming in as Assistant Regional Administrator for that part of the world.” 211 Waiting until September to give his response, Gaud stamped Ravenholt’s memo “Disapproved,” later telling Ravenholt “he didn’t think [the policy] really mattered.” In what Ravenholt described as a “perverse response,” Gaud reported that at a meeting earlier that month in Washington, all of the USAID Mission Directors unanimously agreed that the contraceptives ban in no way hampered their family planning programs. “No doubt many other Mission directors similarly feared for the survival of their favorite non-population grant dollar assistance projects if AID began buying huge quantities of contraceptives,” Ravenholt later speculated. 212 Several motives fueled the quest to include contraceptives in foreign aid. Ravenholt and his “principal patron,” former General William Draper, were committed “supply-siders,” who believed that parents would limit their number of children if only they had access to family planning resources. 213 There were financial interests as well. In his correspondence with Johnson, Robert Komer, a senior staffer for the National Security Council, told the president that “the rapidly declining cost of population control because of new devices” could ultimately help reduce the long-term “burden” foreign aid placed on the United States. 214 The “worsening population crisis abroad,” increasingly acknowledged by both Congress and the American public, had created “a political demand” for what Ravenholt and his allies had been urging. 215 211 William S. Gaud, Interview by Joseph E. O’Connor, February 16, 1966, 3, John F. Kennedy Library Oral History Program, accessed March 26, 2014, http://www.jfklibrary.org/Asset- Viewer/Archives/JFKOH-WSG-01.aspx. 212 Quoted in Ravenholt, World Population Crisis and Resolution, 7, 28. 213 Connelly, Fatal Misconception, 241. 214 Quoted in ibid., 212–13. 215 Carter, “Population Control,” 612. 66 USAID population officers working in developing countries said the ban made it hard for them “to be taken seriously in their efforts to promote social and economic development.” 216 In January 1967, Senator Gruening wrote to Gaud, asking whether USAID would continue to prohibit the distribution of birth control devices. In a complete reversal from his response to Ravenholt just five months earlier, Gaud said that if the Agency received a request for such supplies, he would consider honoring it. 217 At a hearing before the House Committee on Foreign Affairs that April, Gaud appeared ready to change the Agency’s policy. Representative Clement J. Zablocki (D-WI), whose Milwaukee district included a large number of Catholic families, had long been the most outspoken congressional opponent of family planning programs. 218 The ranking Democrat on the House Foreign Affairs Committee, Zablocki had previously questioned Gaud and his colleagues on the subject of funding contraceptives. But when Gaud appeared before Congress on April 5, 1967, even Zablocki seemed to have relaxed on the issue. Writing on the relationship between American Catholicism and the international family planning movement, Peter J. Donaldson notes that even though Zablocki “challenged every expansion of the AID programme, . . . as a Catholic and a politician he was ready to compromise.” As it became increasingly clear that USAID’s population programs would be around for a long time to come, Zablocki likely realized that if he wanted any say in their operation, he had to concede at least some ground. 219 216 Though it is not clear what accounted for Gaud’s turnaround, it could be that due to Ravenholt’s off-putting personality, Gaud simply did not want to give him the satisfaction of approving his request right away. Willard H. Boynton, AID Contraceptive Supply Program of the Office of Population, August 15, 1975 (Redrafted POP/FPSD: November 24, 1978), 1, accessed February 28, 2014, www.ravenholt.com. 217 Carter, “Population Control,” 612. 218 Ravenholt, World Population Crisis and Resolution, 25. 219 Peter J. Donaldson, “American Catholicism and the International Family Planning Movement,” Population Studies 42 (November 1988): 372. 67 When Zablocki asked if he foresaw any upcoming changes to the policy, Gaud responded, “My guess is . . . it won’t be too long before we will be asked to [fund contraceptives] . . . . My inclination would be to change our policy in that respect and use our resources for that purpose.” Assured that distribution would not be done in a coercive manner, Zablocki did not protest and instead just changed the subject. 220 The Washington Post reported at the time, “If AID’s shift from its conservative policy was a surprise, AID officials were equally surprised by the mild Zablocki reception of Gaud’s statement.” A spokesman for Zablocki attributed the congressman’s change in position to new legislative language. While Zablocki had been concerned previously about the “lack of legislative authority for embarking on such a program . . . the new language written into last year’s foreign aid bill went far to correct this.” It is not clear, however, to what language he was referring. It is also likely that Zablocki was aware of the increasing support for birth control from within Congress itself. 221 Gaud wrote to the president immediately to explain his testimony. “We got a fair amount of good press coverage on this point, all of which gave the impression that the changed policy [on contraceptives] had been put into effect,” he explained. “I think it should be followed up quickly with the actual change. I plan to do this unless you have an objection.” 222 A month later, 220 Quoted in The Agency for International Development During the Administration of President Lyndon B. Johnson November 1963–January 1969, Administrative History, Administrative Histories (Washington, D.C.: Agency for International Development, September 30, 1968), 131, Papers of Lyndon Baines Johnson President, 1963–1969, Administrative History Agency for International Development Volume 1, box 1, folder “Administrative History of the Agency for International Development Volume 1, Part 1, Chapters V thru VIII,” LBJ. 221 John Maffre, “AID to Offer Birth Curbs for First Time,” The Washington Post, April 6, 1967. 222 William S. Gaud to Lyndon B. Johnson, “Family Planning Policy,” Memorandum, April 10, 1967, Administrative History, Agency for International Development Volume II, Part 1, box 2, folder “Part 1 Documentary Supplement [2 of 4],” LBJ; see, e.g., Juan de Onis, “Population Curb 68 USAID’s domestic and international offices received an announcement that contraceptives were no longer on the Ineligible Commodity List. Underscoring the significance of the new policy, the message explained that, “by removing contraceptives and equipment for their manufacture from the list of ineligible commodities, greater freedom is afforded the Agency to consider fully all the needs of family planning programs and related activities for each country concerned.” 223 That September, Gaud announced the USAID shipment of contraceptives to India. 224 Explaining the Change The policy change occurred at a key moment in the histories of both medicine and American law. On May 9, 1960, the Food and Drug Administration (FDA) approved the first oral contraceptive, Enovid. According to John L. Harvey, Associate Commissioner of the FDA, “[a]pproval was based on the question of safety . . . . We had no choice as to the morality that might be involved.” 225 Within five years, “the pill became the most popular form of birth control in the United States, prescribed by 95 percent of obstetricians and gynecologists.” 226 To some experts and population control advocates, the pill was “the perfect solution” to population growth “because of its effectiveness and simplicity.” 227 In 1965, five years after oral contraceptives entered the market, the Supreme Court overturned all state laws prohibiting the use of contraceptives by married couples. In Griswold v. Pressed,” The New York Times, April 6, 1967; Maffre, “AID to Offer Birth Curbs for First Time.” 223 Quoted in The Agency for International Development During the Administration of President Lyndon B. Johnson November 1963–January 1969, 132. 224 Carter, “Population Control,” 614. 225 “U.S. Approves Pill for Birth Control,” The New York Times, May 10, 1960. 226 Enovid had been originally been put on the market in 1957 as a “therapeutic agent for various gynecological disorders.” Elizabeth Siegel Watkins, On the Pill: A Social History of Oral Contraceptives, 1950–1970 (Baltimore: The Johns Hopkins University Press, 1998), 34, 36. 227 Elaine Tyler May, America and the Pill (New York: Basic Books, 2010), 37. 69 Connecticut, the Court held that the Connecticut law under consideration violated married couples’ right to privacy as embodied in the First, Third, Fourth, Fifth, Ninth, and Fourteenth Amendments to the U.S. Constitution. Writing for the majority, Associate Justice William O. Douglas posited, “Would we allow the police to search the sacred precincts of marital bedrooms for telltale signs of the use of contraceptives? The very idea is repulsive to the notions of privacy surrounding the marriage relationship.” 228 While the Court would not recognize the right of unmarried people to use contraceptives for another seven years, the holding in Griswold was ground-breaking for its recognition that family planning decisions fell within a protected sphere of privacy. 229 Against this backdrop, USAID faced less and less outspoken resistance from within Congress. While the majority of Congress likely supported the inclusion of birth control before then, the issue was still socially taboo enough that they were not wiling to express their support publicly. As a result, the vocal minority who spoke out in opposition dictated the terms of funding policy. The advent of the birth control pill and its widespread use and acceptance, along with growing concerns about population growth, made contraception “a legitimate subject for national policy.” 230 The decision in 1967 to include contraceptives in USAID programs also likely resulted from the growing public opinion favoring the use of birth control. Until that time, “the birth control movement was a ladies’ volunteer affair, publicly regarded as either inconsequential or embarrassing.” 231 The following year, Gallup polled respondents on how they felt about the 228 381 U.S. 479, 485–86. 229 Eisenstadt v. Baird, 405 U.S. 438 (1972). 230 May, America and the Pill, 43. 231 Judith Blake and Kingsley Davis, “Birth Control and Public Policy,” Commentary 30 (January 1, 1960): 115. 70 government helping other nations who solicited U.S. help in their own birth control programs. A remarkable majority—70 percent— approved of the policy, while only 22 percent opposed it and 8 percent had no opinion. 232 The backlash Johnson and Congress so feared never became a reality. Agency Infighting Though finally authorized to distribute contraceptives, Agency officials still resisted congressional efforts to earmark money for such programming. By 1967, USAID’s population- program budget had increased 800 percent while the overall foreign aid budget was lower than it had been in ten years. The shift in financial allocations stemmed from decisions within the Johnson administration to “step up family planning assistance, and in part to a decision by Congress to force the pace.” Ravenholt, too, proved a force with which to be reckoned. 233 Agency officials feared that designating funds for contraceptives “was sure to divert funds from other AID activities. Activities such as those in the fields of health, education, and economic development, all of which claim a part in reducing population growth, had advocates ready to resist fiscal incursions by the population program.” Past administrators, including Bell, opposed any and all attempts to restrict the ways the Agency divided federal funds. Though Gaud proved slightly more amenable to population programs in general, he, too, implored Congress not to earmark any part of USAID’s already tight budget. Such allotment, Gaud 232 Gallup Poll (AIPO), August 1968, retrieved December 7, 2010 from the iPOLL Databank, The Roper Center for Public Opinion Research, University of Connecticut, http://www.ropercenter.uconn.edu/data_access/ipoll/ipoll.html. 233 Carter, “Population Control,” 612. 71 argued, would hinder his ability to distribute money most effectively and efficiently among the Agency’s various programs. 234 Although Ravenholt pursued better financing, it was General Draper who got Congress to agree. Draper, who had held several high-level government appointments, first came to the population issue when President Eisenhower, a close personal friend, asked him to lead his Committee to Study the U.S. Military Assistance Program. As chair of the committee, Draper had circulated Hugh Moore’s Population Bomb and brought in population experts to brief his own staff. Draper later went on to join the organizing committee for Moore’s World Population Emergency Campaign. 235 In early 1967, Draper visited William Fulbright (D-AK), the Chairman of the Senate Foreign Relations Committee. Having worked with Fulbright on the Marshall Plan, Draper hoped his colleague would be amenable to advancing population programs. Draper’s intuition proved correct. When the 1961 Foreign Assistance Act came up for renewal that year, Fulbright added “Title X,” a one-page amendment designating $50 million for population programs. 236 After a compromise with the House, the final bill allocated $35 million to USAID’s Office of Population. 237 In spite of opposition from USAID’s budget office, Catholic groups, and some members of Congress, the Act passed with Title X attached. Johnson signed the new law on January 2, 1968. 238 234 Ibid. 235 Connelly, Fatal Misconception, 186, 188. 236 Ravenholt, World Population Crisis and Resolution, 12. 237 Carter, “Population Control,” 612. 238 Ravenholt, World Population Crisis and Resolution, 13. 72 Nixon on Population Control: Will He or Won’t He? Upon taking office in 1969, President Richard Nixon maintained the United States position on population growth. Completed under Secretary of State Henry Kissinger, the 1974 National Security Study Memorandum (NSSM) 200, “Implications of Worldwide Population Growth for U.S. Security and Overseas Interests,” provided a detailed justification for international population programs. Along with the action memorandum that followed, NSSM 200 insisted that population control was necessary for national security. 239 Significantly, the study acknowledged that the United States risked being accused of using foreign aid to advance racial or economic imperialism. 240 On July 18, 1969, in a “Special Message to Congress on Problems of Population Growth,” Nixon outlined some of the major problems posed by population expansion. Nixon framed population growth in both foreign and domestic terms, calling it “one of the most serious challenges to human destiny in the last third of this century.” 241 Describing the impact that population growth had on standards of living, food supplies, and economic progress in developing nations, Nixon stressed that USAID needed to prioritize family planning and population programs and resources. 242 239 John Sharpless, “World Population Growth, Family Planning, and American Foreign Policy,” in The Politics of Abortion and Birth Control in Historical Perspective, ed. Donald T. Critchlow (University Park, PA: Pennsylvania State University Press, 1996), 89. 240 Michelle Goldberg, The Means of Reproduction: Sex, Power, and the Future of the World (New York: Penguin Books, 2010), 67. 241 Richard Nixon, “Special Message to the Congress on Problems of Population Growth,” Special Message to Congress, July 18, 1969, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=2132&st=birth+control&st1=. 242 The dangers of population growth, Nixon said, were not solely the problem of developing nations. Nixon noted that population growth in the United States placed significant strains on “social supplies,” specifically, “the capacity to educate youth, to provide privacy and living space, [and] to maintain the processes of open, democratic government.” He announced a national goal that within the next five years, family planning services be made available to all 73 Nixon also used the Special Message to propose that Congress create a Commission on Population Growth and the American Future (“Commission”). He sought recommendations in three areas: the probable course of population growth, internal migration, and other demographic changes through the year 2000; identification of resources in the public sector that would be needed to respond to such growth; and a projection of the ways in which such expansion would impact federal, state and local governments. Envisioning the Commission as both investigative and educational, Nixon hoped the body would provide “a responsible but insistent voice of reason and insight.” 243 With strong bipartisan support, Congress established the Commission on March 16, 1970. In addition to members of the public, two members from each branch of Congress also joined the Commission. John Rockefeller III, the founder and longtime chair of the Population Council and the co-chair of Johnson’s Committee on Population and Family Planning, headed the new commission. 244 Meeting from 1969 until 1972, the Commission stood at a major intersection in the evolution of the population control movement. Advocates had begun using different rhetoric, shifting from discussions of population control to speaking of family planning instead. Such an who want but cannot afford them. In 1970, Congress passed the Family Planning Services and Population Research Act, establishing an Office of Population Affairs and a National Center for Planning Services in the Department of Health, Education and Welfare. Title X of the Act, “Population Research and Voluntary Family Planning Programs,” created a federal program whereby family planning services would be provided to those in need. By June 30, 1973, such services were available to residents in 2,625 of the 3,074 counties in the United States. Richard Nixon to Carl J. Gilbert, Letter, September 25, 1969, White House Central Files, Subject Files: Welfare, box 29, folder “WE 3 7/1/69 – 9/24/69,” Richard Nixon Presidential Library and Museum, Yorba Linda, CA (hereafter “Nixon”); Nixon, “Special Message to the Congress on Problems of Population Growth”; Donald T. Critchlow, “Birth Control, Population Control, and Family Planning,” in Critchlow, The Politics of Abortion and Birth Control in Historical Perspective, 13. 243 Nixon, “Special Message to the Congress on Problems of Population Growth.” 244 Derek S. Hoff, “‘Kick that Population Commission in the Ass’: The Nixon Administration, the Commission on Population Growth and the American Future, and the Defusing of the Population Bomb,” Journal of Policy History 22 (2010): 25. 74 evolution reflected both the proliferation of contraceptives and the frequent criticism that population control was inherently racist. In the process of composing Nixon’s population message to Congress, one adviser even suggested, “I don’t think it should be called ‘population control.’ ‘Population and family planning’ would be better. The word ‘control’ raises hackles of blacks, poor people and nationalists in underdeveloped countries.” 245 The words “population control” did not appear in the final message. Testimony before the Commission further reflected such developments. In April 1971, Wilma Scott Heide, a behavioral scientist and the chair of the National Organization of Women’s board of directors testified before the Commission. Touching upon the feminist aversion to population control in favor of family planning, Heide claimed that U.S. population policy was one of omission. “The objective for this commission should not be to develop a policy of population control because control of someone else is inherently anti-life, a denial of civil liberties and negates the potential of self control,” she explained. She also objected to the lack of feminist viewpoints on the Commission, observing that only four of the twenty-four members were women. “In short, we see evidence one more time even here that women will be acted upon not acting in our own right upon the cultural climate and decisions that affect our lives.” 246 Heide’s sentiments echoed a broader emphasis on fertility taking place in the growing feminist movement: family planning represented “an essential ingredient” to a woman’s ability to control 245 Checker Finn to Steve Hess, Memorandum, September 8, 1969, 1, White House Central Files, Subject Files: Welfare, box 29, folder “WE 3 7/1/69 – 9/24/69,” Nixon. 246 Wilma Scott Heide, “Testimony for the Commission on Population Growth and the American Future,” Washington, D.C., April 14, 1971, 1–2 (emphasis in original), Bernice Resnick Sandler Papers, 1963–2008, MC 558, folder 16, Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA (hereafter “Schlesinger”). 75 her own life. 247 These critiques were of course not limited to the Commission. USAID’s contraceptives programs encountered similar criticisms. A Flood of Funding and Contraceptives Equipped with “oodles of money” and no longer encumbered by birth control restrictions, USAID’s Office of Population proceeded at full speed. 248 From 1968 through 1976, USAID delivered 83,023,800 monthly cycles of oral contraceptives and 353,560,320 condoms to developing nations. 249 The prioritization of contraceptives in family planning programs, however, had significant drawbacks. The Agency “chopped off assistance for health” and “would hear only of birth control.” 250 From 1968 through 1972, USAID appropriations for health care dropped from $164 million to $60 million while its budget for population rose from $34 million to $123 million. 251 By 1974, nearly half of the $125.6 million allotted for the Agency’s population programs went to birth control efforts. 252 This redistribution of funding fueled 247 “What Family Planning Can Do for Women,” n.d., Catherine East Papers, 1916–1996, MC477, box 22, folder 32, Schlesinger. 248 Sinding, Interview; Connelly, Fatal Misconception, 242. 249 Reimart T. Ravenholt and Duff Gillespie, Maximizing Availability of Contraceptives Through Household Distribution, Keynote Address, Village and Household Availability of Contraceptives Conference at Population Center Foundation, Manila, June 6–10, 1976, 3, accessed February 23, 2014, www.ravenholt.com. 250 The Carolina Population Center, “Cracking the World Population Problem: A U.S. Goal for the ‘70s,” University of North Carolina at Chapel Hill, December 1969, 9, White House Central Files, Subject Files: Task Forces, box 6, folder “EX FG 221-30 International Development 1/1/71-[12/31/72],” Nixon. 251 “Women’s International Network – For Whom?,” n.d., 3, Leslie Cagan Papers, TAM 138, box 2, Tamiment Library, New York University, New York, NY. 252 Sharpless, “World Population Growth, Family Planning, and American Foreign Policy,” 88. 76 criticism that the United States only sought to limit the growth of developing nations’ populations and did not actually seek to improve their overall health and quality of life. 253 Having finally secured funding for contraceptives, USAID’s Office of Population had to figure out how to actually get the devices to local populations. In Asia, several governments had already expressed concern with population growth. Through bilateral programs, USAID provided funding and health resources to the countries’ health ministries. 254 In African and Latin American countries where host governments did not directly engage in family planning programming, USAID often channeled population assistance through private sector organizations that in turn worked with existing service delivery organizations on the ground. 255 As nongovernmental organizations, International Planned Parenthood Federation (IPPF), the Pathfinder Fund, Family Planning International Assistance (the international arm of Planned Parenthood Federation of America), and the Association for Voluntary Sterilization, among others, did not face the same diplomatic issues inherent to relationships between industrialized and developing countries. In addition, because these organizations already administered family planning programs, USAID did not need to start from scratch. 256 By the early 1970s, however, Agency officials became frustrated with existing distribution systems, believing that they failed to make contraceptives available to those most in 253 Ruth Dixon-Mueller, Population Policy & Women’s Rights: Transforming Reproductive Choice (Westport, CT: Praeger, 1993), 52; The Carolina Population Center, “Cracking the World Population Problem,” 9. 254 Gerard Bowers, Frank Feeley, and Betty Ravenholt, A Review of USAID’s Experience with the Private Sector in Health: 1968–2009 (Washington, D.C.: The QED Group, LLC, February 10, 2004), 3. 255 Bowers, Feeley and B. Ravenholt note that several Latin American governments “were not, in fact, hostile to family planning; they simply preferred to stay safely in the background, even as they quietly supported the efforts of their respective [International Planned Parenthood Federation] affiliates to expand their programs with USAID support.” Ibid., 4n3. 256 R. T. Ravenholt to Population Colleagues, “The Population Jungle,” Memorandum, June 2, 1980, 5, accessed February 28, 2014, www.ravenholt.com. 77 need. In reviewing USAID’s work with the private sector, Gerard Bowers, Frank Feeley and Betty Ravenholt cited a “growing awareness that the public sector [in host countries] was in fact failing to do this job competently or at reasonable cost in many countries.” 257 For his part, Dr. Ravenholt held a “radical view” that the “principal constraint was the supply of contraceptives not the demand for them.” 258 He explained, In developing countries, there is a deeply ingrained “mentality of scarcity”: an inability to think and plan and act on an assumption of contraceptive abundance. Hence, contraceptives are hoarded at every level: in the capital cities, in provincial cities, and in local clinics . . . . In addition to hoarding because of the mentality of scarcity, each echelon of the system is reluctant to move materials to the next echelon because by doing so they tend to lose rather than gain power. Many prefer to hold on to the materials closely and relinquish only small amounts on any occasion, e.g., one monthly cycle of pills per clinic visit. In this way, they have repeated opportunities to demonstrate their power and function. 259 USAID began experimenting with new methods of distribution. USAID’s mission in India, for example, promoted condom use by providing India’s Department of Family Planning with condoms to disseminate through “commercial channels to an estimated 600,000 small shopkeepers.” The program was the first “government-subsidized, heavily advertised mass distribution of condoms in the world.” 260 In 1974, the Agency launched household contraceptive distribution research projects in Taiwan and Egypt. Similar programs in South Korea, Bangladesh, and Tunisia soon followed. 261 257 Bowers, Feeley and B. Ravenholt, “A Review of USAID’s Experience with the Private Sector in Health,” 5. 258 Sinding, Interview. 259 Ravenholt and Gillespie, Maximizing Availability of Contraceptives Through Household Distribution, 7. 260 “Project Appraisal Report for Project number 386-51-580-322.2,” December 31, 1969, 2, 4, USAID Development Experience Clearinghouse, accessed March 27, 2014, http://pdf.usaid.gov/pdf_docs/PDAAR636.pdf. 261 Ravenholt and Gillespie, Maximizing Availability of Contraceptives Through Household Distribution, 4–5. 78 Based on the archival material, it appears that most, if not all, of these programs evolved out of discussions between the host governments’ family planning programs and the local USAID mission. In Ghana, for instance, the “interministerial nature” of the programs by the Ghana National Family Planning Programme Secretariat (GNFPP) “provided certain advantages [but] also imposed certain bureaucratic delays and restraints.” Subsequently, discussions in 1976 between GNFPP and USAID’s Mission to Ghana, and later with USAID itself resulted in a USAID-funded Contraceptive Retail Sales project being added to the GNFPP activities. Programs could also evolve out of the Agency’s relationships with such private sector partners as IPPF. Johnson and USAID maintained specific programs would be not forced upon host countries. However, as will be discussed later in this chapter, there were often coercive elements to the initiation of family planning programs abroad. 262 The Contraceptive Retail Sales Project The Contraceptive Retail Sales project (CRS) offers insight into the attitudes and motivations that drove USAID’s distribution of contraceptives and its reception in foreign countries. In operation from 1976 to 1983, the CRS project involved a social marketing program of “‘missionary work’ at the Agency level in Washington and with several USAID missions overseas”: in Mexico, Ghana, Bangladesh, Jamaica, Nepal, and El Salvador. The CRS programs in each of the six countries relied on commercial advertising and pre-existing retail outlets to deliver contraceptives. 263 These outlets provided two key benefits. First, the pre-existing 262 Contraceptive Retail Sales Program GHANA, September 1980, Westinghouse Health Systems of Westinghouse Electric Corporation, Columbia, MD, Lot 85-45, Accession 286-85- 056, box 3, no folder, NACP. 263 A CRS project designed for Tunisia never launched. Former Agency officials disagree over the exact origins of the project. Possibilities include a five-country study USAID underwrote in 79 networks could be used “to complement other distribution systems, such as clinics or community-based efforts, and to expand availability into virtually all areas of a developing nation.” Second, USAID hoped that “the use of commercial outlets [would] help reach persons who may have cultural or personal objections to obtaining contraceptives through extant sources and also will maximize the demand created by commercial marketing.” 264 Several motivations drove the development of CRS and subsequent social marketing programs. The population officers within USAID increasingly believed that “a ubiquitous private sector that was successfully marketing every day staples such as matches, soap, kerosene, and aspirin could, and indeed should, be tapped to help deliver contraceptives to low-income people who were beyond the reach of thinly stretched public sector health facilities.” Retail outlets also allowed USAID and its contractors to circumvent the problems endemic to the public sector. Public programs were plagued by corrupt politicians and inescapable bureaucracy and repeatedly proved incapable of reaching all targeted populations or keeping costs and prices under control. The retail approach offered an additional advantage: the Agency viewed CRS programs as an “insurance policy” against what the United States believed to be the “fickle commitments” some 1975, an adaptation of an earlier experimental program in Kenya conducted by Population Services International (PSI), and an unsolicited proposal from Westinghouse Health Systems, a U.S.-based corporation. In response to the increasing management burden that the programs posed by the 1980s, the Office of Population designed the Agency’s first “centrally funded umbrella project,” SOMARC, for the specific purpose of “expand[ing] the role of the private sector in delivering non-clinical contraceptive projects.” SOMARC I lasted from 1984 until 1989 and was subsequently renewed twice, SOMARC II (1989–1992) and SOMARC (1992–1998). USAID operated the CRS projects with multiple contractors including, Westinghouse, Development Associates, Inc., Searle Pharmaceutical Co., the Futures Group, and PSI. Bowers, Feeley and B. Ravenholt, “A Review of USAID’s Experience with the Private Sector in Health,” ii, 4–5. 264 Gregory and Gold, “Cost Reimbursement Type Contract,” 3. 80 developing countries had toward family planning. If a host government terminated existing public sector family planning activities, CRS programs would already be in place. 265 Tailoring the CRS program to each country’s population, USAID and the CRS contractors faced a common set of obstacles to getting target populations to accept and utilize contraception: illiteracy, religious and social opposition, traditional gender roles, significant socio-economic premiums on large families, and poor access. Faced with such challenges in each host country, CRS programs employed a basic framework: To make use of existing commercial outlets to complement other distribution systems, such as clinics or community-based efforts, and to expand availability into virtually all areas of a developing nation. Contraceptives will be supplied by AID at no cost to the contractor. It is believed that the use of commercial outlets will help reach persons who may have cultural or personal objections to obtaining contraceptives through extant sources and also will maximize the demand created by commercial advertising . . . . The objective at the end of the contract period is a self-supporting or nearly so, commercial distribution system. 266 Unlike the private sector, the CRS projects sought to maximize sales, not profits. 267 The goal was instead for each to sell enough contraceptives to be self-sustaining, absent the provision of free contraceptives by the U.S. government. 268 265 Bowers, Feeley and B. Ravenholt, “A Review of USAID’s Experience with the Private Sector in Health,” 5. 266 Gregory and Gold, “Cost Reimbursement Type Contract,” 1. 267 In 1975, oral contraceptives were sold in U.S. drug stores for an average of $2.75/monthly cycle, representing approximately $1.65 at the pharmaceutical firm’s level. The price could be lower, however, if those same pills were “purchased in bulk in a slightly cheaper but equally efficacious package.” According to C. Djerassi, “In 1975 the U.S. Defense Department purchased 5 million cycle equivalents at $0.23/cycle and [USAID] let a contract with one pharmaceutical company for 100 million cycle equivalents at $0.1494/cycle. The profit margin on such bulk sales is so small that it is very unlikely that any new pharmaceutical company would wish to enter this field.” C. Djerassi, “The Manufacture of Steroidal Contraceptives: Technical Versus Political Aspects,” Proceedings of the Royal Society of London, Series B 195 (December 1976): 182. 268 The archival materials do not give reason to believe that the contractors saw the CRS programs as a way to reap profits. 81 A 1980 proposal submitted by a potential contractor enumerated the conditions deemed necessary for programmatic success. 269 Though this pitch was written for a potential project in Ghana, USAID and its contractors evaluated each potential country in a similar manner, though the weight on each factor varied. First, the host country’s government must have acknowledged the need for family planning. Preferably, a potential host government would have also already begun officially promoting the benefits of family planning to its populace. The success of a CRS project also relied on the existence of a minimal number of constraints on the distribution, display, and advertising of contraceptives and on the types of retail outlets allowed to sell them. Ideally, there would not be any prescription requirements for orals. An effective consumer- oriented distribution scheme and a functioning cash economy rounded out the list. 270 Problems Going Over-the-Counter Ravenholt had long argued that family planning programs would fail without contraceptives. 271 He was not alone in his belief that, as historian Elaine Tyler May has observed, “[t]he pill promised to be the stealth weapon that would defuse the ‘population bomb’ by limiting the size of ‘nuclear’ families across the globe.” 272 The U.S. Food, Drug, and Cosmetic Act barred pharmaceutical companies from exporting drugs “for uses not approved for marketing in the United States.” The policy was based on the premise that “one standard of drug approval is necessary, and under this premise, the United States would be promoting a double standard if it exported drugs not approved for use 269 The CRS programs do not appear to have been affected by changes in presidential administrations. The archival materials make no mention of elections or presidents. The programs did not undergo significant changes following any election. 270 Contraceptive Retail Sales Program GHANA, September 1980, 1. 271 Ravenholt, World Population Crisis and Resolution, 3. 272 May, America and the Pill, 37. 82 in the United States.” 273 Because the safety of injectable and implanted contraceptives remained uncertain, USAID relied on condoms and orals. While these regulations ensured the safety and efficacy of the supplies, the Agency also hoped to avoid accusations of distributing to developing nations contraceptives that were not considered good enough or safe enough for consumption in the United States. 274 Most countries, the United States included, required a woman to see a doctor and obtain a prescription to get orals. Prescriptions, though, posed two problems for CRS programs. First, due to the lack of medical professionals and facilities, especially in rural areas, impoverished women often did not have access to physicians or regular health care, let alone prescriptions. Additionally, with contraceptives only recently becoming a part of public discourse, many women likely would not have felt comfortable having to seek out doctors for any type of birth control. Ravenholt and his allies in USAID hoped to get rid of prescription requirements so that poor women, especially in rural areas without prescribing physicians, could obtain and use them. Several obstacles, however, almost prevented the inclusion of orals in CRS programs. First, 273 The internationalization of the contraceptive business meant that when women in the United States succeeded in lowering hormonal doses in birth control pills, multinational manufacturers unloaded older, high-dosage pills on women in developing nations, despite the drugs’ proven side effects. Linda Gordon, Woman’s Body, Woman’s Right: Birth Control in America (New York: Penguin Books, 1990), 427; United States Office of Technology Assessment, World Population and Fertility Planning Technologies: The Next 20 Years (Diane Publishing, n.d.), 11. 274 However, there is some evidence that there was—and still is—a demand for injectable contraceptives in certain developing countries. For a variety of reasons, these contraceptives, which need only be administered bi-monthly or even semi-annually, would not be very attractive in more affluent markets like those in the United States and Western Europe. As a result, “comparatively little work” was being done at the time to develop “an extremely effective injectable steroid contraceptive with tolerable side effects.” Most of the injectable contraceptives at the time had not been approved for clinical use by the FDA. Djerassi, “The Manufacture of Steroidal Contraceptives,” 182; Boynton, AID Contraceptive Supply Program of the Office of Population, 1. 83 Ravenholt faced what he saw as an “overblown threat” to the pill’s potential side effects. What Ravenholt considered a “wave of alarmism” in 1970 and 1971 erupted over a perceived connection between oral contraceptives and thromboembolism, a condition where blood clots move through a woman’s venous system, beginning in the lower limbs and eventually obstructing major vessels in her lungs. Such widespread fear jeopardized congressional support for the inclusion of orals in population programs. Officials at USAID Bureaus around the world insisted on discontinuing their distribution in order to avoid damage suits against the Agency. Research increasingly proved, however, that unless they smoked cigarettes, women in the United States faced a very low risk of thromboembolism death related to oral contraceptives. When additional studies demonstrated that thromboembolism had never been a problem among women in developing nations in the tropics, the Agency succeeded in preserving the use of orals in its programs. 275 When a host government agreed to remove the prescription requirements, USAID had to ensure that the pill’s packaging stayed on message. FDA regulations required that the labels include the statement that the pills are “to be taken under continuous supervision of a doctor.” Writing about a Bangladesh program, Ravenholt noted that the statement “could be interpreted in conflict with the intent of the projects to expand oral contraceptive usage through commercial channels without a doctor’s supervision in countries where such distribution is permitted under their laws.” New labels would reflect “whatever considerations, including anticipated possible risks, if any, the [government] deemed necessary to assure proper use of the orals.” 276 Of course, 275 Ravenholt, World Population Crisis and Resolution, 29–30. 276 R.T. Ravenholt, “Problem: To approve the attached marketing plan and supporting documentation covering a three-year sub-project for commercial contraceptive marketing development in Bangladesh,” Action Memorandum for the Assistant Administrator, PHA, 84 though Ravenholt failed to mention as much, the new labels would not make much of a difference to the huge portion of the targeted populations who could not read. The individual CRS projects implemented other mechanisms designed to inform women about the potential side effects of orals. When the Nepali government agreed to waive the prescription requirement, for example, CRS staff began devising strategies for retailers to sell the birth control pill, Gulaf. USAID attempted to educate dealers about the drug and its possible side effects so that the dealers in turn could screen and inform customers about the pills. After first limiting distribution to chemist and druggist shops, CRS later expanded to include selected retail outlets due to the shortage of health services and physicians in remote areas. 277 By the end of 1979, 418 retail dealers in five urban locations had agreed to sell orals and 2,149 shops in seven cities agreed to sell condoms. USAID also provided contraceptives to dealers who then sold to additional individual retailers. 278 Participating retailers were required to inquire about the general health of any woman seeking to take Gulaf, unless she provided a prescription. 279 If a screening revealed that a woman January 16, 1975, 4–5, Lot 85-43, Accession 286-85-057, box 2, folder “PSI Correspondence 1975,” NACP. 277 “Background Information on Nepal,” November 21, 1978, adapted from “Marketing Design for CRS project,” April 1976, II-108, Lot 85-45, Accession 286-85-056, box 1, folder “Background Information [2],” NACP. 278 “3. Contraceptive Retail Sales,” n.d., 2, Accession 286-85-056, box 1, folder “Nepal Contract Correspondence 1980,” NACP. 279 To be eligible to participate, a retailer had to already distribute similar products, give proof of existing coverage of consumer products already available for distribution, demonstrate his financial and management abilities, propose an approach to distribute Gulaf, and indicate a willingness to adhere to the Dealer Agreement provisions. After attending a half-day orientation, retailers received special certificates indicating their authorization to sell Gulaf on behalf of the Nepal CRS Project. Because this chapter concerns the motivations of USAID and its contractors, the motivations of the dealers and other Nepali men and women on the ground remain outside the scope of this project. While my sources do not convey much about the dealers themselves, the subject remains ripe for analysis in the future. “Information about Gulaf Dealerships in 85 had certain health conditions—high blood pressure, heart disease, varicose veins, diabetes, or breast cancer, to name a few—retailers were to direct her to get her health checked before taking the pills. 280 However, this step appears a mere suggestion since the retailer contract said nothing about refusing to sell the orals under such circumstances. Retailers also needed to notify women of Gulaf’s potential side effects. Over the first three months, women might experience vomiting, headaches, fluctuation in weight, giddiness, and disturbance in monthly menstruation. Since such abnormalities would gradually disappear, women were told to continue taking the pills. If her reactions were severe, however, a woman should visit the nearest family planning center, Nepal Family Planning Association clinic, or hospital. 281 Despite instituting such informal screening procedures, USAID overlooked important realities about life in Nepal and in the other CRS countries. Many of the women the CRS projects aimed to reach never received a comprehensive health exam and could thus not be expected to know whether they had such preexisting conditions as diabetes or a family history of breast cancer. Instructing women to seek out assistance at a clinic or hospital immediately upon experiencing severe side effects further overlooked the absence of such facilities. The parameters for distributing oral contraceptives were simply unrealistic and directly contradicted the underlying problems that had originally prompted development of CRS programs in the first place. Nepal,” The Nepal CRS Project (Nepal FP/MCH Project), n.d., Kathmandu, Nepal, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal: General,” NACP. 280 Pregnant women and mothers still breastfeeding were also not supposed to take Gulaf. 281 “Directions and Concurrence for the Sale & Distribution of ‘Gulaf,’” Kathmandu, Nepal, n.d., Lot 85-45, Accession 286-85-056, box 1, folder “Nepal General,” NACP. 86 Nepal’s CRS Program The CRS program in Nepal will serve as a case study here for several reasons. Each country’s CRS project operated in both rural and urban areas and had “virtually identical project designs” in each country. 282 With a population the third largest among the CRS countries, Nepal’s annual growth rate approximated those for the other countries. 283 Operated by USAID and Westinghouse Health Systems (WHS), the CRS program in Nepal offers insight into the various objectives, challenges, and attitudes surrounding distribution efforts in each of the CRS programs. 284 When USAID approached His Majesty’s Government of Nepal in 1976 to propose a CRS program, the nation’s growth rate stood at 2.09 percent. 285 Without intervention, the population was set to double in thirty-two years. Of the 13.8 million people in Nepal, more than 90 percent lived in rural areas. A widespread fear of side effects, a resistance to doctors, and the lack of access to health care contributed to low contraceptive usage across the country. Only a small upper class practiced some type of fertility control. Despite the establishment of a nationwide family planning program in 1968, by 1976 only 21 percent of the population had heard of at least one method of modern contraception. Married women typically had at least six children; fewer 282 Sander Levin, “Action Memorandum for the Administrator,” June 12, 1978, USAID Development Experience Clearinghouse, accessed March 25, 2014, http://pdf.usaid.gov/pdf_docs/PDAAD341A1.pdf. 283 When Nepal’s CRS program began in 1976, the country had a growth rate of 2.09 percent. That same year, the average annual growth rates in the other countries with CRS programs were as follows: Bangladesh 2.17 percent; El Salvador 2.52 percent; Honduras 3.33 percent; Jamaica 1.35 percent; Ghana 2.21 percent; Mexico 2.51 percent. The United States had an annual growth rate of .97 percent. “International Programs–Region Summary,” United States Census Bureau, revised December 19, 2013, https://www.census.gov/population/international/data/idb/informationGateway.php. 284 Differences with other countries are noted throughout. 285 Gregory and Gold, “Cost Reimbursement Type Contract,” 2. 87 than 4 percent of them reported ever having used an efficient method of contraception. 286 According to one WHS representative, such demographics made “the market potential . . . excellent.” 287 Significantly, this analysis of potential success was based on economic factors and a perceived need, not on Nepali interest or willingness to limit their fertility. Although Nepal’s government initially came to an agreement with USAID for a CRS project in 1976, Nepali officials soon began dragging their feet. 288 USAID expected the Nepali government, like other host governments, to support the project officially, to approve of any instructional material for oral contraceptives, to provide medical support for those experiencing side effects, to relax any related regulations impeding the distribution of prophylactics, and to make warehousing facilities available if needed. However, when USAID awarded the CRS contract to WHS, a subsidiary of Westinghouse Electric Incorporation, and not to the organization favored by Nepal’s government, local officials delayed granting visas to WHS staff. While it is possible that USAID preferred to give business to an American company, it is equally like that WHS received the contract since it was already running a CRS project in Ghana. 289 The delay cost the project a year. More than eighteen months after first reaching an agreement with Nepal, USAID finally received provisional approval for a CRS marketing design in February 1977. Sales of contraceptives began a few months later. 290 286 Gerold V. Van Der Vlugt to Phyllis T. Piotrow, Letter, December 15, 1979, 2–3, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Evaluations,” NACP. 287 Gregory and Gold, “Cost Reimbursement Type Contract,” 2. 288 Staff Reporter, “HRH Princess Prekshya Initiates Sale of Contraceptives,” The Rising Nepal, May 18, 1980, Kathmandu, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Advertising,” NACP. 289 Gregory and Gold, “Cost Reimbursement Type Contract,” 12. 290 Bal Gopal K.C., Under Secretary of His Majesty’s Government, informed the USAID mission in Nepal that the government approved of a CRS pilot scheme “in principle.” J.J. Speidel to DSB, “Justification for Non-Competitive Procurement with Westinghouse Health Systems (WHS) under the Contraceptive Retail Sales Project No. 932-0611 in Nepal,” Action 88 Some Nepali officials continued to resist the program. When sales began that May, the Ministry of Health abruptly and unexpectedly decided not to grant prospective CRS “dealers” the expected thirty days credit. Instead, it would only extend credit after the interested firm secured a large bank guarantee. Although the bond was soon reduced and eventually eliminated all together, the policy change likely was an effort by the Ministry to further impede the program. 291 Crafting the Message A 1978 brochure for the Nepal program sheds light on both the objectives and faulty assumptions that drove CRS programs. The pamphlet explained that the Nepal Contraceptive Retail Sales Project was a “non-profit program developed by His Majesty’s Government of Nepal’s Family Planning and Maternal Child Health Project to commercially distribute contraceptives throughout Nepal in order to encourage more people to practice family planning and thus, to reduce the country’s population growth rate.” Neither USAID nor Westinghouse were mentioned anywhere in the brochure, suggesting that the program’s administrators wanted it to appear to be an indigenous effort. It is likely that by casting the project as Nepali driven and not controlled by American outsiders, it was more likely to gain the trust of the Nepali population. According to the pamphlet, the Nepal CRS Project had four main goals: To increase the AVAILABILITY of contraceptives To create AWARENESS of contraceptive methods To MOTIVATE men and women to use contraceptives, and Memorandum, August 15, 1980, 1, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Contract Correspondence 1980,” NACP; Thapa to Pande, “Commercial contraceptive marketing program in Nepal the Nepal Contraceptive Retail Sales (CRS) Project,” 2–3; Bal Gopal K.C. to Samuel H. Butterfield, Letter, May 29, 1978, 1, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Contract Correspondence 1978,” NACP. 291 Van Der Vlugt to Piotrow, Letter, 3. 89 To increase contraceptive USE 292 Curiously absent is the desire to educate the populace about the benefits and drawbacks of given methods, and the actual mechanics of using the contraceptives. As the narrative that opens this chapter points out, many Nepali men and women did not know what to do with a condom, let alone what it was meant to do. While not a stated “objective,” however, the Americans administering the CRS program did acknowledge the need to educate potential users about birth control. Their “consumer education program” relied on “[p]osters, picture-booklets, leaflets and other materials . . . .” Such an approach disregarded a key factor: only 20 percent of Nepali men and fewer than 10 percent of Nepali women could read. Even the use of images proved problematic since large segments of the population had never been exposed to visual advertisements. When the CRS project began pretesting language for condom instructions, for example, one of the Nepali respondents asked, “What is a picture?” 293 Retailers selling Gulaf pills were also relied upon in the effort and received “special training so that they will be able, to correctly inform women on the proper use of these pills.” 294 Failed Attempts at Cultural Sensitivity In soliciting proposals for a full-service advertising campaign, USAID and Westinghouse administrators acknowledged that, “The attitudes about ‘ideal’ family size and the desire for 292 “Dhaal & Gulaf” (emphasis in original). 293 Van Der Vlugt to Piotrow, Letter, 2. 294 “Dhaal & Gulaf.” 90 male children will not be changed easily; the appeals of the CRS Project must be sensitive to these strongly-held attitudes.” 295 Responding to a WHS proposal for introducing Suki Dhaal condoms, Timothy Seims, a Project Manager in USAID’s Family Planning Services division, similarly examined the issue of cultural discrepancies. Seims discouraged WHS from highlighting the condom’s role in spacing children in future advertisements. In a letter to the contractor dated April 7, 1980, Seims noted, “This may be a proper strategy, but its . . . use assumes that there is a quantifiably important market segment interested in spacing children who might see contraception as the way to do it.” Any message, he continued, that did not touch on the consumer benefits of spacing would “leave them hanging.” 296 In spite of such warnings, the CRS projects often operated on assumptions about the malleability of targeted consumers. Seims was neither the first nor the last USAID official to speculate on indigenous attitudes toward contraception in developing nations. What is striking, however, is that four years into Nepal’s CRS program, neither Seims nor the project contractor, WHS, knew for certain whether Nepali men and women were even interested in spacing their children. USAID designed the CRS programs based on the theory that, if provided with contraceptives, developing nations would readily use them to regulate their fertility. 297 Seims’s doubts about the veracity of this driving philosophy do not appear to have prompted an overhaul of any of the CRS projects. Though his critique indicates a more nuanced approach to the use of 295 “Request for Proposal: Full Service Advertising Campaign,” Nepal Contraceptive Retail Sales Project, n.d., 2, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Advertising,” NACP. 296 Timothy Seims to Theodore Smith, Letter, April 7, 1980, 1, Lot 85-45, Accession 286-85- 056, box 1, folder “Nepal Contract Correspondence 1980 [2],” NACP. 297 Ravenholt and Gillespie, Maximizing Availability of Contraceptives Through Household Distribution, 4. 91 contraceptives, the advertising messages Seims recommended later in his letter reflect an Agency-wide naiveté towards the recipient indigenous communities. His first few marketing suggestions depicted condoms as romantic, pleasant to use, safe and easily concealed, and private. These ideas showed some insight, directly addressing reasons why Nepali men and women did not use condoms. His final note, though, reflects U.S. assumptions about contraceptive use. Seims proposed brainstorming around a message that “Spacing of children means child care can be delegated, the family is less vulnerable, or whatever.” 298 While touching upon concern among the poor about their ability to support a large family with a small cash income, this strategy negates key aspects of all of the CRS countries, Nepal included. The notion of sharing childcare responsibilities was incongruent with the way Nepali men and women viewed marital relations and family life. A study of the Brahmin and Chhetris communities of east-central Nepal, for example, noted that, “For these women, child bearing is the paramount test of their identity and worth as human beings and child rearing the most enjoyable and rewarding of their many tasks.” A reduction in their fertility would mean a diminished self-worth. Pregnancy was a source of pride, a key element of a woman’s status. Women throughout the small villages of the Kathmandu Valley and the surrounding hills held motherhood in a similar esteem. While women of these communities might privately admit to wishing for more time between pregnancies, the social and religious emphasis placed on having children outweighed their personal desires. Moreover, the inability to conceive could have disastrous effects on a woman. If his wife continuously failed to become pregnant, a man could opt to take a second wife. His barren wife would become the subject of public ridicule. One woman told a researcher of her mother-in-law’s scorn for her lack of children after four years of 298 Timothy Seims to Larry Smith, Letter, 2. 92 marriage. “How many times do you have to burst open?” her mother-in-law demanded. “We haven’t had any children from you. Since the day you were married you seem to have always been menstruating.” 299 Selling Nepal on Contraception Each CRS project, Nepal’s included, relied on non-traditional promotional approaches in order to reach a wider segment of the population. In addition to posters, advertisements in bus shelters and newspapers, and radio commercials, they promoted CRS contraceptives by painting rickshaws, using traveling puppet and minstrel shows, and by offering retailers such point-of-sale materials as hanging mobiles. These methods allowed the marketing campaign to cover larger geographical areas and to reach the illiterate populations who could not understand traditional print and billboard advertisements. 300 Having determined methods of communication, the Nepal CRS staff began brainstorming ways to respect cultural attitudes while still promoting contraceptives. In Nepal, the word “condom” translated to “trash or rubbish.” One staffer speculated that such translations “further add[ed] to a low image for the product,” and noted, “there are probably some associations of the condom with illicit sex and/or prostitution.” 301 The fact that such attitudes did not preclude the Americans from trying to establish a CRS program in the first place indicates their hubris in believing they knew better or could change the minds of the local populations. If they could successfully come up with identifiable brand names, using words that Nepali men and women 299 Lynn Bennet, “sex and motherhood among the brahmins and chhetris of east-central Nepal,” INAS Journal, n.d., 1, 3, 5, Lot 85-45, Accession 286-85-056, box 1, folder “Background Information [2],” NACP. 300 “Dhaal & Gulaf.” 301 “Request for Proposal, 2. 93 were more comfortable using in public, the Americans believed they could overcome the stigma associated with contraceptives. In the summer of 1977, WHS held a nationwide contest to determine potential brand names for condoms and for an oral contraceptive, the two main prophylactics to be marketed. After the contest identified several possible options, market research field interviews gauged the popularity of the names as well as appropriate pricing models. The CRS project officially named the condom “Dhaal,” or shield, and the orals, “Gulaf,” or rose. 302 In addition to using such neutral brand names, project staff focused on creating promotional messages highlighting the family planning uses of contraceptives rather than their association with sex. “A good father uses Dhaal for family planning, so his children can become educated,” read one message. “A woman should take one pill daily every day. Gulaf pills are for good health and wanted children,” advised another. 303 Branding worked—almost too well. The words Gulaf and Dhaal soon became synonymous with the contraceptives they represented. Less than a year after the CRS project commenced, Nepal’s Ministry of Information determined that since Gulaf and Dhaal had become generic terms for contraceptives, they were too risqué to be used in radio announcements. 304 In his May 18, 1980 letter to the editor of the local publication, The Rising Nepal, a Nepali man named P. Parsad criticized these efforts and challenged the appropriateness of a CRS radio commercial. “As ingen[i]ous and commendably formulated [as] this ad is, it is a rather frustrating source of embarrassment to radio listeners. Perhaps the advertisers should wait for 302 Thapa to Pande, “Commercial contraceptive marketing program in Nepal the Nepal Contraceptive Retail Sales (CRS) Project,” 2. 303 David Wood to Tim Seims, “Nepal CRS Message Strategy,” Memorandum, July 1, 1981, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Advertising,” NACP. 304 Evaluation Team Report, 1. 94 another twenty years (until sex education is popular enough at schools) to play it over the radio for a wider public.” 305 Packaging the products also posed a series of challenges. Gulaf’s original yellow wrapper with an image of a red rose too closely resembled the packaging of a local brand of tea. So, Gulaf’s background became ivory. Two USAID officials cited the change as “a further indication of the lengths to which the CRS staff went to localize the product.” When the CRS project commenced, the word “Tahiti,” the name of the production company, was still printed on the inner lining of the condom wrappers. Nepal’s Ministry of Health already distributed Tahiti condoms for free. The CRS project ordered new packaging both because of the concern that free government-provided condoms would leak into the commercial distribution system, and because Nepali customers would otherwise rightly question the need to pay for a product obtainable for free. 306 The original contract between USAID and WHS rationalized having Nepali men and women pay for something otherwise attainable for no cost: “While the price to the consumer should be kept at a level affordable by virtually the total populace, or at least the majority, it is felt that the incentive provided to the distributors, wholesalers and retailers is another force which will add to the demand-creating momentum.” 307 According to a 1986 survey of Nepal’s CRS program, “most consumers said they chose to purchase CRS contraceptives from shops, rather than obtain them free from government distribution centres. The shops were easily 305 P. Prasad, “Source of Embarrassment (Readers’ Mail),” The Rising Nepal, May 18, 1980, Kathmandu, Nepal, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Advertising,” NACP. 306 Theodore Smith and Timothy Seims, “Consultant Evaluation of Commercial Distribution of Contraceptives Program in Nepal,” Draft Report, n.d., 3, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Evaluations,” NACP. 307 Charging for the condoms and pills was also part of the effort to make the program self- supporting. Gregory and Gold, “Cost Reimbursement Type Contract,” 1. 95 accessible, were close to home or work, were convenient, and the consumers did not have to wait as they did in clinics.” 308 Stocking the Shelves Although the Nepal CRS project officially began when WHS received government approval in February 1977, outreach to retailers did not begin until June of the following year. 309 The earlier market research on branding did not take into account a shopkeeper’s willingness to sell the product, only the consumer’s interest in purchasing it. Given the centrality of the retailers to the success of the program, this timeline is puzzling. The CRS records do not account for the decision to wait on soliciting retailers. It could be that the Americans were confident in their abilities to financially motivate Nepali dealers to participate. At first, shopkeepers resisted the project’s attempts to get them to stock “dirty” items like condoms and pills. 310 Some even refused talking to CRS sales representatives when they made follow up calls. In hopes of overcoming the shyness of retailers and consumers, the Americans looked for ways to encourage retailers to become CRS dealers. For example, “[p]roft margins for each product were calculated to be generous compared to other consumer products to encourage dealers and retailers to stock and sell the [CRS] contraceptive products.” Offers of cash rewards 308 Ashoke Shrestha, Thomas T. Kane and Hem Hamal, “Contraceptive social marketing in Nepal: consumer and retailer knowledge, needs and experience,” Journal of Biosocial Science 22 (July 1990): 319. 309 Smith and Seims, “Consultant Evaluation of Commercial Distribution of Contraceptives Program in Nepal,” 9; J.J. Speidel to DSB, “Justification for Non-Competitive Procurement with Westinghouse Health Systems (WHS) under the Contraceptive Retail Sales Project No. 932- 0611 in Nepal,” 1; Thapa to Pande, “Commercial contraceptive marketing program in Nepal the Nepal Contraceptive Retail Sales (CRS) Project,” 2–3; Bal Gopal K.C. to Samuel H. Butterfield, Letter, May 29, 1978, 1, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Contract Correspondence 1978,” NACP. 310 Van Der Vlugt to Piotrow, Letter, 3. 96 and other consolation prizes for retailers stocking and successfully selling CRS contraceptives helped break down their initial reluctance. 311 Exporting Hypocrisy Many of the tactics employed by the CRS projects would not have been welcome in the United States either. In their review of Nepal’s program in 1980, just six months into national distribution, two American marketing consultants acknowledged as much: Many questioned the willingness of retailers to openly display condoms in a country where, as compared to the United States, the people are much more modest about sexuality. Yet, even in the United States today, condoms are not displayed above the counter in some of the more conservative regions of the country, and ten years ago, above the counter display of condoms was unheard of anywhere in the U.S. 312 Condoms were just making their way into non-clinical, commercial outlets in the United States when USAID began strategizing methods to convince retailers in Nepal and the other CRS countries to sell the prophylactics. In 1971, the Michigan Court of Appeals upheld a city ordinance restricting the sale of contraceptives to “wholesale druggists, jobbers or manufacturers who sell to retail drugstores for resale.” 313 However, six years later, the Supreme Court struck down a New York state law that limited the distribution of “nonprescription contraceptives to licensed pharmacists” on grounds that the law “clearly imposes a significant burden on the right of the individuals to use contraceptives if they choose to do so.” The Court further held that “the 311 S.J. Thapa, “Detail Summary of the Dhaal Display Contest in the Bagmati Zone,” n.d., 1–2, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Advertising,” NACP. 312 Smith and Seims, “Consultant Evaluation of Commercial Distribution of Contraceptives Program in Nepal,” 8–9. 313 Kalita v. City of Detroit, 226 N.W.2d 699, 701, 703 (1975). 97 prohibition of any ‘advertisement or display’ of contraceptives” to likewise be unconstitutional. 314 In 1975, the San Jose radio station KNTV became the first to run a condom commercial, in direct violation of the National Association of Broadcasters’ (NAB) Code of Conduct. The NAB Code remained in effect until 1979 when the Justice Department opposed it in an antitrust lawsuit. It took another twelve years before Fox Television became the first network to air the first television commercial for condoms. 315 While condoms have today become commonplace in gas stations and even restaurant bathrooms, controversy continues to surround over-the-counter sales of oral contraceptives. A doctor’s prescription is still required for a woman to obtain birth control in the United States, though many public health experts have lobbied for change. As recently as November 2012, the American College of Obstetricians and Gynecologists recommended that women be able to buy orals over the counter. 316 The availability of emergency contraceptives without a prescription is still a subject of political and legal controversy. 317 314 Carey v. Population Servs., Int’l, 431 U.S. 678, 689, 700 (1977). 315 While viewers were overwhelmingly in favor of allowing the commercial to continue, the station decided against it. I could not determine why. Michael Wilke, “Changing Standards: Condom Advertising on American Television,” A Special Report of the Kaiser Daily Reproductive Health Report (June 2001), 1, accessed March 27, 2014, http://www.kaiserhealthnews.org/daily-reports/2001/june/19/dr00005295.aspx. 316 Jacque Wilson, “Physicians: Birth Control Should Be Sold Without a Prescription,” CNN, November 21, 2012, http://www.cnn.com/2012/11/20/health/birth-control-over-the- counter/index.html; J. Trussell, F. Stewart, M. Potts, F. Guest, and C. Ellertson, “Should Oral Contraceptives Be Available Without a Prescription?,” American Journal of Public Health 83 (August 1993): 1094–99. 317 After first rejecting over-the-counter availability of the so-called morning after pill for women of any age, George W. Bush’s administration ultimately allowed it for women ages eighteen and over. The Obama administration lowered the age to seventeen in 2009 after a federal court order. In December 2011, Kathleen Sebelius, the Health and Human Services Secretary, overruled the FDA’s recommendation that the morning after pill Plan B be made available without prescription for all girls of reproductive age. Sebelius was the first health secretary to publicly overrule the 98 Defining and Measuring Success USAID measured the success of a CRS project based on the number of units sold, not on the quantities used. However, getting the devices on the shelves was only half the battle. Purchase of contraceptives in no way guaranteed their proper use or that they were used at all. Recipients could buy condoms or a pack of pills and, despite the best advertising efforts, still not know what to do with them. For example, the local USAID mission and the Nepali government both celebrated the news that CRS sales accounted for 60 percent of measured contraceptive prevalence by June 1979. However, it is unclear how many of those contraceptives were actually used and what proportion of the eligible population was using contraception. 318 A 2009 review of USAID’s experience working with private sector health organizations acknowledged this problem. Due to “USAID’s tendency to focus on process indicators instead of project impact data . . . [i]t is impossible to be sure that USAID projects have actually improved the health status of targeted beneficiaries.” 319 To be sure, several studies indicated slight increases in contraceptive usage. However, the question remains how many potential users were lost due to USAID’s tunnel vision. A 1979 survey of potential contraceptive users reveals the implications of USAID’s focus on sales. The report evaluated the Nepal Household Distribution (HHD) program, a precursor to CRS intended to “sample potential CRS users with contraceptive products (Gulaf and Dhaal) FDA. She claimed her decision was due to the drug manufacturer’s lack of research on whether girls as young as eleven-years-old could use the medication. However, her decision also conveniently “avoided what could have been a bruising political battle over parental control and contraception during a presidential election season.” Gardiner Harris, “Plan to Widen Availability of Morning-After Pill Is Rejected,” The New York Times, December 7, 2011. 318 Speidel to DSB, “Justification for Non-Competitive Procurement with Westinghouse Health Systems (WHS) under the Contraceptive Retail Sales Project No. 932-0611 in Nepal,” 1. 319 Bowers, Feeley and B. Ravenholt, “A Review of USAID’s Experience with the Private Sector in Health,” 5. 99 prior to the commencement of the full-scale CRS product launch. Additionally, the HHD sought to ‘test’ the mass distribution of these products and their effect on practicing contraception.” The survey, which focused on men fifteen-years-old and older and women of child bearing years (fifteen- to forty-four-years old), revealed that the proportion of those who had ever-used contraception almost tripled. The proportion of current users nearly doubled over the course of four months. However, a majority of the people who had accepted the contraceptives opted not to use them, citing a desire for another child, the disapproval of family members, the use of some other method, or other factors. But even usage during the trial did not automatically equate to continued use. According to the final report, “it did not appear either the Dhaal or Gulaf acceptors were very likely to buy additional supplies. Only around 9 percent of the Dhaal ever- users and a little more than a fifth of the Gulaf ever-users bought more products.” While more men and women were using contraception after the program than before, very little attention was paid to the fact that the majority of those who received the samples never even tried them. We can only speculate as to what would have happened had there been a program that was in fact sensitive to existing cultural values surrounding pregnancy, family life, and gender roles. 320 Marc Vincent, the Regional Health Officer at the U.S. Embassy in Ghana, tried communicating to USAID the relevance that other factors played in dictating contraceptive practices. “Starting [the CRS project] with misconceptions leads to disappointment: Thinking that the adoption of contraception is a free, individual choice, is about true in the Western World 320 Gary L. Damkoehler, Lawrence Smith, Jr. and James R. Messick, A Report on the Household Distribution Program in Nepal, Westinghouse Health Systems, Columbia, MD, May 8, 1979, 13, 14, 17, Lot 85-45, Accession 286-85-056, box 1, folder “Nepal Market Research,” NACP. 100 but not in Africa,” he wrote. “In Africa, if population control happens it will be through a communal process, probably prompted by a leader.” 321 By emphasizing a technological solution to the population problem, USAID’s Office of Population and the CRS contractors mostly ignored such advice and with it, the various social, political, and economic conditions that collectively incentivize or discourage the use of prophylactics. 322 As a result, the necessary conditions for contraceptive use—a more balanced power relationship between men and women, increased educational and work opportunities for women, and a reconceptualization of sexual behavior to deemphasize shame, among others— never received the attention needed to ensure that the programs succeeded in limiting fertility rates. 323 A 1981 amendment to a USAID grant for family planning programs in Egypt, for instance, explicitly acknowledged the programs’ intent “to induce a change in fertility and institute a small family norm through widespread modern contraceptive use.” 324 However, by not altering the patriarchal systems that valued boys more than girls, these development programs could never succeed in incentivizing smaller families. The smaller family structure promoted by development would have dramatically altered the traditional cultural and economic foundations on which much of the developing world was based. While providing methods to limit fertility, 321 Marc Vincent to Ray Martin, Letter, November 7, 1977, 1, Lot 85-45, Accession 286-85-056, box 3, folder “GHANA Background Information,” NACP. 322 Dixon-Mueller, Population Policy & Women’s Rights, 51. For more on the relationship between poverty and rates of fertility, see Patricia H. David, “High Fertility and Short Birth Spacing: The Poverty Consequences of Family-building Patterns,” in Population and Poverty in the Developing World, edited by Massimo Livi-Bacci and Gustavo de Santis (Oxford: Oxford University Press, 1999). 323 Gordon, Woman’s Body, Woman’s Right, 420. 324 “Family Planning Project (263-0029) Amendment #4,” United States International Development Cooperation Agency, Agency for International Development, Washington, D.C., December, 1981, 8, Lot 85-45, Accession 286-85-056 box 4, folder “EGYPT – PIO/T RFP Correspondence,” NACP. 101 USAID and other foreign donors ultimately neglected to offer ways to compensate for such changes. 325 At least some Agency staffers understood the relationship between social conditions and a desire for fertility control as early as 1976. That year, an official Agency-commissioned report offered analysis and recommendations on U.S. population-related assistance. In addition to recognizing that with modernization comes the desire for smaller families, the report emphasized that “it is important to ask what about the development process most influences parents to seek smaller families, and how smaller families may be encouraged.” The report also noted the beneficial impact of massive rural development and greatly improved education, health, nutrition and family planning services, “especially when women are encouraged to move beyond their traditional roles.” 326 Ravenholt the Powerful Still, Ravenholt continued to insist that supplying “unmet need” would be sufficient to slow population growth, or was at the very least worth trying before pursuing other avenues. 327 Ravenholt claimed that, 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 325 Gordon, Woman’s Body, Woman’s Right, 391–92, 394; Gilbert Rist, The History of Development: From Western Origins to Global Faith, 3rd ed. (London: Zed Books, 2008), 79. 326 The report suggests several possible “pressure points:” public leadership, laws and administrative regulations; the status of women and female education; the economic cost and benefits of children; child health; and broad rural development. “U.S. population-related assistance; analysis and recommendations,” Agency for International Development Bibliographic Input Sheet, April 1976, 23–30, USAID Development Clearinghouse, accessed March 25, 2014, http://pdf.usaid.gov/pdf_docs/PNAAG166.pdf. 327 Connelly, Fatal Misconception, 245. 102 planning and control program should be the extension of family planning information and means to all elements of the population. 328 Steven Sinding, who became Director of the Office of Population in 1983, often butted heads with Ravenholt. “Ravenholt was, in many ways his own worst enemy,” he later recalled. “He understood that there was more to population than pills and condoms, but by his own utterances he allowed himself to become a caricature of what he actually believed which is more sophisticated than that.” Marshall Green, the population coordinator at the Department of State from 1975 until 1979, also found himself “immediately in a kind of clash with [Ravenholt].” Green did not think that Ravenholt’s approach “was going to be anywhere near adequate” but instead contended that “family planning was simply not enough” to stem the effects of rapid population growth. 329 With USAID’s population programs still in their infancy, Ravenholt “wielded power.” According to Green, Ravenholt, who had worked in the field of family planning for several decades, “had many people in the private organizations dealing with these issues who were beholden to him.” He had also helped the first generation of population officers once their jobs had become redundant, offering them opportunities to go back to school and brought them back to have a “second life in USAID.” 330 Green, like many others at the State Department and in USAID, was “completely disabused of the ideas that were being promoted” by Ravenholt. 331 Ravenholt’s theories ultimately dictated the course of USAID’s population programming for several reasons. First, despite his detractors in the State Department and in other branches of 328 Reimert T. Ravenholt, “AID’s Family Planning Strategy,” Science 163 (January 10, 1969): 125. 329 Sinding spent twenty years at USAID in a variety of roles, including as the Population Officer for the Asia Bureau and the Chief of the Population, Health and Nutrition Division in 1979. Sinding, Interview; Green, Interview. 330 Sinding, Interview. 331 Green, Interview. 103 USAID, Ravenholt ran USAID’s Office of Population, the primary governmental office responsible for administering U.S. foreign aid programs for population control. As such, he controlled the approximately $100 million earmarked each year for population and family planning programs. It is also likely that Ravenholt’s medical training and expertise in public health, and in family planning in particular, ensured allies within the medical community itself. In contrast, other government officials working on population growth came from political and diplomatic backgrounds. Green, for example, had been an ambassador in several countries and while his duties necessarily addressed population growth in the abstract, he was not an expert in the matter. Finally, the power of Ravenholt’s obstinate personality should not be underemphasized. As Green explained, Ravenholt “was a man to reckon with. He was very able and dynamic, he had a strong personality, a rather domineering personality.” 332 Sinding explained that Ravenholt “saw high fertility as a communicable disease basically; he felt that like any other disease this was a condition the people, who had it, didn’t want. And if you provided the appropriate therapy you could prevent it . . . . [H]e really viewed providing pills and condoms as the equivalent of vaccinations or immunizations against an unwanted medical condition.” Based on his interviews with women in several developing countries, Ravenholt was convinced that “in fact, they did not want to be pregnant all the time; that they were having many pregnancies that they didn’t want.” 333 Such theories on contraceptive use did not account for the fact that for many women, such as those in the Brahmin and Chhetris communities of east-central Nepal, pregnancy was the “paramount test of their identity and 332 Ibid. 333 Sinding Interview. 104 worth as human beings and child rearing the most enjoyable and rewarding of their many tasks.” 334 Sinding admits that at the time, “the conventional wisdom in the ‘70s and certainly in the ‘60s was that there was high demand for children.” However, he notes, “history has shown that Ravenholt’s instincts in this regard were much more correct than people then thought they were. People largely discounted the preferences of women in favor of the family economic arguments that seem to support the need for large families. But that was the male perspective.” Ravenholt and his allies on the ground seemed to truly believe in the potential of birth control to transform the lives of men and women around the globe, if only USAID could get the contraceptives into their hands. 335 Competing with Host Governments Although USAID publically claimed otherwise, early contraceptive programs often hindered indigenous birth-control efforts. 336 USAID and WHS, for example, at least publicly intended for their CRS program to complement Nepal’s pre-existing public distribution program. 337 Seims, a Project Manager in USAID’s Family Planning Services, maintained that existing CRS projects did not interrupt similar efforts by other organizations but instead prompted an overall market expansion. “I have spoken with ‘competitors’ in the private sector in 334 Bennet, “sex and motherhood among the brahmins and chhetris of east-central Nepal,” 1, 3, 5. 335 Sinding Interview. 336 Gordon, Woman’s Body, Woman’s Right, 393. 337 Thapa to Pande, “Commercial contraceptive marketing program in Nepal the Nepal Contraceptive Retail Sales (CRS) Project,” Letter, 2. 105 several CRS countries,” he told the head of a New Jersey pharmaceutical company. “They all testify to sale increases in their products coincidental with CRS product introductions.” 338 Various private and public organizations, however, proved that the CRS program had in fact impeded existing projects. The Community Based Distribution of Contraceptives program, established by the Family Planning Association of Nepal in 1976, experienced a drop in contraceptive sales once the CRS project entered the market. 339 The Ghana National Family Planning Program (GNFPP) resisted accepting a CRS project out of concern that U.S. efforts would interrupt their own. “It was apparent from the beginning that GNFPP members did not fully understand the objectives of the CRS Project, considering it in some way competitive to their own efforts,” wrote one WHS staffer. He went on to report, however, that “This non- supportive attitude has changed completely . . . . The [Government of Ghana] in-country counterpart has been formally and informally indoctrinated and involved in the project.” 340 Despite that staffer’s condescending optimism, his observations were both naïve and inaccurate. While USAID and GNFPP eventually agreed to work together on distribution programs, by the time the first contract expired in 1981, USAID refused to renew it. Sales lagged and conflict over marketing plans regularly arose between Agency staff and GNFPP personnel. 341 At the time, Ghana was still reeling from a military coup and was “politically 338 Timothy Seims to Leonard Kaplan, Letter, May 14, 1980, 1, Lot 85-45, Accession 286-85- 056, box 4, folder “Egypt – since consulting visit – before TRITON,” NACP. 339 The Family Planning Association of Nepal was an affiliate of the International Planned Parenthood Federation. “Progress Report of the Third Quarter 1978,” Family Planning Association of Nepal, Kantipath, Nepal, 1978, 14, Lot 85-45, Accession 286-85-056, box 1, folder “Background Information [2],” NACP; Smith and Seims, “Consultant Evaluation of Commercial Distribution of Contraceptives Program in Nepal,” 3. 340 “Status Report,” Westinghouse CRS Project – Ghana, n.d., 2, Lot 85-45, Accession 286-85- 056, box 3, folder “GHANA Contract (2),” NACP. 341 Ralph Susman, “Trip Report: Ghana,” May 8–18, 1981, 17, USAID Development Clearinghouse, accessed March 25, 2014, http://pdf.usaid.gov/pdf_docs/pdaan833.pdf. 106 uncertain, economically chaotic and administratively leaderless.” In his discussion of the project’s major flaws, Ralph Susman, a consultant hired to evaluate and make recommendations for the CRS program, laid most of the blame at the feet of Dr. A.A. Armar, Executive Director of GNFPP. In his field report, Susman described, and then crossed out, Armar as “trying to play ‘chief’ and to reassert control over his ‘turf.’” 342 By blaming the local officials, the Americans negated the flaws in their own efforts. They seem to have resented anything short of complete capitulation to USAID control, faulting local obstinacy rather than evaluating the conflict between U.S. programs and objectives and the local values and norms of the host country’s population. Stranger Danger Clearly, not everyone welcomed the influx of American family planning programs. Critics often viewed birth control devices as tools of imperial power that undermined national sovereignty, circumvented traditional husbandly authority, and disseminated American hegemony. Men resisted such efforts while women became increasingly ambivalent. 343 In Honduras, the Marxist left and Catholic Church both rejected population programs. As a marketing plan for the Honduras CRS project explained, “Both groups believe that the population problem is imagined and that the government of the United States imposes such programs . . . in order to maintain control of the area.” 344 342 R.M. Susman, “Field Report – Ghana,” February 28–March 20, 1982, 3, 13, Lot 85-45, Accession 286-85-056, box 3, folder “GHANA Contract Correspondence 1980,” NACP; Lisa Ann Richey, Population Politics and Development: From the Policies to the Clinics (New York: Palgrave Macmillan, 2008), 24. 343 Gordon, Woman’s Body, Woman’s Right, 394. 344 The criticism is partially accurate. U.S. foreign aid programs were in fact based on the premise that by giving financial assistance to developing countries, the United States could 107 While aware of these criticisms, Ravenholt and the Agency’s other population program staff believed they had something to contribute. As Ravenholt and a colleague once explained, “While we feel that it is presumptuous for outsiders to tell program administrators how they should run their programs, sometimes suggestions from the outside can bring about meaningful change in program pace or can inject constructive new ideas into the process.” 345 Aware of the wariness with which the targeted populations viewed Americans, staff of the CRS projects sometimes took steps to avoid mentioning the role USAID played in the programs. Such caution may explain why the official brochure for Dhaal and Gulaf described the Nepal CRS Project as a “non-profit developed by His Majesty’s Government of Nepal’s Family Planning and Maternal Child Health (FP/MCH) Project,” without mentioning any American involvement. The brochure noted that “programs similar to the Nepal CRS Project” were already underway in several other countries. 346 In a proposal for a household distribution project to occur three weeks prior to the launch of a CRS project in Ghana, WHS acknowledged the importance of public perception. One of the suggested approaches involved teams of one man and one woman taking prepackaged pills and condoms house-to-house in three selected village areas. According to the proposal, the team members would be selected “from the general target area to be covered.” While teams should be prevent them from turning to communism. However, those in USAID and in each of the presidential administrations starting with Kennedy did sincerely believe that population growth posed threats not only to democracy but also to the health and wellbeing of people around the world. Though not their primary motivation, humanitarian concerns did inform Agency programs. “Marketing Plan for the Honduras Contraceptive Social Marketing Program,” Triton Corporation, July 28, 1982, I-23, Lot 85-45, Accession 286-85-056, box 6, folder “CRS- Honduras, Marketing Plan 1980–1982,” NACP. 345 Ravenholt wrote the letter with R.Y. Grant, the Chief of the Near Eastern and South Asian Division Office of Population. It was addressed to the director of USAID/Bangladesh. R.T. Ravenholt and R. Y. Grant to Joseph Toner, Letter, March 17, 1975, Washington, D.C., Lot 85- 43, Accession 286-85-057, box 2, folder “PSI Correspondence 1975,” NACP. 346 “Dhaal & Gulaf.” 108 “honest, friendly, verbal, courteous, patient and reliable,” perhaps more tellingly, WHS wanted them to be people “homophilous (alike) to the eligible recipients so that they will be perceived with credibility and not as ‘outsiders.’” 347 Three years into the Ghana program, CRS staff went into crisis control when a local paper, Daily Graphic, printed a letter to the editor criticizing the program. “It is very embarrassing to see Panther Condom, a contraceptive for men, being sold to children to be inflated like balloons,” wrote Luke Pius Pope Mankrado of Takoradi. “This is very serious because the Panther Condoms made in the United States, [were] specifically designed for birth control and therefore should be sold only to adults.” 348 John Hayes, the Resident Manger of the Ghana project, reported back to officials at USAID and WHS. He began by stressing the positive: the project’s advertising campaign must be working since Mankrado quoted the advertising in his letter. Moreover, Mankrado was “in no way critical of the program itself” and only commented on the “greedy traders” selling the condoms. At least six other stories about such “greedy traders” appeared in the same edition of the newspaper. 349 Hayes went on to doubt that the balloons were in fact American-made condoms. In closing his letter, he tried to reassure his American readers: I am acquainted with Elizabeth Ohene, publisher of the DAILY GRAPHIC . . . . [S]he said the letter was published because she found it ‘interesting and amusing.’ She will publish no more letters on the subject, or make any editorial comment. If a letter is received from GNFPP she will let us know and discuss whether or not to publish. 347 Westinghouse Health Systems to Agency for International Development, “Proposal Reference No. B-1029,” Proposal for Household Distribution of Contraceptives in Ghana, September 1977, 1–3, Lot 85-45, Accession 286-85-056, box 3, folder “GHANA General,” NACP. 348 Luke Pius Pope Mankrado, “New Use for Condom?” Letter to the Editor, Daily Graphic, Ghana, January 16, 1980, 7, Lot 85-45, Accession 286-85-056, box 3, folder “GHANA Technical Correspondence 1977–1980,” NACP. 349 John D. Hayes to Arthur Danart, Letter, January 17, 1980, Lot 85-45, Accession 286-85-056, box 3, folder “GHANA Technical Correspondence 1977–1980,” NACP. 109 Though not necessarily indicative of how all CRS project managers would have handled the situation, Hayes’s actions still reflect USAID’s concerted effort to control the image of the CRS projects. 350 Condoms, Coercion, Critics Federal officials knew that U.S. family planning and development programs risked criticism and opposition. As an aide to President Nixon once complained, “Everyone else thinks our international family planning programs are aimed at weakening them.” 351 Despite such cautioning, it does not appear that these concerns had any immediate effect in changing U.S. family planning or development policy. Allegations of coercion within U.S. population programs only fueled such criticism. From the advent of U.S. population programs, U.S. policymakers underscored, at least on the surface, the importance of choice in the distribution and use of aid. Johnson publicly insisted that the United States would not force foreign countries to adopt specific programs or approaches. 352 In the same spirit, a 1967 USAID Policy Determination explained that as “A pluralist, democratic society, the United States believes in full freedom in the selection and the use of . . . methods for 350 Ibid. 351 Checker Finn to Daniel P. Moynihan, Memorandum, December 4, 1969, White House Central Files, Subject Files: Welfare, box 29, folder “WE 3 10/24/69 – 1/31/70,” Nixon. 352 Lyndon B. Johnson, “To the Congress on the Foreign Aid Program,” February 1, 1966, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=27804&st=foreign+aid&st1=. 110 the regulation of family size as are consistent with the mores and creed of the individual concerned. This is our practice at home; this has been and will remain our policy abroad.” 353 Still, early U.S. population programs at home and abroad did in fact include coercive elements. Just by receiving U.S. aid, foreign nations agreed to embark on population control programs inherently defined by American parameters. Sometimes, the coercion was more direct and explicit. Johnson used “food as leverage” and insisted on personally approving every supply of grain to India. In 1973, Ravenholt threatened withdrawal of American funds from Egypt unless the Egyptian government distributed contraceptives door-to-door throughout the country. In the early 1980s, though against U.S. law, USAID continued to fund 85 percent of the costs of incentive payments for sterilization in Bangladesh. In other instances, women received transistor radios, blankets, and even cash if they consented to sterilization. Women readily agreed to have intrauterine devices (IUD) inserted in exchange for payment. Desperate for cash, they often removed the IUDs on their own so that they could be paid to have another put in place. Living in dire poverty and given the chance to make some money, could these women really be said to have freely accepted family planning without any coercion? 354 Though couched in philanthropy and altruism, development required the transformation—if not destruction—of other societies. Infused by racial sensibilities rooted in eugenics, U.S. constructions of development presupposed a western ideal that did not always reflect the culture and history of the nations being “assisted.” 355 U.S. officials said as much, though mostly in private. In 1979, USAID’s Chief Officer of Health and Family Planning, 353 William Gaud, “Population and Family Planning Programs,” November 3, 1967, 1, USAID Development Experience Clearinghouse, accessed March 25, 2014, http://pdf.usaid.gov/pdf_docs/PDACK264.pdf. 354 Gordon, Woman’s Body, Woman’s Right, 391, 394; Connelly, Fatal Misconception, 217, 354–55; Goldberg, The Means of Reproduction, 52, 59. 355 Rist, The History of Development, 10, 13. 111 Gerold V. Van Der Vlugt, wrote to a colleague, “I am still the relatively ruthless population control advocate who believes in working within the system for change and believes we are forced to try and change a variable threatening the very survival of the western life style with our hands tied behind our back and our shoe laces tied together.” 356 Van De Vlugt likely meant the survival of democratic government against the threat of communism. However, his comment is telling in that the United States population programs were based on faulty assumptions that presupposed a cultural appreciation and approval of family planning. Not all U.S. officials agreed with Van De Vlugt’s objectives. In the 1970s, Senator George D. Aiken (R-VT) was among a handful of politicians to challenge the morality and efficacy of existing approaches to development. “Those who try to maintain the illusion that the world is divided into ‘developed’ and ‘underdeveloped’ nations must answer to the charge that they are investing the state of ‘development’ with qualities of not just economic, but moral superiority as well.” 357 As the Vietnam War became increasingly unpopular, though, Americans both inside and outside of government began adopting interpretations more similar to those espoused by Van Der Vlugt. Conclusion An effort at modernization, foreign aid re-appropriated older conceptual frameworks of imperialism. 358 By linking the financial support of family planning and population control with U.S. foreign policy goals, the federal government explicitly sought to change the demographic 356 Van Der Vlugt to Piotrow, Letter, 1. 357 George D. Aiken, “The Saints and Sinners of Foreign Aid,” Press Release, March 26, 1970, 6, White House Central Files, Subject Files: Task Forces, box 6, folder “EX FG 221-30 International Development [1969–70],” Nixon. 358 Michael E. Latham, Modernization as Ideology: American Social Science and “Nation Building” in the Kennedy Era (Chapel Hill: University of North Carolina Press, 2000), 15, 17. 112 structure and fertility patterns of foreign nations. 359 American foreign aid programs still continued to be officially characterized by voluntary participation for years to come, even when the United States very publicly limited the choices of or placed conditions on recipient countries and private NGOs. While this early emphasis on the voluntary nature of the programs helped appease Catholics domestically, U.S. foreign aid policy continued to be shaped by concern with the Catholic Church. By the time Nixon took office, new variables entered into the equation. 360 While strategic diplomatic objectives continued to fuel U.S. family planning programs, a new domestic controversy soon took over the conversation. Previously preoccupied with the technological aspects, health concerns, and political ramifications of funding contraceptives, everyone from the grassroots to the Oval Office turned their attention to one issue: abortion. Beginning in the late 1960s, abortion all but consumed the way advocates and officials understood the objectives, effects, and ideological implications of international family planning assistance. USAID birth control policies evolved to reflect American cultural attitudes and aspirations and offered a medium through which to channel U.S. power and beliefs abroad. With abortion-related policy constantly morphing to reflect similarly evolving domestic social and political debates, American cultural conflict would prove globally consequential. 359 Sharpless, “World Population Growth, Family Planning, and American Foreign Policy,” 72. 360 The Agency for International Development During the Administration of President Lyndon B. Johnson November 1963–January 1969, 121. 113 Chapter 3 Roe v. World: The U.S. Pro-Life Forces Take on the World On January 23, 1973, news of President Johnson’s death dominated above-the-fold headlines of newspapers across the United States. Below the banner headings and sprinkled throughout the pages of most newspapers, articles announced the Supreme Court’s decisions in the cases Roe v. Wade and Doe v. Bolton. 361 The news: a woman’s fundamental right of privacy “is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy.” The Court overruled all state laws that prohibited or restricted a woman’s right to have an abortion during the first three months of a pregnancy. 362 Associate Justice Harry Blackmun, the author of the majority opinion in Roe, would later call abortion “the most politically divisive domestic legal issue of our time.” 363 Less acknowledged, however, have been the international ramifications of the American political and legal conflict over the topic. By looking at the immediate legislative responses to Roe, the extent to which America’s treatment of abortion was and continues to be globally consequential becomes apparent. Exemplifying this dynamic, the 1973 Helms Amendment to the Foreign Assistance Act prohibited the use of USAID funds “to pay for the performance of abortions as a method of 361 Roe v. Wade, 410 U.S. 113 (1973); Doe v. Bolton, 410 U.S. 179 (1973); see, e.g., “Lyndon Johnson Dies at 64; Sought ‘Great Society’ for Nation,” The Washington Post, January 23, 1973; Robert D. McFadden, “Nation is Shocked,” The New York Times, January 23, 1973. 362 Roe, 410 U.S. at 153; Warren Weaver, Jr., “National Guidelines Set by 7-to-2 Vote,” The New York Times, January 23, 1973. 363 Webster v. Reprod. Health Servs., 492 U.S. 490, 559 (1989) (Blackumn, J., dissenting). 114 family planning or to motivate or coerce any person to practice abortions.” 364 The Helms Amendment, from how it was passed to how it was implemented and eventually expanded, provides perhaps the perfect case study through which to chart the rising influence of the pro-life movement, the emergence of the conservative wing of the Republican Party, and the global ripple effects of both phenomena. From Quickening to Criminalization Whereas questions of morality, individual rights, and medical practice dominate the very public conversations surrounding the procedure today, abortion was simply not an issue for open discussion in early American society. Rather, any references to abortion came through knowing winks, quick whispers among women, and such euphemisms as “taking [the] trade.” Deemed a woman’s concern and thus a private matter, abortion existed beyond the scope of government. Most often procured by unmarried women who feared that others would find out about an illegitimate pregnancy, abortion offered a way to keep illicit behavior out of the public eye. 365 Abortion was legal in the United States long before it was ever criminalized. Following the British common law, early American statutes treated pregnancy and human development as ongoing processes rather than as a series of finite, defined stages. As confirmed by the Massachusetts courts in Commonwealth v. Bangs in 1812, states did not consider abortion a crime if it happened before “quickening,” the time, normally around what we now identify as the 364 Section 114 of the Foreign Assistance Act of 1973, Pub. L. 93-189, 87 Stat. 714 (1973). 365 Susan Klepp, “Lost, Hidden, Obstructed, and Repressed: Contraceptive and Abortive Technology in the Early Delaware Valley,” in Early American Technology: Making and Doing Things from the Colonial Era to 1850, ed. Judith McGaw (Chapel Hill: University of North Carolina Press, 1994), 70; Deposition of Zerviah Grosvenor in Rex. v. Hallowell as cited in Cornelia Hughes Dayton, Women Before the Bar: Gender, Law, & Society in Connecticut, 1639– 1789 (Chapel Hill: University of North Carolina Press, 1995), 24. 115 end of the first trimester, when a woman can feel the fetus moving. To early Americans, quickening was the moment when a reasonable distinction could be made between an inanimate embryo and a moving, living fetus. 366 Until a woman was “quick with child,” there was no way to actually prove she was pregnant. Accordingly, the law only recognized the potential for life. Women themselves could never be certain whether a potential pregnancy or a possible illness had caused her “obstructed menses.” As such, they used the same herbal remedies and medicinal elixirs whether they were intentionally terminating a pregnancy or attempting to cure an unknown ailment. 367 The public condoned abortion to such a degree that there were no abortion-related statutes during the first few decades of the country’s existence. The first relevant regulations in fact did not even focus on the termination of pregnancies. In 1821, the Connecticut state legislature revised the state’s “Crimes and Punishments” law to include a section prohibiting the malicious administration of “any deadly poison, or other noxious and destructive substance” that could, among other things, “cause or procure the miscarriage of any woman, then being quick with child.” Though primarily concerned with the use of poison to commit murder, the legislature also acknowledged the dangerous potential posed by the toxins and extracts then being used as abortifacients. The statute did not criminalize the women taking the prohibited poisons. Rather, Connecticut, and the many states that later followed its example, held accountable the physicians and druggists who gave women the medicines. Nine years later, when revising the state’s criminal codes, the Connecticut legislature included a section that specifically 366 James C. Mohr, Abortion in America: The Origins and Evolution of National Policy (Oxford: Oxford University Press, 1979), 22–23. 367 Klepp, “Lost, Hidden, Obstructed, and Repressed,” 80–85. 116 criminalized abortions after quickening. Punishment for homicide, however, remained different and significantly more severe than the penalty for the crime of performing an abortion. 368 The rest of the states began restricting the procedure in the 1840s. Unlike today’s anti- abortion movement, religious organizations and clergy did not play a major role in these early efforts to criminalize abortion. Even the Catholic Church did not have a position on the issue until 1869. The 1872 Comstock Act, the result of Postal Inspector Anthony Comstock’s crusade for morality, banned advertising for abortion services and tools for their “obscene” nature. Ultimately, though, anti-abortion laws were products of several strategic campaigns for political, professional, and social power and status. 369 Part of a broader democratization of professions taking place throughout American society, and unhindered by licensing laws or stringent admissions requirements to medical schools eager to make a profit, large numbers of men and women began practicing medicine. Feeling the threat of such competition, formally trained physicians, also known as “regulars,” looked for ways to secure their elite status and establish the exclusivity of their profession. Lobbying state legislatures to criminalize abortion at all stages of pregnancy offered them a way to do so. 370 Regulars challenged the legality of abortion before quickening with arguments informed by their educational and professional backgrounds. They had long contended that a relatively 368 Mohr, Abortion in America, 21–22, 24–25. 369 In 1869, Pop Pius IX issued the papal enactment Apostolicace sedis, which extended excommunication to all abortions, and not just those of “ensouled” fetuses as had earlier been the case. Laurence H. Tribe, Abortion: The Clash of Absolutes (New York: W.W. Norton & Company, Inc., 1992), 31. 370 As graduates of the top medical schools, regulars believed in the value of scientific research and cooperative intercommunication. They established medical societies, published medical research journals, and stressed the necessity of formalized medical training. Mohr, Abortion in America, 31–34. 117 continuous developmental process followed the moment of conception and considered quickening a relatively insignificant step. They argued that if society considered the termination of a pregnancy after quickening to be wrong, and if quickening was a relatively arbitrary moment in a pregnancy, then it was equally immoral to abort before a woman was quick with child. By opposing abortion, physicians sought to “save women from their own ignorance” on this fact. 371 Invoking the Hippocratic Oath, regulars viewed abortion to be an attack on the sanctity of life. In 1859, claiming both moral superiority and scientific expertise, the newly-formed American Medical Association (AMA) called for the “general suppression” of all abortions, both before and after quickening. 372 However, the drive to change abortion laws was not just about morality. The regulars’ anti-abortion efforts were part of a strategic effort to professionalize their field; ensure their scientific authority; and protect their practices, social status, and incomes from lesser, untrained healers. As more and more women sought to terminate pregnancies, the regulars’ unwillingness to provide such services gave an edge to the “irregulars”—midwives, quack scientists, and less-trained practitioners who had, until that point, been allowed to practice freely. If regulars could successfully invoke their scientific and moral authority to convince state legislatures to prohibit abortion, irregulars would lose their appeal and their patients. 373 Physicians were not the only ones pushing for these legal changes. By the middle of the nineteenth century, attitudes towards pregnancy, fertility, and reproduction began to change. Not only were abortion rates on the rise, but also more importantly, a new population of women began seeking the procedure. Whereas poor, single women had initially been the most likely to have an abortion, by mid-century large numbers of white middle- and upper-class, native-born 371 Kristin Luker, Abortion and the Politics of Motherhood (Berkeley: University of California Press, 1984), 21. 372 Tribe, Abortion, 30. 373 Mohr, Abortion in America, 31–36. 118 Protestant women increasingly resorted to abortion in an effort to have smaller families. 374 Contributing to the fertility decline characteristic of this period of industrialization, the surge in abortions among these women frightened the men in their communities. Already unnerved by the persistent influx of immigrants, white middle- and upper-class men worried that their wives’ use of abortion would further jeopardize their status as the most populous, and thus influential, demographic. Fearful of the growing number of Catholics, “white male patriotism demanded that maternity be enforced among white Protestant women.” 375 In addition to jeopardizing the power and status of Protestant men over Catholics and immigrants, abortion challenged patriarchal authority within the family. As would be the case throughout the twentieth century, the late nineteenth-century movement to criminalize abortion was also a reaction to women’s activism outside the home. During this period of “voluntary motherhood,” women began asserting their right and choice to control their sexual activity and reproductive lives. These revolutionary arguments threatened some of the most basic understandings of American society, undermining long-held beliefs and cultural norms that treated marriage in part as the sexual submission of wives to their husbands. 376 A well-known writer and women’s activist, Elizabeth Oakes Smith pointed out in 1852, “Do we fully understand that we aim at nothing less than an entire subversion of the present order of society, a dissolution of the whole existing social compact?” 377 In 1840, only eight states had any laws restricting abortion. Whereas these earlier laws targeted medical practitioners, the next round of legislation, beginning with Massachusetts and 374 Ibid., 46. 375 Leslie J. Reagan, When Abortion Was A Crime: Women, Medicine, and Law in the United States, 1867–1973 (Berkeley: University of California Press, 1997), 11. 376 See Linda Gordon, “Who Is Frightened of Reproductive Freedom for Women and Why? Some Historical Answers,” Frontiers: A Journal of Women Studies 9 (1986): 23. 377 Quoted in ibid., 25. 119 New York in 1845, targeted the pregnant woman as well. By 1900, every state banned the use of drugs or instruments to procure an abortion regardless of the stage of pregnancy, unless necessary to save the woman’s life. While white women of means continued to terminate pregnancies in private homes, in doctors’ offices, and with the help of midwives, a major crackdown from 1890 through 1920 all but ended such practices. The medical profession and state legislatures had fully taken control of abortion, moving the procedure from the house to the confines of hospitals. 378 Over the course of the Great Depression and World War II, women began limiting their fertility in order to join the workplace. While these changes may have been a tolerable necessity during the war, few were willing to accept a permanent transformation. New, more restrictive abortion laws were thus part of an overall pronatalist effort to promote reproduction and reinforce traditional gender roles. 379 This status quo lasted until the mid-1950s when doctors, joined by concerned lawyers and later the women’s movement, began agitating for change in an effort to save women from the potentially fatal hazards of back-alley abortions. In 1965, a New York Times article reported on a study on abortion in Buffalo, New York. The study revealed the increased willingness of doctors to perform therapeutic abortions and a shifting public opinion approving of such practices. 380 At the two Buffalo hospitals under examination, the therapeutic abortion rate rose from 4 per 1,000 deliveries between 1943 and 378 Tribe, Abortion, 29; Luker, Abortion and the Politics of Motherhood, 15, 41; Reagan, When Abortion Was a Crime, 15. 379 Reagan, When Abortion Was A Crime, 163; see also Elaine Tyler May, Homeward Bound: American Families in the Cold War Era, rev. ed. (New York: Basic Books, 2008), 144. 380 “Therapeutic” abortions were those performed when the physician determined that continuing the pregnancy would “present a danger to the life or health of the woman.” Elaine Tyler May notes that the criteria were “haphazard and arbitrary. In most states, physicians were able to interpret the danger as they saw fit, and some women were able to have safe operations.” May, Homeward Bound, 145. 120 1949 to 8.4 per 1,000 between 1960 and 1964. While a rubella epidemic was partially responsible for the increase, the report revealed a growing reliance on psychiatric concerns to justify abortions. Whereas psychiatric reasons accounted for 13 percent of abortions in 1943, they were responsible for 87.5 percent in 1963. The doctors conducting the study concluded, “changes are occurring in the attitudes of doctors, and by implication, in the attitudes of society at large . . . . The law has not reflected these changes as yet. If good law represents the opinion of the majority, the time for reconsideration of the laws governing therapeutic abortion has arrived.” 381 Public opinion around the country increasingly favored the liberalization of abortion laws. A January 1972 Gallup poll found that 57 percent of Americans, and 54 percent of Catholics, thought that the abortion decision should be left to the woman and her doctor. 382 But even the public opinion polls were up for debate. The Rev. Msgr. James T. McHugh, for example, criticized the Gallup poll, objecting to a question that framed abortion in terms of a decision between a woman and her doctor. “Since abortion is a medical procedure,” he argued, “it seemed logical that most people would expect a woman to discuss her intention to abort with her physician.” Had the question been worded in terms of abortion-on-demand, McHugh believed the results would have been skewed in the other direction. The question, he suggested, was too simple and negated the unborn child’s existence. 383 381 Harold M. Schmeck, Jr., “Abortions Found Easier to Obtain – Buffalo Study Says Doctors are Stretching the Law,” The New York Times, June 22, 1965. 382 Jack M. Balkin, “Roe v. Wade: An Engine of Controversy,” in What Roe v. Wade Should Have Said: The Nation’s Top Legal Experts Rewrite America’s Most Controversial Decision, ed. Jack M. Balkin (New York: NYU Press, 2005), 6. 383 James T. McHugh, “Gallup Poll on Abortion,” August 25, 1972, Sargent Shriver (#214) Personal Papers, Series 7.2 1972 Campaign: Subject File, box 148, folder “Health: Abortion [Ahmann] (1 of 3),” John F. Kennedy Presidential Library, Boston, MA (hereafter “JFK”). 121 While many lower courts helped advance the cause of abortion liberalization, much of the progress took place when state legislators began passing new laws based on the American Law Institute’s (ALI) 1962 Model Penal Code. 384 When first released as a draft in 1959, Model Penal Code Section 230.3 proposed that abortion remain a felony, with punishment for infractions determined by when in the pregnancy the abortion took place. It added, however, that a physician should be allowed to terminate a pregnancy if the pregnancy posed a substantial risk to the mother’s physical or mental health, if the child would be born with grave physical or mental defects, or if the pregnancy was the product of rape, incest, or other felonious activity. The Model Penal Code also dictated that no abortion should be performed unless two physicians, one of whom would be performing the abortion, certified in writing the circumstances under which the procedure would take place. 385 The Code sought to protect doctors from liability and did not seek to ensure the reproductive rights of women. 386 The Model Penal Code had a tremendous influence on abortion laws throughout the country. In 1967 alone, thirty-eight state legislatures considered liberalized laws. That year, California became the first of fifteen states to pass abortion reform laws based on the ALI model. Shortly thereafter, Colorado passed a law that allowed abortion in cases of permanent mental or physical disability of the child or mother or in cases of rape or incest. Oregon and North Carolina passed similar laws. In total, between 1967 and 1969, fourteen states adapted ALI’s 384 The American Law Institute is the most prominent U.S. organization dedicated to producing “scholarly work to clarify, modernize, and otherwise improve the law.” Its Model Penal Code seeks “to stimulate and assist legislatures in making a major effort to appraise the content of the penal law by a contemporary reasoned judgment.” “ALI Overview” and “Publications Catalogue,” American Law Institute, accessed March 8, 2014, http://www.ali.org. 385 American Law Institute, “Section 230.3. Abortion, Adopted 1959,” in Model Penal Code, in Abortion in the United States: a reference handbook, ed. Dorothy McBride (Santa Barbara, CA: ABC-CLIO, Inc., 2008), 164–65. 386 Linda Greenhouse and Reva B. Siegel, eds., Before Roe v. Wade: Voices that Shaped the Abortion Debate Before the Supreme Court’s Ruling (New York: Kaplan Publishing, 2010), 25. 122 recommendations in their new abortion laws. 387 Justice Blackmun referenced the Code in his majority ruling in Roe. 388 Roe in an International Context Roe was a mere “ripple in a nationwide tide” of legal challenges and court-based changes to abortion laws. By 1973, one-third of the states had already liberalized their abortion laws. Despite the fact that no additional states even attempted repeal or reform from 1971 to 1973, some of Roe’s critics suggest that the states would have eventually changed their laws without the Court’s intervention. Viewed in an international context, Roe was far from premature and in fact reflected contemporary international trends. 389 The Supreme Court’s holding in Roe came during a “period of rapid abortion law reform throughout the world.” Between 1967 and 1978, forty-two countries made abortion more legally accessible. 390 American women were well aware of the abortion laws of other countries for three main reasons. First, periodicals including The New York Times and The Washington Post regularly ran articles on abortion in other countries. 391 Women’s organizations and academic 387 The states were Arkansas, California, Colorado, Delaware, Florida, Georgia, Kansas, Maryland, Mississippi, North Carolina, New Mexico, Oregon, South Carolina, and Virginia. Donald T. Critchlow, Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America (New York: Oxford University Press, 1999), 270n72; Rosalind Pollack Petchesky, Abortion and Woman’s Choice: The State, Sexuality, and Reproductive Freedom (New York: Longman, 1984), 103; Tribe, Abortion, 42. 388 Roe, 410 U.S. 140. 389 Greenhouse and Siegel, Before Roe v. Wade, xiv; Tribe, Abortion, 51. 390 By the end of this period, just 20 percent of the world’s population lived in places where abortion remained illegal. Committee for a Women’s National Abortion Coalition, International Roundup of Abortion Laws, n.d., 1, Patricia Gold Papers, 1964–1990, MC430, folder “40,” Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA (hereafter “Schlesinger”). 391 See, e.g., Robert Trumbull, “South Australia Permits Abortion: State Legalizes Procedure Under Certain Conditions,” The New York Times, December 7, 1969; Joseph Cerutti, “Eased 123 journals also published information on international laws and struggles over abortion. 392 Second, forestalled by the illegality of abortion in the United States, women who could afford to do so traveled abroad to obtain abortions in countries with more liberal laws or where abortions were at least more easily attainable. In the first three months of 1970 alone, more than 600 American women made “quick trips to Britain . . . for legal abortions they couldn’t get” in the United States. If we include the women who went to Puerto Rico, the numbers were even higher. 393 Finally, one country’s legislation could “inspire” legislation in other countries, even when several years passed between bills. 394 For example, the Scandinavian countries’ abortion laws had a lot in common with each other, specifically the dual goals of not only reducing the incidence of illegal abortions but also trying to decrease the total number of abortions by establishing early contact with pregnant women and making available a wide range of social services. 395 Most Eastern European countries also liberalized their abortion laws in comparable ways to one another. In 1955, the Presidium of the Supreme Soviet repealed the existing law prohibiting abortion. The preamble to the decree, “The Repeal of Prohibition of Abortions,” listed among its goals, “the limitation of the harm caused to the health of women by abortions Abortion Law is Passed in Britain,” The Chicago Tribune, July 15, 1967; David Lancashire, “Abortion: Legal and Free in Great Britain,” The Washington Post, June 30, 1968; Stephen Croall, “Sweden Broadens Abortion Choice,” The Washington Post, August 20, 1968; “Abortion Big Business in Juarez,” The Washington Post, November 21, 1968. 392 For other organizational analyses of international abortion laws, see Association for the Study of Abortion, Inc., Analysis of Abortion Laws in the United States, Papers of David E. Bell Ford Foundation Years, box 49, folder “Pop. Comm. - DEB Notes,” JFK; Committee for a Women’s National Abortion Coalition, International Roundup of Abortion Laws. The Reproductive Rights Newsletter, of the Reproductive Rights National Network, also regularly featured articles on international abortion laws and battles. See K. Stamm, TAM 212, box 4, Tamiment Library, New York University, New York, NY (hereafter “NYU”). 393 Sheila Wolfe, “How other nations’ laws treat abortion,” The Chicago Tribune, May 1, 1970. 394 Marge Berer, “Whatever Happened to ‘A Woman’s Right to Choose’?,” Feminist Review 29 (1988): 33. 395 Christopher Tietze, “Abortion in Europe,” American Journal of Public Health 57 (1967): 1926–27. 124 carried out outside of hospitals.” The law also sought to “give women the possibility of deciding themselves the question of motherhood.” Most of the socialist countries of Central and Eastern Europe passed similar legislation. 396 Litigation could have a similar ripple effect. Justice Blackmun alluded to then-recent British developments in his majority opinion in Roe. 397 Likewise, in her concurring opinion in the case of R v. Morgentaler in 1988, Canadian Supreme Court Justice Bertha Wilson explicitly referred to Roe and the line of subsequent U.S. Supreme Court cases reaffirming that decision. 398 Abortion rights advocates looked to other countries as models. As one Boston-based women’s organization wrote in a pamphlet, “Any country or state facing the problem of criminal abortion and reviewing the propriety of its abortion law and practices will find it helpful to take account of the laws in other countries.” 399 For example, the “1967 Act in Britain led many women from other European countries traveling [there] for abortions, which in turn helped to create pressure in those countries for a liberalized law.” 400 The debate in the United States was thus set against a backdrop of international change. Despite the many differences in circumstances, content, and context of the various reforms, several common themes permeated the processes of liberalization. The socialist emphasis on 396 Berer, “Whatever Happened to ‘A Woman’s Right to Choose’?,” 33; Committee for a Women’s National Abortion Coalition, International Roundup of Abortion Laws, 3; see also Tietze, “Abortion in Europe,” 1926; Rebecca J. Cook and Bernard Dickens, “A Decade of International Change in Abortion Law, 1967–1977,” American Journal of Public Health 68 (1978): 641. 397 Roe, 410 U.S. at 137–38. 398 Morgentaler v. The Queen, [1988] S.C.R. 30 (Can.); see also Julia L. Ernst, Laura Katzive, and Erica Smock, “The Global Pattern of U.S. Initiatives Curtailing Women’s Reproductive Rights: A Perspective on the Increasingly Anti-Choice Mosaic,” University of Pennsylvania Journal of Constitutional Law 6 (2003–2004): 760. 399 Female Liberation, knowledge and control: the issue of abortion, Boston, MA, n.d., K. Stamm, TAM 212, box 4, NYU. 400 Berer, “Whatever Happened to ‘A Woman’s Right to Choose’?,” 33. 125 gender equality in the Soviet Union, the 1975 publication of “The Manifesto of the 343” in France, written by Simone De Beauvoir and signed by 343 prominent French women, and the success of the feminist movement in the United States, all framed abortion as a woman’s right. 401 Drastic population growth and rapid urbanization disrupted traditional family life and by extension, also further influenced family planning policy and norms surrounding pregnancy. The liberalization of laws for contraceptives and the provision of equal access to fertility regulation for all women also drove reform efforts. Illegal abortion not only threatened the lives of women but also strained public health and hospital resources. Taken together, such “[s]ocial, cultural, and technological changes, along with an increasing public demand, propelled legal change.” 402 The Exceptionalism of the American Pro-Life Movement The U.S. experience does prove exceptional in one important way: the pro-life movement’s unique size, and its financial and political influence. 403 Whereas in other Western countries, religious leaders opposed to abortion “confined themselves mostly to expressing their 401 “Le Manifesto des 343 salopes,” Le Nouvel Observateur, #334, April 5, 1971, Le Nouvel Observateur, accessed March 29, 2014, http://tempsreel.nouvelobs.com/actualites/20071127.OBS7018/?xtmc=343&xtcr=1; see generally, Henry P. David, “Abortion in Europe, 1920–91: A Public Health Perspective,” Studies in Family Planning 23 (January – February 1992): 1–22; Tietze, “Abortion in Europe,” 57; Committee for a Women’s National Abortion Coalition, International Roundup of Abortion Laws. 402 Cook and Dickens, “A Decade of International Change in Abortion Law,” 641–42; Rebecca J. Cook, “Abortion laws and policies: challenges and opportunities,” International Journal of Gynecology and Obstetrics 30 (1989): 61; David, “Abortion in Europe,” 5. 403 Though it has been less successful than its American counterpart in passing restrictive legislation and in winning court cases, the British anti-abortion campaign has employed similar tactics, even taking on the cause of late term abortions at the end of the 1980s. See Berer, “Whatever Happened to ‘A Woman’s Right to Choose’?,” 30. 126 views without investing resources in political organizing on the issue,” the exact opposite happened in the United States. 404 In the years immediately before and after Roe, the budding anti-abortion movement was largely seen as being orchestrated by the Catholic Church. In 1971, early activists Jack and Barbara Willke published their Handbook on Abortion, in which they tried appealing to a broader audience by dismissing the idea that abortion opponents were all Catholic or that they based their opinions on the Church’s teachings. 405 Americans United for Life (AUL), founded the same year and self-proclaimed to be “the country’s oldest national pro-life organization,” was initially associated with and funded by the Society for a Christian Commonwealth, a conservative Catholic organization. Though initially founded and run almost entirely by Catholics, the AUL was officially nondenominational and sought to frame a secular argument against abortion in order to “attract broad-based support from Americans of all faiths.” 406 In 1973, the U.S. Catholic bishops created the National Right to Life Committee. Two years later, the Pastoral Plan for Pro-Life Activities was launched to facilitate grassroots organizing. 407 As the executive director of the National Right to Life Committee, Roy White, said in 1975, “The only reason we have a pro-life movement in this country is because of the Catholic people and the Catholic Church.” 408 404 Barbara B. Crane, “The Transnational Politics of Abortion,” Population and Development Review 20 (1994): 247–48. 405 J.C. Willke and Barbara Willke, Handbook on Abortion (1971), in Greenhouse and Siegel, Before Roe v. Wade, 99; Lee Epstein and Joseph F. Kobylka, The Supreme Court and Legal Change: Abortion and the Death Penalty (Chapel Hill: University of North Carolina Press, 1992), 208 (discussing public perception of the Catholic character of the pro-life movement after Roe). 406 Greenhouse and Siegel, Before Roe v. Wade, 88. 407 Crane, “The Transnational Politics of Abortion,” 247–48. 408 Tribe, Abortion, 146 127 The Republican Party first began using abortion as a wedge issue to differentiate Nixon from his challengers and to court Catholic voters and social conservatives generally. 409 In March 1971, when Catholic senator and Democratic presidential frontrunner Edmund Muskie announced that he was “concerned about diluting in any way the sanctity of life,” Nixon’s advisors disagreed on how to respond. 410 White House Counsel John Ehrlichman suggested the president stay silent so as not to jeopardize the women’s vote in 1972. Aides Charles Colson and Pat Buchanan, however, encouraged the president to use abortion as a way to increase the conservative Catholic vote. 411 In one memo, Buchanan advised Nixon to embrace the “single- issue” concern of abortion as a way to make Muskie take a position that would alienate Catholic voters. 412 Siding with Colson and Buchanan, Nixon issued his own statement saying that he, too, believed in the “sanctity of human life—including the life of the yet unborn,” and that he therefore opposed “unrestricted abortion policies, or abortion on demand.” The following month, Nixon announced a new policy requiring all military hospitals to conform to the abortion laws of the state in which they were based. These decisions represented a shift for Nixon who, just a year before, had advised congressional Republicans running for reelection to avoid discussion on the “religiously polarizing and politically divisive subject of abortion.” 413 409 Linda Greenhouse and Reva B. Siegel, “Before (and After) Roe v. Wade: New Questions About Backlash,” Yale Law Journal 120 (2011): 2054. 410 James Reston, “Nixon and Muskie on Abortion,” The New York Times, April 7, 1971. 411 Daniel K. Williams, “The GOP’s Abortion Strategy: Why Pro-Choice Republicans Became Pro-Life in the 1970s,” Journal of Policy History 23 (October 2011): 518. 412 Hearings Before the Senate Select Committee on Presidential Campaign Activities, 93d Cong. 4146, 4146–53 (1973) (Memorandum from Patrick J. Buchanan to the President, March 24, 1971); Hearings Before the Senate Select Committee On Presidential Campaign Activities, 93d Cong. 4197, 4201 (1973) (Memorandum from “Research” to the Attorney General H.R. Halderman, October 5, 1971); Greenhouse and Siegel, “Before (and After) Roe v. Wade,” 2054. 413 Williams, “The GOP’s Abortion Strategy,” 519. 128 The Rockefeller Report Nixon was forced to address abortion again in March 1972, when the Commission on Population Growth and the American Future (the “Commission”) released its final report. Established by an act of Congress and at Nixon’s request in 1970, the Commission had been charged with providing recommendations on how the United States should approach the issue of population growth. 414 It had taken the Commission over a year to address abortion. In a memo to David Bell, the former USAID Administrator who was now working for the Ford Foundation, Commission member Robert McLaughlin wrote that the Commission could ultimately not avoid the abortion subject since it would naturally come up in discussions of how to prevent unwanted pregnancies. Still, McLaughlin hoped that the courts would take the “hot potato” off their hands. 415 The commissioners had four options for how to handle the issue. First, they could support the status quo wherein abortion would remain the purview of the states. Second, they could promote the ALI’s Model Penal Code that would legalize abortion in cases of rape or incest or if the mother’s life or emotional or physical health was in danger. Alternatively, the Commission could take the liberal position. Represented by a recent New York abortion law, this stance supported abortion for any woman who requested it, until twenty-four weeks of pregnancy 414 Derek S. Hoff, “‘Kick that Population Commission in the Ass’: The Nixon Administration, the Commission on Population Growth and the American Future, and the Defusing of the Population Bomb,” Journal of Policy History 22 (2010): 25. 415 Robert McLaughlin to David Bell, “Abortion Statutes,” Inter-Office Memorandum, December 18, 1970, Papers of David E. Bell Ford Foundation Years, box 49, folder “Pop. Comm. - DEB Notes,” JFK. 129 (unless the woman’s life was in danger in which case the time limit would not apply). Finally, they could advocate the total repeal of all existing abortion laws. 416 The stakes were high for how the Commission ultimately handled abortion in its final report. After presenting to the Commission on the subject, “Pro-Natalist Aspects of Laws Relating to Contraception, Abortion, and Voluntary Sterilization in the United States,” Harriet Pilpel, the chairwoman of the Law Panel of International of Planned Parenthood Federation, called attention to the power and influence the Commission held. She suggested that the Commission’s treatment of abortion would surely influence the lower courts. While the Commission focused on domestic population problems and policies, Charles Westoff, Associate Director of the Office of Population Research at Princeton University, underscored the global implications of the Commission’s actions. “It would strengthen the U.S. hand in dealing with other countries,” he argued, “even if abortion would have no or almost no demographic impact in this country.” 417 On March 24, 1972, ten months before the Supreme Court announced its ruling in Roe, the Commission released its “Final Report of the Commission on Population Growth and the American Future,” also known as the Rockefeller Report for the Commission’s chair, John D. Rockefeller III. After providing an overview of the various problems caused by population growth, the Commission laid out several policy recommendations for how the federal government could slow population growth. Most controversial, however, were the Commission’s suggestions on abortion. In order to enable all Americans to avoid unwanted births, the Commission proposed the liberalization of all abortion laws. The commissioners added, 416 James Bausch to David E. Bell, “Issues Discussed in Population Commission Meetings During Your Absences,” Memorandum, November 23, 1971, 10–11, Papers of David E. Bell Ford Foundation Years, box 49, folder “Pop. Comm. - Bausch/McLaughlin,” JFK. 417 Ibid., 9, 11. 130 however, that such changes should be accompanied by “the admonition that abortion not be considered a primary means of fertility control.” They further recommended that the delivery of health services related to fertility, including abortion, be improved and extended. 418 A 1968 report from Johnson’s Presidential Advisory Council on the Status of Women had also recommended the repeal of abortion laws and a 1970 White House task force on the mentally handicapped likewise suggested that no woman be forced to bear an unwanted child. The Rockefeller Report, however, represented the first time a federal commission, created through an act of Congress, advocated for the liberalization of abortion laws. 419 Responses to the report offer a window into the evolving attitudes on abortion at the time. While Rockefeller successfully secured support from the Protestant National Council of Churches, the National Catholic Welfare Conference argued the Commission had walked into an “Ideological Valley of Death.” 420 Even before the release of the report, Women Concerned for the Unborn Child and Pennsylvanians for Human Life published a response that included an analysis of the Commission and its projected findings. Their report, “A Pro-Life Report on Population Growth and the American Future,” sought to provide “a sounding board for the pro- life movement . . . in the area of population control and those anti-life activities to which it is inextricably bound.” Crafted largely in reaction to an interim report from the Commission and to public statements supporting abortion by several Commission members, the Pro-Life Report 418 Commission on Population Growth and the American Future, Themes and Highlights of the Final Report of the Commission on Population Growth and the American Future (Government Printing Office, 1972), 13, The Personal Papers of James A. Burke, box 85, folder “Abortion 1972,” JFK. 419 Tribe, Abortion, 46; Ruth Roemer, “Abortion Law Reform and Repeal: Legislative and Judicial Developments (March 1971),” in Greenhouse and Siegel, Before Roe v. Wade, 122. 420 Hoff, “‘Kick that Population Commission in the Ass,’” 44. 131 claimed there was ample evidence that the federal government was promoting and financing “a Malthusian ideology which views abortion as a legitimate birth control technique.” 421 Many in Congress heard from constituents about the Rockefeller Report. Letters received by Representative James A. Burke (R-MA) reveal the variety of opinions expressed. In her letter to Burke, Mrs. John J. Mullen “vigorously protest[ed] the use of tax dollars for the very negative drive of cutting the birth rate” and questioned the appropriateness of the government’s participation in population control. 422 Specifically disturbed by the Rockefeller Report’s language on abortion, Joseph J. Reilly, the Executive Director of the Massachusetts Catholic Conference, expressed his horror that “a federal commission would fall into this trap of inhuman barbarity.” He went on to note that “the vast majority of citizens . . . violently oppose” such measures. 423 Nurse Rube Cline offered a different view, telling the congressman that she thought it was “high time that the Government take severe steps to control the number of children in a family.” She also emphasized her support for abortion as “a start in the discouragement of reproduction.” 424 Nixon rejected the entire Rockefeller Report, in part out of concern with appeasing Catholic voters during an election year. He asked speechwriter Patrick Buchanan to draft his response because, Nixon said, he was the only one who could “kick that population commission 421 Randy Engle, A Pro-Life Report on Population Growth and the American Future (1972), 1–2, Sargent Shriver (#214) Personal Papers, Series 7.2 1972 Campaign: Subject File, box 148, folder “Health: Abortion [Ahman] (2 of 3),” JFK. 422 Mrs. John J. Mullen to James Burke, Letter, February 4, 1972, The Personal Papers of James A. Burke, box 85, folder “Abortion 1972,” JFK. 423 Joseph J. Reilly to Congressman James A. Burke, Letter, March 22, 1972, The Personal Papers of James A. Burke, box 85, folder “Abortion 1972,” JFK. 424 Ruby Cline to James Burke, Letter, September 14, 1972, The Personal Papers of James A. Burke, box 85, folder “Abortion 1972,” JFK. 132 in the ass.” 425 Though Nixon later opted for a milder response drafted by other speechwriters, his disdain for the Commission’s recommendations was clear. In his first public address, Nixon declared, “In particular, I want to reaffirm and reemphasize that I do not support unrestricted abortion policies . . . . In my judgment, unrestricted abortion policies would demean human life.” 426 A few months later, Nixon wrote to Cardinal Terence Cooke of New York, voicing his support of the Catholic Church’s campaign to have New York’s abortion prohibition reinstated. Likely leaked by the White House itself, the letter represented another appeal to Catholic voters. 427 Nixon’s repudiation of the Rockefeller Report and his outreach to Cardinal Cooke were among the first Republican overtures made to abortion opponents. Though not a deciding issue in the 1972 elections, abortion was still “indispensable as a symbolic, rhetorical tool” for the Republican Party. 428 Legislative Responses to Roe From 1967 to 1973, no U.S. Senator or Representative introduced a single anti-abortion bill in Congress. 429 However, following Roe, a handful of congressmen, most notably 425 Quoted in Hoff, “‘Kick that Population Commission in the Ass,’”44. 426 Richard Nixon, “Statement About the Report of the Commission on Population Growth and the American Future,” May 5, 1972, Special Message to Congress, July 18, 1969, Online by Gerhard Peters and John T. Woolley, The American Presidency Project, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=3399&st=population&st1=commission. 427 Richard Nixon to Cardinal Terence Cooke, Letter, May 16, 1972, in Greenhouse and Siegel, Before Roe v. Wade, 157. 428 Timothy A. Byrnes, “Issues, Elections, and Political Change: The Case of Abortion,” in Do Elections Matter?, eds. Benjamin Ginsberg and Alan Stone, 3d ed. (Armonk, NY: M.E. Sharpe, 1996), 114 (cited in Greenhouse and Siegel, “Before (and After) Roe v. Wade,” 2059n122). 429 The Family Planning Services and Population Research Act of 1970 authorized the Secretary of the Department of Health, Education, and Welfare to allocate federal funds for research in 133 conservative Senators James L. Buckley of New York and Jesse Helms of North Carolina, immediately tried to overturn, or at the very least minimize the ruling’s impact. 430 During the 93rd Congress, in session from 1973 to 1974, sixty sponsors introduced forty legislative amendments in the House of Representatives. Nine sponsors introduced two legislative amendments in the Senate. 431 The Department of Health, Education and Welfare Secretary’s Advisory Committee on the Rights and Responsibilities of Women interpreted these legislative efforts in the following way: “It can only be concluded that for some 68 members of the House and nine members of the Senate to attempt to turn back the Court’s ruling, the opponents of abortion must be disproportionately powerful for their numerical strength.” 432 Three legislative riders became laws, denying otherwise available federal funding that would facilitate abortions. First, money provided to the Legal Services Corporation could not be used to help indigent clients obtain abortion services. 433 Second, the Church Amendment to the Health Programs Extension Act of 1973, named for Senator Frank Church (D-ID), permitted “the biomedical, contraceptive development, behavioral, and program implementation fields related to family planning and population.” Section 1008 of the Act, however, specifically prohibited the use of such funds in programs “where abortion is a method of family planning.” Pub. L. No. 91-572, 84 Stat. 1504 (1970); Mary E. King, Abortion: Report to the DHEW Secretary’s Advisory Committee on the Rights and Responsibilities of Women (n.d.), 68, Patricia Lindh and Jeanne Holm Files 1974–1977, General Subject File Abortion – General (1), box 6, folder “Abortion – General (1),” Gerald Ford Presidential Library, Ann Arbor, MI (hereafter “Ford”). 430 Tribe, Abortion, 144. 431 Mary E. King, Overview Report on Abortion Services and Recommendations: DHEW Secretary’s Advisory Committee on the Rights and Responsibilities of Women, Health Subcommittee Chairperson, April 1976, 68–69, Patricia Lindh and Jeanne Holm Files 1974– 1977, General Subject File Abortion – General (1), box 6, folder “Abortion – Report to DHEW Secretary’s Advisory Committee on the Rights and Responsibilities of Women (2),” Ford. At the state level, legislators introduced 188 anti-abortion bills in forty-one states in the first sixth months after Roe. David, “Abortion in Europe, 1920–91,” 12. 432 King, Abortion: Report to the DHEW Secretary’s Advisory Committee on the Rights and Responsibilities of Women, 69. 433 Legal Services Corporation Act of 1974, Pub. L. No. 93-355, 88 Stat. 378 (1973); Tribe, Abortion, 145. 134 “any individual or hospital opposed to abortion to refuse to perform the procedure.” 434 Finally, Congress passed the so-called Helms Amendment to the Foreign Assistance Act, named for Helms, its sponsor. The amendment prohibited the use of foreign aid to assist in the provision of or payments for abortions. 435 Pre-1973 Abortion-Related USAID Programs Taking office just days before the Court announced its ruling in Roe, Helms embodied the forces that would eventually propel the Republican Party and with it, political realignment. A devout Christian who said that he once had a born again experience, Helms drew attention for his regular denunciations of abortion, pornography, sexual promiscuity, and homosexuality. He also became a leading advocate of school prayer. His conservative political credentials were strong: he fought against the civil rights revolution’s accomplishments, advocated for states’ rights, and lamented rising taxes and expansive government bureaucracy. While his confrontational style originally isolated Helms from other Senate Republicans, by the 1980s he was one of the leaders of a powerful New Right movement. 436 When introducing his amendment in October 1973, Helms claimed USAID supported abortion in “at least three major ways.” First, abortion was one of the approved methods of fertility control in its population programs. Second, the Agency financially supported international organizations that provided training, facilities, and hospitals for the performance of abortions, and “propaganda programs to make abortions culturally acceptable in foreign 434 Health Programs Extension Act of 1973, Pub. L. No. 93-45, 87 Stat. 91 (1973); Tribe, Abortion, 145. 435 Section 114 of The Foreign Assistance Act of 1973, Pub. L. 93-189, 87 Stat. 714 (1973). 436 William A. Link, Righteous Warrior: Jesse Helms and the Rise of Modern Conservatism (St. Marten’s Press: New York, 2008) 131–32, 177. 135 countries.” In 1971, for example, the Population Council received a $100,000 grant for the sole purpose of financing the purchase and transportation of abortion equipment to India. 437 Finally, USAID funded research “aimed at developing cheap methods of abortion, principally through so-called abortifacient drugs.” 438 By 1968, for example, USAID funded research into the use of prostaglandin as an abortifacient compound. Researchers hoped to develop a synthetic prostaglandin that would easily induce a miscarriage. Such a drug would enable women to terminate a pregnancy on their own, without medical supervision. It would also save money on equipment and training and make abortion more accessible to women in rural areas. In 1973, the University of Michigan Department of OB/GYN received two grants totaling almost $200,000 to develop pharmaceutical abortifacients. 439 That same year, USAID awarded a grant of $2,368,000 to George Washington University for research on sterilization, prostaglandins, and pregnancy termination. 440 While this was but a fraction of the foreign aid budget, these early efforts reveal the extent to which population officials at USAID supported abortion on an international scale. A report from the Johns Hopkins Program for International Education in Gynecology and Obstetrics provided data behind their support. Written in 1973, the report suggested that, “If the 437 119 Cong. Rec. 32,292–93 (1973); Elmer B. Staats, U.S. Comptroller General, to Senator William Proxmire, Chairman of the Subcommittee on Foreign Operations, Letter, April 21, 1972, accessed March 29, 2014, http://www.gao.gov/assets/210/204288.pdf. 438 119 Cong. Rec. 32,292–93 (1973). 439 Kate Prager, Project Report for Inventory of Federal Research in Population: Report Control Symbol U-1612/2, Title of Project: Tophoblast Study Program, September 27, 1973, and Project Report for Inventory of Federal Research in Population: Report Control Symbol U-1612/2, Title of Project: Effect of PGE, and PGF2a on Uterine Contractility and Endometrial Morphology, September 27, 1973, Lot 85-56, Accession 286-85-064, box 5, folder “Miscellaneous Data Folder,” National Archives, College Park, MD (hereafter “NACP”). 440 Gary Kommer, Project Report for Inventory of Federal Research in Population, Report Control Symbol U-1612/2, Title of Project: Rapid Diffusion of Population Research Findings,” September 20, 1973, Lot 85-56, Accession 286-85-064, box 5, folder “Miscellaneous Data Folder,” NACP. 136 abortions are not used to back up other contraceptives and abortion alone is used for birth control each abortion is conservatively estimated to prevent 0.3 births. If it is used as a back-up for contraceptive failure each abortion is estimated to prevent 1.0 birth.” The report went on to estimate that abortions could prevent from 3.9 million to 23 million births. 441 A grant of over $1 million to the Battelle Memorial Institute of Seattle, Washington is one example of how the United States responded to such information. According to a project report, the main objective of the “Surgical and Engineering Research on Means of Fertility Control” project was to “develop improved and simplified methods of early pregnancy termination, female sterilization, and reversible male sterilization suitable for [Less Developed Countries, or] LDCs.” The report explicitly placed the need for better fertility control methods in developing nations. There is no mention of whether these developments would be useful and applicable to men and women in the United States. The report also noted that following the development of new equipment for pregnancy termination, the Institute would distribute prototypes to “LDC clinics” for evaluation. The clinics’ feedback would then inform the specifications for the final pregnancy termination equipment package. Rather than develop and test new methods for abortion domestically, the projects’ overseers made women and their doctors in developing countries the test subjects. 442 441 Advanced Technology Fertility Clinics (ATFG’s), March 13, 1973, 32–33, Lot 81-125, Accession 286-82-015, box 3, folder “The JHPIEGO Corporation Workpapers 79-74, 3/, 5-24- 79,” NACP. 442 Mary I. Perry, Project Report for Inventory of Federal Research in population, Title of Project: Surgical and Engineering Research on Means of Fertility Control, Population Research Sponsored by the Agency for International Development, FY 72, Capsule Summaries, n.d., Lot 85-56, Accession 286-85-064, box 5, folder “Miscellaneous Data Folder,” NACP. 137 Legislative History Helms introduced his amendment to the Foreign Assistance Act “to prevent the use of AID funds—that is to say, funds collected from the taxpayers of the United States—in the practice and promotion of abortion.” 443 While the Helms Amendment and the Foreign Assistance Act were still in House-Senate Conference, Helms wrote to J. William Fulbright (D-AR), the chair of the Senate Foreign Relations Committee, about a position paper circulated by USAID Administrator Daniel K. Parker. Arguing that it would impede American population programs, Parker strongly opposed the Helms Amendment. His position paper suggested that the amendment would mark a significant change in U.S. policy and that it further “contradicts the principle that every nation should be free to determine its own policies.” 444 Helms claimed that Parker’s paper contained numerous “misleading and false statements.” 445 Suggesting that USAID’s existing abortion-related programs lacked congressional authorization, Helms said that his amendment would, “reverse a policy which was unilaterally adopted by AID in recent years without congressional authority.” The amendment, he said, merely forbade actions found “repugnant,” adding that, “if other nations wish to choose government-funded killing, they can pay for it themselves.” Refuting the position paper’s claim that the amendment would disrupt population assistance programs, Helms said that certain 443 Oklahoma Senator Dewey Bartlett was listed as a cosponsor of the amendment. 119 Cong. Rec. 32,292 (1973). 444 Jesse Helms to Daniel K. Parker, Letter, October 26, 1973, 1, Record Group 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, National Archives, Washington, D.C. (hereafter “RG” and “NA”). 445 Jesse Helms to Honorable J. W. Fulbright, Letter, October 26, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 138 programs would simply need to seek other funding opportunities from outside NGOs, foundations, and foreign governments. 446 Helms wrote to Parker to encourage him directly to disavow the policy paper’s contents. He also expressed his frustration that many USAID staff members had been lobbying against the amendment. Parker’s paper noted that the U.N. had declared abortion the most effective means of fertility control and that accordingly, the Helms Amendment would drastically impact countries’ abilities to check population growth. In response, Helms argued, It might also be said in parallel fashion that Hitler devised Auschwitz as the single most important means of solving the “Jewish problem,” and that our participation in World War II dealt a severe blow to one of the most effective methods of checking the Jewish population growth. Killing is killing, and no declaration by the UN will make it otherwise. 447 After Helms first proposed his amendment, constituents wrote in droves to Fulbright. The letters provide a good snapshot into public sentiment because, as chair of the committee, Fulbright received mail from around the country and not just from his home state of Arkansas. Though the letters came down on both sides of the amendment, a significant majority opposed the measure. Some objected to the influence of a minority opinion on foreign aid while others feared the effects the policy would have on efforts to slow population growth. Several argued that the government should not prohibit abroad the exercise of reproductive rights that were allowed in the United States. Others questioned the appropriateness of narrowly dictating the terms of foreign assistance. 446 Helms to Parker, Letter, October 26, 1973, 2. 447 Ibid. 139 Gladys of Olympia, Washington, for example, considered the bill “unjustifiable control of public policy decisions of other countries.” 448 Ed of Silver Spring, Maryland declared, “Since our Supreme Court has upheld every woman’s right to have an abortion, there is no reason why our foreign aid funds should not help women in other countries enjoy the same right.” 449 Objecting to what she saw as the imposition of a minority viewpoint, a woman named Ellen wrote, “We can not be ruled by a small minority of fanatics.” 450 Sheldon of Royal Oak, Michigan, similarly argued that the amendment reflected “the attempts of a vocal, well-headed minority” to subvert the Supreme Court’s ruling in Roe. Like many other writers, Sheldon also questioned the efficacy of the amendment considering the state of world population growth. “With world population growth at 75 million per year, such restrictions are a serious, possibly disastrous, threat to the future of the peoples of the world.” 451 Echoing this sentiment, Martha of Gainesville, Florida noted, “There is no use to send foreign aid at all if you are going to limit abortions and I.U.D.’s. The stork is ahead of the plow already. Must we always have the butchery of back-room abortions, hunger, and disease for population control?” 452 Several religious organizations opposed what they saw as a Catholic influence on the legislation. John V. P. Lassoe, Jr., the Executive Assistant to the Episcopal Bishop of New York, questioned the “unwarranted imposition of Church upon State.” “It is irrelevant to the foreign 448 Gladys C. Burns to Senator J. William Fulbright, Letter, October 16, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 449 Ed Doerr to Honorable J. William Fulbright, Letter, October 10, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 450 Ellen London to Senator J.W. Fulbright, Letter, October 15, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 451 Sheldon Beck to Senator J.W. Fulbright, Letter, October 11, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 452 Martha Reed to Senator Fulbright, October 13, 1973, Letter, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 140 policy of this country,” he wrote, “while risking intrusion in the domestic policies of other nations.” 453 R.W. Mostek, Chairman of the Church/State Committee of the Third Unitarian Church, expressed similar concerns. The Unitarian-Universalist Association showed great leadership in the fight for abortion reform, Mostek told Fulbright, adding, “We believe that women have too long been denied proper medical care and we do not believe that any church or churches should impose their medical dogma on persons not of their belief.” 454 Joyce Hamlin and Ellen Kirby, the Secretary for Legislative Affairs and the Executive Secretary, respectively, of the Global Ministries of the United Methodist Church also opposed the amendment, arguing that the “language of the section is entirely too broad and severely restricts countries wrestling with the problems of population growth.” 455 Fulbright also heard from members of the medical community. Dr. S.L. Atkinson emphasized that the problem of abortion falls first and foremost on doctors themselves. Citing the “hypocrisy, stupidity and ignorance” of abortion laws that disproportionately affect the poor, the doctor asked Fulbright, “Why should we, or any country for that matter, be subjected to the hypocrisy of the past based on ignorance and the process of shoving someone else’s religious beliefs down everybody’s throat?” 456 Dr. John J. Sciarra, head of the Department of Obstetrics and Gynecology at the Program for Applied Research on Fertility Regulation at the University of Minnesota Medical School, stressed the amendment’s potentially harmful effects on research and 453 John V. P. Lassoe, Jr. to Hon. J. William Fulbright, Letter, October 11, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 454 R.W. Mostek to Sen. J. Wm. Fulbright, Letter, October 14, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 455 Joyce Hamlin and Ellen Kirby to Hon. J.W. Fulbright, Letter, October 11, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 456 S.L Atkinson, Letter, October 29, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 141 medical training. “The law [already] specifically forbids coercion of individuals in the practice of any form of fertility control,” he wrote. “The proposed amendment would have the effect of placing U.S. restrictions on the ability of individuals and governments in developing countries to freely and voluntarily choose among the means of fertility control.” The law, Sciarra said, would prohibit women in developing countries from experiencing “the same range of fertility control measures available to women in the U.S.” 457 Writing on behalf of the National Organization of Women, Ann Scott appealed to all members of Congress not to abandon women in developing nations. Scott warned that because of “this dangerous precedent,” the government could eventually force women not to bear children. “We view this action . . . as the first step toward exercising complete control over the reproductive lives of all women and men in the world.” Like many other writers, Scott also argued that a small minority should not be able to dictate foreign policy, especially when such a position ignores the judgment of the Supreme Court and the health needs of women and their families around the world. 458 The President, Executive Director, and Medical Director, among others, of International Planned Parenthood Federation (IPPF) co-signed a letter detailing the perceived ramifications of the Helms Amendment. While the IPPF did not promote abortion, the organization did receive numerous requests from around the world for training and equipment to deal with dangerous, illegal abortions. The proposed restrictions, they argued, “would be very difficult or even impossible” to administer in an international organization like IPPF. “Furthermore, it could do serious damage to our programmes to take contraceptive advice to women admitted to hospitals 457 John J. Sciarra to J.W. Fulbright, Letter, October 8, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 458 Ann Scott to Member of Congress. 142 with illegal abortions—a group of people who are among the most desperately in need of family planning help and supplies.” 459 Not all concerned constituents contested the proposed abortion restrictions, however. Compared with the dozens of messages opposing the amendment, Fulbright’s files contained only three letters of support, each sent by a member of the Right to Life Society. Mary, the President of a Society chapter in Greater Dayton, commended Helms “on his foresight and concern for human life and the entire family of man here and abroad.” 460 The Westchester Right to Life Committee and Dr. John Middleton of the New York State Right to Life Committee sent similar telegrams urging passage of the amendment. 461 Still, the juxtaposition of the large number of letters against the proposed abortion restrictions with the few in favor suggests the considerable public opposition to the measure. The high volume of mail and public disapproval to the Helms Amendment initially compelled the Senate Conference Committee to delete it on the second day of its meetings. Soon thereafter, however, the Committee reversed its decision. While the Congressional Record does not indicate why that decision was made, it is likely that Helms reintroduced the amendment when many of the committee members were not there. Indeed, with many members absent, the rest of the Committee approved the Helms language for the bill it sent to the Senate for a full 459 Malcolm Potts to Hon. J. William Fulbright, Letter, October 26, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 460 Mary Gigandet to Senator Fulbright, Letter, October 12, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 461 Westchester Right to Life Committee to Senator J W Fulbright, Letter, October 11, 1973, and John Middleton to Senator J W Fulbright, Letter, October 11, 1973, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 143 vote. 462 Helms and Democratic Senator Mike Mansfield of Montana used procedural maneuvers to conclude the session despite the lack of quorum. 463 The Congressional Record from the House provides more insight into how the abortion debate was evolving in Congress at the time. Angelo Roncallo (R-NY) considered the Helms Amendment a strong response to the Supreme Court’s decision in Roe. “The Supreme Court has ruled that the States cannot in effect protect the unborn,” he said, “but the Court in no way indicated that Congress or the states have to appropriate funds for killing the unborn.” The proposed amendment, he said, would “continu[e] a long-established policy of Congress to respect human life, whether it be the life of the unborn or born.” Lawrence Hogan (R-MD) similarly viewed the amendment as “clearly another step in demonstrating Congress’s opposition to the policy of abortion,” which, he claimed, was “so repugnant to the American people.” 464 Representative Bella Abzug (D-NY), however, decried the Helms Amendment as “a manifestation of patriarchal chauvinism.” “It appears that we are attempting to deny the women abroad the freedom of choice in family planning that our own Supreme Court has recently 462 Ann Scott to Member of Congress, Form Letter, November 23, 1973. 463 When it was time to consider the Helms Amendment, Senator Hubert Humphrey (D-MN) suggested the absence of quorum. As the legislative clerk called roll, Mansfield asked for “unanimous consent that the order for the quorum call be rescinded,” thus halting the quorum call. Without objection, it was so ordered. Mansfield then proposed a series of time restrictions on debating the Foreign Assistance Act going forward. It is unclear from the Congressional Record why Mansfield wanted to disregard the lack of quorum. However, it is not uncommon for committees to proceed despite lack of quorum and the procedural steps taken here are likewise used regularly. Based on his request for time limits on subsequent debates, it could be that Mansfield just wanted to expedite the process. If the clerk had finished the roll call and if there was in fact a lack of quorum, the Senate would have been in recess indefinitely until a quorum could be reached. Nothing in the record outwardly suggests that Mansfield had been colluding with Helms. Mansfield did not have any record of being particularly attached to the abortion issue. It is most likely, however, that Helms made an off-the-record deal with others on the Committee to go along with the procedural maneuver. 119 Cong. Rec. 32,529 (1973). 464 119 Cong. Rec. 39,314–39,315 (1973). 144 granted to women in this country,” Abzug argued, adding that it was a “serious interference with the internal affairs of other countries.” 465 In the end, the Senate version of the bill directly prohibited use of U.S. funds for abortion, for the promotion of abortion, or for abortion-related research. The House responded with a similarly worded amendment, but left out the research restrictions. 466 When Nixon signed the amended Foreign Assistance Act into law on December 17, 1973, section 104(f) read: “Limiting Use of Funds for Abortions. None of the funds made available . . . shall be used to pay for the performance of abortions as a method of family planning or to motivate or coerce any person to practice abortions.” 467 Though in its original form the Helms Amendment prohibited the use of foreign aid both for abortions and for advocacy of abortion rights, its final version banned only the former. 468 Moreover, USAID could continue to sponsor abortion-related research. According to Arthur Z. Gardiner, general counsel of USAID, the amendment, was “not intended to prevent the training of doctors or others in medical techniques of abortion or the furnishing of equipment useful in such techniques.” 469 465 119 Cong. Rec. 39,317 (1973). 466 J.W. Fulbright, “Form Letter: on Foreign Relations,” n.d., 1, RG 46, Committee on Foreign Relations, 93rd Congress, Legislative Files (S. 2335), Records of the U.S. Senate, NA. 467 Pub. L. 93-189, 187 Stat. 714 (1973). 468 Jeannie I. Rosoff, “Pregnancy Counseling and Abortion Referral for Patients in Federally Funded Family Planning Programs,” Family Planning Perspectives 8 (January/February 1976): 45. 469 Patrick A. Trueman, “Abortion and American Foreign Policy,” Studies in Law and Medicine (Americans United for Life, n.d.), 2 (internal formatting omitted), Stephen Galebach Files, box 1, folder “Abortion – Agency for International Development (2),” Ronald Reagan Presidential Library, Simi Valley, CA (hereafter “Reagan”). 145 Implementing the Helms Amendment on the Ground Despite his earlier opposition to the restrictions, USAID Administrator Parker was now legally responsible for enforcing the Helms Amendment. He issued a policy determination, “A.I.D. Policies Relative to Abortion-Related Activities,” to inform USAID missions and aid recipients of the new restrictions. The policy determination restated aspects of foreign policy, such as the ban on coercive elements in USAID-related programs. It also announced new terms for family planning programs: USAID would no longer distribute funds to procure or distribute equipment to induce abortions. USAID money could not be used to pay women to undergo abortions nor could it be used to cover the costs of abortions. There was no reference to abortions intended to save the life or protect the health of the mother. While funds could not be spent to support abortion-related activities, USAID would, however, continue to give money to organizations that performed abortions so long as the U.S. funds remained “wholly attributable to the permissible aspects of such programs.” 470 Because Congress explicitly omitted a ban on abortion-related research, USAID involvement in this area did not need to change. Instead, Parker wrote simply that USAID would “continue to support research programs designed to identify safer, simpler, and more effective means of fertility control. This work includes research on both foresight and hindsight methods of fertility control.” 471 Later that month, another policy determination prohibited the use of U.S. 470 National Security Study Memorandum: Implications of World Wide Population Growth for U.S. Security and Overseas Interests (Washington, D.C.: December 1974), 115. 471 Daniel Parker, A.I.D. Policies Relative to Abortion-Related Activities, AID Handbook, (USAID: June 10, 1974), USAID Development Experience Clearinghouse, accessed March 27, 2014, http://dec.usaid.gov/index.cfm?p=search.getSqlResults&CFID=14217834&CFTOKEN=989274 43. 146 funding for “information, education, training or communication programs that seek to promote abortion as a method of family planning.” 472 Testifying before the House Subcommittee on Foreign Operations and Related Agencies in 1976, Parker clarified the Agency’s policy regarding the funding of gynecological and obstetrical training. Pregnancy termination, he explained, “is a standard component of the curriculum to prepare students in the event that such procedures are needed for purposes of saving lives.” Speaking to accusations of hypocrisy otherwise levied against the Helms Amendment, Parker added, “We have not insisted that the training program for developing country students be altered from that which the U.S. doctors and students get.” 473 By 1979, less than one-half of one percent of USAID’s population funds were spent on anything related to abortion, and that money was spent primarily in the field of research. Most of that money went to the International Fertility Research Program in North Carolina for research on effective methods of limiting births including various types of abortion. In 1981, under pressure from anti-abortion groups, USAID discontinued funding for any abortion-related research. 474 (Not) Filling the Gap Since the Helms Amendment only limited the use of American money, recipients could still use other sources of funding to cover abortion-related expenditures. USAID encouraged philanthropic foundations to fill the financing gap. The Population Crisis Committee heralded 472 Ernst, Katzive, and Smock, “The Global Pattern of U.S. Initiatives Curtailing Women’s Reproductive Rights,” 774 (quoting USAID, Policy Determination No. 56, A.I.D. Policies Relative to Abortion-Related Activities (1974), 2). 473 Foreign Assistance and Related Agencies Appropriations for 1977: Hearings before a Subcommittee of the Committee on Appropriations, 94th Cong. 309 (1976). 474 Daniel P. Warwick, “Foreign Aid for Abortion,” Hastings Center Report 10 (April 1980): 31; “Information Sheet on A.I.D. Support for Family Planning Services,” n.d., Stephen Galebach Files, box 1, folder “Abortion – Agency for International Development (3),” Reagan. 147 the Helms Amendment as a “blessing in disguise,” one that forced abortion advocates, “to rely less on large donors and the public sector and make productive explorations into abortion as a business venture.” 475 However, due to the controversial nature of abortion, many organizations refused to redirect their grants to abortion-related programs and projects. Dr. Reimert T. Ravenholt, Director of USAID’s Office of Population, remarked that major foundations “recoiled” from the suggestion. 476 The Ford and Rockefeller Foundations, two leaders in family planning assistance, for example, refused to channel funding to such projects. There are two possible explanations for their hesitancy. First, any affiliation with abortion had the potential to “touch off controversies that would impair work in less volatile areas of higher priority.” Second, because abortion was still illegal in many countries, there was a “common use of clandestine techniques to promote abortion services.” Together, these factors may have caused “considerable squeamishness among professional staff members at the foundations.” 477 From 1952 until 1976, the Population Council supported only abortion research and writing. Despite his support for overall family planning programs, Council president Bernard Berelson had “serious ethical and prudential reservations about foreign aid for abortion, and his board seemed to share those misgivings.” What those exact concerns were, however, is unclear. By 1976, new president George Zeidenstein added abortion to the range of services the Council supported. It is unclear what, if anything other than a change in leadership prompted the decision. Meanwhile, IPPF spent only one-third of one percent of its total budget on abortion. 478 475 Warwick, “Foreign Aid for Abortion,” 32, 35. 476 Crane, “The Transnational Politics of Abortion,” 258n21. 477 Warwick, “Foreign Aid for Abortion,” 32–33. 478 Ibid. 148 The Helms Amendment greatly affected the Pathfinder Fund, which had been using USAID money to establish clinics and distribute vacuum aspiration kits for abortions. According to a Pathfinder official, “The Helms Amendment has disastrously affected population programming by destroying all the linkages between abortion and contraceptive recruiting.” Despite the encouragement of the U.S. government, no major family planning organization or philanthropic foundations fully picked up the financial slack that the restrictions had created. By 1979, only a small group of international donors directly supported abortion activities in developing countries; the rest provided indirect support through research and sponsorship of meetings and conferences. 479 Concerns Over Implementation The Helms Amendment’s supporters worried about how effectively and stringently the law was being implemented. In March 1976, Congressman Clement J. Zablocki (D-WI) wrote to Parker to discuss his concerns and those of Randy Engel, of the U.S. Coalition for Life, that USAID continued to grant funding to IPPF. Zablocki and Engel wanted assurances that the money was being used within the boundaries of the law. In his response, Parker noted that Helms had expressed similar concerns when discussing the final language of the amendment. However, Parker continued, Helms had also stated that the amendment “would not put any restrictions whatsoever upon the programs of foreign governments and international organizations which fund abortion programs from other sources.” 480 479 Quoted in ibid., 31, 34. 480 Daniel Parker to Clement J. Zablocki, Letter, Mar 1, 1976, 1, Government Accountability Office, accessed March 29, 2014, http://www.gao.gov/assets/200/194633.pdf. 149 Parker also specified how far the Agency would go towards enforcing the abortion- related restrictions: While Agency-[IPPF] agreements prohibit the use of the Agency funds for abortion-related activities, costs/expenditures have not been segregated. In the past, the Agency has held that the majority of Federation activities were worthy of its support and would not be excluded from support by U.S. Government legislation. The informal arrangements have been that the abortion-related costs would be financed by other donors. 481 However, the Agency was taking steps to ensure compliance. A 1975 audit of IPPF’s accounting system led USAID to push for a “cost accounting system, adequate to support the attribution of costs at both the central office level in London and at the affiliate level.” IPPF agreed to redesign its accounting procedures. Parker assured Zablocki that the technical monitor in USAID’s Office of Population “believes the revised procedures will be sufficient to overcome the objections of the auditors and to satisfy others responsible for assurances that the spirit and intent of the Helms Amendment are being met.” 482 Though Parker said the Auditor General would be issuing a final report on IPPF’s audit in February 1976, I have not been able to locate it. However, nothing in the records suggests that Parker was not being honest with Zablocki or that he was stalling for time. Johns Hopkins Program for International Education in Gynecology and Obstetrics Zablocki and Engel’s concerns over the implementation and adherence to the Helms Amendment were well founded. Since the advent of USAID and extending back to the Truman and Eisenhower administrations, expansive bureaucracies, inefficiency, and problems with accountability had plagued the management of U.S. foreign assistance. A 1979 audit of the Johns 481 Ibid., 2. 482 Ibid. 150 Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) reveals the ways such weaknesses influenced the Agency’s ability to implement the Helms Amendment’s abortion-related restrictions. JHPIEGO received USAID funding for its program that provided gynecological and obstetrical training for doctors in developing countries. As part of the program, JHPIEGO distributed USAID-financed “diagnostic and surgical equipment to developing country institutions and clinics that furnished Fellows for training at JHPIEGO educational centers.” The equipment included menstrual regulation kits and vacuum aspirators, both of which can be used to perform abortions. On January 5, 1978, Ben Stevens, an auditor for USAID, discovered that five menstrual regulation kits were being “carried on” JHPIEGO inventories. 483 The kits presented two problems. First, they were used for abortions and were thus prohibited by the conditions of the USAID grant. Second, USAID’s previous administrator had directed the Office of Population to purge its offices of any such kits. 484 When questioned on the origin, quantity, procurement, and shipment of the kits, JHPIEGO’s equipment manager, Dale Clapper, said that JHPIEGO had received them from USAID sometime in February 1974, several months after Congress passed the Helms Amendment. Clapper insisted that telephone orders came “from the top.” Pressed further, he disclosed that an assistant had made the call on Dr. Ravenholt’s behalf. Clapper insisted that JHPIEGO’s president had cleared all actions and contacts made with USAID. 485 483 It is unclear if JHPIEGO received menstrual regulation kits from any source other than USAID. However, the document suggests that JHPIEGO received these specific kits from USAID. 484 Ben Fields to The File, “Menstrual Regulation Kits,” Letter, January 5, 1978, Lot 81-125, Accession 286-82-015, box 3, folder “The JHPIEGO Corporation Workpapers 79-74, 4/, 5-24- 79,” NACP. 485 Ibid. 151 If Clapper’s recollection was accurate, the incident indicates that Ravenholt, while director of USAID’s Office of Population, directly violated the terms of the Helms Amendment. Ravenholt and many at the Agency had publicly opposed the abortion restrictions. Though the reasons for such subversion are unknown, it is possible that Ravenholt was deliberately trying to subvert the policy. Steven Sinding, who served as head of the Office of Population from 1983 to 1986, remarked years later about Ravenholt and his staff: “it was a funny group of people. But the intensity of their loyalty to [sic] Ravenholt was really quite a remarkable thing.” 486 Unfortunately, it is impossible to know how many Agency officials and staff worked at circumventing the Helms Amendment’s restrictions. The final audit reported on JHPIEGO’s training program for 1,218 fellows working in Advanced Fertility Clinics in developing nations. Of the 119 fellows interviewed, 40 percent admitted to using USAID-financed equipment for abortions. The auditor noted that if the percentage was an accurate representation of all of JHPIEGO’s fellows, “it becomes evident that a great deal of AID-financed equipment is being used to perform abortions which may be in contravention of the Foreign Assistance Act.” 487 Of the fellows who admitted to performing abortions with USAID-funded equipment, several said that they knowingly and deliberately circumvented both host country and U.S. laws by using practices that masked actual abortion procedures. One unnamed fellow said that he used USAID-financed equipment to perform abortions 100 percent of the time. When a patient 486 Steven W. Sinding, Interview by W. Haven North, The Foreign Affairs Oral History Collection of the Association for Diplomatic Studies and Training, February 27, 2001, accessed March 27, 2014, http://www.loc.gov/item/mfdipbib001070/. 487 “Questionable Use of AID-Financed Equipment,” n.d., Lot 81-125, Accession 286-82-015, box 3, folder “The JHPIEGO Corporation Workpapers 79-74, 1/, 5-24-79,” NACP; Area Auditor General Washington, “The JHPIEGO Corporation: Audit Report Number 79-74,” Agency for International Development, Washington, D.C., May 24, 1979, 17, Lot 81-125, Accession 286- 82-015, box 4, folder “The JHPIEGO Corporation Workpapers 79-74, 33/, 5-24-79,” NACP. 152 became pregnant despite using an intrauterine device (IUD), the fellow, with the consent of the patient and another doctor, would administer an X-ray. Used as a way to locate the IUD, the X- ray also provided the necessary “medical reason” to meet the legal restrictions for abortions in the host country. The fellow called the X-ray his “trick.” If the fellow saw a patient within two weeks of her missed period, he used a Karman Cannula Syringe (not financed by USAID) to terminate the pregnancy. He used the USAID-funded vacuum aspirator when a woman presented with a missed period of more than two weeks but no later than twelve or thirteen weeks. According to the final audit, although the fellow knew that his methods violated USAID protocol, he did not appear remorseful. Confusion over the intent of the original policy directive might account for the fellow’s breach of policy. Based on the fellow’s deliberate “trick” to work around the various laws it is more likely that the he did not agree with the restrictions or simply did not care. 488 The auditor attributed such problems to a lack of effective oversight by the Agency itself and warned that if proper measures were not taken to ensure compliance, the Agency would have to face the consequences of violating the law. 489 The auditor noted that USAID has been “less than expedient [with] advice to contractors and grantees.” For instance, it did not amend JHPIEGO’s grant to include an abortion clause for more than twelve months after circulating the policy determination announcing implementation of the Helms Amendment. 490 Aspects of the abortion restrictions also made enforcement difficult. USAID’s Office of Population had previously endorsed the provision of medical kits and aspirating machines to 488 Theodore M. King to Gerald P. Gold, Letter, December 6, 1978, 27, Lot 81-125, Accession 286-82-015, box 4, folder “The JHPIEGO Corporation Workpapers 79-74, 15/, 5-24-79,” NACP. 489 It is unclear who at USAID was responsible for such oversight. However, Ravenholt surely carried some of the responsibility. 490 “Questionable Use of AID-Financed Equipment.” 153 overseas clinics. While such tools could be used to induce abortions, the Agency continued to justify funding them because of their many other medical uses. The JHPIEGO auditor criticized this interpretation, explaining, “[W]e nevertheless still believe it can be construed that AID is financing abortion as a method of family planning by indirectly furnishing aspirating machines and medical kits.” Adding to the confusion over whether the law had been broken, JHPIEGO had originally ordered the equipment prior to passage of the Helms Amendment, though it did not ship the vacuum aspirators until July 1975 when the policy was in place. 491 The auditor suggested that in order to ensure that clinics would not use their equipment for abortions, NGOs should obtain statements of intent from clinics and countries receiving the tools. Theodore M. King, President of JHPIEGO, cited USAID’s General Counsel when refuting the idea. In December 1973, Counsel had advised JHPIEGO that the House-Senate Conference Committee “did not intend the [Helms Amendment] to be construed as an attempt to dictate medical procedures to individual women in developing countries or to medical practitioners following the prevailing local customs and medical practice or to foreign governments.” 492 The audit also identified problems with the April 1976 JHPIEGO pilot program, “Training for Family Health and Family Planning Administrators.” Of the forty-six sessions offered by the program, three covered induced abortion and another focused on spontaneous abortion. Together they made up less than 10 percent of the overall curriculum. USAID’s Office of Population had approved the program on grounds that the attention paid to abortion was at the level necessary to adequately cover the health problems most doctors would face in regions of 491 Ibid., 28; Area Auditor General Washington, “The JHPIEGO Corporation,”19–20. 492 King to Gold, Letter, 30–31. 154 high fertility. The audit acknowledged the difficulty in determining whether the distribution of educational information amounted to the “promotion” of abortion. 493 It is unclear what, if anything, happened as a result of the audit. JHPIEGO is not mentioned in related congressional hearings. When contacted recently, current officials at USAID and Johns Hopkins did not know about the audit. However, the analysis of the JHPIEGO program and the ways in which the Amendment was circumvented, were precisely the type of reasons motivating further restrictions to foreign aid. Meanwhile, at Home… Despite such early, if limited, successes, anti-abortion conservatives saw modest setbacks in the post-Watergate elections of 1974. In fact, several of the most aggressive anti-abortion leaders in the House were defeated. 494 Meanwhile, all efforts to pass a constitutional amendment banning abortion failed. The initial attempt to ban Medicaid funds for abortion came in 1974. With a vote of 50-34, the Senate opted to keep debate on the proposed bill alive, thus showing existing support for the idea. 495 Two years later, when Democratic Senator Ted Kennedy of Massachusetts came into office and took on the amendment’s author, Republican Dewey Bartlett of Oklahoma, the Senate voted to end consideration on the amendment, 54-36. Another attempt 493 Area Auditor General Washington, “The JHPIEGO Corporation,” 17. 494 It is unclear whether their opposition to abortion was among the factors contributing to their losses. Tribe, Abortion, 146. 495 Congress first authorized Medicaid funding for family planning in 1972. In 1973, service members and their families could have abortions funded through the Defense Department. Women in federal prisons, federal employees, and Medicaid recipients could also receive federal funds to cover the costs of abortion. In 1976, approximately $45 million was spent on approximately 300,000 abortions. See “Achievements in Public Health, 1900–1999: Family Planning,” Morbidity and Mortality Weekly Report 48 (December 3, 1999): 1073–80; Melody Rose, Safe, Legal and Unavailable? Abortion Politics in the United States (Washington, D.C.: CQ Press, 2007), 129. 155 came the following year in the form of an amendment to the Labor/Health, Education and Welfare appropriations bill. The House rejected it. Senator James L. Buckley of New York failed in his efforts to pass a similar amendment to social security legislation. 496 By 1976, pro-life groups had successfully elected a large number of anti-abortion congressmen to office. 497 Republican Henry Hyde of South Carolina, in his first year in the House, became a champion of the pro-life cause and set his sights on Medicaid. Though several states had already banned the use of Medicaid funds for abortions, Hyde proposed an amendment to Title XIX of the Social Security Act to extend the prohibition to the entire country. In the conference committee, due to the demands of several senators, an exception to save a woman’s life was added to the bill. Every subsequent Congress has renewed the amendment. The American Civil Liberties Union estimated that by the early 1980s, the Hyde Amendment and similar federal restrictions affected 20 million women who relied on the government for their health care or health insurance. These laws made abortion inaccessible to poor women on Medicaid, Native Americans, federal employees and their families, volunteers in the Peace Corps, low-income residents of Washington, D.C., federal prisoners, military personnel and their dependents, and disabled women on Medicare. 498 But why was Congress able to restrict international aid for abortions several years before doing so domestically? In the early years after Roe, abortion opponents employed what could best be described as a “go-for-broke” strategy, one that did not pay off right away. It was difficult to even get a hearing on anti-abortion legislation. Congressman Don Edwards (D-CA), 496 Tribe, Abortion, 151. 497 Rickie Solinger, Pregnancy and Power: A Short History of Reproductive Politics in America (New York: NYU Press, 2005), 201. 498 “Public Funding for Abortion,” American Civil Liberties Union, July 21, 2004, http://www.aclu.org/reproductive-freedom/public-funding-abortion. 156 as chairman of the House Judiciary Committee, for example, refused to hold hearings on the proposed constitutional amendments. While there were sixteen days of hearings on such an amendment in the Senate in 1974 and 1975, it never received the majority vote required for being reported out of the subcommittee. 499 For abortion opponents, it proved easier to limit the expenditure of foreign aid than of domestic funds. While there was some opposition to the Helms Amendment both in Congress and among the public, it was ultimately less difficult to restrict the rights of women abroad than it was to do so for women at home. The ruling in Roe did not extend to women abroad. 500 Democratic Representative Bella Abzug criticized the Helms Amendment for precisely this reason, calling it “a misuse of the legislative process and of the aid program. It is providing a channel for the frustrations of those who object to the Supreme Court’s decisions, but it is not the purpose of legislation to provide such a channel.” 501 Legislative efforts in the domestic and international arenas both, however, revealed the growing anti-abortion contingent in the Congress and foreshadowed later attempts to similarly limit the effects of, if not outright overturn, Roe. The Helms Amendment was just the first time anti-abortion forces would succeed in dictating the terms of U.S. foreign aid. As the Republican Party became increasingly successful at turning abortion into a partisan issue, their legislative power only grew. 499 Tribe, Abortion, 144; see also Scott H. Ainsworth and Thad E. Hall, Abortion Politics in Congress: Strategic Incrementalism and Policy Change (Cambridge, England: Cambridge University Press, 2011), 109. 500 Ernst, et al, “The Global Pattern of U.S. Initiatives Curtailing Women’s Reproductive Rights,” 768. 501 119 Cong. Rec. 39,317 (1973). 157 Conclusion Arguably the most significant factor distinguishing the legal and political history of abortion in the United States is the impact that the pro-life movement has had on shaping foreign aid policy, specifically that for family planning. That history began in earnest in 1973 with the Helms Amendment. Just as his amendment was a preview of future legislation, Helms himself was likewise the beginning of a conservative ascendancy within the Republican Party. The Helms Amendment to the Foreign Assistance Act was the first, and certainly not the last time the U.S. government used a financial carrot to coerce other countries into adhering to a specific family planning policy. But it was the deliberate and accidental violations of the policy that provided the justification for Republican presidents and Congresses to institute even stricter restrictions in the coming decades. Indeed by 1984, the United States would stand alone in withholding funding from organizations involved in providing abortion with private resources. The ruling in Roe was merely the “opening event” in the political and legal struggles to follow. 502 Attempted constitutional bans, restrictions on federal funding, and the limits on foreign aid continue to reshape Roe’s legacy. The successful passage of the Helms Amendment showed both the growing power of the pro-life movement in the United States as well as a congressional willingness to modify foreign aid policies responding to domestic cultural shifts. Though the ruling in Roe was part of an international reformation of stringent abortion laws, what happened next largely set the United States apart from other developed nations. A growing contingent within the Republican Party wanted to end all efforts at family planning. They began by focusing on fighting a battle to end the most pernicious aspect of planning: abortion. It was the start of a moral, cultural, and political war. 502 Balkin, “Roe v. Wade: An Engine of Controversy,” 3. 158 Chapter 4 Grassroots to Gagged: The Rise of the Religious Right and the Decline of Family Planning Funding In April 1984, Mr. and Mrs. Williquette of Green Bay, Wisconsin, wrote to President Reagan to express their frustration with U.S. foreign aid policies. “We were shocked and dismayed recently to learn that the United States government bankrolls abortions worldwide,” they wrote. “That means that our tax money is financing abortion throughout the world.” They implored the president to cut off all support for the International Planned Parenthood Federation and to “establish an independent commission to investigate USAID’s vast abortion apparatus, and remove all officials responsible for this deadly game.” 503 Reagan received other letters with the exact same language. Several writers suggested that the administration employ William M. O’Reilly, a certified public accountant in Maryland, to evaluate existing USAID programs and accounting procedures. 504 Earlier that month, an article written by O’Reilly appeared in the monthly magazine of the American Life League, the largest Catholic pro-life organization in the United States. 505 O’Reilly alleged that U.S. family planning grants were funding abortions and coercive family planning methods abroad. Similar allegations appeared around the same time in HLI Reports, a publication of Human Life 503 The letter was misdated 1983. Mr. and Mrs. F. Williquette to Ronald Reagan, Letter, April 27, 1983, WHORM Subject Files, WE 003, box 5, folder “WE003 Family Planning – Abortion (214500-219631),” Ronald Reagan Presidential Library, Simi Valley, CA (hereafter “Reagan”). 504 Dianne Guerney and Martha Lee Muller to Ronald Reagan, Letter, May 24, 1984, E.D. Maxfield to Ronald Reagan, Letter, May 16, 1984, and Sharon Wilson to Ronald Reagan, Letter, May 22, 1984, WHORM Subject Files, WE 003, box 5, folder “WE003 Family Planning – Abortion (214500-219631),” Reagan; Michael Foley to James Baker, Letter, July 25, 1984, WHORM Subject Files, box “Contents: FO 005-03 (586774), FO 006 (540710),” folder “FO 006 232337,” Reagan. 505 “About Us,” American Life League, accessed January 18, 2014, http://www.all.org/nav/index/heading/MTQ/. 159 International, another Catholic pro-life organization. Each edition highlighted the evolution of population programs and the legal status of abortion in foreign countries receiving USAID funding. 506 At the United Nations’ International Conference on Population in Mexico City held several months after the president received these letters, Reagan’s administration announced new restrictions to USAID family planning grants: “The United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.” Reagan also reversed three-decades of American foreign policy: free market economies, not family planning, were the key to slowing population growth. 507 According to a lobbyist for the American Life League, the policy contained “90 percent of what we would have written if we were doing the writing of the policy.” 508 Until then, the Reagan administration had maintained the three-decade U.S. stance on population growth and related foreign aid. In September 1982, USAID released a policy paper showing its support for continued assistance. The paper noted that foreign aid “materially advances social and economic development” and that “the need for voluntary family planning 506 Kathryn Slattery, “Building a ‘World Coalition for Life:’ Abortion, Population Control and Transnational Pro-Life Networks, 1960–1990,” (PhD dissertation, University of New South Wales, 2010), 180, accessed April 1, 2014, http://www.unsworks.unsw.edu.au/primo_library/libweb/action/dlDisplay.do?docId=unsworks_9 072&vid=UNSWORKS (citing William M. O’Reilly, “The Shell Game,” ALL About Issues 6 (April 1984): 18); “Our Mission,” Human Life International, accessed January 18, 2014, http://www.hli.org/about-us/our-mission/. 507 United States, Policy Statement of the United States of America at the United Nations International Conference on Population (Mexico City: August 13, 1984), 5. 508 Bill Keller, “U.S. Policy on Abortion: A Likely Target Named,” The New York Times, July 14, 1984. 160 has never been greater.” 509 Reagan had on several occasions confirmed U.S. support for population programs, including at the G7 summits in Ottawa in 1981 and in Versailles in 1982 and at a population conference in Brazil in 1983. 510 Reagan’s announcement in Mexico City thus marked a complete reversal of U.S. policy. The watershed moment also represented the culmination of the Republican Party’s strategic effort to build a new coalition of socially conservative voters. Taking on a pro-life stance to recruit Catholics and Evangelical Protestants to the party, the GOP realigned the country. The political shift would prove globally consequential, affecting the lives of families around the world. Republicans: The Pro-Choice Party No Longer Although hard to believe if you read today’s news, the Republican Party used to be the pro-choice party. Public polls from as late as 1976 indicate that “Republican voters were, on average, more pro-choice than their Democratic counterparts.” This was at least partially due to the fact that Catholics traditionally affiliated with the Democratic Party. However, as historian Daniel K. Williams has shown, by the early 1980s “conservative Catholics and evangelicals gained control of the GOP [and] bolstered the party’s pro-life stance, ensuring that the issue would remain a central consideration in Supreme Court nominations and national elections.” 511 509 United States Agency for International Development, “A.I.D. Policy Paper: Population Assistance,” (Washington D.C.: September 1982), Davey Boggs Files, box 21, folder “Global Population II (2),” Reagan. 510 Kenneth W. Dam to The Secretary of State, “International Conference on Population,” Memorandum, June 8, 1984, 1, WHORM Subject Files WE003, box 6, folder “WE003 Family Planning – Abortion (237000-239999),” Reagan. 511 Daniel K. Williams, “The GOP’s Abortion Strategy: Why Pro-Choice Republicans Became Pro-Life in the 1970s,” Journal of Policy History 23 (2011): 513, 534. 161 The power of the realignment campaign can be seen in the career of George H.W. Bush. As a representative in the House in the mid-1960s, Bush was such a devout supporter of family planning programs that he earned the nickname “Rubbers.” While the ambassador to the U.N. in 1972, Bush wrote the forward to a book called World Population Crisis, stressing the dangers of population growth. 512 By the time he was elected vice president in 1980, however, the Republican Party had adopted a platform calling for a constitutional amendment banning abortion. As president, he threatened to veto any congressional effort to reinstate U.S. funding for the United Nations Fund for Population Activities. He also kept in place Reagan’s policy that USAID would not give family planning funding to any organization that had anything to do with abortion. 513 The shift was part of a deliberate effort by a core set of party strategists who believed in the political potency of abortion. A pro-life position, they theorized, could lure traditionally Democratic Catholic voters to the Party. 514 Beginning in 1978, conservative leaders including Paul Weyrich, a co-founder of the Heritage Foundation, and Richard Viguerie, the strategist who revolutionized political organizing through direct mail campaigns, began formulating plans to bring in “groups devoted to preservation of the traditional social roles of the family, the churches 512 Anthony Lewis, “Abroad at Home; Who is George Bush?,” The New York Times, November 6, 1988. 513 Republican Party Platform of 1980, Republican National Committee, Online by Gerhard Peters and John T. Woolley, The American Presidency Project (hereafter “APP”), accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/?pid=25844; Larry Nowels, International Family Planning: The “Mexico City” Policy, CRS Report for Congress (Washington, D.C.: Congressional Research Service, April 2, 2001), CRS-4. 514 For more on the Catholic Strategy, see Williams, “The GOP’s Abortion Strategy;” Timothy A. Byrnes, “Issues, Elections, and Political Change: The Case of Abortion,” in Do Elections Matter?, eds. Benjamin Ginsberg and Alan Stone, 3d ed. (New York: M.E. Sharpe, Inc., 1996), 101, 111–15 (concluding that in Nixon’s 1968 and 1972 campaigns, “[a]bortion was tailor-made for use by political operatives seeking to” exploit white racial and anti-elitist anger “and to use the Republican party as a vehicle for conservative political change”). 162 and the schools.” 515 Abortion thus became a “centerpiece of a social agenda designed to (a) break disaffected [Catholic] Democrats free from the party for good and (b) mobilize new, primarily, Evangelical voters who believed that the country had lost its moral moorings.” 516 These voters represented“[t]he people who are alienated . . . the ones who don’t want pot, who don’t want abortion, who don’t want to pay one more cent of taxes.” 517 A New Coalition in Gestation Opposed to the familial and sexual liberalization of the 1960s and the rise in use of contraceptives among Catholics, the Catholic Church saw in abortion all that was wrong with American society. By separating sex from reproduction, abortion gave license to premarital sex. 518 Immediately following Roe, the National Conference of Catholic Bishops (NCCB), the directing body of the Catholic Church in America, declared that it would not “accept the Court’s judgment.” Subsequently, the NCCB created the Pro-Life Legal Affairs Committee, a political action committee that sought to influence elections. Calling for a major legal and educational battle against abortion, the NCCB gave birth to the modern “right to life” movement. Established in 1974, the National Right to Life Committee further shaped the effort. 519 515 Rosalind Pollack Petchesky, “Antiabortion, Antifeminism, and the Rise of the New Right,” Feminist Studies 7 (Summer 1981): 215. 516 Byrnes, “Issues, Elections, and Political Change,” 115. 517 Kevin Phillips quoting Don Muchmore in his article, “How Nixon Will Win,” The New York Times Magazine, August 6, 1972, 8, in Before Roe v. Wade: Voices that Shaped the Abortion Debate Before the Supreme Court’s Ruling, eds. Linda Greenhouse and Reva Siegel (New York: Kaplan Publishing, 2010), 290n113. 518 Linda Gordon, The Moral Property of Women (Champagne, IL: University of Illinois Press, 2007) 303–04. 519 Rickie Solinger, Pregnancy and Power: A Short History of Reproductive Politics in America (New York: NYU Press, 2007), 205; Rosalind Pollack Petchesky, Abortion and Woman’s Choice: State, Sexuality, and Reproductive Freedom, rev. ed. (Boston: Northeastern University Press, 1990), 252. 163 The Republican Party changed its “position on abortion only after [it] decided to bid for Catholic votes.” 520 As Reva Siegel and Linda Greenhouse recently explained in Before Roe v. Wade, “Republican strategists throughout the 1970s and well into ’80s carefully cultivated the abortion issue in the service of party realignment, with the aim of peeling away urban ethnic Catholic voters from their traditional home in the Democratic Party.” 521 Fewer than 40 percent of delegates to the 1976 Republican National Convention considered themselves pro-life. 522 Despite support for Roe and liberalized abortion laws at both the grassroots level and among party leadership, the Republican Party adopted a platform encouraging continued debate over abortion and supporting the efforts of those promoting a constitutional amendment to ban the procedure. 523 Social and political conservatives could give Republicans a new electoral edge. As a result, even though few Americans or Republicans agreed on an opposition to both abortion and federally funded family planning programs, these positions became key to the Republican agenda in the 1980s. At first considered a “temporary political ploy that would increase the GOP’s appeal among traditionally Democratic Catholics,” the platform was a harbinger of things to come. 524 The same year that the Republicans added the plank suggesting the Party’s opposition to abortion, the Democrats adopted a platform supporting Roe. “The [Democratic] platform makes it official,” the Reverend Edward O’Connell wrote just after the Democratic National 520 Williams, “The GOP’s Abortion Strategy,” 519. 521 Linda Greenhouse, “Misconceptions About Roe v. Wade,” The New York Times Opinionator Blog, January 23, 2013, http://opinionator.blogs.nytimes.com/2013/01/23/misconceptions/. 522 Williams, “The GOP’s Abortion Strategy,” 534n1. 523 Republican Party Platform of 1976, Republican National Committee, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/ index.php?pid=25843. 524 Michele McKeegan, Abortion Politics: Mutiny in the Ranks of the Right (New York: The Free Press, 1992), ix; Williams, “The GOP’s Abortion Strategy,” 513. 164 Convention. “They have read us out of the party.” It appeared that the “strategy of branding the Democratic Party as a culturally liberal, anti-Catholic party might be successful.” 525 Targeting Evangelicals The use of abortion as a political recruitment tool, however, was not limited to Catholic voters. Evangelical Protestants also held special appeal to the Republican Party. By 1981, an “estimated fifty million ‘born-again’ Christians” lived in the United States, and could be “reached through both the evangelical church pulpits and, even more directly, the vast broadcasting network (thirteen thousand radio stations, thirty-six television shows) to which the evangelical churches have access.” In addition to their “vast network of colleges, training schools, [and] Bible institutions,” among others, they also had “many large publishing houses which blanket small towns with conservative tracts and pamphlets.” Collectively, they represented a potentially “formidable base of financial and corporate support.” 526 Evangelicals had only recently begun politically organizing to defeat the Equal Rights Amendment. 527 Republican Party leaders saw in these new political activists the building blocks of a new electoral powerhouse, and in abortion a potential recruitment tool. Paul Weyrich, founder of the Heritage Foundation and a key leader of the New Right, encouraged conservatives to experiment with family issues during the 1978 elections. He argued that social and family issues could bring non-elites, those normally deterred by conservative economic policies, into the 525 Quoted in Williams, “The GOP’s Abortion Strategy,” 528. 526 Petchesky, “Antiabortion, Antifeminism, and the Rise of the New Right,” 218. 527 McKeegan, Abortion Politics, 18. 165 fold. According to Weyrich, sexuality and family life were “the Achilles’ heel of the liberal Democrats.” 528 At the time of the decision in Roe, most mainline Protestant groups, including the National Association of Evangelicals and the Southern Baptist Convention supported the liberalization of abortion laws. 529 As late as 1977, the National Council of Churches of Christ (“NCC”) passed a resolution stating that it “in no way affirms abortion, but it does come at the issue from the rights perspective.” 530 In the resolution, the NCC Governing Board “urge[d] the President, Congress and state legislators to guarantee equal access to legal rights, including legal abortion, by ensuring adequate public funding; and requests the National Council of Churches member communions to communicate to legislators their own convictions on this issue.” 531 In fact, the prominence of the Catholic Church in the pro-life movement had effectively dissuaded Protestants from getting involved. Harold O.J. Brown, editor of Christianity Today, 528 Quoted in John D’Emilio and Estelle B. Freedman, Intimate Matters: A History of Sexuality in America: The History of Birth Control Politics in America, 2d ed. (Chicago: University of Chicago Press, 1997), 348. 529 Evangelical Protestant groups tended to “discriminate between ‘personal convenience’ abortions, which they condemned . . . and therapeutically or medically indicated abortions, which they implicitly or explicitly sanctioned.” Robert Post and Reva Siegel, “Roe Rage: Democratic Constitutionalism and Backlash,” Harvard Civil Rights-Civil Liberties Law Review 373 (2007): 46n199. Post and Siegel examine the official platforms of and public statements from a variety of Protestant denominations. Ibid., 45n198. 530 Founded in 1950, the NCC “has been the leading force for ecumenical cooperation among Christians in the United States.” The NCC’s member faith groups include Protestant, Anglican, Orthodox, Evangelical, and historic African American and Living Peace churches from across the country. “NCC at a Glance: Who Belongs, What We Do, How We Work Together,” National Council of Churches USA, accessed March 30, 2014, http://www.ncccusa.org/about/about_ncc.html; Rev. G. William Sheek, Director of Family Ministries and Human Sexuality to Leila Hall, Planned Parenthood Federation of America, Inc., Letter, November 28, 1977, Planned Parenthood Federation of America Files, Accession #88S- 35, box 37, folder “PPWP Religious Affairs Committee: Abortion, From 1970,” Sophia Smith Collection, Women’s History Archives at Smith College, Northampton, MA (hereafter “Smith”). 531 NCCC Governing Board, “Resolution in Support of Non-Discriminatory Legislation,” Adopted November 11, 1977, Planned Parenthood Federation of America Files, Accession #88S- 35, box 37, folder “PPWP Religious Affairs Committee: Abortion, From 1970,” Smith. 166 posited, “At that point, a lot of Protestants reacted almost automatically –‘If the Catholics are for it, we should be against it.’ . . . . The fact that Catholics were out in front caused many Protestants to keep a very low profile.” 532 Only when abortion was reframed as a symbol of the dangers of feminism and the breakdown of traditional gender roles did Evangelicals join the cause. While they had generally accepted “the possibility of abortion in some circumstances,” Evangelicals became “increasingly sympathetic to the pro-life cause when they realized that Roe would permit abortion to be used as a form of birth control, rather than merely as a last resort in extreme situations.” 533 By the end of the 1970s, a critique of secular humanism offered by Swiss theologian Francis Schaeffer and Tim LaHaye, a co-founder of the Moral Majority, gained popularity. 534 According to the “Special Report on Secular Humanism vs. Christianity” in the Christian Harvest Times, “To understand humanism is to understand the women’s liberation, the ERA, gay rights, children’s rights, abortion, sex education, the ‘new’ morality . . . and many of the other problems that are tearing America apart today.” 535 To social conservatives, abortion symbolized American social chaos and reflected the broader changes taking place, including the rise of the feminist movement. 536 For feminists, abortion was not just about a woman’s control over her body or the viability of the fetus. Rather, 532 Post and Siegel, “Roe Rage,” 44, 46. 533 Greenhouse and Siegel, Before Roe v. Wade, 257; Williams, “The GOP Abortion Strategy,” 525. 534 The Moral Majority, established in 1979, was a leading political organization focused on advancing an evangelical Christian political agenda. 535 Post and Siegel, “Roe Rage,” 48. 536 Michelle Goldberg, The Means of Reproduction: Sex, Power, and the Future of the World (New York: Penguin Books, 2010), 87–88. 167 it struck at the heart of broader questions about sex, family, gender, the state, and power. 537 As one women’s publication, Win, noted, “Abortion is not, for us, just an issue of women’s health or even of women’s right to privacy or to religious liberty. The right to decide whether and when to bear a child is absolutely basic to a woman’s control of her body, her sexuality, [and] her life choices.” 538 The feminist embrace of abortion rights thus helped fuel the budding pro-life movement. Abortion had become “a referendum on the place and meaning of motherhood.” 539 The link between opposition to abortion and opposition to feminism and other liberal causes was apparent to proponents of reproductive rights as early as 1973. According to a pamphlet from Planned Parenthood Federation of America, pro-lifers “have strong support from a variety of right-wing groups . . . some of them political extremists,” such as the John Birch Society, National States’ Rights party, and the Young Americans for Freedom. Their opposition to Roe, the publication argued, “is often linked to their views on a variety of other political issues, including opposition to equal rights for women, school desegregation, sex education, civil rights legislation, and unionism.” 540 537 Petchesky, Abortion and Woman’s Choice, xi; Linda Gordon, “Who Is Frightened of Reproductive Freedom for Women and Why? Some Historical Answers,” Frontiers: A Journal of Women Studies 9 (1986): 22, 25; Christina Page, How the Pro-Choice Movement Saved America: Freedom, Politics and the War on Sex (Cambridge, MA: Perseus Books, 2007) 32; Laurence H. Tribe, Abortion: The Clash of Absolutes (New York: W.M. Norton & Company, Inc., 1992), 33. 538 Janet Gallagher, “Abortion Rights: Critical Issue for Women’s Freedom,” Win, March 8, 1979, K. Stamm, TAM 212, box 4, Tamiment Library, New York University, NY. 539 Historian Linda Gordon suggests that it was precisely because of the feminist movement’s support for abortion rights that opposition to abortion was so intense. If not for the movement’s endorsement of abortion as fundamental to a woman’s self-determination, there may have been less resistance to its decriminalization. Gordon, Moral Property of Women, 300; Kristin Luker, Abortion and the Politics of Motherhood (Berkeley: University of California Press, 1984), 193. 540 “Facts About the Threats to the Supreme Court Decisions on Abortion,” Planned Parenthood Federation of America, No. 1441, New York, 1973, 3, PPFA II Records, Accession #88S-35, box 93, folder “Facts About the Threats to the Recent Court Decisions on Abortion, 1973,” Smith. 168 The connection between the feminist movement and abortion rights was further “reinforced by debates over the ERA.” Phyllis Schlafly, a Catholic Republican who mobilized opponents of the ERA, argued that abortion was a “potent symbol[] of the new family forms that the ERA would entrench.” In 1979, Beverly LaHaye, wife of Moral Majority co-founder Tim LaHaye, established Concerned Women for America, the Evangelical equivalent of Schlafly’s STOP-ERA organization, thus consolidating the connection between the ERA and abortion. 541 In May 1979, Weyrich and Howard Phillips, another politically active Evangelical leader, approached Jerry Falwell and other “architects of the New Right” to propose the creation of a “Moral Majority.” 542 They also enlisted Falwell to lead “the Moral Majority’s antiabortion crusade.” Despite Falwell’s later claims that it was Roe that inspired his activism against abortion, “what evidence there is suggests that he realized the potential and importance of the abortion issue gradually during the late 1970s and early 1980s.” In 1976, abortion was included on his list of “America’s sins” in his bicentennial “I Love America” crusade sermons and tracts. However, it was “just one among many other sins, not the cause célèbre it was to become.” His first extended analysis on abortion did not appear in print until 1981 in Listen America! Abortion had been such a non-issue to Falwell at the time that Paul Brown, co-founder of the American Life League, commented in 1982 that, “Jerry Falwell couldn’t spell abortion five years ago.” 543 The successful recruitment of Falwell and his many followers shows the effectiveness with which Republicans used abortion to mobilize voters and activists. Reagan’s election in 1980 was the final step in the effort, representing a major victory for both the New Right and for the 541 Post and Siegel, “Roe Rage,” 48, 50. 542 The phrasing is reminiscent of Nixon and Nixon supporters who referred to themselves as the Silent Majority. 543 Susan Friend Harding, The Book of Jerry Falwell: Fundamentalist Language and Politics (Princeton, NJ: Princeton University Press, 2001), 53, 303n5, 304n18. 169 pro-life movement. Evangelicals, who had previously stayed home on Election Day, this time came out en masse. 544 Running on a socially conservative platform that advocated a constitutional amendment banning abortion, Reagan symbolized a return to traditional American values. According to Reagan’s own declaration, it was morning in America. Pro-life groups were full of hope. Reagan Takes Office At the time Reagan took office in January 1981, the Helms Amendment, Section 104(f) of the Foreign Assistance Act of 1961, still dictated USAID policy on abortion: USAID could not fund abortion services or equipment. By the end of the year, USAID would also no longer support research of abortion methods. All contracts with nongovernmental organizations (NGOs) and host governments contained explicit language prohibiting the use of U.S. funding for abortion-related activities. Organizations could, however, use other sources of income for such activities, provided USAID funds remained in separate, segregated accounts. 545 USAID’s official stance remained that, “Abortion, in fact, is not a method of family planning. We see our role as providing couples in developing countries with a moral alternative to abortion. And we know that when they have an alternative, they will generally use it.” 546 In 1982, USAID issued a policy paper on population assistance, declaring that it “faithfully and fully implements U.S. population assistance in accord with its authorization.” 547 As late as 1989, 544 Godfrey Hodgson, The World Turned Right Side Up: A History of the Conservative Ascendancy in America (Boston: Houghton Mifflin Company, 1996), 159. 545 Kate Semerad to Mr. and Mrs. M. F. Williquette, Letter, June 28, 1984, 1, WHORM Subject Files WE 003, box 5, folder “WE003 Family Planning – Abortion (214500-219631),” Reagan. 546 Ibid., 2. 547 “Joint Resolution: Reaffirming the U.S. commitment to international population and family planning assistance, as authorized by Sec. 104 of the Foreign Assistance Act,” n.d., 1, Robin 170 USAID maintained that it did not know of any organization that had “actively promoted abortions in violation of U.S. law.” Congress had likewise not identified any violations of the Helms Amendment. 548 However, as discussed in the last chapter, the JHPIEGO audit indicates that at least one such violation had occurred. 549 Despite assurances that U.S. funds did not go towards abortion services, pro-life groups considered the existing restrictions to be ineffective and sought more extreme measures. In December 1981, they tried to abolish USAID’s entire budget for population assistance. The Office of Management and Budget, under pressure from the White House, eliminated all international population assistance from the president’s draft budget for 1983. Vice President Bush, Secretary of State Alexander Haig, six assistant Secretaries of State, and moderate Republicans successfully lobbied to reinstate the family planning aid. 550 Undeterred, pro-life activists shifted their focus to abolishing specific USAID expenditures. According to an Americans United for Life publication, “The prolife movement is now a powerful force in the United States and it has the ability to drive AID completely out of Chandler Lynn Duke Papers, Rare Book, Manuscript, and Special Collections Library, Duke University, Durham, NC (hereafter “Duke”). 548 The Effect of the Mexico City Policy on International Family Planning: Hearing Before the Subcommittee on International Operations of the House Committee on Foreign Affairs, 101st Cong. 19–21, 47 (1989). 549 See Lot No. 81-125, Accession No: 286-82-015, box 3, folder “The JHPIEGO Corporation Workpapers 79-74, 4/, 5-24-79,” and box 4, folder “The JHPIEGO Corporation Workpapers 79- 74, 33/, 5-24-79,” National Archives, College Park, MD. 550 Marshall Green, “Evolution of U.S. Population Policy,” January 14, 1993, 15, Robin Chandler Duke Papers, 1998-0350, 1998-0372, box 3, folder “Duke, Robyn C. – Subject Files – Population Int’l Misc. 1997,” Duke. 171 the abortion business.” The publication went on to argue that USAID “has had a profound influence on the spread of abortion as a means of population control throughout the world.” 551 In the spring of 1984, pro-life groups began lobbying Congress to approve an amendment to the International Security and Development Cooperation Act prohibiting USAID from contributing to any population program that included forced abortions or supported programs that did. 552 The National Right to Life Committee (NRLC), for example, coordinated grassroots telephone blitzes to district offices urging their representatives to vote for the amendment. The NRLC focused on USAID’s support for the United Nations Fund for Population Activities (UNFPA) and the International Planned Parenthood Federation (IPPF) in particular. Both organizations, the NRLC claimed, “heavily supported” China’s “ruthless population control campaign.” 553 News of NRLC’s campaign got the attention of the White House. Steve Galebach, Reagan’s Deputy Assistant Director for the Office of Policy Development, circulated a memorandum on and materials from the NRLC. “Apparently, federal funds go from A.I.D. through the United Nations Fund for Population Activities and the International Planned Parenthood Federation to the Chinese ‘population control’ program, which, according to seemingly reliable reports, forces women to have abortions,” Galebach wrote. “Forced abortion 551 Patrick A. Trueman, Abortion and American Foreign Policy, Studies in Law and Medicine (Americans United for Life, n.d.), 9, Stephen Galebach Files, box 1, folder “Abortion – Agency for International Development (2),” Reagan. 552 Representative Dante B. Fascell (D-FL) proposed such a provision as an amendment to the International Security and Development Cooperation Act of 1984 (H. Amdt. 718). The House voted in favor of the amendment but it appears that the Senate never addressed it. International Security and Development Cooperation Act of 1984, H.R. 5119, 98th Cong. (1984); International Security and Development Cooperation Act of 1984, S. 2346, 98th Cong. (1984). 553 Douglas Johnson, Legislative Director, to National Right to Life Committee, Inc. Board of Directors, et al, “LEGISLATIVE ALERT: Forced abortions in China,” Memorandum, April 27, 1984, 3, Galebach, Stephen: Files, box 1, folder “Abortion – Agency for International Development (1),” Reagan. 172 is so abhorrent a policy that it makes sense not only to deny direct funding to population programs that engage in it, but also to refuse funding to population planning organizations that promote it or engage in it using their own funds.” 554 It was around this time that Human Life International (HLI) began publicizing the purportedly illicit conduct of USAID-funded NGOs. One HLI press release, for example, declared that “Relaxed AID Policy Kills Honduran Children.” According to HLI, “American funding of population control groups” led to liberalized abortion laws in Honduras. “A cut-off of American aid for paying for abortion overseas is a good gesture, but in the real world the cut-off has no impact until it affects agencies that advocate abortion.” 555 Senator Jesse Helms (R-NC) passed on the press release to the White House. “AID’s adamancy about continuing the indirect funding of pro-abortion groups, in a Reagan administration, remains a mystery to me,” he wrote. “Elaborate accounting procedures, segregated funds, and periodic audits are not going to stop” the type of activity documented in Honduras. 556 Jack Svahn, Assistant to the President for Policy Development wrote back to Helms, reassuring him that the administration was taking steps “towards ending the type of abuse documented in your letter.” Svahn sent Helms a draft of the U.S. policy statement for the U.N.’s 554 Steve Galebach to Bob Reilly, “Indirect U.S. Support for Forced Abortions,” Memorandum, May 7, 1984 (emphasis in original), Galebach, Stephen: Files, box 1, folder “Abortion – Agency for International Development (1),” Reagan. 555 Paul Marx, “Relaxed AID Policy Kills Honduran Children,” HLI Press Release, (n.d.), 2 (emphasis in original), WHORM Subject Files, box 6, folder “WE003 Family Planning – Abortion (237000-239999),” Reagan. 556 Jesse Helms to Edwin Meese III, Letter, June 21, 1984, WHORM Subject Files, box 6, folder “WE003 Family Planning – Abortion (237000-239999),” Reagan. 173 upcoming World Population Conference. “As you can see,” he told Helms, “our new funding policy should go a long way towards ending the type of abuse documented in your letter.” 557 Reagan’s Population Bomb On August 6, 1984, the United Nations convened the International Conference on Population in Mexico City. The meeting presented pro-life groups with an opportunity to leverage their newly found political power. They had the ear of the president and Reagan had reason to listen. They were some of his most loyal campaign volunteers. Moreover, Reagan’s aides insisted that his reelection depended on friendly relations with Catholics and their leaders. 558 As The New York Times noted that summer, “Mr. Reagan’s conservative supporters believe they are entitled to some substantive victories, and they think they may have found one in the Administration’s emerging position on world population control.” 559 Richard E. Benedick, the Coordinator of Population Affairs at the State Department, was originally expected to assume the role of chief delegate to the Conference. An outspoken proponent of family planning programs, he had the support of U.N. Ambassador Jeane Kirkpatrick and Secretary of State George Shultz. The American Life Lobby, among other pro- life organizations, however, considered Benedick “the single most dangerous anti-life official.” 560 A group of representatives from pro-life groups met with White House staff that 557 John A. Svahn to Jesse Helms, Letter, June 21, 1984, WHORM Subject Files, WE 003, box 5, folder “WE003 Family Planning – Abortion (214500-219631),” Reagan. 558 Matthew Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge, MA: Belknap Press of Harvard University Press, 2008), 353. 559 Stephen Engelberg, “Conservatives Hope to Link Abortion With Overseas Aid,” The New York Times, June 24, 1984. 560 American Life League, “Special Warning to Islamic Pro-Lifers: These men are dangerous to your health,” A.L.L. About Issues, July 1984, Robin Chandler Lynn Duke Papers, ca. 1930s– 2001 (bulk 1970s–1980s) 2001-0147, box 2, folder unnamed, Duke. 174 January and encouraged the president to send a “pro-life” delegation to Mexico City. A month later, the NRLC followed up with Chief of Staff James Baker, again urging that the “delegation should be led by individuals who will firmly communicate the American government’s position that abortion is not a method of ‘family planning,’ and who will strongly oppose any resolutions which advocate or promote abortion in any way.” 561 Reagan subsequently tapped former New York Senator James L. Buckley to lead the U.S. delegation. While in the Senate, Buckley had led efforts for a constitutional amendment banning abortion. As an Under Secretary of State, he opposed international population assistance and even called for a review of the Reagan Administration’s population aid, questioning its overall usefulness. 562 Buckley enjoyed the full support of the pro-life lobby. Both the American Life League and Americans United for Life had pushed the White House for Buckley’s appointment. 563 Despite the Conference focus on population issues, there were no population specialists on the final nine-person delegation to Mexico City. Except for select pro-life members, Congress was kept largely out of the loop. 564 561 National Right to Life Committee, Inc. to Ronald Reagan, Letter, February 10, 1984, Robin Chandler Lynn Duke Papers, FG Federal Gov’t – Organizations, box 76, folder “FG 001-02 (195000 – 204-411),” Duke. 562 Williams, “The GOP Abortion Strategy,” 524; Green, “Evolution of U.S. Population Policy,” 15. 563 National Right to Life Committee, Inc. to Ronald Reagan, Letter, February 10, 1984, and Dennis J. Horan, Chairman of the Board for Americans United for Life to Ronald Reagan, Letter, March 1, 1984, Robin Chandler Lynn Duke Papers, FG Federal Gov’t – Organizations, box 76, folder “FG 001-02 (195000 – 204-411),” Duke. 564 Jason L. Finkle and Barbara B. Crane, “Ideology and Politics at Mexico City: The United States at the 1984 International Conference on Population,” Population and Development Review 11 (March 1985): 17; Mark O. Hatfield et al to George P. Shultz, Letter, April 13, 1984, WHORM Subject Files, WE 003 (161000-233549), box 5, folder “WE003 Family Planning – Abortion (223840-224699),” Reagan. 175 A “Wholesale Change in U.S. Policy” A draft of the U.S. policy paper for the Mexico City conference became public in mid- June of 1984. 565 Showing the influence of pro-life groups’ lobbying efforts and New Right economic theories of population growth, the Mexico City policy paper drastically departed from precedent. The paper announced Reagan’s new position on population growth: “population growth is, of itself, a neutral phenomenon” and does not pose any threat to Earth or its inhabitants. 566 The administration’s new interpretation of population growth was a drastic departure from those of previous presidential administrations. At the time, demographic experts projected substantial world population increases and the World Bank predicted that 87.5 percent of the people born each year were born in developing countries. And yet, Reagan and his administration maintained that a population crisis did not exist. 567 The world leader in contributions for population research and responsible for the largest foreign aid program for population assistance, the United States now held the position that population growth helped free market economies. By describing a “demographic overreaction in the 1960’s and 1970’s,” the policy statement repudiated past American involvement in stemming 565 Phil Gailey, “White House Urged Not to Bar Aid to Countries Supporting Abortion,” The New York Times, June 20, 1984. Representative John Porter referenced the policy statement on June 7 but did not have it published in the Congressional Record. 130 Cong. Rec. 15358 (1984). 566 United States, Policy Statement of the United States of America at the United Nations International Conference on Population, 1. 567 While many historians point to the Reagan administration as the turning point in population control policy, historian Derek S. Hoff argues that the economic arguments in support of population growth actually began in the 1960s and flourished under Nixon. See Derek S. Hoff, “‘Kick that Population Commission in the Ass’: The Nixon Administration, the Commission on Population Growth and the American Future, and the Defusing of the Population Bomb,” Journal of Policy History 22 (2010): 23–63; Susan F. Rasky, “Reagan Restrictions on Foreign Aid for Abortion Programs Lead to a Fight,” The New York Times, October 14, 1984. 176 the effects of population expansion. Steven Sinding, Director of the Agency’s Office of Population at the time, called it “a wholesale change in U.S. policy.” 568 The declaration of new terms by which the United States would distribute foreign aid for family planning proved the most controversial of the proposed policy changes. The policy statement announced that, “The United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.” 569 Rather than simply disallowing the use of USAID money to fund abortions as the Helms Amendment had done, now the United States would no longer give money to NGOs that used other funds to offer such services. Under the first draft of the policy paper, the new restrictions applied to all recipients of U.S. aid, including sovereign governments that incorporated abortion in their government- sponsored family planning programs. USAID and State Department lawyers “wade[d] in and persuade[d] the White House to change that aspect so that it only applied to the foreign NGOs, who were not in a position to defend themselves and had no protection under U.S. law.” This portion of the draft was eventually modified so that the policy would apply only to multilateral NGOs. Treating governments as sovereign entities, the United States mandated that USAID funds be channeled through segregated accounts. This change also meant that the new 568 Eric Eckholm, “Population Growth: How U.S. Policy Evolved,” The New York Times, August 11, 1984; Finkle and Crane, “Ideology and Politics at Mexico City,” 11; Steven W. Sinding, Interview by W. Haven North, The Foreign Affairs Oral History Collection of the Association for Diplomatic Studies and Training, February 27, 2001, accessed March 27, 2014, http://www.loc.gov/item/mfdipbib001070/. 569 United States, Policy Statement of the United States of America at the United Nations International Conference on Population, 5. 177 restrictions would not apply to such domestic government-sponsored entities as universities and research institutions. 570 No Womb for Debate Critics in both the public and private sectors lobbied for the administration to change its stance before the August conference. Opposition came from a wide range of political affiliations and a diverse array of interest groups. Members of Congress from both sides of the aisle appealed to Reagan not to go through with the policy statement as drafted. A bipartisan coalition of sixty-one congressmen and women wrote USAID Administrator Peter McPherson, expressing their support for existing family planning programs as well as their concern about the pressure the Agency faced to change its policies. In a letter to the president, Senator Barbara Boxer (D-CA) suggested that not all developing countries were ready for industrialized economies. Writing in The New York Times, Representative Peter H. Kostmayer (D-PA) criticized the proposed policy as, “contrary to the law, to reason and to our national security interests.” A group of seventeen Republicans and Democrats in Congress wrote to Chief of Staff Baker, arguing that the policy changes would cripple existing clinics and diminish their impact on population growth. 571 570 Finkle and Crane, “Ideology and Politics at Mexico City,” 25–26n42; Sharon L. Camp, “The Impact of the Mexico City Policy on Women and Health Care in Developing Countries,” NYU Journal of International Law and Politics 20 (1987–1988): 36. 571 Sam Gejdenson, et al to M. Peter McPherson, Letter, August 2, 1983, WHORM Subject Files, WE 003 (161000-233549), box 5, folder “WE003 Family Planning – Abortion (211000- 213299),” Reagan; Barbara Boxer to Ronald Reagan, Letter, June 15, 1984, FG Federal Gov’t – Organizations, box 76, folder “FG001-02 (217000-217699),” Reagan; Peter H. Kostmayer, “Our Stake in Population Control Abroad,” The New York Times, June 30, 1984; Nancy L. Johnson, et al to James A. Baker III, Letter, June 29, 1984, 1, WHORM Subject Files, WE 003, box 5, folder “WE003 Family Planning – Abortion (214500-219631),” Reagan. 178 The State Department “objected vigorously” to the policy statement, concerned that it would unnecessarily complicate foreign relations. 572 Former senators Robert Taft, Jr. (R-OH) and Joseph D. Tydings (D-MD), both now affiliated with the Population Crisis Committee, argued the policy reflected a “fundamentalist, know-nothing” political ideology, one that would embarrass the United States. Former Army Chief of Staff General W.C. Westmoreland expressed similar concern that the proposed policy would set back an already effective program. 573 Many within USAID also disagreed with the new terms for funding and suggested that the United States instead support a resolution calling for family planning programs to help women avoid abortions in the first place. 574 Steven Sinding, the Director of USAID’s Office of Population, argued that “the antiabortion statement not only violates the sovereignty of countries and is inconsistent” with the fact that abortion was legal in the United States, “but it also violates the first amendment rights of the American NGOs. How can you tell them that they can’t use their own money to engage in abortion promotion and advocacy?” 575 Administrator McPherson 572 While the State Department or USAID would traditionally write the policy paper for such conferences, Jack Svahn, Assistant to the President for Policy Development, drafted the policy statement instead. Phil Gailey, “White House Urged Not to Bar Aid to Countries Supporting Abortion;” George Archibald, “White House backed on population paper,” The Washington Times, June 15, 1984; Connelly, Fatal Misconception, 353; John A. Svahn to Jesse Helms, Letter, June 21, 1984, WHORM Subject Files, WE 003, box 5, folder “WE003 Family Planning – Abortion (214500-219631),” Reagan; “Draft White House Position Paper Threatens Pop Aid Cutoff,” Washington Memo, June 20, 1984, 2, Robin Chandler Lynn Duke Papers, ca. 1930s– 2001 (bulk 1970s–1980s) 2001-0147, box 2, folder “unnamed,” Duke. 573 Christine Russell, “End Urged to Aiding Population Control,” The Washington Post, Washington, D.C., June 14, 1984; W.C. Westmoreland to James Baker, June 20, 1984, Letter, James W. Cicconi Files, box 15, folder “World Population Conference I (2),” Reagan. 574 Gailey, “White House Urged Not to Bar Aid to Countries Supporting Abortion.” 575 Sinding Interview. 179 agreed, saying that the policy would be “extremely, and in our view, unnecessarily, controversial.” 576 Reagan faced criticism from within his own party. Senator Bob Packwood (R-OR), a longtime supporter of family planning programs, argued that the proposed policy was less about abortion than “about denying support for family planning and services that Third World countries are seeking from the United States,” adding, “We have no business mandating morality about how other countries should deal with the question of abortion.” 577 Senators Charles Percy of Illinois and Mark Hatfield of Oregon, both moderate Republicans, protested to Secretary of State Shultz, asking that they “be involved in any decision and reminding him that the Foreign Assistance Act emphasizes the need for voluntary population control.” 578 Even President Nixon expressed reservations about Reagan’s interpretation of population growth and the restrictions to foreign aid. In his 1992 memoir, Seize the Moment: America’s Challenge in a One-Super Power World, Nixon criticized anti-abortion activists’ “morally shortsighted” views on population assistance. “If we ban all funds to such organizations, we might prevent hundreds or thousands of abortions,” he wrote. “But if we provide funds for birth control methods other than abortion . . . we will prevent the conception of millions of babies who would be doomed to the devastation of poverty in the underdeveloped world.” Nixon argued that 576 M. Peter McPherson to Robert McFarlane and Jack Svahn, “Mexico Population Conference - U.S. Position paper,” Memorandum, June 13, 1984, 12, James W. Cicconi Files, box 15, folder “World Population Conference I (3),” Reagan. 577 Bob Packwood to Friend, Letter, July 10, 1984, 1–2, Robin Chandler Lynn Duke Papers, ca. 1930s–2001 (bulk 1970s–1980s), 2001-0147, box 2, folder [unknown], Duke. 578 Jane Mayer and Gerald F. Seib, “Mobilizing Reagan Allies?: Anti-Abortion Stance Fans Flames,” Wall Street Journal, June 22, 1984. 180 Americans should not “export our views on abortion to overpopulated countries in the undeveloped world.” 579 Reagan was not without support, however. Twenty-eight congressmen, all Republicans, wrote to the president endorsing the draft. They noted that while there might appear to be a shift in policy, the draft statement was fully consistent with the administration’s fundamental philosophies, goals, and values. 580 Senator Helms considered the policy paper “right on target.” 581 Representative William E. Danneymeyer (R-CA) also supported the abortion restrictions, and maintained that, “abortion and coercive family planning are symptoms of non- capitalist economies.” 582 Hearing from the Family Planning Proponents Reagan’s stance on the neutrality of population growth defied all major studies on the subject. The World Bank, for example, had just issued a report stressing the dangers that population growth posed to development. 583 Some argued that Reagan’s interpretation negated the political dangers—such as ethnic tensions and urban riots—that resulted from population growth. 584 Such concerns had been among the original reasons President Johnson first supported foreign assistance for family planning in the 1960s. 579 Richard Nixon, Seize the Moment: America’s Challenge in a One-Super Power World (New York: Simon and Schuster, 1992), 263–64; Richard Nixon, “Richard Nixon on US Assistance for Population Programs,” Population and Development Review18 (June 1992): 378–79. 580 Henry J. Hyde, et al to Ronald Reagan, Letter, June 29, 1984, PR Public Relations, PR 014-06 222623-232450, box 11, folder “PR 014-08,” Reagan. 581 Helms to Meese, Letter, June 21, 1984. 582 U.S. Policy on Population Assistance: Hearing Before the Subcommittee on Census and Population of the Committee on Post Office and Civil Service, 98th Cong. 120 (1984). 583 John H. Galbreath to Ronald Reagan, Letter, July 24, 1984, WHORM Subject Files, WE003, box 6, folder “WE003 Family Planning – Abortion (233530-236999),” Reagan. 584 “Population Bomb,” Wall Street Journal,” June 27, 1984. 181 At a congressional briefing on the position paper that June, demographers, academics, and population activists all warned against the proposed policy changes. They emphasized what they considered to be the policy statement’s inaccurate, distorted interpretation of demographic knowledge and stressed the ultimate value of family planning programs. 585 The president-elect of the Population Association of America, Jane A. Menken highlighted the effectiveness of existing family planning programs. While current efforts were not without flaws, she said, programs in places like Bangladesh and Indonesia proved their ultimate efficacy and value. 586 D.A. Henderson, dean of the Johns Hopkins School of Public Health, expressed his great concern with the administration’s “distressingly strange analysis of population trends.” He argued that the policy would discredit American efforts in the developing world and was “wholly counterproductive to preventative medicine.” 587 In addition to minimizing the effects of population growth, the policy statement argued that population growth helped free market economies and did not pose a threat to the planet. Rafael M. Salas, the head of the United Nations Fund for Population Activities, disagreed. He argued that by significantly cutting back donations for family planning work, the policy would actually “have a devastating effect on the frail economies of many third world countries.” 588 Charles F. Westoff, the former Executive Director of the Rockefeller Commission and a past member of the U.N. Committee of Experts that drafted the World Population Plan of Action 585 Michael S. Teitelbaum, “Statement of Michael S. Teitelbaum, Ph.D.,” Thomas W. Merrick, “Statement of Thomas W. Merrick, Ph.D.,” Jane A. Menken, “Statement of Jane A. Menken, Ph.D.,” and T. Paul Schultz, “Statement of T. Paul Schultz, Ph.D.,” Statements Presented at the Congressional Briefing on White House Population Position Paper, Washington, D.C., June 27, 1984, James W. Cicconi Files, box 15, folder “World Population Conference I (1),” Reagan. 586 Menken, “Statement of Jane A. Menken, Ph.D.,” 1–4. 587 D.A. Henderson to George H.W. Bush, Letter, June 1, 1984, 1–2, WHORM Subject Files, box 6, folder “WE003 Family Planning-Abortion (248500-250276),” Reagan. 588 Eckholm, “Population Growth: How U.S. Policy Evolved;” Rafael M. Salas, “Poisoning Population Assistance,” The New York Times, June 28, 1984. 182 in 1974, wrote to Vice President Bush with his concerns about the draft’s economic interpretation. “This document is seriously flawed in many ways,” he began. “Its ideological message—that there is no ‘population problem’ in the developing countries that cannot be remedied by reduced government involvement in national economics—not only diminishes an enormous social and individual problem, but seriously misreads economic and demographic history.” 589 An editorial in the usually conservative Wall Street Journal called the administration naïve to think that developing nations could handle population growth the way Europe had during the Industrial Revolution. 590 T. Paul Shultz, Chair of the Census Advisory Committee on Population Statistics, expanded on what he considered to be the problems with Reagan’s economic analysis. “There is virtually no scientific evidence to suggest that greater population density would be of economic value in the majority of low income countries that contain the bulk of the Third World’s population,” he explained. “Nor is there any accepted evidence for believing that growth in the size of the population, by merely expanding the numbers of consumers in the market, will create significant economies of scale for nations today.” Instead of expediting economic progress, population growth had the exact opposite effect and expanded the inequality gap in developing nations. 591 Reagan’s economic analysis was not without support. The theory that free market economies were the primary factor in improving the human condition came from economist Julian Simon of the University of Maryland. According to Simon, “free people create additional resources.” That June, Simon testified to Congress, suggesting that Hong Kong was an example 589 Charles F. Westoff to George H.W. Bush, Letter, June 12, 1984, WHORM Subject Files, box 6, folder “WE003 Family Planning-Abortion (248500-250276),” Reagan. 590 “Population Bomb,” Wall Street Journal, June 27, 1984. 591 Schultz, “Statement of T. Paul Schultz, Ph.D.,” 4, 9. 183 of the ways in which population growth could be successfully combined with rapid economic expansion. 592 The conservative Heritage Foundation also championed the economic interpretation. “[E]conomic growth and enhanced economic opportunity, given sufficient natural resources and spurred by free economies, can provide sufficient improvements in per capita living standards so that family size preference drops, in some cases drops rapidly,” announced a Heritage Foundation pamphlet. 593 James Miller, speaking on behalf of Human Life International, agreed. “We generally don’t think there is a population problem . . . . All countries that are alleged to have population problems are those that have socialist, communist governments or have corruption or graft in governments.” 594 Despite such allegations, the Mexico City Policy was actually similar to the Soviet Union’s position on population expansion. Pointing to the Marxist-Leninist economies of post- war Eastern Europe, Michael S. Teitelbaum, Chair of the Public Affairs Committee of the Population Association of America, testified to Congress that fertility declines actually resulted from a lack of economic freedom, not from free markets. He further noted that Reagan’s new position, that economic development would take care of population growth, most closely mirrored the Soviet bloc’s position at the U.N.’s population conference in Bucharest in 1974. 595 Another critic warned Reagan, “The Soviets have long contended that population growth is not a 592 Rasky, “Reagan Restrictions on Foreign Aid for Abortion Programs Lead to a Fight.” 593 Peter R. Huessy, The United Nations’ Flawed Population Policy, Pamphlet, The Heritage Foundation, Washington, D.C., August 27, 1984, 2, Edwin Meese Files, box 49, folder “Population Control,” Reagan. 594 Human Life International had affiliates in more than 100 countries at the time. Reena Shah, “U.S. aid influences abortion policies,” St. Petersburg Times (Florida), August 24, 1989. 595 “Statement of Michael S. Teitelbaum, Ph.D.,” 1–3. 184 problem. Rather, the USSR states that unsound economic principles are at fault . . . . We do not want to say this, too.” 596 Population Politics Reagan candidly insisted that USAID policies needed to come into line with his own views on abortion. The administration argued that by cutting off U.S. funding from organizations that provide abortions, the new policy would lower international abortion rates. However, family planning proponents argued that the restrictions would actually cause birth, abortion, and infant mortality rates to spike. 597 Directly countering the administration’s claims, the U.N. publication, Development Forum, declared that the new U.S. policy would “have the very effect the [it] seeks to avoid. Since family planning awareness is now very high in many countries, women who cannot get contraceptive services will inevitably resort to abortion in increasing numbers.” 598 Opponents of the policy were quick to suspect backroom dealing. Sharon L. Camp, vice president of the Population Crisis Committee, for example, said the policy was “clearly an election year ploy.” 599 William Hamilton, director of Planned Parenthood Federation of America’s Washington Office, told the Wall Street Journal “What’s distressing to us is that after three years of fending them off, the White House has let the New Right get its nose under the tent in international population control.” 600 596 “Talking Points for Baker Meeting: Population Issue Paper,” n.d., Davey Boggs Files, box 21, folder “Population [1],” Reagan. 597 See, e.g., Menken, “Statement of Jane A. Menken, Ph.D.,” 1–4; Schultz, “Statement of T. Paul Schultz, Ph.D.,” 9. 598 “Back street abortion threat for IPPF,” International Women’s News 80 (1985), Sisterhood is Global Institute Records, 1963–2005 and undated, bulk 1990–2002, box SUBJ4, folder “Global Women’s Movement,” Duke. 599 Keller, “U.S. Policy on Abortion”. 600 Mayer and Seib, “Mobilizing Reagan Allies?” 185 Representative Chester G. Atkins (D-MA) argued that the new policy “placed [U.S.] population assistance at the heart of our domestic abortion controversy.” 601 Senator Robert T. Stafford (R-VT) reported to Reagan that constituents had sent him letters expressing concern that the aid restrictions would “reflect just one of the many groups who are interested in our international population policy.” 602 In another letter to the president, two constituents wrote pointedly, “There are many Americans who believe that you would sell yourself for a block of religious votes but [we] would like to believe differently.” 603 John H. Galbreath, director of the Council of Theological Seminaries of the United Presbyterian Church, told Reagan that the new policy “puts in serious question not only the intelligence but also the credibility of our nation.” He added, “I am further informed that there is pressure to withdraw funds for family planning from the U.S. aid to third world countries. One must ask if this is a consequence of our new relationship to the Vatican.” 604 James Lake, spokesman for the Reagan-Bush ’84 campaign, insisted that the new population policy was “not a political issue.” However, pro-life groups were quick to disagree. Gary Curran, director of the 135,000-member American Life Lobby, the largest anti-abortion group in the country, warned, “If the administration backs down . . . we would be very, very upset. The pro-life movement, which provides the political troopers who ring the doorbells and stuff the envelopes, could very well hang out a sign saying, ‘Gone Fishing.’” One Democratic Senate staffer speculated that the proposed aid restrictions were “a cynically calculated move to 601 The Effect of the Mexico City Policy on International Family Planning: Hearing Before the Subcommittee on International Operations, 101st Cong. 26 (1989) (statement of Hon. Chester G. Atkins). 602 Robert T. Stafford to Ronald Reagan, Letter, July 2, 1984, PR Public Relations, PR 014-06 222623-232450, box 11, folder “PR 014-08,” Reagan. 603 Bill Baird and David Rich to Ronald Reagan, Letter, August 17, 1984, WHORM Subject Files, box 6, folder “WE003 Family Planning-Abortion (255500-258999),” Reagan. 604 Galbreath to Reagan, Letter. 186 combat complacency.” He added that the administration had “nothing to lose politically, and [the policy] should move certain fundamentalist segments of the Republican Party to get out the vote.” 605 It does appear that the new stance on population was part of the strategy to woo Catholic voters. According to Carl Bernstein and Marco Politi, Reagan agreed to restrict funding for international family planning programs in an effort to secure the Vatican’s support for U.S. anticommunist efforts in Eastern Europe. “There was an explicit quid pro quo there,” Bernstein and Politi concluded, “that Reagan was essentially delivering on his commitment to the Vatican and to the Catholic right in the U.S.” 606 Several polls revealed widespread disapproval of the new foreign aid policy. According to a survey conducted by Planned Parenthood Federation of America that August, 61 percent of adults supported the federal government “providing assistance for governments in developing countries for birth control programs even if they also have abortion programs.” Thirty-five percent of adults opposed such a policy while 4 percent did not have an opinion. 607 A majority of those polled also opposed the abortion-related restrictions on foreign aid and disagreed with the policy paper’s characterization of population as a nonissue for the economies of developing countries. They also favored the continued provision of contraceptives as a part of foreign aid. Not a single aspect of Reagan’s new policy garnered a majority’s support in any of the polls. 608 605 Meyer and Seib, “Mobilizing Reagan Allies?” 606 Carl Bernstein and Marco Politi, His Holiness: John Paul II and the Hidden History of Our Time (New York: Doubleday Religious Publishing Group, 1996), 270. 607 Sex Education, Family Planning and Abortion, August 1985, retrieved March 12, 2014 from the iPOLL Databank, The Roper Center for Public Opinion Research, University of Connecticut, http://www.ropercenter.uconn.edu/data_access/ipoll/ipoll.html (hereafter “iPOLL”). 608 Sheldon J. Segal, Under the Banyan Tree (Oxford: Oxford University Press, 2003), xxviii. 187 Between June and September 1984, 245 newspaper editorials opposed the draft while only thirty- seven showed support and twenty others were mixed. 609 Witnessing the widespread opposition to the draft policy statement, pro-life groups urged the administration not to recant. As one aide told Reagan, “You don’t want major questions raised about the position the U.S. Government is taking a week before the [Republican National] Convention. We don’t want to have to explain it to a convention with a number of people who have strong views on the subject.” 610 The White House assured pro-life groups of its commitment to the new policy. Curran, director of the American Life Lobby, reported that he had received assurances from an aide to Chief of Staff Baker that “the White House is going to hang tough on this one.” 611 Though it went through several drafts, the main thrust of the policy paper remained the same. Roy C. Jones, Director of Legislative Affairs for the Moral Majority, praised the administration’s commitment to the pro-life cause. “I would like to take this opportunity to do something that leaders in the ‘New Right’ rarely have the opportunity to do – publicly praise White House Chief of Staff James A. Baker III,” Jones wrote in the conservative Washington Times. “Jim Baker is to be commended for his tenacity and loyalty to the president’s position on the abortion issue. I certainly hope that he will not bend as the wave of pro-abortion special interest groups converge on the White House.” 612 609 See Finkle and Crane, “Ideology and Politics at Mexico City,” 27n59. 610 Gailey, “White House Urged Not to Bar Aid to Countries Supporting Abortion.” 611 Russell, “End Urged to Aiding Population Control.” 612 Roy C. Jones, “Public Praise for James Baker,” The Washington Times, July 2, 1984. 188 NGOs that refused the new terms for USAID funding would lose all forms of U.S. support, including contraceptive supplies. 613 This, too, represented a success for pro-life advocates who could use “any connection to abortion or coercive sterilization, no matter how tenuous . . . to justify defunding organizations that supplied condoms, pills, and IUDs to millions of people—something that could never be achieved by attacking contraception head on.” 614 “You can’t stop abortion without fighting contraception: it is the gateway to abortion,” explained Father Paul Marx, president of Human Life International (HLI). 615 According to James Miller, an HLI spokesman, “The pill and the IUD are part of the same problem as abortion.” 616 Judie Brown of the American Life Lobby agreed. She described population programs as sending taxpayers’ dollars “down the funnel of filth inappropriately called ‘family planning.’” 617 Indeed, family planning proponents feared the effects the restrictions would have on population assistance abroad. 618 Salas, of the United Nations Fund for Population Activities, called the new U.S. policy an “attack,” one that “poisons the atmosphere for effective population programs and undermines the role of the United Nations in population work.” 619 Announced in the middle of the presidential race and with the U.N. Conference set to take place only a few weeks before the Republican National Convention, the new foreign aid policy reflected the growing influence of the New Right and the pro-life movement in American 613 The Mexico City/Global Gag Rule: Its Impact on Family Planning and Reproductive Health, Before the House Comm. on Foreign Affairs, 110th Cong. 90 (2007) (Written statement of Serra Sippel, Acting Executive Director for the Center for Health and Gender Equity). 614 Connelly, Fatal Misconception, 351–52. 615 Gordon, The Moral Property of Women, 304. 616 Shah, “U.S. aid influences abortion policies.” (internal formatting omitted) 617 Eckholm, “Population Growth: How U.S. Policy Evolved.” 618 “Population Draft Angers Pro-Abortionists,” Human Events, June 30, 1984. 619 Salas, “Poisoning Population Assistance.” 189 politics. 620 Despite the public opposition and scientific evidence contradicting the new policy’s foundations, the president ignored the critics. The International Response The new U.S. foreign aid policy faced staunch opposition in Mexico City, particularly from the developing nations it would most affect. 621 “The U.S. may be concerned about abortion, but it cannot impose its views on the free world,” argued a delegate from India. 622 A Brazilian organization even refused a “no-strings-attached” grant of private funds from USAID because it “wished no further association with any American organization linked to such an onerous U.S. policy.” 623 In contrast to the new U.S. stance that population growth was a neutral phenomenon, other countries at the conference emphasized the dangers of such expansion. Olof Palme, Prime Minister of Sweden, stressed that there were no shortcuts to diminishing population growth. 624 Similarly, the Federal Republic of Germany called population growth an “ever more urgent problem of our times.” While acknowledging that substantial development does eventually lead to a decline in population growth, Germany’s position paper declared that population growth 620 Connelly, Fatal Misconception, 354; Russell, “End Urged to Aiding Population Control.” 621 In addition to the administration’s new stance on the population crisis and the new policy related to abortion, the U.S. delegation also departed from precedent by making no policy utterances on the status of women. However, fearing the gender gap in the upcoming election and responding to pressure of women’s groups lobbying at the Conference, the United States did endorse a proposal to strengthen women-related language and agreed to create a separate section on women near the beginning of the Conference’s Recommendations. Finkle and Crane, “Ideology and Politics at Mexico City,” 14. 622 Connelly, Fatal Misconception, 355. 623 Constance Holden, “U.S. Antiabortion Policy May Increase Abortions,” Science 238 (November 27, 1987): 1222. 624 Olof Palme, “Statement by the Prime Minister of Sweden, Mr. Olof Palme, concerning the International Conference on Population,” n.d., 1, PR Public Relations, PR 014-08 198000- 215159, box 7, folder “PR 014-08 (204567-204747),” Reagan. 190 itself is an obstacle to economic and social development. 625 Even British Prime Minister Margaret Thatcher, one of Reagan’s closest allies, endorsed the need for population control. “For humanitarian reasons, and to achieve the highest standard of living and improved quality of life which are the aims of all countries,” Thatcher said, “urgent action is needed to reduce the rates of population growth.” 626 The United Nations Fund for Population Activities While at the conference, the U.S. delegation also announced new terms for U.S. contributions to the United Nations Fund for Population Activities (UNFPA), a longtime target of the pro-life lobby. Established in 1969 largely due to the efforts of the U.S. government, the UNFPA operates under the authority of the U.N. General Assembly and is the world’s largest population and family planning assistance organization. 627 In 1984, a quarter of the UNFPA’s $150 million budget came from the United States. Less than one-quarter of one percent of its budget went towards abortion-related activities. 628 Still, abortion opponents often identified the UNFPA as one of the primary organizations propagating abortion throughout the world, primarily due to its support for questionable family planning programs in China. China ran a national population program with varying degrees of intensity beginning in the 1950s. The one-child-per-family rule went into effect in 1979. By the early 1980s, American newspapers reported that thousands of Chinese women were being “rounded up and forced to 625 “Statement for the 1984 International Population Conference in Mexico,” 1–2, n.d., PR Public Relations, PR 014-08 198000-215159, box 7, folder “PR 014-08 (204567-204747),” Reagan. 626 Margaret Thatcher, Statement, n.d., PR Public Relations, PR 014-08 198000-215159, box 7, folder “PR 014-08 (204567-204747),” Reagan. 627 “Facts about UNFPA,” United Nations Population Fund, n.d., 1, Robin Chandler Lynn Duke Papers, 1974–1999, box 1, folder “N.A.R.A.L.,” Duke. 628 Huessy, The United Nations’ Flawed Population Policy, 3–4. 191 have abortions.” 629 In 1983, Stanford academic Steven Mosher released a well-publicized book in which he alleged that China’s one child policy resulted in coercion and infanticide. According to the U.S. State Department, “those becoming pregnant outside the ‘plan’ are subject to peer pressure, harassment, and sometimes economic penalties and in many cases are forced to have abortions, even in late stages of pregnancy.” 630 In March 1984 Jacqueline R. Kasun, professor of economics at Humboldt State University, testified on the subject before the Senate Foreign Relations Subcommittee. “It is widely known that the People’s Republic of China is operating the world’s most coercive program of population control, including forced abortion, sterilization, and infanticide.” 631 Despite reports of coercion, that the U.S. delegation joined the other member governments of UNFPA’s Governing Council in approving a new five-year program of family planning support for China. 632 Salas and the UNFPA maintained that the organization never subsidized abortions of any kind and that its contract with China prohibited coercion. 633 Still, U.S. officials were skeptical about China’s population practices. In April 1984, Jay F. Morris, USAID Deputy Administrator, noted, “there’s no denying what the Chinese are doing” with birth control but there was so far no 629 Christopher Wren, “Chinese Region Showing Resistance to National Goals of Birth Control,” The New York Times, May 16, 1982; see also Michael Vink, “Abortion and Birth Control in Canton, China,” Wall Street Journal, November 30, 1981. 630 Quoted in Christopher Smith, “Opening Remarks of Rep. Chris Smith: Smith Offers Amendment to End U.S. Aid to Chinese Forced Abortion Policy,” n.d., 1, James W Cicconi Files, box 15, folder “World Population Conference II (1),” Reagan. 631 “Population Draft Angers Pro-Abortionists.” 632 Barbara B. Crane and Jason L. Finkle, “The United States, China, and the United Nations Population Fund: Dynamics of US Policymaking,” Population and Development Review 15 (March 1989): 31. 633 According to the UNFPA itself, it “does not provide support for abortions or abortion-related activities anywhere in the world.” In accordance with a decision by the UNFPA’s Governing Council, “it is the policy of the Fund . . . not to provide assistance for abortion, abortion services or abortion-related equipment and supplies as a method of family planning.” “Facts about UNFPA,” 2 (internal quotations omitted). 192 evidence that USAID money had been used to finance coercion. Indirect subsidies, Morris said, were “a much larger issue that we really don’t deal with.” 634 While legislators failed to pass legislation to defund the UNFPA prior to the U.N. conference, abortion opponents finally achieved a victory in Mexico City. 635 Despite initial proposals to exempt the UNFPA, the U.S. policy statement directly addressed the Fund. 636 It stated: The U.S. will insist that no part of its contribution be used for abortion. The U.S. will also call for concrete assurances that the UNFPA is not engaged in, or does not provide funding for, abortion or coercive family planning programs; if such assurances are not forthcoming, the U.S. will redirect the amount of its contribution to other, non-UNFPA, family planning programs. 637 In announcing the policy, the United States became the only country that would deny funding to the UNFPA for ideological and non-budgetary reasons. 638 Implementing the Mexico City Policy USAID began implementing the Mexico City Policy (“MCP”) on January 1, 1985. Over several months, the Agency drafted new clauses to be included in new grant agreements with 634 “Paying for Abortions,” Wall Street Journal, April 9, 1984. 635 The International Security and Development Cooperation Act of 1984, H.R.5119, for example would have prohibited “using population planning funds to carry out population planning programs in the People’s Republic of China or for contributions to any international organization or any private or voluntary organization which carries out a population planning program in such country if the program includes forced or coerced abortion.” 636 George Archibald, “Four GOP lawmakers attack proposal to exempt agency on abortion-aid ban,” The Washington Times, July 2, 1984. 637 United States, Policy Statement of the United States of America at the United Nations International Conference on Population, 6. 638 United Nations, “United Nations Fund for Population Activities,” Press Release, July 16, 2004, accessed March 10, 2014, http://www.unfpa.org/public/cache/bypass/parliamentarians/pid/3615;jsessionid=139D1847747F F37FCB54675B21A02D70?newsLId=7203. 193 direct recipients, also known as Cooperative Agencies (“CA”) or grantees. 639 The clauses applied solely to “foreign NGOs which received USAID population funds, either as a direct recipient or as a subrecipient receiving grants through an American NGO recipient.” They prohibited grantees from purchasing or distributing equipment “for inducing abortions as a method of family planning;” providing fees or incentives to coerce or motivate women to have abortions; paying “persons to perform abortions or to solicit persons to undergo abortions;” supplying “information, education, training, or communication programs that seek to promote abortion as a method of family planning;” and lobbying for liberalized abortion laws. CAs had to certify their compliance in writing. 640 These restrictions did not just apply to the use of U.S. money. The standard clause specifically stated, “This censorship of all non-pejorative speech about abortion is not limited to AID-funded speech, but extends to all activities of the recipient, including activities that are funded entirely from sources other than the U.S. government.” 641 Because the MCP effectively “gagged” organizations from certain types of speech, opponents nicknamed it the Global Gag Rule. 642 639 The policy only applied to grants and cooperative agreements and to cost-reimbursable contracts. As such, some ongoing projects could be extended through funding mechanisms that would not carry the new restrictions. Camp, “The Impact of the Mexico City Policy on Women and Health Care in Developing Countries,” 40. 640 Nowels, International Family Planning, CRS-4n7. 641 Camp, “The Impact of the Mexico City Policy on Women and Health Care in Developing Countries,” 39. 642 It was also similar to the domestic gag rule on family planning organizations from the Public Health Services Act of 1987. Like its international counterpart, the domestic gag rule prohibited recipients of Title X funds from providing abortions, counseling or referrals. The American College of Obstetricians and Gynecologists, the American Medical Association, the American Psychological Association, and the National Association of Social Workers all opposed the provision. The Supreme Court upheld these restrictions in Rust v. Sullivan, 500 U.S. 173 (1991). Gloria Feldt, The War on Choice: The Right-Wing Attack on Women’s Rights and How to Fight Back (New York: Bantam Books, 2004), 48. 194 USAID would give family planning funding to foreign governments and foreign government-sponsored entities so long as “the grants were held in segregated accounts and not used to perform abortions.” Administration officials maintained that applying different restrictions to foreign governments “was a matter of accommodating a country’s sovereign prerogatives” and that withholding funds “might appear to be an attempt to use financial pressure to change domestic laws of a foreign nation.” 643 American NGOs receiving USAID funding “could perform or promote abortions” provided they used money from non-government sources. If a U.S.-based organization redistributed U.S. funds to a foreign NGO, the subgrantee had to certify “in writing that it did not, and would not during the time of the aid agreement, perform or actively promote abortion as a method of family planning or provide financial assistance to any NGO that engaged in such activities.” Any funds “denied or withheld from organizations not willing to sign the Mexico City clauses would be reallocated to other international family planning programs.” 644 Efforts to Reverse the Mexico City Policy Opponents of the new aid restrictions quickly attempted to reverse them. While the conference was still underway in Mexico City, the Democrat-controlled House passed a nonbinding resolution stating that “overseas population assistance money should be administered in accordance with previously established A.I.D. policies” and that “money should not be denied to programs because of abortion-related activities that are not paid for by the United States.” When Senators Bob Packwood (R-OR) and Bill Bradley (D-NJ) introduced a similar resolution in the Senate, Helms attached an amendment in support of the president’s new aid policy, 643 Nowels, International Family Planning, CRS-4–5. 644 Ibid., CRS-4, CRS-6. 195 effectively voiding the original resolution. Helms’ version prevailed, supported by thirty-five Republicans and seventeen Democrats. Unfortunately, the Congressional Record does not provide any insight into the Senators’ individual voting decisions. 645 In April 1985, the House Foreign Affairs Committee approved an amendment to the Foreign Assistance Act that prohibited the president from denying foreign aid for family planning programs “to a foreign country, an international organization, or a nongovernmental organization . . . because of the types of voluntary and noncoercive family planning programs which it carries out or promotes . . . so long as it does so entirely with funds other than the funds made available by the United States . . . .” 646 During floor debate, Representative Chris Smith (R-NJ), co-chair of the Congressional Pro-life Caucus, introduced an amendment “to strike that language, and thus . . . preserve current policy.” The House adopted Smith’s language upholding the existing foreign aid policy by a vote of 234 to 189. 647 Meanwhile, the Senate Committee on Foreign Relations approved an amendment, which stated that the USAID Administrator “shall not subject any nongovernmental or multilateral organization to any requirement more restrictive than any requirement applicable to a foreign government for such assistance.” 648 Because the Mexico City Policy did not apply to foreign governments, “the Administration would either be forced to broaden the policy to direct 645 In addition to Packwood, Bradley, and Helms, only four other Senators spoke during the debate over the amendment. 130 Cong. Rec. 22741 (1984); “Senate Vote #588 in 1984,” GovTrack.us, accessed March 14, 2014, https://www.govtrack.us/congress/votes/98-1984/s588. 646 Committee on Foreign Affairs, International Security and Development Cooperation Act of 1985, H.R. Rep. No. 99-39, at 121 (1985). 647 Ninety Democrats and 144 Republicans voted in favor, while 152 Democrats and thirty-seven Republicans voted against. Nine Democrats and one Republican did not vote. 131 Cong. Rec. 18416, 18423 (1985); “House Vote #197 in 1985,” GovTrack.us, accessed March 26, 2014, https://www.govtrack.us/congress/votes/99-1985/h197. 648 Committee on Foreign Relations, International Security and Development Cooperation Act of 1985, S. Rep. 99-34, at 59–60 (1985). 196 government aid or drop the restrictions on NGOs and international organizations.” In response, Helms introduced an amendment similar to the one proposed by Smith in the House. Despite the slight Republican majority, the Senate tabled Helms’s amendment by a vote of 53 to 45. 649 Unable to resolve the differences between the two versions of the bill, Congress dropped all references to the MCP restrictions in the enacted bill. 650 The closest Congress came to reversing the MCP came in 1991 when the House passed a bill stipulating that family planning aid could not be denied on the bases of conditions that did not also apply to foreign governments. The Senate version of the bill similarly dictated that foreign NGOs and international organizations could not be subject to conditions more restrictive than those applied to foreign governments. The Conference Committee adopted the Senate version, in spite of the threat of a presidential veto. The House, however, rejected the conference report and the bill never went before the president. 651 The Congressional Record is once again silent as to the reasons for these decisions. Refusing the Terms It is difficult to measure the immediate effects of the Mexico City Policy on family planning efforts. For some organizations, the policy’s restrictions were delayed until existing 649 Eighteen Republicans and thirty-five Democrats voted in favor of tabling the amendment. Thirty-five Republicans and ten Democrats voted against tabling the amendment. The Congressional Record does not provide any insight into why each Senator voted as they did. 131 Cong. Rec. 15068, 15084 (1985); “Senate Vote #121,” GovTrack.us, accessed March 31, 2014, https://www.govtrack.us/congress/votes/99-1985/s121. 650 International Security and Development Cooperation Act of 1985, Pub. L. 99-83, 99 Stat. 190 (1985); Nowels, International Family Planning, CRS-11. 651 Nowels, International Family Planning, CRS-11. 197 contracts expired. For others, accommodations and exceptions were made. 652 Ultimately, though, most USAID grantees signed the standard clause, accepting the restrictions as a condition of funding. International Planned Parenthood Federation, London (IPPF/London) and the Family Planning International Assistance of Planned Parenthood Federation of America, the “two largest cooperating agencies supporting family planning services in developing countries,” both refused the new terms and subsequently lost USAID funding when their existing contracts expired. 653 Over the course of its previous contract with USAID, IPPF/London distributed 29 percent of the 4.5 billion condoms, 38 percent of the 37.5 million intrauterine devices, and over half of the 630 million birth control pill cycles that USAID sponsored worldwide. Only $400,000, or less than .80 percent of IPPF/London’s entire budget went towards abortion-related activities. No U.S. funding went to those programs. 654 When its existing contract expired in 1985, IPPF/London opted not to renew it due to the new abortion restrictions. The organization lost $17 million in funding, including $4 million worth of contraceptive supplies, and subsequently cut a quarter of its staff, closed several field offices, and reduced its country grants. 655 IPPF/London claimed that even if it wanted to sign the standard clause, its constitution “barred the central organization from setting service policies for its independent associations.” Local IPPF affiliates could, however, choose to sign the standard clauses and receive U.S. funding. 656 Family Planning International Assistance (FPIA), the international arm of the Planned Parenthood Federation of America (PPFA), was USAID’s largest American grantee, receiving 652 Camp, “The Impact of the Mexico City Policy on Women and Health Care in Developing Countries,” 41. 653 Sinding Interview. 654 “Planned Parenthood Federation of America President Issues Statement on Court Decision to Uphold Mexico City Policy,” PR News Wire (New York, NY), September 20, 1990. 655 “Back street abortion threat for IPPF.” 656 According to Representative Chris Smith (R-NJ) in 1991, forty-four IPPF affiliates had signed the clauses. Nowels, International Family Planning, CRS-5. 198 95 percent of its funding from the Agency. PPFA established FPIA after being approached by USAID “to gauge interest in an international program.” Following its first USAID grant in 1971, FPIA “grew to be the largest of the USAID-funded international family planning assistance programs.” Evaluations sponsored by the U.S. government consistently found FPIA “to be an innovative, well-managed, and courageous model for replication. One review referred to FPIA as the engine of USAID’s international family planning program.” From 1972 until 1989, FPIA distributed 330 million cycles of birth control pills, 1.3 billion condoms, and 14 million IUDs, all provided by USAID. FPIA had distributed “almost $92 million of USAID furnished financial assistance to over 439 projects in 61 countries.” 657 FPIA also refused to accept the new abortion-related restrictions. The organization had programs in thirty-five countries when its contract with USAID expired in 1987. A University of Michigan study predicted that less than one-third of those who lost services from FPIA programs would continue to use contraceptives. Consequently, there would be 311,000 additional births in the first three years, along with 1,200 additional maternal deaths from pregnancies and 69,000 more abortions. 658 Responding to the Michigan report, “supporters of the [Mexico City Policy] simply denied the conclusion.” The National Right to Life Committee dismissed the findings, saying, “This manufactured ‘study’ was commissioned and funded by [Planned Parenthood Federation of America] itself.” 659 Years later, USAID’s then-Administrator Sinding recalled that when FPIA lost its funding, “many strong programs in developing countries, often administered 657 Planned Parenthood Global Partners, “The Impact of the 2001 Global Gag Rule: Draft Briefing Paper,” June 22, 2001, 2 (internal quotations omitted), PPFA-II Records, Accession #08S-14 #08S-14, box 23, folder “Global Gag Rule – PPGP Briefing Paper, June 22, 2001,” Smith. 658 Holden, “U.S. Antiabortion Policy May Increase Abortions,” 1222. 659 Jonathan Baron, Judgment Misguided: Intuition and Error in Public Decision Making (New York: Oxford University Press, 1998), 147. 199 by faith-based groups, were weakened, sometimes even beyond the point of recovery.” 660 PPFA sued USAID over implementation of the MCP but ultimately lost in court. Two lawsuits from other domestic NGOs also proved unsuccessful. 661 Defunding the UNFPA U.S. officials originally accepted UNFPA’s assurances that it did not support abortion or coercion and that it would keep U.S. money in a segregated account, not to be used in China. As long as the United States was appeased, the UNFPA would continue receiving its financial support. In 1985, The Washington Post published a series of articles alleging that China’s population program relied on coercion. While the articles did not directly address the UNFPA, pro-life activists used them as ammunition against the Fund. Later that year, USAID Administrator McPherson released only $36 million of the $46 million originally promised to the UNFPA. He did so despite having determined that there was no evidence that the UNFPA intentionally or unintentionally supported or promoted abortion in any country. McPherson warned the UNFPA to “distance itself from coercive practices” and said that the United States will not associate itself, even indirectly, with coercion that violates human rights. 662 Pro-life advocates achieved a second major victory that year. Though not explicitly naming the UNFPA, the Kemp-Inouye Amendment to the Supplemental Appropriations Act of 1985 prohibited, “the availability of appropriated funds to any organization or program which, as 660 The Mexico City/Global Gag Rule: Its Impact on Family Planning and Reproductive Health, Before the House Committee on Foreign Affairs, 110th Cong. 108 (2007) (Statement of Steven W. Sinding, Senior Fellow, Guttmacher Institute, Agency Director for Population, USAID, 1983–1986). 661 Planned Parenthood Fed’n of Am., Inc. v. Agency for Int’l Dev., 915 F.2d 59 (2d. Cir. 1990); DKT Mem’l Fund Ltd. v. Agency for Int’l Dev., 887 F.2d 275 (D.C. Cir. 1989); Pathfinder Fund v. Agency for Int’l Dev., 746 F. Supp. 192 (D.D.C. 1990). 662 Quoted in Crane and Finkle, “Dynamics of US Policymaking,” 31, 37–38. 200 determined by the President, supports or participates in the management of a program of coercive abortion or involuntary sterilization.” 663 Acting on Reagan’s behalf, McPherson determined that the “UNFPA participated in the management of a program of coercive abortion and involuntary sterilization, within the meaning of the Kemp/Inouye amendment . . . as a result of the assistance UNFPA provided to the population programs of China.” He maintained, however, that if China punished abuses in its population program, thus preventing coercive abortion and involuntary sterilization, or if the UNFPA radically changed the nature of its support for China, the UNFPA could once again receive U.S. funding. 664 The UNFPA resisted pressure to change its funding policies and attached no spending restrictions to its grants. Salas, the Fund’s director, indicated that the organization had no plans to disassociate from the Chinese program. Salas criticized the United States for conditioning its contribution on “moral considerations.” “You have to leave the countries to decide from themselves,” Salas said. “You are in no position, morally or culturally, to dictate to others what they want.” 665 The decision to withdraw funding from the UNFPA marked the first time the United States cut off support for an international organization based solely on its program in one country. No major U.S. diplomat, including the President and Secretary of State, ever publicly 663 Section V of the Supplemental Appropriations Act, 1985, Pub. L. 99-88, 99 Stat. 293 (1985). Senator Daniel Inouye, for whom the amendment was originally named, later opposed the Administration’s decision not to fund the UNFPA. The amendment then became known as the Kemp-Kasten Amendment after its original sponsor, Representative Jack Kemp, and Senator Bob Kasten, a strong supporter of the amendment. Luisa Blanchfield, The U.N. Population Fund: Background and the U.S. Funding Debate, CRS Report for Congress. (Washington, D.C.: Congressional Research Service, 2008), 9n13. 664 M. Peter McPherson to Christopher H. Smith, Letter, June 20, 1986, Carl Anderson Files, box 1, folder “Abortion (6),” Reagan. 665 Quoted in Christopher H. Smith, et al to M. Peter McPherson, Letter, June 25, 1986, 1, Carl Anderson Files, box 1, folder “Abortion (6),” Reagan; Daniel P. Warwick, “Foreign Aid for Abortion,” Hastings Center Report 10 (April 1980): 32. 201 addressed China’s population policy. 666 Maintaining relations with China meant the United States would not prioritize the population issue. The choice to defund the UNFPA can thus be seen as a minor way to appease opponents of family planning programs. The Population Institute, a family planning NGO, filed suit against McPherson and the U.S. government to block the redirection of UNFPA funds. On August 12, 1986, the U.S. Court of Appeals for the District of Columbia upheld USAID’s decision to defund the UNFPA. 667 The UNFPA did not receive U.S. funding for the remainder of the 1980s and early 1990s. Assessing the Mexico City Policy Between the time Reagan first announced the MCP and when President Bill Clinton rescinded it in 1993, only two major studies and one law review article evaluating the policy’s effects on the ground. In early 1987, the Population Crisis Committee (PCC) began assessing the policy’s current and potential future impact on foreign family planning programs. 668 Three years later, the USAID-funded Population Technical Assistance Project sponsored the “Blane- Friedman Report,” named after authors John Blane and Matthew Friedman. 669 666 Smith, et al to McPherson, Letter, 25. 667 Population Inst. v. McPherson, 797 F.3d 1062 (D.C. Cir. 1986); Blanchfield, The U.N. Population Fund, 11. 668 The PCC identified thirty-one major organizations with ongoing USAID-funded population and family planning programs. Of that group, thirteen agencies operated under cost-reimbursable contracts and were thus not covered by the MCP. Another seven had contracts that had not come up for renewal by the time of the study or had not been presented with the standard clause for other reasons. As a result, the MCP only applied to nine of the thirty-one organizations. The anti- abortion restrictions affected only six of those groups. Camp, “The Impact of the Mexico City Policy on Women and Health Care in Developing Countries,” 42. 669 Blane and Friedman studied five cooperating agencies and their subgrantees in six developing countries (for a total of forty-nine subprojects). John Blane and Matthew Friedman, Mexico City Policy Implementation Study, Population Technical Assistance Project Occasional Paper (Population Technical Assistance Project, November 21, 1990), v. 202 While the Mexico City Policy’s influence on the number of abortions was not immediately clear, both studies found that that the regulations had more subtle effects on family planning programs. Due to confusion surrounding the new rules, many NGOs instituted extra restrictions in order to avoid violating the conditions of their USAID contracts. According to Sinding, Director of USAID’s Office of Population, “There were a lot of things that the policy was not intended to curtail which were curtailed, because organizations erred on the side of caution.” 670 This over-cautiousness manifested in a variety of ways. Blane and Friedman cited unnamed organizations in Turkey and Bangladesh, which had expressly prohibited passive referrals for abortion, even though they were allowed under the MCP. 671 Rather than providing referrals, some clinic staff were instructed “not to say anything or to turn the person away” even under permissible circumstances, “for fear they will be thought to be advocating abortion.” In several clinics in Bangladesh, because of such concerns, “if a woman were to come in suffering from a septic abortion, the staff would not be permitted to accompany her to the hospital for treatment, even if it were done on a staff member’s own time.” A vasectomy clinic in Brazil, with only male clients, fired a health worker upon discovering the staff member’s pro-abortion views. Blane and Friedman explained, “The person was fired simply out of fear that his views might affect the program’s funding.” 672 Some NGOs avoided certain countries all together while others restricted their staffs from documenting information related to women’s abortion histories. The isolation of abortion providers from family planning services reduced the quality and quantity of post-abortion 670 Sinding Interview. 671 A passive referral is when a patient makes an unprompted inquiry about where to get an abortion. 672 Blane and Friedman, Mexico City Policy Implementation Study, 23, 26. 203 contraceptive services and counseling. Such a tendency, the PCC report argued, would inevitably lead to more abortions. 673 According to Blane and Friedman, that fear of “guilt by association” resulted in missed opportunities to exchange valuable information on family planning activities. They cited a 1985 conference where a Brazilian women’s group tried to stop discussions about abortion for fear that it would breach the terms of its funding from USAID. According to one of the conference participants, “There was a feeling that this was a form of censorship and went against the U.S. government’s own emphasis on freedom of speech.” As a result of the conflict at the conference, the Brazilian organization weakened its collaborative relationships with several of the other groups in attendance. 674 Clinton Ungags Foreign Aid The Mexico City Policy remained in place throughout George H.W. Bush’s presidency. President Bill Clinton rescinded the policy on January 22, 1993, his third day in office, explaining, “These excessively broad anti-abortion conditions are unwarranted. I am informed that the conditions are not mandated by the Foreign Assistance Act or any other law. Moreover, they have undermined efforts to promote safe and efficacious family planning programs in foreign nations.” 675 Grantees welcomed the news. Fred Sai of Ghana, chairman of the U.N. 673 Camp, “The Impact of the Mexico City Policy on Women and Health Care in Developing Countries,” 46. 674 Blane and Friedman, Mexico City Policy Implementation Study, 26, 27. 675 William J. Clinton to the Acting Administrator of the Agency for International Development, “AID Family Planning Grants/Mexico City Policy,” Memorandum, January 22, 1993, APP, accessed March 27, 2014, http://www.presidency.ucsb.edu/ws/index.php?pid=46311&st=%5C%22Mexico+City+Policy%5 C%22&st1=#axzz1T47P8JQP. 204 Preparatory Committee, explained, “As one of those who had to struggle within the old U.S. policy it is like a breath of fresh air.” 676 And then came the 1994 mid-term elections and the so-called Republican Revolution. Republicans won a majority in the House for the first time in four decades. It was also the first time since 1946 that they held majorities in both houses simultaneously. The GOP also had a net gain of ten governorships, which resulted in a majority of Republican governors for the first time in almost twenty-five years. In contrast to many sitting Democrats who lost to Republican challengers, not a single Republican incumbent lost an election. The Republican Party had successfully “tapped into the deep vein of moral/religious conservatism that ha[d] been growing in the US in recent years . . . .” The election revealed “the extent to which the ‘centre’ in American politics ha[d] shifted to the right.” 677 The battle over the 1996 appropriations bill proved the extent of the power the anti- abortion contingent in Congress now wielded. The House version of the bill contained language authored by Representative Smith that would reinstate the Mexico City Policy. In contrast, the Senate’s bill included an amendment, proposed by Republican Nancy Kassenbaum of Kansas, “that would have specifically prevented the reinstatement of a Mexico City-type policy like the one that the Smith Amendment proposed.” The conference report was adopted with the abortion issue “reported in disagreement,” meaning that both the House and the Senate would have to vote on that single issue that remained in dispute. During the debate in the House, “senior Administration officials went on record” threatening a presidential veto “if the conference report presented to [President Clinton] added additional restrictions on the use of the population 676 Steven A. Holmes, “U.S. Set to Change Abortion Policies,” The New York Times, May 12, 1993. 677 “Republican ‘Revolution,’” Economic and Political Weekly 29 (November 26, 1994): 3005– 06. 205 assistance beyond those contained in existing law.” Clinton maintained his veto threat while “the House and Senate voted to reaffirm their respective positions on a total of seven separate occasions.” 678 After several months of gridlock, Congress attached the foreign operations bill to a continuing resolution passed in February. 679 House Republicans agreed to drop the “abortion- related restrictions that had delayed passage of the bill for months” in exchange for a 35 percent cut to family planning programs. The appropriated funds could not be spent until July 1 and then only at a monthly rate of 6.7 percent of the total. As a result, only a small fraction of the fiscal year 1996 funds could actually be spent. The same restrictions governed UNFPA funds. Both the monthly apportionment formula and the nine-month delay in release of population funds were unprecedented. Clinton signed the bill as part of a deal with congressional Republicans to prevent a government shutdown. It was a game of chicken. The government would shut down if Clinton did not agree to the delayed population funding. Clinton relented. 680 House Republicans again succeeded in restricting USAID’s family planning funding in the 1997 omnibus spending bill. 681 This time, the legislation blocked the release of appropriated family planning money until July 1, 1997, after which funds could only be spent at the rate of 8 percent of the total for each of the next 12.5 months. Funds could be released as of March 1 if the 678 Victoria Markell, Vivian Escobar-Stack, and Craig Lasher to Population and Family Planning Colleagues, “Legislative & Policy Update,” Memorandum, February 8, 1996, 2–4, Robin Chandler Lynn Duke Papers 1998-0310, 1998-0311, box 3, folder “Population Action International, 1993,” Duke. 679 Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1996, Pub. L. 104-107, 110 Stat. 704 (1996). 680 Markell, Escobar-Stack, and Lasher to Population and Family Planning Colleagues, “Legislative & Policy Update,” 1–2. 681 Omnibus Consolidated Appropriations Act, 1997, Pub. L. 104-208, 110 Stat. 3009 (1997). 206 president submitted findings to Congress on the negative impact of such a delay and Congress approved such findings with a joint resolution by February 28. 682 On January 31, Clinton issued such a report: “[A] delay will cause serious, irreversible and avoidable harm. In the balance are the lives and well-being of many thousands of women and children and America’s credibility as the leader in family planning programs around the world.” Accusing family planning opponents of trying to “mischaracterize” the vote and the work of USAID, Clinton continued, “let me be clear: The United States provides family support where it is wanted and needed. We are prohibited by law from ever funding abortion—and we abide faithfully by that law. . . .” 683 The House voted by a narrow margin to approve the president’s request to release the funding: forty-four Republicans, 175 Democrats, and one Independent voted in support of Clinton’s request; 187 Republicans and twenty-seven Democrats voted in opposition. The Senate also approved Clinton’s request, with eleven Republicans and forty-two Democrats voting in support. The House subsequently voted 231 to 194 to approve separate legislation that would tie the Mexico City Policy to the release of the money. The vote “allowed antiabortion lawmakers who support family planning services to cast a vote demonstrating opposition to abortion.” Sixteen Republicans and twelve Democrats voted for both measures. It does not appear that the Senate voted on the second piece of legislation. 684 682 Judy Mann, “Time to Reverse a Family Planning Fiasco,” The Washington Post, January 24, 1997. 683 “Statement by the President on USAID Funds for International Family Planning,” The White House, Office of the Press Secretary, Press Release, January 31, 1997, Robin Chandler Lynn Duke Papers, 1942–2000, 2000-0176, box 2, folder “Population Action Int’l – Misc. 1997,” Duke. 684 John E. Yang, “House Releases Foreign Aid for Family Planning,” The Washington Post, February 14, 1997; Janet Hook, “Senate OKs Release of Family Planning Funds Abroad,” Los Angeles Times, February 26, 1997. 207 The votes suggest that there were fault lines within the Republican Party. Representative James C. Greenwood (R-PA) said the repeated votes on pro-life proposals made “the Republicans appear extreme.” Representative Constance Morella (R-MD) described the votes as “about family planning and against abortion,” noting that the 35-percent cut in family planning funds since 1995 caused 4 million more unintended pregnancies, and 2 million more abortions worldwide. Representative Smith and his pro-life colleagues disagreed with Morella’s characterization and argued that abortion was in fact “the heart of the matter.” According to Smith, the administration’s policy would “further empower, strengthen and tangibly aid and abet the abortion industry overseas.” 685 Senator Tim Hutchinson (R-AR) declared, “It is obvious that this battle will be renewed each year . . . until the pro-life position prevails.” 686 That moment came in 1999 when the Republican Congress held the country’s U.N. dues hostage to get Clinton to accept the MCP restrictions. Clinton was under pressure “to pay the UN debt by the end of the year to stave off the imminent loss of the United States’ vote in the General Assembly.” Clinton conceded, allowing a one-year “rider” to the 2000 foreign aid appropriations bill. The rider effectively reinstated the Mexico City Policy, though, with the option of a presidential waiver. The waiver, which Clinton executed hours after signing the bill, placed significant restrictions on the dispersal of population funds by USAID. As a result, only $15 million could be distributed to NGOs that provided abortion services. 687 With the rider about to expire, President George W. Bush reinstated the Mexico City Policy on his first day in office in 2001, also the 28th anniversary of the ruling in Roe v. Wade. 685 Yang, “House Releases Foreign Aid for Family Planning.” 686 Hook, “Senate OKs Release of Family Planning Funds Abroad.” 687 Susan A. Cohen, “Global Gag-Rule Threatens International Family Planning Programs,” The Guttmacher Report on Public Policy 3 (February 2000), accessed March 30, 2014, <http://www.guttmacher.org/pubs/tgr/03/1/gr030101.html> 208 In August 2003, Bush expanded the reach of the MCP to family planning grants awarded by the State Department. Bills trying to overturn or at least mitigate the effects of the MCP were proposed, and ultimately failed, in almost every year of Bush’s presidency. 688 The Mexico City Policy stayed in effect until 2009. President Barack Obama repealed the restrictions within days of taking office, just as Clinton had done before him. 689 Efforts both to reinstate and permanently repeal the restrictions since then have failed. Conclusion The Mexico City Policy has a long and contested legacy, one that reveals the far reach of the pro-life movement in American politics. Frustrated by the inability to restrict abortion domestically, pro-life organizations tried to do so abroad. Their message made its way from the grassroots to the Capitol. While Senator Helms and a handful of other congressmen and women had long been committed pro-life advocates, foreign aid gave the less devout Republicans the political cover necessary to appease their growing and increasingly vocal pro-life constituencies. 690 As a result, “anti-abortion campaigners [were] far more successful at incorporating their ideas in programs intended for overseas than for the United States.” 691 Foreign aid thus not only increasingly became a site of major political controversy but its conditions became a way to export the ideology favored by the political party with the upper hand. 688 “Global Gag Rule Timeline,” Population Action International, accessed January 15, 2014, http://populationaction.org/data-and-maps/global-gag-rule-timeline/. 689 Ibid. 690 Reena Shah, “U.S. turning away from population control efforts,” St. Petersburg Times (Florida), November 12, 1989. 691 Neil A. Lewis, “Abortions Abroad Are New Focus of Widening Battle Over Reagan’s Policy,” The New York Times, May 31, 1987. 209 The Mexico City Policy exemplifies this dynamic. Over time, more and more population organizations and NGOs have spoken out against its negative effects on family planning programs. The policy’s supporters maintain its benefits in preventing American tax dollars from being spent on abortion. While politicians and activists will likely continue to debate the consequences and benefits of both laws, one thing does remain clear: the Helms Amendment and Mexico City Policy serve as international conduits for American cultural change, directly affecting people around the world. 210 Epilogue Ever since President Kennedy established USAID in 1961, U.S. foreign aid programs have had the officially stated purpose of, “furthering America’s foreign policy interests in expanding democracy and free markets while improving the lives of the citizens of the developing world.” 692 The history of abortion and USAID complicates this official narrative by proving instead that foreign aid policies first and foremost serve the ideological objectives of the party with the upper hand in Washington. The Helms Amendment and the Mexico City Policy bring this dynamic into sharp relief. Testifying before the Senate Foreign Relations Committee in 2001, Dr. Nirmal Bista, Director General of the Family Planning Association of Nepal (FPAN), shed light on the sweeping implications of the Mexico City Policy. A subset of the International Planned Parenthood Federation, FPAN was the largest NGO in Nepal, providing 25–30 percent of the country’s family planning assistance. Along with offering pre- and post-natal care, immunizations, basic primary care, and treatment for sexually transmitted infections, FPAN also lobbied to change the country’s very restrictive abortion laws. Half of Nepali maternal deaths resulted from unsafe, illegal abortions. 693 Dr. Bista told the story of Min Min, a thirteen-year-old girl who had become pregnant after being raped by a relative in 1997. Min Min subsequently had an abortion, despite the 692 “Who We Are,” USAID: From the American People, accessed March 30, 2014, http://www.usaid.gov/who-we-are. 693 Dina Bogecho and Melissa Upreti, “The Global Gag Rule: An Antithesis to the Rights-Based Approach to Health,” Health and Human Rights 9 (2006), 22; Mexico City Policy: Effects of Restrictions on International Family Planning Funding, Hearing Before the Senate Committee of Foreign Relations, 107th Cong. (2001) (Statement of Dr. Nirmal K. Bista, Director General, Family Planning Association of Nepal, Kathmandu, Nepal). 211 procedure being illegal and very dangerous. When her sister-in-law told the police about the abortion, Min Min was arrested and sentenced to twenty years in jail. FPAN launched a campaign to help Min Min and to change the country’s abortion laws. Min Min was eventually released after two years in prison. However, one in five women remained in prison for the crime of abortion. 694 When President George W. Bush reinstated the Mexico City Policy restrictions in 2001, FPAN had to decide whether to accept the abortion restrictions or continue its work helping women like Min Min. FPAN chose the latter and lost approximately $250,000 in U.S. funds as a result. The organization closed several clinics and terminated family planning services for thousands of clients. “This is the challenge,” Dr. Bista explained, “do I listen to my own government that has asked FPAN to help save women’s lives, or do I listen to the U.S. government?” Bista continued, “Were we to accept the restricted funds, I would be prevented from speaking in my own country to my government about a health care crisis I know first hand. But by rejecting U.S. funds, I put our clinics—clinics addressing that same health care crisis—in very real jeopardy.” 695 Opponents of the Mexico City Policy argue that by prohibiting organizations from lobbying for liberalized abortion laws and from actively referring patients to abortion facilities, the funding restrictions violate recipient NGOs’ freedom of speech. However, as foreign entities, non-American NGOs do not have the same First Amendment protections enjoyed by their American counterparts. As Representative Tom Lantos (D-CA) observed in 2000, “It is not 694 Mexico City Policy: Effects of Restrictions on International Family Planning Funding; Hearing Before the Senate Committee of Foreign Relations, 107th Cong. (2001) (Statement of Dr. Nirmal K. Bista, Director General, Family Planning Association of Nepal, Kathmandu, Nepal). 695 Ibid. 212 enough to talk about human rights and democracy and free speech. It is important to practice what we preach . . . [it is about] advocating globally what we so cherish for our own citizens here at home.” 696 Advocates of the Mexico City Policy claim the restrictions will cause abortion rates to drop. Family planning providers on the ground, however, suggest that the restrictions have in fact had the opposite effect. Testifying before the House Committee on Foreign Affairs in 2007, Joana Nerquaye-Tetteh, the former executive director of Planned Parenthood Association of Ghana (PPAG), discussed the effects of the Policy. In my country the Global Gag Rule has had the exact opposite effect of its stated intent. It did not reduce abortions. Indeed PPAG began to see a sharp rise (almost double) in post-abortion care services in our clinics, especially in the rural areas which is a reflection of the worsened access to reproductive health care and supplies. 697 PPAG did not perform abortions but did provide referrals to government hospitals where women meeting the criteria established by Ghanaian law could have abortions. These referral services precluded PPAG from receiving USAID funding under the Mexico City Policy. 698 Representative Chris Smith, one of the Policy’s leading advocates in Congress, responded to Nerquaye-Tetteh by pointing out that Ghana had received a 50 percent increase in contraceptives from 2002 to 2007. Moreover, he said, “If one NGO does not agree to the Mexico City clause, another NGO is there to take the funding.” 699 While PPAG hoped to find another organization to take over the USAID contract, however, no other NGO came close to having the 696 Susan A. Cohen, “Global Gag Rule: Exporting Antiabortion Ideology at the Expense of American Values,” The Guttmacher Report on Public Policy 4 (June 2001), accessed March 30, 2014, https://www.guttmacher.org/pubs/tgr/04/3/gr040301.html. 697 The Mexico City/Global Gag Rule: Its Impact on Family Planning and Reproductive Health, Before the House Comm. on Foreign Affairs, 110th Cong. 40 (2007) (Statement of Joana Nerquaye-Tetteh, Ph.D., Former Executive Director, Planned Parenthood Association of Ghana). 698 Ibid., 31–32. 699 Ibid., 49. 213 same country-wide structure or the expertise PPAG had built over thirty-three years in the field. 700 Smith’s argument that USAID merely redirects money to organizations willing to accept the abortion restrictions neglects the fact that those NGOs losing money are often the most effective, if not the sole family planning organizations in a given country. In Zambia, for example, there was only one NGO operating reproductive health clinics. When it opted not to sign a USAID contract with the Mexico City clause, the organization lost 40 percent of its staff, had to reduce its services, and ultimately eliminated its contraceptives distribution programs. 701 The debate over the Mexico City Policy, and about foreign aid policy more generally, is thus ultimately about priorities. At any given moment in time, national security concerns, humanitarian motivations, and economic interests inform U.S. foreign assistance programs. While they sometimes align, these objectives often conflict with one another. Where the Helms Amendment allowed for subversion, the Mexico City Policy achieved the pro-life goal of preventing U.S. money from being used on abortion-related activities. However, in doing so, the Policy’s restrictions ultimately undermined broader foreign policy interests in the health and industrialization of developing nations. American debates over a woman’s ability to take a certain pill or undergo a specific procedure will thus continue to have an impact around the globe, from the marbled hallways of the Supreme Court to a physician’s examining room in Ghana. Such conversations are about the role of mothers and fathers, women and men, interest groups and politicians, the legislative 700 Ibid., 31–32. USAID continued to do work with a variety of Ghanaian non-profits after PPAG lost its funding. Ibid., 119 (Statement by Dr. Kent R. Hill, Assistant Administrator for Global Health, U.S. Agency for International Development). 701 Ibid., 118 (Written Statement of Nancy Northrup, President of the Center for Reproductive Rights). 214 branch and the executive branch, science and religion. 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