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Western feminists, reproductive rights and contraception in bangladesh

Western Feminists,
Reproductive Rights and

Contraception in Bangladesh
Santi Rozario
Department of Sociology and Anthropology, University of Newcastle, N.S.W.
Family planning has been a major preoccupation of development agencies in South Asia for several decades now. However, the way family planning programs have beenimplemented and are still being aggressively promoted in different parts of South Asiacauses problems for, rather than furthering, women's reproductive rights and women'shealth. The priorities of development agencies reflect Western obsessions with limitingpopulation rather than the actual needs of local women. These issues have been taken upand promoted by local groups such as UBINIO in Bangladesh, as well as by internationalfeminist organizations such as FINRRAGE (Feminist International Network of Resistanceto Reproductive and Genetic Engineering), allied to the growing international concernwith medical abuse of women's bodies. There are however problems with the strategiesof these movements. While their opposition to the forms of contraception which are currently being promoted is entirely justified, they have little to offer in their place. Theirmostly educated, middle-class memberships tend to have little empathy with, orunderstanding of, the situation of village women. In examining the problematicrelationships between urban feminist groups in developing countries, Western feministorganizations, and the rural populations whom they seek to aid, this paper hopes tocontribute towards a feminist politics more attuned to the reality of rural women in SouthAsia and similar contexts.
It has become increasingly clear that the process of "development" is often damagingand destructive for Third World women, especially poorer women living in villages orurban slum areas. Contraception and population control policies have been a particularconcern, especially in the South Asian context, and this has been an area where linksbetween Western and Third World feminist groups have been significant. Western feminist groups have at times acted as an effective lobby against the more damaging and abusiveaspects of population control policies, such as the pressure on women to accept long-term injectable and hormonal contraceptives without informing them of the considerableassociated health risks, and the frequent lack of any assistance for women who experienceproblems with these and other forms of contraceptive intervention (e.g. sterilization).
However, much of the Western awareness of these issues, particularly among the more general feminist readership, has been dominated by a particular perspective. This Journal of Interdisciplinary Gender Studies 4.1 (June 1999) is the position represented by such Western writers as Janice Raymond (author of Womenas Wombs) and Maria Mies (joint author with Vandana Shiva of Ecofeminism). BothRaymond and Mies are members of a group known as FINRRAGE (Feminist InternationalNetwork of Resistance to Reproductive and Genetic Engineering). While they have rightlyled the attack on abusive and damaging forms of contraception and abortion, they have also argued in effect that village women in South Asia do not want or need access to anyforms of mechanical contraception. They have backed up these claims through referencesto statements by South Asian women, primarily (in fact more or less exclusively) thosederiving from one specific Bangladeshi women's group, UBINIG, and its director, FaridaAkhter.
In this paper I want to examine the relationship between Mies, Raymond and the FINRRAGE activist group, on the one hand, and UBINIG and Akhter on the other. Ishall argue that UBINIG, despite its claims, does not provide a valid picture of what thewomen at the receiving end of family planning programs in fact want. While internationalnetworks tend to assume that indigenous women's organizations in South Asia are able to speak on behalf of local women, in practice organizations such as UBINIG, with theirmostly educated, urban and middle-class memberships may have little empathy with orunderstanding of the situation of poorer women from village or urban slum backgrounds.
In reality, UBINIG "s involvement has in several respects been damaging rather thanhelpful to the interests of many of the poorer village and urban women.
Here I am referring not to the FINRRAGE-UBINIG campaign against hormonal contraceptives, but to their willingness in effect to deny all forms of contraception toBangladeshi village women. This denial, which in the case of UBINIG has gone as faras an alliance with Australian right-wing political forces to block contraceptive aid tothe Third World, is based on an ideological commitment which is less than apparent onthe surface. More precisely, there are two sets of ideological commitments, one on thepart of Mies and Raymond, the other on the part of Akhter, and I shall try to spell out inthis paper what they involve. Between them, they generate an extremism which may be attractive to Western women distant from the South Asian village scene, but is potentiallyvery damaging to the lives of those Bangladeshi women whose desires are beingmisrepresented and whose real needs are being overridden.
Before going any further I should emphasize that the international women's movement is not a monolithic body, and that the following discussion applies specificallyto the extreme positions held in relation to population policies and contraceptives byUBINIG in Bangladesh and FINRRAGE internationally. While the positions of theUBINIG/FINRRAGE alliance have been disproportionately influential on general feminist opinion in the West, they are by no means the only feminist organisations,researchers and activists in Bangladesh and internationally who have been concernedwith population policies, and they do not represent the majority of such activity. Otherorganisations who have been actively and effectively criticising abusive population controlmeasures in the Third World include Development Alternatives for Women for a NewEra (DAWN)1, the Women's Global Network of Reproductive Rights (WGNRR), theBangladesh International Action Group (BIAG),2 the International Women's HealthCoalition (IWHC) and the Women Living Under the Muslim Laws Network (WLUML).
As will become evident in the course of my discussion, I would support by and large thepositions adopted by these women's organisations in relation to women's health andreproductive rights issues.
In addition, UBINIG has been active in areas other than contraception, for example in campaigns for agricultural sustainability and against genetically-modified foods, ashave individual FINRRAGE members such as Maria Mies. I have no particular criticismsof these campaigns, which I would broadly support. This article is directed specificallyto the issue of contraception.
FINRRAGE was organized in Groningen, the Netherlands, in 1984. It was originally called FINNRET (Feminist International Network on New Reproductive Technologies),and it seems that the shift in name from FINNRET to FINRRAGE reflected the adoptionof a more militant position. The original members of FINNRET seem to have beenconcerned essentially with the "new" reproductive technologies such as IVF (in vitrofertilization), sex predetermination, embryo transfer, surrogacy and the like. This isreflected in the writings of the group in the mid-eighties (e.g. Corea et al. 1987). By the 1990s, some members at least were taking a much stronger position of opposition to all forms of reproductive technologies, including chemical and hormonal contraceptives aswell as the more controversial technologies such as IVF and sex predetermination(Raymond 1993, Mies and Shiva 1993). According to Janice Raymond, in a bookpublished in 1993, FINRRAGE by then had 1000 members distributed through 35countries. It is possible that its membership has since declined, since when I was in theNetherlands, where FINNRET was founded, in 1995 the local FINRRAGE affiliate,RHEA, had only four members, and they seemed to have moved away from the moreextreme position represented by major writers associated with the movement such asRaymond and Mies.
FINRRAGE's position has nevertheless had considerable impact internationally through works such as Maria Mies and Vandana Shiva's Ecofeminism and Raymond's Women as Wombs. I shall make some reference here to Raymond's work, but focus mostly on Mies's book, since the linkage with UBINIG emerges particularly clearly inher writing. I should note that while Ecofeminism appeared under the joint authorship ofMies and Shiva, the relevant parts of the book are all authored by Mies, and Shiva doesnot appear to have ever been an active member of FINRRAGE or to have subscribedpublicly to its position.
UBINIG, which describes itself as an independent centre for policy research for development alternatives in Bangladesh, was established in 1984, the same year asFINRRAGE. While FINRRAGE has had a number of high-profile members, UBINIG is very much a one-person show, with its executive director, Farida Akhter, being the primaryfigure involved in articulating its position. Akhter, who is an active member ofFINRRAGE, is also the president of Gonotantrik Nari Andolon (Democratic Women'sMovement), a member of the Protirodh Network (Network for Resisting the Abuse ofContraceptives on Women's Bodies), and the Asian editor for the journal Issues inReproductive and Genetic Engineering. She has attended numerous internationalconferences in India, Philippines, Japan, Australia, Germany, The Netherlands, Spainand Ireland among other places. She has also organised several conferences in Bangladesh on issues of reproductive technologies, three of them explicitly on behalf of FINRRAGE.
She has also written extensively in support of her position (collected in Akhter 1992).
Farida Akhter's involvement in these various organisations and activities reflects a particular political position which is in fact in the minority within Bangladesh.
FINRRAGE and UBINIG's critique of the abusive practices of population control policieswould find support and sympathy among most feminist and human rights activists, whoshare their opposition to the abuse of contraceptive practices both in the West and in theThird World. I found in my research that UBINIG's critical position in relation to abusivecontraceptives is well-known amongst the family planning NGOs, and it seems likelythat UBINIG's campaign may lead to greater caution by these NGOs in distributing andhandling new untested contraceptives. However, on some fundamental issues, UBINIGand FINRRAGE differ from the other women's groups and associations. It is these issues,and their implications for poor Third World women, which are the focus of my discussion.
In this section I consider the basic premises of UBINIG and FINRRAGE. The overallposition of both organizations is that only radical transformation in the present worldorder, i.e. changes internationally in the economic, social, political and cultural domain,can have a real effect on the situation of women in regard to reproductive rights, self-determination, empowerment and other such issues. They share the concern of manywomen's organisations that the language and concepts of the women's liberationmovement have been co-opted by governments and supra-governmental organizationswhose primary interests are in the control of population rather than the welfare of women.
Thus in a document prepared for the 1994 Cairo conference on population, they opposedpopulation control because: population policies ate designed to control the bodies, the fertility and the lives of women.
population policies have inbuilt racist and eugenic ideologies. population policies represent the interests of the privileged elites and a lifestyle of over-consumption in the countries of the North as well as of the elites in the Third World. there cannot be a feminist population control policy because it violates and contradicts the basic premise of feminism (UBINIG While other women's organisations might well go along with much of the thinking behindthis quotation, its implications for FINRRAGE and UBINIG are more radical than might appear at first sight. For FINRRAGE and UBINIG, the denunciation of the populationpolicies of the developed world extends to a rejection of the whole concept of reproductiverights for women, and to opposition, in practice, to any provision of contraception. It isin these respects that they differ from most other feminist organisations active in thedevelopment arena.
While there is a remarkable coincidence of political objectives between Akhter and Western members of FINRRAGE such as Mies and Raymond, it is also evident at timesthat they are approaching these objectives from somewhat different directions. Thus itis clear on reading Akhter's work carefully that she is trying to distance herself from Western feminism, which she sees as associated with Western values of individualism and self-centredness that are alien to Bangladeshi society. This opposition to Westernvalues, as we will see, underlies much of her overall position. Mies and Raymond areequally critical of Western individualism, but it is less clear whether they would subscribeto the highly conservative underpinnings of Akhter's position.
Thus Akhter is critical of the separation of sex from procreation, and sees modem sexual pleasure without taking any social responsibility of giving birth. [I]n contradistinction,birth control in a prebourgeois society like Bangladesh never meant the separation of sex fromprocreation. It was family planning in content and substance (Akhter 1992,59).
in Bangladesh couples restricted or increased the number of their children, whichever theythought was prudent. It was the father, of course, in societies like this who took the decisionon family size, because of the patriarchal culture. The form of execution of such a decisionwas his responsibility, too. The forms of birth control method are known as natural methods,and involved active participation of the male partner. Religiously speaking, two forms ofpractice were prevalent; azal or coitus interruptus among Muslims, and moral restraint orabstinence among the Hindus (Akhter 1992, 60, emphasis mine).
Akhter argues that these "natural" methods were not taken into consideration by theproponents of population control. It can be seen, though, that she sees the husband as theperson who should rightly be responsible for the decision about whether, and when, touse them, a position that Mies and Raymond might be less than happy about.
Akhter's opposition to the separation of sex from procreation in Western feminism underlies her opposition to applying the concept of "reproductive rights" to Third Worldwomen. For her the ideology of "reproductive rights" is the offspring of the separationof sex from procreation. She is critical of Western feminists who demand such rights(Akhter 1992, 90) and sees these demands as making an arbitrary separation of thereproductive sphere from the spheres of politics and economy. She considers reproductiverights to be based on bourgeois individualism and therefore unacceptable (1992, 39).
On the question of reproductive rights, Raymond and Mies have expressed quite similar views to Akhter's. Thus Raymond argues in Women as Wombs that "viewingreproductive technologies and contracts mainly as a woman's choice results from aparticular Western ideology that emphasizes individual freedom" (Raymond 1993, x).
For Raymond, "reproduction is the consequence of men's sexual access to women".
Consequently, debates about abortion, contraception, reproductive rights, and reproductivetechnologies cannot take place without considering how and why women become pregnant (1993, xxv). For her, demands for reproductive rights by Western feminists derive fromtheir tacit acceptance of the "reproductive fundamentalism" of modern biomedicine, aset of unquestioned beliefs which "reduces infertility to a disease and promotes the newreproductive technologies. as a cure" (1993, viii).
Similarly, Mies sees women's demands for self-determination, autonomy and control of their own bodies as deriving from bourgeois values. In Ecofeminism, Mies quotesAkhter to support her own rejection of "reproductive rights," "self-determination" and Farida Akhter has rightly pointed out that notions such as "reproductive rights" for women, propagated by feminist groups in the West, have no meaning for the majority of women inBangladesh who are covered by population control measures (Mies and Shiva 1993,190).3 Mies again quotes Farida Akhter at length as a demonstration of why "self-determination"and reproductive rights are meaningless for women, especially for the Third World women: It is difficult for a feminist of the West to understand that a notion like the reproductive rightsof women or the control of women over their own bodies has no meaning for the majority ofwomen in Bangladesh. The processes of poverty and underdevelopment have reduced theirlives to a margin narrowly above death by chronic starvation. The instinct of survivalpredominates over the urge for emancipation. In the sterilization camps and clinics ofBangladesh, when a woman undergoes surgery for ligation, she submits her body to mutilationnot because she wants to emancipate herself from reproductive responsibilities, but in most cases for money and an apparel known as sari, which are received as incentives. They add toher ability to survive as they can be exchanged for food. Nowhere do the rights of womenbecome of any concern (Akhter in Mies 1993, 219).
Akhter's statement, and Mies's use of it, are persuasive at first reading. Situations ofextreme poverty such as Akhter describes are a reality in the Third World, and the questionof "reproductive rights" may seem like a meaningless luxury in such situations. Yet Ithink we must recognize that even in such extreme situations, and however constrainedby economic, social, cultural and political factors, women are making choices, womenare exercising agency. We should think carefully before deciding, as I will argue thatUBINIG and FINRRAGE do, that they should be deprived of that choice. I think thatthis would hold even if it were true that women were primarily motivated, as Akhtersuggests, to undergo sterilization by the prospect of obtaining a sari and money. In reality,as I will argue later, it is overwhelmingly clear that poor rural women want access to contraception quite apart from any material incentives (cf. Reysoo et al. 1995), and thatin so doing they are making rational and sensible choices in relation to their situation.
That Maria Mies should find an ally in Farida Akhter is not surprising when one looks at the politics of Mies's version of ecofeminism. Like Akhter, Mies is also interestedin preserving "nature," "tradition" and "community" all of which are threatened by moderntechnologies and the modern values of individual freedom and autonomy. She arguesthat the women's movement in the West today is no longer striving for liberation fromexploitation and from oppressive male-female relations, but is concerned "with thequestion of emancipation from the uncontrolled reproductive potential of the femalebody, of emancipation from our female nature" (Mies and Shiva 1993, 221). "Third World" women, by contrast, according to Mies, criticize the demand for self-determinationbecause: their concept of women's liberation does not imply severing all communal relations, theycannot conceptualise the isolation of the individual woman as something positive. They knowthat for them there is no such safety net as the modern welfare state, and that they thereforeneed the net of relations provided by family, village and community. They do not wish to live free and alone in the anonymity of big cities, to die finally, as we shall, in a home for the old(Mies 1993, 220).
Now, it is certainly arguable that the emphasis on individual autonomy in Western societyhas gone too far. However, this does not mean that sexual and reproductive rights are irrelevant to poor Third World women, or that they are driven purely by a desire forsurvival. This position conies dangerously close to denying the autonomy and individualagency of these women altogether.
As a woman who grew up in Bangladesh, who has carried out extensive research in Bangladeshi villages, and is closely acquainted with the concerns of poor rural women, I have no doubt whatsoever that many of them do want contraception and do desire tolimit their families. This is not only my experience: most serious researchers in rural South Asia have come to similar conclusions. Thus during their fieldwork in Bijnor, North India, Jeffery et al. (1989, 197) interviewed many women about their familyplanning practices. When talking to one woman about the number of children she wanted,the woman said "[e]nough. I endure the trouble, my husband doesn't." Other womendetailed the troubles of having too many children, their consequent physical weaknessand their continuous problems with sleeping. In my own research, I have had numerouswomen enquiring about reliable contraceptives. They typically make comments like "Lookat my body, I cannot take it any more," or "How can we feed any more children when wecan't even look after the ones we already have?" Women desperate for reliable contraceptives often visit their natal families in order to defy their in-laws' and husbands' wishes, or to avoid shame in the husband's household.
Jeffery et al. (1989) also report similar instances. There are also incidents of inducedabortion at a very late stage of pregnancy leading to the women's death.
In my briefer research with slum women in Dhaka they were even more anxious to gain access to contraception. In the villages, most women wish to stop having childrenonly after they have had two or three children, but a significant number of the slumwomen and their husbands want to delay having their first child for up to five years aftermarriage.
Akhter and her Western allies do not deny that the demand for contraception exists.
What they do, however, is to imply that the women who express it do so purely becausethey are dominated by the "instinct of survival". What they say is therefore simply anexpression of their desperate situation, and can be discounted in favour of what UBINIGhas to say on their behalf, which is that their survival depends on the "community," and that the only forms of contraception available to them should therefore be those whichthe community, in the form of their husbands, ought to supply, i.e. coitus interruptus or It is precisely because coitus interruptus and sexual abstinence require a generally unrealistic degree of male cooperation and self-restraint, not to say a denial of the women'sown sexual desires, that women want other forms of contraception. What is more significant for my argument, though, is that the UBINIG-FINRRAGE position refuses to recognise that poor village and urban slum women are in fact exercising agency andautonomy. They have at least as much right to have that autonomy recognised and supported as women in other situations.
Of course, the women's desire for contraception cannot be divorced from their poverty and their lack of economic resources, nor from their often poor health situationand the risks involved in childbirth, both worsened by lack of adequate nutrition andmedical resources. But this in itself is no reason to deny that the women are able to makechoices. Agency in all social situations can only be exercised in relation to the constraintsof a specific context.
In fact, there are plenty of indications that village and slum women are exercising conscious agency, both individually and in cooperation with their husbands and families.
Notice, for example, the differing demands of village and urban slum women. Villagewomen typically want contraception after they have achieved what they see as asatisfactory family size (three children or more, including one or two sons), while slumwomen often think in terms of postponing childbirth altogether for up to five years untilthey have some economic security.
The kinds of contraception wanted also reflect the women's agency and their understanding of the situation. Thus they are more interested in injections and long-termmodes of contraception, including sterilization, than in contraceptive pills, which theyneed to remember to take each day. Less frequent injections are preferred to more frequent;when I was going round a village in Dhaka district with a family planning worker, thewomen complained that she only had two-monthly rather than three-monthly injections.
Longer-term methods such as Norplant, which involves the insertion of capsules underthe skin of the upper arm, releasing the contraceptive hormone gradually over a five-year period, are particularly valued, because of their better fit with the social constraintswithin which the women operate, where each time they contact medical or family planningstaff may require difficult negotiation with husband and family. In Noakhali District (in Southern Bangladesh) in 1994, the FPAB (Family Planning Association of Bangladesh)had just introduced Norplant and had run out of supplies because of the level of demand.
Thus while NGOs may initially introduce a particular contraceptive method, and indeedmay promote one method more than others, rural women's demands also have an impacton the actual use of contraceptives.
This is not of course meant as an endorsement of Norplant, which it is now clear has dangers of which the village women were certainly not properly informed, or of theuse of any technique (including sterilization) without adequate information and propermedical backup, but it does imply that family planning campaigns need to recognisewomen's ability to make choices, and need to work with them to find methods that areculturally appropriate and practicable.
Another striking demonstration of women's agency in my own fieldwork was the introduction of EPI (Expanded Programme on Immunisation) in Noakhali. Initially,government and NGO activity in the area was directed exclusively to family planning.
However, village women would constantly ask the family planning workers for otherforms of health care, arguing that if the government could supply contraception, it couldalso help with other health care problems. While the worldwide emphasis on MCH (Mother and Child Health) programs as a complement to family planning is generallyattributed to pressure from the international women's movement and human rights activists, it is important to recognise that there was also extensive pressure for suchservices from village women themselves. Nowadays EPI in particular is quite widespreadin Noakhali and in other parts of Bangladesh. The Noakhali programme is administeredby the government and funded by UNICEF, who supply disposable syringes, injectionsand other tools.
These women are clearly exercising choice and agency, and I see no justification at all in denying them the right to make those choices on the grounds that ideas such asreproductive rights and sexual rights "have no meaning" in this context. In contrast, Iwould agree with Sonia Correa and Rosalind Petchesky of the DAWN group (Correaand Petchesky 1994, 108), who write that "contrary to many social critics, we are notconvinced that reproductive and sexual rights (or human rights) are simply a "Western"concept". For Correa and Petchesky, the issue is not to reject concepts such as "reproductive rights," "bodily integrity," and women's right to sexual self-determinationbut to rephrase them in a more appropriate way. They argue that we need to "shed theabstract universality, formalism, individualism and antagonism encumbering rightslanguage" and "to recast rights discourse in a more inclusive 'referential universe'."(1994, 110): The purpose is to transform the classical liberal rights model in order: (1) to emphasize thesocial, not just individual, nature of rights, thus shifting the major burden of correlative dutiesfrom individuals to public agencies; (2) to acknowledge the communal (relational) contexts inwhich individuals act to exercise or pursue their rights; (3) to foreground the substantive basisof rights in human needs and a redistribution of resources; and (4) to recognize the bearers ofrights in their self-defined, multiple identities, including their gender, class, sexual orientation,race, and ethnicity (Correa and Petchesky 1994, 110).
Elsewhere they note that" the concept of sexual and reproductive rights is being enlarged to address the social needs that erode reproductive and sexual choice for the majority ofthe world's women, who are poor" (1994, 109).
Lois Keysers, writing in the WGNRR Newsletter, similarly argues that: despite differences in conditions, views, and power, women share an interest in sexuality andreproduction. Sexuality and reproduction are matters of life and death, of the highest fulfilmentand of deep suffering, of passion and of cool calculation, of intimacy and of public policymaking. Women's decision making in sexuality and in reproduction becomes a matter ofbalancing personal desires and needs against socially, economically, politically defined normsand regulations which in today's world are hierarchical, patriarchal and exploitative, and notgeared to people's well-being (1995, v).
My own research in Bangladesh and elsewhere in the Third World leads me to similarconclusions. I agree strongly with Correa, Petchesky and Keysers, and feel that the positiontaken by FINRRAGE and UBINIG is fundamentally problematic. FINRRAGE andUBINIG are undoubtedly right in arguing that the language of "reproductive rights" isopen to co-option by population policy members whose sole concern is with population reduction, but what we need is not to abandon the concepts of rights, but to find ways to make them more relevant to poor Third World women. To see why this is so, I will nowgo on to look at the implications and consequences of the FINRRAGE and UBINIGpositions for the women whose interests they claim to represent.
IMPLICATIONS OF FINRRAGE-UBINIG POLITICS FOR POORTHIRD WORLD WOMEN As I emphasized above, I do not see all of the UBINIG/FINRRAGE critique of populationpolicies and family planning practices in Bangladesh as inappropriate or misguided.
Their campaign against Norplant and against inadequate health safeguards forcontraceptive use in general was fully justified, and their critique of the misuse of thefeminist language of "reproductive rights," "self-determination," women's health andempowerment by population policy makers, merely to serve their own agendas andwithout any attempt to implement them at the grassroots level, is a valid one. This line ofcritique has also been pursued by other feminist organisations and is beginning to make an impact on the population control policies.
However, I see the positive impact of UBINIG and FINRRAGE ending here, and, as I have already suggested, I see their attack on Western feminism as being obsessedwith reproductive rights as a serious mistake. Akhter is quite correct in emphasising thatthe interests of Western feminists and rural Bangladeshi women are very different, aboveall because of the sheer poverty of the latter. Nevertheless, by rejecting most forms ofcontraceptives on behalf of these poverty-stricken women, she is denying these womenthe choice which they are led to make precisely because of their desperate economicsituation and health status, while also implying that this is for their own good.
This is not simply a question of an ideological opposition but of active intervention; Farida Akhter, for example, went as far as visiting Australia to support the campaign bythe right-wing Catholic Tasmanian senator Brian Harradine to block the use of Australian aid funds for contraception (Robinson 1995). In effect, UBINIG and FINRRAGE aresaying that these poor rural women do not know what is good for them, and they areassuming the right to decide for them. Even when confronted directly with demands forcontraception by poor rural women, they are unwilling to shift their position. Thus in a 1989 FINRRAGE-UBINIG conference held in Comilla, Bangladesh: Kamaxi of India reported that poor women in the villages do want to get contraception because they do not want to bear so many children. It is not only a demand of the educated women. In reply to that, Panda [Akhter] said, it is because the poor women in the villages do not have the power to say no to the sexual desire of men. We probably need to change our ways of looking at problems (quoted in Kabeer 1994, 201).
In rejecting notions of "reproductive rights" and "self-determination" as Westernbourgeois concepts which they claim are not applicable to poor Third World women,FINRRAGE and UBINIG are adopting a dangerously "fundamentalist" line. Thatconcepts such as "reproductive rights" and "self-determination" can be problematic inthe context of the present situation in the Third World is certainly true. However, theFINRRAGE-UBINIG position risks throwing out the baby with the bath water, so to speak. I have no doubt whatsoever from my own experience that poor rural women inBangladesh want to have some form of control over their fertility. Whether one can finda better language than "reproductive rights" and "self-determination" to conceptualisethese women's concerns is a different debate, but it is no excuse to deny them access tocontraception.
Research in other parts of the Third World also reveals that women are extremely concerned about their poor health and their inability to look after their children properly(Jeffery et al. 1989; Carter 1995; Greenhalgh 1995). It is undoubtedly true that theirinterest in contraception is closely linked to the circumstances they find themselves in,including poverty, poor health, suffering as a member of the female gender in their socialand cultural milieu, and lack of control over any sphere of then- lives, let alone theirchildren. Their decision to adopt contraceptives was no doubt being made within thesesevere constraints. However, can we really justify denying these women contraceptiveson the grounds that they are not making their decisions in an ideal and unconstrainedsituation? It may well be true that a total social transformation might bring about a situation in which these women will no longer want contraception, or even that, as Maria Miessuggests, following such a transformation, more appropriate contraceptive techniquesmight grow out of saner male-female relationships. However, all this is of little use topoor rural Third World women now. They will be dead and gone long before this happens-as will their children if they cannot feed them and look after them properly. In the meantime, these women want to have some control over their lives before it is too late.
FINRRAGE and UBINIG's opposition to abortion is open to similar objections.
Indeed, in combination with their opposition to available forms of contraception, theirposition would make the situation of poor rural women almost impossible. If FINRRAGE-UBINIG were mainly concerned about the harmful effects of contraceptives on women'shealth, they could support a combination of safer if less reliable methods of contraceptionsuch as the barrier method and the natural method with abortion as a backup in case offailure. However, the FINRRAGE-UBINIG dismissal of "reproductive rights" and "self-determination" leads them to argue that abortion is unnatural and irrelevant for rural poor women. They are vehemently against abortion, because for them sex without procreation is all to do with men's desire and men's abuse of women's bodies. Thus toallow abortion is simply to give in to the desires of men.
Like Keysers, I see abortion as a cutting edge issue. While none of the existing methods of contraception is either 100% safe or 100% reliable, abortion is the surestmethod for preventing childbirth. However, as Keysers notes: the public policy debate on abortion has been shaped by a kind of "moral fundamentalism." The modern crusade to ban abortion is motivated by deep felt sentiments against any form of women's self-determination and carries normative overtones, defining women's sexuality in terms of fertility and servitude as wife and mother (Keysers 1995, vii).
I would argue that it is precisely this kind of "moral fundamentalism" that we can see atwork in Farida Akhter's position-and it is not at all surprising that she became an ally of Brian Harradine in his campaign against contraceptive aid (Robinson 1995). Akhter's position is ultimately quite consistent with the deeply conservative and anti-feministpolitics of a figure such as Harradine. In the context of contemporary Bangladesh,"tradition" and "culture" are also used by religious fundamentalist groups such as the Jamaat-i-Islam, whose agenda is a far cry from addressing the concerns of poor women.
I cannot help feeling that the politics of middle class feminists like Akhter, who can afford the luxury of falling back on the values of "tradition" and "indigenous culture," isof little use to the rural poor in Bangladesh, or in the Third World in general.4 We should remember that families, local culture, traditions and communities are often at the root of the problems of Third World women. They do not provide unmediateddeliverance from the hands of the imperialists or other local sources of exploitation, asMies and Akhter tend to imply. It is unfortunately true that, as Correa and Petcheskysuggest: for many girls and women, the most severe violations of their human rights are rooted deeplywithin the family system, bolstered by community norms of male privilege and frequently justified by religious doctrines or appeals to custom or tradition. (Correa and Petchesky 1994, Cecile Jackson has similarly argued that "the complex of social relations in family, villageand community is the locus of gender struggles rather than a 'safety net' . and therepresentation of Western self-determination as inevitably entailing isolation, loneliness and anonymity is as questionable as that of the cosy web of family and kinship" in SouthAsia (1995, 128). Jackson notes that technology may be male-biased, but this does notmean that it is of no benefit to women. In fact the dispossessed may well view technologyas empowering (1995, 133).
While we should and must continue to challenge the unfair, unjust world order, I feel we do not have the right to deny these poor Third World women what limited optionsare available to them within the existing system, including in particular the limited choiceof contraceptives available within their present social, economic, cultural and politicalconstraints.
In the concluding section of the paper, I think it is useful to put UBINIG and FINRRAGEin their wider political context. There are in fact many groups of feminists and of humanrights activists operating in this area, and some of them have had a very significant influence on changing family planning policies in Bangladesh over the last two decades.
It is worth looking briefly at some of these.
I begin with the Bangladesh International Action Group (BIAG), which played a crucial role in redirecting family planning policies in the mid-1980s. BIAG campaigned against human rights abuses in the Bangladesh population control programme, and wereespecially involved in the question of financial payments in relation to sterilization.
They came across several instances where food aid was withheld from destitute womenunless they accepted sterilisation. Betsy Hartmann and Hilary Standing (1989) wrote apamphlet on Food, Saris and Sterilization: Population Control in Bangladesh. Althoughthe incentives system has not been abolished, the pamphlet generated considerable debate over this issue within the international aid community, as well as putting pressure on theBangladesh government to be more restrained in its sterilization drive (Hartmann andStanding 1989,7). Sweden withdrew from the Population III project, while some otherdonor countries (the Netherlands, W. Germany, Canada, Australia, Great Britain andNorway) entered separate agreements with the Bangladesh government, such that their funding would be spent on MCH (Mother and Child Health) programs rather than onsterilisation (Hartmann and Standing 1989:3).5 The campaign demonstrated that by thelate 1980s feminists were finally able to wield some power within the population controlcommunity (Hartmann 1987).
Other groups in Bangladesh, including Naripokkho, Gonoshashtha Kendra (Peoples' Health Centre), Bangladesh Women's Health Coalition and various other small NGOshave been persevering in providing safe and effective health care and contraceptives towomen. Ain-O-Salish Kendra (Legal Aid Centre) has taken an active role in defending women against the more oppressive aspects of "traditional" village justice, and has avoidedsupporting Farida Akhter's stand on population or on other matters.
Along with international organisations such as Women's Global Network for Reproductive Rights (WGNRR), Development Alternatives for Women for a New Era(DAWN), Women Living Under the Muslim Laws Network (WLUML), and theInternational Women's Health Coalition (IWHC), such Bangladeshi groups have agreedwith the FINRR AGE-UBINIG position on the promotion of inappropriate family planningmethods at the expense of women's health. However, they have seen the solution not inbanning contraception, but in rinding ways to deliver safe and voluntary family planningservices to village women.
In reality, there is, as Naila Kabeer has argued, no necessary contradiction between promoting family planning and the "broader feminist goal of equitable development"(1994, 202). Any meaningful progress towards equitable development in fact involveslistening to village women and responding to their real needs. Ironically, FINRRAGE'sWestern members probably believed that they were doing just this, while in fact theywere being drawn into supporting a conservative, urban-based position that few poorvillage women would, in my experience, recognise or identify with. Their mistake wasunderstandable, but it led to a programme of action that would, if it were successfully implemented, do far more harm than good to those they aim to help.
1 DAWN is a network of Southern women activists and researchers concerned with the impact of development models on gender systems. See Sen and Grown 1987, Correa 1994.
2 Based in London, BIAG consists of a number of national groups, in Bangladesh and in various Western countries, working to improve the situation of the poor in Bangladesh. See Hartmann 3 While the book is co-authored, Mies and Shiva take specific responsibility for individual chapters, 4 Akhter's general conservatism was also demonstrated by her unwillingness to support the Bangladeshi feminist writer Taslima Nasreen, both at the time of the initial campaign against her in 1994 and when she returned to Bangladesh in 1998. On the latter occasion, Akhter wasquoted as saying "Under no circumstances would we agree with the fanatics: to cut off herhead is not desirable or acceptable to anybody. But she is responsible for the fact that peopleare not coming forward to support her. Taslima Nasreen is not a women's movement issue, butan issue created by the international media" (Ahmed 1998).
5 In the USA this pamphlet also made an impact, and put USAID under pressure for its role in financing sterilisation incentives. Unfortunately, the National Women's Health Network (a right-wing network of anti-abortion activists) exploited it to demand cutting off all public fundingfor international family planning. BLAG itself is not against family planning as such, only theabusive practices occasionally associated with it.
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Correa, Sonia and Rosalind Petchesky. 1994. Reproductive and Sexual Rights: A Feminist Perspective. In Population Policies Reconsidered: Health, Empowerment, and Rights, ed. G.
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Robinson, Kathryn. 1995. Who's Making the Choice? Population Policy, Women's Rights and Australian Overseas Aid. Just Policy 3:44-50.
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Cpp153a 126.144

Clin. Psychol. Psychother. 5, 126±144 (1998)Michelle L. Van Etten1 and Steven Taylor2*1Department of Psychiatry, University of Michigan, USA2Department of Psychiatry, University of British Columbia, Vancouver, CanadaA meta-analysis was conducted on 61 treatment outcome trials for post-traumatic stress disorder (PTSD). Conditions included drug therapies(TCAs, carbamazepine, MAOIs, SSRIs, and

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