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Excerpt from Piotrow’s “World Population Crisis” Re: Jaffe

Source: WORLD POPULATION CRISIS by Phyllis Piotrow, pgs 150-156.  1973

Excerpt:

[Strategies]

Ravenholt who had drafted much of the cable was even more determined than Gaud to meet or exceed the congressional targets of $35 million in 1968 and $50 million in 1969. Under his leadership the Population Service became more than just a staff office and moved deliberately to fill the gaps left by country missions and regional bureaus. For him, the first challenge in 1968 was to make sure that the earmarked money was in fact going to population programs. “The bees are coming to the honey pot,” Ravenholt would say as he fought off other offices that suddenly wanted to redefine their ongoing projects as “population’ control.” The Alliance for Progress, for instance, wanted to finance maternal and child care programs that included no contraceptives and to call them family planning. The Ford Foundation wanted AID to turn $10 million directly over to the National Institutes of Health where Congress had cut back population research. Every bureau, every discipline had tentative plans for using the money that Gaud had called excessive. But :Ravenholt insisted that it was all needed for population programs with direct impact. In most cases, Gaud backed him up.

In order to meet the short fiscal-year deadlines, Ravenholt’s strategy also required other channels of funding in addition to government-to-government agreements negotiated by the overseas missions. In practice, the only way that a small central staff could obligate large sums of money in a short time was through private intermediaries, either universities, professional institutions like the Population Council, or other organizations already active in the field like the International Planned Parenthood Federation or the Pathfinder Fund in Boston. Because of the time pressure and the limited number of qualified organizations in the field, a strategy emerged of relatively large grants to those who could perform in a variety of places and programs. Thus the trend of funding by the central population unit was consistently toward larger, less specific, more programmatic grants. The average size of individual Population Service grants increased steadily, a trend not evident in regional or country grants. (See Table 15.4.)

Furthermore, in a field where few experts existed at a time when financial stringency prevented AID from hiring any of them anyway (and skepticism about AID prevented any of them from wanting to be hired) the. use of intermediaries became a virtue dictated by necessity. Within the framework of the War on Hunger, support for nongovernmental organizations also made considerable sense to Gaud because he wanted to promote private enterprise generally; it made sense to Waters because he appreciated the political support that private agencies could bring to hear; it made sense to Ravenholt because he found the private groups more willing than governments to undertake the specific contraceptive distribution, evaluation, and demonstration projects that he wanted to encourage. Finally, as Draper constantly reiterated, the history of the birth control movement, from private voluntary groups to family planning associations to government programs, suggested that vigorous private sector activity was necessary to persuade governments to take action. In birth control programs, too, even governments are basically intermediaries in reaching the individual decision maker-and often intermediaries with less experience and conviction than many private organizations.

Beyond the pressures of time and money, Ravenholt also developed a basic program strategy that went beyond the still-repeated but more and more meaningless principles of assistance on request to governments for voluntary programs, offering free choice of method, with no AID advocacy of policy or method.  In a 1968 article in Demography he listed six major and continuing areas of AID program emphasis: project and program grants to qualified organizations like the Population Council, the International Planned Parenthood Federation, and the Pathfinder Fund; basic support to university population centers; grant assistance to government family planning programs; purchase of commodities, especially contraceptives; contributions to the United Nations Population Fund, and research funds for evaluation of specific methods and delivery systems.

The goals that Ravenholt outlined for the program were very simple: “To make family planning information and services fully available to and used by all elements of these developing societies.”Family planning programs were thus broadly defined to include information, education, clinics, general availability of contraceptives, and elimination of restrictive laws.

The strategy sounded elementary but the underlying issues were complex. In November 1967 the sociologist Kingsley Davis rocked the family planning world with a forceful article in Science magazine insisting that family planning could not solve the population problem.

Motivation, not birth control, was the critical factor, he argued. Motivation depended not on contraceptives or on family planning as he narrowly defined it, but rather on laws, customs, and social policies that in most countries still encouraged childbearing.

Many of the population activists were horrified, Planned Parenthood came down firmly on the side of family planning. As Fred Jaffe put it, the sociologists’ stress on motivation or in the United States on the culture of poverty” was a “cop-out” to excuse the fact that family planning was still not easily accessible for poor disadvantaged women and that social services were still inhibited in making it available.  One irate businessman suggested, “Why don’t we lock all these academics up in a room somewhere and not let them out until they can agree on something?”

Nevertheless many professionals, especially those with a social science background, began to move in the direction that Kingsley Davis was beckoning. When his wife Judith Blake, also a professor of sociology, later raised the demand for alternative, non-child-bearing careers for women, the feminists also were attracted. “Motivation” became the newest word in the population jargon. The Kingsley Davis article, Bernard Berelson observed, marked “the end of the honeymoon period, when we still thought that the answers were simple and that we were all on the right track.” Berelson’s formal response was a judicious·synthesis entitled, “Beyond Family Planning,” in which he pointed out that many of the other proposals were still not politically or technically feasible while family planning was.

Ravenholt, like Jaffe, considered the whole approach a “cop-out. Family planning administrators who were supposed to be delivering the services were falling down on the job, he declared. Ravenholt, in Washington, trying to push family planning support out into the field despite the resistance of regional bureaus and country missions, handicapped at every point by the organizational weakness of the War on Hunger office, was determined not to dissipate AID resources. in a will-of-the-wisp pursuit of “motivation.” Women with full access to family planning would not over-reproduce, he declared. Furthermore, he insisted it was a waste of time even to talk about motivation until a full range of methods was available.

Another conspicuous and even more controversial feature of the AID program was Ravenholt’s predilection for pills. Draper and Ravenholt were both impressed. by the 1965 Westoff and Ryder study that revealed unexpectedly rapid U.S. acceptance of orals.[…] The Population Council, which had officially sponsored and promoted the intrauterine contraceptive device, and many others considered the pill at first too expensive.

[…]

The pill-IUD debate (in the absence of any more conclusive medical evidence than that produced to date) can be seen in terms of a power struggle. Before 1968 the professional organizations like the Population Council that were associated with the IUD and the activist organizations like Planned Parenthood that received help from the drug companies were fairly evenly balanced. Governments and administrators seemed to favor the IUD while most women chose the pill.

The advent of the population program in AID, however, which by June 1969 had become the largest single supporter of population and family planning programs in the world, upset the prevailing balance of power. By aligning himself strongly with the pill supporters, Ravenholt brought the issue out into the open at a time when some drug companies had quietly spread rumors against the IUD and some professional organizations were using their channels of communication to tell only the IUD side of the story.

The final results are still in doubt, although IUD programs have run into increasing difficulty while the newer pill programs still seem to be gaining. Whichever method may ultimately be a better weapon in the birth control armory it will, because of AID involvement, be much more widely available, both to individual seekers and within national programs. It will also be more thoroughly tested and evaluated by its proponents-in self-defense-because of the increased professional concern.