Huge Birth Control Programs Don't Work: Time to Give Education a Chance

I recently moved from a job as grant proposal writer for an NGO working in several different development areas to a similar job in a secondary boarding school for girls, which is being built in a country where many girls don't even finish primary school. So I was comforted to find an article entitled 'Women's Education Slows Population Growth'. That women's education can have such profound and positive consequences is not the issue, that has been recognized for a long time, at least by those working in education. But the priority is so often given to population growth, rather than to education or any other development area.

A shocking proportion of 'development' money and a disturbing number of development related insitutions concentrate almost exclusively on population control, in some form or other. They bang on about an unmet need for contraception as if many women will have depleted health or lives as a result of lacking birth control methods, when they are likely to be in far greater need of better nutrition, healthcare, security, governance, equality, infrastructure and, indeed, education. Shovelling contraceptives into rural communities may be a lot easier than providing people with what they need, but without the education and other development areas being addressed, the only gain will accure to the pharmaceutical companies who produce contraceptives.

Similar remarks apply to a lot of other 'health' programs, which target whatever health issue is currently fashionable and well funded; many of them are also necessary, but they would work a lot better if people had the level of education to capitalize on them. Otherwise, they can just go through the motions of attending numerous courses, often for the per diem they may be paid or the free lunch or other minor benefits on offer. I have met people who have been to various 'training courses' only to attend the same course several more times, sometimes provided by the same NGO as before. Training courses are a great way to spend money and it's easy enough to gather data that allows the donor to pronounce the intervention successful. Some health drives pick out some particular disease, perhaps a water borne disease, without addressing water and sanitation in the area. The current drive to 'eliminate' polio is a cases in point; those who attend immunization drives go home to drink contaminated water and contract something else.

Education itself, as we found in my own country, Ireland, is not enough when there are no jobs to go to. And here in Tanzania, women are not considered to be able to do many jobs that they would in fact be well able to do, if they had the education. Sadly, they are considered to be able to do many jobs that are not particularly appropriate for them when they are too young, too old, pregnant, childraising or breastfeeding, but that's another matter. I always feel a bit dishonest when I tell people about how important education is when there is little guarantee many of them will ever get to use it, especially girls and women.

As if there are not enough obstacles, also, school-going girls who become pregnant are excluded from school. In the rare instances where they are allowed to return to school, most do not. This is to 'set an example', we are told. And it does. It shows that girls who get pregnant will be treated very harshly, whereas the boys or men who make them pregnant, generally, will not. The fact that underage girls being made pregnant by older men is a serious crime doesn't get the girls off the hook. Men don't appear to be prosecuted, boys are generally not excluded from school and the strong prejudice against females appears to be practiced by the very institutions that might be in a position to change things.

According to the article, the average birth rate is less than half in regions where education is valued; as I'm working in one of those regions, I'm hoping that birth rates are lower because education is valued. However, even expensive schools with nice, well-funded buildings and facilities, don't always have especially high educational standards. As a fundraiser, sometimes I can see funds for all sorts of things, but not so many that clearly improve education. There is not so much available for good teachers or other provisions that would make a difference. And many fundraisers are tasked with raising money for the buildings, which is important, but often distracts from the ultimate purpose of these buildings.

So, as the article suggests, it's not the correlation between higher standards of education and lower birth rates that is important; it is the priority that is given to education. Proponents of the population control theory of development, so beloved throughout the last fifty years (and still loved by the Rockefeller Foundation, the Gutmacher Institute, the Gates Foundation, Population Services International, Family health Internationa and many more), never appeared to realize what needed to come first, that with development of education, health, infrastructure and the rest, lower birth rates would follow. Similarly, poverty is pervasive in Tanzania, but lower birth rates does not have much direct effect on poverty; rather, lower poverty rates result in improved health, education and the like.

For education to be of benefit, many other things need to be in place as well. But one thing is for sure; reducing birth rates and hoping that other development areas will benefit accordingly has not worked. The funding these charlatans have received urgently needs to be directed towards people's true needs, which are still education, health, a decent standard of living, security, food security and the rest, just as these are the true needs of all people.

Sterilizations of HIV+ Women May Not Be the Worst Thing Health Services Do

When HIV and AIDS started to hit the headlines in the 1980s, there was a lot of scaremongering that did little to help assess the extent of the pandemic and figure out what could be done to prevent its spread. Sadly, this has not changed completely. Headlines are often about revenge, punishment, criminalization and the like.

Even some of the so called prevention strategies sound a bit like a kind of punishment, aiming to place severe limits on sexual and other sorts of behavior. It's hard not to see mass circumcision campaigns, ardently championed by the HIV movers and shakers despite little evidence of their potential effectiveness, as being a kind of punishment.

Such attitudes towards a disease do little to stem its spread, as we have seen in the 25 or more years that have passed since HIV became universally acknowledged. Beatings, persecutions, murders and other travesties have occurred, and continue to occur. But states seem more anxious to create laws that risk punishing those who are HIV positive or who are at risk of being infected, rather than protecting them.

Pregnant women in many countries seem to be at exceptionally high risk and astonishing figures of rates among pregnant women in South Africa were the subject of yesterday's blog post. But I asked, and I ask again, how can we go on believing that HIV is almost always transmitted sexually? We appear to be accusing women of knowingly taking risks while pregnant, without regard for their own health, that of their babies and that of other family members.

Some countries, Namibia being only one, have taken the extreme step of forced and coerced sterilization of HIV positive women. This should not be tolerated and women should be protected from such treatment by law. Of course, it's far easier to identify women as the 'culprit'. Being pregnant means they are evidently sexually active. They are in need of medical care, often vital medical care. And they are unlikely to be able to escape if anyone, or any body, decides to 'punish' them for being infected with HIV.

The authors of the above article, Jennifer Gatsi Mallet and Aziza Ahmed, go on "Life is not that straightforward when it comes to reproduction, not for an HIV positive women, and not for many other women.  Women frequently face a lack of access to contraceptives, inability to access safe abortion services, lack of education and information about preventing pregnancy.  Further, social factors including sexual violence, pressure to bear children, and a woman’s fears around child survival can influence when and how a woman becomes pregnant."

These things may all be true and if so, they all need to be remedied. So, are we then going to blame men? Of course, many men may have views that are inimical to preventing HIV transmission; perhaps the actions of many even cause a good deal of HIV transmission. And if men are violent or if their behavior causes harm, this certainly needs to be addressed. But that's true regardless of whether it has anything to do with HIV transmission.

Rather than looking at individual sexual and social behavior, which may be very much in need of scrutiny, it would be a good idea to look at the weighty but relatively unexamined body of data suggesting that people face serious risks of HIV infection through unsafe medical procedures. Pregnant women are especially at risk because they can receive numerous injections, often unnecessary, usually in health facilities where there is a concentration of HIV positive people and far too few overworked, undertrained, badly supplied health professionals.

The ultimate danger of this blinkered view of HIV transmission is not that innocent people will continue to be punished, though that is bad enough. The worst aspect of clinging to the behavioral paradigm, the assumption that almost all HIV is transmitted sexually, is that the virus will be allowed to continue to spread.

If people are being infected in health facilities, HIV 'prevention' work could be doing more to spread the virus than any other mode of transmission. We don't know if that's true yet; but it's just the sort of thing that we should know after almost three decades of HIV.

Would You Risk HIV While Pregnant or When Planning a Family?

South African's City Press has an article entitled 'Survey finds staggering HIV rate in pregnant women'. And the figures are, indeed, staggering. National prevalence among pregnant women is almost 30%. Rates have been stable for several years and the health minister wishes to see prevalence decrease to 17.3% by 2015. Of course, this is unlikely unless death rates reach equally spectacular levels.

But what is really staggering is how one could believe that so many women who intend to have children or who are already pregnant would risk contracting HIV and possibly passing it on to their child, in addition to having to live with a life-threatening disease themselves. Doesn't that strike anyone as odd?

Many African women are infected when they are already pregnant, often well into their pregnancy. Are we supposed to believe that so many people wish to have a child but don't really care whether that child will live or whether the child will lead a healthy life?

Frankly, I don't believe that South Africa, or any other country in the world, is populated by so many people who don't care whether they or future generations continue to suffer from this terrible pandemic, which is hundreds of times worse in some sub-Saharan African countries than it is anywhere else.

Try thinking about it: you want to get pregnant or you are already pregnant, intentionally or otherwise; and you take many risks and no precautions towards ensuring your own safety or the safety of your child. This would require total ignorance or total heartlessness. Are we seriously suggesting that so many people in South Africa are either ignorant, heartless or both?

Transmission rates among pregnant women in South Africa and other African countries cannot be explained by sexual behavior, no matter how much sex people are having and no matter how 'unsafe' it is. These rates could only be explained by some efficient mode of transmission, such as nosocomial transmission. This is where the disease is transmitted through unsafe medical practices.

I have mentioned it before but it's worth repeating: the WHO estimates that 70% of medical injections in sub-Saharan African countries are unnecessary. And almost 20% of injections are unsafe.

Pregnant women attending ante-natal clinics in African countries get a lot of injections. Often, their babies also get a lot of injections. There is ample opportunity for high rates of transmission in countries where HIV prevalence is high and safety standards are low.

To believe that HIV is being sexually transmitted among pregnant women at such high rates is to believe appalling things about African women (and probably men, too). In short, to believe such things is to be a racist, a sexist and probably much else that's not very pleasant.

Not only do Africans behave sexually much like other human beings, they also place value on human life, especially their own and those of their children. Just what are those who believe HIV is almost entirely sexually transmitted in African countries trying to say about Africans?

Education is Not a Prophylactic, it's a Human Right

When a school girl becomes pregnant here, she is usually excluded from school. Ostensibly, she is allowed to return to school once she has delivered but, in practice, most never return to school. She is excluded on the grounds that she is a 'bad example' to her peers. The boy or man responsible for her pregnancy, apparently, does not set such a bad example. School boys who make school girls pregnant, if identified, are not excluded. Adults who make school girls pregnant can't be excluded, but they are rarely punished. Sometimes the adults who make school girls pregnant are their teachers.

So I was surprised to hear that seven teachers, one of whom is a principal, have been interdicted for such an offence in Bomet and Chepalungu districts, Kenya. In Bomet, 37 girls have become pregnant and have dropped out of school. Whether any of the girls are underage or not is less important than the fact that the teachers have behaved inappropriately for people in their position. It is hard to believe that they have not taken advantage of their position, in addition to breaching the trust of both their pupils and the parents of the pupils.

An official in the district referred to the teachers as 'amorous', which doesn't seem to be the most appropriate term and seems to miss the seriousness of the offences. Amorousness is not a crime but sexual assault and sexual assault on a minor are. Teachers are supposed to educate their pupils to enable them to avoid things like underage sex, sexually transmitted diseases and unplanned pregnancy. The schools may be willing to allow the girls to return to school later but the damage has been done. Some may return, but they will be at a serious disadvantage as a result of their experience.

Another article suggests that education is 'crucial to lowering [HIV] prevalence' because HIV prevalence in Tanzania has dropped among those with secondary education whereas it has remained static among those with little or no education. I object to the suggestion that education is good just because it reduces the risk of HIV. Education is a human right. It is an intrinsic good, not just an instrumental good that reduces HIV prevalence.

However, the article's conclusions must be difficult to establish because primary and secondary students who become pregnant, the ones who were least likely to be using condoms (and therefore at most risk of contracting HIV and other sexually transmitted infections), are excluded from school. They are no longer in the demographic in question. But they can not be excluded from the 'little or no education' demographic. This may skew the figures, somewhat. (I don't have access to the full paper, so the authors may have allowed for this possibility).

I'm glad to hear that education officials are realising that when a girl gets pregnant, a male is involved, either a man or a boy. They are also starting to admit that some teachers are involved and are punishing the perpetrators, rather than just the victims. But education, and education for girls, in particular, still appears to be seen as something less important than education for boys. And it also appears to be seen as a way of reducing HIV prevalence, rather than a human right. Well educated boys and girls, men and women, will be able to ensure their own health and welfare, that's why it is a human right.