From: rich@pencil.cs.missouri.edu (Rich Winkel)
Subject: Coercive birth control in Indonesia
Followup-To: alt.activism.d
Originator: rich@pencil.cs.missouri.edu
Organization: PACH
Date: Tue, 14 Apr 1992 03:19:02 GMT

/** gen.women: 388.0 **/
** Topic: The ACTivist vol8#4, April 1992 **
** Written 12:04 am  Apr 11, 1992 by web:MAILER-DAEMON in cdp:gen.women **
Subject: The ACTivist vol8#4, April 1992

/* Written 11:55 pm  Apr 10, 1992 by act in web:gen.newsletters */
/* ---------- "The ACTivist vol8#4, April 1992" ---------- */
THE BODY AS BATTLEGROUND IN INDONESIA

By Maggie Helwig
The ACTivist

It has recently come to public attention that the Canadian 
government, via CIDA, is partially funding a coercive birth control 
program involving massive delivery of Norplant to women in 
Indonesia and its occupied territories.

The Indonesian Norplant program is administered by the 
Indonesian Department of Public Health, and funded by the 
Population Council and the United Nations Fund for Population 
Activities. CIDA provides core funding for the UNFPA, and has also 
provided funding to the Population Council. The Population Council 
is an organization which develops and promotes birth control methods 
in developing countries, and whose board of directors includes 
McGeorge Bundy, and W. David Hopper, the vice president for South 
Asia of the World Bank.

Norplant is an implant, placed in a woman's upper arm, which 
releases low levels of the hormone progestin into a her body over 
a period of about five years. It alters the body's hormonal balance 
and prevents her from conceiving a child for the full five years. 
Progestin is thought to be a safer contraceptive hormone than estrogen 
("The Pill"), but it is also the active hormone in the notorious 
Depo-Provera, which is banned in the United States and Canada and 
has been linked with cancer and sterility. Norplant is legal in the 
States, though not in Canada.

Despite its apparent advantages when compared to Depo-Provera, 
women using Norplant have reported a variety of side effects -- 
headaches, excessively heavy menstrual flows in some cases and 
skipped periods in others, cervical erosion and changes in cervical 
emissions,  mood and weight changes. There is also a risk of infection 
where the implant is placed, and many women's health authorities 
say the Norplant, like Depo, increases the risk of ectopic pregnancy 
if a woman conceives after discontinuing the contraceptive.

As to longer term effects, like cancer, sterility and birth defects, 
we simply do not know. Long term studies have never been 
completed.

It is questionable whether a high-tech contraceptive program like 
Norplant should be implemented at all, without the medical 
infrastructure to make it tolerably safe. And Indonesia is certainly 
lacking that infrastructure. Health care in Indonesia is poor even by 
the standards of the developing world, and both infant mortality rates 
(82 for 1,000 live births) and the rates of death in childbirth (4.5 for 
1,000 live births; 11 for 1,000, for women 15 to 19) are very high. 
Of course, this is averaged out over the different regions. Mortality 
rates are lower in areas like Jakarta, but much higher in outlying 
areas, and highest of all in occupied East Timor; where, predictably, 
the health infrastructure is weakest. And where high-tech 
contraceptive programs are most eagerly pursued by Indonesian 
authorities.

Perhaps the most distressing thing about Norplant, though, is its 
potential for use in coercive birth control programs. More than any 
other method of birth control, it removes from a woman any 
possibility of choice -- once the implant is in, it is difficult to remove, 
and until it is removed she simply cannot decide to bear a child. 
Indeed, in a test case in Bangladesh in 1985, doctors refused to 
remove any Norplant implants, though some of the women were 
suffering severe side effects.

The involvement of the Population Council, with its World Bank 
links, is clear enough evidence of the sort of elite-based model of
 'development' that is behind this, and other, birth control programs. 
Even in the United States, Norplant is already clearly being used in 
coercive ways; for instance, in the case of Darlene Johnson, who was
 convicted of child abuse and sentenced to Norplant. The Kansas 
state legislature is considering paying welfare mothers to get 
Norplant, and the medical director of Planned Parenthood of 
Sacramento Valley has said that "the best candidates are 
non-compliant patients" (i.e. women who want to bear children when 
their doctors don't want them to).

Norplant is as effective a method of forced birth control as 
sterilization, and much easier to carry out.

In Indonesia, there have long been accusations that the birth 
control program is coercive, that women are not given enough 
information about what is being done to them, that they are not 
offered options, that they may be threatened or bribed into compliance. 
It is important to note that Indonesian family planning authorities are 
trying to phase out methods, like the Pill and condoms, which are 
largely under the woman's control and depend on her co-operation. 
The family planning agency much prefers injections and implants. 
Indonesia is by far the world's largest user of Norplant -- fully two 
thirds of all implants produced are used by Indonesia. This is an 
all-too-familiar pattern, in which the excuse of 'population control' 
is used to deprive women of control over their own bodies and lives.

And, critics say, this is especially the case in East Timor.

The Depo-Provera program of 1987 strongly suggests that this is 
true. Depo, in fact, was and may still be the primary form of birth 
control in East Timor. Of the women using any form of contraception 
in East Timor in 1987, 60% were receiving Depo-Provera injections 
(which are effective for about 90 days), compared to about 12% in 
most of the rest of Indonesia. Indonesian figures suggest that perhaps 
one in every 50 East Timorese women was receiving Depo injections
 regularly. Few women in East Timor used condoms or the Pill. 

These figures alone would suggest a coercive birth control program, 
even without supporting testimony from East Timorese women that 
the visiting doctors and nurses came accompanied by soldiers, and 
that they were not allowed to refuse the Depo injections. Or, as 
in one instance documented by TAPOL, all of the girls and none of 
the boys at senior high schools in Dili, the capital of East Timor, 
were given allegedly anti-tetanus injections. When asked why only 
the girls received the injections, the Indonesian authorities were 
unable to answer.

The East Timorese are largely Catholic, and reject birth control 
on religious grounds; moreover, they know that the Indonesian 
government aims to replace them, the indigenous inhabitants of 
Timor, with transmigrants. They want to rebuild their devastated 
population, not to further reduce it, given that a third of the 
indigenous Timorese have died at the hands of Indonesia 
since 1975.

The figures given for the Norplant program show that 500,000 
women received Norplant in 1987/8 . This is implantation on a 
massive scale. We do not have regional figures like we do for the 
Depo program. I did make repeated attempts to contact people at 
the Indonesian Embassy who might have this information, including 
an official from the Indonesian Department of Health who was 
visiting Canada but who chose not to return my phone calls. 
The Population Council also said they would not have such 
information, as the program was implemented entirely by the 
Indonesian government.

But it is a fair guess that an experimental technology, ideally 
suited to a coercive birth control program, is once again being 
implemented most heavily on the East Timorese; the population 
that Indonesia would most like to reduce.



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