About the Book
The Reproductive and child health policy (RCH) in India has been in force since 1995. Coming after the Cairo conference, 1994, the RCH was expected to usher in a 'paradigm shift' in India's population policy. From a family welfare programme that has historically been top-down, even coercive, the Indian government projected the RCH to be a participatory, women-centered reproductive health service. Ironically, the policy was devised barely four4 years after the start of the Indian State's tryst with market development, and was launched into a political environment in ideological transition.
This book provides a Political analysis of the RCH policy, tracking how neo-liberal and, purportedly, women-centered reproductive health discourses are positioned against each other.
About the Author
Rachel Simon Kumar works in New Zealand. Her current research portfolio ranges from indigenous Maori economic development, to sexual practices among migrants in New Zealand.
The International Conference on Population and Development (ICPD) held at Cairo in 1994 is considered a landmark event in the history of population and development thought. The Conference coalesced ideas about reproduction and women's empowerment that had been fermenting within women's movements in the North and the South for nearly two decades. The ICPD brought together women's groups, heads of governments, academics, and representatives of religious bodies who vigorously debated and gave shape to an ever-evolving concept: Reproductive and Sexual Health and Rights. At the end, there was a new understanding and-as many have later pointed out-an international 'consensus'. The Secretary-General of the Cairo ICPD, Nafis Sadik, captured the significance of the Conference thus:
The ICPD is often referred to as a benchmark conference. Indeed, it was. It galvanised political will, forged new partnerships, crafted a new approach to population and development and focused the spotlight on women's rights and their pivotal role in achieving sustainable development.
The ICPD will be remembered for its unprecedented departure from the discourses that conventionally mark debates on population policy. To the discerning observer, there was a perceptible shift in the ethos of the Conference discussions- away from a Malthusian focus on population control to a broader concern with reproductive health and rights. The ICPD represented the start of a new global rhetoric on population policy which drew on feminist visions and had the sanction of the mainstream population community. Fred T. Sai, the President of the International Planned Parenthood Federation noted:
Cairo signalled an understanding that population is at last seen as part of the necessary investment in people, without which none of our development or environmental problems will be solved. Educating girls and making women truly equal partners in development, reducing infant and child mortality, promoting safe motherhood, giving access to quality family planning, tackling the problems of STDs, and providing clean water and adequate food and nutrition are all connected with improving reproductive and family health and reducing family size (Sai 1997).
By the end of the nine-day conference, approximately 179 states had ratified the resolutions negotiated at the conference. A Programme of Action (POA) was charted that outlined definitional issues, key concerns in specific areas of reproductive health and proposed forms of actions to improve or redress reproductive health violations. A fifteen-point chapter on the Principles of the POA firmly embedded the debates of the ICPD within the language of 'dignity and rights' (Principle 1), 'gender equality and empowerment' (Principle 4), 'universal access to health care' (Principle 8) and 'sustainable development' (Principle 2,6,7, 15).
It is now over a decade since the Cairo ICPD. There is a voluminous record of the spectacle that has unfolded since the conference. Academics, policy-makers, health practitioners, demographers and activists have all contributed to the outpouring of introspective analyses of the ICPD and its aftermath. Reviews have examined the effect of the ICPD on health status, programmes and services, women's empowerment, and so on. Yet, what makes the Conference a lively and relevant subject of study even today is that it represents a watershed commentary on fundamental ideas of our contemporary society-human rights, women's rights, economic growth, globalization, population, and the State. In 1994, these ideas were still nascent as governments, civil society and academia wrestled with what the concepts meant for each of them, independently and in tandem. Retrospectively, it is easier to see that although these groups were speaking similar words, they were communicating in very different languages. Beneath the veneer of consensus, the Programme of Action reflects multiple, and sometimes conflicting, expectations.
Yet, a new language, a new rhetoric did emerge from the Cairo Conference-Reproductive Health, Quality of Care, Gender Empowerment, Women's Rights. These are ideas that have had immense consequences in the global landscape of population thought and practice and must not be underestimated. Research has shown that national level policies in both developing and developed countries are directly influenced by debates in the international arena, and that what are likely to be codified as national programmes and policies would have been discussed in earlier international conferences and forums. Conventionally, the International Population Conferences have tended to provide the basis for a shared, if fraught, action on population and development. The UN-sponsored decennial Conferences (in 1974, 1984 and 1994) have been the international platform where diverse and often contending politics-and academic opinions- are played out. From the first Conference (held at Bucharest), the ICPDs have been an important benchmark of ideas and visions that influence population policy-making of individual countries. As Barret and Frank 0999: 217) point out, international discourses, in effect, 'precede and predict' national population policy. The ideas legitimized at the Cairo ICPD, therefore, became all the more important for the influences they bring to bear on national population policy-making. A 1999 study that examined the progress of the ICPD on the reproductive health programmes of eight developing countries concluded that' excellent progress has been made in placing Cairo on national health agendas Most respondents (in the study) said that the (Cairo) conference recommendations provided the impetus to design new programs or redesign existing ones using a client-centred approach to integrated care' (Hardee et al. 1999: S8).
However, as a researcher with a background in feminist politics, to me the Cairo Conference raised questions about consequences that were not contained in statistics or programme redesign but rather manifest, if at all, in social change: what became of the countries that took the language of reproductive health back to their respective homes, once the hype of Cairo had died down? How did the ideas that were proliferated at the Conference, many of them foreign to their native cultures, translate into the everyday machinery of government? What is lost or altered in translation from the global to the local? Beyond the health programmes, beyond the delivery of contraceptives, beyond the statistical records of health and contraceptive achievement-what processes underlie the diffusion of ideas from one context to another? The discourse of women's empowerment, which made the Cairo Conference noteworthy, is of particular interest. Has the ideology of women's empowerment and agency been embedded or transformed as the state institutionalized reproductive health discourse? Or, was the global discourse of reproductive health merely new wine poured into old bottles, subsumed by long-standing ideologies of patriarchal states?
It is these questions that drive the research presented in this book. In seeking answers, the issue of reproductive health is moved from the domain of demography and health to that of the political and the social. Rather than focus on abortion rates or quality of health services, this research examines the settings in which reproductive health has been embedded as a state intervention. Institutional arrangements and tacit rules, historical processes, value systems and individual interpretation-all create an environment where ideas are translated into specific forms of practice.
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