Letters 42(1)

First published online:

Coercive Sterilization

It was recently brought to our attention that the comment "Achieving the Goal of the London Summit on Family Planning by Adhering to Voluntary, Rights-Based Family Planning: What Can We Learn from Past Experiences with Coercion?" [2014, 40(4):206–214], by Karen Hardee et al., seriously misrepresents our scholarship. It cites our 1985 pamphlet, Food, Saris and Sterilization: Population Control in Bangladesh, as an example of the group of academics and activists described in the paragraph below:

"However, in 1985, allegations of coercive user payments for sterilization were leveled against the program in Bangladesh—both by the "new right" movement that wanted the United States to cut off all aid to family planning other than natural family planning, and by a group of academics and activists who opposed family planning because they considered it to be foisted on people in developing countries."

In our pamphlet, we make it abundantly clear in several places that although we do not support coercive sterilization measures, we support voluntary family planning programs. In fact, at the end we call on readers to ask their governments to fund "voluntary family planning programs, which respect people's right to choose, offer a wide range of contraceptives and give adequate counselling, screening and follow-up care."

Such misrepresentations do a professional disservice not only to us, but to many other people, including staff members of family planning and international development agencies, who worked long and hard to improve the quality of Bangladesh's family planning program.

Betsy Hartmann

Hampshire College

Amherst, MA, USA

Hilary Standing

University of Sussex

Brighton, UK

Authors' Response

Hartmann and Standing question our characterization of their pamphlet "Food, Saris and Sterilization" as an example of academics who opposed family planning because they considered it to be foisted on people in developing countries. We acknowledge that the wording of the sentence in which we cite Hartmann and Standing's work suggests the authors oppose family planning, which was not our intention. We should instead have said that the authors characterized most donor-funded family planning programs, particularly those supported by USAID and the World Bank, as foisted on people as part of a population control agenda. For example, in their pamphlet, Hartmann and Standing contended that, "In Bangladesh today [then 1985] population control is an intensely political issue, involving full-scale attack on the urban and rural poor by the World Bank, USAID, and their allies in the Bangladesh Government." The pamphlet is highly critical of the government's family planning program and characterizes most donors, particularly USAID and the World Bank, as supporting coercive programming.

The authors make no effort to show the positive work of these donors, including supporting monitoring of the sterilization program to ensure voluntarism; and funding technical assistance and training for improving the quality of family planning services, among other activities. USAID funded activities to monitor and to improve the quality of sterilization services in an effort to address the quality issues noted in the pamphlet.

Hartmann and Standing say they are for voluntary family planning, just as we are. There were indeed grounds for concern about coercion in Bangladesh at the time Hartmann and Standing wrote the pamphlet, particularly regarding the use of incentives for providers. Our paper provides a definition of coercion that helps identify practices that have the effect of being coercive and points the way to actions that would respect and protect rights while working toward universal access to family planning services for those who want them.