By Deborah Van Hoewyk
Loyal readers of The Eye know that the birth control pill was actually created in Mexico City in 1951, when chemist Carl Djerassi synthesized hormones from Mexican yams. And, as we speak, other scientists from Mexico City are working on a molecule that will keep sperm from getting where they’re supposed to go—should work with everything from fish to cattle to men!
Mexico’s 2000 census counted about 100 million people in Mexico (about 118.4 million in 2013). That’s about a 700% increase in population over the 20th century, which started with 13.6 million, neared 20 million by 1940, and then hit 48.2 million in 1970—more than double in thirty years. At that point, the population was growing at 3.4% a year, one of the highest growth rates in the world.
But then a funny thing happened on the way to the 21st century—from the late 1970s until 2000, the population grew at only 1.9% a year, less than the 2.1% considered to be the “replacement rate” necessary for a stable population.
What happened? José López Portillo y Pacheco, president of Mexico from 1976 to 1982, instituted an “aggressive” national family planning program to reduce Mexico’s fertility rate. Progress on fertility reduction had occurred before Portillo took office: in 1973, it became legal to advertise contraception; in January 1974, the government was legally required to offer free birth control services; in December 1974, the Constitution was amended to allow each family to choose how many children they would have, making Mexico the second country worldwide to legislate that right.
Portillo’s program worked through the Rural Health Program of the Secretariat of Health (SSA) and the Mexican Institute of Social Security (IMSS) to provide education about the benefits of smaller families and access to contraceptives (emphasis on IUDs and female sterilization). In 1976, women of child-bearing age had 5.4 live births on average; by 1979, they were having only 4.6 children, and by 1997, thirty years after the Portillo initiative, only 2.76 (for 2013, the estimate was 2.25.)
Most of this reduction can be attributed to the Portillo program, which targeted rural communities and used sophisticated propaganda to disseminate its message. The chart below shows that only women aged 25-29 failed to double their use of birth control, but even they went from 38.6% to 67.8%, an increase of over 75%.
The campaign had to do more than just provide access. From August 1977 to April 1978, Mexico’s largest broadcast station, Televisa, aired a telenovela called Acompañame (Accompany Me), which showed how family life could be improved with birth control. Over half a million women took to contraceptives with enthusiasm, more than tripling the rate of contraceptive sales. There were TV and radio spots, posters in public transportation and hospitals, all touting the theme that “The Small Family Lives Better.”
Televisa followed up with four more telanovelas about the wonderful powers of birth control to improve family life. A US AID report credits the telenovelas as making “the single most powerful contribution to the Mexican population success story.” Perhaps even more important than increasing the use of contraception was the attitude change the campaign brought about. Among young urban couples, the machismo notion of large families as a sign of virility virtually disappeared. While the challenge of disseminating the concept and practice of birth control was not so easily met in rural villages, what gains were achieved were largely due to television, really the only feasible way to get the message out to remote areas.
Backlash?
As noted, the Portillo campaign emphasized IUDs and female sterilization, which was still the norm twenty years later. The following chart compares data on people who use birth control; U.S./Canadian data are from 1996, Mexican data from 1997. Compared with the U.S. and Canada, Mexico had the lowest percentage of people using birth control, just over two-thirds of people of child-bearing age.
Of those using birth control, the most prevalent (permanent and most effective) form in all three countries was female sterilization (30% in Mexico, 30.6% in Canada, and 23.8% in the U.S). Mexico then has the highest utilization rate of semi-permanent “I” methods (14.1%–injections, implants, and IUDs). Methods that give the woman or the couple complete control are less popular; traditional methods (rhythm, withdrawal, abstinence, folk remedies) are used by 9.1% of people, while the pill is used by only 7.1% of Mexican women, but 14.4% of Canadian and 15.6 of U.S. women. If it involves the male’s being proactive (condom/sterilization), Mexico comes in last (5% for the two methods combined, but 24.6% and 26.5% in Canada and the U.S., respectively). Use of “modern” methods (vaginal barriers, “morning after” pill, etc.) is negligible in Mexico.
Lowering fertility is usually seen as a key component of improving health and welfare, but there has been a change in global attitudes about family planning. The paradigm seems to be changing from the “Small Families are Better” framework to one of reproductive rights, in which government-sponsored programs to stem population growth through sterilization and contraception are seen as coercive. In 1994, the International Conference on Population and Development brought together 179 countries to sign a “Program of Action” that called for giving women absolute autonomy over their reproductive choices.
Mexico signed on, and is considered a model of transparency in its family planning programs, as well as for championing women’s rights. Its current program, PROGRESA/Oportunidades, is a conditional cash-transfer program in which low-income women receive payments if they send their children to school and visit the local Casa de Salud for regular checkups; those checkups ostensibly provide freedom of choice in family planning methods.
The program has received very positive external evaluations, with data showing significant achievements on health indicators, although somewhat less success in promulgating rural education. Qualitative, on-the-ground observation sees a different picture. When anthropologist Vania Smith-Oka of Notre Dame University went to northern Vera Cruz to study how Nahua women used medicinal plants to promote reproductive health, she found that these women were losing their extensive ethno-botanical knowledge as the presence of “biomedical,” i.e., “modern,” clinics and hospitals increased. Smith-Oka also found that the women who went to the clinics and participated in the PROGRESA/ Oportunidades program felt that they “pressured” to comply with clinic instructions, and “coerced” when it came to family planning methods, especially if they already had two children.
PROGRESA/Oportunidades has also been criticized for its basic approach—giving fish (the cash transfer) rather than teaching how to fish (effective economic opportunity), and from a gender perspective, in that it makes mothers responsible for poverty alleviation and uses them as “conduits for policy,” i.e., policy spending is channeled through the mothers in order to achieve society-wide progress.
These are major, albeit still isolated, criticisms of a program that could be essential to improving the life chances of the rural poor. Mexico suffers from income inequality—the richest 10% of Mexicans have 27 times the wealth of the poorest 10%, and that gap is still increasing, although the increase is slowing down.
We seem to be left with a philosophical, if not profoundly moral, question of how to balance individual reproductive rights (how many of us are in the Our Bodies, Our Selves generation?) against the collective futures of Mexican children living in poverty.