Director of Population and Reproductive Health Judith Helzner reviews recently published The Means of Reproduction: Sex, Power, and the Future of the World. The book review originally appeared in Studies in Family Planning.

Michelle Goldberg
The Means of Reproduction: Sex, Power, and the Future of the World
New York: The Penguin Press, 2009. 260 pages. Cloth, $25.95, ISBN-13: 978-1594202087; paper, $16, ISBN-10: 0143116886

Each reader of Studies in Family Planning has her or his own mental landscape of the international population and reproductive health field, based on personal and professional life experiences, contact with other countries, reading, and ideology. Michelle Goldberg, an investigative journalist, takes readers on a guided journey of that landscape in her book The Means of Reproduction: Sex, Power, and the Future of the World. Even the most engaged actors will have their perspectives challenged and their knowledge enhanced by this book.

Her research — using written materials ranging from the popular press to social science literature, as well as interviews carried out around the globe — covers not only the history of concern about population growth in the global South but also other demographic topics such as skewed sex ratios in Asia and declining fertility in Europe. Goldberg clearly describes the evolution of the population field, including early worries about potential increases of Communist hordes, Malthusian fears, and the movement toward an emphasis on women’s health and rights. She demonstrates how the focus on women’s rights would eventually leave “birth control programs far more politically vulnerable to right-wing attacks, since nothing but women’s lives was at stake” (page 41).

The book covers a variety of topics that one might not expect to find in a single volume. Chapter 1, “Sandanista Family Values,” addresses the complexity of the abortion issue by focusing on the ideological battleground over abortion in Nicaragua, illustrating how the pregnancy of a nine-year-old became a media sensation, galvanized political forces, and had unexpected and lasting effects on the abortion debate. Chapter 2, “The Great Population Panic,” and Chapter 3, “Sisterhood Is International,” offer the chronology and multiple backstories of the population-growth debate, with an emphasis on specific individual characters such as Joan Dunlop and Adrienne Germain, who eventually teamed up to create the International Women’s Health Coalition, and Rei Ravenholt, who initiated USAID’s population program. Chapter 4, “Cairo and Beijing,” sets the battles for women’s rights at UN meetings in the context of “a fight over modernity itself” (page 104), and details the Vatican’s engagement in those events.

Chapter 5, “Rights versus Rites,” focuses on female genital “circumcision,” or “cutting,” or “mutilation” — and helps the reader understand that the choice of words used to describe the practice represents an ideological perspective about it. Emphasizing the issue’s complexity, Goldberg chronicles its history and local meaning in Africa. She gives equal weight to both sides by profiling a highly educated African woman who is a proponent of excision. The debate is seen as being “about who has the right to intervene in the sexual practices of others, about absolute standards and the prerogatives of culture” (page 123).

Chapter 6, “The Globalization of the Culture Wars,” describes how religious conservatives organized to bring their influence to bear on international reproductive rights issues. Tracking their efforts to affect both the State Department and the outcome of various UN conferences, Goldberg keeps the big picture in perspective and reminds her readers that “throughout all this the United States remained the world’s largest donor to global family planning” (page 161). She describes conservative Christians’ efforts to form alliances with Muslim forces at international forums — including how the September 11th attacks in 2001 made such contacts more cautious and difficult.

Chapter 7, “Missing Girls,” documents the trends and implications of skewed sex ratios, focusing primarily on India but with references to China and South Korea. Continuing her effort to avoid oversimplification and to stress the complexity inherent in reproductive rights, she analyzes the impact of the combination of son preference, dowry traditions, and the easy availability of sonograms that allow for sex-selective abortion. “To confront the issue of sex-selective abortion as a feminist is to see the world in much the same way pro-lifers do, at least for a moment. It’s to look in horror at a culture where potential life is tossed away in the quest for economic advancement and status, debasing all involved. It’s to see some choices as illegitimate” (page 187). As in other chapters, Goldberg complements these philosophical musings with real-life stories of poor women who suffered from, and sometimes triumphed over, the type of problem being described. One perspective that is beyond the scope of her effort here is a comprehensive attempt to document the contributions of the many women’s groups based in the global South that influenced the field, through interviews with their leaders and a review of documents that would recognize their strategies and successes.

Chapter 8, “The Birth Strike,” turns to the topic of below-replacement fertility and the prospect of declining population in Europe. Goldberg compares liberal versus conservative views about women’s roles in the home and in the paid labor force. She shows how greater support for working mothers — in the form of sufficient maternity and paternity leave, child care, after-school programs, and paid sick leave to handle parental duties — correlates with higher birth rates in Europe, at least in recent decades. She emphasizes that helping women to juggle successfully the duties of work and childbearing is a more appropriate strategy for encouraging births than returning to an era where women are relegated to the home. “The first-world fertility crisis has been caused by women reacting to the constraints on their lives with a kind of birth strike. Further restricting their choices isn’t just morally wrong — it’s demographically counterproductive” (page 207). While acknowledging that the possibility exists of allowing migration to increase the workforce and improve the dependency ratio, Goldberg also documents the challenges involved in a European country’s incorporating “the other” and still maintaining a national identity with which it feels comfortable.

In her conclusion, “Sex and Chaos,” the author summarizes her argument that “the absence of women’s rights [is] creating existential dangers” (page 223), including overpopulation, underpopulation, and sex-ratio imbalances. She sees these as problems the solutions for which are inextricably tied to improved fulfillment of women’s rights around the world. The conclusions also make clear her understanding that, although women’s rights may be necessary to solve multiple problems, they are not sufficient to do so.

Throughout the book, Goldberg notes that international reproductive rights and population issues are little understood — or cared about — by most of the American public. She describes how “[t]he importance of … UN declarations can be hard to see from the United States because they carry no weight here” (page 114), compared with developing countries or even with Europe, where international agreements are used to advocate for domestic legal and policy changes. She also documents how, over time, “religious conservatives were learning from the success of the international women’s movement and, in many ways, imitating it …, taking direct action on the ground …, organiz[ing] coalitions of sympathetic groups worldwide …, form[ing] NGOs …, and mak[ing] their way onto country delegations for United Nations meetings” (page 151). The author’s understanding of this opposition is clearly enhanced by the research she conducted for her previous book, Kingdom Coming: The Rise of Christian Nationalism (2006).

The concerned reader is left with the question of whether and how Americans — particularly those who care about reproductive rights — can be motivated to become better informed and take action to support international reproductive health and rights. The United States media gives scant attention to such topics as, for example, the more than 500,000 maternal deaths estimated to occur each year, most from preventable causes, in resource-poor settings. Although clearly any deaths caused by accidents are tragic, why should a ferry sinking or a bus plunging off a road somewhere qualify as news in the mass media, when the constant toll of nearly 1,500 women dying every single day is ignored in the press? The new Global Health Initiative of the Obama administration and the recommitment to the principles of the International Conference on Population and Development by Secretary of State Hillary Clinton in January 2010 are promising developments, but surely more could be done to mobilize ordinary Americans to take up the cause of global reproductive rights. No prescriptions along these lines are to be found in Goldberg’s book, but her poignant human stories and thoughtful analysis can pave the way for others to take the next steps.

Throughout my career, I have tried to combine the task of following population growth trends with a personal passion for feminist principles. As I finished Goldberg’s book, I thought of my first demography course, where I learned about the demographic transition. According to that framework, birth and death rates are in balance at high levels in preindustrial societies; deaths decline (slowly in the industrialized world, rapidly in the global South); and balance is restored at low levels of fertility and mortality. It was considered theoretically possible but not morally acceptable for death rates to rise again to achieve balance. So, too, perhaps, families and cultures of past eras could function smoothly with women playing traditional roles and lacking their reproductive rights. But once women’s status begins to improve, a new equilibrium can be restored only if that process continues. Just as a massive increase in death rates cannot be the solution to achieving a world in demographic balance, backsliding on women’s reproductive rights is unacceptable as a strategy to achieve a new era of equity and peace. The Means of Reproduction helps to clarify the reasons why improving women’s status and rights is crucial to the future, and Goldberg’s argument may help to motivate the sympathetic reader to action.

Population & Reproductive Health, Africa, Asia, Health, Population