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A CONVERSATION WITH INGAR BRUEGGEMANN

DECEMBER 25,  1995– JAN 14, 1995

A CONVERSATION WITH INGAR BRUEGGEMANN

‘When social taboos prevent discussion of sexuality, that is not fair to young people’

Ingar Brueggermann of Germany is off to a roaring start as the new Secretary General of

the International Planned Parenthood Federation. The London-based organization

is pursuing its vision 2000, an ambitious, comprehensive reproductive health program

for women youth.

Brueggermann worked for nearly two decades with the UN’s World Health Organization on family planning, public health and international coordination. Following are excerpts from a recent conversation at her London office:

What is the main focus of your work as the new head of IPPF?

Our focus is expressed in “Vision 2000,” which means providing young people–and

I stress that this includes boys as well as girls–with the information and resources

to  make clear-cut choices of their own regarding reproductive health.

Many people think reproductive health involves only the specifics of having babies, but we see our work in a larger context: the entire period of our life span during which we are sexual entities. We have to reach young people, because their sexual life starts long before they are ready to start a family.  We feel very strongly that young people have a right to know unwanted pregnancies and sexually transmitted diseases. Social taboos have prevented discussion of our sexuality, and that is not fair to young people.

Society must recognize the negative consequences of unwanted pregnancy and unsafe abortion. Half a million women die every year from pregnancy-related causes, and at least half of those deaths, by a conservative estimate, result from unsafe abortion.

Many thousands more women suffer consequences like infertility, infection and psychological trauma. IPPF is taking on quite a large package, and this a tremendous challenge. Our priority is to reach those who currently  have no access to reproductive health services.

Do you believe that the international community has a serious commitment to the action programs adopted at the UN population conference in Cairo and women’s summit in Beijing?

Our organization has pushed hard for women’s empowerment and free choice,

and this work was 100 percent confirmed in Cairo and Beijing. But implementation is

not only a task for women. The brave, angry women who brought these issues to

the fore must he recognized, but the problems are now on the global and governmental agendas. If I were to answer you as a pessimist, I would say that there is not a serious, political commitment. Governments that were still trying to digest the promises they made in Cairo were soon making more promises in Beijing. There was a certain anxiety about how to react to all of these identified priorities. But the agendas set at these meetings, and at the earlier conferences in Rio (on the environment) and Vienna (human rights), form a spectrum of where development has to go.  The issues are all closely interrelated, and that makes me more optimistic. The challenge is to find a good synthesis among these various demands so that governments feel confident in providing the resources. I would like to see agencies like IPPF work hard now on making good suggestions.

How do you relate population issues to other priorities for development?

Family planning cannot be separated from the need for a sustainable environment, for human rights and women rights. But there is a difficulty if we talk about it simply in global terms. We tend to see it as a “macro” program, and do not yet fully grasp that the solution lies at the “micro” level, with the individual. Men and women must be able to decide to have just two or three children with the confidence that their sons and daughters will survive. They need assurance that disease will not  take the children away, and that their own social security is not dependent on having a large number of offspring.

Once governments recognize the correlation between “micro” action and “macro” effect,  I don’t think there will be any reluctance to invest in reproductive health, which has such a long-term impact. If you look at societies that have a high G.N.P., you see that their birth rates are going down.  In the West, there is  sometimes the view that “there is no way you can convince ‘those people.”’ But this , is a very false understanding of how “they” think.  Another unfortunate interpretation is that people who want to enable women to make a free choice are not really “pro-life.”

What can be done to correct such misinterpretations?

This is where I believe the media have a tremendous role to play. It is particularly

sad that we seem to act more quickly when we feel threatened than when we get good

advice on how to avoid a future disaster. A good example is the criticism being made

of China’s family planning policies. There is no question that anything involving the

coercion of people, the forcing of women, is negative. However, one has to look into

the proportion of positive and negative features. Education about the balance between resources and population is gaining ground among young people in China. The government is also trying to establish a guaranteed pension for people over 60, particularly to reassure the parents of a daughter. The critics ignore those measures and refuse to make the reverse equation: What would it be like if China did not have a family policy. If there is a famine, how many countries would lift a  finger to help? We need to learn a lot.

Our main objective at IPPF is to assist individuals in making life worthwhile, so that their children have a chance to lead a reasonab1y happy life. It has been proved scientifically that children whose births have been spaced, who are born to mothers who are neither too young nor too old have a fairer chance of being healthy and happy.

What can be done to minimize a duplication of labor among the various UN agencies, nongovernmental organizations and government institutions?

We must try even harder to establish common policies, a common concept of where we want to go. We need mechanisms for the UNFPAs,  the IPPFs and the donors

to sit around a table and work that out. I like to say that our work should reinforce

each other, rather than overlap. Rather than all of us studying the same thing, we should agree that something has already been analyzed enough, and use the

available  funds to go forward with implementation.

What has been the impact of the South-South partnership initiatives, where developing countries share successful experiences with family planning programs, literacy drives and other projects to empower women?

When such efforts began some 20 years ago there was a lot of skepticism. Many

people did not grasp that a expert in primary health care in rural Thailand, for example, might have something valuable to share with a counterpart in Nepal. Now,  fortunately, that view has changed completely. Governments understand that there is no need to call in a highly paid expert from the North when there are qualified people right in their own

countries, or in a neighboring country. My impression is that serious donors—those more interested in fostering development than in selling their own experts–are making resources available for South-South cooperation.

DECEMBER 25, 1995

Teaching the value of girl children

CHINA

China’s family planning program is highly controversial, with  human rights organizations citing draconian limits on family size. But some international population

experts say the outside world ignores many positive aspects of Beijing’s family planning

campaign.

“The Chinese arc trying to systematically address two key concerns,” says demographer,

V. Palan, “continuing to improve both the status of women and the quality of their children’s health care and education.”

Palan, who is the International Planned Parenthood Federation’s regional director for Southeast Asia and Oceania, notes that China is actively working to convince parents of the value of their girl children and allay widespread concerns that the lack of a son will leave them without security in their old age. The government has instituted an insurance scheme to guarantee retirement benefits and is helping to boost women’s economic status and incomes. Chinese women, he observes, now occupy high-level, policy-making positions.

Thc country’s vast size makes family planning “a major challenge,” adds Palan. China’s

Family Planning Association has a huge volunteer base of 60 million people working at

various levels in urban and rural areas. In the poorer parts of country, these activists focus on improving women’s access to health care and organizing income-generating projects.

Fighting illiteracy, poverty

The International Planned  Parenthood Federation’s  top priority in Africa is  reaching young people. Half the population of the continent’s Sub-Saharan region is under the age of 16, and early pregnancy and sexually transmitted diseases pose critical problems for teenagers.

Local Family Planning Associations (FPAs) work to convince governments, religious

leaders and educators to “accept educating children on reproductive health in schools,”

according to Marc Okunnu, the Federation’s regional director for Africa. IPPF also trains

teachers and parent-teacher groups to talk with young people about the issues, and

provides youth centers with a wide variety of posters, leaflets and services. Publicizing

information about the prevention of HIV infection and AIDS is a vital component of this work.

African youth programs have made strides in recent years, said Okunnu. Most important

has been a push to directly involve young people in peer counseling and project design,

In Tanzania, where many teenagers resort to unsafe abortion and 30 percent to 40 percent of patients treated for sexually transmitted diseases arc in their teens, the local FPA, called UMATI, has started a Youth Family Planning Services Through Peers project. “Such project arc critical to the region and one of the ways that teenagers can learn about reproductive health and spread the message to others,” said Okunnu.

Helping IPPF affiliates become better organized, more effective and “more relevant to

the demands of their countries” is the prime task, he told  Thc Earth Times. But Okunnu has misgivings about the survival of grass-roots organizations in countries with armed conflicts and other unstable conditions.

Politicians hold the key

Arab World

Family planning programs in the Middle East vary widely, depending on each country’s resources policies. Mohammed Bouzidi, the regional director of the Arab World Regional

Bureau for International Parenthood Federation  since 1993, said that there arc countries

 like Tunisia, Morocco, Egypt and Jordan where political commitment have led to an increasing awareness of the need for health services that include family planning. Syria and Iraq her hand had pro-natal policies till  very recently.

“Two years ago there was a policy in Iraq that not only encouraged women to have more children but actually gave a medal to women who had more than 10 children,” said

Bouzidi. Both governments have now changed the policy and are actively seeking help

from the local Family Planning Associations (FPAs) to help provide services for the

country .

“Even in Palestine, just a few years ago the slogan was, ‘Every empty uterus is a crime against the revolution.’ Now the Minister of health is asking the local FPAs to provide services,”said Bouzidi.

“Another issue is that because women are now more educated and work, they are feeling the backlash of religious fundamentalism. This has led to a demand for FPAs to develop programs to empower women as far as legal and reproductive rights are concerned,” said Bouzidi.  FPAs are also playing a vital role in providing community based services in the poorer rural areas, where due to a lack of infrastructure and communications, women have little access to good health care.

Unusually high abortion rate

Europe

The International Planned parenthood Federation’s work in Europe took a sharp new turn with the emergence of the Commonwealth of Independent (CIS). Unlike Western Europe, which has well shed Family Planning Associations (FPAs) and a highly developed health-care system, the former Soviet lacked many essential reproductive health services.

A high abortion rate posed a :significant health problem in a and the other CIS countries,

 where “women had no access to contraceptives,” PPF’s European Regional Director, Lyn Thomas. Now, as family planning services take hold, the  abortion rate is beginning to fall.

IPPF set up its first Russian in 1991 and currently operates 40 local clinics that work closely with local authorities. The clinics train hers and urge hospital officials to authorize purchases contraceptives (only hospitals are permitted to order such supplies). IPPF has opened youth centers in Tula, Moscow and Stavropol to provide information and services to teenagers.

The Russian authorities arc extremely supportive of family planning initiatives, says

Thomas, a stand symbolized by the local governor’s appearance at the inauguration

of the Tula youth facility.

The government has launched a committee on women’s health and is developing legislation to establish reproductive health services.