Indigenous contraceptive knowledge and practices are widely dispersed, and the systematic importation of new contraceptive technologies does not take place in a vacuum. As with pharmaceuticals, it is largely through the mediation of government that contraceptives such as the contraceptive pill (the Pill) and intra-uterine devices (IUDs) are made available to populations and this is carried out, almost without exception, in association with national policies of "family planning." The large ethnographic literature on contraception produced by anthropologists reveals several dominant themes, among which is a prominent concern by informants about unwanted side-effects associated with pharmaceutical contraceptives, and with the insertion of objects into the body for contraceptive purposes. Nichter (1989) writes about a "rhetoric of rumor and side effects" in Sri Lanka and describes how local accounts about the way in which the Pill works are absorbed into ethnophysiological knowledge. Fear about negative effects of the Pill on the normal functioning of the body make its use unacceptable to many women. Good (1980) notes that Iranian women fear that the Pill will render them sterile because it "dries out the uterus." Similar concerns about the drying properties of the Pill have been reported worldwide. In Japan the Pill was not made legally available as a contraceptive until 2000 due in part to a powerful opposition lobby by Japanese companies that make condoms and to a concern among men about female promiscuity associated with the Pill (noted in many other parts of the world). But a fear among women about unwanted side-effects was also implicated (Lock, 1993). The result has been that abortion, relatively easily available in Japan, has been made of regular use for family planning (Coleman, 1983).
Lopez (1998), whose research deals with sterilization, the preferred method of population control in Puerto Rico, argues that a focus on individual women is inappropriate in this type of research. Lopez insists that the reproductive decisions made by Puerto Rican women, and by implication women virtually everywhere, can only be understood within a larger historical and social framework as well as through an ethnographic lens. Contradictions in connection with the application of technologies of contraception are then made apparent. She wants more attention given to community rights in connection with such technologies, and less on individual rights and interests, as is the case for the bulk of research carried out in North America and Europe.
Family planning in most countries is implemented by governments on the assumption that economic development can be brought about by reducing family size. China is the best known example of this approach, where a rhetoric of an overly populous nation prevails, and the enforced one-child policy is implemented with a concurrent discourse of neo-eugenics about "raising the quality of people" (Anagnost, 1995). Ong (1995) shows how the ideology of family planning in Malaysia increases tensions between many husbands and wives. The Pill was introduced in Malaysia together with a rhetoric that implied that the life of couples would improve with its use by reducing the burden placed on women. Moslem men actively resisted the planning of their families, and although birth rates among the Chinese and Hindu populations fell in Malaysia, among the Moslem population it rose, something that Ong attributes to the negative reaction of men. Moslem men argued that the Pill was making their wives sick, and even very poor men with large families resisted its use.
In Egypt, the state, collaborating with donor agencies, explicitly uses a family-planning program as a tool to modernize its population, to improve its overall health, and to remove "weakness." The concepts of "progress" and of "material wealth" are made use of in association with efforts to normalize nuclear families and to promote ideas about individuality and privacy in the hope of reducing family size. Ali (1996) shows how Islamic principles have been interpreted by the State so as to support family planning, but he also demonstrates the mixed reception this policy has had, particularly among Islamic parties who object vehemently to the secularization of the moral and family life of Egyptians. Similarly to the responses of nationalist and religious groups in India, Indonesia, Nepal, North America, and elsewhere, Islamists in Egypt actively seek to defend the domestic sphere from what they perceive to be moral breakdown. Clearly, accounts about increasing individual autonomy for women, so often associated with the introduction of birth control, must be situated in context and suitably tempered. It may well be that at times the reverse is actually the case.
In recent years condom use has been widely promoted because of its value in preventing the transmission of HIV, and several anthropologists have documented the social, cultural, and political issues at stake here (see Grundfest-Schoepf, 1993, for example). (Pigg, 2002) has analyzed the fraught relationship among participants in a public debate about sexuality, national identity, and the introduction of HIV/AIDS prevention strategies in Nepal.
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