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Colombia Blogging: Saturday October 30
Today we visited Colombiaton, a new settlement on the outskirts of Cartagena, built to relieve the overcrowding of the refugee camps. The school we visited was new and spotless with a large playground. We attended a workshop on violence for Profamilia peer educators. The new wrinkle today was that Profamilia had asked 1200 students in Cartagena whom they wanted to hear from on this topic and other reproductive health issues. Out came a long list of movie and music stars. Profamilia contacted them, and many agreed to be spokespeople and to appear at events in schools. Today Tony Cruz and Johnny Legendario, rap stars, were scheduled to appear at the school.

After a few preliminaries, in came the rap stars to the screams of the girls and the blare of the "music" and within a few seconds I was hauled out onto the dance floor and put through my paces, making a total fool of myself, but for a good cause.

Fortunately it was soon time for the workshop, I got to sit and my heart rate retreated from the danger zone. Tony and Johnny called on the peers to describe their experiences with violence. A ten year old described how verbal and physical assaults hurt her heart, leading to an imbalance in her soul, making it difficult to walk across the tightrope of life. Then a slim, big-eyed eleven year old, named Alex, who looked all of seven, stood to speak. Because of malnutrition, he is a stunted child but with the heart of a giant and an articulateness beyond his years. He spoke of how he often witnessed his father beating his mother. This made him afraid that this experience could lead him to beat his children someday because that was the only example of how parents behaved that he had seen growing up. He told of coming home from school one day to find his mother gone. He has not seen her since. His father works selling fruit on the street and is not home to cook dinner for him, his father explaining that he must work late to provide what food they have. The program director explained that, although many people in the school community care for Alex, he is no one's child. Alex then sang a song called Love in the Seven Seas a cappella. It was haunting.

We finished the workshop with another rap number with everyone getting their cardio workout on the dance floor. As Tony and Johnny posed for pictures with the peer educators, it began to rain. In the adjacent streets deep puddles began to form, and children splashed and danced through them as children would anywhere. Two boys threw a ball back and forth, oblivious to the downpour. I stepped out towards them and motioned for the ball. The bigger boy threw it to me and we proceeded to have a catch over the ten-foot chain-link fence that separated their houses from the schoolyard. Other boys and girls quickly gathered, and I threw to each of them in turn. There we were - two worlds, a high fence and a ball in the rain - children becoming adults before they should, experiencing things no child ever should, and an organization trying against all odds to have children be born wanted and loved, to parents able to raise them, educated and ready for a world where there is often more rain than sun.

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Colombia Blogging: Friday, October 29
Today we visited the Nelson Mandela Displaced Persons Settlement in Cartagena. Colombia has the dubious distinction of having, after the Sudan, the greatest number of displaced persons. These are refugees from the endemic violence that has wracked this country for years. In Cartagena, a city of a million, there are about 65-70,000 refugees, mostly in two main settlements. The Nelson Mandela settlement has dirt roads, steep hills, jerry-built huts, little electricity, no running water and no sewage system.

A nun founded a community center, a series of cinder block buildings that serve as a soup kitchen, meeting hall and ad hoc health center. Because this nun understood the needs of the women of this community, she invited Profamilia to come in. Today, the Profamilia mobile health brigade, after advance work for several weeks, came to provide pediatric and Women's health care services. The waiting room was jammed with mothers and babies, many of whom had traveled miles, carrying their babies. There was also one father holding his baby. While many of the women were refugees, not all were, and natives to Cartagena came from surrounding areas as well to get services.

Most of the mothers I talked to gave birth as teens. Nationwide, the incidence of teen pregnancy is one in five. Here it is one in three. Malnutrition is more common in the settlements than in the rural areas these refugees came from, since they cannot harvest their own food in the city. Jobs are hard to come by too since the refugees' farming and fishing skills are not transferable to an urban setting. Only one woman I spoke to worked, and she was doing odd jobs as a cleaner. The men scavenged. As a result, children are often exploited in the sex trade. These are the poorest of the poor, and they came to take care of their babies. Interestingly, over 80% give birth in hospitals, so the health care system is not entirely hopeless, but family planning and pediatrics are harder to come by, given the bureaucracy and limited resources of the system. Profamilia fills this gap and brings the services to the people with a grant from USAID, which is expiring this year. Profamilia does not know how it will continue this program of its mobile health brigades reaching these desperate women and children. They literally have no where else to go.

The stories women told ranged from 1) a refugee woman in her '30s with seven children was thinking about a tubal ligation, 2) an 18 year old' whose husband was in prison for 36 years for murder; she visits him every Sunday with the baby, 3) a 34 year old had never used birth control, had 4 children and just had a tubal ligation. All came with their latest baby for pediatric care.

We next walked through a nearby settlement built on a garbage dump. Open streams of sewage ran through the camp. Buildings were built from scavenged materials. The children said they were in school (in Colombia there are not enough schools and the schools run two shifts, morning and afternoon). As always, children gathered around and wanted their pictures taken. Few wore shoes. One seven year old latched onto our photographer and shadowed her every move. As we were leaving, the girl asked if she could come with her to live. This girl, and others living in this settlement, was ripe for exploitation by the unsavory elements of society and could be easily lured or trapped into the sex trade.

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Colombia Blogging: Thursday October 28
Today we visited Pasa Nuevo, a small fishing village with unpaved roads on the Caribbean coast, to see the Profamilia mobile brigade in action. We traveled down a dirt road for several miles to access the village, which has maybe 1,000 inhabitants. The Profamilia social workers had visited houses in the surrounding area for the previous two weeks to let the inhabitants know that they would be in town. Women traveled to see us from a two hour radius. Profamilia visits Pasa Nuevo every six months, this being the limit of the birth control pills and injections. (they leave behind enough supplies for six months).

Profamilia had the use of the village school for the day. The school had no running water but was neat and clean. Exam rooms were set up in empty classrooms with cardboard taped over the windows for privacy. A changing room was fabricated with a sheet taped to the walls in a corner of the room. A Profamilia medical team of a doctor, nurse, nurses aides, social workers and a psychologist went into action.

There were two separate activities happening. The first was the adults, who were sitting under a broad tree getting instruction on breast self examination and sexually transmitted disease. A few had infants on their laps but there were no children running around waiting for a pediatric care, they were taken care of at another facility. Those who thought they had symptoms got immediate attention. There were separate exam rooms for birth control, where the women got IUDs or implants or the Pill or an injection, and another room for STD exams.

Meanwhile the teens of the school, the girls resplendent in their plaid Uniforms and the boys in white shirts and jeans, gathered in classrooms playing sexual health quiz games under the supervision of Profamilia peer educators. The kids ranged from 15 to 20 in age. There were variations of the Concentration game with questions on sexual health. The kids were divided into four teams for each event, with wonderful names like the Crocodiles, the Divine Ones, and the Pirates. There was great good-natured competition among them. When one team got a wrong answer, a boy and girl from the team had to dance the salsa in front of the class. I told them that I considered it a reward! Lots of hilarity. I was not invited to dance. Another punishment was to have the entire team stand with their backs to the class and shake their rear ends - Planned Parenthood does the hokey-pokey!

The educator had a unique way of getting the teens to pay attention. She had a code word for each team, like "restaurant", or "cornbread" and each time she used the word the team would have to stand up at attention. It was Planned Parenthood meets the Marines!

In another exercise, one of the girls explained how to do a breast self-examination. There was rapt attention and no snickering. These are very self-possessed teens. In another class the kids had to put a condom on a wooden penis, again with no snickering from the peanut gallery.

the age of sexual initiation in this village is 12. There is a very high rate of teen pregnancy, but many of these teens now have contraceptive implants. We did not meet a single sullen, disaffected youth, here or in our other visits. They are friendly and not self conscious. They are way ahead of US teens in sexual health knowledge.

The Mayor the the town appeared and, like politicians everywhere, made a speech to the adult voters and then gave a pep talk to the kids about family planning. He hopes to expand this program to other parts of his district.

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Colombia Blogging: Wednesday October 27
Today we visited the Robinson Pitalua public high school school in Monteria, in the north of Colombia. Profamilia peer educators were conducting games/exercises to bring accessible sex, health and violence prevention information to their fellow students. These peer educators get over 100 hours of training. I was immediately assigned to a team of three 13 year olds. The first game was to throw a dart at a dart board and then answer a question on contraception depending what ring you hit. The next game was a version of Concentration where we had to match questions and answers on violence. Another game involved rolling dice and having to answer a question from the square where you landed. My question was whether an IUD could cause uterine cancer. I had to think for a second. My team was probably thinking, why we'd get this guy? But I said 'no' and won a lollypop which I gave to my team. If it had been a chocolate prize, the scene could have gotten ugly. In the final game, I had to spin a wheel and answer a question. Mine was on economic violence and because of Monday's session at the school with the Profamilia Wamba rock band, I was able to answer to great cheers from my team and high fives all around.

I was so impressed that the kids knew their stuff on sex ed. The girls were really empowered. When one girl on my team, age 13, won a condom as a prize, the boy next to her took it from her; she grabbed it right back and put it in her pocket. You go girl!

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Colombia Blogging: Tuesday October 26
Today a visit to the hilltop suburb of Alto de Florida, an hour south of Bogota. The last mile in was on a steep, rutted dirt track. The community has electricity but no running water or sewage. Water is delivered in tank trucks. The school is a one hour walk for the children. The Church runs a communal soup kitchen. We climbed the last bit to reach the site of the Profamilia mobile health clinic, which did not operate out of a van, but instead, was set up inside two ramshackle huts on a precipitous ledge. The Profamilia team consisted of two doctors, two nurses, two social workers and a van to transport all the necessary equipment. The social workers had visited many times over the past weeks to educate the community on the upcoming visit. When we arrived at 9am, about ten women and children were already lined up and waiting. An hour later there were about 80 mothers and children, and a few men, waiting. The Profamilia staff quickly set up a consultation room and exam suit in one hut and another consultation area and dispensary in the other. The lead doctor took everyone's name.

Most of the visits were pediatric, but the mothers also wanted family planning for themselves. The number of children ranged from one to eleven. The women worked as scavengers mostly. Their education level averaged sixth grade. Few of their husbands worked. About half were married. Almost all started as teen mothers. They all looked ten years older than their real age.Some opted for the IUD, some for implants and four opted for sterilization. They participated in an education class on tubal ligation, and were firm in their determination not to have any more children. These women had two or three already. Their major concern was whether the sterilization would affect their sex life. The logistics were also a concern, since they had to arrange child care and to be picked up after the operation. They figured out among themselves how to handle all this. It was carefully explained that the procedure was permanent and that there were other temporary methods available until they were sure. They were and all showed up for their appointments the next day. Profamilia is unique in that a woman can get a sterilization the next day, whereas in the health system it can take months and by that time the woman is often pregnant. The cost of the procedure is fifty cents. The rest
Is subsidized by a private foundation.

This Profamilia program is imperiled by funding cuts. It is the only health care these women and children get. It is almost entirely free but the patients are charged a nominal fee so that they will value the services. It costs $2200 per day to take these mobile health services to remote villages like Alto de Florida.

I quickly made friends with the six and seven year olds, my Spanish was about on their level. My camera became the big hit and soon I was showing them how to put the wrist strap on and how to take photos and show their finished work on the digital screen. They shared the camera quite fairly and were thrilled to take each others photos. Their work was in many cases stunning. Their Photos are attached.

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Colombia Blogging: Monday October 25
Colombia has poverty unlike anything we see in the US. On average Colombia is a middle income country, but the disparities in wealth mean that it's poor are among the most disadvantaged in the world. Transportation is spotty and communication erratic. Machismo is alive and well, and teen pregnancy is increasing. So, how to reach the kids? You don't wait for them to come to you; you go to them.

We drove an hour south of Bogota to a private boarding school, Zoraida Cadavid, where several hundred girls, grades 5-8, awaited us, sitting on stools in their assembly hall, all in uniforms, like all schoolchildren in Colombia. These students are not from well-to-do families and their education is subsidized to a large extent by a family foundation. We took seats on the side. Soon, five scraggly, unshaven males in their late teens arrived carrying guitar cases. They quickly took seats on stools in front of the girls. They were the rock band, Wamba, and also peer educators from Profamilia, the Planned Parenthood of Colombia. I'm thinking, what kind of gender imbalance is this? Where are the female educators?. I soon found out how wrong I was.

The educators had received six months of training at Profamilia and this was their first visit to the school, though other Profamilia educators had been to the school over the past six years. Profamilia also has a psychologist on staff at the school for the girls to talk to. The school was originally run by nuns and it took some doing to get permission for Profamilia to have programs there. Wamba launched into a discussion of violence - physical, psychological, verbal, economic and, finally, sexual. For an hour the educators told stories and asked the teens to share their views. The liveliest interchange from the students came when the topic of sexual violence came up. Rape and incest are epidemic in Colombia, and these girls knew it and some had experienced it. The message of the day was, you can't always prevent bad things happening, but you can control how you react. You can take control of your life. You can get help. Respect yourself. You may get victimized but don't be a victim. The girls were riveted and participating and learning. Clearly the boys from Wamba and Profamilia were just what the doctor ordered.

The boys then handed out song sheets and took the stage where they proceeded to play a sing-along rock concert. It was like the Beatles at Shea Stadium! Screaming and arms waving, no fainting though.

The Profamilia educators cover a variety of topics in their visits. Ever since this program started six years ago, there have been no pregnancies at the school.

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Alexander Sanger
Alexander C. Sanger, the grandson of Margaret Sanger, who founded the birth control movement over eighty years ago, is currently Chair of the International Planned Parenthood Council.
Mr. Sanger previously served as the President of Planned Parenthood of New York City (PPNYC) and its international arm, The Margaret Sanger Center International (MSCI) for ten years from 1991 - 2000.

Mr. Sanger speaks around the country and the world and has served as a Goodwill Ambassador for the United Nations Population Fund.

Beyond Choice
Beyond Choice
The new book by Alexander Sanger published by PublicAffairs

Purchase from

Click here for full book information

With reproductive freedom in jeopardy, Alexander Sanger, grandson of renowned family planning advocate Margaret Sanger and a longtime leader in the reproductive rights movement, has taken an urgent, fresh look at the pro-choice position—and even the pro-life position—and finds them necessary, but insufficient. In Beyond Choice he offers the first major re-thinking of these positions in thirty years.

“Well researched and readable, Beyond Choice should be required reading for both pro-choice and pro-life supporters.”
—Governor Christine Todd Whitman


» Much more on Beyond Choice, including an excerpt, discussion guides, reviews
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