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Reproductive Health in the Sacred Valley of Peru - July 2011
Reproductive Health in the Sacred Valley of Peru - July 2011

The Sacred Valley of Peru, outside of Cusco and the gateway to Machu Picchu, but so much more, is one of the last indigenous bastions of Peru. The people speak Quechua, an ancient Inca language, and make their living by farming and livestock. Men, women and children work the farms on the valley floor and high on ancient Inca terraces that climb the Andean peaks up to 4,000 meters or more. They dress in traditional clothes and live in mud brick dwellings, which the higher you go, the fewer amenities like electricity and water they have.

I spoke to some of the local women through a translator. Rosario is 47, farms and has 6 children from 27 to 14. Her first five were delivered at home; her sixth she delivered in the local hospital, because she was having a difficult pregnancy (risks in pregnancy increase with the number of deliveries). Just before she entered the hospital, her husband had an accident and injured his foot so badly that he was unable to work their farm. Because she, and her children, were now responsible for the farm without his help, she decided to have a tubal ligation after her delivery. She wanted more children but sacrificed for her living children and husband, whom she had to feed.

Her method of birth control between pregnancies? Achank’aray, a local herb grown high in the Andes. The indigenous women collect it and boil it to make tea. One cup a day prevents pregnancy. When Rosario was ready for her next child, she stopped taking the tea. As for sex ed, this is commonly done by the grandmother. Herbal recipes are passed down from generation to generation. There are no herbal contraceptives, alas, for men. There is, however, one plant that lessens male aggression. If a husband is abusive or violent, then the local women wash his underwear in a plant called tuberculo. Alternatively, they put it in his drink. After two days the husband’s libido and aggression are markedly lessened.

I then met an extended family: Mercedes, age 62 with her daughters and daughters-in-law, Florentina, Isidora and Isabella. They all live in the same small house, in the valley. Mercedes, age 62, had 8 children ages 38 to 19. These children have 2, 3 or 4 children each. Florentina, age 25, a daughter-in –law, has just two, ages 7 and 2. She does not want any more children and uses birth control injections every three months from the local health facility. She pays 10 Soles per injection, or around $3. She gets headaches as a side effect but continues, since she cannot afford to educate her children. While the tuition is free, the school uniforms, books and school supplies are not. My gifts of pens and paper were most welcome.

Isidora, age 35, a daughter, has 4 children, ages 12, 10, 7 and 4, all delivered at home except the last. She too uses injections for birth control.
Isibella, age 37, another daughter, has 3 children, ages 16, 8 and 4. She says she does not use contraception.

I passed on to a pair of women waiting to take batches of barley to the Sunday market in Pisac. Regina, age 37, has two children , ages 16 and 12. She uses the calendar method for birth control, since injections are too expensive. She lives too low in the valley to find the herbal plants.

Her friend, Modesta, age 43, had four children. After the delivery of her fourth at the local health facility, the doctor pressured her into having a tubal ligation, even though she wanted more children. She says she feels constantly sick, since she is not getting her monthly period and toxins are building up inside her body. She is angry.

None of the women tell their husbands they are on birth control. Machismo is a reality of life. Men want children and equate birth control with their wives having extra-marital affairs.

While hardly a scientific sample, these women represent the challenges of poor women in Peru. Traditional methods remain in use, but many have changed to modern methods despite the costs and side effects. The number of children per woman is declining. The concept of unwanted children is virtually unknown, rather, women want many children to farm the land. Women alone are responsible for birth control and have to use it surreptitiously. None mentioned abortion. Nor was there any infant mortality.
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Guardian Op-Ed
Herman Cain's Planned Parenthood 'genocide' slur
African American leaders welcomed the women's health services my grandmother started. And Republicans supported them, too

Alexander Sanger, Tuesday 1 November 2011 11.33 EDT
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Margaret Sanger, founder of the Planned Parenthood Federation. Photograph: Corbis
Republican presidential hopeful Herman Cain issued a blistering, and factually incorrect, attack on Planned Parenthood on Sunday's Face the Nation. During the interview, Cain confirmed remarks he made six months ago at the Heritage Foundation, where he said: "When Margaret Sanger – check my history – started Planned Parenthood, the objective was to put these centers in primarily black communities so they could help kill black babies before they came into the world. It's planned genocide."

Cain's accusation is not only dangerous, it's inaccurate. According to the Guttmacher Institute, white women account for 36% of abortions compared to 30% of black women and 25% of Latinas. Sixty-three per cent of abortion clinics are in neighborhoods where more than half the residents are white. Beyond that, Planned Parenthoods do much more than provide safe abortion services: contraception, prenatal care, HIV testing and breast and cervical cancer screenings, to name a few.

Similarly, Cain could use a history lesson. When my grandmother started Planned Parenthood in 1916, her first clinic was in Brownsville, Brooklyn, then a mixed neighborhood of primarily European immigrants. Within a decade and a half, her nascent organisation received the endorsement of several prominent African Americans, including Mary McLeod Bethune, WEB DuBois and Rev Adam Clayton Powell Jr. At their urging, in 1930, Harlem's first birth control clinic was opened, in partnership with the New York Urban League. In years to come, African American leaders endorsed her efforts to bring contraceptives to poor, rural black residents – the same services Planned Parenthood delivered to poor, rural white residents.

To think that my grandmother was clever enough to enlist prominent black religious and community leaders to exterminate their own race is not only nonsensical; it's racist. Throughout her career, my grandmother's driving force was to ensure that every child was a wanted child.

While it took 30 more years for America to catch up to my grandmother, the goal of securing reproductive healthcare for all was less controversial than it is today. In a 1969 address to Congress, Republican President Richard Nixon stated that "no American woman should be denied access to family planning assistance because of her economic condition." A year later, Title X of the Public Health Service Act passed the House by a landslide and the Senate unanimously, giving low-income and uninsured women access to family planning and reproductive healthcare services.

Back then, Republicans supported voluntary family planning programs as much as Democrats did. Back then, sound public health policies trumped politics when it came to women's health.

Today, the debate has shifted, and militant conservatives are waging a war on women in an effort to advance politically. Cain and the other Republican presidential hopefuls now support eliminating federal funding for Planned Parenthood, which provides millions with vital health services, including contraceptives, each year. But it doesn't stop there: House Republicans are attempting to abolish funding for family planning programs throughout the world.

If my work has taught me anything, it is that there is a universal desire among women, and men, to plan their families to give their children the best chance of being born healthy and loved. And if Cain's experience as a businessman has taught him anything, he'd recognise that it's a simple matter of supply and demand: more than 200 million women around the world want access to family planning, but lack these basic services.

If we don't supply them, women will go without. The result? A rise in unplanned pregnancies and unsafe abortions. And we don't think that even Herman Cain would want that.
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NY Daily News Op-Ed
Republicans' war on abortion rights continues: But we can't give up the fight for women's rights

Thursday, October 27 2011, 4:00 AM

On Nov. 8, Mississippi residents will vote on a proposed constitutional amendment that would categorize a fertilized human egg as a legal person. If passed, this measure would prohibit not only abortion, but common birth control methods such as the IUD. While a similar measure was twice defeated in Colorado, in 2008 and 2010, by wide margins, other states - including Florida and Ohio - are considering comparable initiatives.
These attacks are dangerous, but they are nothing new, part of a century-long war on women. While we all know it generally takes two to tango when it comes to sex, women - specifically poor women - have historically paid the disproportionate share of the price when politics and misguided morality triumph over public health necessities.
One hundred years ago this month, my grandmother began her career as an advocate. A recent arrival in New York herself, Margaret Sanger worked as a nurse in the lower East Side, where immigrants lived crowded in fetid tenements and the infant mortality rate was of Third World proportions.
My grandmother was particularly struck by the daily drudgery of mothers. She immediately saw the connection between the dire living conditions and the fact that many births were unwanted, recalling one 72 year-old woman who said "she would gladly have another baby if nature were willing, but her daughters and sons, who had endured poverty and neglect. . .preferred risking imprisonment and death rather than bearing children and have them go through what they lived through."
My grandmother soon learned that women were routinely denied access to contraception and information about how to prevent pregnancies. It was the attitude at the time that women - and women alone - were responsible for the consequences of marital relations. The draconian Comstock Laws made it illegal to distribute contraceptives or provide educational materials about sexual health or reproduction, as this information was then considered "lascivious.
My grandmother soon discovered that Comstock carried implications far more serious than censorship when she tried to save the life of one of her patients following a botched back-alley abortion. She swore "no more" and founded the birth control movement in America, subsequently opening the first of her clinics in the Brownsville section of Brooklyn.
Her clinic was open less than two weeks before being closed by the police as a "public nuisance." She went to jail for 30 days, but kept fighting, eventually founding the International Planned Parenthood Federation.
Today, IPPF has more service points worldwide than McDonald's does franchises, providing millions with contraception and reproductive health care each year. In the U.S., Planned Parenthood partners with city, state and federal health agencies to bring healthcare to those who cannot afford it.
But then again, many modern-day Comstocks are seeking to characterize sex as a public threat, trying to pass legislation that will once more burden the poorest of mothers. The proposed amendment in Mississippi - as well as other anti-woman initiatives brewing in other states - compromises decades of hard- won gains in public health, all for the sake of outdated and dangerous ideology. There is, in fact, nothing ideal about denying women the health services and education they need and want: We know from experience that women will risk their lives to avoid unwanted pregnancies.
My grandmother's cause began a century ago this month in the slums of lower Manhattan; her fight continues today. And like Margaret Sanger, we will not retreat until reproductive rights and health become a reality for all.

Sanger is the chairman of the International Planned Parenthood Council and the author of "Beyond Choice: Reproductive Freedom in the 21st Century."
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Guardian op-ed
Here is a link to my op-ed today in the Guardian
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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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» Eugenics, Race, and Margaret sanger Revisited: Reproductive Freedom for All?
Hypatia, Indiana University Press
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» When Sex Counts: Making Babies and Making Law, by Sherry Colb