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Universidad de Navarra Dpto. Medicina Preventiva y Salud P煤blica


By Jokin de Irala and Cristina L贸pez Tuesday, 21 November 2006 One of the world's most prestigious medical journals is pushing a failed strategy to promote "reproductive health". The Lancet, Britain's most prestigious medical journal, is publishing a series of articles throughout November about sexual and reproductive health. Each article has been written to decry how badly this has been neglected over the past ten years. The magazine is only stating the obvious when it asserts that sexual and reproductive health is a matter of life and death and imposes an enormous burden of illness and disability, especially on women and children, all over the globe. Nonetheless, it is regrettable that The Lancet has chosen to mix science with ideology and sectarian divisiveness. The thrust of its message is that "conservative political, religious and cultural forces" are threatening the progress made since the 4th International Conference on Population and Development in Cairo in 1994. The Lancet's editor, Richard Horton, is particularly critical of the Catholic Church: "For doctrinal reasons, [it] has rejected simple and effective techniques for family planning, techniques that would have a substantial impact not only on fertility rates but also on rates of human development." (1) Horton even claims that there is a "culture of political censorship and fear, which now pervades many public-health institutions when reproductive health is at issue". This is what The Lancet's series is supposed correct with "the best available evidence". The term "reproductive health" became widespread after the Cairo Conference. At the time it was defined as "state of complete mental, physical, and social well being in all matters relating to the reproductive system and to its functions and processes." (2) The complete definition included objectives such as "a satisfying and safe sex life", " the capability to reproduce and the freedom to decide if, when and how often to do so", "the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice", and "the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant ". Nearly everyone accepts these principles; but how are they to be applied? What exactly do they mean? Is the terminology correct? For example, it seems more appropriate to speak of "procreation" rather than "reproduction" when dealing with human beings. Whatever the case, the objectives of this definition should not be distorted. This is why


Universidad de Navarra Dpto. Medicina Preventiva y Salud PĂşblica

the Holy See made the following reservations to the final document: (3) "Regarding the terms 'sexual health' and 'sexual rights', and 'reproductive health' and 'reproductive rights', the Holy See considers these terms as applying to a holistic concept of health, which embrace, each in their own way, the person in the entirety of his or her personality, mind and body, and which foster the achievement of personal maturity in sexuality and in the mutual love and decision-making that characterise the conjugal relationship in accordance with moral norms. The Holy See does not consider abortion or access to abortion as a dimension of these terms." The Lancet's articles make assertions which pay lip service to the notion of scientific evidence. But quickly one discovers that many of them are not based on reliable sources. They contend that the poor situation of global reproductive health (abortions, teenage pregnancies, sexually transmitted infections, poor maternal health and so on) is due to the growing attention given to other public health strategies. In particular they point an accusing finger at those which combat AIDS by delaying the onset of sexual relations and by mutual monogamy. Is this realistic? Since 1994 huge sums have been spent by governments and NGOs to promote family planning and to fight AIDS with massive distribution of condoms. It beggars belief that simple risk-avoidance programs like promoting chastity and mutual monogamy could have scuppered The Lancet's favoured reproductive health strategy. These new ideas have emerged precisely because the old ones failed miserably. The export of condoms from the US to Africa, Asia and Latin America has grown every year since 1995. In 2005, 612 million condoms were exported. And yet the health statistics have only become worse. What The Lancet needs is a more critical attitude towards the conventional wisdom. In the table below, we have summarised a few conflicts of interest which do not seem to trouble its editors. In scientific publications it is normal for authors to acknowledge possible conflicts of interest. Astonishingly, the authors of the article "Unsafe abortion: the preventable pandemic" needed 50 lines to list their conflicts of interest. (4) This is absolutely unprecedented in a medical publication. Underlying this debate is a profound disagreement about the meaning of human sexuality, which has become mixed up with powerful financial interests. In all likelihood, we will not see improvements in world reproductive health until this link is broken. As well, programs which have not demonstrated their effectiveness in bringing about improvements in health should not be financed. Whatever happens, we should keep reflecting upon the true significance of human sexuality. Jokin de Irala and Cristina LĂłpez are lecturers at the University of Navarra in Spain. Eva FernĂĄndez Micheltorena helped in research.


Universidad de Navarra Dpto. Medicina Preventiva y Salud Pública

Reproductive health spinmeisters The sex industry: Google the word "sex" and you will get 405,000,000 pages. Google the word "solidarity" and you get 22,800,000 pages. • • • • • • •

They ignore what works for most people -- delaying the onset of sexual relations and mutual monogamy. They assert that programs based on the concept of "safe sex" do not increase promiscuity. They say that marriage does not protect people from promiscuity. They deny that multiple sex partners is the key element in the epidemic. This is equivalent to affirming that not smoking is as healthy as smoking. They criticise the effectiveness of delaying the onset of sexual relations and mutual monogamy, even though several studies have shown that it is successful. They say that poverty is the key element in the HIV/AIDS epidemic and turn a blind eye to other factors. They talk more about controlling sexually transmissible infections than about preventing them. Control is a technical fix which reduces risk, while prevention avoids the risk altogether.

Pharmaceutical companies and family planning NGOs -- selling drugs to healthy people is a lucrative business for drug companies. • •

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They state, without giving any proof that economic development will only happen if the population decreases. They approve of coercive population control measures such as abortion and forced sterilisation and they shrink from criticising programs such as China's one-child policy. They say that contraceptives prevent abortion when exactly the opposite is the case. They ignore the fact that millions of teenage pregnancies are due to the fact that these boys and girls live in a sex-soaked atmosphere in which contraceptives are marketed indiscriminately and irresponsibly. The widely-promoted condom has a 15 per cent failure rate. They ignore natural family planning methods, which are safe, effective, cheap and acceptable. Instead, they promote profitable contraceptives. They ignore the potential of natural family planning for promoting equality of decision making between men and women.

The abortion business: sales of the morning after pill and portable abortion units which can be used by non-medical personnel. • • • •

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They manipulate the statistics for "unsafe" abortions and use questionable data. They say that abortion cannot be banned. They say that legalising abortion will not lead to an increase in abortion. They say that abortion is not a problem if it is carried out under hygienic conditions. Would female genital mutilation be acceptable if it were carried out under hygienic conditions? They propose abortion as a form of birth control. They deny scientific evidence of the psychiatric trauma of abortion on women.


Universidad de Navarra Dpto. Medicina Preventiva y Salud Pública

• •

They deny scientific evidence that demonstrates the existence of a human being from the moment of conception. They deny that the child has any rights. They never mention sex-selective abortions of girls or female infanticide.

Notes (1) Richard Horton. "Reviving reproductive health". The Lancet. November 4, 2006. (2) Cairo Programme of Action, para 7.2. (3) Cairo Programme of Action Part 2: reservations. (4) D.A. Grimes et al. "Unsafe abortion: the preventable pandemic". The Lancet. November 1, 2006.

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Jokin de Irala - Focus on Reproductive Health