Population Politics and Development: From the Policies to the Clinics (review)

Lisa Ann Richey provides a panoramic view of family planning operations in Tanzania, examining discourses and practices ranging from the global purview of the United Nations Fund for Population Activities (UNFPA) to the daily minutiae of a rural clinic. Her work is organized around two themes: the proliferation of often conflicting ideas about why women should (or should not) use contraception; and the polarization of “tradition” and “modernity” in the words and practices that accrete around women’s reproductive actions.

The first theme is developed through the analysis of interviews and key documents in the history of family planning in Tanzania. Richey identifies three major discourses, presented as three elaborated answers to the question “what is contraception good for?” The first, the demographic discourse, identifies population growth as a problem, and contraception-led declines in birth rates as a partial solution. The second, the development discourse, identifies poverty as the problem and smaller families as a potential gain in quality of life. The third (and more recent) discourse draws from feminist tenets on the empowerment of women. Focusing on women’s rights as the building blocks of policy, this approach underscores the importance of contraception in enhancing women’s control over the timing of pregnancies as part of a broader paradigm of total reproductive health.

On the surface, the agendas that follow from these three discourses seem compatible. However, as Richey demonstrates, the multiplicity of these discourses leads to confusion over operational priorities and conflicts over the means to these ends. One of the unique strengths of this book is the way Richey moves from the global and national abstractions of official policy statements through the mediating sites of program planning and operationalization to the grounded praxis of clinics in order to illustrate the cacophony of means and ends in family planning operations.

Her second major theme, the false dichotomy of tradition and modernity, will be familiar to scholars in African studies, as will the interpellation of women as “backward” and in need of “modernization.” However, Richey’s contribution to this area of study is her emphasis on how deeply implicated female bodies are in this ideological construction, and how the traditional/modern dichotomy imbues nearly all aspects of reproduction— not only for the women whose bodies are subject to surveillance, but also for those (mainly also women) who do the surveilling.

While the first half of the book will be of interest to students of policy and international development, Richey’s work really comes alive in the second part, where she draws on her own work in clinics and in an integrated reproductive health program in rural Tanzania. She employs Caroline Bledsoe’s insightful concept of “contingency” to explore how rural women, the “targets” of family planning programs, actually use the technologies to enhance their reproductive lives in ways not foreseen in the ideologies of family planning. Richey demonstrates that the image of women enshrined in family planning documents—as rational calculating agents who make firm plans for an ideal family size—simply does not reflect the ways that actual people use actual pills, condoms, and injections.

This book is not without flaws. The concepts, citations, and proliferating theoretical frameworks in the introductory chapters can be overwhelming. The presentation would have benefited from stronger definitions of key terms, including “tradition” and “modernity.” The author tends to assume that the World Bank, USAID, UNFPA, and other complex organizations are more monolithic than is actually the case (though dissecting the internal contradictions of these major players in the family planning field would probably not have been possible in a book of this length).

Overall, however, this is a strong and important contribution to the growing literatures on the global political economy of reproduction and on local experiences of global processes, both for specialists and for readers with a less specialized background in family planning—who will find the ethnographic “local” chapters particularly compelling. I...