NICHOLAS D. KRISTOF
The Bush administration this month is quietly cutting off birth control supplies to some of the world's poorest women in Africa.
Thus the paradox of a "pro-life" administration adopting a policy whose result will be tens of thousands of additional abortions each year — along with more women dying in childbirth.
The saga also spotlights a clear difference between Barack Obama and John McCain. Senator Obama supports U.N.-led efforts to promote family planning; Senator McCain stands with President Bush in opposing certain crucial efforts to help women reduce unwanted pregnancies in Africa and Asia.
There is something about reproductive health — maybe the sex part — that makes some Americans froth and go crazy. We see it in the opposition to condoms to curb AIDS in Africa and in the insistence on abstinence-only sex education in American classrooms (one reason American teenage pregnancy rates are more than double those in Canada). And we see it in the decision of some towns — like Wasilla, Alaska, when Sarah Palin was mayor there — to bill rape victims for the kits used to gather evidence of sex crimes. In most places, police departments pay for rape kits, which cost hundreds of dollars, but while Ms. Palin was mayor of Wasilla, the town decided to save money by billing rape victims.
The latest bout of reproductive-health madness came in the last couple of weeks when the U.S. Agency for International Development ordered six African countries to ensure that no U.S.-financed condoms, birth control pills, I.U.D.'s or other contraceptives are furnished to Marie Stopes International, a British-based aid group that operates clinics in poor countries.
The Bush administration says it took this action because Marie Stopes International works with the U.N. Population Fund in China. President Bush has cut all financing for the population fund on the — false — basis that it supports China's family-planning program.
It's true that China's one-child policy sometimes includes forced abortion, and when traveling in rural China, I still come across peasants whose homes have been knocked down as punishment for an unauthorized child. But the U.N. fund has been the most powerful force in moderating China's policy, and a State Department team itself found no evidence of any U.N. involvement in the coercion.
Mr. Bush's defunding of the U.N. Population Fund — backed by Senator McCain — has persisted since 2002. What is new is the extension of that policy to a leading private family-planning organization like Marie Stopes International.
"The irony and hypocrisy of it is that this is a bone to the self-described 'pro-life' movement, but it will result in deaths to women who just want to space their births," said Dana Hovig, the chief executive of Marie Stopes International. The organization estimates that the result will be at least 157,000 additional unwanted pregnancies per year, leading to 62,000 additional abortions and 660 women dying in childbirth.
That may overstate the impact. Kent Hill, an official of the U.S. aid agency, insists that there will be no increase in pregnancies because the American contraceptives will simply be routed to other aid groups in Africa.
That will work to some degree in big cities. But it's a fantasy in rural Africa. Over the years, I've dropped in on a half-dozen Marie Stopes clinics, and in rural areas there's typically nothing else for many miles around. Women in the villages simply have no other source of family planning.
"This nearsighted maneuver will have direct and dire consequences," a group of prominent public health experts in America declared in an open letter, adding that the action "will translate almost immediately into increased maternal death and disability."
Proponents of the cut-off are not misogynists. They are honestly outraged by forced abortions in China. But why take it out on the most impoverished and voiceless people on earth? Mr. McCain seems to have supported Mr. Bush, mostly out of instinct, and when a reporter asked him this spring whether American aid should finance contraceptives to fight AIDS in Africa, he initially said, "I haven't thought about it," and later added, "You've stumped me."
Retrograde decisions on reproductive health are reached in conference rooms in Washington, but I've seen how they play out in African villages. A young woman lies in a hut, bleeding to death or swollen by infection, as untrained midwives offer her water or herbs. Her husband and children wait anxiously outside the hut, their faces frozen and perspiring as her groans weaken.
When she dies, her body is bundled in an old blanket and buried in a shallow hole, with brush piled on top to keep wild animals away. Her children sob and shriek and in the ensuing months they often endure neglect and are far more likely to die of hunger or disease.
In some parts of Africa, a woman now has a 1-in-10 risk of dying in childbirth. The idea that U.S. policy may increase that toll is infuriating.
Nicholas D. Kristof writes op-ed columns that appear twice each week in The New York Times. A two-time Pulitzer Prize winner, he previously was associate managing editor of The Times, responsible for the Sunday Times.