Global Policy Forum

By Nicholas D. Kristof

In a sincere, well-meant and tragic political maneuver, President Bush is blocking $34 million meant for the United Nations Population Fund. I wish he could visit the women whose lives are thus devastated - teenagers like Aisha Idris.

Mrs. Idris was lying in a Khartoum hospital where she is one of dozens of women awaiting surgery for obstetric fistula. She married at 13 and, because no contraception was available, gave birth at 14 after no prenatal care. She did not even have the help of a midwife.

After three days of labor, the baby was born dead and Mrs. Idris had suffered a fistula: the tearing of her rectum, urethra and vagina, leaving her incontinent and causing bodily wastes to seep through her vaginal canal and down her legs. As with hundreds of thousands of other women in the developing world who have fistula, Mrs. Idris's clothes were constantly wet and soiled, and her husband promptly divorced her.

"People were saying things behind my back, and some insulted me to my face," Mrs. Idris said, speaking in a catatonic whisper. Now 19, she has lived with this nightmare for five years and spent her family's entire savings, $80, on two failed operations.

"This is a 100 percent preventable problem," Dr. Abdullah Kannan, a gynecologist in Khartoum, said of fistula. "It has disappeared completely from Western countries." New York's hospital for fistula patients closed in 1895 because of diminishing cases and now the condition is almost unknown in America - yet Khartoum has 10 to 20 new patients arriving from the countryside each week because of poor midwifery.

The United Nations Population Fund supports precisely the kind of third-world maternal health care programs that can save women's lives in childbirth and avoid medical complications like fistula. Yet the White House for now is crippling the fund by withholding the 13 percent of its budget that the United States provides.

President Bush is responding to concerns of a group of 55 congressmen led by Christopher Smith, a New Jersey Republican; they complained in a letter to the White House that the fund's program in China "supports coercive abortion and sterilization and therefore is in violation of our conscience and our law." I was always impressed by Mr. Smith's sincerity during his visits to China when I lived there, and I'm sure he genuinely wants to protect peasant women in China from forced abortion.

But unfortunately his approach is catastrophic for poor women. The critics are right that the Chinese one-child policy is sometimes monstrous, but wrong about the United Nations' being complicit: while the population fund is active in China, it has been a voice for restraint there. It is, for example, behind Beijing's recent experiments with voluntary family planning rather than forced sterilization.

Moreover, it was the population fund that persuaded China to replace its catastrophic old IUD, a steel ring, with much safer and more effective IUD's made of copper. This won no headlines or applause, yet it was a triumph for the health and welfare of 60 million Chinese women with IUD's, and the decline in accidental pregnancies has also meant about 20 million fewer abortions over the last 10 years.

The critics falsely portray the issue as one of abortion. In fact, the population fund does not support abortion services; on the contrary, the cutoff of $34 million could result in an additional 800,000 abortions per year because of less contraception available. The reality is that the population fund is active not only in providing contraception but also in waging a lonely struggle to oppose female genital mutilation, the spread of AIDS and the scourge of mothers dying in childbirth.

The debate about funding a United Nations program may seem an arcane budget issue. But for ordinary Sudanese teenagers, less money has practical consequences: more genital mutilation, more AIDS and more fistula. Is that what the Bush administration wants to stand for?

Sitting beside these women, like Ahnis Tigaina, who has suffered from fistula for nine years and received her divorce papers when she was still in the hospital for the first time, it seems unbelievable that the United States is cutting off funds to one of the few organizations that helps them.

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