I would like to tell you the story of a development program that failed I would
development program that failed I would
development program that failed I would like to take you back 50 years ago to
like to take you back 50 years ago to
like to take you back 50 years ago to Iran when the Shah was still in power
Iran when the Shah was still in power
Iran when the Shah was still in power the Shah had a vision of westernizing
the Shah had a vision of westernizing
the Shah had a vision of westernizing the country and the US was ecstatic
the country and the US was ecstatic
the country and the US was ecstatic about the opportunity to make Iran the
about the opportunity to make Iran the
about the opportunity to make Iran the example of the possibilities of a
example of the possibilities of a
example of the possibilities of a Western development program but despite
Western development program but despite
Western development program but despite the Shahs full dedication to the success
the Shahs full dedication to the success
the Shahs full dedication to the success of the program it fell flat as part of
of the program it fell flat as part of
of the program it fell flat as part of the Shahs initiative in 1967 he launched
the Shahs initiative in 1967 he launched
the Shahs initiative in 1967 he launched a family planning program support of
a family planning program support of
a family planning program support of experts from the population council but
experts from the population council but
experts from the population council but despite the Shahs full commitment to the
despite the Shahs full commitment to the
despite the Shahs full commitment to the success of the program it fell flat when
success of the program it fell flat when
success of the program it fell flat when the program ended abruptly after just 12
the program ended abruptly after just 12
the program ended abruptly after just 12 years women were only having marginally
years women were only having marginally
years women were only having marginally fewer children than they had had prior
fewer children than they had had prior
fewer children than they had had prior to the beginning of this program and
to the beginning of this program and
to the beginning of this program and towards the end fertility had begun to
towards the end fertility had begun to
towards the end fertility had begun to climb again why did this program fail it
climb again why did this program fail it
climb again why did this program fail it seems like it was set up to succeed it
seems like it was set up to succeed it
seems like it was set up to succeed it had the full support of the government
had the full support of the government
had the full support of the government which had received thorough guidance on
which had received thorough guidance on
which had received thorough guidance on the delivery of information and services
the delivery of information and services
the delivery of information and services the messaging of the program was rights
the messaging of the program was rights
the messaging of the program was rights based it emphasized the right of couples
based it emphasized the right of couples
based it emphasized the right of couples to make decisions about their own family
to make decisions about their own family
to make decisions about their own family size but the program was still met with
size but the program was still met with
size but the program was still met with hesitation and mistrust why first the
hesitation and mistrust why first the
hesitation and mistrust why first the program failed to integrate the
program failed to integrate the
program failed to integrate the religious leaders and gain their support
religious leaders and gain their support
religious leaders and gain their support there was not even an effort to
there was not even an effort to
there was not even an effort to publicize a pre-existing religious
publicize a pre-existing religious
publicize a pre-existing religious ruling from Iran that had clarified that
ruling from Iran that had clarified that
ruling from Iran that had clarified that there was no religious prohibition to
there was no religious prohibition to
there was no religious prohibition to the use of any temporary method of
the use of any temporary method of
the use of any temporary method of preventing pregnancy and this mistake
preventing pregnancy and this mistake
preventing pregnancy and this mistake was made despite the fact that programs
was made despite the fact that programs
was made despite the fact that programs from across the globe from Costa Rica to
from across the globe from Costa Rica to
from across the globe from Costa Rica to Iran to Pakistan have demonstrated the
Iran to Pakistan have demonstrated the
Iran to Pakistan have demonstrated the importance of the support of local
importance of the support of local
importance of the support of local religious leadership for the success of
religious leadership for the success of
religious leadership for the success of a family planning program additionally a
a family planning program additionally a
a family planning program additionally a great mistrust had developed for this
great mistrust had developed for this
great mistrust had developed for this program in Iran even though the
program in Iran even though the
program in Iran even though the messaging had emphasized the right for
messaging had emphasized the right for
messaging had emphasized the right for couples to make decisions about their
couples to make decisions about their
couples to make decisions about their family size many were suspicious they
family size many were suspicious they
family size many were suspicious they suspected it was a plot by the West to
suspected it was a plot by the West to
suspected it was a plot by the West to limit the size of the Muslim population
limit the size of the Muslim population
limit the size of the Muslim population I spent a lot of time during the past
I spent a lot of time during the past
I spent a lot of time during the past five years studying the history of
five years studying the history of
five years studying the history of family planning programs in the Muslim
family planning programs in the Muslim
family planning programs in the Muslim world and I’ve seen some that have
world and I’ve seen some that have
world and I’ve seen some that have worked well but I’ve also seen a number
worked well but I’ve also seen a number
worked well but I’ve also seen a number that have failed even ongoing programs
that have failed even ongoing programs
that have failed even ongoing programs in places like Egypt and Pakistan have
in places like Egypt and Pakistan have
in places like Egypt and Pakistan have continued to make similar mistakes to
continued to make similar mistakes to
continued to make similar mistakes to those that were made during this program
those that were made during this program
those that were made during this program in Iran when the program began in 1965
in Iran when the program began in 1965
in Iran when the program began in 1965 in Egypt it had the support of USAID and
in Egypt it had the support of USAID and
in Egypt it had the support of USAID and it enjoyed that support for decades but
it enjoyed that support for decades but
it enjoyed that support for decades but despite the duration of this program it
despite the duration of this program it
despite the duration of this program it only experienced moderate success fifty
only experienced moderate success fifty
only experienced moderate success fifty years into the program women were having
years into the program women were having
years into the program women were having about half the number of children they
about half the number of children they
about half the number of children they had had prior to the beginning of the
had had prior to the beginning of the
had had prior to the beginning of the program but they were still having on
program but they were still having on
program but they were still having on average above three children and this
average above three children and this
average above three children and this meant that population growth was still
meant that population growth was still
meant that population growth was still high and there was a strain on resources
high and there was a strain on resources
high and there was a strain on resources and there were a couple of factors that
and there were a couple of factors that
and there were a couple of factors that limited the success of this program even
limited the success of this program even
limited the success of this program even though high profile religious leaders
though high profile religious leaders
though high profile religious leaders including state-sponsored sheiks
including state-sponsored sheiks
including state-sponsored sheiks offered their support for the program
offered their support for the program
offered their support for the program since the 1980s a number of other
since the 1980s a number of other
since the 1980s a number of other religious leaders remained skeptical and
religious leaders remained skeptical and
religious leaders remained skeptical and rejected the program additionally
rejected the program additionally
rejected the program additionally at times the program had initiatives
at times the program had initiatives
at times the program had initiatives that reinforced concerns about the
that reinforced concerns about the
that reinforced concerns about the program in the 1980s there was a big
program in the 1980s there was a big
program in the 1980s there was a big push to expand the use of IUDs and IUDs
push to expand the use of IUDs and IUDs
push to expand the use of IUDs and IUDs are a great tool because they are what’s
are a great tool because they are what’s
are a great tool because they are what’s called a long-acting reversible
called a long-acting reversible
called a long-acting reversible contraceptive and that means a woman may
contraceptive and that means a woman may
contraceptive and that means a woman may use an IUD to space births for years
use an IUD to space births for years
use an IUD to space births for years with only minimal effort and minimal
with only minimal effort and minimal
with only minimal effort and minimal medical intervention but if she wants
medical intervention but if she wants
medical intervention but if she wants another child she’s able to do so but in
another child she’s able to do so but in
another child she’s able to do so but in Egypt in the 1980s that’s not what I you
Egypt in the 1980s that’s not what I you
Egypt in the 1980s that’s not what I you DS are used for they were not used to
DS are used for they were not used to
DS are used for they were not used to empower women they were pushed in
empower women they were pushed in
empower women they were pushed in response to reports that it described
response to reports that it described
response to reports that it described Egyptian women as not being responsible
Egyptian women as not being responsible
Egyptian women as not being responsible enough to use oral contraceptives
enough to use oral contraceptives
enough to use oral contraceptives properly in effect they were used as a
properly in effect they were used as a
properly in effect they were used as a barrier to preventing women from having
barrier to preventing women from having
barrier to preventing women from having more children without first visiting
more children without first visiting
more children without first visiting their doctor to have an IUD removed in
their doctor to have an IUD removed in
their doctor to have an IUD removed in Pakistan the program was launched in
Pakistan the program was launched in
Pakistan the program was launched in 1965 and it continues to receive support
1965 and it continues to receive support
1965 and it continues to receive support from USAID and fifty years after the
from USAID and fifty years after the
from USAID and fifty years after the program began the fertility rate has not
program began the fertility rate has not
program began the fertility rate has not quite dropped it has decreased notably
quite dropped it has decreased notably
quite dropped it has decreased notably but women are still having well above
but women are still having well above
but women are still having well above three children closer to four children
three children closer to four children
three children closer to four children on average and this program faced
on average and this program faced
on average and this program faced similar challenges to that program in
similar challenges to that program in
similar challenges to that program in Iran and that program in Egypt the
Iran and that program in Egypt the
Iran and that program in Egypt the support of religious leadership was
support of religious leadership was
support of religious leadership was inconsistent and this had a significant
inconsistent and this had a significant
inconsistent and this had a significant impact on individual communities in fact
impact on individual communities in fact
impact on individual communities in fact the Pakistan National Institute of
the Pakistan National Institute of
the Pakistan National Institute of population studies found that women were
population studies found that women were
population studies found that women were 70% more likely to use contraceptives in
70% more likely to use contraceptives in
70% more likely to use contraceptives in communities where their religious leader
communities where their religious leader
communities where their religious leader had offered explicit support and again
had offered explicit support and again
had offered explicit support and again there were imperfect initiatives during
there were imperfect initiatives during
there were imperfect initiatives during the early years of this program
the early years of this program
the early years of this program men were actually paid to receive
men were actually paid to receive
men were actually paid to receive vasectomies and this disproportionately
vasectomies and this disproportionately
vasectomies and this disproportionately took power away from poor men because
took power away from poor men because
took power away from poor men because when you offer a poor man money to do
when you offer a poor man money to do
when you offer a poor man money to do something he may not feel that he has
something he may not feel that he has
something he may not feel that he has the power to do to say no and this
the power to do to say no and this
the power to do to say no and this initiative cause some possum Ungh many
initiative cause some possum Ungh many
initiative cause some possum Ungh many religious leaders because many Muslims
religious leaders because many Muslims
religious leaders because many Muslims consider any elective sterilization
consider any elective sterilization
consider any elective sterilization procedure to be forbidden so we have
procedure to be forbidden so we have
procedure to be forbidden so we have three examples of programs that have
three examples of programs that have
three examples of programs that have failed but we also have examples of
failed but we also have examples of
failed but we also have examples of times that it has worked well so let’s
times that it has worked well so let’s
times that it has worked well so let’s go back to that first program in Iran
go back to that first program in Iran
go back to that first program in Iran because 10 years later Iran launched a
because 10 years later Iran launched a
because 10 years later Iran launched a second program and this time it thrived
second program and this time it thrived
second program and this time it thrived fertility plummeted couples embraced
fertility plummeted couples embraced
fertility plummeted couples embraced contraception and after just 10 years
contraception and after just 10 years
contraception and after just 10 years the fertility rate had more than halved
the fertility rate had more than halved
the fertility rate had more than halved Egypt and Pakistan did not experience
Egypt and Pakistan did not experience
Egypt and Pakistan did not experience this same level of change in the course
this same level of change in the course
this same level of change in the course of more than 50 years and the fertility
of more than 50 years and the fertility
of more than 50 years and the fertility rate in Iran has continued to drop today
rate in Iran has continued to drop today
rate in Iran has continued to drop today women in Iran have fewer children than
women in Iran have fewer children than
women in Iran have fewer children than women in the United States and women
women in the United States and women
women in the United States and women married women in both countries use
married women in both countries use
married women in both countries use contraception at identical rates this
contraception at identical rates this
contraception at identical rates this program in Iran the second program was
program in Iran the second program was
program in Iran the second program was able to succeed because it addressed the
able to succeed because it addressed the
able to succeed because it addressed the first program’s shortcomings in a
first program’s shortcomings in a
first program’s shortcomings in a meaningful way it involved the religious
meaningful way it involved the religious
meaningful way it involved the religious leadership rigorously they became an
leadership rigorously they became an
leadership rigorously they became an integral part in the development of the
integral part in the development of the
integral part in the development of the program and this was partially a result
program and this was partially a result
program and this was partially a result of the fact that Iran became a
of the fact that Iran became a
of the fact that Iran became a theocratic state after the Iranian
theocratic state after the Iranian
theocratic state after the Iranian Revolution in 1979 so the same political
Revolution in 1979 so the same political
Revolution in 1979 so the same political leaders who were driving the program
leaders who were driving the program
leaders who were driving the program this time were also religious leaders
this time were also religious leaders
this time were also religious leaders and so they were prepared to discuss the
and so they were prepared to discuss the
and so they were prepared to discuss the program in social and economic terms
program in social and economic terms
program in social and economic terms that justified the program in an Islamic
that justified the program in an Islamic
that justified the program in an Islamic context
context
context an Iran without a strong advantage here
an Iran without a strong advantage here
an Iran without a strong advantage here because the Shia Islam practice in Iran
because the Shia Islam practice in Iran
because the Shia Islam practice in Iran is much more hierarchical and
is much more hierarchical and
is much more hierarchical and centralized than in Sunni Islam so it
centralized than in Sunni Islam so it
centralized than in Sunni Islam so it did not face the same challenges of
did not face the same challenges of
did not face the same challenges of gaining the universal support of
gaining the universal support of
gaining the universal support of religious leadership in dealing with
religious leadership in dealing with
religious leadership in dealing with inconsistencies but also addressed other
inconsistencies but also addressed other
inconsistencies but also addressed other shortcomings too it addressed mistrust
shortcomings too it addressed mistrust
shortcomings too it addressed mistrust in the program by changing and building
in the program by changing and building
in the program by changing and building upon its narrative that family it was
upon its narrative that family it was
upon its narrative that family it was the right of families to determine their
the right of families to determine their
the right of families to determine their family size and it introduced fertility
family size and it introduced fertility
family size and it introduced fertility treatments as part of the program to
treatments as part of the program to
treatments as part of the program to empower families who could not have as
empower families who could not have as
empower families who could not have as many children as they wanted to have
many children as they wanted to have
many children as they wanted to have more children so this changed
more children so this changed
more children so this changed perceptions about the program it was not
perceptions about the program it was not
perceptions about the program it was not a plot and couples who wanted them felt
a plot and couples who wanted them felt
a plot and couples who wanted them felt comfortable accessing contraceptive
comfortable accessing contraceptive
comfortable accessing contraceptive resources so what can we learn from
resources so what can we learn from
resources so what can we learn from these three programs how can we better
these three programs how can we better
these three programs how can we better design development programs in the
design development programs in the
design development programs in the future first we need to work to empower
future first we need to work to empower
future first we need to work to empower the people we are aiding people want and
the people we are aiding people want and
the people we are aiding people want and are willing to work for what they will
are willing to work for what they will
are willing to work for what they will believe is best for themselves and their
believe is best for themselves and their
believe is best for themselves and their families we can help them make better
families we can help them make better
families we can help them make better choices by introducing new information
choices by introducing new information
choices by introducing new information or new technologies but we cannot make
or new technologies but we cannot make
or new technologies but we cannot make decisions for people and nor should we
decisions for people and nor should we
decisions for people and nor should we because anytime you introduce a
because anytime you introduce a
because anytime you introduce a technology or a program the in if it’s
technology or a program the in if it’s
technology or a program the in if it’s the aid agency of individuals you are
the aid agency of individuals you are
the aid agency of individuals you are trying to help you are going to generate
trying to help you are going to generate
trying to help you are going to generate mistrust second you need to know the
mistrust second you need to know the
mistrust second you need to know the context you are working in you need to
context you are working in you need to
context you are working in you need to know the social structures and beliefs
know the social structures and beliefs
know the social structures and beliefs that will guide people’s decisions and
that will guide people’s decisions and
that will guide people’s decisions and this means you need to collaborate with
this means you need to collaborate with
this means you need to collaborate with local leaders and be prepared to change
local leaders and be prepared to change
local leaders and be prepared to change your ideas about how the program should
your ideas about how the program should
your ideas about how the program should be implemented so that it aligns with
be implemented so that it aligns with
be implemented so that it aligns with local values
local values
local values third you need to be prepared to not
third you need to be prepared to not
third you need to be prepared to not only listen to but to respond to
only listen to but to respond to
only listen to but to respond to resistance to your program that means
resistance to your program that means
resistance to your program that means that even after the program has been
that even after the program has been
that even after the program has been launched you need to not only listen for
launched you need to not only listen for
launched you need to not only listen for but seek out your programs critics and
but seek out your programs critics and
but seek out your programs critics and if you are hearing patterns in the
if you are hearing patterns in the
if you are hearing patterns in the within the feedback you receive you need
within the feedback you receive you need
within the feedback you receive you need to be prepared to make changes to your
to be prepared to make changes to your
to be prepared to make changes to your program and you need to be prepared to
program and you need to be prepared to
program and you need to be prepared to do so
do so
do so even if it feels counterintuitive to
even if it feels counterintuitive to
even if it feels counterintuitive to your program schools if we are able to
your program schools if we are able to
your program schools if we are able to incorporate these three elements into
incorporate these three elements into
incorporate these three elements into development programs we will be able to
development programs we will be able to
development programs we will be able to design projects that are both more
design projects that are both more
design projects that are both more ethical and more effective thank you
ethical and more effective thank you
ethical and more effective thank you [Applause]
”
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