As Raúl Necochea López convincingly argues in his opening pages, ‘family planning held the promise of giving lay people a greater degree of control over their sexual and reproductive lives, and, countries, a host of opportunities to boost their economic fortunes through the management of population growth.’ For Peru, its neighbours in Latin America, and other developing countries incorporating family planning schemes, the stakes in the mid to late twentieth century were ‘huge’ (2) Necochea López demonstrates that, while family planning remained a consistent concern for a variety of Peruvian actors including the Catholic Church, local physicians, and the federal state, proposals and positions on this vital issue diverged greatly over time. By examining the shifting positions of these stakeholders as well as the reproductive choices and strategies of everyday Peruvian families, Necochea López weaves an important story of demographic change, access to health care, gender politics and public policy in Peru’s dynamic twentieth century. Significantly, he revises and challenges the cultural presumptions made by demographic transition and modernisation theorists of 1960s in their characterisations of the rural and urban dynamics of Latin America’s poor. Necochea López critiques the assumption behind these theories that foreign influence created Latin American family planning, and he problematises the division of ‘traditional’ and ‘modern’ societies according to family size and constitution. Behind the scenes, the author probes the limitations of investment in family-planning projects as a route to wider economic development by highlighting the failure of decades of such efforts to actually result in better indicators of maternal and child health. Necochea López contributes a fascinating and significant history of the medicalisation of family life in Peru and the inter-American collaborations and conflicts over family-planning policy.
In his second chapter, Necochea López introduces the notion of the ‘well-constituted families’ as promoted by conservative Senator and family education advocate Irene Silva de Santolalla. In many ways, this phrase captures what various actors in this history sought from the nineteenth century to the Cold War – properly constituted and gender-appropriate (normative) Peruvian families that would form the basis of both the order and hierarchy of society. In doing so, religious, medical and political spokespeople debated under what circumstances Peruvians should have sexual intercourse and then legitimately claim the right and the resources to control their fertility. Despite competing and even conflicting notions and projects, one thread Necochea López illustrates across the political, religious and clinical spectrum is that all of these stakeholders insisted that reproductive control was not an individual issue, rather one to be considered in terms of the relation between family, community and nation. In medical terms, physicians and health care workers usually genuinely sought to aid Peruvian women and families (although at times within a top-down model) but they did so without any presumption of empowering families vis-à-vis medical authority. In his ground-breaking chapter on contraception and the Catholic Church, Necochea López demonstrates the imperative of historicising family planning by deeply investigating specific contexts and moments. He found that a significant sector of the Peruvian Church promoted the use of the pill as a means of strengthening Catholic families and fostering a particular understanding of responsible parenting. With this approach, the Catholic Church ‘embraced birth control, but on different terms’ (148) and connected to a long tradition of tackling social justice issues and critiquing socio-economic disparities and the inequality of nations that disproportionately impacted the ability of poor Peruvians to constitute and raise safe and healthy families.
Though Necochea López traces the origins of family-planning theory and policy back to the Peruvian medical academy of the nineteenth century, it was really in the 1960s when a confluence of factors including urbanisation, a demographic explosion, and transnational collaborations on health care and population control brought the most innovation and controversy over family planning. It was in this decade that family-planning clinics provided counselling, dispensed contraception and, at times, assisted women and their partners in search of abortions. From the clinics, Peruvian families accessed emerging biomedical technologies such as the birth control pill, intrauterine devices and surgical sterilisation. Necochea López investigates the experiences of practitioners, and women and their partners to understand the ways in which all of these historical actors conceived of abortion and reproductive control more generally within complex networks of circumstances and relationships. Similarly, health care workers considered their role in providing access to contraception and sexual education as a means of protecting women and children from suffering and reducing disharmony in the larger society.
The 1960s also marked the emergence of new international actors such as the Centro Latino Americano de Demografia (CELADE), Ford Foundation, Planned Parenthood and the Population Council with their mandates to study demography and fertility and offer solutions to the ‘newly discovered’ problems of population growth and ‘underdevelopment.’ From within Peru, the transition from civilian to military rule complicated and ultimately frustrated the narrative of family planning as a foundational component of economic and social development. The nationalist politics of the military regime further intensified concerns that the involvement of US organisations in promoting family planning projects in the developing world primarily reflected imperialist intentions rather than genuine international collaboration. Thus, the military government separated reproductive issues and fertility control from maternal and child health programs, diverting public financial resources to the latter areas and away from family planning services with uneven success. The author successfully navigates these overlapping layers of social, political and economic interest, and interprets the Peruvian experience in its particularities but also within patterns that emerged in Latin American–U.S. relations.
In all of this and from multiple directions, A History of Family Planning demonstrates internal and external divergences and tensions within the long history of family planning as a shifting yet controversial concept, ultimately supporting Necochea López’s main argument that family planning has been a multifaceted and highly consequential twentieth-century constant. The book is a highly engaging contribution to the robust yet growing recent literature on the social history of medicine in Latin America.
