By Donella Meadows
–August 25, 1993–
Most Americans, according to opinion polls, believe that huge quantities of their tax dollars go to foreign aid, and that this money is largely wasted.
In fact our foreign aid budget, nearly $7 billion a year, accounts for roughly half a cent out of every dollar the government spends. It comes to, on average, $28 a year from each of us.
As for that money being wasted, some of it is. Aid has to go through two bureaucracies, ours and theirs, and a good deal of it disappears before it reaches the poor. Not all aid projects work, and a few are just plain stupid. Our tax dollars built a milk-processing plant in Iquitos, Peru, where, it turns out, there are no dairy cows. The plant was finally put to work bottling reconstituted dry milk imported from New Zealand, but then it was discovered that people in Iquitos don’t drink milk.
There are stories like that. But there are success stories too. Every now and then our aid dollars do something wonderful.
In Ghana in West Africa (population 16.4 million, average income per person $400, average number of children per woman 6.2) the American College of Nurse Midwives runs a USAID-sponsored project with the Ghana Registered Midwives Association. The U.S. midwives help design and conduct courses in lifesaving obstetrical skills — how to sterilize the scissors before cutting the umbilical cord, how to stop hemorrhage, how to resuscitate the newborn — and in family planning.
The town of Koforidua has a couple of main streets lined with metal shacks, a new post office, a thriving roadside market. Last May, with the temperature and humidity constantly in the 90s, 25 midwives gathered there in a rundown hotel. The gift shop and beauty parlor were permanently closed, the air conditioners didn’t function even when the electricity worked, and the electricity worked fitfully. Water was brought to the rooms by the staff, two pails per person per day. But the training room in the hotel was newly painted for the midwives, and its rickety tables were covered with fresh linen cloths.
Three teacher-trainees presented a two-week course with the help of one U.S. nurse-midwife. The average age of the students was 50. Most had a 7th or 8th grade education, plus a midwife’s certificate. They run their own maternity centers, offering prenatal advice, delivery, and vaccinations for babies. In much of Ghana they are the only source of help for pregnant women.
Traditional birth control methods in Africa range from the effective to the dangerous. Half a lemon may be scooped out and inserted as a diaphragm — the acid makes it work quite well. Some women stuff grasses or leaves into the vagina, or pieces of bone or candle into the cervix as a rough (and infection-causing) IUD. Some wear rings and talismen. Some go home to their parents for a year or two after every baby.
The course examined both traditional and modern contraceptive methods, their costs, risks, and effectiveness. These midwives had been taught to deliver babies, but they had only the haziest idea of the physiology of reproduction. They learned about the menstrual cycle in order to understand how birth control pills work.
They examined models of every technique, practicing with condoms on bananas, to peals of giggles. They learned how to do pelvic and breast exams. They learned about one of the most serious health problems in Africa — sexually transmitted diseases.
There were heated debates. What do you do if the husband doesn’t approve of the wife using birth control? How can a woman get a man to use a condom if he’s been exposed to HIV? Should you give contraceptives to a wife who is having an affair? To an unmarried teenager? What happens to a 13 year old, if she gets pregnant? What is our role in someone else’s moral life?
The midwives wouldn’t let a session end until all their questions had been answered. They worked from 7:30 in the morning till 6 at night, then in the evening they watched videos. Late at night the American midwife would hear quiet knocks on her door — sorry to disturb you, but could I ask just one more question?
They practiced how to talk to a teenager, to a woman with many children close together, to a husband. They took a field trip to the drugstore to see what kinds of contraceptives were available. They conducted surveys among market women, high school students, workmen. What do you know about family planning? Then they came back and wrote up training classes for these groups.
“How many children do you yourself have?” they were asked. The average was six. How many do you want your children to have? Two or three. Why? It’s too HARD to raise so many children.
For two weeks the energy didn’t flag. The midwives wrote a play featuring a mother who is sick because she has so many children, a father who won’t allow contraceptives, and a neighbor who practices family planning — look at me, I have more energy, my children are healthier, I have more time for my husband, because I space my children farther apart.
They wrote a song to boost their own spirits — take care of yourself, so you can take care of others. They made a solemn pact with each other to keep their statistics carefully, to stay in touch, to break the isolation in which they have been working. They asked the Midwives Association to keep them supplied with printed materials, manuals, a regional library.
Together, in their starched uniforms, they went to the Anglican Church on Sunday. The priest gave them a special blessing. “The work of population control is the most important work you can do in Africa,” he said.
The crowning moment came when each midwife was presented with a packet containing a speculum, a blood pressure cuff, stethoscopes, pills, foam, 450 condoms, stacks of rubber gloves, notebooks full of articles, and two neatly painted signs for her maternity center: “FAMILY PLANNING AVAILABLE HERE. SAFE, EFFECTIVE, REASONABLE.” They received these gifts with tears in their eyes.
Now that the Ghanaian trainers are trained, they will give seven more workshops. Each one will cost American taxpayers $10,000.
Copyright Sustainability Institute 1993
