But these people of vision lost that debate in the 1940s, and now premature death on an appalling scale is just getting underway in Africa. It is reasonable to predict that more than half of the Africans alive today will die prematurely, and that a substantial majority of African children born in this decade will die either in this decade or the next.
Because of his position and the length of his tenure, Milton P. Siegel is considered among the world's foremost authorities on the development of World Health Organization policy. In this videotaped interview (available from the Center for Research on Population and Security, P.O. Box 13067, Research Triangle Park, NC 27709, for $19), he reveals the influence of the Vatican in shaping WHO policy, particularly in blocking adoption of the concept that overpopulation is a grave public-health threat -- a concept which, in WHO's early years, enjoyed a broad consensus among member countries.
Without this separation of population dynamics from WHO public-health policy, the Vatican would have found it much more difficult to subsequently manipulate governments on such issues as family planning and abortion. National leaders would have been able to refer to the international consensus, as demonstrated by WHO policy. WHO, they could have insisted, has determined that family planning and abortion -- like clean water, good nutrition, and immunizations -- are necessary to protect public health.
Professor Siegel has now decided to speak out on the subject. As he was involved in the World Health Organization at an early stage, his personal experience provides ample evidence that the Vatican influenced WHO policy development from the outset, during the early period of the Interim Commission in 1946. In its 44-year history, this international health body has had a deplorable record in family planning. Its commitment has been miniscule, and even today family planning accounts for only a tiny fraction of its budget.
Professor Siegel joined the World Health Organization in 1946, when it was still in its formative stages -- under the umbrella of the United Nations, created just the year before. Because of Siegel's earlier work in North America and the Middle East, he was asked, in effect, to be one of WHO's "founding fathers." So he came on board on the senior staff of the Interim Commission. Dr. Brock Chisholm of Canada was the executive director of the commission. The Interim Commission set up the permanent organization with headquarters in Geneva, Switzerland, and Dr. Chisholm was chosen to be WHO's first director general.
- MUMFORD
- In your role as assistant director general of WHO, you were in a position to know all of the essential facts that went into all WHO policy-making decisions, weren't you?
- SIEGEL
- I feel it might be useful for me to point out my
participation in, first, the creation of the World Health
Organization, and my role as assistant director general
for 24 years, which is when I reached retirement age. I
attended every meeting of the World Health Assembly and
every session of the executive board. The board met twice
a year. The Health Assembly met annually, and I was
present, exercising my functions at these meetings. I
didn't miss a single one.
- MUMFORD
- How did Dr. Chisholm regard family planning in those early days as a potential concern for WHO?
- SIEGEL
- He considered it absolutely essential. . . . Brock
Chisholm was a realist, and he firmly believed that
overpopulation was a threat -- a security threat, if you
will -- to all the nations of the world. And that
steps must be taken, and it should be considered part of
health function to do something about population-growth
control.
- MUMFORD
- Did you and Brock Chisholm ever discuss the opposition to family planning?
- SIEGEL
- Yes, we had to. It was an issue even before I joined the
Interim Commission. I joined the commission a year after
it was created.
- MUMFORD
- When did you first start witnessing this opposition to WHO involvement with family planning?
- SIEGEL
- Well, my first exposure to it -- the initial stages of
opposition to family planning by the Catholic
church -- started as soon as I joined WHO and word
reached me that this was a real problem. I was visited by
one of the representatives of the Vatican in Geneva, who
wanted to know who I was and where I came from and what I
believed in. And I politely invited him out of my office,
because I did not consider that I was under any obligation
to reveal anything that I knew to someone outside the
organization -- whether it was someone from the Vatican
or any other organized group. So they couldn't get any
information out of me. But as a result, I had the
beginnings of conversations with my colleagues,
particularly with Dr. Chisholm.
- MUMFORD
- What was the basis of opposition within WHO to the discussion of population and population problems?
- SIEGEL
- Well, the position simply was that population-growth
control, family planning, or whatever you want to call it,
was not a health problem and therefore should not even be
debated. That was the position of Ireland, Italy,
Lebanon, and later on Belgium. The issue of population
growth came up at every meeting WHO held.
You couldn't separate population problems from health in
the minds of most of the delegates. But these few
countries -- particularly those which were dominated by
the Vatican -- didn't want to see that discussed in a
health organization. Because as soon as you introduce
anything under the subject of health -- whether it's
peace, security, or family planning -- it's pretty hard
to argue against improving the health of people. These
countries knew that, and they tried to defend
themselves by saying, "These are political considerations
and shouldn't be discussed in a health arena."
- MUMFORD
- Wasn't the question of religion, as such, ever raised in the discussion?
- SIEGEL
- Well, it was raised indirectly. Religion always was
raised indirectly one way or another. But sometimes they
would simply call it politics.
I think one can provide many illustrative examples of the way in which politics has interfered with the progress of health. And the influence of religion never did show itself until the Vatican began to use its influence through the church organizational structure, which, incidentally, probably is one of the best organizational structures the world's ever seen.
So, one way or another, sometimes surreptitiously, the Catholic church used its influence to defeat, if you will, any movement toward family planning or birth control.
- MUMFORD
- I've read -- and we've discussed -- that in the second World Health Assembly the representative from Ceylon commented that the security and peace of the world is threatened by population growth, and that the need for birth control must be considered internationally. What reaction was there to this?
- SIEGEL
- Well, it's interesting to note the fact that the second
World Health Assembly was not held in Geneva, it was in Rome.
The environment which we were subjected to in Rome for the second World Health Assembly made it particularly difficult for anyone to make the kind of statement made by that man, the representative of the country that was then called Ceylon. . . . But he still had the courage to get up and make that statement about the importance of peace and security and health, and the role that health can play with regard to population control or family planning or what I choose to call management of population growth.
- MUMFORD
- Yes, I recall how action was stymied in the second World Health Assembly. What happened at the third assembly?
- SIEGEL
- When we reached the third World Health Assembly, which was
back again in Geneva . . . for the first time to my
recollection a strong effort was made in the steering
committee to add the subject of population and family
planning to the agenda to be discussed at the third World
Health Assembly.
Well, the delegation of Ceylon was on the steering committee that drafted the agenda to go to the Health Assembly for approval, and the delegates did their utmost to argue that population for them was an exceedingly serious problem, because they were a small island with a relatively large population, considering the size of the island. And they felt that population just had to be considered by the World Health Organization, and for that reason they were making very strong efforts to get the steering committee to allow the subjects of family planning and population to be added to the suggested agenda.
When that hit the assembly for its approval of the agenda, it was the delegate from Ireland -- Dr. Hourihane -- who made a rather strong, forceful statement (in the style which was the one style he could handle extremely well), saying there were two major religions, and his country was one of them -- that is, the major part of its population was one of the religions -- which absolutely refused to permit its delegation to participate in any meeting where the problem of family planning was being discussed.
When the vote came on the subject of whether to put population and family planning on the agenda, the vote was 30 against, one in favor, and there were somewhere between four and six abstentions.
- MUMFORD
- So Ireland simply intimidated just about everyone. While the Catholic opposition was developing earlier, how did Dr. Chisholm react? Was he concerned?
- SIEGEL
- Oh, he was very concerned because he was beginning to feel
pressure from the member states of WHO that were
predominantly Catholic in all respects -- politically
and in the development of their programs. And they were
putting pressure on Brock Chisholm as director general of
WHO to do as little as possible about family planning.
Then later on, as time went by, when they weren't very
successful in influencing the development of the program,
they became extremely difficult and put considerable
pressure on the director general to do
nothing about family planning. It took them about three years before they could get the kind of resolutions or consensus in our annual meetings of the Health Assembly to prevent the director from proposing programs that included such things as family planning.
- MUMFORD
- It took them three years? You're talking about the Catholic church's representatives?
- SIEGEL
- Well, they had to work through government representatives because they couldn't speak officially; they didn't have the prerogative of being recognized to speak at a meeting of the World Health Assembly or any of its subsidiary bodies unless they were invited. So they operated through the countries where they knew they had influence. I think it's a well-known fact who those countries are. Two outstanding ones are Ireland and Italy.
Then later on, the Belgians became very much involved, and it was the Belgian and Irish delegates -- the chief delegates -- who went to Brock Chisholm and demanded that he make a clear statement to the assembly that he would not propose any family-planning programs in any of the annual programs and budget of the organization. They threatened that, if he didn't do that at the then-ongoing Health Assembly, which was, I think, the third (1950), they would withdraw from the organization and take steps to destroy the organization. They went so far as to use these words threatening him -- that, if he didn't do what they wanted him to do, they would first withdraw and then create a new organization altogether and destroy the World Health Organization.
Among the people Chisholm talked to was myself. Who else he talked to, I don't know, but I think I was the only one of his top policy-makers with whom he discussed this. I told him that he should not allow himself to be virtually blackmailed into taking the action they wanted him to take. "Let them go ahead and withdraw and see what happens," I advised.
Well, he did not want to do that because his term as director general only had a couple more years to run, and he didn't want to leave that problem in the hands of his successor. He knew that he was not going to remain for a second term as director general, having already served two years as executive director of the Interim Commission.
So he made a statement to the Health Assembly in full complete session that he would not, as long as he was director general, do anything to include family planning in the programming of the organization. And that put a stop to anything that had been going on previously.
Now the only thing that was going on previously was a program in India which took place almost from the outset of the organization -- because the then-minister of health of India was a woman, not a doctor, who was formerly secretary to Mahatma Gandhi, and she was a converted Catholic dead set against any kind of family-planning programs in India. The Vatican would accept the idea of the use of the rhythm method but no contraceptives.
We provided an expert, whose name was Abraham Stone, to go to India to try to set up a program for the rhythm method, together with the minister of health -- whose name, incidentally, was Rajkumari Amrit Kaur. She was a princess; that's what rajkumari
means. I knew her well, and she was a charming person and certainly a great supporter of WHO; but her being a converted Catholic made her more Catholic than the pope, and she refused to support any kind of family-planning program. When the rhythm method failed miserably -- it produced absolutely no results -- then there was nothing else that was acceptable to her. It was only after she retired as minister of health that India began to do something about family planning.
- MUMFORD
- How very sad. At last, Chisholm felt he had to knuckle under.
- SIEGEL
- After what had happened at the third World Health Assembly, the fourth -- which was in 1951 in Geneva -- didn't even touch the subject. It was almost taken for granted that it would simply be a repetition of what had happened at the third Assembly -- and therefore let's not waste time at the fourth.
And so we get to the fifth World Health Assembly, in 1952. I have equated the fifth assembly in my own mind with the death knell of WHO's involvement in population -- primarlily because of the pressure put on the director general by, particularly, the governments of Ireland and Belgium.
- MUMFORD
- So I gather Dr. Chisholm's capitulation at the third World Health Assembly wasn't quite the end of it, was it?
- SIEGEL
- The representative of Ceylon at the fifth World Health Assembly was Dr. Wickremsinghe, and, in referring to the population problem he said: "We must therefore always regard the population problem as a vital one, and see how, without violating any religious beliefs or moral standards, we could solve this problem in a scientific and careful manner." This then led to a proposal by one of the outstanding members of the delegations that came to WHO meetings -- Dr. Karl Evang from Norway. The Scandinavian countries, as most people know, have almost always been in favor of doing something about family planning. This has particularly been true of Norway, Sweden, and Denmark.
Dr. Karl Evang was an outstanding public-health person in the world and spoke absolutely perfect English. He proposed, after hearing what the representative from Ceylon had to say, that it was time to establish an expert committee to examine the problem and report on the health aspects of the population problem.
His proposal met with the support of representatives of a number countries; I won't take time to list them all, but, of course, one of them was Sweden and another Ceylon. The group of countries under the influence of the Vatican proposed another resolution: that, from a purely medical stand-point, population problems do not require any particular action on the part of WHO at the present time.
In the meantime, the delegate from India, whom I knew quite well (incidentally, he was a gynecologist and obstetrician from Madras, India), proposed a resolution that an expert committee should be set up with the aim of acquiring knowledge with regard to the spacing of children and birth-control problems as well as the other health aspects of population.
- MUMFORD
- So, two countries proposed expert committees?
- SIEGEL
- After heated debate, discussion was closed, and it was time to put the resolutions to a vote.
One of the members said he didn't understand what was taking place, because, as he understood it, discussion of the subject had already been declared closed and he didn't see why it should be reopened. The chair of the committee, being mindful of what the problem was growing into, suggested that, in the interest of harmony and conciliation, the best procedure would be to withdraw all
the resolutions. And that was accepted by consensus.
- MUMFORD
- What was the implication?
- SIEGEL
- Well, the implication of that was that nothing happened; the discussion was closed and there was no resolution. Therefore, the director general having already made his statement that he would not include family planning in any program as long as he was director general -- but he only had another year to two to go -- the result was that the organization did absolutely nothing about family planning for a period of somewhere between seven and nine years.
That gave me an awful lot of problems; every time I'd go to New York, I'd be jumped on at the United Nations because of WHO's failure to take what the United Nations considered to be the kind of action that WHO was the appropriate organization to deal with.
The failure of WHO to be able to do anything during this period to which I referred -- seven to nine years -- was clearly the result of the very effective job done by the Vatican and its representatives, not only at WHO but at meetings of the United Nations and other organizations.
The United Nations itself, first by its division of social affairs, tried to do something about the population problem and was very disappointed that WHO had been placed in a position where it was virtually stopped and prevented from doing anything. That probably had a great deal of influence in the United Nations on the establishment of the United Nations Fund for Population Activities, which it set up because WHO had miserably failed to do what the United Nations had hoped it would do.
- MUMFORD
- Do you think the Vatican exerts pressure on WHO even today?
- SIEGEL
- I believe that the Catholic church still has considerable influence on WHO's policies and program development.
