Poor Women, Powerful Men

Poor Women, Powerful Men chronicles the achievements and subsequent failure of the Louisiana Family Health Foundation, the most extensive family planning program ever to operate in the United States. Martha C. Ward's even-handed account reveals the mechanisms—of politics, poverty, and public health policies—at work in the perpetual controversies surrounding reproductive rights and the delivery of health care services to the poor. Ward's book begins in the early 1960s when Louisiana was among the most underdeveloped states and ranked at the bottom of all scales measuring illiteracy, illegitimacy, and infant mortality. Despite the free statewide Charity Hospital system, many routine preventive medical and public health services were not available to poor women and their children, particularly if they were black. But in the mid-1960s, a visionary group of doctors and health care practitioners began to clear the hurdles erected by law, church, and the medical-political establishment. By 1970 they had set up the first statewide family planning program for poor people in the United States. The Louisiana experiment was a spectacular success. The Ford, Rockefeller, and Kellogg Foundations poured millions of dollars into the program. The Great Society and War on Poverty programs placed a high priority on the health of poor mothers and infants. With the help of the population lobby—including Planned Parenthood and the Agency for International Development—the Family Health Foundation moved into Latin America and other developing areas. But in 1974, the bubble burst. Accusations of fiscal mismanagement, fraudulent statistics, patronage, and political payoffs led to federal indictments and jail sentences for top officials. Poor women and powerful men, the black and white communities, and the liberal and conservative medical factions were pitted against each other. With the collapse of the program, methods for handling the epidemic of adolescent pregnancies and the high infant mortality rate reverted to the state bureaucracies. Poor Women, Powerful Men is the first book-length account of the Louisiana experiment. In a clear and dispassionate voice, Ward demonstrates that many of the questions raised by the experiment persist. Is family planning an answer to the cycle of poverty, teenage pregnancies, and infant mortality? How can the conflict between private and public delivery of medical care be resolved? Where do the reproductive rights of women fit into governmentally supported birth control programs? We seem no closer today to answering these questions than the Louisiana Family Health Foundation was more than a decade ago.