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Birth control: An international assessment
612
Book Reviews
evidence to the contrary notwithstanding. In Chapter 11 women's menstruation is regulated ( a euphemism for early abortion), although "there has been no systematic evaluation of the possible serious, delayed complications..." (p. 194). The tragedy is that birth control should be a choice available to poor women, and there are contraceptive methods that can be used safely; foreign intervention of the sort described here only. retards the development of family health services.. The net result of the approach to birth control adopted in this book is the separation of reproduction from issues of unjust social structures and unequal economic growth. As Banerji points out, family planning side-tracks "work on the country's basic problems of poverty, social injustice, ill health, unemployment and illiteracy" [11]. By diverting countries from the real issues, the international family planning movement reinforces the social and economic system, at national and international levels, which is at the root of people's underdevelopmant, poverty and disease [12].
favorably disposed to these programs might nevertheless criticize the book on many of the same grounds, i.e. that it focuses almost exclusively, one might say with something like a religious zeal couched in mathematical language, on the "successful" aspects of "successful" programs. The majority of family planning programs in the developing world are having rough going because of sociocultural obstacles and logistic inadequacy, and even the successful ones have important aspects on the non-success side. The book is almost one-dimensional in its approach and is certainly to be criticized in this regard. Having said this, one can add that the book represents an enormous and useful stock of data on the successful programs it discusses, in an area that has its place as one of the critical factors in the population and resource crisis of our time.
MEREDETH TURSHEN
The Division in British Medicine: A History of the Separation of General Practice from Hos~Ud .Care 1911-1968, by FRANK HONINOSnAUM.St Martin's Press, New York, 1979, 445 pp. $27.50
African studies and Research Program Howard University Washington. DC. U.S.A.
REFERENCES 1. Porerty and Landlessness in Rural Asia. ILO, Geneva. 1977: Ghai D., Lee E. and Radwan S. Rural poverty in the third world: trends, causes and policy reorienrations. WEP Working .Paper. No. 23. ILO. Geneva. 1979: Beqnele A. and van der Hoeven R. Poverty and inequality in sub-Saharan Africa. lnt. Labour Rer. 119, 381. 1980. 2. Mamdani M. The Myth of Population Control: Famil): Caste, and Class in an Indian Village, p. 14. Monthly Review Press, New York. 1972, 3. Mass B. Population Target: The Political Economy of Population Control in Latin America. Latin American Working Group, Toronto, 1976: Caress B. Sterilization. Hltb PAC Bull. 62, 1; 1975. 4. Halimi G. La Cause des Femmes. Grasset` Paris, 1973. 5. Powles J. The limits of modern medicine. Sci. Med. Man 1, 1, 1973. For a discussion of the professionalization of the birth control movement in the U.S, see Gordon L. The politics of birth control, 1920-1940: the impact of professionals. Int. J. Hhh Serf. 5, 253, 1975. 6. WHO Technical Report Series No. 619, p. 46. 7. Huber found the majority were breastfeeding; quoted in Minkin S. F. Abroad, the U.S. pushes contraceptives like Coca-Cola, Med. Care Rer. 36, 1042, 1979. 8. WHO Technical Report Series No. 619, p. 39. 9. WHO Technical Report Series No. 575, p. 13. 10. WHO Technical Report Series No. 600, pp. 42, 43. 11, Banerji D. Population planning in India: national and foreign priorities. Int. J. Hlth Sen-. 3, 774, 1973. 12, For a fuller discussion of this analysis in the context of Bangladesh, see Segall M. Review of Disaster in Bang, ladesh. Int. J. Hhh Serr. 5, 521, 1975.
Birth Centrol: An lntefnetimml Assessment, edited by M. POTTS and P. BHIWANDIWALA. MTP Press, Lancaster, England, 1979. 305 pp. £12,95. University Park Press. Baltimore, MD, 1979. $29.95. The following review is a strong critique not only of the book by Potts and Bhiwandiwala. but also of national family planning programs generally. A reviewer more
African Studies Boston Unirersity. U.S.A.
ROBERT MORGAN
The United Kingdom differs from the United States and most other industrial countries in that a general medical practitioner is the normal point of entry to the medical care system, while taking no formal part in the care of his patient during admission to a specialist hospital unit. It is this aspect of the British National Health Service whose development has been selected by Frank Honingsbaum for intensive study since he came to Britain from the U.S.A. in 1957 with, as he puts it, "the deliberate aim of finding out what my country could learn from the British example". The book is arranged in eight sections, of which the first covers the introduction of the panel system under the National Health InsuranceAct of 1911, which made gen,Jractitioner carefree and available to one.third of the nation. There follow three sections tracing developments between the establishment of the Ministry of Health in 1919 and the outbreak of World War II in 1939: a further three sections describe discussions and negotiations during and following the war, leading up to the introduction of the National Health Service and National Insurance scheme in July 1948. The main source material supplemented by many personal interviews, is derived from a painstaking examination of the voluminous medical press of the period, on which many fascinating sidelights are thrown by internal government papers now available, 30 years after the event, in the Public Record Ofiice. The author traces in detail the interplay between various interested pressure groups, medical, financial` political and trade union', and the government of the day. He brings out clearly how frequently the policies of representative organisations reflect a limited and sectional outlook, however enlightened the views of individual members. His account is meticulously supported by 76 pages of source references in addition to a -select bibliography" and brief biographies of prominent personalities. Helpful though these are, the text assumes a fair background acquaintance with British social history of the period. The wealth of material so far presented lives up to Professor Ahel-Smith's description in his foreword as "the most comprehensive and fascinating interpretation of the politics of medical organisation that has ever been published". By contrast the final section is disappointing. It consists of two chapters only. the first purporting to cover in 15 pages the, first 20 years of the National Health Serviee and the second a brief review confined to the, period 1911-1948.
Book Reviews
evidence to the contrary notwithstanding. In Chapter 11 women's menstruation is regulated ( a euphemism for early abortion), although "there has been no systematic evaluation of the possible serious, delayed complications..." (p. 194). The tragedy is that birth control should be a choice available to poor women, and there are contraceptive methods that can be used safely; foreign intervention of the sort described here only. retards the development of family health services.. The net result of the approach to birth control adopted in this book is the separation of reproduction from issues of unjust social structures and unequal economic growth. As Banerji points out, family planning side-tracks "work on the country's basic problems of poverty, social injustice, ill health, unemployment and illiteracy" [11]. By diverting countries from the real issues, the international family planning movement reinforces the social and economic system, at national and international levels, which is at the root of people's underdevelopmant, poverty and disease [12].
favorably disposed to these programs might nevertheless criticize the book on many of the same grounds, i.e. that it focuses almost exclusively, one might say with something like a religious zeal couched in mathematical language, on the "successful" aspects of "successful" programs. The majority of family planning programs in the developing world are having rough going because of sociocultural obstacles and logistic inadequacy, and even the successful ones have important aspects on the non-success side. The book is almost one-dimensional in its approach and is certainly to be criticized in this regard. Having said this, one can add that the book represents an enormous and useful stock of data on the successful programs it discusses, in an area that has its place as one of the critical factors in the population and resource crisis of our time.
MEREDETH TURSHEN
The Division in British Medicine: A History of the Separation of General Practice from Hos~Ud .Care 1911-1968, by FRANK HONINOSnAUM.St Martin's Press, New York, 1979, 445 pp. $27.50
African studies and Research Program Howard University Washington. DC. U.S.A.
REFERENCES 1. Porerty and Landlessness in Rural Asia. ILO, Geneva. 1977: Ghai D., Lee E. and Radwan S. Rural poverty in the third world: trends, causes and policy reorienrations. WEP Working .Paper. No. 23. ILO. Geneva. 1979: Beqnele A. and van der Hoeven R. Poverty and inequality in sub-Saharan Africa. lnt. Labour Rer. 119, 381. 1980. 2. Mamdani M. The Myth of Population Control: Famil): Caste, and Class in an Indian Village, p. 14. Monthly Review Press, New York. 1972, 3. Mass B. Population Target: The Political Economy of Population Control in Latin America. Latin American Working Group, Toronto, 1976: Caress B. Sterilization. Hltb PAC Bull. 62, 1; 1975. 4. Halimi G. La Cause des Femmes. Grasset` Paris, 1973. 5. Powles J. The limits of modern medicine. Sci. Med. Man 1, 1, 1973. For a discussion of the professionalization of the birth control movement in the U.S, see Gordon L. The politics of birth control, 1920-1940: the impact of professionals. Int. J. Hhh Serf. 5, 253, 1975. 6. WHO Technical Report Series No. 619, p. 46. 7. Huber found the majority were breastfeeding; quoted in Minkin S. F. Abroad, the U.S. pushes contraceptives like Coca-Cola, Med. Care Rer. 36, 1042, 1979. 8. WHO Technical Report Series No. 619, p. 39. 9. WHO Technical Report Series No. 575, p. 13. 10. WHO Technical Report Series No. 600, pp. 42, 43. 11, Banerji D. Population planning in India: national and foreign priorities. Int. J. Hlth Sen-. 3, 774, 1973. 12, For a fuller discussion of this analysis in the context of Bangladesh, see Segall M. Review of Disaster in Bang, ladesh. Int. J. Hhh Serr. 5, 521, 1975.
Birth Centrol: An lntefnetimml Assessment, edited by M. POTTS and P. BHIWANDIWALA. MTP Press, Lancaster, England, 1979. 305 pp. £12,95. University Park Press. Baltimore, MD, 1979. $29.95. The following review is a strong critique not only of the book by Potts and Bhiwandiwala. but also of national family planning programs generally. A reviewer more
African Studies Boston Unirersity. U.S.A.
ROBERT MORGAN
The United Kingdom differs from the United States and most other industrial countries in that a general medical practitioner is the normal point of entry to the medical care system, while taking no formal part in the care of his patient during admission to a specialist hospital unit. It is this aspect of the British National Health Service whose development has been selected by Frank Honingsbaum for intensive study since he came to Britain from the U.S.A. in 1957 with, as he puts it, "the deliberate aim of finding out what my country could learn from the British example". The book is arranged in eight sections, of which the first covers the introduction of the panel system under the National Health InsuranceAct of 1911, which made gen,Jractitioner carefree and available to one.third of the nation. There follow three sections tracing developments between the establishment of the Ministry of Health in 1919 and the outbreak of World War II in 1939: a further three sections describe discussions and negotiations during and following the war, leading up to the introduction of the National Health Service and National Insurance scheme in July 1948. The main source material supplemented by many personal interviews, is derived from a painstaking examination of the voluminous medical press of the period, on which many fascinating sidelights are thrown by internal government papers now available, 30 years after the event, in the Public Record Ofiice. The author traces in detail the interplay between various interested pressure groups, medical, financial` political and trade union', and the government of the day. He brings out clearly how frequently the policies of representative organisations reflect a limited and sectional outlook, however enlightened the views of individual members. His account is meticulously supported by 76 pages of source references in addition to a -select bibliography" and brief biographies of prominent personalities. Helpful though these are, the text assumes a fair background acquaintance with British social history of the period. The wealth of material so far presented lives up to Professor Ahel-Smith's description in his foreword as "the most comprehensive and fascinating interpretation of the politics of medical organisation that has ever been published". By contrast the final section is disappointing. It consists of two chapters only. the first purporting to cover in 15 pages the, first 20 years of the National Health Serviee and the second a brief review confined to the, period 1911-1948.