Tool of economic development, metric of global health: Promoting planned families and economized life in Nepal

Abstract

In contemporary global health and development discourses, contraception is cast in multiple roles: an antipoverty tool at the household level, a tool of economic development at the national level, a smart investment with net gains, a means of empowering women, a way of lowering maternal mortality ratios. In order to examine such discursive uses of contraception - and their implications for women - in a concrete way, I use a compelling case of the history of the promotion of planned families in Nepal and a recent social and behavior change communication contraception campaign designed in the US. Using social text analysis to examine this multi-year, multi-platform campaign in Nepal, I found that the advertisements present idealized images of "smart couples:" progressive, middle-class families engaged in rationalistic family planning to delay and space their offspring. A major theme identified, aspirations to be middle class, links these specific family planning behaviors to upward economic mobility. The small-family ideal previously promoted in the global South had outlived its relevance as Nepal and other countries reached near replacement-level fertility rates. The gradual historical refashioning in Nepal of a discourse that promotes the "small family" to one that promotes the modern "smart couple" is an illustrative example of the global trend in which a message of replacement-level fertility is repackaged as a message of delaying and spacing births under the guise of health, as funding agencies promote contraceptive adoption as a women's health issue. Underlying this discursive repackaging, however, is a continued economization of life and health.

Keywords: Contraception; Family planning; Fertility; Global health; Indicators; Maternal health; Nepal; Reproductive health.