Social Affairs. Vol.1 No.3, 33-47, Fall 2015

Social Affairs: A Journal for the Social Sciences ISSN 2362-0889 (online) www.socialaffairsjournal.com

WOMEN IN THE PATRIARCHAL WELFARE STATE Darshi Thoradeniya* Branch of the South Asia Institute, Heidelberg University, Germany

ABSTRACT This essay analyses the implications of the state performing a welfare function for an extended period of time in relation to the social contract between women citizens and the state. It argues that a prolonged status of ‘welfare provider’ ascribes certain patriarchal attributes to the state, which in turn reduces the position of the citizens, especially women, to a mere ‘beneficiary’ level. With the use of two specific policy documents relating to public health – Well Woman Clinic (WWC) programme launched in 1996, and the Population and Reproductive Health (PRH) policy designed in 1998 – it shows that in the absence of a rights based approach to public health, women have become mere beneficiaries, as opposed to active citizens, of the prolonged welfare State of . This relationship has deterred women citizens from exercising the right to demand their needs from the State.

Keywords: Welfarism, Social Contract, Women Citizens, Sri Lanka, Reproductive Health

INTRODUCTION

This essay attempts to engage critically with a performs this responsibility for decades, discourse on welfarism in Sri Lanka. Welfare the State looms as a patriarch to its people/ state is a form of administration/government beneficiaries, especially to women (see in which the State plays a key role in the Seccombe 1974, Dalla Costa and James protection and promotion of economic and 1975, and Eisenstein 1978). Within such a social well-being of its citizens. In other words patriarchal welfare State what happens to the State becomes in-charge of providing the the social contract between the State and basic needs of the people. When the State woman citizen? Do women citizens have a bargaining power/mechanism or exercise any *Author e-mail right to demand their needs from a patriarchal [email protected] ©2015 Social Affairs Journal. This work is welfare State? What is really at stake within licensed under a Creative Commons Attribution- this patriarchal relationship? In short, will NonCommercial 4.0 International License. there be citizens in a patriarchal welfare state,

-33- Social Affairs. Vol.1 No.3, 33-47, Fall 2015 let alone women citizens? HISTORICAL BACKGROUND OF WELFARE STATE POLICIES OF Even though welfare state policies deal SRI LANKA with provisions of education, health care, housing and a well administered system of Welfare state policies were introduced food security, in this paper I will tackle the to Sri Lanka through the British colonial above questions in relation to public health regime in the early 20th century (along with policies in Sri Lanka. I will look at two specific constitutional reforms in 1932) with the policy documents on reproductive health introduction of public health (Jones 2002). (i.e. Well Woman Clinic (WWC) programme The roots of public welfare go back to launched in 1996, and the Population and the 1830s where the modern British state Reproductive Health Policy (PRH) designed intervened with issues related to destitution, in 1998) which were adopted in response to sickness and squalor which were largely the the International Conference on Population result of the Industrial Revolution. In other and Development (ICPD or Cairo) held in words welfare did not have a clear existence Cairo in 1994 to analyse the relationship before the emergence of the modern state between the welfare State and women in Sri (Hewitt 1983). Scholars studying colonial Lanka. Cairo was widely hailed for its call societies have pointed out that the colonial to end the prevailing coercive, target-based administrations worked towards disciplining approach to population control in favour of the subjects/people/colonial bodies through an approach that centred on reproductive the introduction of Christianity and luxury health and rights (Abeykoon 2009). How consumer products such as soap, cologne did this rights based approach reflect in the and powder. In order to ‘civilise’ the ‘savage’, social contract between the welfare State the colonial administration introduced public and women beneficiaries of public health in health through Western medicine, and Sri Lanka? education through missionary schools (See Chatterjee 1993; McClintock 1995; Mohanty The first section of the paper gives a brief 1991; Jayawardene 1986; De Alwis 1996, historical background of the welfare states in 1997, 2004; De Mel 2004, 2007; Managuru the world and welfare policies of Sri Lanka. 1995; Ismail 1995; and Stoler 1989). With that understanding I have moved on to an analyze of two policy documents Analyzing Foucault’s reading of social on reproductive health to illustrate how policy and welfare, Hewitt (1983) perceives Malthusian thinking/ideology was imbedded the role of social policy as a ‘co-ordinating in these policies. Taking the Sri Lankan role, in forming ‘the social’. It promotes and political context of the 1990s (specifically organizes knowledge, norms and social violations) into consideration I practices to regulate the quality of life of the have shown how the WWC programme and population – its health, security and stability’ PRH policy failed to initiate a discussion on (p. 67). By doing so social welfare policies reproductive rights. By doing so I conclude ‘regulate the unproductive in disciplinary that, in the absence of a rights based approach institutions such as schools, factories and to public health, women have become mere prisons and sanitise the living conditions of beneficiaries, as opposed to active citizens, the general population through public health’ of the prolonged welfare State of Sri Lanka. (p. 67-68). In other words the State deploys welfare policies to organize knowledge,

-34- Women in the Patriarchal Welfare State Darshi Thoradeniya norms and social practices in a particular welfare State while making the State a way to get maximum productivity of the able patriarchal welfare State. How long should population. people be ‘beneficiaries’ of the State? Would beneficiaries talk about their needs and With decolonization after the Second World rights and start a dialogue with the State? War, former colonies worked towards Would the State instigate a dialogue with developing their countries and establishing ‘beneficiaries’ of its welfare services? What their new national identities. Welfare policies will happen to the social contract between seemed the best method to deploy people the State and people with this lengthy period towards the development of the State/Nation. of ‘beneficiary–ness’? Population was carefully monitored, controlled and planned through health policies. By Patriarchal Welfare State the late 1950s Sri Lanka invited renowned A number of Scandinavian studies have been Swedish economist Gunnar Myrdal and done on the relationship between the welfare his team to design a national development state and women in the 1970s and 1980s, plan for Sri Lanka. The Ten Year Plan of which I found useful in my analysis of the 1959 was the outcome of this invitation. patriarchal nature of the Sri Lankan welfare In the post-war global context Sweden state. Leira (1992) notes that a number emerged as a neutral country in Europe of feminist scholars, such as Seccombe (with absolutely zero involvement in both the (1974), Dalla Costa and James (1975), world wars) and was a great proponent of and Eisenstein (1978), conceive of the the welfare ideology. Thus Gunnar Myrdal as welfare state as ‘patriarchal’ and inherently an economist and his wife Alva Myrdal as a oppressive because it organises social social reformer came to assist South Asian reproduction in such a way by assigning governments on their national development childcare and upbringing to women. They projects. According to Gunatilleke (2005) see it as a perpetuation of men’s dominance post independence Sri Lanka was a and women’s subordination (Ibid). In her ‘benevolent welfare State’ providing social analysis of women’s status as citizens, clients services to its needy population. Since the and employees of the state, Hernes (1984) coverage of these services was universal, it argues that the welfare state exercises did not have the social stigma of poor relief some form of ‘tutelage’ towards women in and was regarded as the entitlement of its policies. Contesting this interpretation, citizens (Gunatilleke 2005). By the 1970s, Siim (1984) contends that the welfare state internationally renowned demographers, forms a partnership with women in social development economists and health experts reproduction (as cited in Leira 1992). Drawing hailed Sri Lanka as a ‘development model’, on Eisenstein’s and Siim’s works Leira based on low fertility and mortality levels, argues that the welfare State acts both as increasing life expectancy, commendable a ‘patriarch’ and in ‘partnership’ with women women’s literacy rates, and sound public and their social reproductive role (Ibid). When health services (Kirk 1969; Caldwell et al looking at the Sri Lankan welfare state, the 1989; Alam and Cleland 1981). Indeed State product of colonialism, I feel it is particularly welfare policies that were carried out through patriarchal when it comes to the provision of national development plans improved the free education and health care. living conditions of the people. With improved living conditions development indicators What I mean by patriarchy is the autonomy, of the country improved and consequently power and privilege that men enjoy over people became mere beneficiaries of the women in Sri Lankan society. This power

-35- Social Affairs. Vol.1 No.3, 33-47, Fall 2015 is not limited to the family, it extends to the run WWC programme (Weerasooriya 2009). community, village, work place and all human The government’s stated aim in launching relations. The welfare state’s patriarchal its WWC programme was to introduce the attitude and responsibility as the provider of concept of reproductive health in order free education and health services has made to enhance women’s health in Sri Lanka. the Sri Lankan state acquire a form of paternal Suvanari sayana kanthavange saukya tutelage towards women. This could be seen thathvaya nagasituveema aramunukaragena especially regarding women’s issues, such prajanana saukya sankalpaya yatathe as family planning, contraception and nation kriyathmaka karanalada nawa sayanika building. sevavaki (Suvanari Seva Athpotha, p. 1. Translation from Sinhala to English is mine). Identifying the nature of the Sri Lankan State, I’ll turn to the two reproductive health The WWC programme came under the aus- policies that were designed in response to pices of the Family Health Bureau (FHB), the the ICPD held in Cairo in 1994 to explore the central organisation of the Ministry of Health relationship between the State and women (MOH) responsible for planning, coordinat- citizens in Sri Lanka. ing, monitoring and evaluating the Maternal and Child Health (MCH) and Family Planning WELL WOMAN CLINIC PROGRAMME OF programme in Sri Lanka.1 The stated objec- SRI LANKA – 1996 tive of the WWC programme was, Well Woman Clinic Programme was launched in Sri Lanka in 1996 with the aim of addressing a global paradigm shift in Avurudu 35ta vædi kanthavan muhunapæ women’s health –from family planning to hæki pradhana rogithathvayan kihipayak reproductive health and reproductive rights. handuna gæneemen ovunge saukya The leader of the Sri Lankan delegation to thathvaya vædi diyunu kireema mema the ICPD Cairo, Deshamanya Bradman vadasatahane aramunai (to improve Weerakoon, described the Cairo consensus women’s health by early detection of as a set of guidelines to plan and implement common, non-communicable diseases such population programmes as hypertension, breast cancer, Diabetes Mellitus and cervical cancer of women who from primarily, societal goals are past their reproductive age of 35 years) to individual rights; from family (General Circular, 1996 Aug. 19, p. 1-2). planning to reproductive health and reproductive rights; from population As in the West where it originated, WWCs reduction to women’s health and the were set up in Sri Lanka within the sphere welfare of women, men and children; of preventive medicine as ‘screening centres’ and from vertical health service and not centres for treatment (Guidelines delivery to integrated services for Operationalizing Well Woman Clinic (Weerakoon 2009, p. xi). Programme, 1997Feb. 22, p. 1).

In line with this paradigm shift, the WWC Since the inception of the programme, the programme was introduced as a reproductive FHB has issued three circulars and published health initiative to address women’s health one handbook providing guidance on how to ‘beyond reproduction’ (Suvanari Seva implement the WWC programme.2 WWCs Athpotha 2003). Further, to the credit of the function at the base of the well-structured women’s health ‘success story’, Sri Lanka was public health system in Sri Lanka (i.e. Health the first in South Asia to launch a government- Unit). They provide free medical access

-36- Women in the Patriarchal Welfare State Darshi Thoradeniya to women from every strata of society. The rights in the State rhetoric of women’s health. Medical Officer of Health (MOH) is respon- The term ‘reproductive rights’ was not coined sible for preventive and promotional health at the ICPD in Cairo; rather, it emerged care in a defined area known as a Health during the 1980s as a consequence Unit. Currently, there are 280 health units in of the second wave of feminism in the Sri Lanka headed by a MO/MCH carrying out 1970s largely generated by the women’s preventive care services (De Silva 2007).3 movements in North America, Europe, The first WWC was set up in June 1996 in and Latin America (Global Health the Kalutara District in the Western Province Watch 2005-06 Report). Petchesky (1998) of Sri Lanka (Wijesinghe 2003). By the end points out that women’s rights movements in of 2007, 611 WWCs were functioning in the both the global North and South developed country, based mostly at pre-existing MOH and expanded the concept of reproductive health centres (Annual Report on Family health and sexual rights through ‘cross Health Sri Lanka 2006-2007, 2009, p. 21). fertilisation of ideas –across many countries The number of women attending the clinics and continents’ (p. 3) during the 1990s. They increased from 61,707 in 2004 to 113,712 in were brought onto international platforms at 2007 (Ibid, p. 22). However, the FHB notes the World Conference on Human Rights in that only 18 percent of women who attend Vienna in 1993, the International Conference were over 35 years of age.4 on Population and Development in Cairo in Even though the leader of the Sri Lankan 1994 and the Fourth World Conference on delegation to the ICPD in Cairo identified Women in Beijing in 1995 (Ibid). reproductive rights as a concept that Sri Even though the Annual Reports of Lanka should introduce in order to uplift the Family Planning Association (FPA) women’s health in the country, surprisingly, have explicitly articulated the concept of I did not come across the term ‘reproductive reproductive rights in the gender equity rights’ in any of the official documents relating and women’s empowerment programme to the WWC programme published by the that began in 1997, it was carefully omitted FHB. Didn’t the State see health as a right of from the official rhetoric of women’s health women in Sri Lanka? in Sri Lanka (Annual Report of Family Did Reproductive Rights Miss the Flight Planning Association’97-’98,p. 24). I would From Cairo? be a careless reader of official documents if I were to brush this off as a ‘mistake’ made Is the absence of reproductive rights in by the FHB. Rather, I see this primarily as an government rhetoric a ‘mistake or an ‘official oversight’ due to the over-emphasis oversight’ on the part of the Government, or placed on demographic indicators. Second, is it a deliberate policy decision made at the I see this omission as an ‘official impasse’, level of implementation? I see this absence wherein the state was incapable of producing of reproductive rights both as an ‘official a reproductive rights discourse at a time oversight’ and ‘official impasse’ of 1990s when human rights were undermined. Sri Lanka. When the State provides health care as a welfare service for decades, the Reproductive Rights as an ‘Official social contract between the two parties (the Oversight’ State and women in this instance) transforms In the context of Sri Lanka’s demographic from a service provider-citizen to a donor- history, the policy shift from family planning beneficiary relationship. The following section to reproductive health sounds—ostensibly— deals with a critical analysis of reproductive

-37- Social Affairs. Vol.1 No.3, 33-47, Fall 2015 convincing, considering that Sri Lanka charge of WWC programme] Colombo, had achieved replacement level fertility in 26 March 2010). Nevertheless, it provides 1994,so that by 1996 the state could claim some insight into the day-to-day workings that population was no longer a ‘problem’ and decision-making processes of the FHB. for development.5 Deshamanya Bradman It also depicts the usual lack of resources Weerakoon, leader of the Sri Lankan (monetary and expertise/technology) story of delegation to Cairo, also attested in his the Third World.6 This was a decision made speech at the ICPD that ‘Sri Lanka has from above (first at Cairo and then by the reached the final stage of its demographic minister of health), hence the officials were transition. The annual rate of population compelled to implement it without further growth has come down to 1.2 percent, the total questioning or deliberation. Additionally, the fertility rate was 2.2 and the life expectancy FHB doctors involved with the launching of for women was almost 75 years’ (Johnson the WWC programme confided in me that it 1995, p.196). Therefore, after the Cairo was indeed a ‘mistake’ to launch a national conference, the establishment of the WWC programme without conducting a feasibility programme as a reproductive health initiative study. During my discussions with the WWC appeared—according to demographic and programme designers and implementers it developmental thinking—the logical and best was evident that the inception of the WWC step forward. programme was mainly a political decision taken by the then honourable Minister of However, leaving such contentious issues Health and Nutrition Mr. A.H.M. Fowzie. For as marital rape, domestic violence, and policymakers and implementers, the ‘mistake’ legalisation of abortion unaddressed, was a procedural one: failing to conduct a the State ostensibly designed the WWC feasibility study prior to implementing an programme around the notion of reproductive island-wide WWC programme. But, what health. The WWC programme was launched was at stake in this mistake? I find all these as a screening mechanism to detect common procedural mechanisms rather meaningless non-communicable diseases among women when policymakers turn a blind eye to the over thirty-five years of age, conveniently larger picture that has serious implications ignoring the reproductive rights aspect of for women’s health and bodies. From my the ICPD resolution. The WWC programme, interviews with the policymakers of the WWC therefore, became a half-realised dream of programme, it was clear that they did not a post-Cairo women’s health programme in recognise that the conceptual shift proposed Sri Lanka because reproductive rights were at the ICPD should have been reflected in not incorporated. This was the result of State the WWC programme. They were simply officials failing to see reproductive rights as interested in implementing orders from human rights during the 1990s. above, and in procedural mechanisms When I asked officials at the FHB why Sri of programme implementation. In short, Lanka decided to launch a WWC programme the FHB of Sri Lanka launched the WWC at this particular moment, I received very programme in 1996 without engaging with vague answers, such as ‘After the ICPD [the] the conceptual/ideological shift that the ICPD Minister of Health decided to launch it and was supposed to have enacted because of [the] UNFPA provided technical and financial the way in which funds and technical support assistance, so here we are with WWCs.’ came from the UNFPA: in a neat technocratic (Interview with the National Programme package. Manager Gender and Women’s Health [in- When I posed the same questions [Why

-38- Women in the Patriarchal Welfare State Darshi Thoradeniya did Sri Lanka decide to launch a WWC donor (UNFPA) and recipient (Government programme in 1996? Do you think Sri Lanka of Sri Lanka, in this case the FHB) within an was ready to launch the WWC programme international discourse on women’s health by then?] to the present WWC programme defining each party’s role. director of the UNFPA, she evaded the From my conversations with officials at the question by saying that, ‘it is a chicken and FHB and the UNFPA, it is clear that both egg situation.’ According to her, I was asking these institutions (FHB and the UNFPA) have the wrong set of questions.7 She explained clearly demarcated their respective positions that: and defined their implementation procedures The important thing about the WWC within the WWC programme, but have not programme is how it performs today. made any effort to understand the paradigm Not about questioning its timing. shift that the ICPD calls for within the WWC When introducing a new programme programme or considered how it would affect it is very difficult to say how it will be women at the grassroots level. I reckon that received by the public. So whether the FHB and UNFPA officials were too eager we should wait until the time is ripe to make this shift in order to be the first in South to launch the WWC programme Asia to do so, thus upholding Sri Lanka’s or whether we should launch the long-standing record in possessing the best programme and make it happen is a women’s health indicators in the region. In very intricate question (Interview with their eagerness, these officials ‘overlooked’ the WWC programme director of the the concept of reproductive rights, making UNFPA, 17 Aug. 2011). the WWC programme a half-realised dream of a post-ICPD women’s health programme According to her, the most important for Sri Lanka. After achieving replacement- thing about the WWC programme is its level fertility, the next demographic step was performance: for Sri Lanka to be the first to adopt a comprehensive women’s health in South Asia to launch an island-wide approach by shifting from family planning to WWC programme through the government reproductive health. Conferring reproductive healthcare sector (Ibid). By ‘performance’ she rights to women was not seen as a necessity meant encouraging more women to attend by the State and also there was not any WWCs to be examined in order to detect demand for such a right from women. common, non-communicable diseases. She then spoke of the WWC programme in Reproductive Rights as an ‘Official laudatory terms, emphasising its operation Impasse’ even within the war zone during the ethnic I see this omission of reproductive rights conflict. She emphasised that as an ‘official impasse’ wherein the State The WWC programme is a was incapable of producing a reproductive government programme. The UNFPA rights discourse at a time when human rights is only providing technical support in were undermined by the State. Analysing terms of training the pathologists and the Cairo Programme of Action, Petchesky cytologists and also the screening (1995) points out that reproductive rights procedures and equipment. The (in a very broad sense) are defined by and monetary contribution is insignificant linked to fundamental human rights. In the (Ibid). absence of a situation where Sri Lankans enjoyed fundamental human rights, it is During the interview she clearly placed the hardly surprising that in the 1990s women’s

-39- Social Affairs. Vol.1 No.3, 33-47, Fall 2015 reproductive rights (that is the right to make beneficiaries of State welfare services and decisions about one’s reproductive body ignorant of their rights as citizens of the State. free from direct or indirect coercion) were In other words the social contract between not included in an official policy or everyday women and the State became a beneficiary- bureaucratic practice. Discussing women’s donor relationship. In her analysis of the activities in 1990s Sri Lanka, a feminist importance of social welfare policies for the scholar says that ’women’s groups had to lives of Scandinavian women, Hernes (1987) keep the issues of domestic violence, sexual deals with a very intriguing question (that harassment, equal opportunities, abortion, also applies to the welfare health policy of Sri women’s access to safe contraception Lanka), which is and informed choice about contraceptive whether women’s status as clients and methods, women’s reproductive health, the their political profile as recipients has image of women in the media etc. on hold’ prolonged and institutionalised their due to the socio-political crisis within the powerlessness, or whether the minimum country in the 1990s (De Mel 2002, p.235). livelihood that the welfare state has Supporting de Mel’s argument, an eminent guaranteed them has given them the lawyer points out that a bill to broaden the opportunity and the resources to wage exceptions and permit abortion ’in the event their war of independence (p. 27). of rape, incest or grave foetal defects’ was withdrawn under pressure from religious From my interviews, it is clear that their groups in 1995, even before it was tabled in prolonged ‘beneficiary’ status caused parliament (Goonasekere 2009, p. 30).8 This the powerlessness of women to be confirms that it was absolutely not possible to institutionalised. This situation further instigate a discussion on reproductive rights deteriorated in the 1990s once women within sealed doors of human rights in 1990s were considered national objects, thanks to Sri Lanka. the biological and social reproductive role conferred upon them. The institutionalisation Furthermore, the ‘official impasse’ to confer of women’s powerlessness in Sri Lanka in reproductive rights to women could be clearly the context of women’s health occurred both seen in the FHB officials’ attitude towards due to the longstanding ‘beneficiary’ ideology women. During my conversations with the held by many women, and the State’s policymakers of the WWC programme at the paternalistic approach towards women’s FHB, the idea of denying rights when offering issues. This in turn precluded the state from a free service came up frequently. This is perceiving women as citizens, creating an aptly expressed in the common Sinhala idiom ‘official impasse’ to grant reproductive rights nikam dena assayage dath balanne næne, to them. which means ‘never look a gift horse in the mouth.’ When reproductive health is provided POPULATION AND REPRODUCTIVE as a free service, government officials did HEALTH (PRH) POLICY - 1998 not (and do not) see reproductive rights The need for formulating a population policy as women’s rights which the government was quite clearly stated in almost all the should confer on them. The long history of literature that I came across, although I did welfareism in Sri Lanka has made women not find a concrete policy document until beneficiaries of the public health system, 1998: The Population and Reproductive which in turn has made them indebted to Health Policy.9 The PRH policy was initiated the State for what they are receiving free and supported by the Population Division of of charge. Consequently, they became

-40- Women in the Patriarchal Welfare State Darshi Thoradeniya the Ministry of Health, and formulated within health therefore implies that couples are able 12 months by a National Task Force. The to have a satisfying and safe sex life, and that PRH policy was approved by the National they have the capability to reproduce and the Health Council on 23rd December 1997 freedom to decide responsibly on the number and by the Cabinet on 27 August 1998 of children they may have”(Population and (Population and Reproductive Health Policy Reproductive Health Policy 1998, emphasis 1998 ; Abeykoon 2009). This is Sri Lanka’s mine). only policy document on population, and it These changes illustrate how influential was formulated as a direct consequence Malthusian thinking was in the PRH policy, of the ICPD. Therefore, it should clearly even at the supposed point of departure from demarcate the shift (from family planning to a ‘controlled and planned’ programme to an reproductive health and rights) in women’s emancipated women’s health approach. health proposed at the ICPD. However, the PRH policy, like the WWC programme, did Instead of ‘People’, ‘Couples’ was not adopt the concept of reproductive rights. Adopted As I pointed out above, human rights were Since children are typically conceived within deeply undermined in 1990s Sri Lanka, and the setting of a heterosexual nuclear family in in that context, there was no space for a Sri Lanka, the term ‘couple’ is used to denote reproductive rights discourse to germinate. parents (husband and wife). De Silva (2000) Furthermore, the PRH policy was preoccupied reminds us that single mothers and children with demographic goals, such as stabilising born out of wedlock are very rare in Sri Lanka; the size of the population by at least the thus, the PRH policy uses the term ‘couple’ middle of the next century (Population and (meaning husband and wife) in place of the Reproductive Health Policy 1998, p. 27). In term ‘people’ used in the ICPD Programme this context, the introduction of reproductive of Action (Ibid). Furthermore, the discourses rights did not seem imperative. on , gay, bisexual and Indeed, the PRH policy has adopted the (LGBT) rights are limited to a very exclusive meaning of reproductive health exactly niche group in Sri Lanka. Sri Lanka refused (word for word) as it is outlined in the ICPD to sign the December 2008 UN Declaration Programme of Action, with a few changes that urged member-states to de-criminalise to suit the Sri Lankan context. According to homosexuality. Homosexuality is a criminal the ICPD Programme of Action, reproductive offence under Section 365 and 365a of the health implies Sri Lankan Penal Code (‘Penal Code’ 2004). Even today, despite substantial pressure by “that people are able to have a satisfying and the LGBT community in Sri Lanka, the state safe sex life and that they have the capability has refused to de-criminalise homosexuality. to reproduce and the freedom to decide if, This demonstrates the state’s inability to when and how often to do so” (emphasis accommodate non-heterosexual forms mine) ( ICPD Programme of Action 1994, of sexual orientation, and reveals the Chapter VII, Paragraph 7.2). heterosexual nature of the state’s ideology.10 The PRH policy document replaced the Given these facts, the ‘couples’ mentioned ‘people’ in the ICPD Programme of Action in the PRH policy are clearly those in with ‘couples’, and ‘freedom to decide if, heterosexual relationships. when and how often to do so’ with ‘freedom to By stating that ‘couples are able to have a decide responsibly on the number of children satisfying and safe sex life,’ the PRH policy they may have.’ It thus states: “Reproductive

-41- Social Affairs. Vol.1 No.3, 33-47, Fall 2015 addresses only heterosexual couples who are example, the one child policy in China), capable of bearing children. The PRH does the two child family norm was nevertheless not accommodate other forms of sexuality established in Sri Lanka by the late 1980s such as homosexuality and , and through the dynamic family planning excludes non-procreative bodies such as campaign under a former secretary of the infertile or unmarried women, because these Ministry of Plan Implementation. groups do not impact the population growth Moreover, by placing the term ‘decide’ rate. Not only is their sexuality muted, but parallel to ‘responsibly’, the empowering also their right to health care is ignored within effect implied by the term ‘decide’ is the public health care system by its exclusion diminished. Instead, the couple is bestowed from the PRH policy. By adopting the term with a responsibility towards the nation and ‘couples’ and excluding other forms of the state, which urges them towards a two sexualities the State’s donor attitude towards child family norm. This process is reminiscent welfare services emerges very sharply in the of the film “In your hands”, produced by the PRH policy document. FPA in 1964, and the slogan ‘punchi pavula Instead of ‘freedom to decide’, freedom raththaran’ (a small family is golden) used in to ‘decide responsibly’ was Adopted the 1980s to convey the message that having a small family is part of the responsibility of What does the PRH policy mean every citizen to further the development by ‘responsibly’? To whom are they cause of the nation (Annual Report of the responsible? As responsible citizens of the Family Planning Association 1963–64). country, heterosexual couples are expected Therefore, it can be said that the sinews to reproduce according to their social and of the controlling and planning ideology of economic status in society. Referring to the women’s health are embedded in the PRH post-ICPD Indian experience, Simon-Kumar policy of 1998. Although the ICPD promoted (2007) says that neo-liberal market forces women’s empowerment through reproductive convert citizens into ‘ideological subjects’ and rights, the Sri Lankan State was unable to make them believe that their relationship with capture the ‘reproductive rights’ ideology in the state is less about what ‘rights’ they can its PRH policy of the 1990s. Furthermore, claim from the state than what ‘obligations/ major violations of human rights during this responsibilities’ they owe the state (p. 367). period prevented the state from addressing In the Sri Lankan case, I argue that it was the reproductive rights of women. not neo-liberal market forces that influenced the formulation of PRH policy but deep- Instead of ‘if, when and how often to do rooted state welfare policies in Sri Lanka. so’, ‘the number of children they may As I have pointed out above, because the have’ was Adopted State provides free health care to the public, The PRH policy suggests that couples could state officials fail to see health as a right of decide responsibly the number of children the people anymore; they continue to treat they may have, not the number of children people as beneficiaries of the public health they ‘want’ to have. The whole notion of care system and to hold citizens responsible freedom that was proposed in the statement for the health care they are given. Through ‘if, when and how often to do so’ in the logos and other published material, the state ICPD Programme of Action is negated by holds women responsible for the number its substitution for the ‘number of children of children they produce. Even though no they may have’ in the PRH policy. Moreover, number is explicitly mentioned (unlike, for it implies that the number is in fact decided

-42- Women in the Patriarchal Welfare State Darshi Thoradeniya for the couple by some external force, planning programme in the 1980s. However, rather than by the couple themselves. The it seems that the same quantitative aspect ‘number’ mentioned in the PRH policy is itself of population resonates in different avatars crucial, because the ICPD explicitly rejected well into the late 1990s, not least through the numbers and targets; it was a shift from ‘an PRH policy. approach based on demographic targets As Hartmann (1995) correctly points out, the to a comprehensive reproductive health ICPD has taken out the ‘hard core coercion’ approach,’ and from “numerical quotas to but brought back the ‘soft sell strategy’ (p. informed choices” (Petchesky2003, p. 35; 153). This is clearly manifested in the family Simon-Kumar2006,p. 6).By stating that planning incentives offered in Sri Lanka from couples should ‘decide responsibly on the the 1980s to the present day. Despite the number of children they may have’ the PRH PRH policy, the FHB still makes a payment policy hints at the implicit coercion of the for sterilisation: LKR 500 (GBP 2.39) for ‘controlled and planned’ ideology of the pre- the client and LKR 65 (GBP 0.31) to the ICPD era. Moreover, it confirms that, to use medical doctor and PHM (General Circular Hodges’ (2010) phrase, ‘Malthus is forever’ No. 01-09/2007 on ‘Payment for female/ haunting the actions of the policy makers of male sterilizations’ of the FHB, April 3,2007). the PRH policy in Sri Lanka.11 This amount has been consistent from the Numbers and spacing of children is further 1980s. Furthermore, addressing the rise stressed in goals one and two of the PRH in total fertility rates (2.3 according to Sri policy document: Lankan Demographic and Housing Survey 2006/2007) from November 2010, the Goal 1 Strategies – Improve quality Ministry of Health has decided to distribute of service delivery to enable couples oral contraceptive pills and condoms free to decide freely and responsibly the of charge (General Circular No. 01-39/2010 number and spacing of their children. on ‘Removal of fee for Oral Contraceptive Goal 2 Strategies – Promote family Pills (OCP) & Condoms’ November 2 2010). planning so that pregnancies do not Both these decisions not only reflect a ‘soft take place too early in life or too late sell strategy’, but also exemplify the elision in life, are appropriately spaced and of reproductive rights. By offering an ‘out are not too many (Population and of pocket allowance’ to the client and the Reproductive Health Policy 1998, p. medical staff and—to borrow a phrase from 29-30). a government minister in the 1980s—‘doling out’ pills and condoms through PHMs, the Goal 2 echoes the FPA slogan of the 1980s, government exercises indirect coercion, ‘not too many, not too soon, not too early, not which in turn denies clients (mostly women) too late (Annual Report of Family Planning their reproductive rights and makes them Association 1980, 1981, p. 10). Even beneficiaries of State welfare. though the PRH policy attempts to advocate reproductive health, it nevertheless implicitly Even though the WWC programme and PRH signals the number of children a family policy were designed as a consequence should have, and how important it is to space of the ICPD, it failed to address the core these children in order to produce a healthy concept of the ICPD: reproductive health and future generation. Number and spacing rights free from any form of direct or indirect were the linchpins of the Sri Lankan family coercion.

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CONCLUSION women cannot be considered as citizens of the State anymore, but mere beneficiaries Sri Lanka has been a welfare State for almost of the prolonged welfare State of Sri Lanka. eighty three years. Within such a lengthy This contention demands a redefinition of time span any concept would and should welfare State policies in such a way to have transform, change, adapt and reform to a healthy social contract between the State economic, social, political and other changes and women citizens. in society. Through two public health policies of Sri Lanka (i.e. WWC Programme and Population and Reproductive Health Policy) NOTES I attempted to understand in this paper the transformation of the social contract between 1. Family Health Bureau (FHB) of Sri Lanka was the welfare State and women. set up in 1968. 2. These three circulars are; General Circular No. After becoming a ‘development model’ for 1926 dated 19th August 1996, Guidelines for Op- South Asia by the 1970s, the welfare State erationalising the WWC programme dated 22nd February 1997 and Guidelines for Implementation of Sri Lanka seemed to assume a patriarchal of the WWC programme dated 14th July 1999. [I responsibility towards the people, especially wish to express my gratitude to Dr Chithramali de women, through maternal and reproductive Silva and Dr Sanjeewani Karunarathna of Family health policies. This relationship deterred Health Bureau, Sri Lanka for locating these docu- ments for me. These circulars were addressed women citizens from exercising their right to all the key government officials in the public to demand their needs from the State. health sector.] Consequently it made women mere 3. The first Health Unit was set up in Kalutara in ‘beneficiaries’ of the patriarchal welfare 1926 and the second in Weudawili, Hatpattu in State. On the other hand the State loomed the North Western Province in Nov. 1927, and the as the ‘donor’ of welfare services, creating third in Matara in the Southern Province in May 1928 (Uragoda 1987, p. 163). a disproportionate power relationship in 4. WWCs are operated in four settings in Sri the social contract between the State and Lanka. They are at MOH health centres and gov- women. ernment base hospitals offering free medical ser- vices to the public. Private hospitals and private In line with the neo-liberal market forces in the institutions geared towards health and wellness 1990s, ICPD broke away from controlled and offer different health packages to undergo tests planned reproductive policies and embarked done at WWCs. Apart from these institutions the FPA of Sri Lanka established a WWC in Decem- on reproductive health and rights. The focus ber 1997 within its reproductive health initiative. became a rights based approach as opposed Since the majority of the population depend on to the coercive target-based approach. Even public health services in Sri Lanka and also be- though Sri Lanka ratified the programme cause I am analysing government policy docu- ments I have limited my study to the government of action of ICPD, the welfare State failed WWC programme and the beneficiaries of the to bring in a reproductive rights discourse government health care system. through the public health sector. Apart from 5. By 1995 Total Fertility Rate has come down to being a war torn society where priorities 1.9, which is below population replacement level. were forfeited, I attribute this failure to the 6. Critics of development aid programmes such failed social contract between the State and as Bastian (2007) point out how development ac- women over the years. State’s status as the quired different nuances due to these issues at implementation level. ‘donor’ of welfare services pushed women 7. Since it is unusual for a historian to inquire to a ‘passive beneficiary’ status. There is about women’s health policies, I frequently en- very little space for a beneficiary to demand countered this type of hostile responses from their rights. As a consequence I argue that medical doctors in Sri Lanka.

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8. In fact the criminal offence of abortion has ex- Alam, I. and J.C. Cleland. (1981). Illustrative isted unchanged in Sri Lanka since it was intro- Analysis: Recent Fertility Trends in Sri duced to the Penal Code by the British in 1883 under Section 303. More information can be Lanka. World Fertility Survey Scientific found athttp://www.commonlii.org/lk/legis/con- Report No. 25. Voorburg: International sol_act/pc25130.pdf (“Penal Code” n.d.). Statistical Institute 9. Despite the success story of Sri Lanka in curb- ing population growth rates Annual Report of Family Planning 10. de-criminalised private, consensual Association’97-’98. (1999). Colombo: sex between adults of the same sex on 2nd July FPA 2010. Sri Lanka has still not taken any affirma- tive action in this regard. For the current status of Annual Report of Family Planning LGBT rights in Sri Lanka see http://groundviews. Association1980. (1981). Colombo: org/2010/07/07/celebrating-a-lesbian-gay-bisex- FPA ual-transgender-inquiring-and-queer-sri-lanka/ (‘Celebrating LGBT and questioning Sri Lanka Annual Report on Family Health Sri Lanka 2010). 2006-2007. (2009). Colombo: Family 11. By reviewing Hartmann, Connelly, Hal- Health Bureau fon, Rao and Simon-Kumar, Hodges points out how Malthus is ever so present in the framing of Bastian, S. (2007).The Politics of Foreign population policies in the third world. See Hodg- Aid in Sri Lanka; Promoting Markets es, ‘Review Article: Malthus is Forever (2010). and Supporting Peace. Colombo: International Centre for Ethnic Studies REFERENCES Caldwell, J.C., I. Gajanayake, B. Caldwel, ‘Celebrating LGBT and questioning Sri and P. Caldwell. (1989). Is marriage Lanka’. (2010). Groundviews.org. delay a multiphase response to Retrieved from http://groundviews. pressures for fertility decline? The org/2010/07/07/celebrating-a-lesbian- case of Sri Lanka. Journal of Marriage gay-bisexual-transgender-inquiring- and the Family, 51, pp. 337¬–351 and-queer-sri-lanka/ Chatterjee, P. (1993). The Nation and its ‘Penal Code’. (2004). GLAPN.org. Fragments: Colonial and Postcolonial Retrieved fromhttp://www.glapn.org/ Histories. Princeton: Princeton sodomylaws/world/sri_lanka/sri_ University Press lanka.htm Dalla, C. M. and S. James. (1975). The ‘Penal Code’. (n.d.). Retrieved from http:// Power of Women and the Subversion www.commonlii.org/lk/legis/consol_ of the Community. Bristol: Falling Wall act/pc25130.pdf Press

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