US is key player in Salvador's controversial birth control plan

A major controversy here - one that has gone largely unreported in the United States - concerns the key role played by the US in El Salvador's family planning program.

Believing that a high population growth rate is ''a principal causal factor of social-political tension'' in El Salvador, the US Agency for International Development (AID) has pumped nearly $5 million into family planning here over the past five years and named population control as one of its four main objectives here.

AID helped to start the Salvadorean Health Ministry's Family Planning Coordination Office and has sunk more than $4 million into the other key family planning organization here, the Salvadorean Demographic Association (ADS). Both of these organizations distribute contraceptives nationwide and perform surgical sterilizations on women. Between them, the Family Planning Coordination Office and ADS have spent well over $10 million promoting population control.

The family planning programs are successful, US AID and ADS officials say. AID estimates that about 25 percent of the women of child-bearing age in El Salvador use some type of contraception - a dramatic increase since AID became involved in family planning here.

Nonetheless the program has come in for heavy criticism. Many physicians and local health workers argue that the US is not attacking the really pressing health needs of El Salvador and that there have been some serious abuses in the surgical sterilization program.

''What this country needs is basic pharmaceutical supplies and fundamental medical equipment,'' says Jose Rodolfo Iraheta, administrator of the Rosales Hospital in San Salvador.

And the director of San Salvador's maternity hospital, Dr. Luis B. Duarte, says, ''You cannot solve the social problems here through family planning. These problems are not demographic problems. Unless the family planning program is coupled with other changes in the social structure, it will fail to bring the promised better conditions to the poor.''

Some groups suggest the US has not just grabbed a wrong end of the health problem here but is involved in an effort to try to change El Salvador's social structure. The Roman Catholic Church and many relief and health workers charge that the goal of the family planning effort is to limit the number of poor people.

US AID provides contraceptives to El Salvador - which are available for sale at approximately 800 pharmacies and are given to ADS and the Ministry of Health for distribution. The proceeds from contraceptives that are sold support ADS, which is the primary recipient of AID family-planning funds. AID also donated 47 jeeps to ADS in 1981, allowing teams to travel throughout the country to promote family planning.

AID officials say the intent of this effort is to make contraceptives available to those who normally do not have access to pharmacies or cannot afford birth control. The head of ADS, Dr. Enrique Enriques, says the contraceptive program is focused on Salvadoreans in the countryside. ''Improverished families habitually have large numbers of children,'' he says.

The most explosive aspect of the family programs in El Salvador, however, is not the distribution of contraceptives, but the surgical sterilizations performed on some 21,000 Salvadorean women a year.

A health official says that strict norms and procedures are adhered to in El Salvador's family planning programs. But relief workers charge that is not always the case. They say, for example, that food has been offered to women in displaced persons camps in Santiago de Maria if they will agree to be sterilized. Some workers also say that many expectant women who go to state-run hospitals are pressured by medical staffs to have sterilization operations after they give birth. Sometimes, these workers say, the mothers are sterilized without prior consultation or consent.

''My wife went into the hospital on Oct. 2, 1982, to have our last child,'' says a man who lives just outside San Miguel. ''We had heard the rumors about sterilization and asked both the nurse and doctor not to perform the sterilization operation. My wife was in the operating room to have a Caesarean. They told her to sign a piece of paper or she would lose the child. Unable to read the paper and scared, she signed. It was a request for sterilization.''

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