Abstract

This article analyzes the role of fertility surveyors as framing specialists, who in the 1940s portrayed Latin American populations as likely to change their attitudes regarding birth control. A heterogeneous group of social scientists, clinical workers, and their financial supporters, all of whom were interested in population limitation and women’s health issues, were involved in the deployment of the fertility survey, a tool that played an essential role justifying the promotion of birth control methods and population limitation policies. This group also included locals who became involved in research alongside US experts, albeit as unequal partners.

1. Introduction

Fulfilling the “unmet need for contraceptives” in Latin America is still a contested rallying cry for local activists, policymakers, and physicians (Melhado 2013; UNFPA 2012). It evokes both the consumerist aspiration to choose birth control methods, as well as implies the existence of health and welfare institutions that ought to guarantee a human right. In the 1940s, however, the “unmet need for contraceptives” was a fledgling notion that a group of experts had only begun to popularize through the use of a crucial population-making technology: the fertility survey. This paper analyzes the role fertility surveyors played in the mid-twentieth century, framing Latin American populations as rapidly growing and likely to come to embrace birth control. To instantiate this role of surveyors, I focus on the careers of two North American researchers, US sociologist Joseph Stycos and Canadian-Belgian physician Marie-Françoise Hall, both of whom spent a considerable part of their professional lives moving across Latin American nations while conducting studies about what lay people knew, how they felt, and what they did about the birth control they purportedly needed but could not get.

Experts such as Stycos and Hall carried out their surveys in dozens of countries, including Peru, Chile, Argentina, Brazil, Colombia, Costa Rica, Mexico, Panama, Haiti, Puerto Rico, Honduras, and Venezuela, making Latin American women visible as potential yet underserved users of contraceptives (Tabah 1963; Aguirre 1966; Stycos and Marden 1970; Keller 1971; Bailey, Lopez Escobar and Estrada 1973; van Keep and Rice-Wray 1973; Reynolds 1973; Germain 1975; Bailey, Measham and Umana 1976). As I will show, this type of research made the surveyor into a framing specialist, one who portrayed Latin American populations as likely to change their attitudes regarding birth control, and as capable of producing locals who could become involved in research alongside US experts, albeit as unequal partners. Despite the relevance of their research, we know little about the social and intellectual foundations of fertility surveyors’ work.

Like other social scientists in the mid-twentieth century, surveyors partook of the broad North American concern with the effects of rapid demographic growth on poverty, environmental degradation, and political instability in the Third World. A Cold War classic, this worry led to support for the “modernization” of developing regions, using strategies that included the limitation of population growth, in order to prevent the spread of sympathy for communism (Notestein 1945; Davis [1946] 1947; Vogt 1948; Nelson 1956). Unlike other population experts at the time, however, the new investigators did not solely rely on existing official censuses or vital statistics, but also drew on the social scientific, medical, and advertising genres to create novel ways to collect data in small areas, test specific hypotheses, and evaluate pilot programs in family planning (Bogue 1966).

The production of censuses had gained importance in the 1930s, partly due to the post-WWI economic planning needs of the League of Nations.1 In 1936, the Milbank Memorial Fund endowed the Princeton University Office of Population Research (OPR), which began a research program on Europe. Later, with the Cold War about to set in, the US Department of State commissioned the OPR to extend its studies to Asia (Notestein et al. 1944; Lorimer 1946; Davis 1951; Taeuber 1958; Coale and Hoover 1958). In addition, the 1945 charter of the United Nations called for the establishment of a Population Commission within its Economic and Social Council. Frank Notestein, a demographer at the Milbank Memorial Fund who later headed the OPR, became the first UN Population Advisor (Notestein 1971). Convinced of the interplay between demographic factors and economic and social ones, the UN’s Population Commission helped create regional demographic training and research centers in Chembur, India (1956), Santiago, Chile (1957), and Cairo, Egypt (1963) (Symonds and Carder 1973). The UN regional center in Santiago, named the Centro Latino Americano de Demografía (CELADE), played a crucial role disseminating knowledge about population trends and educating demographers at a time when academic and governmental research in Latin America in this field was negligible, uncoordinated, and lacking in prestige (Stavenhagen 1964; Somoza 1964).

While interested in improving census data, US researchers were also building a case for population limitation. Since the mid-1940s, for example, Frank Notestein had argued that the social and economic improvements brought on by modernization in developing regions would lead people to limit their fertility spontaneously, but not quickly enough to avoid political upheaval or damages to the environment (Notestein 1970). Beginning in the mid-1940s, a handful of US actors put this insight into practice. Their initiatives went from the scholarly to the improvised, and did not exclude international blackmail. Established in 1952 by John D. Rockefeller III, the Population Council, for example, started to offer graduate study fellowships in demography and reproductive physiology in 1954. The wealthy Clarence Gamble, in contrast, founded the Pathfinder Fund in 1957 to distribute contraceptives anywhere he wished. Moreover, though unheeded, the 1958 report of the Committee to Study the United States Military Assistance Program recommended conditioning international aid to the implementation of population limitation policies (Osborn 1954; Donaldson 1990; Necochea López 2014a).

All these actors put a premium on persuasion as a first-level intervention, aimed at both potential users of contraception, and at medical and policymaking elites in developing regions. The need to change people’s minds regarding contraceptives played directly to the strengths of the fledgling intellectual community to which Stycos and Hall belonged. It would lead to the strong promotion of a particular kind of population-making technology, the KAP survey, that could render people’s knowledge, attitudes, and practices regarding birth control and sexuality legible to experts and policymakers within and without Latin America.

2. Surveys, Attitudes, and Sex

The knowledge-attitudes-practice (KAP) survey harnessed and combined three broadly autonomous scientific developments with roots in early twentieth century US social science: (1) the methodology of survey research via statistical sampling; (2) advertising research aiming to change a target population’s attitudes towards a particular product or idea; and (3) the new field of sexuality and reproduction studies. These developments must, in turn, be seen in the context of early twentieth century US social science’s emphasis on the integration of different populations within a common system of national values. There is a significant continuity between the latter and the flattening of local variation that KAP research intended mid-century.

Survey research became relevant and possible in the 19th century, with the emergence of aggregated individual opinions as a factor to be considered in government or capitalist schemes (Herbst 2003; Igo 2007). By the 1930s, professional political and market surveyors, such as Gallup, Roper, and Crossley, entered the polling field, aided by recently developed probability sampling techniques already in use at the US Department of Agriculture, the Works Progress Administration, and the US Census Bureau. The notion that a mere segment of a population could be representative of the whole universe of possible opinions promised to make data collection less expensive and work-intensive, without sacrificing reliability, but critiques over the ways in which samples could be biased followed pollsters, and continued haunting them despite dramatic successes, such as Gallup’s prediction of Franklin Roosevelt’s victory in the US 1936 presidential election (Warwick and Lininger 1975; Desrosières 1991).

The participation of psychologists and mathematicians affected the practice of polling, transforming it into the versatile field of communications research, which aimed to rigorously describe human behavior, and also alter it (Lazarsfeld 1935). The International Journal of Opinion and Attitude Research, and Public Opinion Quarterly began to be published in the 1930s with these goals in mind. Philanthropic organizations and universities were also interested in how mass media influenced individual actions. In 1933, for example, the Rockefeller Foundation invited Viennese mathematician Paul Lazarsfeld to come to the US, and funded the Office of Radio Research at Princeton University in 1937 with Lazarsfeld as Director. The project moved to Columbia University in 1940, still led by Lazarsfeld, and became the Bureau of Applied Social Research in 1944 (Jeábek 2001).

With the patronage of corporate brands (such as Lucky Strike, Ex-Lax, and Kolynos) and the Department of State’s propaganda program during the Cold War, the Bureau of Applied Social Research (BASR) carried out communications research that resulted in advertising innovations, such as the use of focus groups, focused interviewing, and the concept of the opinion leader. It was enriched by a vibrant group of scholars that included C. Wright Mills, Robert Merton, and Kingsley Davis (Merton and Kendall 1946; Katz and Lazarsfeld 1955). Arguably, the most crucial insight the BASR exploited was that of the malleability of individual attitudes, popularized by sociologist W.I. Thomas in the early 1900s. As Thomas posited them, attitudes acted as a psychological mechanism linking the mind to its changing environment, and predisposing the individual to act in certain ways. Dynamic by nature, attitudes were relevant to the investigation of human development because they could change over the course of a lifetime through personal experiences and education, instead of congealing in childhood, as personality traits presumably did (Thomas 1912).

BASR researchers pursued the idea that understanding individuals’ attitudes was the first step in the development of communications strategies that could modify those attitudes and, therefore, behavior. Among these strategies were currying the favor of influential members of a given group, advertisements, and films.2 The sine-qua-non of any strategy, however, was a solid understanding of an individual’s attitudes, acquired through an interview. By 1948, the BASR had distilled its collective experience into a 73-page manual on qualitative interviewing, which would become a foundation for the training of generations of later KAP surveyors.3 Unlike regular polling, this interview format did not offer a set of alternative answers from which to choose, but rather aimed to help the respondent articulate his or her own individual view regarding a topic of investigation.

The bulk of the manual was devoted to the training of interviewers, who were called to be more than mere data recorders. They must know what problem they were investigating, why they asked the questions they asked, and how the collected materials would be analyzed. Their training focused on the establishment of rapport with respondents and on learning how to use the question guides given to them by their project supervisors, in order to cultivate a sense of when to deviate from the script provided. Indeed, the manual acknowledged that questionnaires could become “a strait jacket” if the interviewer followed them too closely and failed to engage with unanticipated responses or an interviewee’s reluctance. Sharing the interviewer’s own views (“a confession”), and antagonizing the respondent (“is [what you tell me] really true?”) were among the tips offered to make the best of these situations.4

More decisive than the manipulative tips, however, was the interviewer’s stock of scholarly knowledge. The BASR manual demanded a mastery of sociological and anthropological works, such as the Lynds’ Middletown (1929), Margaret Mead’s And Keep Your Powder Dry (1942), and Ruth Benedict’s Patterns of Culture (1934). What this literature accomplished, according to the BASR manual, was to sensitize interviewers to the idea that attitudes vary greatly with the stage of individual development, socio-economic status, place of residency, and national identity. Such general knowledge was deemed relevant even if it did not pertain strictly to a particular topic of investigation, because it served as “a reservoir of hunches for the interviewer in a specific interview.”5

KAP survey research also drew inspiration from contemporary social studies of sexuality and reproduction. Among them were Whelpton and Kiser’s research on the psychological factors that affected white Protestant couples’ attitudes towards fertility, a multivolume present-day classic known as the Indianapolis Study (Whelpton and Kiser [1946] 1955). A more daring and influential work was Alfred Kinsey’s research on male sexuality, which aimed to document actual sexual practices (Kinsey et al. 1948). The BASR manual credited Kinsey with an important cautionary insight: interviewee rapport was difficult to establish when a survey topic, such as sex, was taboo.6

Like the BASR manual, Kinsey realized the importance of educating interviewers. Their ability to make a respondent comfortable and their knowledge of sexual practices, especially those considered deviant, were key to asking follow-up questions and understanding the richness of each disclosure. Presciently, Kinsey noted that “[h]owever involved the reader may become in the statistics, the fine points of the argument, and the grand intricacies of the minute details, he will never understand this study until he comprehends the human drama that has been involved in securing the data” (Kinsey et al. 1948, p. 36). His interviewers were his most trusted students, who trained for a full year before being allowed to conduct interviews on their own. Anthropologist Paul Gebhard, one of these interviewers, and the eventual director of the Kinsey Institute after Kinsey’s death, called the training “agonizing,” and compared it to “a perpetual final examination” (PBS 2005). Given the responsibility interviewers bore, both the BASR and Kinsey invested considerable time and resources preparing them.

The reliance on surveys and attitude modification, which would characterize KAP research, points to a broader trend in US social science in the early twentieth century. As Dorothy Ross has argued, the discipline was imbued with the notion that liberal republican values, technological advances, and economic opportunities put the country in an exemplary position (Ross 1991). Not surprisingly, the most enduring sociological representatives of this trend were inspired by urban charity and reform work, and addressed the living conditions of African Americans, workers, and immigrants. Prone to understanding the behavior of migrants or the poor as the result of maladaptive national characters or subcultures, classics such as Thomas and Znaniecki’s The Polish Peasant (1920) and E.A. Ross’s Social Control (1901), emphasized the importance of understanding the mentality of “primitive peoples,” predicting their behavior when faced with a new environment, and assimilating them to “modern” US culture, in order to provide them with a measure of wellbeing.

Like their intellectual forebears, mid-twentieth century US demographers suspected that a modernizing goal, population limitation, could conflict with Latin Americans’ views regarding sex and family size. KAP research earned a place in their toolkit as a technology that made a population’s “maladaptive” habits visible, a pre-requisite to design plans to change those attitudes in favor of the small family ideal. Latin America’s presumed homogeneity on this issue loomed in the background early on. As Joseph Stycos put it, “we cannot afford to rest on the easy assumption that each society’s problems are unique and consequently must be studied in a unique fashion. The major bent of international research should be toward the discovery of similarities rather than differences among societies” (Stycos 1958, pp. 36, 148).

Unlike previous researchers, however, KAP surveyors were part of the techno-political project that matured in the 1940s to promote birth control in the Third World. Their research, like much of what came out of the BASR, dealt with the most expedient ways to position a novel product (contraceptives) before an allegedly homogeneous population of wary consumers and local decision-makers reluctant to sacrifice their political capital for a controversial cause. The critique of KAP research as intertwined with political imperatives and contraceptive innovations is not new, but scholars have understated its reliance on the communications research that also undergirded commercial advertising, as well as its departure from census-based demographic research (Marino 1971; Bulmer and Warwick 1983). More importantly, we have yet to address the actual work US surveyors carried out to convey the unfamiliar circumstances of developing nations to fellow experts and patrons.

3. KAP Counterpoint: Stycos and Hall

The methodology of KAP research was a boon to the heterogeneous group of intellectuals interested in population and health matters in developing nations. The careers of just two seasoned practitioners in this tradition, Joseph Stycos and Marie-Françoise Hall, illustrate well how their different backgrounds and professional trajectories could still converge towards a similar approach to framing fertility research. It was one that emphasized the need to uncover attitudes and motivate behavior changes, as well as to find a suitable division of labor in the research enterprise, with Latin Americans and US experts as unequal partners. Such conclusions were readily intelligible to other US experts.

Joseph Mayone Stycos was born in Saugerties, New York, in 1927. He completed his Bachelor’s degree in economics at Princeton in 1947, just as the OPR’s program linking demographic changes to economic policy acquired global visibility. In 1946, in cooperation with the University of Puerto Rico’s Centro de Investigaciones Sociales (CIS), Kingsley Davis and Frank Notestein of the OPR had launched a project to ascertain how Puerto Rico’s population could be made to decrease so as to not slow down industrialization (Hatt 1952). Sociologist Paul Hatt was Princeton’s man in San Juan, and Stycos helped him supervise local research assistants. Stycos’s early experiences in Puerto Rico are telling of his encounter with the educated middle class, deeply ambivalent about the US’s domination of the island’s political and economic life. The young Stycos dismissed these concerns as emerging from their wounded pride and their irrational desire “to keep from being absorbed” by US culture.7 Puerto Rico’s Governor, Rexford Tugwell, shared this assessment, and described Puerto Ricans as afflicted by a pride so dysfunctional that it “prevent[ed] the public acknowledgment of inferiority of any kind and [led] to the covering up of weaknesses and incompetencies” (Tugwell 1947, p. 8).

Like Stycos, Marie-Françoise Hall started her career in Puerto Rico. However, unlike Stycos, Hall was there as a physician, not a social scientist. Her interest in a health career was fashioned early. Born in Rocourt, near Liège, Belgium, in 1932, she lived through the bombing of her hometown by Germany during World War 2. As she put it, the traumatic experience was pivotal in her decision to “at all costs, decrease suffering.” Her family moved to Montreal, and she graduated from McGill University in 1953. She later attended Harvard Medical School, where she met and married Thomas Hall, another medical student. Marie-Françoise Hall graduated with a medical degree, and had her first son, in 1957 (Hall 2008).

After an internship year at the Royal Victoria Hospital in Montreal, the Halls left for Puerto Rico. The US was escalating its intervention in Vietnam, and the service project the Halls chose would stand for military duty. They worked as general practitioners at the Castañer General Hospital, in the rural central west of the island, as part of the missionary outreach of the Church of the Brethren. The daily experience of caring for anemic women and children with gastrointestinal parasites moved Marie-Françoise Hall to consider further training in public health. She found herself back in the US in 1960, taking courses at Johns Hopkins University just as Carl Taylor helped found the department of International Health, one of the first such academic units in the US. Hall returned to Puerto Rico, however, and obtained her MPH from the University of Puerto Rico (UPR) in 1962.

In the 1950s, US researchers deemed the Puerto Rican environment particularly favorable, with government agencies employing social scientists, and with an active interest on the part of the cabinet to keep abreast of work done at the university (Hill et al. 1955, vol. 3). In fact, since the early 1940s, the Puerto Rican political elite, led by Senate President Luis Muñoz Marín, along with Governor Tugwell, had endeavored to present the island as something of a social laboratory with a unique mix of Latin and US cultures, where social research could provide guidance to create a progressive and modern society, while showcasing the merits of the expert-driven change that had been frustrated in the US by opponents of the New Deal (Lapp 1995). Stycos and Hall, therefore, were not only contemporaries living in different areas of Puerto Rico, but also beneficiaries of the closer scrutiny of the Puerto Rican government over health matters, and of its interest in applied research. Both also witnessed and communicated the ambivalence of the general population towards US-led modernization. Smaller families, part and parcel of that imperative, were perceived as both a foreign standard and a means to promote maternal and child wellbeing (Briggs 2002; Lopez 2008).

In Hall’s case the emphasis on maternal and child health was reinforced by the support of the UPR’s Department of Preventive Medicine where she worked as a Research Associate, and by the availability of new birth control technologies, the intra-uterine device and the contraceptive pill. Although very recently invented (or re-invented, in the case of the IUD), the novel contraceptives were a thrilling improvement over the methods Hall had seen in action in Puerto Rico, mainly condoms and abstinence from sex. However, unlike Stycos’s presence, Hall’s was not determined by a patron’s population limitation agenda. Her motivation, instead, was pastoral. “When you diagnosed a pregnancy,” she noted, “usually the women were sad.” Offering birth control was, in her opinion, an effective clinical response to their suffering, a sort of suffering with which she could empathize as a mother herself (Hall 2008).

As Hall’s interest in family planning grew, social research of Puerto Rican popular attitudes towards contraception did as well at the UPR. To continue the work Paul Hatt started, the university’s CIS hired Reuben Hill as Director of a major KAP project, the Puerto Rico Family Life Study. The Rockefeller Foundation and the Milbank Fund provided funding to encompass an ethnographic study of child-rearing practices in rural Puerto Rico and, more importantly to the patrons, a survey of fertility goals and attitudes.8 Following his involvement with Paul Hatt’s and the OPR’s survey, Stycos had joined the PhD program at Columbia. As a graduate student, he worked in several of the advertising and public opinion projects of the BASR. Upon learning of the Puerto Rico Family Life Study, Stycos took a yearly leave from his studies to pursue a possible dissertation topic there. Kingsley Davis recommended him to Reuben Hill as “one of the most brilliant men we have on the Bureau staff.”9 Stycos’s first duty as Assistant Director of the Puerto Rico Family Life Study was to conduct a pilot KAP survey with 72 people to learn about child-training practices, sex roles, courtship patterns, the nature of consensual unions, and attitudes toward marriage, fertility, and birth control. The survey later expanded to include over 1,200 interviewees (Hill et al. 1959).

One of the most remarkable aspects of Stycos’s beginnings as a surveyor was his approach to turning the educated Puerto Ricans he met at the CIS into reliable information-gathering interviewers, one of the pillars of attitude research in the BASR tradition. Stycos allocated three weeks to the interviewers’ training, which comprised background readings and lectures about the project, interviewing tips and techniques, and a week of practice interviews (Stycos 1955a). The three-week training fell vastly short of the minimum demanded by Kinsey’s one-year standard, and failed to incorporate the broad social scientific literature the BASR called for. Considerations of cost, the treatment of local personnel as subordinate and ad-hoc allies, and the governmental need for rapid delivery of policy recommendations determined the quick pace of data gathering, turning the day-to-day work into something akin to guerrilla sociology: scantily equipped but motivated interviewers deployed by the project’s leader to visit locales for short bursts of questioning, followed by swift retreats to prevent communal backlashes against the indelicate interview topic.

Despite these challenges, the native interviewers exceeded Stycos’s expectations as data collectors. He judged their “unanticipated excellence” according to the standards of the BASR manual for accuracy, thoroughness, and resourcefulness.10 Asking questions in roundabout ways, seeming empathetic, and cajoling answers from unwilling respondents, were all proven BASR techniques that the Puerto Rican interviewers made theirs with ease and gusto to get answers to their questions. As one of them concluded, “every person can talk freely to anybody whom he believes to be serious and trustful in character and especially who have proved to be friendly.”11

Stycos’s Puerto Rican sojourn nourished a conviction that governments and educational institutions in developing nations ought to create a motivated pool of part-time workers who could be repeatedly called on for whatever projects US social scientists might have in mind. Proper training and job security were certainly issues to be resolved, but “most important of all is to give the interviewer a sense of his professional status; to alter the traditional concept of the interviewer as an enumerator who fills in blanks on a questionnaire, to that of the junior social scientist who conscientiously strives to secure reliable and valid information as the crucial first stage of a scientific project” (Stycos 1955b, p. 77).

Other distinguished social scientists sympathized with this pigeonholing of natives. Immanuel Wallerstein at Columbia University, surprisingly, believed US scientists had a duty to train local researchers, to “turn out not scholars but workmanlike applied social researchers who could design a study, utilize the necessary research tools, know basic methodology and some statistics, [and] be able to supervise a field staff.” In his opinion, Third World governments would more readily accept policy recommendations from US social scientists if locals were involved in the research, regardless of the subordinate conditions of the participation of the latter.12 This view of the non-US researcher as a professional sidekick, crafty but theoretically naïve and lacking initiative, was a fundamental departure from US standards, which called for a much deeper level of mentorship, participation, and theoretical understanding for interviewers. It was also one of the most telling statements that KAP surveyors made about the proper role of Latin Americans in scientific research, one which resonated with their US peers’ and patrons’ longstanding etnnocentrism.

Stycos carried this disposition towards Latin American researchers over to his subsequent KAP research projects in Jamaica, Haiti, and Peru in the 1950s and 1960s, where he sub-contracted the interviewing to social work students or specialized marketing firms (Stycos and Back 1964; Stycos 1964a; Stycos 1965). He preferred to keep local social scientists at arms length from his research, scornfully referring to them as “jobless intellectuals” who felt survey work was beneath them, who added their own interpretations to the data collected, and who “argued verbosely about grand theoretical points in the social sciences.” Stycos held fast to the asymmetric partnership model in which it was a US researcher’s prerogative to translate foreign cultures for funding agencies and experts, interpret findings, explain theoretical implications, and recommend policy changes, regardless of his (or her) ignorance of local history and politics (Kahl and Stycos 1967)13.

Though less inclined than Stycos to antagonize local social scientists, Hall also preferred asymmetric partnerships with local talent. While working on a fellowship in International Health from Johns Hopkins, she followed her husband to Peru, where he had a USAID contract to study the country’s health human resources. Between 1963 and 1964, Hall worked as a Research Associate at San Marcos University’s School of Medicine. Building on her established work as a family planning provider, she applied for funding from the Milbank Fund to carry out her first KAP survey. Like Stycos, she relied on a ready-made corps of interviewers: university social work students at San Marcos University, who received the same abbreviated training Stycos favored for developing regions. Given her lack of knowledge of the locale, Hall also engaged a marketing firm, the Oficina de Investigaciones de Mercado de Lima, to select a sample of 500 women in different socioeconomic strata and neighborhoods in Lima. The interviewers bore a letter of introduction from the Dean of the School of Medicine at San Marcos University. While pleased by the support of academic authorities, Hall was aware of how her status as a foreigner and a woman made her peripheral to such authorities. The latter would have barely registered her failure: “I did not have much to lose,” she believed. “It was my first venture. If I had failed, I would have tagged back on to my husband and gotten back to the States” (Hall 2008).

Fortunately for Hall, a few health policymakers supported the kind of KAP research she pursued, including Senator Alberto Arca Parró, Minister of Health Javier Arias Stella, and the Ministry’s Chief of Planning, David Tejada de Rivero. They were encouraged by President Fernando Belaúnde’s openness to discussing the problems caused by rapid population growth. However, they were also cautious about embracing a national family planning program without some evidence that such a program would provide significant health and socioeconomic advantages.14 Ironically, the asymmetric partnership model revealed the extent to which KAP researchers were dependent on local political patrons, even as the researchers made local social scientists into dependents.

What started off as a way to make something of her stay in Peru turned, with the funding, San Marcos’s support, and the changing political climate, into a chance to call attention to women’s reproductive lives. As Hall concluded, “practically without exception, [women] showed interest, concern, and willingness to talk about their pregnancies” (Hall 1965a, p. 432). More significantly, Hall documented a problem that echoed throughout Latin America with galvanizing force in the early 1960s: the high rates of illegal abortions that frequently landed women in emergency rooms, putting their lives in danger and depleting hospital resources. This finding would become the key to framing contraception as a health policy priority: the more women and medical workers had access to it, the more effectively they could lower abortion rates.

The 4th conference of the International Planned Parenthood Federation/Western Hemisphere Region, held in Puerto Rico in April of 1964, concluded with a momentous resolution to this effect. All delegates (over 200 of them) signed the document, including government representatives of Argentina, Bolivia, Brazil, Chile, the Dominican Republic, Ecuador, Guatemala, Haiti, Honduras, Nicaragua, Panama, Paraguay, Peru, and Venezuela. Signatories called illegal abortions a “critical problem” that threatened women, families, and national economies. Furthermore, they demanded a joint demographic study, coordinated by the Pan-American Health Organization, the Organization of American States, and the World Health Organization, to measure the magnitude and causes of the phenomenon, along with the identification of those most at risk.15 While supportive of KAP research, therefore, this was also a statement by Latin American governments about the transnational institutions they trusted to carry out such investigations and, by omission, those they did not.

Although the rallying cry against abortion united Latin American experts and policymakers by the early 1960s, it did not consistently lead to the popularization of family planning programs. Chile was farther than most in this regard, with pioneering KAP research on the epidemiology of abortion by physicians Rolando Armijo and Tegualda Monreal since 1960, a private family planning organization (the Asociación Chilena de Protección de la Familia) established in 1962, and a national family planning policy dating from 1965 (Rojas 2009; Zárate and González 2015). On the other hand, the Central American Federation of Obstetrics and Gynecology Societies, while acknowledging the risks and costs of abortion, recommended better sexual education and care for pregnant women to diminish it, along with a new legal framework to sanction abortion more effectively.16 These differences, in turn, spurred further KAP research, to persuade local policymakers and experts of the open attitudes of the populace towards birth control.

Armijo and Monreal’s and Hall’s scandalous findings about the frequency of illegal abortions in Peru and Chile reached a wide audience. The weekly magazine Caretas ran a feature on Hall’s survey, in which it attacked health authorities’ reluctance to promote a more vigorous defense of maternal health (Anonymous 1964). Princeton sociologist Charles Westoff was awed by Hall’s interviewees’ willingness to discuss their sexuality, a disposition he attributed to the whole population: “It is amazing in Latin America, where fertility surveys started much later [than in the US], that investigators moved much more quickly and without any seeming hesitation to ask questions on abortion and appear to get results” (Hall 1965b, p. 113). Mary Calderone, medical director at Planned Parenthood Federation of America, used the visibility KAP research gave to abortion to castigate her own country: “the Latin American countries are out-shining the United States in one aspect of maternal health care: recognition of, and beginning efforts to control, the serious problem of illegal abortion, which we have equally seriously in our own country but refuse to admit” (Calderone 1964).

Along similar lines, Hall explained that the goal of her study, more than recording the precise incidence of abortion, was framing it as a major social problem for local and foreign constituencies. As she put it, “what I did was break the ice” (Hall 2008). Indeed, a few physicians followed her lead and used her questionnaire in other KAP surveys in Peru. Moreover, Peru’s first population research agency, the Centro de Estudios de Población y Desarrollo, established in 1964, would go on endorse the campaign to curb the reliance on abortion to end unwanted pregnancies (Iannacone 1964; Silva 1966; Bachmann 1969). Much to Hall’s surprise, there was no feared Catholic Church reprise against her work, not even after her endorsement of a non-reiterative barrier method, the IUD (Hall 1966). Likewise, Hall found little opposition by men to their wives’ use of contraception, a finding that led her to advocate for the greater availability of family planning information in schools and clinics for men and women, teens and adults alike. The latter recommendations arose from another KAP survey Hall conducted with USAID funds in Chile, where she lived between 1967 and 1971, again, because of her husband’s work. That survey included 960 men in the city of Santiago and the rural township of María Pinto, and was conducted by male students at the Universidad de Chile, hired through the School of Public Health, and trained for about eight hours (Hall 1969; Hall 1971). Mentoring time for interviewers in the KAP entreprise trended downwards over time.

While Hall stayed close to the notion of contraception as the medical alternative to abortion, Stycos was less enthusiastic about this rationale’s effectiveness in popularizing family planning. In his opinion, bringing the prevalence of abortion to light could motivate family planning use, but not as effectively as networking beyond the clinic. His own KAP research convinced him that professional public relations personnel had skills complementary to those of health workers since “physicians transfer family planning technologies to patients, and communicators transfer motivation and information so patients demand and use those technologies.”17 Satisfied users of birth control were, also, underutilized resources who could help spread positive views of birth control. Harkening back to his BASR days, Stycos argued that such tactics ought to be “deployed flexibly, imaginatively, and pragmatically, like a market researcher or advertising agency would.”18

Stycos’s emphasis on creating demand is crucial to understand KAP surveys as the population-making technologies they were. These not only brought to light attitudes about family planning and sexuality, but also simultaneously portrayed those attitudes as mutable, and prescribed that communications strategies would encourage contraceptive use. “The most important function of such surveys,” wrote Stycos, “is similar to any market research project: to demonstrate the existence of a demand for goods or services, in this case for birth control” (Stycos 1964b, p. 368). Like sellers of tampons, toilet paper, and deodorant, birth control advocates faced the challenge of selling something that people wanted, but found difficult to discuss. For peddlers of the indelicate, “[i]magination and boldness is what is required, but those will never be cultivated until we break away from the medical atmosphere which views advertising as a vice rather than a virtue.”19 In other words, it was not necessary to wait for a woman to face the stark and joyless choice between an unwanted pregnancy and an abortion. Rather, the most important message should titillate, with slogans like “contraceptives mean sex with no babies” (Omang 1977).

Stycos’s marketing and Hall’s medical approaches to changing knowledge, attitudes and practices through persuasion contrasted with the strong-arm approach the US government used to make others fall in line with its prescriptions. The establishment of the Alliance for Progress in 1961 as a counterweight to Cuba’s joining the Communist bloc, for example, legitimized the overt expression of hostility towards left-wing ideas that were a regular feature in the Latin American political landscape. Department of State officers began to decry the “communist menace” in international forums, alienating Latin American attendees. Stycos groaned while thinking that these “Bumblers of Good Will,” as he called them, strengthened the impression that “whatever the United States does for Latin America is only in its self-interest in its personal struggle with Communism” (Stycos [1959] 1960).

Hall too noted that Latin Americans grew suspicious of the US government’s narrow obsession with population limitation. In her opinion, the US was seen as primarily interested in preventing social disturbances that would diminish its power, in finding quick technological fixes to rapid population growth, and in instilling consumerist patterns of behavior to benefit US industries. This agenda, in her opinion, overshadowed much-needed US-Latin America cooperation to improve child nutrition, housing, sanitation, education, employment, and international trade conditions (Hall 1973).

There were, according to both Stycos and Hall, ample medical, ethical, and socioeconomic grounds on which to build family planning programs, more persuasive to Latin Americans than the US’s anti-communist calculations. Building on the work of development economists such as Richard Nelson, for example, Hall and Carl Taylor embraced the idea that a smaller and healthier population could make substantial contributions to economic productivity. Women’s health, in particular, could be vastly improved with voluntary and regular access to contraception to space pregnancies, and with comprehensive health programs beginning in pregnancy and extending through the postpartum period (Nelson 1956; Taylor and Hall 1967).

Despite surveyors’ nods towards the importance of debating poverty and development, however, changing popular attitudes through the publicizing of survey results, and negotiating common ground with medical experts and policymakers remained their favored strategies. In fact, they feared that broadening the discussion too far beyond family planning, or demanding more aid for development-related topics went beyond their scope as researchers and could even paralyze ongoing collaborative endeavors. As Stycos noted in the mid-1960s, “Latin America is a touchy region, population control a touchy subject, and American dollars a touchy means to almost any end today. Put them all together and they spell danger” (Anonymous 1965, p. 39).

4. A Farewell to KAP

Despite the inroads she made as an international health researcher in family planning, Hall missed clinical work. The intellectual community that surrounded her in Santiago was abuzz over the election of Salvador Allende when the Halls left the country in 1970. She too felt the need for change: “In public health you can do a lot of good, but you don’t know whose life you’re saving, and I was ready for more intimate contact with my patients” (Hall 2008). Hall’s departure from the field of fertility research and her return to practice were radical. In 1973, she began a residence in psychiatry at the University of North Carolina, specializing in child psychiatry. After 1976, she worked as a staff psychiatrist and lecturer at UNC, and in private practice in various places in North Carolina until her retirement in 1997. Throughout those twenty years, she also worked briefly in Taif (Saudi Arabia), San Francisco, North Dakota, and New Zealand. She never again worked on another KAP survey (Hall 2008).

Joseph Stycos, in contrast, became increasingly invested in population research and pedagogy through Cornell’s International Population Program (IPP), which he founded in 1962 and directed until 1992. Early on, its funding came from philanthropies like the Ford Foundation and the Population Council. It grew in the late 1960s with USAID and NIH grants to produce family planning pedagogical materials and to consult on the effectiveness of family planning communications programs in developing nations.20 Between 1969 and 1979, the IPP prepared KAP questionnaires through an agreement with CELADE, and trained over 50 graduate students, some of whom became important decision makers at CELADE, the US National Center for Health Statistics, the UN’s Demographic Center in Cairo, the Population Council, the World Bank, and Canada’s International Development Research Agency.21 By the early 1970s, some 400 KAP surveys, of varying quality and scope, had been conducted worldwide (Cleland 1973). Some population researchers complained about how the methodology was increasingly becoming a component of a family planning communications and evaluation industry, with decreasing interest in producing new insights, or even in fieldwork itself (Demeny 1988). In 1971, the USAID began negotiations with the International Statistical Institute, a prominent international society of statisticians based in The Hague, to create the World Fertility Survey (WFS). This program aimed to help interested developing countries carry out “nationally representative, internationally comparable, and scientifically designed and conducted sample surveys of human fertility.” Although intended to overcome the methodological fragmentation of KAP research, the prestigious and well-funded WFS also framed fertility research as the basis of sound population policies, and considered previous KAP studies as its forerunners, without which “a world survey would no doubt be impossible” (Sprehe 1974).

More important to the decline of KAP research, however, were changes in developing countries that militated against the US imperative to limit population size. For one, a highly contested World Population Plan of Action was approved at the International Conference on Population of Bucharest in 1974. In it, developing country signatories defeated the US position to establish demographic growth quotas, and instead demanded respect for national sovereignty in population policymaking (Finkle and Crane 1975). Representatives of developing countries moved away from defining rapid population growth as the problem, and instead claimed that the root cause of most social ills had to do with the poverty that resulted from the unequal distribution of wealth in the world. This position had been building up in developing countries since the 1960s, and became institutionalized with the creation of the UN Conference on Trade and Development (Prebisch 1964). Developing nations’ insistence that population problems derived from social and economic ones, and that development was, therefore, necessary to tackle population problems effectively, contrasted sharply with the priorities of KAP research: producing knowledge about people’s attitudes towards contraception to come up with more effective population limitation strategies.

Lest we throw the baby out with the bathwater, we must move beyond the decline of KAP research to consider its momentous historical role as a technology of population-making. Surveyors succeeded uniformly as framing specialists who portrayed Latin American populations as likely to welcome family planning, given the right combination of incentives and communications strategies. The desirability of lowering the incidence of illegal abortions was one of those incentives, and it spurred support for family planning programs in the 1960s. In addition, KAP surveyors documented lay people’s willingness to discuss their sexuality and childbearing aspirations. Those reports both shed light on and encouraged the popular desire to normalize birth control as just another consumer product. Neither the problem of the recourse to abortion nor that of the lack of access to contraception has been completely resolved yet, and remain, therefore, crucial aspects of Latin American fertility debates. Both problems, furthermore, point to the existence of multiple “Populations of Cognition” in Latin America, made up of experts, policymakers, and lay men and women. However different their attitudes towards contraception might have been, KAP research portrayed those attitudes as modifiable.

This volume’s Population of Cognition analytic can also be aimed upstream: KAP surveyors themselves were a Population of Cognition that sought to produce new knowledge about demographic problems in the developing world. These experts enjoyed substantial institutional resources in the mid-twentieth century, thanks to CELADE, local universities, the Milbank Fund, the Ford Foundation, the Conservation Foundation, the Population Council, the Rockefeller Foundation, and, later, the USAID and the NIH. These organizations provided not only money, but also opportunities for researchers to discuss each other’s work, network, and to learn to reproduce their research in new locales. Hall’s and Stycos’s works highlight the effectiveness of this patronage and collegiality. Their major studies were products of generous external funding, local partnerships, and the adaptation of existing questionnaires.

The use of KAP survey technology, in addition, gave consistency to this Population of Cognition. Between the 1940s and 1970s, this ubiquitous tool brought together new ideas, practitioners, publics, and sponsors into a rich amalgam that departed from established demography. The KAP survey rested on the pillars of statistical sampling, advertising, and sexuality research, which were features of US social science by the mid-twentieth century, but had not yet been brought together. The impetus for such a convergence came early in the Cold War, over the effects of rapid population growth on political instability. In that context, new strategies to understand and change attitudes towards contraception benefitted the population limitation agenda. Surveyors in practice, however, did not completely embrace that agenda, siding with local allies for more comprehensive maternal health interventions, as Hall did, or criticizing the clinic-bound nature of birth control discussions, as did Stycos.

In general, however, the US interest in curbing rapid population growth encouraged research that isolated this problem from other aspects of life in developing nations. Deep understanding of and a longstanding interest in a specific country were not required to produce results that other surveyors accepted. KAP research could well be the outcome of short-term opportunities. The low time investment required for KAP studies, relative to anthropological fieldwork, for example, may have made them especially attractive to female intellectuals like Hall who, regardless of their accomplishments, still expected to subordinate their research interests to those of their male partners in the mid-twentieth century.

A more significant cleavage within the population of KAP researchers was determined by national origins. US investigators dominated the upper echelons of KAP work, with most Latin Americans framed as competent assistants or interviewers since the earliest forays in Puerto Rico. This asymmetic partnership model failed to develop local talent systematically and reproduced the ethnocentric assumptions of early twentieth century US social scientists. In addition, by refusing to enter broader discussions with Latin American social scientists, US KAP researchers squandered an opportunity to make demography more broadly relevant to Latin Americans.

Notes

1. 

On the history of censuses in Latin America, see Loveman (2014).

2. 

BASR, Papers of the Bureau of Applied Social Research at Columbia University archives. (Hereafter BASR). Stanley Bigman. 1951. “Evaluating the Effectiveness of USIE Programs: A Manual on Research Methods and Techniques.” Box 119, folder B-0396.

3. 

BASR, 1948. “Training Guide on the Techniques of Qualitative Interviews.” Box 155.

4. 

BASR, 1948. “Training Guide on the Techniques of Qualitative Interviews.” Box 155, pp. 16–7, 25, 29.

5. 

BASR, 1948. “Training Guide on the Techniques of Qualitative Interviews.” Box 155, p. 68.

6. 

BASR, 1948. “Training Guide on the Techniques of Qualitative Interviews.” Box 155, p. 13.

7. 

JMS, papers of Joseph Mayone Stycos at Cornell University archives. (Hereafter JMS.) ND1. “Puerto Rican Strength.” Box 11, folder 16, pp. 64–5.

8. 

FSC, Family Study Center collection at University of Minnesota archives. (Hereafter FSC.) ND1. “The Family in Puerto Rico Research Project”; and “Stages in a long-term project in family life.” Box 15, folder “Progress reports, Univ. of PR project.”

9. 

FSC. 1951. Kingsley Davis to Reuben Hill, June 25. Box 15, folder “Progress reports, Univ. of PR project.”

10. 

RHP, Reuben Hill papers at University of Minnesota archives. (Hereafter RHP.) ND. “My experience as interviewer in the Family Life Project.” Box 41, folder “Puerto Rico Study.” JMS. 1959. Kurt Back, and J.M. Stycos, “The Survey under Unusual Conditions.” Box 11, folder 18.

11. 

RHP. ND. “My experience as interviewer in the Family Life Project.” Box 41, folder “Puerto Rico Study.” JMS, papers of Joseph Mayone Stycos at Cornell University archives. 1959. Kurt Back, and J. M. Stycos, “The Survey under Unusual Conditions.” Box 11, folder 18, p. 12.

12. 

BASR. 1961. Immanuel Wallerstein to Bernard Berelson on Special Training Program for Social Researchers from Underdeveloped Areas. Box 106, folder 262.

13. 

JMS. 1963. “Encuestas para Ciencias Sociales a Base de Muestreo en las Zonas Subdesarrolladas.” Box 11, folder 6.

14. 

See chapter five in Necochea López (2014b).

15. 

PPFA II, Planned Parenthood Federation of America papers at Sophia Smith Collection, Smith College Archives. (Hereafter PPFA II.) 1964. “Resolution (April 25).” Box 202, folder 4.

16. 

PPFA II. ND. Elías Faraj and René Carranza, “Aborto – Factores Médico-Sociales.” Box 202, folder 3.

17. 

JMS. ND2. “El Papel de los Directores de Información y Educación y las Prioridades Pragmáticas en Comunicaciones en Planificación Familiar.” Box 11, folder 6, p. 25.

18. 

JMS. ND2. “El Papel de los Directores de Información y Educación y las Prioridades Pragmáticas en Comunicaciones en Planificación Familiar.” Box 11, folder 6, p. 1.

19. 

JMS. 1961. “Motivation and Clinics.” Paper presented at the 3rd IPPF/WHR Conference in Barbados, April 19–23. Box 11, folder 9, p. 2.

20. 

JMS. 1963–1979. International Population Program annual reports. Box 10, folders 16–18, 23–25; and box 11, folder 1. JMS. 1971. Joseph Stycos, “My Vintage Year with the Foundations.” Box 11, folder 9.

21. 

JMS. 1979. Final report: Cornell NICHHD Training Grant (January). Box 14, folder 40.

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