The Akha Heritage Foundation - www.akha.org
Akha Human Rights - Akha University
 
 
 
Document
You may copy and save this document for later reading.
Please remember to do a site search for other related documents which may not be shown here.

Paul Lewis Sterilizes the Akha Chapter 1

Missionary Genocide against the Akha
(This is the first installment of Pau Lewis's family planning document. Future installments will be posted to the link in Contents section, "Sterilization"

Paul Lewis was an American Baptist Missionary. When seen in perspective of Thai attitudes about the hill tribes and their demands for sterilizations of these people, then Paul Lewis fits right in. However he seeks to make out as if he is doing the people a favor rather than doing himself a favor. As well we see many prejudicial remarks in this document typical to how missionaries rewrite the identity of a people, something the Akha say Paul Lewis was very good at. The Akha have not come to an end, dispite Paul Lewis's dreary picture and the huge funds missionaries have enriched themselves by exploitation of the Akha "distress". This report gives detailed evidence by Paul Lewis, how he conducted a sterilization program on the Akha.

Paul Lewis states as late as the 1990's that his sterilization program of the Akha was a good thing.)

 

It should be noted that Paul Lewis's project was protested by individuals who claimed that the Akha women did not have Free, Prior and Informed Consent to this precedure. Thai witnesses stated that the women did not know what the implications were of what was being done to them. Paul Lewis's network of Pastors was used to gather the women in, paying a commission for each woman, and also used to help keep the women silent afterwards. We talked specifically to Pastors who said that this was the case, how they were involved.

****

Chapter One

THE INTRODUCTION OF A FAMILY PLANNING PROGRAM TO AKHAS IN THAILAND

by PAUL WHITE LEWIS

A DISSERTATION
Presented to the Department of Anthropology and the Graduate School of the University of Oregon in partial fulfillment of the requirements for the degree of Doctor of Philosophy

March 1978

An Abstract of the Dissertation of Paul White Lewis for the degree of Doctor of Philosophy in the Department of Anthropology to be taken March 1968

Title: The Introduction of a Family Planning Program to Akhas in Thailand

Approved:

(Dr. Theodore Stern)

An analysis is made of the introduction of family planning to the Akha (Ekaw) tribal group living in Thailand over the period from November 1973 through July 1977.

The Akha population of Thailand, numbering approximately 14,000 in mid 1977, has experienced a 3.5% growth rate per year, which means they are doubling their population every twenty years. They face severe land shortages, inadequate economic resources, and poor health.

A family planning program was introduced by a missionary-anthropologist, under the medical auspices of the McCormick Family Planning Program, and under approval by agencies of the Thai government. An Akha field worker was selected, trained, and sent out to the villages to give information and contraceptive aid. Of various methods offered, female sterilization became popular, with many Akha and other tribal women asking for the operation.

Read More......

Central to the program was the formation of the Akha Advisory Committee, made up of Akha elders from many of the villages. This group met several times each year to guide the program. They also initiated other programs which became part of the total family planning outreach, including: village education, innoculation [sic] of children, and economic development. It was found that such an integrated approach to these tribal people met with excellent response.

The impact of the program upon the Akhas, both socially and demographically, is analyzed, along with the routes of diffusion of the information. The conclusion reached is that the program has made some impact upon the demograpphic situation, although there are many other variables, and the time is so short, it is impossible to pin-point the exact cause-effect relationship.

How the decision is made by Akhas to have sterilization is discussed against the background of their culture. Also, the way Akha women view the sterilization is considered, with special interest in finding the factors which will be helpful or harmful to the program in the future.

It is believed that the family planning program should continue, but with a significant expansion of service to include much more medical care (including innoculations) as a regular part of the program. The conclusion is reached that a program which attuned to the culture and needs of the people, and operated (where possible) by them, while at the same time cooperating with government programs, is ideal for helping a preliterate minority group of people in Southeast Asia solve their population problem.

VITA [p.iii]

NAME OF AUTHOR: Paul White Lewis

PLACE OF BIRTH: Denver, Colorado

DATE OF BIRTH: June 30th, 1924

UNDERGRADUATE AND GRADUATE SCHOOLS ATTENDED:

Baylor University
Eastern Baptist Theological Seminary University of Colorado

DEGREES AWARDED:

Bachelor of Arts, 1944, Baylor University

Bachelor of Divinity, 1947, Eastern Baptist Seminary

Master of Arts, 1968, University of Colorado

AREAS OF SPECIAL INTEREST:

Southeast Asian Tribal Groups
Applied Anthropology
Medical Anthropology
Action Anthropology

PROFESSIONAL EXPERIENCE:

Missionary, Board of International Ministries, American Baptist Churches/USA, in Burma 1947-1966, in Thailand 1968-1977

Lecturer in Anthropology, University of Chiang Mai, May 1969-March 1971

PUBLICATIONS:

1968 Akha-English Dictionary. Ithaca, New York: Cornell University, Data Paper: Number 70.

1968 The Role and Function of the Akha 'Village Priest'. Behavior Science Notes 3(4):249-262. [p.iv]

1969 Ethnographic Notes on the Akhas of Burma. HRAFlex Book A04-001, vol. 1,2. New Haven: Human Relations Area Files.

1969 The Rice Theme in Akha Culture (in Thai), The Journal of Sociology and Anthropology. University of Chiang Mai, Vol. 2, No. 2:31-35.

1970 Introducing the Hill Tribes of Thailand. Chiang Mai University: Faculty of Social Science. (Mimeographed)

1970 Ethnographic Notes on the Akhas of Burma. HRAFlex Book A04-001, vol. 3,4. New Haven: Human Relations Area Files.

1972 Phonetic Problems Involved in Teaching Thai to Speakers of Lahu and Akha. Thailand Phonetics Conference. Mahidol University: Faculty of English.

[p.v]

ACKNOWLEDGEMENTS

It was December 1947, while driving in Burma from Rangoon to Kengtung, that I first saw some members of the Akha tribe. I was impressed with them then, and am even more impressed after living and working with them since that time. I acknowledge with sincere gratitude all they have taught me and shared with me. I am especially grateful to those who have. I am especially grateful to those who have participated in this project: the Advisory Committee members, Yaju Cehmui, the people of Ba Jaw village, and other Akhas, both old and young.

Special thanks to the leaders of the Board of International Ministries of the American Baptist Churches/USA, for their backing and support, and for their willingness for me to use furlough time for the writing of this dissertation.

Family Planning International Assistance, the funding agency during most of the life of the Tribal Family Planning Project, has been more than simply the provider for budgetary needs. Carrie Lorenzana, Director of the Asian office, has been like another member of our team. FPIA Director Dan Weintraub saved the program from being summarily cut off, which act I trust he will never have reason to regret. Funds for the writing of this dissertations were also graciously provided by FPIA.

[p.vi]

It is impossible to thank by name all in the Royal Thai Government who contributed so helpfully to this project. From the Ministry of Public Health to the local health and government officials, we have had excellent cooperation and backing. Besides their help to me personally, I am especially grateful for their sincere desire to help the tribal people.

My special thanks to the two Overseas Missionary Fellowship couples, Peter and Jean Nightingale, and Peter and Ruth Wyss, for all their help. Along with the Akhas of Thailand, I mourn the tragic death of Peter Wyss in March 1977. He completely gave himself for them in life and death.

Sincerest gratitude is due to the members of my committee from the University of Oregon: Dr. Theodore Stern (advisor), Dr. Homer Barnett, Dr. Vernon Dorjahn, and Dr. Walter T. Martin. They helped prepare me for time in the field, backed me up while there, and patiently guided me in the writing of my findings.

Drs. Lucien and Jane R. Hanks have helped in many direct and indirect ways. Their data have been of great value, and their counselling and encouragement have been priceless.

[p.vii]

My sincerest thanks to the McCormick Family Planning Program, and especially the director, Dr. Edwin B. McDaniel. This project would never have become a reality apart from their help and concern. Dr. Arunee Fongsri, also part of that program, is the one who deserves very special credit for making tubal ligation such an attractive alternative to tribal women in Thailand and Kentung State, Burma. The 1,128 tribal women who have received tubal ligations at her cappable and loving hands would no doubt wish to join me in expressing deepest thanks to her, and to the efficient staff she has trained.

Thanks too to Kathy Toepel for producing the maps and charts for this dissertation.

And very special thanks to my wife, Elaine, who has been completely involved in all of my life and service among the tribal people of Southeast Asia. She has helped in more ways than she can ever know. She has been the perfect partner for the project, and the writing up of the project.

[p.viii]

TABLE OF CONTENTS

page

ACKNOWLEDGMENTS............................................................................................................................................ v

LIST OF TABLES..................................................................................................................................................... xi

LIST OF FIGURES................................................................................................................................................... xii

CHAPTER ONE: Theoretical Considerations............................................................................................................. 1

The Setting................................................................................................................................................. 2

The Demographic Problem........................................................................................................................... 4

Conclusion................................................................................................................................................. 10

CHAPTER TWO: The Akhas: A People in Distress................................................................................................. 11

Orientation................................................................................................................................................. 11

Settlement Patterns.................................................................................................................................... 16

Marriage and the Family.............................................................................................................................. 20

Sociopolitical Structure............................................................................................................................... 22

Religion..................................................................................................................................................... 23

Health....................................................................................................................................................... 24

Economy.................................................................................................................................................. 26

Mobility..................................................................................................................................................... 29

Opium....................................................................................................................................................... 33

Contacts with Others.................................................................................................................................. 35

CHAPTER THREE: Akha Attitudes Regarding Reproduction..................................................................................... 41

Introduction............................................................................................................................................... 41

Attitude Toward Number and Sex of Children................................................................................................ 42

Attitude Toward Sex................................................................................................................................... 45

Attitude Toward Childlessness.................................................................................................................... 47

Attitude Toward Pregnancy......................................................................................................................... 51

Attitude Toward Birth................................................................................................................................. 53

Attitude Toward Limiting Pregnancy............................................................................................................ 57

Akha Reaction to Limitation of Pregnancies................................................................................................ 63

Conclusion............................................................................................................................................... 64

[p.ix]

CHAPTER FOUR: Amelioration Programs for Akhas................................................................................................ 66

Royal Thai Government (RTG)..................................................................................................................... 66

Missionary Groups..................................................................................................................................... 78

Other Groups............................................................................................................................................. 82

Reaction of the Akhas................................................................................................................................ 84

CHAPTER FIVE: Introducing Family Planning to the Akhas..................................................................................... 86

Historical Background................................................................................................................................ 86

Initial Contacts.......................................................................................................................................... 89

The Program Develops............................................................................................................................... 91

Diffusion of Family Planning Information....................................................................................................... 104

Conclusion................................................................................................................................................ 108

CHAPTER SIX: An Analysis of People and Program................................................................................................ 109

Program Director....................................................................................................................................... 109

Medical Advisor......................................................................................................................................... 110

Medical Supervisor.................................................................................................................................... 111

Local Workers.......................................................................................................................................... 111

Precautions.............................................................................................................................................. 113

Problems Encountered............................................................................................................................... 115

Advisory Committee Expands Program....................................................................................................... 121

Cooperation with Other Groups.................................................................................................................. 123

Opposition to the Program........................................................................................................................ 124

CHAPTER SEVEN: Program Acceptance by the Akhas.......................................................................................... 127

Acceptance of Reversible Contraception..................................................................................................... 127

Acceptance of Female Sterilization............................................................................................................ 136

Male Methods........................................................................................................................................... 149

Rejection of Abortion................................................................................................................................. 149

CHAPTER EIGHT: Decision Making Regarding Tubal Ligation.................................................................................. 151

Introduction.............................................................................................................................................. 151

Who Makes the Decision?........................................................................................................................ 152

Factors Involved in Making the Decision..................................................................................................... 162

Conclusion.............................................................................................................................................. 165

CHAPTER NINE: The Sterilization Process........................................................................................................... 166

Pre-operation........................................................................................................................................... 166

Arriving at the Hospital.............................................................................................................................. 172

The Operation.......................................................................................................................................... 177

[p.x]

Post-operation......................................................................................................................................... 180

Conclusion............................................................................................................................................... 183

CHAPTER TEN: Demographic Impact of the Program............................................................................................. 184

Ba Jaw Village......................................................................................................................................... 184

Population Sample................................................................................................................................... 188

Comparison with Other Populations........................................................................................................... 196

Conclusion.............................................................................................................................................. 203

CHAPTER ELEVEN: Conclusion.......................................................................................................................... 204

The Program............................................................................................................................................ 204

The Future............................................................................................................................................... 212

The Akha People...................................................................................................................................... 214

APPENDIX: Telegram Concerning the Program....................................................................................................... 217

BIBLIOGRAPHY................................................................................................................................................... 223

[p.xi]

LIST OF TABLES

TABLE

Page

1. Summary of Bennington-Cornell Survey of the Akhas...................................... 15

2. Akha village change over ten years................................................................ 31

3. Acceptance of contraception by Akhas......................................................... 128

4. Tribal tubal ligation...................................................................................... 138

5. Comparison of sterilizations among Thai and tribal women.............................. 139

6. Age-parity grid for women accepting sterilization: Akha women from Thailand... 144

7. Age-parity grid for women accepting sterilization: Akha women from Burma...... 145

8. Comparison of women who have been sterilized............................................. 146

9. Comparison of Ba Jaw village....................................................................... 189

10. Comparison of villages where addiction is heavy and light............................... 195

11. Akha women 15-44 in seventeen villages...................................................... 196

12. Demographic facts related to Akha sample................................................... 197

13. Comparison of tribals and Thai in Hogan's survey.......................................... 199

14. Comparison of three populations.................................................................. 202

[p.xii]

LIST OF FIGURES

FIGURE

Page

1. North Thailand.................................................................................. 14

2. Mae Chan Nikhom north to the Burma border...................................... 18

3. Injections of DMPA to Akhas............................................................. 131

4. Rate of female sterilization................................................................. 142

5. Rate of sterilization: Akha women only.............................................. 143

6. Age pyramid of Ba Jaw village (November 1974).................................. 186

7. Age pyramid of Ba Jaw village (Mid 1977)........................................... 187

8. Age pyramid for Akha sample (Mid 1977)........................................... 191

9. Lahu village of Goshen (Mid 1977)..................................................... 200

p.1

CHAPTER ONE

THEORETICAL

CONSIDERATIONS

The Akha population living in Thailand has been experiencing rapid growth, as have other populations in Southeast Asia (Myrdal 1970:139-163, Kunstadter and Chapman 1970:148, Hinton 1970:6). Pressures resulting from this acceleration of population growth create increasingly serious problems for the and the country in which they live.

Is it possible to introduce and develop a family planning program that will help the Akhas reduce their population growth in a way which will meet their needs, as they perceive them, and still be compatible with their culture? What will be their reaction to contraceptive methods which originated in a different culture, as well as to a program which is introduced to them by someone outside of their ethnic group? Are there certain patterns and themes from this program developed for the Akhas which can be useful in presenting such a service to similar populations in other parts of the world?

This dissertation is an account and analysis of the introduction, acceptance, and results of a family planning program for the Akhas of Thailand, which is attuned to their culture and needs.

p.2

The Setting

Problems

In viewing the Akha population, we see a situation, in which there are currently too many people for the available land and resources (Conway and Romm 1973:6, Kunstadter 1970:57, Wanat and Oughton 1970:320). Myrdal gives a grim picture of the Asian scene (1968, 1970). He indicates several basic factors which create the many interrelated problems confronting the people of Southeast Asia.

1) Technological. The technology they now possess is too simple and inefficient to meet their needs (Myrdal 1970:130).

2) Capital. There is a lack of necessary capital to effect the changes which are essential for sound and lasting development (Myrdal 1970:363-385).

3) Organizational. There is a problem of developing an organization which will provide communication aimed at binding decisions within the group, along with the establishment of networks with outside resources.

4) Education. There is a lack of the right type of training which will enable the people to solve their own problems (Myrdal 1970:182-193)

p.3

5) Population. Population pressure magnifies the other problems and hinders their early solution (Myrdal 1970:140-143).

Possible Solutions

Myrdal's basic assumptions are accurate, but at the same time there are some hopeful signs:

1) Science and technology provide a means of helping to relieve the situation. The "miracle grains" are a specific example of this (Conway and Romm 1973, Greenland 1975, SEADAG 1970, vol.1 and 2). Miracle rice has been a boon to many large-scale farmers in Asia, making some areas self-sufficient in rice. The aid to poor farmers living at or near a subsistence level is slight, however, since the fertilizers, pesticides, machinery for tillage and harvesting, proper irrigation control, and access to both seed and markets are out of their reach. Even more significant to the tribal people of Thailand is that no strain of miracle rice has yet been developed which is suitable for dry cultivation (Kunstadter and Chapman 1970:160).

2) Various international organizations are working together in an attempt to bring relief to poverty areas. The work of WHO, FAO, UNDP, and the World Bank has helped directly and indirectly to lift many of Asia's distraught, undernourished masses (King 1974). Some multi-national efforts to build dams or jointly exploit natural resources have also been carried on in an effort to raise the economic level of the Third World.

p.4

3) Governments are much more aware of the problems than before, and are anxious to do something to rectify the situation-- if for no other reason than to save themselves. There are more and more well-trained men and women in key positions of government in the Third World nations who are anxious to push active programs to assist the needy in their countries. {footnote 1: Often bureaucracy, inertia, and corruption hamper their well-intentioned plans, however.}

4) Many of those most deeply affected by Third World poverty, the poor themselves, are taking more responsibility in remedying their own situation. There are more educated people among them with skills needed to cope with their mounting problems, but often they do not have opportunities to use their skills, especially when they are a minority people.

The Demographic

Problem

This study focuses on a set of problems, primarily demographic in character, of one ethnic group in Southeast Asia. The solution of these problems will not meet all of the needs of the group being reached. It may help to remove impediments to its development, however. Also, it provides valuable experience in addressing such problems with a multi-organizational approach.

p.5

The problem Thailand faces as it considers the demographic picture in the tribal areas is at once strategic, economic, and humanitarian. Strategic because it involves populations along international borders, economic because it deals with forest and land resources in the north, and humanitarian because it affects the life of people for whom Thailand feels a responsibility.

The segment of Thailand's population which faces this demographic problem tends not to understand the complexity or depth of the problem. They realize their situation is deteriorating economically, physically, and socially, but they know neither the root causes nor the possible means of correction.

Can Anthropology Help?

The demographic problem is so large and complex that many disciplines must seek, both individually and in concert, to find workable solutions. Demographers, rural sociologists, rural economists, agronomists and many others have already made significant contributions.

Anthropology as a discipline can also make valuable contributions to solving this problem. Anthropologists (especially applied anthropologists) have long been interested in the guidance of the introduction of change in the light of the characteristics of the subject group (Spicer 1952, Barnett 1956, Foster 1969). They have found that a knowledge of the cultural problems involved is absolutely essential in order to introduce programs of change. For example, Opler (1964) tells how in the mid 1960's the government of India introduced a cheap and effective method of birth control to the Indian people. They did not, however, take into account the deeply rooted, traditional practices and beliefs of the people, and as a result that particular program failed. A technical solution by itself is not enough to insure acceptance.

p.6

Cultural Change

Several things should be noted about cultural change, which are pertinent to this study:

1) Individuals and groups change all the time. Any group (including the Akhas) is not the same today as it was yesterday, and tomorrow it will be different yet (Goodenough 1963:272-283). {footnote 2: Change for the Akhas takes place within a fairly well bounded 'Akhaness' which they recognize. Change which is too violent may cause them to feel that a person is no longer a 'true Akha.'}

2) Cultures are constantly changing, but they do not always change in predictable ways, nor does the change necessarily parallel that of other cultures. People around the world want to change in a way that will meet their wants and needs, with the least possible breakdown of their social control mechanisms (Goodenough 1963:349).

3) Some change takes place against the will of the people (Barnett 1953:62). Sometimes the change does not work out like the group thought it would. Or sometimes there were so few indicators of the future course of change that the group involved has little chance to determine its value at a time when the group could have done more to control the direction of that change.

p.7

4) In the strictest sense of the word, cultures do not change--it is people who change. The Akha tribe cannot be said to "want family planning," but there may be many Akha couples in Thailand and Burma who are anxious for contraceptive help. {footnote 3: When in the course of this study I speak of the 'Akhas wanting this,' or the 'Akhas doing that,' I mean that this is the general trend that I have seen over the last eight years. When writing about 'the Thai,' 'the Akha,' 'the Lahu.' etc., I am giving my own judgment [sic] of the condition I see among the majority of that groups. The actual condition is not that simplistic.}

5) Some proffered change will be rejected (Spicer 1952:18). Sometimes the change will be accepted in part, or perhaps adapted by the accepting group. Also, some change will be rejected today, but accepted tomorrow when certain conditions are altered. The possibilities are endless, especially when examining populations in the Third World. {footnote 4: Sometimes the change they want to make (such as watching TV) will not be available to them, since they have neither electricity nor the TV set.}

6) The change must meet the target group's needs. For example, in Thailand some agricultural schools have experimented with a new variety of rice for swidden cultivation which matures in only ninety days, about sixty days earlier than most rice now planted (Tuck 1970:207). There are practical problems with this rice, however: a) the taste is not nearly as good as the mountain rice the people now plant, b) its storage qualities are poor, c) it must be harvested before the monsoons are over (which creates severe harvesting problems), and d) it ripens at a time when no other rice is ripening, so for some time before and during harvest people have to remain in the fields to drive away the droves of birds that will otherwise eat the crop.

p.8

My Field Approach

In describing what he called "action anthropology," Tax states that the anthropologist comes into a field situation with two coordinate goals: 1) to help the informant group in solving a problem, and 2) to learn something in the process (Tax 1958). In action anthropology, as practiced by Tax and those who worked with him in the Fox Project, it is believed that the people being studied should have the right of self-determination in the project, as well as the chance to make their own mistakes (Gearing 1960:169).

The action anthropology approach best describes my own field method in introducing a family planning program to the Akha people. However, I went beyond what is usually termed action anthropology, in that I helped to organize the group, and worked with them in defining and solving one of their major problems. (For a description of my activities in the project see especially pages 94-114.)

p.9

There is often a vast cultural gap between the group that needs the service, and the group which can provide it. Basically I saw my role as a catalytic agent who had some understanding of the Akha people and the group which could provide family planning services. This being the case, I sought to do the following:

1) Point out the actual situation to both groups, and then help them reach their goals in a mutually reinforcing way.

2) Point out alternat choices when there was conflict of purpose, with special consideration being given at all times to the cultural variables of the group to receive the services.

3) Evaluate and criticize the program as it developed, so as to encourage the two groups to find workable solutions which would allow the program to grow at its own pace.

4) Give special consideration to make sure the program did not produce deleterious effects on the population receiving help.

In some ways this general approach is not new to missionaries, since many have long been convinced that it is the ideal way in which to help goups in the Third World. It should be noted, however, that I did not spend my time on the field primarily as an anthropologist, or primarily as a missionary, but as one friend helping another. I only hope that I at least partially achieved the goals Tax set up: 1) that I did help the informant group in solving (or beginning to solve) a problem, and 2) that I did learn something in the process.

p.10

Conclusion

The people of the Third World, especially those in rural areas, face serious problems which appear to be proliferating by the moment. Change is taking place among them constantly, often at a dizzying pace. They may consider some of this change to be helpful, but for the most part they have no choice as to what changes take place, or the direction in which they will go. They are becoming increasingly frustrated about this, for they feel they should be masters of their own destiny.

What is the answer, or better yet the answers, since the complexity of the situation precludes any simple solution? Can a missionary-anthropologist give constructive help in this situation? Is there anything that can be learned from one group's experience that will help other preliterate groups handle their own change more effectively?

In this section we have considered the macro situation. Let us move to the micro world--the world of the Akhas living in Thailand.


Copyright 1991 The Akha Heritage Foundation