美援下的衛生政策：一九六○年代臺灣家庭計畫的探討

本文討論一九六O年代臺灣的大規模節育活動。以往大多數衛生與人口政策史論者依據人口成長率的下降，認為該計畫應是十分成功的衛生政策。本文試圖將該計畫的決策與執行重新置於當時美援主導臺灣政治經濟發展的歷史背景，進而提出補充與質疑。在政策制定與執行上，本文指出個人節育與國家節育在邏輯上的區別，並釐清當時在經費短缺下臺灣衛生政策的決策實際。此外，本文也探討在政策說詞與執行實際的差異下，衛生當局的因應與婦女的抗拒。成果方面，對政治經濟學者所關心的美援性質問題，本文以臺灣家庭評劃的個案研究，提出美援在經濟與政治方面外的具體影響，擴展批評的範圍與層次。其次對將衛生視為中立客觀的醫療政策論者，本文主張衛生與健康並非孤立的知識與真理，它們必須回到歷史脈絡下理解才有意義。最後，藉著統計資料的重新爬梳與解讀，本文試圖體現在衛生說詞與國家政策下婦女的異議聲音，點出在衛生與人口政策史的論述下，婦女再現與論述的可能。

關鍵字

美援；人口控制；家庭計劃；子宮內避孕器；婦女身體

並列摘要

This paper examines a salient example of medical policies in Cold War period Asia-the population control program in Taiwan. Influenced by America, Taiwan was singled out by policy experts as the successful story among East Asian countries attempting family planning. However, unlike those non-historical approaches, this paper places this topic within social and historical context, examining the rhetoric and reality of the population control program in 1960s Taiwan. My argument addresses the following: 1. Pressured by the US, the Taiwanese government ignored the difference between the ideologies behind ”individual birth control” and ”national population control. ” Thus was accepted the US' suggestion that the over-growth of population was the most important concern of Taiwan seeking more rapid economic development-besides, the enforced control of the number of new births was the only way to solve the problem. 2. Furthermore, because of the limited health budget, the US, rather than the Taiwanese government, determined the medical policies in Taiwan. Thus, population control became a medical concern in the rhetoric of the Taiwanese health department; forced upon the people, this birth control program was practiced under the name of family planning. 3.In doing so, the health officers used IUDs and implanted them in Taiwanese women's bodies, claiming them to be the best choice for women to avoid unnecessary pregnancies and the best tool for the state to control new births. In the meantime, because of IUDs' severe side effects, some women refused to use them, but had no chance to speak out directly in public.