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This is FRESH AIR. I'm Terry Gross. The culture wars have gone international, and at the center of them is who controls women's fertility. That's the premise of the new book, "The Means of Reproduction: Sex, Power, and the Future of the World," by my guest, Michelle Goldberg.

She says reproductive rights are the place where many of the crucial forces shaping and changing women's lives intersect: religious authority, globalization, patriarchal tradition, international law, feminism and American foreign policy.

One example of how American foreign policy can come into play is the so-called gag rule that said the U.S. would not offer financial aid to health and family-planning organizations around the world that performed or promoted abortion.

The policy was begun under President Reagan, rescinded by President Clinton, reinstated under President Bush and rescinded again by President Obama.

Michelle Goldberg is a former senior writer for Salon.com, where she wrote extensively about the Christian right. She's now a senior correspondent for the American Prospect. Her previous book was called "Kingdom Coming: The Rise of Christian Nationalism."

Michelle Goldberg, welcome back to FRESH AIR. Why, after writing a book on Christian nationalism, did you want to focus on reproductive issues around the world?

Ms. MICHELLE GOLDBERG (Author, "The Means of Reproduction: Sex, Power, and the Future of the World"): I would say there are two reasons. The first is that while I was, you know, working on this book about religious fundamentalism in American politics, I really saw a lot of the groups that I was writing about getting involved internationally.

Even though they disliked and distrusted the United Nations, they saw the power it was wielding, and they started to organize within it. They started building alliances with fundamentalist movements around the world, including with some conservative Muslim groups.

So I was, you know, kind of fascinated in the globalization of the phenomenon that I had first written about domestically. And at the same time, after spending a year immersed in a world whose values were in many ways very hostile to my own, even if the people were often quite lovely, it was such a relief to spend time with women all around the world who were fighting the very forces that I had written about in my first book.

GROSS: Some of the history is so interesting. You write that during the Cold War, Republicans saw birth control and family planning as a way to strengthen capitalism around the world. What did they see as the connection between family planning and strengthening capitalism?

Ms. GOLDBERG: Basically, at the time, overpopulation was an issue of public concern, almost analogous to the way that global warming is now. It was something that all educated people, you know, had heard about, talked about. It was something that people believed was going to create apocalyptic devastation in the very near future.

And a lot of Republicans were just kind of Cold War, national-security types, thought that overpopulation was going to cause so much misery in the developing world that it was going to lead a lot of these countries to communist revolution.

GROSS: So you say a lot of this global family-planning infrastructure was actually created by Republicans during the Cold War. Give us some examples of that family-planning infrastructure created by Republicans.

Ms. GOLDBERG: Well, an obvious example would be George H.W. Bush, who was absolutely obsessed with this issue, who saw family planning as crucial to the future of world prosperity, American prosperity.

He presided over international family-planning conferences, where he tried to convince other nations to adopt population-control measures. You know, he was so concerned about this issue that people used to call him Rubbers.

You also had Dwight Eisenhower, who not only, you know, wrote about this issue, but was actually at one point a co-chairman of Planned Parenthood, and even during the Nixon administration was seen in many ways a golden age of family planning. And it was during the Nixon administration that Americans first pushed for the creation of the United Nations Population Fund, which today is really enemy number one for many on the right.

GROSS: What does it do? What does it fund?

Ms. GOLDBERG: Well initially, it just funded population control, and it did, you know, population-control research and funded contraception and sterilization and that sort of thing.

Things have changed a lot since then, and now it's much more involved in a kind of global program of women's empowerment. So it fights for women's education, against fistula, against female genital mutilation or what some people call female circumcision. It's involved in this much broader kind of program of women's health and rights, but it was really founded as an agency of population control.

GROSS: So during the Cold War, when American political leaders saw family planning as a weapon against communism, what was happening in the communist countries with birth control? What were their, you know, birth control and abortion policies like?

Ms. GOLDBERG: Well, this is something that's so interesting because, obviously, China today is the kind of apotheosis of coercion with the one-child policy, and they're absolutely obsessed with getting their birth rate down. But at this time, their policy was, just as the kind of Republican policy was the mirror image of what it is today, so was the Chinese policy.

They believed that more people equaled more power, and that these efforts by the developed world to reduce human numbers was just an attempt to weaken them and, you know, was just a kind of another front for imperialism.

GROSS: Okay, so you're painting this picture where, you know, it's Republicans who are really pushing for family planning because they see it as a weapon in the Cold War. Is there a line where that changes, where positions change, and suddenly the Republican Party moves more against family planning? Or you know, at least against birth control, and on the far end of the right, maybe against contraception, too?

Ms. GOLDBERG: Yeah. I think that that kind of culminates with the rise of the religious right and the kind of rise of Nixonian, you know, silent-majority politics, the rise of kind of cultural populism.

I mean, and it wasn't just Republicans. It was this - who was initially pushing for family planning. It was this kind of Cold War consensus that this was a huge issue that the United States had to tackle, so you know, with Harry Truman and Eisenhower, who were co-chairmen of Planned Parenthood.

What happened, I think, was that birth control and abortion became associated in the American mind with the counterculture. You saw the rise of the religious right in the 1970s. You saw this kind of attempt by Nixon that's been followed by all later Republicans to capture working-class Catholics, and so it became just another issue in the culture war.

GROSS: You write that in the '70s, a group of feminist-minded women who came up through the ranks of the population-control movement decided to take it over from within. And their goal was that women's rights and women's health had to be ends in themselves, that population control wasn't the only goal. It was about women's rights and women's health. So how did that change the movement?

Ms. GOLDBERG: Well, population control was often kind of quite callous about the way women made decisions, about the kind of lives that they wanted to live, about why they had so many children.

You know, it tended to think of them in these very coldly impersonal, technocratic terms. And then it was the women who came up through the movement who said the kind of things you're talking about have no relation to what we see of women's lives and that you can't just, you know, kind of open sterilization camps or, you know, try to bribe people into getting an IUD inserted.

You know, there are reasons that women have so many children, and you need to kind of look at the entire of spectrum of their lives. You know, so as I think, you know, many of us know now, one of the best ways both to bring down family size and to increase the number of children who survive and increase child health is to educate women.

You know, when you educate women, when they work, when they have more power about the kind of decisions that they make within their own households, you have a kind of much more holistic improvement in children's health that translates to lower population sizes.

GROSS: How successful were the feminists within the population-control movement in defining the issue as about women's rights?

Ms. GOLDBERG: Well, by 1994, when there was this huge conference in Cairo, you basically had kind of the feminists succeed in writing the platform. So no longer was the language about population control. It was about reproductive rights, reproductive health.

That's the paradigm now, and that's what shifted. And it can sound like just kind of so much verbiage, or it can sound as if there's, you know, this is just a kind of new gloss put on a kind of old Malthusian program, but it really has changed the way that these things operate on the ground. And slowly, it's also changed international law so that we now have reproductive rights basically recognized in international law, which is quite a new thing and I think hasn't gotten the kind of attention that it deserves.

GROSS: You know, a point that you've made is that the passage of Roe v. Wade, which legalized abortion in the United States, turned reproductive issues into larger issues about women's rights, women's reproductive rights. It wasn't just about family planning. And if you - can you just describe a little bit how you think that resonated around the world?

Ms. GOLDBERG: Sure. Well, it's not even that it was just Roe versus Wade that transformed the issue in that way. It was that Roe versus Wade, first of all, you know, transformed the issue to one about local sovereignty versus, you know, the kind of abstract and tyrannical power of the federal courts.

And at the same time, it happened as the feminist movement was itself kind of gaining steam, and so groups that had really not been that concerned about abortion in the past - you know, most Evangelical groups had not gotten unduly worked up about abortion. You know, they generally saw that as a Catholic issue, and they saw the Catholics as their theological enemies.

But because they emerged in response to, you know, the social chaos of the '60s and '70s, as abortion became kind of synonymous with the feminist movement, with the breakdown of the family, they reacted. And so abortion has become the kind of symbol of everything that they feel has gone wrong in American society since the 1950s.

And one of the things I think is fascinating is that it's only usually when abortion is understood in these terms that it becomes really contentious. India legalized abortion at around the same time that the United States did, and it's never been an issue in that country. It's never - there's no anti-abortion movement, save for a few kind of Catholic groups. And part of the reason for that is that it was always done under the kind of rubric of population control. It had nothing to do with changes in gender roles, and thus it didn't really seem to threaten people.

You know, Japan is similar. I mean, Japan legalized abortion far before we did. It was actually, I think, the first country to do so. But again, when it was just presented in terms of population control, it didn't seem to upset people that much.

It's the change in gender roles and the change in gender dynamics that is this kind of symbol of the end of one order and the kind of onrushing of the modern world that always, in different ways in different countries but over and over again, creates these big upheavals.

GROSS: My guest is journalist Michelle Goldberg, author of the new book, "The Means of Reproduction: Sex, Power, and the Future of the World." We'll talk more after a break. This is FRESH AIR.

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GROSS: If you're just joining us, my guest is Michelle Goldberg, and her new book is called "The Means of Reproduction: Sex, Power, and the Future of the World."

You write that although a lot of religious conservatives weren't really fans of the U.N. or of, you know, global political groups, they learned from the success of the international women's movement when it came to reproductive issues and in many ways started to imitate the women's movement. Give me some examples of what you mean.

Ms. GOLDBERG: Well, basically, a lot of the stuff that the United Nations does is kind of opaque, especially to Americans. It's hard to see how some of the decisions and statements that come out of these big conferences actually affect people's lives, but abroad, they really, really do.

And so as kind of some of these conservative groups became more and more aware of that, they got consultive status within the U.N., which gives them the ability to attend all these meetings as NGOs and to put on their own meetings, you know, to put on their own kind of sessions during some of these global conferences.

They also just started organizing to stack the delegations so that, you know, you have these delegations. They negotiate all of these seemingly obscure decisions, but again, that have quite a lot of impact. So they would start kind of lobbying to get their people on the delegation so that, you know, instead of, say, having a professor of public health from Columbia University, you started to have, you know, a kind of famous televangelist or somebody from the Family Research Council or something stacking a lot of these delegations.

And then they also started networking. There's now something called the World Congress of Families, which brings together religious fundamentalists and religious conservatives from all around the world, you know, in which they put aside their theological disputes and they meet every two years and they try to form common cause against what they see as the real enemy, which is, you know, feminists and secularists and liberals.

GROSS: You say that the U.S. found support for its anti-abortion policies in some of the more repressive quarters of the Middle East and North Africa. And as an example, you give a U.N. family-planning conference in 2002, where American delegates joined hands with delegates from Iran and Sudan. Can you talk about that alliance at this conference?

Ms. GOLDBERG: Well, this is, you know, this kind of amazing irony because, right, this is after September 11th. This is at a time when the United States is ostensibly at war with this axis of evil, and yet there were - there's always been people on the Christian right, although obviously hostile to Islam on a theological level, who recognize that their kind of real allies when it comes to social policy are Iran and Sudan and Saudi Arabia.

And that would almost sound like a slander if it was just me saying it, but, you know, in this book, you'll see it's often them saying it. And so they realize that if you're going to have a bloc at the United Nations that's going to fight improvements in the spread of reproductive rights, if you're going to fight, you know, any attempts to expand women's rights in international law, you're going to need to form a bloc to stand against the many countries that are seeking to expand women's rights at the global level.

So the natural allies - you know, you have, on the one hand, you have France and Britain, Canada, all these - Japan, you know, are kind of countries who should be our natural allies. But under Republican leadership, you consistently saw the United States willing to put aside all of its, you know - you know, it's interesting.

The United States was refusing to talk to Iran about so many things, but they were willing to talk to them and to cooperate with them when it came to this, which in a way also shows what a serious threat they see women's rights and reproductive rights to be.

GROSS: For your book, you not only researched the shifting American position on family planning, you also traveled to Africa, you traveled to Latin American countries.

Now you say in Africa, there are countries in East Africa where botched abortions are responsible for a third of maternal deaths. Give us just a sense, just looking at this very big continent, how reproductive issues affect larger health issues for women.

Ms. GOLDBERG: Well, it's so profound, and I think I had read about some of these numbers, but they don't become real to you until you visit some of these hospitals.

You know, I've been in hospitals in Ethiopia and in Nairobi in Kenya where doctors who work in gynecological wards will tell you that that is what they do all day. They clean up botched abortions all day long.

In the vast majority of sub-Saharan African countries, these laws banning abortion are basically left over from colonial constitutions. So the countries that gave them these laws, you know, England and France, have long since left them behind, but they've remained in place in almost all of Africa.

And I think, you know, we all know that maternal mortality in Africa is a global scandal. One in every 26 women is going to die in childbirth in Africa, and in some countries, it's one in six women that's going to die in childbirth. And so you can't solve maternal mortality by legalizing abortion and providing safe abortions, but you also can't cut maternal mortality without doing that.

If you have, you know, unsafe abortion responsible for a third of maternal deaths, it's one of the easiest ways that you can start to bring down some of these, you know, scandalously high numbers. And the other piece of this, of course, is just the kind of shockingly inadequate provision of contraception, right?

High abortion rates mean that there's a really big failure of contraception. And it's interesting that in these countries where abortion is illegal, abortion rates are shockingly high. They're higher than they are in the United States.

And so these laws are not, you know, protecting life, as abortion opponents would have it. They are simply kind of driving women to these kind of brutal and desperate measures to - and, you know, women know in general when they can support a pregnancy and when they can't, and it takes a lot to get a woman to have a child when she doesn't want to or is not ready to.

GROSS: One of the places you went to for your research was Uganda and where a domestic-reform bill had failed. What were the provisions of this bill, of this failed bill?

Ms. GOLDBERG: You know, often when you get to some of these countries, it's kind of shocking how much we take for granted here in terms of rights that are still completely out of reach for people, for women in other countries.

And so this particular reform bill, it had a number of provisions, but the one that proved the most contentious was the one that would have banned spousal rape.

Men were outraged at the notion that they could be charged for raping their wives. You actually had legislators arguing that the real violence lay in women who refused to have sex with their husbands. And so, you know, in a country where AIDS is a enormous problem, where marriage is a primary risk factor, and where women have no ability, in many cases, to you know, ask, much less force their husbands to use condoms - even what seems to us like a relatively obvious reform had people marching in the streets in kind of mocking opposition.

GROSS: Michelle Goldberg will be back in the second half of the show. Her new book is called "The Means of Reproduction: Sex, Power, and the Future of the World." I'm Terry Gross, and this is FRESH AIR.

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GROSS: This is FRESH AIR. I'm Terry Gross back with journalist Michelle Goldberg, author of the new book "The Means of Reproduction: Sex, Power and The Future of the World". It's about how reproductive rights have become the focal point of the global culture wars. Goldberg's previous book was about the rise of Christian nationalism in the U.S. She's a former senior writer for Salon.com and is now a senior correspondent for the American Prospect. Your book opens with the story of a woman who became the minister of health in Ghana. And it's the story of how she switched from being anti-abortion to pro-choice. Would you just tell us a capsule version of her story?

Ms. GOLDBERG: Sure. Well she was the stepdaughter of an Anglican minister. Had very conservative views, kind of the typical views of her class, you know, a kind of upper middle class, educated woman living in Ghana. And she told me about when she was in training, when she was a resident, women who would come into the hospital with botched abortions were put in something called the Chenard Ward, and they were essentially kind of left on the floor until everyone else in the hospital had been taken care of.

When everyone else in the hospital had been taken care of, they would be kind of marched across the courtyard to have their evacuations done without people really cleaning the operating rooms. I mean they were just, you know, as she told me they treated them like the scum of this earth. And what changed her mind was when a family that she was treating, and she'd become very close to them, when their daughter who she, you know, really loved came to her and asked her for something to bring on a late period. This was a 14-year-old girl who didn't really understand what's happening to her. And she sent her away angrily and told her to send her mother. And then a few days…

GROSS: Because she opposed abortion at that point.

Ms. GOLDBERG: She opposed abortion and was kind of horrified that this girl would even ask for something like that. So she sent her away and then a few days later she heard noise. Well she's heard some drumming and heard noises while she was in her - while she was in her office and a nurse told her that it was the funeral procession for this young girl, Ameena, who - it turned to the older man who'd gotten her pregnant had -after this doctor refused her - the older man had taken her to some kind of traditional quack.

He had tried to do an abortion, it had killed her. And this doctor described that to me as a kind of road to Damascus. She was really devastated by that and had since become kind of one of the most - one of the most important advocates for reproductive rights in all of Africa.

GROSS: What's her name?

Ms. GOLDBERG: Her name is Dr. Eunice Brookman-Amissah.

GROSS: The people who got into positions of influence, internationally, during the George W. Bush administration - and I'm referring here to positions pertaining to, you know, birth control and abortion - what happens now during the Obama administration? Do they - do new appointees replace them?

Ms. GOLDBERG: Yes. The vast majority of those people who were appointees who will now be replaced. I mean, you know, one really good example is Mark Dybul who is the head of the president's global AIDS program, which is called PEPFAR. And Mark Dybul was not in many cases, you know, he didn't come from a conservative background but he proved very willing to, kind of, hew to the conservative line since that was the way to get Evangelicals invested into global AIDS programs, you know? So he was, you know, would often side with him against contraception and against various kind of woman's reproductive health issues.

You know, one of the first things that happened when Hillary Clinton became secretary of state. Hillary Clinton is someone who has a long history with the International Women's Movement, who has been very strong on these issues. And no sooner had she been appointed, or no sooner had she - no sooner had she taken office then he was told, kind of unceremoniously, to leave by the end of the day.

GROSS: So you think that will be happening with other people too?

Ms. GOLDBERG: Yeah absolutely. I think that, especially because so much of - so many of the people who make important decisions in this area are in the State Department. The fact that there's someone in the State Department who has made global women's rights a priority, it just has a kind of incalculable impact.

GROSS: Michelle Goldberg, thank you so much for talking with us.

Ms. GOLDBERG: Oh thank you so much for having me.

GROSS: Michelle Goldberg is the author of the new book, "The Means of Reproduction: Sex, Power, And The Future of the World."

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