Divest

March 26th, 2015
Navajo Mine at  Four Corners Generating Plant

“Apathy is Deadly”
Bumper sticker

Our planet could support many more people if each person consumed less. One of the largest problems caused by our consumption is greenhouse gas emissions from using fossil fuels.
The divestment movement aims to reduce our reliance on fossil fuels and to increase usage of renewable energy. It pressures institutional endowments to sell off investments in companies that produce fossil fuels.
Most colleges and universities have endowments. Gail (my wife) and I met at and graduated from Swarthmore College near Philadelphia; its endowment is over a billion dollars. It uses the interest from this money in excellent ways—to provide student scholarships, increase salaries and to build new, efficient buildings. Unfortunately it won’t disclose how the endowment is invested.
Divestment (freeing endowments from investments in fossil fuel companies) makes sense for three reasons. The financial and environmental reasons are intertwined and one affects the other. Let’s examine the financial reason first—the value of oil and coal stocks is declining so it doesn’t make sense to invest in them. The current low price of petroleum is a short-term cause for this decline. Another reason for their loss of value is that society is finally recognizing the “externalities”—costs of fossil fuels that are not included in the price of these commodities.
An example of an externality is the mercury that coal fired power plants have pumped into the air for years. This poisonous metal is a trace pollutant of coal. When coal is burned, mercury settles into streams and contaminates the fish we eat. Mercury is especially toxic to pregnant women and young children. Paradoxically, fish is “brain food” that would otherwise be good during pregnancy and for youngsters. The price of the electricity we buy from power plants does not pay for the harm done by the mercury they emit—that harm is an externality. If all the externalities were accounted for, the cost of electricity generated by coal should be twice or even triple the price that we actually pay for it.
In order to protect our health, the Environmental Protection Agency is increasing regulation of ozone and carbon dioxide as well as those of mercury emissions. Ozone causes serious respiratory problems and premature deaths, and the CO2 emissions, of course, are changing our climate. The recent disastrous oil spill and subsequent fire in West Virginia illustrates additional problems with the transport and use of fossil fuels.
The esthetics of energy development are also problematic. Mountaintop removal is hideous. Having a pumpjack in your yard is ugly and noisy.
The value of traditional carbon-based investments is diminishing as society recognizes how problematic they are. It is possible that they will become worth next to nothing—“stranded assets”—as regulation of the industries increases and as more and more people realize the harm they are causing. These are reasons many colleges and universities have already divested.
Investments in renewable sources of energy, on the other hand, are improving. The cost of photovoltaic panels that convert sunlight into electricity has dropped significantly over the past years, bringing solar generation into parity with generation by coal in some cases. As the price drops, it is expected that more and more people will be able to afford to generate their own “juice”. The cost of wind-generated power is also dropping. I expect investments in these technologies to do well in the future.
The two reasons for divestment already mentioned—financial and environmental—are closely connected in our capitalistic society. The third reason may not be intuitive, but for me is the strongest motivation—young people are sparking the divestment movement. A group of students at Swarthmore College recognize the destruction caused by mountain top removal for coal in Appalachia. They are propelled by the injustice of rich people in remote cities who use the labor of poor people in the “hollers” to destroy their own future livelihood. These students advocate keeping coal and oil in the ground to avert a climate disaster that might otherwise imperil the future, including my granddaughters.
My generation has innocently benefitted from using fossil fuels. We have had an inconvenient awakening that our use of petroleum, coal and gas has changed our world.  Although we will not see most of the repercussions of these changes, our progeny will. We owe it to our grandchildren to do what we can to mitigate these alterations. One small but significant step is to divest from personal investments in fossil fuels, and to demand that endowments to which we contribute also divest.
© Richard Grossman MD, 2015

Provide Family Planning in the Democratic Republic of the Congo

February 22nd, 2015

DR Congo woman & child small 

The London Summit on Family Planning was the start of something big. If kept, an array of promises made at the groundbreaking July 11 [2012] event could have a major impact on the lives of women and girls for years to come.

                                               Susan A. Cohen, Guttmacher Institute

 

In a prior article I wrote about how it was possible for one doctor to perform hundreds of tubal ligations in one day—but probably not honor the rights of the patients. The next column was about putting human and reproductive rights first and foremost. Today’s column focuses on one country where FP2020 is making amazing improvements in the lives of women and children.

FP2020 is the nickname of the ambitious program started in 2012 at the London Summit on Family Planning. Its goal is to reach 120 million women of the 225 million who are unable to access modern contraception, but wish to regulate their fertility. These are women in developing countries who currently have little or no access to reproductive health care. Typically they have high fertility rates and high rates of child deaths, illegal abortion and maternal mortality. Often these women are the poorest of the poor, have little schooling and are subservient to men. Many of these women live grim lives.

A very high percentage of people in wealthy countries already use family planning (FP); indeed, that is part of how we became wealthy. It is time to share that knowledge and technology with our less fortunate brothers and sisters. Unfortunately where access to FP is limited, infrastructure is also challenging—transportation, sanitation and communication are often poor. Reaching these people will be difficult.

Providing full reproductive health care for every woman in the world who does not currently have access to those services would cost a whopping 40 billion dollars annually—about the same amount as the US military spends in a month. The lives saved by such an investment would make that money very well spent, however. Reaching all people in developing countries with FP and with maternal and newborn care would prevent 79,000 maternal deaths, 26 million abortions and 21 million unplanned births each year.

The cost of providing just FP services for these people would be about nine billion dollars a year. Because moms will be healthier, improved birth spacing alone would prevent over a million infant deaths globally each year!

Funding is a major challenge for FP2020. The programs are jointly supported by developing countries and by donor (wealthy) countries. In addition, generous funding has come from foundations; the Bill and Melinda Gates Foundation is a major source of financial support as well as being a prime mover. Assistance also comes from the UN and the US Agency for International Development, among many other organizations.

One of the FP2020 programs is in the Democratic Republic of the Congo. This beleaguered country has had a miserable history of colonialism, dictators and civil war. Average income there is less than two dollars per day. Only 53 % women are literate, and only one in twenty married women uses a modern method of contraception. Indeed, a 1933 law makes contraception illegal! The average woman bears over 6 children in her lifetime and the country will double in population every 23 years—exacerbating many of its economic and political problems.

Despite these challenges, FP2020 is seeing successes in DRCongo. One project was to map existing FP resources, using a sophisticated system of data collection with cell phones. They now know where there are trained FP personnel and which pharmacies have pills or injectable birth control. Fortunately, all sites offer condoms.

Women in DRCongo have been relying on traditional methods of FP for years, with too many unintended pregnancies—more than a million in 2013. Contraceptive implants (such as Nexplanon®) were introduced in 2014 with great success. So far, the program has recruited almost 200,000 new users of modern contraception.

What FP2020 has meant to women in DRCongo is telling. More than 300,000 unintended pregnancies were averted in 2013. Calculations suggest that 1481 women’s lives were saved, and 76,000 unsafe abortions were prevented by the use of modern contraception.

FP2020 offers hope for the future, especially for people in countries such as DRCongo. I am optimistic that FP2020 can help women and families lead healthier and happier lives and will be a model for the future of family planning. And I expect it and future programs will be built on respect for the people that they serve.

© Richard Grossman MD, 2015

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Thank you! Richard Grossman MD, MPH  richard@population-matters.org

Preclude Abuse in Family Planning Programs

February 4th, 2015

 

Ethiopia-s-Family-Planning-Success_650x400

Image courtesy of Pathfinder International

The London Summit on Family Planning in 2012 was the start of a new focus on family planning (FP). The last time FP had received so much attention was the Cairo conference in 1994.

Several factors had turned attention away from FP. The HIV/AIDS epidemic received a huge amount of attention and funding. Donor fatigue was another factor, since FP programs are expensive and the results can be difficult to measure. Perhaps abuse was the most important reason that people lost interest in FP programs. For instance, it became clear that people in many countries, including our own, had been sterilized without informed consent.

Long ago I assisted with infertility surgery on a woman who had had 3 cesareans in Texas and was unable to conceive a fourth child. We found that her Fallopian tubes had been surgically interrupted without her knowledge or consent. Apparently her doctor in Texas didn’t think she should have any more children and had tied her tubes.

The darkest chapter in the history of FP was eugenics, the practice of trying to improve human genetics. In some cases eugenicists mandated sterilization of “undesirable” people—people of color, people with birth defects or learning disabilities, and people with mental problems. Often the eugenics movement was allied with political goals; the enemies were labeled as “undesirables”. My personal experience is that some of my favorite patients might have fallen into an “undesirable” category.

A number of women in California prisons were sterilized without following proper legal procedure—and probably without respect for the women’s human and reproductive rights. There are also stories of widespread abuse from India and Peru among other countries. It is unforgivable that people have been taken advantage of, but that is no reason to halt all FP programs.

Last month I wrote about the women who died in India after tubal ligation surgery. The press has focused on the terrible conditions where the surgery was performed. Also disturbing is how the women were treated before the surgery—they were not given a choice of temporary contraceptive methods nor told about the risks of the surgery.

225 million women worldwide want to avoid pregnancy but don’t have access to modern contraception. How can services to these people be delivered without abuse?

The goal of the London Summit is monumental, but attainable: to reach 120 million new users of FP by the year 2020. This effort is nicknamed FP2020. The memory of past abuses triggered concerns that such an ambitious goal could lead to new abuses. One of the first steps FP2020 took was to consult social scientists about ways to decrease the chances of coercion. In their report they asked: “How can we ensure public health programs oriented toward increasing voluntary family planning… respect, protect and fulfill rights in the way they are designed, implemented, and evaluated?”

In response they developed an innovative plan. Instead of focusing on getting people to adopt FP, they recommend working from a basis of human rights. That is correct: family planning should be based on human rights.

Although this seemed revolutionary to me at first, I realized that a major reason I became interested in FP is to further human rights. On the individual scale the lives of parents are improved if they have the right to choose how large their family will be. Of course their children benefit, too! On a global scale people’s rights may be trammeled as population density increases.

The authors of the report define reproductive rights as reproductive self-determination; access to reproductive health services, supplies and information; and nondiscrimination. Self-determination is the key—people must be able to choose what method of family planning (if any) they use. Both information and supplies need to be readily available for this to succeed. In most of the world, including the USA, lower-income folks are less able to access FP, but this discrimination must stop.

How can policies be made so rights are more important than quotas? Standards will be made and enforced to deliver quality care. Supplies are often a problem in developing countries, but that problem can be solved with technology. Production should be judged not by the numbers of patients served but by how well they are served. For instance, clients can be given questionnaires before they leave a clinic to be sure that they were given information about all available FP methods.

So far, this is theoretical; it remains to be seen if reproductive and human rights can be honored consistently. Next month I’ll report on FP2020 in action.

© Richard Grossman MD, 2015

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.