Stay Current on International Family Planning

December 29th, 2016

family-planning-sign-in-ethiopia-by-maurice-chedel

 A sign in Ethiopia showing the positive effects of having only 2 children. (Escape from poverty, health, a better housing, a fertile surrounding with trees, a better education) Picture by Maurice Chédel

“All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so.”                         United Nations, 1994

 

Although reproductive rights may be in jeopardy in this country, there is reason for optimism both here and abroad.

India has the world’s second largest population—about a billion and a third people. Thanks to family planning programs, family size there has been decreasing slowly through the years. Unfortunately there have been some bad bumps on the road. For instance, decades ago both men and women were sterilized without really understanding their surgery. The government put pressure on family planners to meet quotas and they, in turn, pressured patients to have surgery. Recently several women died after shoddy surgery in tubal ligation “camps”. It turned out that these unfortunate women wanted family planning, but weren’t given the option of temporary contraceptive methods nor adequately told of the risks of the surgery.

Sterilization, condoms, “the pill” and IUDs have been the mainstays in India, but the government has just added contraceptive injections to the short list of methods available to women without cost. The “Depo” shot has the advantages of lasting 3 months, of being very effective and lacking the serious side effects of contraceptives with estrogen. Therefore women who cannot use “the pill” can use it. Worldwide, “Depo” has been prescribed for birth control for over 40 years.

Although the USA has some of the most stringent rules for approving medications, I find it interesting that some other countries have limited access to birth control that we take for granted. Depo in India is one example, and birth control pills in Japan are another. For years Japanese women were not able to get “the pill” and couples mainly relied on condoms for contraception. The rationale was that condoms prevented the transmission of disease and could prevent problems if there was marital infidelity. It was only in 1999 that this policy was changed.

In many parts of Africa women needed a physical examination and blood tests before they could get a prescription for “the pill”. Few could afford these luxuries, driving up the number of unplanned pregnancies. In much of Latin America, on the other hand, a woman can walk into a “farmacia” and purchase whichever brand she would like.

Emergency contraceptive pills are easily available throughout much of the world. Plan B and other brands are now available in pharmacies in this country without prescription. They have been shown to be amazingly safe, although not as effective as having an IUD inserted. Of course EC should only be used in case of an emergency, such as rape or a broken condom, and it provides no protection against infection.

Price gouging for medications exists outside the USA. In England, for instance, the cost for EC could be more than US$40—while the same medication in France would cost less than US$10. There is an eye-catching British campaign suggesting that a woman in need could save money by taking the bus to Paris to get her pills!

Although millions more women in the USA have access to free family planning thanks to “Obamacare”, unfortunately there are still limitations. Some 20 million women in the USA live in “contraceptive deserts”. These are areas without reasonable access to publically funded clinics that offer the full range of contraceptive methods. Despite this, the teen-pregnancy rate has fallen precipitously in the past 25 years—a big reason for celebration!

Globally there is mixed news from the immense attempt to provide family planning services in some of the most difficult to reach and poorest parts of the world. The Family Planning 2020 campaign is now about halfway through its tenure, which started in 2012 and goes until 2020. Its goal is to reach 120 additional women with family planning services in 8 years. They have reached 30 million new users of contraception, which is an amazing achievement—but short of their interim goal by 20 million. It is incredibly difficult to deliver health services in areas where this campaign is working; I wish them luck.

Speaking of luck, last month I was hit by a car while crossing Main Avenue in a crosswalk. Fortunately I have no serious injury except for a broken ankle. It is also fortunate that I am totally retired from the practice of medicine—but plan to continue writing these columns. Happy Holidays to readers of Population Matters!

© Richard Grossman, 2016

Give Children Every Advantage

November 28th, 2016

dislexia

            New parents hope that their children will be perfect. Unfortunately, there is often disappointment when reality sets in.

We have always cared about the welfare of our children, but now each child seems to matter more as family size is decreasing. Fortunately much can be done now to help children with disabilities. Difficulty with reading, dyslexia, is a good example.

Dyslexia is estimated to affect as many as 20% of people—that is one in five! Reading is an amazingly complex skill, so it is no wonder so many people have difficulty. As many females have dyslexia as males, but girls tend to stand out less. Dyslexic boys often act out in school, while girls with the same problem tend to become quiet and not call attention to themselves.

Teachers are recognizing dyslexia more now than when I was in school. I remember struggling with reading in first grade. I envied one of my classmates who read much better than I. Many years later at a reunion when I mentioned this to her, she replied “Didn’t you know I was repeating first grade?”

Probably both she and I suffered from dyslexia. I managed to squeak by until 7th grade when my English teacher realized that something was wrong. Mr. Johnson focused on the spelling part of the problem. I’m a pretty good speller now, but unfortunately I am still a slow reader.

My freshman year in college was rough. I was faced with large volumes of reading that I couldn’t plough through at my slow pace of 200 words-per-minute. Once again coaching helped me. Only recently have I realized that the basic problem is that I have mild dyslexia.

Unfortunately dyslexia is ignored frequently, as it was with me. Its treatment is time consuming and expensive, and it is best to start early. Although some adults are successful despite dyslexia, many are not so fortunate because they get off to a bad start in school. This can lead to poor self-esteem, dropping out of school and perhaps even to criminal activity. Two thirds of prisoners have poor reading skills, and many of these have been found to be dyslexic.

Research on dyslexia is ongoing, but two doctors developed an effective method of treating it. The Orton-Gillingham method employs multiple senses in its approach, including visual, auditory and kinesthetic pathways. A student will see a word, say the same word and write it at the same time so it gets firmly implanted in her brain. This is very intensive of teachers’ time since it involves one-on-one interaction, but amazingly successful in improving reading ability.

It is wonderful that our community has a school that offers education for dyslexics. In fact, it is so good and so well known that it has attracted families to move here. The Liberty School provides state-of-the-art instruction for kids from 1st through 8th grades. It also has programs to challenge children who are exceptionally bright. Often children will spend only a year or two at the school, to get an educational boost.

A friend sent two of her children to the Liberty School, not because they were doing poorly in the public schools but because she thought that they could do better. Indeed, they improved markedly! Her daughter went from performing at a 5th grade level in math to 12th grade—in just one year! The son hadn’t been writing well, but at Liberty wrote a great play together with classmates.

My friend couldn’t say enough good things about Liberty and the influence it had on her kids. She is a school psychologist as well as being an excellent, involved mother.

One of the keys of Liberty is integration: the older kids help the younger, and those who read well help the ones who don’t. I observed this when I visited the school recently. I interviewed several of the students; all were enthusiastic about their school and the progress they were making. I saw lots of smiling faces.

The Liberty School is building a new facility up Junction Creek Road. It will not only be state-of-the-art but also have wonderful land for recreation and nature studies. There was an excellent story about their campaign on the front page of the Herald 12 days ago.

            Being able to help a child afflicted with dyslexia succeed in life is just one advantage of a small family. Fortunately we live in a society that does not judge people by the number of children they have.

© Richard Grossman 2016

Shape the World You Want by Voting

October 24th, 2016

constitution_we_the_people

            In November we will have the opportunity to vote, and thus help shape our world—both nationally and locally. Please vote, even if you don’t follow my suggestions!

Most politicians have personality traits that set them aside from the normal populace. Usually those traits are an asset. Unfortunately this is not true with one of the current presidential candidates who has a personality disorder: narcissism. This psychiatric illness is concerning for someone who must make decisions that will affect our country and the whole world. A person with narcissism thinks of himself, not of his constituency. This narcissistic personality disorder has allowed Trump to lie with impunity; he probably believes his own untruths! I fear what might happen if he were president and had to make a decision about launching a nuclear attack. Trump is a disgrace to our country.

Several amendments to the Colorado constitution are on the ballot. One would create a new healthcare system for citizens of our state. Currently we don’t have a healthcare system in our country; we have a tangle of fiefdoms run by overpaid administrators. Insurance companies and other financial parasites suck half of healthcare dollars away from actual care. We need a single payer system such as the other 9 of the richest countries have. Unfortunately, I don’t think that ColoradoCare will do what is needed. I will vote against proposed amendment 69.

My main concern about 69 is women’s issues. The ColoradoCare’s board of trustees might end up with a majority adverse to contraception. It couldn’t happen, you say? Surely the board would realize that reproductive health is a human right and saves up to $7 for every dollar spent? Unfortunately our elected officials don’t always make rational decisions. Remember what happened in the Colorado legislature to the bill that would have paid for effective IUDs? Sponsored by Republican Representative Coram, that bill was killed in our state senate.

There are economic reasons to support Amendment 70, which will raise the minimum wage in Colorado from $8.31 to $12.00 per hour over the next 4 years. Boosting the economy is one. For me, however, it is just ethical to pay employees close to a living wage—about $13.00 for a single person in La Plata County. I will vote for 70.

Using tobacco is incompatible with good health; therefore it is beneficial to decrease its use. Taxing tobacco is a good idea, and increasing the current tax with Amendment 72 is a great plan. The tax is a disincentive, and the money will further healthcare and medical research.

I am of the age when terminal illnesses become common—although I’ve been lucky so far. We have come a long way with hospice and palliative care, but there are people with terminal illnesses whose lives are miserable and would like to take “life-ending, doctor-prescribed sleeping medication”. I have cared for some people whose last days were wretched and who wanted an end to their misery. I support Proposition 106, the “Medical Aid in Dying” initiative.

In La Plata County we have the opportunity with Ballot Issue 1B to fund a new terminal and other improvements to our airport. As one who flies fairly often, I am aware of the problems with our current facilities. However, I see reasons to vote against the expansion. I suspect air service is in its heyday. As the price of fuel rises and constraints on emissions come into play, it seems likely that people will fly less rather than more. Furthermore, the airport expansion would propel county expansion, but is that what we want? Isn’t our population big enough as it is? Let’s not vote for this big tax increase.

There are three Ballot Issues I do support even though they will mean an increase in taxes. 1A will be used to maintain our roads and bridges. Roads are used by everyone and are essential for our economy. I believe that having our roads in good condition is more important than a new airport terminal, and at much less cost. Furthermore, well-maintained roads improve the safety of all who travel in our county, so I consider this an issue of public health. Two Ballot Issues are for money to improve our schools, 3A for Durango and 3B for Bayfield. Educating our children well is vital for our future; please vote for this support.

            I don’t like politics, but chose this subject because this election is so important that we all need to participate in the democratic process.

                                           © Richard Grossman MD, 2016

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