Don’t Control Population this Way

January 28th, 2018

Human skulls at the Nyamata Genocide Memorial

There are many ways to decrease human numbers, and most of them should be shunned. Indeed, some of them are quite horrifying. In this and subsequent columns I’ll write about some of them.

It has been more than 20 years since the Rwandan genocide, but it stands out in my mind as the worst episode of human slaughter in recent history. Estimates of the number of people killed in a terrible 100 day period range from 1/2 million to a million. The population of Rwanda at that time was less than 8 million; a huge proportion of this small country’s people killed each other. In addition, an estimated 2 million were displaced or fled the country.

Genocide is the intentional destruction of a national, ethnic, racial, or religious group. Theories about the causes of genocide include tribalism, autocratic rulers and lack of resources. An article about this genocide, “Remember Rwanda” by James Gasana was published in WorldWatch. Gasana is Rwandan and had held 2 different cabinet positions in that country. In this article he noted that murder was most common where people went to bed hungry. That hunger, contributed to by overpopulation, apparently was part of what fueled the killing

In 1994 Rwanda had an almost entirely agricultural economy and was overpopulated. As the population rose the size of landholdings shrank and the overworked land became less productive. Even if people wanted to limit their fertility, the predominant religion, Roman Catholicism, preached against “artificial” contraception.

That is in the past. With international help and amazing resilience, the Rwandan people have put that terrible part of their history behind them. However, another country appears to be enduring a religiously motivated genocide. The Rohingya people in Myanmar (Burma) are both an ethnic minority and, as Muslims, have different religious beliefs from the Buddhist majority.

Genocide Watch lists 10 stages that are seen in preparation for and carrying out a genocide: Classification, Symbolization, Discrimination, Dehumanization, Organization, Polarization, Preparation, Persecution, Extermination and Denial. Most of these stages can be seen with the treatment of the Rohingyas.

Although they live in Myanmar, the Rohingyas aren’t allowed citizenship—classification. While they are not forced to wear identifying symbols, their freedom is restricted in other ways. They must live in ghettoes and are restricted by curfews—organization and polarization. Mobs attack Rohingya settlements while officials offer no protection—preparation. “Security” forces have killed thousands of Rohingyas while others have been tortured, “disappeared” or have suffered rape—extermination. The country admits to no wrongdoing—denial.

Perhaps the most dire of the measures against the Rohingyas is limitation of their reproductive rights. While there is no limitation on other people in Myanmar, the Rohingyas are only allowed to have two children. Apparently the Muslims tend to have larger families than the Buddhists in the same area. The state officials’ reason for this limitation is to “…ease tensions between Buddhists and their Muslim Rohingya neighbors.” Even if this is the true motivation, legislating the number of children in a family is wrong.

Unfortunately, Myanmar and Rwanda are not unique; there are many historical examples of peoples being singled out and exterminated. In the chapter on genocide, “The Great Big Book of Horrible Things” tallies an estimated 32 million deaths from genocides in the past 3 millennia. This includes a huge but unknown number of indigenous people killed in the Americas when we Europeans invaded.

Currently there are several countries where genocide is happening or is very likely. These include South Sudan, Sudan, Syria, Yemen and the Democratic Republic of Congo, all of which have unstable governments and terrible records of civil rights.

What can we do to prevent genocide? In “Warning Signs of Genocide: an anthropological perspective” Drs. Gene and Barbara Anderson state that the most important protection against genocide is critical thinking—the process of independently analyzing, synthesizing, and evaluating information as a guide to behavior and beliefs. They have written a second book, “Halting Genocide in America”, in which they are concerned that some people in the USA are already taking steps along the road to genocide.

Genocide is perhaps the most vicious way to slow population growth, but there are several others on my list of means to reject. Nature tends to limit populations with disease and famine, over which we have only limited control. Some other ways of slowing growth are imposed by people and governments. These include eugenics, family size coercion, war, gun violence, and the Voluntary Extinction Movement. More about them in future essays.

© Richard Grossman MD, 2018

Graph showing dip in Rwandan population after genocide, followed by recovery.

Reduce Barriers to Family Planning

December 24th, 2017

There’s no good news about male contraceptives yet, but there is much progress in the field of family planning for women. This column will touch on some of the high points.

Perhaps the best news is that, globally, more women who want to avoid pregnancy are using an effective contraceptive method. The number who weren’t using modern contraception was estimated to be 225 millionin 2014but is 214 million now. The decrease is partly due to huge efforts from Family Planning 2020 to make better family planning available in developing countries. With local support as well as funding from rich countries and foundations, FP2020 has provided over 30million women with effective contraception.

The goal of FP2020 is to reach 120 million previously unserved women with effective family planning by the year 2020. In many places couples only had access to one or two methods, such as condoms or tubal ligation. FP2020’s strategy includes avoiding coercion and offering a choice of several methods.

Please remember that it is not just developing countries that wrestle with unintended fertility. In 2008 in the USA 51% of pregnancies were unintended. There is good news here, too; it is now just 45%. This decrease, and the significant decrease in abortions, is thought to be due to Long Acting Reversible Contraception—LARCs. These methods include IUDs, implants and the 3-month shot. One in 7 women in the USA is now using these most reliable types of birth control.

LARCs have two shortcomings, however. In general they are expensive—but remember that dollar-for-dollar, contraception saves more than any other health intervention!

The other problem with LARCs is convenience, since most require a health care professional. An exception is the 3-month shot, “Depo” or DMPA. This has been in use for birth control for almost 50 years, but requires a clinic visit 4 times a year.

Sayana Press® is an innovative solution that is accepted very well. It is a small plastic bubble filled with the medication and a short attached needle. The woman just punctures her skin, squeezes the bulb and she is protected against pregnancy for 90 days.

Malawi, a small East African country with large families, compared women who went to the clinic to get their shots with women who injected the medicine themselves. They found that women who were given the first shot at the clinic then took home 3 Sayana Presses® were much more likely to use the medication for a full year.

Birth control pills are available without prescription in many countries, and the USA will be following suit if Daniel Grossman has any say. Grossman and I may be distantly related, and we are very close in our belief that “the pill” is amazingly safe and there should be minimal barriers to its access. Grossman has started the “Free the Pill” campaign. This would follow the way Emergency Contraceptive (EC) pills have gone over the counter; Amazon.com now sells EC pills!

Another physician named Grossman—Jessica—heads up Medicines 360. This organization has as its mission “…to expand access to medicines for women regardless of their socioeconomic status, insurance coverage, or geographic location.” Their first product is a big success! Liletta® is an IUD that releases a hormone over 4 years, is safe and very effective, and decreases menstrual bleeding and cramping. It is primarily sold to clinics and is significantly less expensive than similar IUDs.Recently there is good news about all IUDs; they reduce the risk of a woman getting cervical cancer.

When Trump reinstated and expanded the Global Gag Rule, the Dutch started “SheDecides” to replace essential funding for reproductive health. More countries, foundations and individuals have stepped up to pledge $200 million! This amazing organization’s goal is to make it possible for “…girls and women to decide freely and for themselves about their sexual lives, including whether, when, with whom and how many children they have.”

Most couples in the USA use contraception at some time in their lives, even if their religion opposes birth control. In much of the global south, however, this is not the case. There the Roman Catholic hierarchy turns most women away from birth control. This might change, however. The Pontifical Gregorian University in Rome will be holding a series of talks on the 50th anniversary of Humanae Vitae, according to the National Catholic Register.

Despite political forces in this country that are trying to erect barriers around access to family planning, there is a lot of good news about contraception for women.

© Richard Grossman MD, 2017

Heed this Warning

November 25th, 2017

In 1992 the Union of Concerned Scientists published the “World Scientists’ Warning to Humanity”. Twenty-five years later it has just been updated.

Most of the Nobel Prize winners then alive and 1575 senior scientists signed the original warning. It started with the words: “Human beings and the natural world are on a collision course. Human activities inflict harsh and often irreversible damage on the environment and on critical resources. If not checked, many of our current practices put at serious risk the future that we wish for human society and the plant and animal kingdoms, and may so alter the living world that it will be unable to sustain life in the manner that we know.”

After this powerful introduction there are several headings. The heading titled “Population” states what many people (especially economists) are still denying. It starts with: “The earth is finite.”

Later in the “Population” heading you can read: “Pressures resulting from unrestrained population growth put demands on the natural world that can overwhelm any efforts to achieve a sustainable future.” I find it remarkable that those who write about “sustainable development” so often ignore this obvious fact.

This 1992 Warning had 5 points under the title “What We Must Do”. Point #3 states: “We must stabilize population. This will be possible only if all nations recognize that it requires improved social and economic conditions, and the adoption of effective, voluntary family planning.” Unfortunately this was all but ignored. In fact, just 2 years later, at the UN’s International Conference on Population and Development, delegates decided to turn the focus away from population and toward HIV and reproductive rights. This had an unfortunate effect on support for family planning programs.

So much for the past. Not too many people were aware of the 1992 document, and fewer took it to heart. Scientists have updated the Warning on its 25th anniversary in a remarkable fashion. “World Scientists’ Warning to Humanity: A Second Notice” was published last month in BioScience, a well-known journal. Although eight authors appear on the title page, the total number of signatories is huge—15,364 scientists from 184 countries! It is not too late to join this elite crew if, indeed, you are a scientist. Go to http://scientistswarning.forestry.oregonstate.edu to find out more and to endorse the article. Over 3,000 people have done added their names.

The current Warning is not optimistic. Of the 9 issues treated 25 years ago, only one shows improvement. The good news is that ozone-depleting emissions (chlorofluorocarbons) are decreasing. They jeopardize the atmospheric ozone that guards us against dangerous ultraviolet radiation. The other 8 trends are all bad; these include fresh water supplies, total forest area, vertebrate species abundance and ocean dead zones. Need I also mention that the CO2 level is rising and the climate is heating up?

It comes down to two factors—population and consumption. The authors put it this way: “We are jeopardizing our future by not reining in our intense… material consumption and by not perceiving continued rapid population growth as a primary driver behind many ecological and even societal threats.”

Slowing population growth seems much more attainable than decreasing consumption, however. So many people want to manage their fertility but don’t have access to effective contraception—we must expand access to birth control here and abroad.

There is hope. The new Warning points out that pressure on politicians, especially from scientists and concerned citizens, can create change. The authors also cite the importance of changing individual behaviors such as choosing to have small families and to consume less—including moving toward a plant-based diet. They celebrate the decrease in family size throughout most of the world and praise the decrease in world hunger. They use the example of the decrease in chlorofluorocarbons as an example of what can be done when there is political will.

The Warning gives 13 steps to take in order to move in the correct direction to save our life support systems. The 12th is to revise our economy to reduce inequality of wealth and to take into account the externalities that harm our planet. The last proposes a revolutionary idea—to determine what a long-term sustainable human population might be, then to rally support to reach that goal.

Can more than 18,000 scientists make a difference in a positive direction? We have seen how much damage one person, the president of the USA, can do by moving us away from sustainability. It is time for us to heed the far-sighted Warning for our progeny’s sake.

© Richard Grossman MD, 2017

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