Repudiate the Practice of Eugenics

July 30th, 2018

Although Francis Galton started the modern eugenics movement in England in the 19th century, eugenics reached its peak in Germany during the Nazi era. Although sometimes well-meaning, eugenicists have done terrible things to human rights.

The history of eugenics actually goes back much further in history; apparently Plato advocated selective breeding of humans. Eugenicists advocate for higher rates of reproduction among people with desired traits and reduced rates or even sterilization of people with undesired traits.

Galton was the first person to study human variation in a systematic way. He observed that upper-class people tend to marry later and have smaller families, and suggested that eminent people be given incentives to have more children. He was concerned that small family size amongst the cognoscenti, along with poor people having lots of children, would cause a decrease in people’s mental ability.

Fortunately it seems as though Galton’s prediction has not come true. Over all, 

average intelligence is not decreasing significantly in the USA and actually may be increasing. This is a strike against eugenics.

In Germany the eugenic movement started in the late 19th century but didn’t become strong until 1927, when the Kaiser Wilhelm Institute of Anthropology, Human Heredity and Eugenics was founded. One if its early directors, Eugen Fischer, wrote a long treatise titled “Principles of Human Heredity and Race Hygiene”. Hitler read and was inspired by this treatise.

In 1933, when the Nazis came into power, it became illegal to oppose eugenics and the “Law for the Prevention of Hereditarily Diseased Offspring” was passed. It established “eugenic courts” throughout Germany. Doctors were required to report “inferior” people (including people with retardation or mental illness, hereditary blindness or deafness, or other hereditary diseases). Cases were then presented to genetic courts, which would decide if the people should be sterilized without their consent. Hundreds of thousands of people were kept from having children because of this law.

As time went on, elimination of “undesirables” by sterilization was not sufficient. From 1939 to 1945 people with birth defects or in psychiatric hospitals were murdered by order of the Nazis. These murders were in addition to millions who were killed because of their ethnic heritage, religious beliefs or sexual orientation.

German history illustrated the worst of eugenics, but the USA was not immune from tromping on reproductive rights. Carrie Buck was a case in point. She was a young woman who was able to read and write. Nevertheless Carrie was labeled “feeble-minded of the lowest grade, moron class” when admitted to the Virginia State Colony for Epileptics and Feebleminded in 1924. Three years later her tubes were tied, even though she wanted more children.

This was not an isolated case of a woman getting sterilized against her will; it was condoned by the Supreme Court of the United States. Ms. Buck was a test case brought to the Supreme Court to support eugenic sterilization. It appears that a “guinea pig” was needed and Buck was chosen because she was poor and had had a child out of wedlock (after being raped), despite being of normal intelligence.

Unfortunately, Carrie Buck was one of thousands of American women and men who were sterilized in the past without their consent. For instance, records from California institutions show that 20,000 people were approved for sterilization in the first half of the 20th century. The vast majority of these victims had Spanish surnames, reflecting the prejudices of the era. More recently 39 women in California prisons were sterilized without consent between 2005 and 2013. Retarded people, people of color  and prisoners still have human rights, don’t they?

Fortunately, laws that govern sterilization procedures are strict now as a reaction to the abuses that took place in this country. The person must be at least 21 years of age and must sign a special consent at least 30 days before the procedure. This is onerous in a way, because it means that some people who truly want to end their ability to reproduce miss out.

The Eugenic Protection Law in Japan subjected 16,500 people to forced sterilization. Over a quarter million indigenous women were sterilized against their will in Peru. The list goes on; eugenics wasn’t just practiced in Nazi Germany but in many other societies, including our own.

No one seems to be espousing eugenics now. It was a theory that has seen its heyday and has died. It was unjust, especially when in the hands of rulers such as Hitler or Fujimori. We now recognize that reproductive coercion is unnecessary and counterproductive.

© Richard Grossman, MD 2018

Plan for a Healthy Baby

July 15th, 2018

You might have thought that I’m against people having children and therefore be surprised that I am writing about having children. I am definitely in favor of people having babies; my goal is for all babies to be planned, loved and healthy—and not too many!

I believe family planning should include the treatment of infertility. It was always a joy for me when a couple who had dealt with fertility issues was able to conceive. Often I was able to attend the birth of that child—a double joy!

What a child needs most is two loving parents. It appears that marriage before childbearing is no longer in style—40% of women giving birth in the USA are unmarried. However, a marriage certificate is not nearly as important as parents being in a stable relationship. Planned pregnancies are most likely to produce healthy, loved children. This column is an update on steps people can take to have a healthy child.

If the couple has been using hormonal contraception, it may be wise for them to stop and use a barrier method for a couple of months before trying to conceive. The chances of having twins may be increased if conception occurs right after stopping “the pill”.

There are several actions that people can take to improve fertility without seeing a doctor. Being overweight is a cause of female infertility, so losing weight may help. Eating well helps improve fertility for both men and women. The suggested diet includes healthy protein, whole grains, fruits and vegetables—the same as for all of us. “Fast food” seems to prolong infertility!  For men, underwear can make a difference; the “family jewels” make more sperm if they hang loose.

Grain products in the USA are now enriched with traces of folate (a B vitamin). Fewer kids are born with neural tube defects (like spina bifida) and other problems, thanks to this vitamin. It is recommended that women start taking prenatal vitamins (which contain folate) at least 1 month before trying to conceive. It is even suggested that all women of reproductive age take folate supplementation, even if they use contraception, because failures happen. Furthermore, folate may increase a woman’s fertility.

Women usually take better care of themselves when they are pregnant, knowing that a healthy mom is more likely to have a healthy baby. For instance, women often want to know how much weight they should gain. I respond that the quality of the food is as important as the pounds gained. 

In medical school I was taught that alcohol is ok for women to drink in pregnancy. More recently we have been recommending that women avoid any alcohol when pregnant—but that recommendation has changed again. It is now thought that a very small amount of alcohol is possibly safe—but total avoidance is safest.

The literature is clear on tobacco products: they are harmful in pregnancy and should be avoided completely. Marijuana use in pregnancy has not been studied very much because of its legal status. One advantage of its legalization in Colorado is that it will be possible to get better information about its safety. I hope that medical scientists are following children whose mothers used “weed” when pregnant, but we won’t know about bad effects, if any, for many years.

Here is the latest information about some other “dos and don’ts” in pregnancy. Things that seem safe include: artificial sweeteners, caffeine in low to moderate amounts, insect repellants (including DEET), hair dyes, air travel and sexual intercourse (unless advised otherwise). Dental care, including x-rays and local anesthesia, is safe and encouraged during pregnancy—but laughing gas should be avoided, especially early in pregnancy. Exercise is encouraged, although women should take extra care to avoid injury when pregnant.

It is best to avoid getting overheated in the first trimester (up to 12 weeks), so hot tubs and long, hot showers are out. Swimming is safe, but waterskiing is not. Fish are good nutrition, but fish with high levels of mercury are especially dangerous in pregnancy. The fetal nervous system is particularly vulnerable to this toxic metal. Pregnant women should pay attention to local advisories concerning fish in lakes and streams, and avoid the most toxic ocean species: swordfish, tilefish, shark and mackerel king. Some kinds of tuna are contaminated with more mercury than others.

In a world that is overpopulated our goal should be for every child to get a good start in life by being healthy and loved.

© Richard Grossman MD 2018

Recognize Family Planning as a Human Right

May 29th, 2018

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Family planning was declared to be a basic human right fifty years ago this month. The right to family planning was included in the International Conference on Human Rights held in Tehran, May 1968.

The concept of universal human rights started after World War II with the United Nations. Its charter included the obligation “…to promote… universal respect for, and observance of, human rights and fundamental freedoms for all without discrimination….” The Tehran conference was held 23 years later to define what those rights are. One of several points states:

“The protection of the family and of the child remains the concern of the international community. Parents have a basic human right to determine freely and responsibly the number and the spacing of their children”

The 84 countries attending this Iranian conference agreed to be bound by the decisions, but the world has changed radically since then. For one thing, there are more than double that number of countries. Furthermore, global population has more than doubled from 3,600,000,000 to 7,500,000,000 people. On the good side, there are more, safer and more effective methods of contraception available. The right to family planning is supported by many programs, including FP2020 which works in many developing countries. Planned Parenthood and the federal Title X (ten) program in the USA are under jeopardy because of a proposed law limiting healthcare providers from mentioning the word “abortion”.

Unfortunately the right to family planning is being limited or taken away in many countries. Funding for many organizations working internationally has been barred by the Global Gag Rule. The GGR prevents the US from funding any foreign agency that provides abortion services anywhere—or even mentions the word “abortion”. Because of the lack of these services women will go without birth control and there will be millions of unplanned pregnancies, and thousands of women will die from complications of pregnancy—and, ironically, there will be more abortions!

The Tehran Proclamation has 9 standards to uphold the human right to family planning. These include non-discrimination, availability of information, accessibility of services and supplies, quality, autonomy of decision making, privacy and confidentiality. I am happy to report my experience has been that these standards are upheld everywhere I have worked,. 

It is difficult to envision a UN conference being held in Iran now—there have been many changes since 1968. The Shah was overthrown in 1979 and the country became an Islamic theocracy, lead by a “Supreme Leader”. A pleasant surprise came about a decade later.

High level government and university experts held a conference in 1988 to discuss Iran’s population, which was increasing rapidly at that time. Attendees agreed “…that the rate of population growth in the Islamic Republic of Iran was high and this would have a negative effect on the welfare of the people. Hence, the participants strongly urged the Government to set up a family planning programme and integrate population factors in policy-making.” (quoted from “A New Direction in Population Policy and Family Planning in the Islamic Republic of Iran”)

The High Judicial Council of Iran decided “family planning does not have any Islamic barrier” so long as abortion was not involved. New laws were passed to promote small families. Couples were required to take birth control classes before they could get a marriage license. Government clinics were set up offering a wide choice of methods, including vasectomy. In addition, the government discouraged childbearing before age 18 and after 35 and recommended that children be spaced 3 or 4 years apart. The family planning program urged couples to have no more than 3 children; government employees lost some of their benefits, such as maternity leave and food coupons, if the family had more than 3 children. 

The TFR (the average number of children that a woman bears in her lifetime) in Iran had been as high as 7.0, had decreased to 5.5 in 1988 and now is less than replacement at 1.8—the same as the USA. It doesn’t mean that population is shrinking—there are millions of children and teens whose reproductive years are still ahead of them—so it will take decades before the population stabilizes.

A dictatorship can use its influence to slow population growth. Although there are many dictators in the world today, I think Iran is the most successful in slowing its growth. That sort of heavy-handed governing wouldn’t work in the USA. Indeed, I believe that people should have the right “…to determine freely and responsibly the number and the spacing of their children.”

© Richard Grossman MD, 2018

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