Honor Childfree People

August 26th, 2016

Graph of childfree women %

“Let each of us honor someone who does not have children.”

                                    Ecologist Jim Schenk

            I stopped in a store on Main Avenue to buy a Christmas present. When I returned the proprietor’s greeting and asked how he was, he replied honestly. “Not too good”. He had just broken up with his girlfriend.

He went on to explain that they had been together for a long time, but were splitting up over her wish to have a child. He explained that he did not want the responsibility of parenting.

A Brit who subscribes to my monthly Population Matters! emails wrote: “For your next email to us in a month or so, would you perhaps consider discussing why women [feel they need to] have babies; and why it is not questioned? It brings reproductive rights in conflict with the planet very starkly. Is anything so important so not discussed?”

Finally, I was talking with the director of a nonprofit. She told me that the day, August first, was International Childfree Day. There is Mothers’ Day and Fathers’ Day, but I had never heard of Childfree Day. “People like me don’t get much recognition!” she exclaimed.

These events lead me to write about the option of not having children. We tacitly assume that women will contribute one or more babies to the human family: our society is pronatalist. This is especially true in some religions that encourage large families. The book “Confessions of a Later Day Virgin” brings this out well, with humor. The author, Nicole Hardy, had no idea that a Mormon woman could be childfree until she read Terry Tempest Williams’ “Refuge”. Williams and her husband are both Mormons, and childfree.

Despite our pronatalist society, some people elect not to bear children—they are voluntarily childless. There are many reasons for this, including religious (e.g. nuns and priests), dedication to work and the huge responsibility of being a parent—like my Main Avenue salesman. In the past being childfree required sexual abstinence, but that is no longer the case—fortunately!

There is another, important reason to be childfree. From time to time I hear from patients that they want to limit their fertility because of their concern about overpopulation.

The woman who started International Childfree Day, Laura Carroll, is married but childfree. She has studied pronatalism in our culture, as well as the effect of bearing children on individuals and on our society. She suggests several “Alternative Assumptions” in her book, “The Baby Matrix”. One alternative assumption is that there is no need for almost everyone to parent. We have already “been fruitful and multiplied” and now increasing our numbers is counterproductive. Another Alternative Assumption: parenthood should be a conscious decision.

What will happen when I’m old if I don’t have children? In many societies the only social security is family—especially children. That is no longer so true in our society, where families are often geographically spread out. Carroll’s Alternative Assumption is: “Finding my elderhood support structure is my responsibility.”

You want to parent? Carroll also writes about the advantages of bearing just one child. She dispels the myth that “only” children have problems; indeed, they tend to excel. Then she dispels myths about adoption, which she says is easier and less expensive than rumored. She suggests adoption for second and subsequent children for parents who want more than one. She points out that our human population is already unsustainable. “Having fewer, not more, biological offspring is the true humanitarian act because it ultimately lessens the

suffering of people and the world’s natural environment.”

Don’t childfree people miss out on a lot? Yes—but what they miss out on is both good and bad. Dirty diapers aren’t that much fun! Is it possible to weigh the pros and cons of parenting versus a childfree lifestyle? Of course that comparison will vary immensely from person to person. However an analysis of the responses of almost 2 million people in the USA, after controlling for factors such as marital status and income, “…the presence of a child has a small negative association with life evaluation….” Put simply, childfree adults are happier!

The number of childfree women is increasing. Whereas 40 years ago only one in ten women in the USA spent her life without bearing a child, now the figure is closer to one in six. This is good for the planet, and good for the people who do not want to parent. We should honor and support them in this choice.

© Richard Grossman MD, 2016

Evaluate “Facts” Carefully

July 28th, 2016

fluoride-in-dentistry-350

Image courtesy of Deardoctor.com

In 1999 the CDC listed “Ten Great Public Health Achievements of the 20th Century”. Family Planning is one. Another is “Fluoridation of Drinking Water to Prevent Dental Caries”.

The CDC report summarizes the science: “Fluoridation of community drinking water is a major factor responsible for the decline in dental caries (tooth decay) during the second half of the 20th century…. Although other fluoride-containing products are available, water fluoridation remains the most equitable and cost-effective method of delivering fluoride to all members of most communities, regardless of age, educational attainment, or income level.”

Last month three well-respected Durango citizens collaborated on an op-ed for the Opinion page of the Herald. Unfortunately much of what they wrote is not well supported. I know and respect all three—but feel that they didn’t do their homework well.

The first author wrote: “The fluoride we add to Durango’s water supply is Hydrofluorosilicic Acid.” In December I asked the City’s staff what is used to fluoridate Durango’s water supply and received this answer: “Dr. Grossman: The fluoride additive utilized is Sodium Fluoride (NaF) with a finished water fluoride concentration goal of 0.70 ppm.” Message #1: ask questions.

The assertion is made that water fluoridation causes arrested brain development, ADD and ADHD, decreased IQ, autism, learning disabilities and cancer. Writer #1 states: “More than one in six children are effected [sic] by these conditions.” What are the sources for this information? Presumably one journal, “Fluoride: Quarterly Journal of the International Society for Fluoride Research”. I find articles in this journal to be strongly biased—they all seem to be against fluoridation.

How can one tell if a scientific journal is reputable, since many periodicals seem to be trustworthy, but are not? First of all, look to see if articles in it are peer reviewed. If they are not, the information is less credible. I check one thing before deciding on the credibility of a medical journal: is the journal listed in the National Library of Medicine? “Fluoride” is not.

The second writer, a dentist, states “…I have never been able to distinguish which children (or adults) grew up in a fluoridated community or a non-fluoridated community.” This is not the sort of information with which to make educated decisions that affect the public’s health. Rather than just an impression, it would be more believable to have records of the rates of cavities where water is fluoridated and where it isn’t.

I admire this writer for checking with the Cochrane review on water fluoridation. These reviews are the standard for evaluation of the quality of medical knowledge. He quotes: “There is very little contemporary evidence, meeting the review’s inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries.” Message #2: the research on the effectiveness of water fluoridation is old, but still valid.

The third writer states that fluoride is “…an endocrine disruptor that is wreaking havoc with our thyroid glands….” This interests me for two reasons. The topic of endocrine disruptors is important, as there are many (especially organic) chemicals that cause subtle but serious problems. Additionally, I have taken thyroid medication for decades. I did some research to find out if there is good evidence that fluoride is an endocrine disruptor.

What I found is that, indeed, preliminary evidence suggests that fluoride may have an effect on thyroid function. Some of the information is from England, where most salt is not iodized. Fluoride may make lack of iodine (which is essential for thyroid function) worse. This supports the idea that it is healthy to use iodized salt, but doesn’t necessarily go against water fluoridation.

What is not mentioned by any of the three writers is that many of the studies showing bad effects of fluoride were done in places where the levels of water fluoride are very high. Those studies are not relevant to Durango, where the level is much lower. Message #3: read original studies to find relevance to our community.

Public health’s goal is to facilitate health for all people. My understanding is that the Durango City Council made the decision to continue with a low level of fluoride in its water supply. This was a good decision from the standpoint of public health because it will benefit those who have the greatest need—people who can least afford dental care, and who may have the poorest diets. Those who feel strongly that fluoride is bad can arrange to drink water without it.

© Richard Grossman MD, 2016

Advocate for LARC (Long Acting Reversible Contraception)

June 28th, 2016

IUD

This is a picture of an IUD in a mockup of a uterus.

The potential of LARCs (Long Acting Reversible Contraception) is so great that I am advocating that all voters advocate for them to be paid for by government. The savings–both financial and in terms of human potential–are enormous!


 

Your doctor tells you that she can prescribe either of two treatments, but that one is 20 times as likely to fail as the other. Which would you choose?

Over a quarter of women in the USA use birth control pills, which fail much more frequently than Long Acting Reversible Contraception. LARCs, as they are nicknamed, are amazingly effective yet not used as frequently as one might hope.

IUDs (Intrauterine Devices) are the most commonly used LARCs. There are four available now; they are all made out of flexible plastic in the shape of a “T”. Three emit a tiny amount of hormone into the woman’s uterus, where it is most effective. The fourth IUD uses copper to gain effectiveness. IUDs are usually well tolerated, although sometimes they can increase cramps or change menstrual flow. The best medical knowledge is that IUDs do not work by aborting pregnancies.

IUDs can stay in place for a maximum of 3 to 10 years, depending on which type. Since there is a string attached, they are usually easy to remove. The string also allows the woman to check that it is in the correct place. The pregnancy rate is vanishingly small—only a couple of LARC users in 1,000 will conceive each year. This statistic for “the pill” is much higher—almost 50 per thousand will experience an unplanned pregnancy. Apparently the high failure rate of oral contraceptives in the USA is due to noncompliance. In Europe the failure rate is significantly lower; European women take their birth control pills more regularly.

There are two major drawbacks to both IUDs and the implant: they are expensive and they need to be placed by an experienced clinician. IUDs have a further drawback—bad press.

It used to be that only women with health insurance or a plump checking account could afford LARCs, but that is changing. Thanks to the Affordable Care Act (“Obamacare”), any woman with insurance, including Medicaid, can get her chosen birth control without copay. In addition, one IUD, Liletta®, is priced much lower than the others. Here in Colorado there is a program that provides contraception, including LARCs, at little or no cost.

Placing an IUD is not difficult for a trained practitioner. The opening of a woman’s cervix may be tight is she hasn’t borne a child, but a little local anesthesia and gentle dilatation will help with the insertion.

The other type of LARC is the implant, Nexplanon®, which is as effective as an IUD. It is a thin plastic rod that is inserted under the skin of the woman’s arm, where it can stay for up to 3 years. It emits a hormone that is very effective in preventing pregnancy. Although it is in a very low level in the woman’s blood, it is sufficient to change menstrual patterns; most women with Nexplanon® will have spotting or breakthrough bleeding. Perhaps this is why less than 1% of women in the USA choose an implant, whereas about 6% use an IUD.

Unfortunately, reproductive health has become a political football. Here in Colorado a grant demonstrated that access to LARCs can give young women a better chance in life by decreasing teen pregnancies. By taking away the consideration of expense, the use of LARCs expanded 4 fold. Nevertheless, the false fear that IUDs might abort pregnancies kept our legislators from continuing funding to provide this effective contraception. The best way to prevent abortions is with effective birth control!

Ohio took a tip from Colorado with a program to provide LARCs. Part of that state’s motivation is to lower their infant mortality rate. They are targeting young teens and women who have just had a child, since these two groups are at high risk of having an infant die if they were to get pregnant. They also note that the state saves almost $6 for every dollar invested in LARCs.

Ohio has been proactive in another way. Some healthcare providers have misconceptions about IUDs. They think that they should only be used if a woman already has delivered a baby, or that an IUD makes a woman more susceptible to sexually transmitted infections, or teens shouldn’t use IUDs, or that IUDs can lead to sterility. All of these perceptions are wrong! Indeed, almost every woman can safely use an IUD, and start her family as soon as it is removed.

Safe, effective contraception is an important step in empowering women. We should advocate for making LARCs available to all women!

© Richard Grossman MD, 2016

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