Archive for March, 2010

Welcome Back Family Planning–12-2009

Monday, March 8th, 2010

Welcome Back Family Planning—12-2009
© Richard Grossman MD, 2009

The International Conference on Population and Development helped propel me toward being a more dynamic population activist. Bryan (our younger son) and I attended the conference in 1994 with press credentials from The Durango Herald.
You may remember that the ICPD in Cairo, Egypt, strongly supported reproductive health. Unfortunately it was soft on population. Reproductive health includes family planning, but is much broader, and therefore more expensive. Abuses, especially in India and China, were cited as the reason to turn away from goals in reducing population growth rates.
Certainly reproductive health is important; I have spent my professional life working for this goal. It is unfortunate that the ICPD turned attention away from population growth, however.
It is true that setting goals and offering incentives for meeting those goals caused some abuses. In the past family planning workers were given bonuses depending on how many people they convinced to limit their family size. Now there is careful policing of programs to avoid that sort of coercion, so family planning programs are purely voluntary. Incentives are unnecessary since people are happy to accept contraception of their free will; they want to limit their fertility.
The first major international family planning conference in fifteen years was held last month in Kampala, Uganda. It was a lot smaller than the Cairo conference, and was sponsored by nongovernmental agencies rather than by the United Nations. Sub-Saharan Africa was very well represented, showing great interest in family planning in that part of the world.
Human population has been out of the limelight for fifteen years now; indeed, the Kampala conference received scant attention in the US press. The consequences of the burgeoning population have received attention, however. Global climate change, extinction of species, pollution and depletion of fisheries all make the headlines. In the intervening fifteen years the number of people in the world has increased by 1.2 billion with nary a mention of this basic cause of these problems.
The recent International Conference on Family Planning in Kampala focused on several important issues. People reported on the importance of family planning in decreasing transmission of HIV to newborn babies, lowering infant and maternal mortality, and reducing unsafe abortions—largely by preventing unwanted pregnancies. Research also demonstrated the importance of involving men. For instance, a study in Nigeria found that women were much more likely to use contraception postpartum if their husbands were with them and witnessed their giving birth.
Researchers are stressing the importance of linking family planning with HIV prevention. There is a call for methods, such as a vaginal gel, that will achieve both these goals.
Another point from the conference is that women are relying more on long acting contraceptive methods. This is just as true here in Durango as it is worldwide. In much of the world IUDs and implants are favored over short acting methods (such as pills and condoms) because their supply is more reliable. In Durango, with excellent pharmacies, women like the long acting methods because they don’t have to worry about taking a pill every night.
In much of the world vasectomy is becoming more popular. Unfortunately, tubal ligations still outnumber vasectomies. For many providers it will require a new mindset to include men.
Dr. Cates, a US family planning expert, mentioned another change in mindset when he summarized the conference. He pointed out that the cost to provide reproductive health care and family planning worldwide would be less than just ten days of worldwide military action.
The Kampala conference was an important step in the correct direction. Remember that the least expensive way to reduce carbon emissions is by reducing the number of unplanned pregnancies—and thereby reducing the number of people causing emissions. As I write this, the Copenhagen conference on climate change is underway. It is much bigger than the Kampala one, and is receiving much more press coverage—partially because President Obama will attend. Please remember, however, that if more attention had been paid to family planning over the past fifteen years, the climate crisis would be much less severe. We can slow carbon emissions if the 200 million women who wish to limit their fertility (but lack the wherewithal) had access to modern contraceptive methods.
“Reproductive health is a human right” was the mantra at ICPD. Although RH is an important goal, it may be too inclusive at this point in time. We need to move quickly to help people limit their fertility when they wish to do so.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

Picture Prehistoric Life in the Desert–2-2010

Monday, March 8th, 2010

Picture Prehistoric Life in the Desert
© Richard Grossman MD, 2010

If there is magic on this planet, it is contained in water.
Loren Eiseley

Living in the desert is challenging. We spent the week after Christmas in Baja California camping on the beach. Fortunately, our tents were comfortable and meals were cooked for us. Pedro, a Baja native, gave us a glimpse into a very different past.
The afternoon was cool with sun shining through broken clouds and a rare rain in the offing. As we climbed up the steep, rock-strewn path we were careful to watch our step. Although vegetation is sparse, most of the plants wear spines or thorns for protection. A little stumble could result in a painful jab.
Despite their armor, many desert plants are edible. Pedro assured us that the common prickly-pear cactus fruit tastes good, and even the pads are edible—after removing the spines.
We reached a cave that Pedro told us had been the winter home for a band of Pericú people, the extinct indigenous tribe of southern Baja. Small and stark, a single red ochre pictograph decorated the cave. We imagined a dozen people huddled in the chill admonishing their toddlers to stay away from the edge. A midden of shells lay below, showing that the Pericú enjoyed the ocean’s bounty.
On top of the mesa we found their summer home. There was little to mark it except for another heap of shells and four round depressions in the rock. Grinding holes, Pedro commented. When asked about their use he looked embarrassed.
Pedro explained that there is a type of manna—the pitahaya fruit—that ripens in late summer. It grows on the organ pipe cactus (pitahaya dulce) that resembles a clump of spiny fingers pointing skyward. The size of a tennis ball, pitahaya fruit has the color and a bit of the flavor of watermelon. Although rich in energy, the tiny seeds pass through without being digested.
European missionaries recorded that the indigenous peoples were hungry except during the brief pitahaya season—perhaps wishful thinking on the Europeans’ part. Lacking any means of preserving fruit, how could people prolong this short season of plenty? Baja natives came up with an unlikely solution that your mother would not approve of.
The indigenous people developed a system to harvest the nutrition in pitahaya seeds that disgusted missionaries. While enjoying the abundance of the harvest, people collected their poop in special places. When it had dried, the seeds were separated, washed, and then pulverized in those circular rock depressions. After grinding they make an edible paste high in fat. Their “recycling” of calorie-rich pitahaya seeds illustrates how desperate they must have been to get enough nutrition.
Baja California is a desert peninsula: the sun is brilliant, the growing season long and vacant land plentiful. What is lacking is enough fresh water; not much grows with only five inches of rain a year. Without plentiful seafood this place could not support humans.
Every living system has limits to the number of plants or animals it can sustain. Biologists call it “carrying capacity”—the number of plants, animals or people that an area can support given the quality of the natural environment. Ingenuity can extend the environment’s ability to support people, but not forever. We are subject to biological and other limits.
When a habitat’s carrying capacity is exceeded, it becomes degraded and the population will be forced to decrease. Carrying capacity in the desert is dictated by the supply of water. Many people think that the ultimate limitation here in the arid Southwest will be water, just as it was for the Pericú.
We have exploited the resources of our planet for so long, and found so many ingenious ways to increase its productivity, that we often forget about limits. The desert reminds us of the finiteness of biological systems.
Humans are cleverer than most animals in cultivating nature. There is no evidence that the Pericú had formal agriculture. Nevertheless, some seeds must have escaped from the pitahaya gatherers and landed near their habitations, thus increasing future harvests. Accidental seeding may have been one of the ways that agriculture got started in other parts of the world.
Planting seeds and controlling water are two of the first steps to growing crops. Agriculture freed people from spending so much time producing food, and eventually led to our abundant lives. We must not lose track of our dependence on water, however, nor forget that the earth can support only a finite number of people.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

About Haiti

Monday, March 8th, 2010

Be Thankful 1-2010
© Richard Grossman MD, 2010

“Whatever affects one directly, affects all indirectly.”
Dr. Martin Luther King, Jr.

I was riding in a taxi in New York City. The radio was tuned to music on a Spanish language radio station.
“Your accent doesn’t seem to be Spanish,” I remarked. “Are you Hispanic?”
“No, I’m from Haiti. But I like Spanish music.”
My driver had come north many years before, he explained. He had been an accountant in Haiti and had earned good money there, he said, by Haitian standards. “But I like it better here.”
The tragic earthquake of January 12th struck at the heart of Port au Prince, capital of Haiti. Badly constructed buildings crumbled with the terrible shaking, trapping many thousands of people.
Almost three quarters of the people in Haiti live on two dollars or less a day. This unbelievable poverty makes it the poorest country in the western hemisphere, and among the poorest in the world. Building codes are not part of such poverty. Migration to cities is common all over the world, including Haiti. It is ironic to realize that many people who were injured or killed in Port au Prince might have been safe if they still lived in traditional wood homes rather than modern concrete structures.
This devastated city has become the focus of the media, with minute-by-minute reports of horror. A few minutes watching CNN displays graphic accounts of private tragedies—bodies unceremoniously being spilled from a dump truck into a common grave, a beautiful eleven-year-old girl caught in a splintered building who was freed but died of injuries, people breathing through cloth to mask the smell of death.
We are privileged to live in an amazing age. We can see and hear immediately such personal stories of devastation. Highly skilled teams of helpers started to arrive within days with sophisticated equipment and trained dogs to free trapped people. Internet is used to send and receive word of friends and relatives in the affected area.
Those of us who live in a rich country (such as the USA) at this time in history often don’t appreciate how lucky we are. We have grown up with expectation of comparatively easy, relatively safe lives. Most people of the world do not share our good fortune, although the worldwide media make the disparity between rich and poor obvious.
The contrast between rich and poor was brought home to me by one of Durango’s expert doctors. He told me that he is sad that he cannot get to Haiti to help. I don’t think that he fully understands what would await him: scores of injured people and no organization, no laboratory tests, no x-ray machines, no medications, no casts for broken bones. Many people are dying alone, surrounded by collapsed concrete and the stench of death.
In addition to not being able to practice in any way that he is accustomed to, he would be using precious food and water that is needed by the Haitians.
Tragedy visited people in the past, too. In rich countries our expectations and ability to respond has changed immensely.
The explosion of the Indonesian volcano Krakatau in 1883 is an example of a catastrophe. Lava and superheated gases killed nearby people instantly. Tsunamis triggered remote devastation. The short-term death toll was over 100,000 people. In the long term the climate was two degrees Fahrenheit colder for five years because clouds of gas and ash shot into the stratosphere.
How has the world changed in the century and a quarter from Krakatoa to Haiti? Most of the world is financially much better off than a century and a quarter ago (although Haiti lags behind). What I perceive as the biggest change, however, is our acceptance of risk.
People died young in the nineteenth century. If you were involved in an accident, it was perceived as an act of God, not someone else’s fault. Accident prevention (including building codes) was undeveloped or didn’t exist at all. Medical care was rudimentary—just as it is in Haiti now.
One of the reasons that Haiti is so poor a country is that many of its most industrious people leave—such as my taxi driver. Another reason for poverty is the high fertility rate. The average woman will bear four children during her lifetime. The percentage of couples using contraception is low.
A tragedy such as hit Haiti is a horrendous way to reduce population. Acceding to people’s wishes to limit their fertility by providing modern contraception is much more humane.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

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