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.
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