Pay Attention, Healthcare Workers!

            Family planning could bring more benefits to more people at less cost than other single technology now available....      James Grant
            Either we reduce the world’s population voluntarily or Nature will do this for us, but brutally.                                          Maurice Strong

            Two physicians who are concerned about human population just published an article titled “Doctors and overpopulation 48 years later”. It is based on an article that was published almost a half century ago.

            The original “Doctors and Overpopulation” was signed by 52 physicians. The first paragraph states: “Many regard overpopulation as the supreme dilemma of our age….” It goes on to say that most people consider overpopulation to only be a problem of developing countries, but that Britain would soon be overpopulated. The population of the USA rose by 121 million, from 210 to 331 million, in those 48 years. Global population has doubled since 1972. 

            Our medical profession helped cause overpopulation by improving health so people live longer. Decreasing childhood mortality has had a huge effect in increasing population growth, but it is perhaps the most humane action in the history of medicine. The authors of “Doctors and Overpopulation” take some responsibility for the rapid growth. 

            What could those doctors recommend to combat overpopulation? They list 5 actions, all of which are still relevant today: Convince the government of the seriousness of overpopulation; Increase family planning services, including access to vasectomy; Keep abortion legal and available to all women; Empower women; Include population studies at all levels of education and use mass media to spread information on the subject.

            One of the authors of the current article, Dr. John Guillebaud, was also one of the 52 original signers. Guillebaud is a family planning guru and retired professor of reproductive medicine in London. The other author, Jan Gregus, is a gynecologist and philosopher in the Czech Republic. He recently presented a paper at the World Congress of Bioethics on the ethics of small families.

            They write about 5 roots of overpopulation: the decline in mortality and population momentum (the large number of young people who have yet to have their families). These 2 causes cannot be changed, but the other 3 can be. There are millions of women who want to control their fertility but don’t have access to reliable contraception; access to family planning services can help. Even more women and men are forced by custom and convention to have large families. Social norms in some societies force women to be mothers because that is the only role open to them. Education can help here—especially by non-traditional methods such as telenovelas. The Population Media Center has done an excellent job of using electronic media to educate and empower women and to show the advantages of small family size. 

            I strongly agree with Guillebaud and Gregus in condemning reproductive coercion. It was unnecessary in India and in China, but coercive programs there and elsewhere have done great harm not only to the affected people but to the movement to slow population growth.

            They also talk about the effect of large international conferences, and lament the fact that the huge Cairo conference in 1994 “failed to articulate the threat of unremitting population growth on a finite planet….” Instead, that conference highlighted the importance of reproductive health services. It also promoted education of girls and women and supported “…childbearing needs to become a woman’s personal choice, and not her obligation or a matter of chance….”

            Another conference, held last year in Nairobi on the 25th anniversary of the Cairo conference, followed the global trend of ignoring overpopulation. To quote Guillebaud and Gregus, “Despite… much evidence that unremitting population growth is one of the ‘upstream’ driver[s] of climate change… at the Nairobi population conference the word population was nowhere….”

            Yes, there is a taboo against talking about population as a cause of environmental problems. In addition to climate change, the authors list 13 other global crises related to overpopulation—but you seldom see the media making this connection. They call for a “taboo-free talk”. Thanks, Drs. Guillebaud and Gregus; that has been the goal of Population Matters-USA for the past 25 years!

            There is good news! Physicians have been slow to recognize the concept of overpopulation, and to acknowledge the connection between medical care and environmental problems. This article, “Doctors and overpopulation 48 years later”, was a step in the correct direction. Earlier this year the equivalent journal in the USA, Contraception, ran a similar editorial: “Family planning, population growth, and the environment.” I only wish that both articles were published where more people could read them.

© Richard Grossman MD, 2020


Discuss Childbearing with your Fiancé

            A friend told me a story that revealed a blind spot in some relationships. He was speaking about his son and new daughter-in-law.

            My friend (who is also concerned about population) and the newlyweds had just seen the film “An Inconvenient Truth”. The groom, concerned about the future, asked his dad what was the most important thing that the newlyweds could do to slow climate change. My friend told me that his response was “have a small family.”
            The son responded that he never wanted to father a child. The new daughter-in-law replied “Of course we’ll have kids!”
            My friend could understand his son’s reluctance to father children. This young man was born with a serious congenital problem that took multiple surgeries to correct. He was worried that any child he might father would have the same problem, even though the risk was only about 1 in 20.
            When practicing obstetrics and gynecology, I was amazed and concerned by the number of couples I encountered who disagreed about childbearing. Sometimes the woman wanted a child (or more kids) but the man didn’t, and sometimes it was vice versa. Often this was mentioned to me in passing as a minor concern. However, to parent or not was a major sticking point for some couples.
            There are a growing number of young people who plan to be childfree; most of them are women. Their reason for rejecting parenthood is fear of the future condition of the world that the movie describes.
            Fortunately, Gail and I both wanted two kids, and we even had the name for one chosen before we got together. I had always wanted to name a son, if I had one, David—and Gail the same.
            A few years ago, I mentioned “Jane” in one of my essays. She wrote me that she had resulted from an unplanned pregnancy. Her parents had different ideas about childbearing. When her mother found out that she was pregnant with the third child (Jane), she demanded that the father (a physician) abort the pregnancy. Jane’s mother and father went together to his office more than once, but he refused to perform the abortion. Jane wrote that being born from an unwanted pregnancy severely affected her life adversely. She never wanted, nor had, children. Jane reported that she was happily married, and that, fortunately, her husband was pleased to be childfree.
            Another couple was just the opposite. They were active in outdoor sports and had never planned on parenting. Accidents happen; they were delighted to relive their son’s birth and update me on his progress when we met at City Market. Fortunately, this sort of good outcome is much more common than lifelong regrets about parenting.
            How can this sort of discrepancy about parenting be approached? Many couples go through religiously-based premarital counseling, which makes sense to me, although Gail and I didn’t 50+ years ago. She went to a doctor and had her first Pap smear in order to get a prescription for birth control pills. We agreed to wait 5 years before deciding to have our first child, David.
            My understanding of most premarital counseling is that it is most common in religions that encourage large families, so I doubt that family size or contraception is likely to be discussed. My own faith, the Religious Society of Friends (Quakerism), does not have a prescribed curriculum for premarital counseling. Quakers recommend that the couple select a “clearness committee” of Friends to help them decide if marriage is right for them. The goal is for the two to determine for themselves if they are truly prepared to spend the rest of their lives together. Suggested topics for a clearness committee for marriage include “background”, “religious beliefs” and “growth and fulfillment”.
            Under the heading “relationships with others” is a relevant question for a clearness committee to consider: “Have they considered whether they desire children—the problems as well as the joys children would bring, and the responsibilities for nurturing and guiding them?” There is no mention of birth control—but certainly no prohibition against using it.
            Fortunately, there is a happy ending to my friend’s story. Although the newlyweds started off their relationship with a serious discrepancy in their desire for childbearing, they eventually resolved their difference. My friend is the grandfather of a beautiful and playful young girl. The proud parents were reassured by the ultrasound pictures taken routinely during pregnancy that there was no sign of the same congenital defect that the father dealt with.
© Richard Grossman MD, 2020