Archive for the 'Population' Category

Stay Current on International Family Planning

Thursday, December 29th, 2016


 A sign in Ethiopia showing the positive effects of having only 2 children. (Escape from poverty, health, a better housing, a fertile surrounding with trees, a better education) Picture by Maurice Chédel

“All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so.”                         United Nations, 1994


Although reproductive rights may be in jeopardy in this country, there is reason for optimism both here and abroad.

India has the world’s second largest population—about a billion and a third people. Thanks to family planning programs, family size there has been decreasing slowly through the years. Unfortunately there have been some bad bumps on the road. For instance, decades ago both men and women were sterilized without really understanding their surgery. The government put pressure on family planners to meet quotas and they, in turn, pressured patients to have surgery. Recently several women died after shoddy surgery in tubal ligation “camps”. It turned out that these unfortunate women wanted family planning, but weren’t given the option of temporary contraceptive methods nor adequately told of the risks of the surgery.

Sterilization, condoms, “the pill” and IUDs have been the mainstays in India, but the government has just added contraceptive injections to the short list of methods available to women without cost. The “Depo” shot has the advantages of lasting 3 months, of being very effective and lacking the serious side effects of contraceptives with estrogen. Therefore women who cannot use “the pill” can use it. Worldwide, “Depo” has been prescribed for birth control for over 40 years.

Although the USA has some of the most stringent rules for approving medications, I find it interesting that some other countries have limited access to birth control that we take for granted. Depo in India is one example, and birth control pills in Japan are another. For years Japanese women were not able to get “the pill” and couples mainly relied on condoms for contraception. The rationale was that condoms prevented the transmission of disease and could prevent problems if there was marital infidelity. It was only in 1999 that this policy was changed.

In many parts of Africa women needed a physical examination and blood tests before they could get a prescription for “the pill”. Few could afford these luxuries, driving up the number of unplanned pregnancies. In much of Latin America, on the other hand, a woman can walk into a “farmacia” and purchase whichever brand she would like.

Emergency contraceptive pills are easily available throughout much of the world. Plan B and other brands are now available in pharmacies in this country without prescription. They have been shown to be amazingly safe, although not as effective as having an IUD inserted. Of course EC should only be used in case of an emergency, such as rape or a broken condom, and it provides no protection against infection.

Price gouging for medications exists outside the USA. In England, for instance, the cost for EC could be more than US$40—while the same medication in France would cost less than US$10. There is an eye-catching British campaign suggesting that a woman in need could save money by taking the bus to Paris to get her pills!

Although millions more women in the USA have access to free family planning thanks to “Obamacare”, unfortunately there are still limitations. Some 20 million women in the USA live in “contraceptive deserts”. These are areas without reasonable access to publically funded clinics that offer the full range of contraceptive methods. Despite this, the teen-pregnancy rate has fallen precipitously in the past 25 years—a big reason for celebration!

Globally there is mixed news from the immense attempt to provide family planning services in some of the most difficult to reach and poorest parts of the world. The Family Planning 2020 campaign is now about halfway through its tenure, which started in 2012 and goes until 2020. Its goal is to reach 120 additional women with family planning services in 8 years. They have reached 30 million new users of contraception, which is an amazing achievement—but short of their interim goal by 20 million. It is incredibly difficult to deliver health services in areas where this campaign is working; I wish them luck.

Speaking of luck, last month I was hit by a car while crossing Main Avenue in a crosswalk. Fortunately I have no serious injury except for a broken ankle. It is also fortunate that I am totally retired from the practice of medicine—but plan to continue writing these columns. Happy Holidays to readers of Population Matters!

© Richard Grossman, 2016

Honor Childfree People

Friday, 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

Responding to my Climate Change Denying Friends

Tuesday, May 24th, 2016

Curves of pop & CO2 in air

Please note the two curves above. Although the graph of CO2 concentration in the atmosphere (Keeling curve) on the left starts in 1958 and the one on the right (human population) starts in 1800, they follow the same trajectory of steep increase over the past 50+ years.

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

Upton Sinclair

            A recent Letter to the Editor of the Herald got my attention. It would seem that its author and I are living on different planets.

The writer calls Dr. James Hansen’s statement that the world would “overheat” because of carbon emissions “a ridiculous assertion”. NASA has a web page devoted to statements from our country’s foremost scientific organizations. For instance, the American Association for the Advancement of Science states: “The scientific evidence is clear: global climate change caused by human activities is occurring now, and it is a growing threat to society.”

The LTE was in response to Herald article about the wager between Roger Cohen and me. Dr. Cohen (former manager of strategic planning at Exxon Mobil) earned a PhD in physics and is a member of the American Physical Society, which states: “The evidence is incontrovertible: Global warming is occurring.”

Let’s go back to the other planet where the writer of the LTE seems to be living. He asserts that polar bears are thriving. The International Union for the Conservation of Nature lists the status of polar bears as “vulnerable”, This would not lead me to believe that they are thriving. Dr. Steven Amstrup, head scientist with Polar Bears International, wrote: “One of the most frequent myths we hear about polar bears is that their numbers are increasing and have, in fact, more than doubled over the past thirty years.”

“The polar ice caps, both of them, are robust” according to this LTE. Unfortunately, Earth’s ice caps are not healthy. Indeed, a large freighter recently navigated the fabled Northwest Passage through the Arctic Ocean!

There is mixed news from Antarctica. Although ice in west Antarctica is melting, the amount of ice is increasing over the continent. That is a bit of a paradox since the average temperature there has gone up by almost 1 degree Fahrenheit—but it is just so darn cold in Antarctica.

Studies find rising levels of CO2 help some plants but hinder others. Studies of phenology (when plants and animals wake up after the winter) find that climate change is already causing problems that may lead to decreased crop productivity. Many places in the world are experiencing decreased precipitation from climate change. Overall, the bonus of increased CO2 seems to be overwhelmed by other aspects of climate change.

The LTE ends up by stating “…the standard of living of some of the world’s poorest of the poor has risen because of increased vegetation to feed themselves and their animals….” Try telling that to the people who are starving in Madaya—where the Syrian revolution was triggered, in part, by drought caused by climate change. The Horn of Africa is also suffering from chronic malnutrition, as are many other places in Africa and Asia. Drought caused by climate change has worsened starvation in these places. Although the percentage of people who are undernourished in the world has decreased, the improvement is not generally attributed to increased CO2.

People are also suffering from climate change closer to home. Residents of Isle de Jean Charles, Louisiana, will be relocated because their community is disappearing under the rising ocean.

What I find amazing is that, although people deny climate change (or perhaps deny that climate change is anthropogenic), I have yet to read any refutation of the observation that the atmospheric concentration of CO2 is rising, and that its rise is anthropogenic. We all understand that this gas, along with methane and water vapor, are greenhouse gases. Without GHGs our planet Earth would be 60 degrees Fahrenheit colder—and totally unable to support life. Doesn’t it make sense that, as the CO2 level rises, the temperature will also rise?

Perhaps we can excuse some of the denial of climate change thanks to the findings of a recent study of people’s reaction to the climate. Apparently the warming that we in the USA have experienced actually has made the climate more agreeable—although that is far from true in other parts of the world.

Greenhouse gases released by people cause climate change; the more people, the faster the climate will change. Family planning is part of the solution! Another part of the solution is convincing our political representatives to support legislation to slow climate change. The Citizens’ Climate Lobby ( has an effective plan to do this. A local chapter has just been formed; you can contact them at:

© Richard Grossman MD, 2016

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