Archive for the 'Population' Category

Let Her Decide

Monday, February 27th, 2017

          “Father slapped his hand on the table. ‘If Sarah was a boy, she would be the greatest jurist in South Carolina!’” This quote is from Sue Monk Kidd’s popular novel, The Invention of Wings. It is inspired by Sarah and Angelina Grimké, whose family were slaveholders in the first half of the 19th century. These sisters moved from South Carolina to Philadelphia where they joined the abolition movement and the Religious Society of Friends. They were condemned because Quakers didn’t allow women to lecture in public at that time. Speaking as a Quaker, I am pleased that one of our religion’s current core beliefs is equality, including equal status of men and women.

In Nobel Prize winner Orhan Pamuk’s A Strangeness in My Mind, one of the characters waited tables at the Bounty Restaurant in Istanbul, Turkey. A reflection of the status of women in 1984 is that the owner’s idea of success “…was for a woman to come in with a group of men and be able to have a pleasant evening… without being subjected to innuendo and arguments all night, and to enjoy herself enough to come again, though in all the Bounty Restaurant’s checkered history, this had sadly never happened.”

The status of women in many countries is terrible, as it was in the early history of the USA. Fortunately women’s status is slowly improving globally, but there have been setbacks. Some of the worst have to do with access to reproductive health. While the science of birth control and abortion has improved, restrictions have made it more difficult and more expensive for women to receive the services they desire.

First came the Helms Amendment in 1973, the year that abortion was legalized in the USA. Appended to the Foreign Assistance Act, this amendment prevents federal money from being used abroad to provide abortions or even information about abortion.

The Helms Amendment kills women. It is estimated that 11,000 women die annually because they do not have access to safe abortions. Each year there are 20 million unsafe abortions world wide, mainly in poorer countries, that kill 47,000 women. Remember that the abortion rate is paradoxically higher where it is illegal! Sadly, many of these women are mothers of large families. Many lives could be saved if the USA would encourage safe abortion services.

Passed 3 years later, the Hyde Amendment prohibits federal Medicaid funding for abortions in the USA. There are three exceptions to this, fortunately—for cases of rape or incest, or if the pregnancy presents a risk to the woman’s life. Some states use non-federal funds to pay for abortions; New Mexico does, but Colorado does not. Both of these amendments regrettably target the poorest of women, especially women in rural areas with limited access to health care.

Nicknamed the “Global Gag Rule”, the Mexico City policy was announced in 1984. Many overseas organizations get their funding from multiple sources, including from the federal government. This Rule prohibits any recipient of federal funds from any counseling or provision of abortion services—even if that funding comes from another source. The Gag Rule is a political football. Started by Reagan, every Democratic president since has rescinded it, but every Republican, including most recently Trump, has reinstated it in even more restrictive form.

138 organizations have signed a statement opposing the Global Gag Rule. What can we as individuals do? Population Connection (formerly “ZPG”) started a campaign supporting Congress’s move to block the Rule permanently. 46 senators have co-sponsored Senate Bill 210, the Global Health, Empowerment and Rights (HER) Act. In the House, a companion bill H.R. 671 has support from 140 Representatives. Go to for more information

A new organization was formed in reaction to the reinstatement of the Global Gag Rule. Lilianne Ploumen, a social activist and minister in the Dutch cabinet, started “She Decides – Global Fundraising Initiative”. The Dutch government announced that it will contribute 10 million Euros to this initiative to help replace the funding the Gag Rule has taken away—and it has been joined by support from 7 other governments. There is more information and the opportunity to donate at:

Here in Colorado some members of our State Legislature have recognized the problems caused by diminished reproductive rights and have written House Resolution 1005. Democrats, including our own Barbara McLachlan, support this resolution. It champions the full range of reproductive health, including abortion. Would that there were more strong advocates nationwide such as we have here in Colorado!

© Richard Grossman, MD 2017

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

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