Give Thanks for Good News

An unintended pregnancy can change a young woman’s life. Worldwide, there are 120 million unintended pregnancies each year.

            The world our three granddaughters will inherit will be different from the world that we have known. I hope that their world in half a century is not too ghastly—and there is reason to support that hope.

            The risk of extreme overpopulation seems to be waning. The global TFR (the number of children a woman will bear) is close to replacement. Also, the number of global unplanned births approximates the net number of people added to the planet each year.

            In 2020 the global TFR was 2.3. In 1990, just 30 years ago, the TFR was almost one child larger, at 3.2. 

            The global TFR was over 5 when I was born in 1943 and has been dropping ever since. For a country with a low child mortality rate, replacement TFR is about 2.1. That is one child to replace the mother, another to replace the father and one tenth to account for children who don’t live to reproductive age. That number is higher where the child mortality rate is high—2.2 or 2.3. Fortunately, child mortality has dropped considerably in the past 3 decades, which is why we use 2.1 for the goal of ZPG (Zero Population Growth). We have made amazing progress!

            Well, if the TFR is so close to ZPG, we don’t need to worry about overpopulation, right? WRONG! There are three problems with that contention. Most important is that the planet is already overpopulated. We have almost 8 billion people on Earth, whereas 3 billion would be sustainable. To get our population down to a sustainable number without massive mortality will require a TFR close to 1. Second, it has taken many years to lower the TFR to 2.3, and most of the “low-hanging fruit” has been picked. It will be difficult to get it to 2.1 or below. Third, population momentum will keep growth going for decades after we reach ZPG since there will be many young people who will be starting their families. We will need a TFR significantly less than 2 in order to reach a sustainable population. Today’s children, including our granddaughters, will be happier and safer if the world becomes less crowded rather than more so. 

            The number of unintended (or unplanned) pregnancies globally is about 120 million each year. What is an “unintended pregnancy”? Social scientists recognize that there is a spectrum of desire. At one end of the spectrum are our two sons who were definitely planned—and also very much loved. At the other end of the continuum might be a pregnancy that results from rape during war.

            The global rate of unintended pregnancy has dropped from 79 to 64 per thousand reproductive-aged women from the early 1990s to the late 2010s. The global abortion rate also dropped slightly in the same 25-year period. Safe, effective contraception has helped lower both of these rates. Of those 120 million unintended pregnancies, many will be miscarried and others will be aborted, so perhaps 80 million are carried to term.

            It is coincidental that the number of unintended births is close to the net growth of our population. If we can make family planning services available to all people, there is a good chance that global population will stabilize or start to decrease. Because we consume the most, we in richer countries must have the fewest unintended pregnancies. Remember, consumption multiplied by the number of people determines environmental impact. Therefore, unintended pregnancies cause the most impact in rich countries, such as the USA. In this same 25-year period, the unintended pregnancy rate has dropped by almost half in Europe and northern America, some of the world’s richest countries.

            Unfortunately, there is also bad news. Politicians are not very interested in investing in family planning, although it has been shown that every dollar spent would save many dollars for maternal and newborn care—and save many lives of women and children.

© Richard Grossman MD, 2021


Chastise Texas about its unsafe abortion law

Women’s March, 3 October 2021, in Durango, Colorado

There is no such thing as banning abortion, there is only banning safe abortion.

            Texas has just passed the country’s most draconian and restrictive law on abortion, which the Supreme Court initially refused to consider. What bothers me is not just the lack access to safe abortion services but also some aspects of the law.

            S.B.8 (nicknamed the “Texas Heartbeat Act”) prohibits a doctor from performing an abortion if a fetal heartbeat is present. Before performing an abortion, doctors must know if the fetal heartbeat can be seen by ultrasound. An abortion can only be performed with a heartbeat if there is a “medical emergency”, although that term is not defined. I assume that would include true medical emergencies (such as an infected pregnancy), or if the woman has a serious medical condition that might kill her if the pregnancy were to continue, such as a tubal pregnancy.

            The law empowers normal citizens to be abortion “vigilantes”. It says: “Any person… may bring a civil action against any person who….” Reasons for legal action include a doctor who performs an abortion with a heartbeat, a person who helps someone else get an abortion, or even a person who has the intention to help someone have an abortion. The penalties are dire, and include a bounty of not less than $10,000 for each abortion. The law has no exceptions for rape or incest.

            What is really remarkable is that the law prevents the usual enforcement, but rather encourages spying and snitching. It states: “…shall be enforced exclusively through the private civil actions….” This law allows anyone, in or outside of Texas, to attempt to grab the bounty on a doctor who performs an abortion beyond 6 weeks.

            The people who wrote this law knew that it would be challenged and that the challenge would probably go to the Supreme Court of the USA, so put in a remarkable clause: that no regard would be given to “a defendant’s belief that the requirements of this subchapter are unconstitutional….”

            Furthermore, the legislature has stopped using the correct medical term for an early pregnancy, “fetus”, but rather substituted “unborn child”. Although this might be satisfying for people who are against abortion, I hate to see legislators change medical terminology for their nefarious purposes. Isn’t there a law against lawyers practicing medicine? To make things worse, courts are playing legal pingpong with women’s reproductive rights, the law having been stayed by one court, then reinstated by another.

            What can we expect to see as a result of S.B.8? More women will travel outside of Texas for abortion care. One clinic in Oklahoma City already reports that two thirds of their patients come from Texas. More concerning is that there will be more unsafe abortions as women become desperate—as was the case before Roe v. Wade in 1973. We can expect an increase in maternal mortality in Texas, as has happened in states when they have enacted laws that decrease access to safe abortion services. Texas already has a higher-than-average number of women dying from pregnancy-related problems. 

            A brave Texas OB-GYN, Dr. Alan Braid, openly broke the law and wrote about it in the Washington Post. His patient, a 42-year-old mother of 4 young children, couldn’t leave them to go to another state. Braid wrote that during his training, before 1973, he saw 3 teenagers die from illegal abortions; this is part of his motivation for performing safe abortions. 

            What can be done? Studies in other countries have shown that home abortions with medications can be safe. Women can put away their hangers and knitting needles and safely purchase the medications needed on Internet. AidAccess is one source of information about the medications that can cause an abortion safely. For Texas women who live close to the border, misoprostol is available in Mexico and is a safe way to cause an abortion by following instructions at the International Women’s Health Coalition website.

            What is clear, according to a recent Economist survey, is that the majority of Americans favor access to safe, legal abortion services. Texans, don’t be bullied by religious fanatics!

© Richard Grossman MD, 2021