Archive for the 'Reproductive Health' Category

Don’t Control Population this Way

Sunday, January 28th, 2018

Human skulls at the Nyamata Genocide Memorial

There are many ways to decrease human numbers, and most of them should be shunned. Indeed, some of them are quite horrifying. In this and subsequent columns I’ll write about some of them.

It has been more than 20 years since the Rwandan genocide, but it stands out in my mind as the worst episode of human slaughter in recent history. Estimates of the number of people killed in a terrible 100 day period range from 1/2 million to a million. The population of Rwanda at that time was less than 8 million; a huge proportion of this small country’s people killed each other. In addition, an estimated 2 million were displaced or fled the country.

Genocide is the intentional destruction of a national, ethnic, racial, or religious group. Theories about the causes of genocide include tribalism, autocratic rulers and lack of resources. An article about this genocide, “Remember Rwanda” by James Gasana was published in WorldWatch. Gasana is Rwandan and had held 2 different cabinet positions in that country. In this article he noted that murder was most common where people went to bed hungry. That hunger, contributed to by overpopulation, apparently was part of what fueled the killing

In 1994 Rwanda had an almost entirely agricultural economy and was overpopulated. As the population rose the size of landholdings shrank and the overworked land became less productive. Even if people wanted to limit their fertility, the predominant religion, Roman Catholicism, preached against “artificial” contraception.

That is in the past. With international help and amazing resilience, the Rwandan people have put that terrible part of their history behind them. However, another country appears to be enduring a religiously motivated genocide. The Rohingya people in Myanmar (Burma) are both an ethnic minority and, as Muslims, have different religious beliefs from the Buddhist majority.

Genocide Watch lists 10 stages that are seen in preparation for and carrying out a genocide: Classification, Symbolization, Discrimination, Dehumanization, Organization, Polarization, Preparation, Persecution, Extermination and Denial. Most of these stages can be seen with the treatment of the Rohingyas.

Although they live in Myanmar, the Rohingyas aren’t allowed citizenship—classification. While they are not forced to wear identifying symbols, their freedom is restricted in other ways. They must live in ghettoes and are restricted by curfews—organization and polarization. Mobs attack Rohingya settlements while officials offer no protection—preparation. “Security” forces have killed thousands of Rohingyas while others have been tortured, “disappeared” or have suffered rape—extermination. The country admits to no wrongdoing—denial.

Perhaps the most dire of the measures against the Rohingyas is limitation of their reproductive rights. While there is no limitation on other people in Myanmar, the Rohingyas are only allowed to have two children. Apparently the Muslims tend to have larger families than the Buddhists in the same area. The state officials’ reason for this limitation is to “…ease tensions between Buddhists and their Muslim Rohingya neighbors.” Even if this is the true motivation, legislating the number of children in a family is wrong.

Unfortunately, Myanmar and Rwanda are not unique; there are many historical examples of peoples being singled out and exterminated. In the chapter on genocide, “The Great Big Book of Horrible Things” tallies an estimated 32 million deaths from genocides in the past 3 millennia. This includes a huge but unknown number of indigenous people killed in the Americas when we Europeans invaded.

Currently there are several countries where genocide is happening or is very likely. These include South Sudan, Sudan, Syria, Yemen and the Democratic Republic of Congo, all of which have unstable governments and terrible records of civil rights.

What can we do to prevent genocide? In “Warning Signs of Genocide: an anthropological perspective” Drs. Gene and Barbara Anderson state that the most important protection against genocide is critical thinking—the process of independently analyzing, synthesizing, and evaluating information as a guide to behavior and beliefs. They have written a second book, “Halting Genocide in America”, in which they are concerned that some people in the USA are already taking steps along the road to genocide.

Genocide is perhaps the most vicious way to slow population growth, but there are several others on my list of means to reject. Nature tends to limit populations with disease and famine, over which we have only limited control. Some other ways of slowing growth are imposed by people and governments. These include eugenics, family size coercion, war, gun violence, and the Voluntary Extinction Movement. More about them in future essays.

© Richard Grossman MD, 2018

Graph showing dip in Rwandan population after genocide, followed by recovery.

Reduce Barriers to Family Planning

Sunday, December 24th, 2017

There’s no good news about male contraceptives yet, but there is much progress in the field of family planning for women. This column will touch on some of the high points.

Perhaps the best news is that, globally, more women who want to avoid pregnancy are using an effective contraceptive method. The number who weren’t using modern contraception was estimated to be 225 millionin 2014but is 214 million now. The decrease is partly due to huge efforts from Family Planning 2020 to make better family planning available in developing countries. With local support as well as funding from rich countries and foundations, FP2020 has provided over 30million women with effective contraception.

The goal of FP2020 is to reach 120 million previously unserved women with effective family planning by the year 2020. In many places couples only had access to one or two methods, such as condoms or tubal ligation. FP2020’s strategy includes avoiding coercion and offering a choice of several methods.

Please remember that it is not just developing countries that wrestle with unintended fertility. In 2008 in the USA 51% of pregnancies were unintended. There is good news here, too; it is now just 45%. This decrease, and the significant decrease in abortions, is thought to be due to Long Acting Reversible Contraception—LARCs. These methods include IUDs, implants and the 3-month shot. One in 7 women in the USA is now using these most reliable types of birth control.

LARCs have two shortcomings, however. In general they are expensive—but remember that dollar-for-dollar, contraception saves more than any other health intervention!

The other problem with LARCs is convenience, since most require a health care professional. An exception is the 3-month shot, “Depo” or DMPA. This has been in use for birth control for almost 50 years, but requires a clinic visit 4 times a year.

Sayana Press® is an innovative solution that is accepted very well. It is a small plastic bubble filled with the medication and a short attached needle. The woman just punctures her skin, squeezes the bulb and she is protected against pregnancy for 90 days.

Malawi, a small East African country with large families, compared women who went to the clinic to get their shots with women who injected the medicine themselves. They found that women who were given the first shot at the clinic then took home 3 Sayana Presses® were much more likely to use the medication for a full year.

Birth control pills are available without prescription in many countries, and the USA will be following suit if Daniel Grossman has any say. Grossman and I may be distantly related, and we are very close in our belief that “the pill” is amazingly safe and there should be minimal barriers to its access. Grossman has started the “Free the Pill” campaign. This would follow the way Emergency Contraceptive (EC) pills have gone over the counter; Amazon.com now sells EC pills!

Another physician named Grossman—Jessica—heads up Medicines 360. This organization has as its mission “…to expand access to medicines for women regardless of their socioeconomic status, insurance coverage, or geographic location.” Their first product is a big success! Liletta® is an IUD that releases a hormone over 4 years, is safe and very effective, and decreases menstrual bleeding and cramping. It is primarily sold to clinics and is significantly less expensive than similar IUDs.Recently there is good news about all IUDs; they reduce the risk of a woman getting cervical cancer.

When Trump reinstated and expanded the Global Gag Rule, the Dutch started “SheDecides” to replace essential funding for reproductive health. More countries, foundations and individuals have stepped up to pledge $200 million! This amazing organization’s goal is to make it possible for “…girls and women to decide freely and for themselves about their sexual lives, including whether, when, with whom and how many children they have.”

Most couples in the USA use contraception at some time in their lives, even if their religion opposes birth control. In much of the global south, however, this is not the case. There the Roman Catholic hierarchy turns most women away from birth control. This might change, however. The Pontifical Gregorian University in Rome will be holding a series of talks on the 50th anniversary of Humanae Vitae, according to the National Catholic Register.

Despite political forces in this country that are trying to erect barriers around access to family planning, there is a lot of good news about contraception for women.

© Richard Grossman MD, 2017

Speak Truth to Power

Wednesday, January 25th, 2017

While watching the presidential election returns in November and disbelieving the results, this poem kept going through my head:

 

Manifesto: The Mad Farmer Liberation Front by Wendell Berry

                                                Used with permission

 

Love the quick profit, the annual raise,

vacation with pay. Want more

of everything ready-made. Be afraid

to know your neighbors and to die.

 

And you will have a window in your head.

Not even your future will be a mystery

any more. Your mind will be punched in a card

and shut away in a little drawer.

 

When they want you to buy something

they will call you. When they want you

to die for profit they will let you know.

So, friends, every day do something

that won’t compute. Love the Lord.

Love the world. Work for nothing.

Take all that you have and be poor.

Love someone who does not deserve it.

 

Denounce the government and embrace

the flag. Hope to live in that free

republic for which it stands.

Give your approval to all you cannot

understand. Praise ignorance, for what man

has not encountered he has not destroyed.

 

Ask the questions that have no answers.

Invest in the millennium. Plant sequoias.

Say that your main crop is the forest

that you did not plant,

that you will not live to harvest.

 

Say that the leaves are harvested

when they have rotted into the mold.

Call that profit. Prophesy such returns.

Put your faith in the two inches of humus

that will build under the trees

every thousand years.

 

Listen to carrion — put your ear

close, and hear the faint chattering

of the songs that are to come.

Expect the end of the world. Laugh.

Laughter is immeasurable. Be joyful

though you have considered all the facts.

So long as women do not go cheap

for power, please women more than men.

 

Ask yourself: Will this satisfy

a woman satisfied to bear a child?

Will this disturb the sleep

of a woman near to giving birth?

 

Go with your love to the fields.

Lie down in the shade. Rest your head

in her lap. Swear allegiance

to what is nighest your thoughts.

 

As soon as the generals and the politicos

can predict the motions of your mind,

lose it. Leave it as a sign

to mark the false trail, the way

you didn’t go.

 

Be like the fox

who makes more tracks than necessary,

some in the wrong direction.

Practice resurrection.

 

Wendell Berry is a renowned writer of prose and poetry, and an activist. Now in his 80s, Berry has given up the bright lights of New York and Palo Alto where he has taught and lives on a farm in Kentucky.

Berry is facetious when he writes “Love the fast profit….” Yet that is what the public in the USA has elected—a man who has little care for the future, nor for people, but has entered politics to further himself and the cadre of the superrich.

The next four years will be a especially difficult for reproductive health issues. The new administration has pledged to get rid of Obamacare, which has put health insurance within reach of millions of people. One of its best benefits is the availability of contraception without copay. Furthermore, the proposed Health Secretary is a foe of abortion.

There are actions bubbling up all over the country and they have already started locally. Dan Olson wrote about “Our 1st 100 Days”: “…a number of folks in the community are organizing a major campaign to combat the hate, fear, and lies so common in this last election cycle by growing and invigorating local efforts to advance social, environmental and economic justice in our community.” For more information: WWW.OUR1ST100DAYS.US.

RESPOND is offering a day of free classes on January 21st. For more information: www.respond2017.weebly.com.

The worst global crisis is climate change. Durango has already responded with a chapter of the Citizens Climate Lobby; https://www.facebook.com/DurangoChapterCCL/?fref=ts. CCL will be showing a video, “The Age of Consequences”, on Wednesday 15 February at both 5 and 8 PM. It will be at the Vallecito Room of the Student Union Building at Fort Lewis College.

In mid-February “Truth to Power: Writers Respond to the Rhetoric of Hate and Fear,” will be available at Maria’s Bookshop. The scores of voices there, including Berry’s, collected and published by local writers Pam Uschuk and Will Root, can strengthen our resolve for the next 4 years.

If you are unhappy about the direction our country is headed, join with your neighbors to regain control. Participate in local actions!

© Richard Grossman MD, 2017

Afterword: This piece is most relevant to the Durango area, but there is concern and action all over the globe–including a demonstration that was held in Antarctica! No one knows what is going to happen, but I am certain that the current administration will set back human rights–especially women’s rights–terribly.

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