Look Where We Need Family Planning the Most

April 27th, 2017

“As we crawled through the city, we encountered a crowded slum area. The temperature was well over 100, and the air was a haze of dust and smoke. The streets seemed alive with people. People eating, people washing, people sleeping. People visiting, arguing, and screaming. People thrusting their hands through the taxi window, begging. People defecating and urinating. People clinging to buses. People herding animals. People, people, people, people.”   Ann and Paul Ehrlich in Population Bomb, 1968

Impact = Population x Affluence (consumption) x Technology

                                                Ehrlich and Holdren, 1971


Close your eyes for a moment and conjure up an image of overpopulation. Did you picture hundreds of people hanging off a train in India? or dark-skinned crowds in a street in a poor country?

Yes, family planning is important in those scenarios. Voluntary access to modern contraception is important for humanitarian reasons in the global south. You probably know the litany of its benefits: decreased maternal mortality, healthier children, economic savings, progress in standard of living and education, local environmental protection.

However, the need for effective, universal access to family planning and to safe, legal abortion is much more important in rich countries in the global north. This is because of the issue of consumption.

What! you might be asking. The average woman in many African countries has 5 or more children. Niger tops the list; the total fertility rate there is over 7! Surely the population explosion there must be causing problems. Yes, Niger is one of the lowest ranked countries in the UN’s Human Development Index. Repeated drought has caused famine; population pressure and overgrazing cause environmental degradation.

Let’s compare two countries in the Western Hemisphere—the USA and Haiti. They are, respectively, one of the richest and one of the poorest in the world. The carbon footprint of an average person in the USA is about 20 tons of CO2 per year, while that of a Haitian is 0.2 tons—one hundredth of ours! Thus it would take a hundred Haitians to equal the climate damage done by one of us.

Another way to compare the impact of a single person in the two countries is with Ecological Footprint. The ratio between the two countries is 16 to 1. Thus 16 kids of a really large Haitian family would have the same impact of a single-child family in the USA. I have to admit that there are several problems with this comparison: it doesn’t include the two parents, the average Haitian family size is just a little over 3 so I doubt that there are many as large as 16. The legacy of a large family grows over generations. In Niger, if each generation has 7 children, the number of grandchildren would be 49!

The two measures of impact are different. The carbon footprint is global, since carbon emissions into the atmosphere spread over the whole planet. The Ecological Footprint includes carbon emissions, but it also includes effects that are localized, such as damage to the local environment. In any case, the impact of a person in the USA is much greater than one in Haiti or Niger, and it is spread over the planet.

There is good news! The unintended pregnancy rate (this includes mistimed and unwanted pregnancies) has dropped significantly in the USA. Whereas this rate has hovered at about 50% for years, the latest information is that it has dropped to 45%. The news is especially good for young women, when an unintended pregnancy can be devastating. This decrease is due to increasing use of effective contraception. It is very concerning that the new administration threatens women’s reproductive health and may make contraception and abortion services either unaffordable or totally unavailable.© Richard Grossman MD, 2017

Walk Carefully

March 26th, 2017

Walk Carefully

            This month’s column has almost nothing to do with human population. It details an event that was life-changing for me, and could have been life-ending. However, getting bumped off by a careless driver is no way to solve overpopulation! I write to help others be safer.

Back in November my wife and I were crossing Main Avenue in the crosswalk on the way to one of Durango’s restaurants. We weren’t sure if it was north or south of 7th Street, and I remember looking to the left to see if the eatery was in that direction.

The next thing I knew was waking up in the CT scanner at Mercy. I had been hit by a car whose driver “didn’t see me”. Fortunately he stopped; unfortunately he parked with my foot under a tire.

Happily the results of the CT scan and other tests showed nothing terrible was done. I had a broken bone in my right ankle in addition to multiple bruises and “road rash”. The concussion saved me from remembering the accident, and its aftereffects are gradually resolving. There was a large bruise on my left leg where the car had probably first hit me. The hematoma became infected and had to be drained.

The hematoma and dead skin that covered it seeded another infection. I went back to the operating room to have that removed, leaving an open wound. Now, almost 4 months after the accident, I am still recovering but am almost healed.

I am very fortunate: my injuries could have been so much worse. Searching the Herald archives since my accident I found 4 more pedestrians who had been hit by vehicles in Durango and one in Hermosa, so mine was not an isolated misfortune. It would seem that it isn’t safe to be a pedestrian in Durango!

There are several lessons when looking at my accident from a public health standpoint. Everyone knows that drugs and alcohol are among the most common causes of motor vehicle accidents. Texting and talking on a cell phone are frequent causes of accidents. Apparently none of these possible factors was pertinent to my accident.

One possible contributing factor is that I was wearing a blue jacket and dark jeans. These are less visible than lighter colors. Although the “dark skies” initiative is admirable, I think that the lights in downtown Durango are dimmer than they should be.

The care I received has been excellent. A woman who was working at a store close by came and kept my neck from moving and made sure I was responsive. My wife and others told the driver that he was parked on my foot and got him to move the vehicle. The police and ambulance arrived quickly. They started two IVs and drove me to Mercy with all the proper precautions. An emergency physician evaluated me and ordered appropriate tests. Then they applied a splint to the broken ankle.

There was a surprise in the ER—a bouquet of flowers brought by unknown well-wishers. It turned out that they had just started one of new restaurants where Francisco’s had been. We ate dinner there a month or so after the accident; their chile rellenos are excellent!

I have several suggestions to try to prevent pedestrians from being hurt in the future. Individuals can avoid trauma by being more paranoid when crossing streets—even in the crosswalk. Wear light-colored clothes at night; even better, wear clothes that have reflective markings.

The City of Durango already is concerned about lighting. From Christina Rinderle’s column “From the Mayor” in the January 29th Herald: “Other items were placed in the high impact/low effort quadrant that we hope to be “quick wins”, like enhancing downtown lighting to make it safer and more inviting….”

A traffic light at the corner of 7th and Main would help. My wife, Gail, has a suggestion for a less expensive solution. Mount spotlights aimed at the crosswalks on poles at the corners of Main that do not have traffic lights. When a pedestrian wants to cross, s/he would push a button to turn on the spotlight for long enough to safely cross the street.

I feel very fortunate that my injuries were no worse, but even with relatively minor trauma it is taking me 3 surgeries and over 4 months to recover. Please be careful!

© Richard Grossman MD, 2017

Let Her Decide

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 http://www.populationconnectionaction.org/fight4her/ 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: https://www.shedecides.eu.

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

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