Plan for a Healthy Baby

July 15th, 2018

You might have thought that I’m against people having children and therefore be surprised that I am writing about having children. I am definitely in favor of people having babies; my goal is for all babies to be planned, loved and healthy—and not too many!

I believe family planning should include the treatment of infertility. It was always a joy for me when a couple who had dealt with fertility issues was able to conceive. Often I was able to attend the birth of that child—a double joy!

What a child needs most is two loving parents. It appears that marriage before childbearing is no longer in style—40% of women giving birth in the USA are unmarried. However, a marriage certificate is not nearly as important as parents being in a stable relationship. Planned pregnancies are most likely to produce healthy, loved children. This column is an update on steps people can take to have a healthy child.

If the couple has been using hormonal contraception, it may be wise for them to stop and use a barrier method for a couple of months before trying to conceive. The chances of having twins may be increased if conception occurs right after stopping “the pill”.

There are several actions that people can take to improve fertility without seeing a doctor. Being overweight is a cause of female infertility, so losing weight may help. Eating well helps improve fertility for both men and women. The suggested diet includes healthy protein, whole grains, fruits and vegetables—the same as for all of us. “Fast food” seems to prolong infertility!  For men, underwear can make a difference; the “family jewels” make more sperm if they hang loose.

Grain products in the USA are now enriched with traces of folate (a B vitamin). Fewer kids are born with neural tube defects (like spina bifida) and other problems, thanks to this vitamin. It is recommended that women start taking prenatal vitamins (which contain folate) at least 1 month before trying to conceive. It is even suggested that all women of reproductive age take folate supplementation, even if they use contraception, because failures happen. Furthermore, folate may increase a woman’s fertility.

Women usually take better care of themselves when they are pregnant, knowing that a healthy mom is more likely to have a healthy baby. For instance, women often want to know how much weight they should gain. I respond that the quality of the food is as important as the pounds gained. 

In medical school I was taught that alcohol is ok for women to drink in pregnancy. More recently we have been recommending that women avoid any alcohol when pregnant—but that recommendation has changed again. It is now thought that a very small amount of alcohol is possibly safe—but total avoidance is safest.

The literature is clear on tobacco products: they are harmful in pregnancy and should be avoided completely. Marijuana use in pregnancy has not been studied very much because of its legal status. One advantage of its legalization in Colorado is that it will be possible to get better information about its safety. I hope that medical scientists are following children whose mothers used “weed” when pregnant, but we won’t know about bad effects, if any, for many years.

Here is the latest information about some other “dos and don’ts” in pregnancy. Things that seem safe include: artificial sweeteners, caffeine in low to moderate amounts, insect repellants (including DEET), hair dyes, air travel and sexual intercourse (unless advised otherwise). Dental care, including x-rays and local anesthesia, is safe and encouraged during pregnancy—but laughing gas should be avoided, especially early in pregnancy. Exercise is encouraged, although women should take extra care to avoid injury when pregnant.

It is best to avoid getting overheated in the first trimester (up to 12 weeks), so hot tubs and long, hot showers are out. Swimming is safe, but waterskiing is not. Fish are good nutrition, but fish with high levels of mercury are especially dangerous in pregnancy. The fetal nervous system is particularly vulnerable to this toxic metal. Pregnant women should pay attention to local advisories concerning fish in lakes and streams, and avoid the most toxic ocean species: swordfish, tilefish, shark and mackerel king. Some kinds of tuna are contaminated with more mercury than others.

In a world that is overpopulated our goal should be for every child to get a good start in life by being healthy and loved.

© Richard Grossman MD 2018

Recognize Family Planning as a Human Right

May 29th, 2018


Family planning was declared to be a basic human right fifty years ago this month. The right to family planning was included in the International Conference on Human Rights held in Tehran, May 1968.

The concept of universal human rights started after World War II with the United Nations. Its charter included the obligation “…to promote… universal respect for, and observance of, human rights and fundamental freedoms for all without discrimination….” The Tehran conference was held 23 years later to define what those rights are. One of several points states:

“The protection of the family and of the child remains the concern of the international community. Parents have a basic human right to determine freely and responsibly the number and the spacing of their children”

The 84 countries attending this Iranian conference agreed to be bound by the decisions, but the world has changed radically since then. For one thing, there are more than double that number of countries. Furthermore, global population has more than doubled from 3,600,000,000 to 7,500,000,000 people. On the good side, there are more, safer and more effective methods of contraception available. The right to family planning is supported by many programs, including FP2020 which works in many developing countries. Planned Parenthood and the federal Title X (ten) program in the USA are under jeopardy because of a proposed law limiting healthcare providers from mentioning the word “abortion”.

Unfortunately the right to family planning is being limited or taken away in many countries. Funding for many organizations working internationally has been barred by the Global Gag Rule. The GGR prevents the US from funding any foreign agency that provides abortion services anywhere—or even mentions the word “abortion”. Because of the lack of these services women will go without birth control and there will be millions of unplanned pregnancies, and thousands of women will die from complications of pregnancy—and, ironically, there will be more abortions!

The Tehran Proclamation has 9 standards to uphold the human right to family planning. These include non-discrimination, availability of information, accessibility of services and supplies, quality, autonomy of decision making, privacy and confidentiality. I am happy to report my experience has been that these standards are upheld everywhere I have worked,. 

It is difficult to envision a UN conference being held in Iran now—there have been many changes since 1968. The Shah was overthrown in 1979 and the country became an Islamic theocracy, lead by a “Supreme Leader”. A pleasant surprise came about a decade later.

High level government and university experts held a conference in 1988 to discuss Iran’s population, which was increasing rapidly at that time. Attendees agreed “…that the rate of population growth in the Islamic Republic of Iran was high and this would have a negative effect on the welfare of the people. Hence, the participants strongly urged the Government to set up a family planning programme and integrate population factors in policy-making.” (quoted from “A New Direction in Population Policy and Family Planning in the Islamic Republic of Iran”)

The High Judicial Council of Iran decided “family planning does not have any Islamic barrier” so long as abortion was not involved. New laws were passed to promote small families. Couples were required to take birth control classes before they could get a marriage license. Government clinics were set up offering a wide choice of methods, including vasectomy. In addition, the government discouraged childbearing before age 18 and after 35 and recommended that children be spaced 3 or 4 years apart. The family planning program urged couples to have no more than 3 children; government employees lost some of their benefits, such as maternity leave and food coupons, if the family had more than 3 children. 

The TFR (the average number of children that a woman bears in her lifetime) in Iran had been as high as 7.0, had decreased to 5.5 in 1988 and now is less than replacement at 1.8—the same as the USA. It doesn’t mean that population is shrinking—there are millions of children and teens whose reproductive years are still ahead of them—so it will take decades before the population stabilizes.

A dictatorship can use its influence to slow population growth. Although there are many dictators in the world today, I think Iran is the most successful in slowing its growth. That sort of heavy-handed governing wouldn’t work in the USA. Indeed, I believe that people should have the right “…to determine freely and responsibly the number and the spacing of their children.”

© Richard Grossman MD, 2018

Meet Three Endangered Animals

April 28th, 2018

Ajo Middle School Citizen Scientists  NPS photo

I learned about two sea creatures while vacationing this spring near Puerto Peñasco in Mexico. By coincidence, we were close to the home of these two endangered animals, at the north end of the Sea of Cortez.

The totoaba is a large fish that only lives in a very small area, and only spawns in the Colorado River delta. Most notable, however, are its swim bladders, which are prized delicacies in China. These organs make the fish valuable, so that it is often captured even though it is protected by law. Locals fish with gill nets which allow small fish to pass through, but the holes are sized to catch the totoaba.

Totoabas reproduce slowly. They don’t become fertile until they are 6 or 7 years old, but they live to be 15 at most and only spawn just once a year. The young are picky—they require brackish water. Totoaba eggs are laid in the Colorado River delta where the river mixes with the ocean. Indeed, their whole population is confined to the area near the Colorado’s mouth.

Unfortunately, the Colorado River has so much water diverted for human needs that most of the time no fresh water reaches the Sea of Cortez. With no fresh water to mix with the ocean, there is no brackish water for spawning—one of the reasons the totoaba is going extinct.

The second species, the vaquita, is the world’s smallest porpoise and shares in the same small habitat with totoabas. Vaquitas are smaller but plumper than their neighbors causing them to also get caught in gill nets. Since they are mammals, they drown unless they can get to air every few minutes.

These two neighbors are both critically endangered because of habitat destruction and “overharvesting”. Both species are likely to become extinct in the near future. Although the Mexican government has passed laws forbidding the use of gill nets, that hasn’t prevented destruction of the two creatures. Unfortunately the prospect of a large payout from selling a totaba is too large an incentive for many poor fishermen to resist.

Vaquitas are also protected by Mexican law, but they apparently are only killed by accident. Their population, which was never large, is now estimated to be as few as a dozen. These animals are secretive and difficult to see, but scientists can listen to their high frequency sound, which vaquitas use to communicate. These calls allow scientists to estimate the animals’ numbers.

In an effort to save vaquitas, scientists from 9 countries banded together to organize VaquitaCPR. After months of planning they captured one of these little animals, with the hope of keeping it safe in an enclosed area of ocean. The specimen showed signs of severe stress, however, so they released her. The second animal didn’t fare as well—it died shortly after capture. 

I first read about vaquitas and totoabas in a Scientific American article, “Goodbye, Vaquita: How Corruption and Poverty Doom Endangered Species”. It is sad to learn that our human needs and carelessness are destroying these beautiful animals.

Driving home from Puerto Peñasco we entered Organ Pipe Cactus National Monument right after we crossed the border. We stopped at the visitor center to get oriented to the Monument and eat a picnic lunch. The nature trail offered a great way for all 3 of us (our dog traveled with us) to stretch our legs. At its end we were surprised to find a small oasis with shady trees, luxuriant plants, a pond and a sign with the unpronouncable title: “Quitobaquito Pupfish”. This is the name of another endemic species—meaning its entire geographic range is tiny, like the totaba and vacquito. This species of pupfish only occurs naturally in 2 places in the world. In the USA the only habitat is in the Monument’s Quitobaquito Spring, which forms a small pool. The second location in the Rio Sonoyta, just over the border in Mexico.

A few years ago the Spring appeared to be drying up. In an attempt to preserve these small, rare fish, the Monument enlisted the help of 160 young citizen scientists—students at the nearby Ajo middle school! They collaborated to design and to build the pupfish refuge. The kids continue to monitor the condition of the oasis, water quality and number of fish.

This story of endangered species started out sadly with the totaba and vaquito, but has a happy ending with the pupfish. Unfortunately, many more species are lost to our expanding human population than can be saved.

© Richard Grossman MD, 2018

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