Categories
Population

Pay Attention, Healthcare Workers!

 
            Family planning could bring more benefits to more people at less cost than other single technology now available....      James Grant
            Either we reduce the world’s population voluntarily or Nature will do this for us, but brutally.                                          Maurice Strong

            Two physicians who are concerned about human population just published an article titled “Doctors and overpopulation 48 years later”. It is based on an article that was published almost a half century ago.

            The original “Doctors and Overpopulation” was signed by 52 physicians. The first paragraph states: “Many regard overpopulation as the supreme dilemma of our age….” It goes on to say that most people consider overpopulation to only be a problem of developing countries, but that Britain would soon be overpopulated. The population of the USA rose by 121 million, from 210 to 331 million, in those 48 years. Global population has doubled since 1972. 

            Our medical profession helped cause overpopulation by improving health so people live longer. Decreasing childhood mortality has had a huge effect in increasing population growth, but it is perhaps the most humane action in the history of medicine. The authors of “Doctors and Overpopulation” take some responsibility for the rapid growth. 

            What could those doctors recommend to combat overpopulation? They list 5 actions, all of which are still relevant today: Convince the government of the seriousness of overpopulation; Increase family planning services, including access to vasectomy; Keep abortion legal and available to all women; Empower women; Include population studies at all levels of education and use mass media to spread information on the subject.

            One of the authors of the current article, Dr. John Guillebaud, was also one of the 52 original signers. Guillebaud is a family planning guru and retired professor of reproductive medicine in London. The other author, Jan Gregus, is a gynecologist and philosopher in the Czech Republic. He recently presented a paper at the World Congress of Bioethics on the ethics of small families.

            They write about 5 roots of overpopulation: the decline in mortality and population momentum (the large number of young people who have yet to have their families). These 2 causes cannot be changed, but the other 3 can be. There are millions of women who want to control their fertility but don’t have access to reliable contraception; access to family planning services can help. Even more women and men are forced by custom and convention to have large families. Social norms in some societies force women to be mothers because that is the only role open to them. Education can help here—especially by non-traditional methods such as telenovelas. The Population Media Center has done an excellent job of using electronic media to educate and empower women and to show the advantages of small family size. 

            I strongly agree with Guillebaud and Gregus in condemning reproductive coercion. It was unnecessary in India and in China, but coercive programs there and elsewhere have done great harm not only to the affected people but to the movement to slow population growth.

            They also talk about the effect of large international conferences, and lament the fact that the huge Cairo conference in 1994 “failed to articulate the threat of unremitting population growth on a finite planet….” Instead, that conference highlighted the importance of reproductive health services. It also promoted education of girls and women and supported “…childbearing needs to become a woman’s personal choice, and not her obligation or a matter of chance….”

            Another conference, held last year in Nairobi on the 25th anniversary of the Cairo conference, followed the global trend of ignoring overpopulation. To quote Guillebaud and Gregus, “Despite… much evidence that unremitting population growth is one of the ‘upstream’ driver[s] of climate change… at the Nairobi population conference the word population was nowhere….”

            Yes, there is a taboo against talking about population as a cause of environmental problems. In addition to climate change, the authors list 13 other global crises related to overpopulation—but you seldom see the media making this connection. They call for a “taboo-free talk”. Thanks, Drs. Guillebaud and Gregus; that has been the goal of Population Matters-USA for the past 25 years!

            There is good news! Physicians have been slow to recognize the concept of overpopulation, and to acknowledge the connection between medical care and environmental problems. This article, “Doctors and overpopulation 48 years later”, was a step in the correct direction. Earlier this year the equivalent journal in the USA, Contraception, ran a similar editorial: “Family planning, population growth, and the environment.” I only wish that both articles were published where more people could read them.

© Richard Grossman MD, 2020

Categories
Population

Don’t Control Population this Way

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 common where people went to bed hungry.

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

The graph to the left shows a remarkable dip in the population of Rwanda, with the lowpoint in 1995. The numbers on the vertical axis are population in 1000s. Remember that population figures are approximate–especially in a less developed country.

Note the decrease started before the genocide, as people started to emigrate; and also note that the genocide didn’t seem to cause a permanent decrease in Rwanda’s population.

Update: Although this essay was written in 2015, I never published it on the blog. Since then I have been in Rwanda and witnessed both the horror of the genocide and also resilience of these wonderful people.