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


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