Discuss Childbearing with your Fiancé

            A friend told me a story that revealed a blind spot in some relationships. He was speaking about his son and new daughter-in-law.

            My friend (who is also concerned about population) and the newlyweds had just seen the film An Inconvenient Truth. The groom, concerned about the future, asked his dad what was the most important thing that the newlyweds could do to slow climate change. My friend told me that his response was: “Have a small family”.
            The son responded that he never wanted to father a child. The new daughter-in-law replied “Of course we’ll have kids!
            My friend could understand his son’s reluctance to father children. This young man was born with a serious congenital problem that took multiple surgeries to correct. He was worried that any child he might father would have the same problem, even though the risk was only about 1 in 20.
            When practicing obstetrics and gynecology, I was amazed and concerned by the number of couples I encountered who disagreed about childbearing. Sometimes the woman wanted a child (or more kids) but the man didn’t, and sometimes it was vice versa. Often this was mentioned to me in passing as a minor concern. However, to parent or not was a major sticking point for some couples.
            There are a growing number of young people who plan to be childfree; most of them are women. Their reason for rejecting parenthood is fear of the future condition of the world that the movie describes.
            Fortunately, Gail and I both wanted two kids, and we even had the name for one chosen before we got together. I had always wanted to name a son, if I had one, David, and Gail the same.
            A few years ago, I mentioned Jane in one of my essays. She wrote me that she had resulted from an unplanned pregnancy. Her parents had different ideas about childbearing. When her mother found out that she was pregnant with the third child (Jane), she demanded that the father (a physician) abort the pregnancy. Jane’s mother and father went together to his office more than once, but he refused to perform the abortion. Jane wrote that being born from an unwanted pregnancy severely affected her life adversely. She never wanted, nor had, children. Jane reported that she was happily married, and that, fortunately, her husband was pleased to be childfree.
            Another couple was just the opposite. They were active in outdoor sports and had never planned on parenting. Accidents happen; they were delighted to relive their son’s birth and update me on his progress when we met at City Market. Fortunately, this sort of good outcome is much more common than lifelong regrets about parenting.
            How can this sort of discrepancy about parenting be approached? Many couples go through religiously-based premarital counseling, which makes sense to me, although Gail and I didn’t 50+ years ago. She went to a doctor and had her first Pap smear in order to get a prescription for birth control pills. We agreed to wait 5 years before deciding to have our first child, David.
            My understanding of most premarital counseling is that it is most common in religions that encourage large families, so I doubt that family size or contraception is likely to be discussed. My own faith, the Religious Society of Friends (Quakerism), does not have a prescribed curriculum for premarital counseling. Quakers recommend that the couple select a clearness committee of Friends to help them decide if marriage is right for them. The goal is for the two to determine for themselves if they are truly prepared to spend the rest of their lives together. Suggested topics for a clearness committee for marriage include “background”, “religious beliefs” and “growth and fulfillment.
            Under the heading “relationships with others” is a relevant question for a clearness committee to consider: “Have they considered whether they desire children, the problems as well as the joys children would bring, and the responsibilities for nurturing and guiding them?” There is no mention of birth control, but certainly no prohibition against using it.
            Fortunately, there is a happy ending to my friend’s story. Although the newlyweds started off their relationship with a serious discrepancy in their desire for childbearing, they eventually resolved their difference. My friend is the grandfather of a beautiful and playful young girl. The proud parents were reassured by the ultrasound pictures taken routinely during pregnancy that there was no sign of the same congenital defect that the father dealt with.
© Richard Grossman MD, 2020


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.