Population Matters-USA – working for a sustainable world

Image by Stan Shebs, via Wikipedia.

Today our very survival depends on our ability to stay awake, to adjust to new ideas, to remain vigilant and to face the challenge of change.

Martin Luther King, Jr., “The World House”

Recently I went to visit a friend whom I knew would be dying soon. She had failing health and failed eyesight. I arrived with two goals in mind, but left with a third.

Earlier this year I attended my 65th high school reunion. It was that long ago—2/3 of a century—that I pledged to work in the field of human overpopulation. I also had a realization in high school about myself: I don’t like and don’t understand politics. I appreciate the necessity for politics, but I vowed to remain unsullied by never running for office. That vow was broken only once—long ago when I ran for the Durango School Board. Fortunately, I lost.

Most of my professional work was at the beginning of life. I have enjoyed helping families bear healthy children, and helping them to avoid bearing children when that was their choice. However, I am ending my medical career at the other end of the lifespan, with Medical Aid In Dying (MAID).

Is this MAID work in response to my concern about overpopulation? No, it is not. It is in response to my own aging, and a desire to have some control over my own death. It is also a response to an image from my internship that I cannot get out of my mind.

Mrs. Jones was too young to be dying of cancer. She was in her late 40s, as I remember, but she looked to be much older. She had had breast cancer that had spread throughout her emaciated body. This was 1970 and doctors didn’t know much about the care of people with terminal disease. Mrs. Jones was in constant pain which was only partly controlled by periodic injections of morphine. We now have hospice care which can help keep people comfortable in the last chapters of their lives.

I have battled one potentially fatal illness—bladder cancer—and won. Who knows what the future holds for my health, and I would like to be able to have control over my own death if living becomes unbearable.

If you read the Herald’s beautiful editorial on July 20th, you already know about Salye Stein’s death. This editorial was written by her daughter, Ellen Stein, the Herald’s Opinion Editor.

Fortunately, there are many safeguards in the Colorado MAID law, which requires that a person fulfill several requirements before they can get medication for MAID. They must be likely to die of natural causes in the next 6 months. They must be mentally competent, and able to drink the medication. Two physicians are needed to certify these conditions; I was one of those who attested this for Salye.

Many people get the MAID medication and keep it in their refrigerator, but never take it.

My official visit was a few weeks before her death. I returned a few days before the planned death for two reasons: to be certain that she realized that she could change her mind, if she wished, and to say good-bye to my friend. However, Salye reminded me of my responsibility to my values and my country, and I left her apartment with a third motivation.

Salye was distraught over the condition of democracy in the USA. She made me realize that I need to be more active politically to be a good citizen and to protect this country’s democracy. Since then I have taken several steps to do my civic duty.

©?Richard Grossman MD, 2026

Most of us in wealthy countries know where we can go to find good family planning care. Unfortunately that is not always true in other parts of the world—unfortunately, even in the USA, 7% of women had trouble getting birth control according to a recent survey.

Alicia (name changed), the 23 year-old niece of a Kenyan friend, is an example. She had a boyfriend who took no responsibility when Alicia found she was pregnant. I helped pay for her prenatal care, then got an urgent text that she was at term and the baby was breech. I was able to pay for a cesarean at the best hospital in western Kenya. The baby weighed almost 9 pounds; I’m glad they didn’t attempt a vaginal birth!

Alicia thought she knew when she wasn’t fertile, but apparently she guessed wrong. To get effective contraception, she would have needed bus fare to travel to a city, plus the cost of the public clinic. Perhaps the clinic would have required an examination and tests (both common in some countries)—meaning more expense. These would have been insurmountable barriers to a young woman living in a subsistence economy. Perhaps the largest barrier Alicia faced was admitting that she needed birth control in her traditional society.

Here is my perception of what is needed to overcome barriers to successful use of family planning.

Start young: Sex ed starts in first grade in Finland and some other European countries. Teen sex is common there, but teen pregnancy is rare. It is interesting that the states in the US that have the least sex education have the most teen pregnancies.

Make Contraception Easily Available: Many school-based clinics can provide family planning. Colleges and universities have started stocking vending machines with condoms and emergency contraception, amongst other goodies, they are available anytime with the student’s identification card. Planned Parenthood has a very successful program. Women only need to fill out a questionnaire about their health and have their blood pressure checked to get birth control pills—and they can get up to a year’s supply at one visit.

Make Contraception Affordable: A study in Missouri has shown that when birth control is inexpensive or free, people choose the most effective methods. That has also been found true in Ceará state, Brazil and in British Columbia, Canada.

Reduce infant Mortality: “What,” you might think, “does this have to do with family planning?” Knowing that children will live to adulthood motivates people to decrease their fertility. This is especially true in countries without a social security system; children are the only security people have when they are injured and as they age.

Take away Stigma: There are many jokes about teens buying condoms—but often it is not so funny for the young man. A study done in the Midwest found that more guys would purchase “rubbers” if they knew that they would be supplied in a plain paper bag.

A small group of concerned people formed “Free the Pill” in order to get the FDA to approve an oral contraceptive available without prescription. OPill^®?. A national study found that many of the people who used OPill^®? had previously used no family planning or a less effective method.

Unfortunately, President Trump has destroyed USAID, the world’s largest funder of family planning. Although other countries and private foundations are stepping in to fill that needed aid, we can expect an increase in unintended pregnancies.

Back to Kenya. Alicia hopes for a university education. She was an excellent student in school, but her family doesn’t have the money for college. Now she has an infant to care for in addition to other challenges. Fortunately, her mother is willing to help with the baby, and I am able to help with finances.