Richard – Page 2 – Population Matters-USA

A woman came to me with a very sad and perplexing story shortly after I started practicing OB-GYN. She was in her late 30s and had 2 or 3 children. She told me that she had been raped at work in a janitorial closet, after all the other staff had left. She did not report the assault—in the mid 1970s there was no provision for the care of sexual assault survivors in our town.

This woman went to her family doctor, she told me, because her period was late. He told her that she shouldn’t worry—that she was still recovering from the trauma of what had happened to her. A month later she still hadn’t started her period and she returned to that doctor and requested a pregnancy test. He told her not to worry, and didn’t order the test. The third time he did what she wanted, and the test was positive. If I were she, I would be terrified of her coworker and outraged at the doctor.

There are three lessons here: Even good doctors are fallible. Pregnancy is common after rape, even though there is a false belief that it is rare. Do-it-yourself pregnancy tests are a good idea.

When I was in medical school the only pregnancy test involved injecting an animal with a sample of the woman’s urine—and waiting a couple of days for the result.

Tests had improved a few years later when I was in general practice. We had kits that the nurse would use. As I remember, it took a half hour for the test to develop, so we’d often call the patient when the result was available. Unfortunately, a positive result looked different with different brands of tests. When we switched brands we misinterpreted a few tests and made some embarrassed calls. “I’m sorry to say that what I told you yesterday was wrong. Your test result is negative, not positive.”

Now you can get tests at the store that are inexpensive, sensitive and quite accurate. We can thank Margaret Crane, a product designer at Organon who designed the first at-home test. It became available in 1971 in Canada, but not until 1977 in the USA.

What caused the lag in making it available in this country? The (male) executives of her company didn’t trust women to do their own tests. There might also have been some pressure from the medical community to not give up the income from pregnancy testing. This innovation required a woman with imagination, artistic ability and faith in womenkind to make the first model of a home pregnancy test.

Another heroine of reproductive health just died. Sharon Camp earned a doctorate in foreign relations, then spent years in D.C. as a lobbyist. She learned that Emergency Contraceptive Pills (ECPs) were available in Europe, but not in the USA. This seemed wrong to her, and she lobbied drug manufacturers to sell ECPs, but without success. Although she had no background in the pharmaceutical business, she started her own company to market Plan B, the first ECP in the USA.

At first the FDA required a prescription for Plan B. I told the local pharmacies that I was available to call in that prescription, and did so many times for women whom I never met. Later Camp lobbied the FDA successfully to make ECPs available without a prescription to women over a certain age, and eventually to women without any age limit.

Neither Crane nor Camp had medical training. However, both realized a need and were able to find a way to help women get the care they wanted. They found ways to lower barriers to reproductive health care.

©Richard Grossman MD, 2025

I attended an international family planning meeting in Santo Domingo, the Dominican Republic, in 1984. At that time we were living just a short plane ride away in Puerto Rico.

The meeting was full of people from different countries speaking different languages and was an excellent opportunity to make connections in the family planning world. One person was outstanding.

I was chatting with someone one afternoon and mentioned that I was tired and was headed back to our hotel to take a nap. “You should stay and listen to the next speaker, Malcolm Potts. He is amazing, mixing a lot of knowledge with a bunch of British humor”.

I took their advice, and was not disappointed. Dr. Potts was a world leader in family planning. He died this spring at age 90.

Potts was an innovator. He helped to start the first clinic in Cambridge, England, that offered birth control to young people. He was also the first director of the International Planned Parenthood Federation. He collaborated with Dr. Karman, a psychologist, to develop a simple technique for treating miscarriages and performing early abortions. It uses a flexible cannula with vacuum created by a syringe, thus it is especially useful in places where there is no electricity. Although I learned the Karman method long ago, only by reading it in an obituary of Malcolm’s did I realize that he had aided in its invention.

Potts told me how he had helped with another innovation. The work of Henry David, a psychologist, is often quoted to help justify abortion. David studied children born to women twice denied abortion for the same pregnancy. He followed these kids for 20 or more years. The studies unequivocally showed that the children of unwanted pregnancies did not do as well as matched controls. Potts told me that it was he who suggested David study unintended pregnancies in Prague, Czech Republic, because they had stringent laws limiting who could have an abortion at that time.

In 1984 I interviewed for a job where Potts was the director. It had been called the “International Fertility Research Program”. Potts had realized that the name was long and might prejudice some people against the organization, so had it changed to the more copacetic “Family Health International”.

More recently Potts was the inaugural director of the Bixby Center for Population, Health, and Sustainability, and held an endowed chair at the Berkeley School of Public Health. He was an admired professor and used his imagination to innovate: his nonprofit, OASIS, advances education and choice for women and girls in the African Sahel. He also cofounded a company that is trying to bring birth control pills to the marketplace without the need for a prescription.

My favorite saying of Potts dates from the era when tobacco was sold in vending machines: “Birth control pills should be available in vending machines and cigarets only by prescription.” His wish has come partly true—now cigaret sales are much more restricted and reproductive health materials are available in vending machines. Many college campuses have machines that dispense condoms, pregnancy tests, emergency contraceptive pills and now, even Opill, the new over-the-counter birth control pill without estrogen (see photo above).

Potts was a pioneer in lowering barriers to reproductive health care. For instance, he set up a clinic at a central train station in India to perform vasectomies because people feared hospitals. He was known for this sort of imaginative, out-of-the-box thinking.

One of his coworkers, Alisha Graves, stated that Potts believed “We really have to trust that women are doing the best things for themselves and their families.” It took me years to come to the same conclusion.