Author: Richard

I am a retired obstetrician-gynecologist who has been fortunate to live and work in the wonderful community of Durango, Colorado for 40 years.

Categories
Population Public Health Women's Issues

Honor Girls–4-2011

I noted that Mrs. Lee was early in her third pregnancy when I was getting ready to see her in the office.

“How are you today?” I asked

“Very well, thank you. The morning sickness is getting better,” was her accented reply.

My examination showed that the size of her uterus was compatible with her 14 week gestational age and the fetal heart rate was average at 140 beats per minute. Then she had a question that I did not expect.

“How do I arrange an amniocentesis?” she asked.

Usually this procedure is done only if there is an increased risk of a genetic abnormality. It involves inserting a thin needle into the woman’s uterus to remove a tablespoon or so of the amniotic fluid that cushions the fetus. An amnio hurts a little bit and carries a small amount of risk of miscarriage.

“I don’t know why you should have an amnio. The blood test that could be done next week—the quad screen—is cheaper and without risk.”

“We already have two daughters and I want to see if this is a boy.”

Something clicked in my head. The Lees, being recent immigrants, wanted a son. “What would you do if you are carrying another daughter?” I asked.

“Well, we would have to think about it,” she answered evasively.

Many cultures favor males over females. In Hindu India, only a son is able to release a dead parent’s soul to go on its journey of reincarnation. Without a son to perform the ritual, the parent’s soul will be trapped forever in the corpse. Furthermore, since child mortality rates are very high in much of the developing world, it is safest to have two or three boys. Dowry is another motive. For a poor family a dowry can require a large proportion of the family’s wealth, making a girl child more of a liability than an asset.

When we traveled in China some fifteen years ago I photographed a beautiful tile picture, permanently imbedded in a wall at the railroad workers’ housing compound in Guangzhou. It showed a proud couple with the smiling father holding a baby up in the air. The child was obviously a girl, and no writing was needed to know the picture’s message. Although China hasn’t been very successful in convincing people to value girls as much as boys, South Korea has. Once females were treated inferiorly there, but now women have almost equal status with men. It is possible to change a society’s attitudes.

In some parts of the world one can pay for an ultrasound just to determine fetal gender. If female, it is likely that the mother will seek an abortion. Both India and China have outlawed these practices, but sex selection sonograms are still readily available.

Worse is what happens if a girl is born where female infanticide is still practiced. When a newborn is an undesired girl, she may be left outside to die. Even where femicide is not practiced, girls may be given short shrift. They may not be fed as well as their brothers, they are less likely to be taken for medical care when sick, and they are less likely than boys to go to school.

Without sex selection, more boys are born, but male infants are more likely to die than female. Overall, women live longer than men. Thus there should be more females alive than males, but sex selection has changed this. Males now exceed females worldwide by one percent.

In China there are 117 boys under age fifteen for every 100 girls. The ratio in India is slightly better at 113 to 100. Lots of young men will have difficulty finding wives!

The Chinese deal with their strong desire for a son in another way. Because of the limitations on most parents in China to raise only one child, many girls are abandoned to orphanages. They are usually well cared for there, but not all are able to go to school. Lucky American parents adopt a few of these Chinese children, who are almost all girls.

Back to my patient: should I do as Mrs. Lee asked?

“I will not do an amnio just to find out the fetus’s gender, without a medical reason,” I told her emphatically.

For many reasons we need to honor and empower girls, not select against them. One is that who girls are educated and have control over their lives will have smaller families when they grow up.

© Richard Grossman MD, 2011

Categories
Population

Grieve Appropriately

This is a difficult time for environmentalists. The carbon dioxide level is rising faster than ever, the human population is still growing, measures of environmental quality are deteriorating—and almost no one seems to care.

Don’t look to politicians for help. We cannot rely on people whose term in office is just a few years to make rational decisions about the world our grandchildren will inherit.

We need to depend on individuals and nonprofit organizations (including some religious organizations) to assure the planet’s future. This responsibility is daunting! It is easy to become depressed.

I have some suggestions of how to deal with this discouraging situation rather than feeling overwhelmed.

First of all, realize that you are not responsible for the whole mess. This is obvious, but easily forgotten. There is only so much that one person can do.

My second recommendation is to find groups of people with similar beliefs and concerns. I am fortunate to have the support of several such groups, including the community where I live, Heartwood.

Heartwood is one of over a hundred cohousing communities in the USA.  They have individual homes with front porches plus a common house—one of several shared facilities. But much more important is the human infrastructure. People who live in cohousing want to enjoy close relationships with their neighbors. We make our decisions using the consensus decision-making process at regular community meetings. People feel included in decisions with consensus rather than having a winning side and a losing side, as with a vote.

My faith community is the Religious Society of Friends (Quakers). We have a strong belief in the importance of simplicity, thus our footprints are smaller than average. I am active in the Friends’ environmental organization, Quaker Earthcare Witness. QEW has two meetings a year, plus an internet discussion group. New ideas are passed around and people support one another in our environmental efforts.

An informal network of people all over the country share concerns about human population growth. With this network I know whom to call on for the answer to a particular question.

As with many worries, environmental concerns seem less terrifying when they are shared. Communicating about them helps to put worries in perspective. This group of population activists also helps chip the rough corners off some of my ideas.

We should also look at our successes. Yes, environmentalists have many successes to celebrate. In the population field we can be thankful that more and more people are realizing the importance of family planning programs.

Perhaps our biggest victory is voluntary use of modern contraception, which has slowed the growth of our population. In 2008, 188 million unintended pregnancies were avoided in the developing world alone. A consequence of this is that a quarter million maternal deaths were prevented and over a million deaths of newborn babies were averted. The CDC named family planning as one of the most important public health achievements in the 20th century!

It is easy to become depressed despite recognizing our successes, belonging to support groups and realizing that you are not solely responsible for our circumstances. Depression (or, more properly, grieving) is a normal reaction to the world situation.

A friend recently took his own life. Frank was an activist; we stood together on the corner of 11th and Main on several Friday afternoons for Durango’s weekly peace demonstration. I am sure that things in his personal life may have also triggered his despair, but his anguish over the state of the environment was a major factor.

He wrote a letter that appeared in this month’s Friends (Quaker) Journal. Titled “She listens to us”, it mourns the difficulty Earth has in both serving natural processes and also supporting humans.

How can we best deal with grief? Experts can help. Environmental philosopher Joanna Macy and my former neighbor Molly Brown have written Coming Back to Life, a book dealing with grief caused by our misuse of the environment.

For me, being outside is an excellent tonic. Earlier this month we were skiing at Purgy (Durango Mountain Resort). On lift 8 I discovered that grey jays will eat off my outstretched hand. What a thrill to have a wild animal perch on my palm!

It is normal to grieve for the deterioration of the natural world. Recognize your grief, share it with friends (and, if necessary, a professional) and do what you can to improve the world. Above all, get outside to enjoy the magnificent planet we live on.