Family Planning – Population Matters-USA

Well, the answer to the title’s question is “yes, no and maybe”.

First, I should define a “reproductive health desert”. It is an area without a provider of reproductive health. Thus, there are maternity, fertility, contraceptive and abortion deserts.

Cortez (Montezuma County) was a maternity desert for a brief period of time. The hospital’s administration closed down their birthing center. Outrage from the community pressured the management to open it up again.

There were a few years that we had sophisticated infertility services in Durango. Unfortunately, the two doctors who provided this care are gone. The OB-GYN doctors who remain can help couples with most fertility issues, but some folks will need to go to Albuquerque or elsewhere for more complex infertility problems.

There shouldn’t be a real shortage of effective contraception anywhere in the US now that OPill® is available to anyone with a uterus. Or without—I got a package of this over-the-counter birth control pill for an art project from Amazon. They didn’t quibble over my gender.

(More about Opill®: It is a birth control pill that is available without a prescription. The only contraindications are pregnancy or a history of breast cancer. It needs to be taken every day at the same time.)

However, there are women who don’t want to use hormones or aren’t regular in taking pills or cannot afford $20 a month. They may live in a county without a clinic that provides the full range of family planning methods—this is how “contraceptive desert” may be defined, and almost 20 million women live in counties that lack this care.

La Plata County is far from a contraceptive desert. Even though Planned Parenthood is closed, the health department (in the beautiful AXIS Health System building), many physicians, and midlevel providers are happy to prescribe desired methods.

Unfortunately, we do live in an abortion desert now that PP is closed. PP clinics in neighboring Cortez and Farmington do provide medication abortion care, however they are limited to 11 weeks gestational age. Regrettably, procedural abortions (those done in the clinic) are not available in the Four Corners area at this time.

While on the subject of abortion, I just read a reason that the religious right has chosen to fight against this important part of healthcare. It was written by a Methodist pastor, David Barnhart.

‘“The unborn” are a convenient group of people to advocate for. They never make demands of you; they are morally uncomplicated, unlike the incarcerated, addicted, or the chronically poor; they don’t resent your condescension or complain that you are not politically correct; unlike widows, they don’t ask you to question patriarchy; unlike orphans, they don’t need money, education, or childcare; unlike aliens, they don’t bring all that racial, cultural, and religious baggage that you dislike; they allow you to feel good about yourself without any work at creating or maintaining relationships; and when they are born, you can forget about them, because they cease to be unborn….

‘It’s almost as if, by being born, they have died to you. You can love the unborn and advocate for them without substantially challenging your own wealth, power, or privilege, without re-imagining social structures, apologizing, or making reparations to anyone. They are, in short, the perfect people to love if you want to claim you love Jesus but actually dislike people who breathe.

‘Prisoners? Immigrants? The sick? The poor? Widows? Orphans? All the groups that are specifically mentioned in the Bible? They all get thrown under the bus for the unborn.”

A small group of concerned people are working to bring back both medical and procedural abortion services to Durango, but it may take months.

**BRAZIL–**From: Policies for expanding family planning coverage: Lessons from five successful countries. Hellwig et al., 2024.

The Cairo Conference “Programme of Action” includes a statement that all people should have the right to decide freely and responsibly the number and spacing of their children. Unhappily, many people have been forced to follow the old adage “the rich get richer and the poor get children”.

Fortunately, this adage has been disproven in at least 5 countries where voluntary Family Planning (FP) has been made accessible to all, with little regard to income. Brazil, Ecuador, Egypt, Ethiopia and Rwanda were chosen for study because they represent different societies on different continents. 196 policies affecting the availability of FP services were identified in these countries from 1961 to the present, and the effect was described in a 2024 analysis. The progress in the availability of high-quality FP is amazing in all five of these countries!

The genocide in Rwanda was 30 years ago. Hunger was a factor that led to neighbors killing neighbors. People in many places in this largely agrarian society were not able to produce enough food to keep away hunger. Contributing factors included land degradation and rapid population growth; there was no violence in areas where people had at least 1500 calories of food per day. The average American eats almost twice that amount!

Back in the year 2000, few low-income people in Rwanda had access to modern FP. The country was largely Roman Catholic, which forbad modern FP and relied heavily on unreliable rhythm for birth spacing. Then, in 2005, the government started supporting a more effective method of natural FP, the Standard Days Method (SDM). The Church approved of SDM and it became popular. It is simple and is up to 95% effective—if used properly. Only 5 years after its introduction, the proportion of the poorest couples using effective contraception had risen to half!

The year 2005 also marked a presentation that changed attitudes in the Rwandan Parliament. The RAPID Model is a computer-based tool that stakeholders can use to demonstrate the effect of rapid population growth on different sectors, and the benefits of FP programs. The model demonstrated how FP can reduce mortality, improve health and increase the availability of women in the workforce. Rwanda has taken advantage of that benefit: almost 2/3 of members of parliament are women—the highest percentage of any country! RAPID also showed the economic benefits of FP—for every dollar spent on contraception, the government would save four. To quote a minister of health, “family planning is a tool of development.”

Since the five countries have different conditions and customs, each approached the need to slow population growth with different policies. For instance, the literacy rate is low in rural Egypt, so they used TV to get across FP messages. Ethiopia established primary health care for all—including contraception. Brazil focused on preventing adolescent pregnancies by improving sexuality education and facilitating access to FP for teens. In 2008 a change in Ecuador’s constitution named health care as a right, and ensured that women could make their own decisions about FP. Rwandan policies have already been discussed. It is remarkable that all 5 countries established policies that increased use of effective FP—and in 3 of the countries, there is equity between rich and poor in their use of FP.

Although each of these countries has its own policies and areas of focus, they all received help from the US government and from other rich countries. Nongovernmental agencies, such as the Gates Foundation, also provided expertise and resources. It is wonderful that all 5 of these countries did what they could to make family planning services available to all.