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Abortion Family Planning Global Climate Change Public Health

Don’t Get Pregnant

Microcephaly-comparison-500px

Image courtesy of the CDC

“The Zika virus provides a glimpse into a future we should do everything possible to avoid, a terrifying reminder why the fight for a stable physical planet is the fight of our time.” Bill McKibben

“Don’t get pregnant until 2018” is the advice given women in El Salvador. Yet only two thirds of married women there are using modern contraception.

The Zika virus, declared “public health emergency of international concern”, is the cause of the Salvadorian government’s warning against pregnancy. “We’d like to suggest to all the women of fertile age that they take steps to plan their pregnancies, and avoid getting pregnant between this year and next….” This quote from Deputy Health Minister Eduardo Espinoza is frightening.

Although it hasn’t caused an epidemic in Africa where it was first identified, it is raising havoc in the Americas. Zika virus symptoms are usually mild: eye inflammation, fever, rash and joint irritation—but the majority of infected people have no symptoms at all. There is no treatment for Zika disease. Mosquitoes of the Aedes genus spread Zika, dengue and other diseases, and it may also be spread by sex.

The best way to avoid getting Zika is to avoid being bitten by mosquitoes—insect repellant, dress appropriately and avoid areas where mosquitoes live. So far Colorado is safe from Aedes.

Climate change has recently increased the range of Aedes mosquitoes. Air travel has allowed the virus to spread like lightning. Humans have destabilized the planet, as McKibben states.

The Zika story in the Americas is still being written, but began last year. Brazilian doctors noticed a huge increase in the incidence of babies born with small heads—microcephaly. They found an association with the mothers having had Zika virus infection early in pregnancy.

I am terrified that brain scans of affected babies show other serious abnormalities usually associated with profoundly impairment. There are dozens of causes of microcephaly, but most of them are associated with cognitive and other problems.

The CDC recommends avoiding Zika when a woman is, or could become, pregnant. If the mother could have been exposed to the virus during pregnancy, it recommends ultrasounds to monitor fetal head growth.

What is so concerning is that where Zika is found, family planning services may be spotty. Fortunately El Salvador, where women are supposed to abstain from pregnancy for the next 2 years, has had a pretty successful reproductive health program. It is regrettable, however, that El Salvador is one of only 6 countries worldwide that outlaw abortion for any reason.

Beloved Pope Francis recently gave Catholic women who are at risk of Zika virus permission to use “artificial” contraception. This is great news for the millions of women where Zika is a threat, and will hopefully encourage governments in those areas to make contraception easily available.

One of the reasons that the U.S.A. liberalized of our abortion laws was that we had a viral epidemic that caused severe fetal damage. Fortunately, immunization has made rubella a disease of the past.

What happens if a woman is infected with Zika in pregnancy and ultrasound shows that her fetus has microcephaly? The Salvadorian punishment for having an abortion is 2 to 8 years in prison for the woman and up to 12 years for the doctor. Nevertheless hundreds of women risk having an illegal abortion. Often they cause their own abortions by thrusting a knitting needle or piece of wood into their uterus. Tragically, suicide is not uncommon among pregnant women in El Salvador.

Here is a hypothetical situation. Luisa, a Salvadoran campesina, has two healthy children. She was taking birth control pills, but her clinic ran out. Shortly after conceiving her third pregnancy she had what she thought was a cold with a mild red rash. During a routine ultrasound at 5 months the doctor said everything was ok except the fetus’s head seemed small, and she could see calcifications in the brain. What can Luisa do? If this baby’s brain was severely damaged she couldn’t afford to take care of it, and her other two children would suffer because of the family’s very limited resources.

What is wrong with a society that puts women in such a difficult bind? Rape is common in El Salvador, yet a woman who has been raped or is carrying a terribly compromised fetus has no legal recourse. Climate change and international travel make it more important that women everywhere have access to family planning and safe abortion services.

© Richard Grossman MD, 2016

Categories
Environment Global Climate Change Public Health

River Spill was a Signal to End Business as Usual

3 kayakers on Animas

Our Animas River received a serious insult recently. Fortunately the river seems to be recovering, but we cannot predict what the long-term effects will be.

Contractors working for the United States Environmental Protection Agency recently released a huge amount of toxic water and tailings from the Gold King Mine. The water spilled into the Animas River, originally named “el rio de las animas perdidas” or the “river of lost souls”.

It wasn’t long before the finger pointing started. The EPA was blamed not only for the spill but also for the long delay in notifying our community. To the EPA’s credit, they are taking responsibility for the accident and for monitoring its environmental effects. There is also talk of compensating the businesses for their loss of revenue.

I am impressed that the EPA’s chief, Gina McCarthy, came to Durango to take command of the event. This is so different from the way the chief executive of BP reacted during the Deepwater Horizon disaster. While his well was polluting the Gulf of Mexico, Tony Hayward went to a sailboat race.

I know little about mining and mine remediation, but I have had plenty of home maintenance projects go awry. I can understand how the contractors working for the EPA could make the mistake that resulted in this tragedy. Fortunately the EPA is accepting responsibility, but I’ll bet that they will be careful in hiring those same contractors again!

The laws that govern hard-rock mining were written over 140 years ago, when the west was wilder and the number of people of European descent was small. Mining claims were inexpensive and easily available. The laws allowed mining with little concern for environmental protection or for remediation. This has lead to hundreds of mines such as Gold King where the value was extracted and the shaft abandoned. Water continues to flow through many of these mines, picking up silt and poisonous metals, as it has for decades. Before the deluge on August 5th up to 250 gallons of contaminated water poured out of the Gold King every minute—that’s 360,000 gallons every day! The flow has increased significantly since the dam was broken.

Folks have been concerned about pollution from the mines in Silverton for years, but insufficient remediation has been done. Being inundated by an estimated 3 million gallons of sickly orange water at one time has finally brought attention to the problem. Unfortunately, it includes international attention that puts southwest Colorado in a bad light.

This is an opportunity for those who believe that the government is too big and has too much power to be critical of the EPA. Many politicians have want to abolish it. We should be wary of their efforts to use this spill as an excuse. That doesn’t make much sense to me, however. If we didn’t have any laws that controlled mining, the Animas would run orange every day!

I think that this catastrophe (to use the word the Herald chose for its headline) will finally motivate cleanup of the Silverton mines. Even more important is to prevent future hard-rock mining problems by changing the ancient mining laws. Furthermore, this spill should motivate legislators to pass “good Samaritan” laws to protect people who work to clean up the mines from liability if things go wrong.

But maybe there is a broader lesson to be learned from the Gold King misfortune. Let me ask a couple of questions: what are we doing now that will result in Gold King-like problems in the future? Are companies charging enough to pay for cleanup that will be required in the future? I think you know what my answers will be.

Let’s look at electricity. Much of our power is generated using coal; indeed, we have two coal-fired power plants just across the border in New Mexico. Testing the mud at the bottom of Narraguinnep Reservoir north of Cortez showed low levels of mercury until about the 1970 stratum, when those plants started up. We are advised against eating fish that are caught there, a consequence of mercury from the power plants. A neurotoxin, mercury is especially bad for the most vulnerable—developing fetuses and the young. Yet the coal companies are trying to reduce the price they pay to the government for coal mined on federal land and they fight public safety regulations.

Climate change is much worse than the mercury problem since it affects all of life. Future generations may never recover from the damage we are causing with anthropogenic climate change.

            © Richard Grossman MD, 2015