Know this about Population Matters!

Amanda Gorman at President Joe Biden’s Inauguration

Our lives begin to end the day we become silent about things that matter.                                         Martin Luther King, Jr.                                                       

            In the past year, many organizations have affirmed their beliefs against racism. An example from my life will help illustrate my beliefs.

            Anthropologists teach us that hunter-gatherers tended to group into small bands. Individuals in a band were usually homogenous in appearance, language and customs. When one band of people encountered another band, they recognized their differences and were likely to be wary. In some cases, an encounter would result in violence.

            Distrust or fear of different ethnicities is understandable; some might even claim that it is built into our species’ DNA. However, that sort of discrimination is no longer tenable in today’s globalized world. We are surrounded by people of different skin colors, speaking different languages and with different cultures. We can either try to maintain separatism or dive in and enjoy the wonderful variety that is around us.

            I grew up with contacts with other cultures; my father had friends in many countries. As a kid I used to stay up at night searching for foreign stations on my shortwave radio. It was exciting to receive stations in other countries, although I couldn’t understand what was being said much of the time. When I was 9, our family was fortunate to travel in Europe where my father spoke at meetings. Two years later we all went to Latin America. Although not a linguist, I have studied French and Spanish and a little German in school. When hitch-hiking in Europe during college, I learned that speaking even a little of the local language helps communication.

            Little did I know how valuable studying Spanish would be! Many people from Latin America live in the Durango area. Often the husbands join the workforce and the wives stay at home, so often women don’t learn much English. However, they seek prenatal care when pregnant and give birth in the hospital. For years the most constant translation services were school kids who came with their mothers. In the hospital sometimes we called on the bilingual cleaners for help.

            Maria had a Cesarean in Mexico for the birth of her first child. We couldn’t get her medical records so we had no idea of the direction of the incision in her uterus. This is important, because a vertical scar is weak and can tear apart during labor, while a transverse incision is much stronger and unlikely to tear apart. Should the uterus rupture, the mother would probably hemorrhage and the baby might die—pretty terrifying! As a consequence, Maria was scheduled for a repeat Cesarean.

The morning Maria arrived at the hospital for her repeat Cesarean, she was in labor. In fact, her cervix was already dilated 6 centimeters! I sat next to her and explained, in Spanish, the risks and advantages of a vaginal birth. Between contractions she asked some questions, then said “quiero dar luz naturalmente.” Both she and the baby did well, and they went home the next day. I was happy that I could communicate with her directly in Spanish.

            My goal as a physician has always been to treat all folks equally, with respect and the best care I’m capable of. That goes for people of different cultures, colors and tongues. It goes for people regardless of their academic achievement.

            Eugenicists have theorized that our species’ average intelligence would decrease because (in general) people of lower socioeconomic class don’t do as well on intelligence tests, but they tend to have more children. If eugenicists were correct, the average IQ of our species would decline. However, this has not proven to be the case: average intelligence test scores of all groups have actually increased over the past decades, both globally and in the USA. This is called the Flynn Effect, and helps defeat the argument of elitist eugenicists.

            At Black Lives Matter demonstrations, I listened to people retelling bad experiences in our community—how they had been targeted because of their skin color. Some were followed when shopping, others were ignored by clerks or treated rudely. Although this might be expected in a big city, I am saddened that this sort of offensive behavior would happen in our community. 

            My belief is that all people should be treated with respect. Although I have not always succeeded in living up to this goal, I feel it is important that this aspiration be an integral part of all medical care, and especially in family planning programs.


Pay Attention, Healthcare Workers!

            Family planning could bring more benefits to more people at less cost than other single technology now available....      James Grant
            Either we reduce the world’s population voluntarily or Nature will do this for us, but brutally.                                          Maurice Strong

            Two physicians who are concerned about human population just published an article titled “Doctors and overpopulation 48 years later”. It is based on an article that was published almost a half century ago.

            The original “Doctors and Overpopulation” was signed by 52 physicians. The first paragraph states: “Many regard overpopulation as the supreme dilemma of our age….” It goes on to say that most people consider overpopulation to only be a problem of developing countries, but that Britain would soon be overpopulated. The population of the USA rose by 121 million, from 210 to 331 million, in those 48 years. Global population has doubled since 1972. 

            Our medical profession helped cause overpopulation by improving health so people live longer. Decreasing childhood mortality has had a huge effect in increasing population growth, but it is perhaps the most humane action in the history of medicine. The authors of “Doctors and Overpopulation” take some responsibility for the rapid growth. 

            What could those doctors recommend to combat overpopulation? They list 5 actions, all of which are still relevant today: Convince the government of the seriousness of overpopulation; Increase family planning services, including access to vasectomy; Keep abortion legal and available to all women; Empower women; Include population studies at all levels of education and use mass media to spread information on the subject.

            One of the authors of the current article, Dr. John Guillebaud, was also one of the 52 original signers. Guillebaud is a family planning guru and retired professor of reproductive medicine in London. The other author, Jan Gregus, is a gynecologist and philosopher in the Czech Republic. He recently presented a paper at the World Congress of Bioethics on the ethics of small families.

            They write about 5 roots of overpopulation: the decline in mortality and population momentum (the large number of young people who have yet to have their families). These 2 causes cannot be changed, but the other 3 can be. There are millions of women who want to control their fertility but don’t have access to reliable contraception; access to family planning services can help. Even more women and men are forced by custom and convention to have large families. Social norms in some societies force women to be mothers because that is the only role open to them. Education can help here—especially by non-traditional methods such as telenovelas. The Population Media Center has done an excellent job of using electronic media to educate and empower women and to show the advantages of small family size. 

            I strongly agree with Guillebaud and Gregus in condemning reproductive coercion. It was unnecessary in India and in China, but coercive programs there and elsewhere have done great harm not only to the affected people but to the movement to slow population growth.

            They also talk about the effect of large international conferences, and lament the fact that the huge Cairo conference in 1994 “failed to articulate the threat of unremitting population growth on a finite planet….” Instead, that conference highlighted the importance of reproductive health services. It also promoted education of girls and women and supported “…childbearing needs to become a woman’s personal choice, and not her obligation or a matter of chance….”

            Another conference, held last year in Nairobi on the 25th anniversary of the Cairo conference, followed the global trend of ignoring overpopulation. To quote Guillebaud and Gregus, “Despite… much evidence that unremitting population growth is one of the ‘upstream’ driver[s] of climate change… at the Nairobi population conference the word population was nowhere….”

            Yes, there is a taboo against talking about population as a cause of environmental problems. In addition to climate change, the authors list 13 other global crises related to overpopulation—but you seldom see the media making this connection. They call for a “taboo-free talk”. Thanks, Drs. Guillebaud and Gregus; that has been the goal of Population Matters-USA for the past 25 years!

            There is good news! Physicians have been slow to recognize the concept of overpopulation, and to acknowledge the connection between medical care and environmental problems. This article, “Doctors and overpopulation 48 years later”, was a step in the correct direction. Earlier this year the equivalent journal in the USA, Contraception, ran a similar editorial: “Family planning, population growth, and the environment.” I only wish that both articles were published where more people could read them.

© Richard Grossman MD, 2020