Categories
Carrying Capacity

Glimpse at Religion in Africa

            In Africa, as elsewhere in the world, religious beliefs have an influence on the number of children a woman will bear. There are many factors that go into family size choices, and religion is one that is rarely explored.

            In the USA, Utah is an example of how religion influences family size. It has had the highest fertility rate, probably in part because of its large number of Mormons (Latter Day Saints). This religion has traditionally encouraged large families, and many Utahans have complied. I know an example from my practice. An LDS patient from Utah requested reversal of her tubal ligation, which was done after her 5th child was born. She regretted the sterilization and wanted more children. I succeeded in putting her tubes back together, and she ended up with 12 kids!

            In many African countries—especially south of the Sahara—the predominant religions encourage high fertility. Many groups of both Christians and Muslims believe that children are gifts from God and feel that contraceptive use is prohibited. Part of the motivation for large families seems to be that there is strength in numbers—especially if a group feels threatened. In addition, agrarian people tend to look upon children as a resource for work, while urban societies may consider kids financial burdens. Furthermore, rural people have less access to contraception than those who live in cities. A third major group of religious believers, those who follow traditional faiths, tend to have many children, perhaps because they are more likely to be subsistence farmers. 

            What can be done to help women get effective birth control? IUDs and implants, the most effective temporary contraceptive methods, are expensive and require skilled providers. Fortunately, a promising new variation of an old method has won favor in several African countries. For over 50 years women have trusted DMPA (DepoProvera®) for contraception. It is very effective, but requires a shot every 3 months—which is especially difficult for rural women. Some women have sickle cell anemia, an inherited disease in Black Africans, which causes painful crises. DMPA can actually prevent these crises in addition to preventing pregnancy!

            Sayana Press® is the same medication in a more convenient form. In a trial, Ugandan women who chose Sayana Press® were taught how to give themselves the first shot in a clinic. They went home with 3 more shots to self-administer at 90-day intervals. This meant only one clinic visit a year—much better for someone who might need to walk miles or take an expensive bus to the nearest family planning clinic.

            Education is an important way to empower women and for them to gain control of their fertility. Perhaps this teaching could include mention of the advantages of smaller families. In Sub-Saharan Africa, as in other parts of the world, the more years of school a girl or woman attends, the smaller her family is likely to be. Joyce Asimit Simiyu of northwest Kenya is a good example. She is the oldest of seven kids. Although elementary school was free, her family didn’t have resources for her to go to secondary school. The Quaker Girlchild Education Fund provided scholarship aid for high school and eventually she finished college. She and her husband are the parents of only two.

            There are innovative ways that family planning services are delivered in Africa. Catholic dogma is against modern contraceptive methods, but people have found ways around that doctrine. I asked a Catholic nun who runs a health center in Tanzania if they provided contraception. “No,” she said, “we leave that to the Protestants down the road.” Rwanda is another example, where much of the health care is provided by the Catholic Church. After the 1994 genocide, the government recognized the importance of family planning and placed a family planning clinic close to each of the Catholic facilities.

            Many places in Africa already exceed the land’s ability to feed its people, yet the world’s fastest growing populations are there. What works to slow growth? In many cultures religious leaders are key to promoting successful family planning. Although they may not be interested in slowing the growth of their congregation, most leaders will want to improve the health of their mothers and children. One of the best ways of doing that is with contraception to lengthen the interval between pregnancies.

© Richard Grossman MD, 2022

Categories
Population

Pray for Ukraine

The map above, from Wikipedia, shows the extent of the Russian invasion as of 3/15/22

“We believe that widespread, effective and voluntary use of medically sound and individually acceptable birth control is an essential factor in any humane design to raise world living standards and achieve international peace.”

            I read these words in Scientific American in 1960. It was close enough to World War II that I knew about the quest for the Germans for “lebensraum”, so it made intuitive sense. 

            Hitler was envious of the people who left Europe and settled the Americas. Immigrants were treated to unspoiled forests and fertile land, unlike what they had left behind in Europe. Those settlers used murder, disease and starvation to rid the land of the indigenous people who were already there. We descendants benefitted hugely from the Americas’ resources.

            As part of the “Masterplan for the East”, Hitler and the Nazis invaded what is now Poland, Ukraine and other countries. This genocidal plot was to get rid the of the inhabitants of the rich land to the east and replace them with Germans. Fortunately, however, the Nazis were fighting on other fronts and the masterplan was only partially accomplished. Starvation, outright murder and disease were the Nazi tools of extermination.  

            The Russians took over after WW II, using similar techniques of annihilation. Stalin was just as cruel as the Nazis, and perhaps even more successful in killing. Although millions died, it was more than just luck that some survived. Survivors used whatever means they could to eke out a living. In 2008 my wife and I visited western Ukraine and met a distant family member who had been an OB-GYN in a town similar in size to Durango. (I have changed the family’s names.) Dimitri Kovalenko’s mother and grandmother planted plum trees during Stalin’s reign of terror, and sold prunes to pay Dimitri’s medical school tuition. After graduation, Dimitri was able to build two homes, one for his mother and the other where he raised his family. 

            When we visited, Dimitri’s wife, Iryna, was still working parttime as a pediatrician. Their two daughters, Kira and Natasha, were both in the same town. Kira, also a physician, lived in the house that Dimitri had built for his mother, a short walk away. Natasha had recently moved from Kherson, a large city to the south, to be with her elderly parents.

            Kira’s husband, also a gynecologist, gave me a tour of the local hospital. The hospital was similar in many ways to what I was used to, but with some major differences. I remember a patient’s room as being drab, with no TV, and the equipment was similar to what we had in the USA 30 years earlier.

            I have stayed in touch with this family. Dimitri’s health continued to deteriorate; he died 3 years ago. Iryna retired to help take care of him—she is now in her 80s. When the Russian invasion started, Kira and Natasha decided to leave Ukraine any way they could. Sasha wanted to stay in her home, understanding well the horrors she that might face. Fortunately, she has neighbors who will help take care of her.

            The two younger women left Ukraine with only a small bag each, not knowing what the future held for them. They made their way to Moldova, then to Rumania and are now in Germany. They are safe there, living in the home of some kind strangers. Fortunately, they have had our help and the help of a friend who speaks German. I imagine that most of the Ukrainian refugees have no one who can translate for them, nor much money, nor friends in the USA to assist them.

            US media talk about the millions of refugees from Ukraine. For me it is much more personal, knowing Dimitri’s family. 

            Many wars are over resources. Putin may want to take over the Ukraine’s rich agriculture and natural resources, including uranium, or it is possible that he is trying to reconstitute the Russian empire. What is clear is that Putin is a megalomaniac, and cannot be trusted. I don’t know if overpopulation is playing a part in the invasion of Ukraine, but in general, more people lead to more conflict.

© Richard Grossman MD, 2022