Applaud Fewer Births

            The US Census Bureau recently reported that the Natural Increase (NI) of our country’s population had dropped below 1 million for the first time in decades. That is both good and bad news.

            The NI is the number of births in a year minus the number of deaths, and does not consider migration. You may already know the number of births has been decreasing gradually for a dozen years. This is good because it is an indication there are fewer unplanned pregnancies. It is also good because it means that the rate of increase of overpopulation is slowing.

            There are many demographic measures. I like the Total Fertility Rate, the number of children a woman has given birth to during her lifetime. It is easy to remember that a country with a TFR of 2.1 will reach a steady population (zero population growth) after 4 or 5 generations, if it isn’t already there. Any TFR greater than 2.1 suggests a country is growing, while less than 2.1 indicates that growth has slowed and eventually the population may even decline. A shortcoming of TFR is that death and migration rates also affect growth, but are ignored by this measure.

            The TFR of our country decreased appreciably in the past decade from 2.1 in 2009 to just 1.7 now. This change might seem small, but over generations it becomes very significant. We are on track to have a gradually shrinking population unless more people immigrate than leave the country. However, it will take decades before that happens, and immigration will probably prevent this from occurring.

            Although it is good the Natural Increase is decreasing, there are several reasons for concern. A graph from the US Census Bureau shows one: the number of deaths has increased over the past decade. Some of this rise in mortality is because there are more older people. Oldsters are more likely to die than youngsters, of course. The sad fact, however, is that the death rate among younger folks is also increasing due to drug overdoses, guns and suicides. We here in La Plata County have seen too many die from these causes. Another cause of the rise in mortality is because people are less healthy. Obesity, fast foods and lack of exercise are also taking their toll.

            Although the TFR seems to have decreased recently, this trend may not last. Women are waiting until they are older to start their families. Whereas women used to have their first baby in their late teens or early twenties, now it is common for first-time mothers to be in their late thirties or even forties. The oldest woman whom I assisted in birth was 52!

            How is this possible? Mrs. Smith (I don’t remember her real name) had been a teacher, then earned her doctorate in education and stayed on at the university as a professor. After retirement she fell in love, married and took advantage of advanced reproductive technology to conceive. All this despite having gone through the menopause! She told me that she didn’t have to worry about genetic testing because the egg had come from a young donor.

            I don’t know how I feel about sophisticated assisted reproduction. I admit that it is wonderful to see a happy, healthy baby resulting from IVF in the arms of her delighted mother. However, there are thousands of children right here in the USA who need loving, adoptive homes. 

            An increase in deaths is not my only concern about the dropping NI. With fewer babies being born our population will age—the average age of people in the USA will increase. Although there are some advantages to an aging populace, the percentage of people in the workforce is likely to diminish. Sometimes I wonder if there will be anyone to take care of me when I’m old and frail.

            Another reason to be concerned about our low TFR and the aging population is that our economic system, capitalism, is based on growth. No biological system (including humans) can grow forever. How will the end of growth play out? We have enjoyed a wonderful era of prosperity that was made possible, in part, by our growing population. Unfortunately, that expansion has been at tremendous cost which we often ignore—climate chaos, water pollution and extinction of species, among other disasters.

            Even though there will be some difficulties as our growth slows, a smaller population in the USA will be better. 

© Richard Grossman MD, 2020


Observe a Quarter Century of Change

            Twenty-five years ago I was in hot Cairo, Egypt for the United Nations International Conference on Population and Development. It changed the direction the world has taken and also was life-changing for me.

            There were thousands of people at ICPD and many simultaneous events. It was exciting to be among people from all over the world who were concerned about the subject that had caught my attention 3 decades before—human population.

            One of the experiences I remember best was sitting in a sweltering room waiting for my conference pass. The Durango Herald had provided three of us from Durango with journalist credentials, but we needed UN sanctioned passes. Sitting and sweating to my left was a journalist from Cameroon. I offered my water bottle to him and struck up a conversation.

            â€œWhy are you concerned about population?” he asked. I told him that I had 2 children and a vasectomy. He said he had 3 young kids and wasn’t sure what the future would bring. I answered that all children should have those advantages a small family can bring, including a good education.

            The ICPD moved interest away from population and toward reproductive health. Pushback against incentives, where people were given money or gifts if they agreed to be sterilized, motivated this change. Some countries, most notably India and China, had demographic goals so family planning workers were given quotas. As a result people were coerced into using contraceptive methods that weren’t suitable, were sterilized without understanding that they couldn’t bear children, or were forced to have abortions.

            The fact that Earth’s population was not sustainable was seldom discussed at ICPD. In the quarter century since we have grown by 2 billion people and the world is even more overpopulated.

            There is good news, however. At the ICPD25 Summit that just ended in Nairobi, Kenya, people celebrated the improvements in the past 25 years. Among notable achievements is the doubling of the number of women in the least-developed countries who use modern contraception. Furthermore, the worldwide maternal mortality rate has dropped by 40%–partly because of the increased usage of birth control, and partly because more than 3/4 births worldwide are attended by trained people. These improvements have required huge efforts. For instance, FP2020, the largest international effort ever to distribute family planning information and access, has reached millions of women and couples in many of the poorest areas in the world.

            The global population growth rate has declined over the past 50 years. The peak was in 1970, when world population increased by more than 2% annually, but now it is just 1%. However, we are still growing: the net growth is about 80 million each year.

            The Nairobi Summit recognized that there are still unattained reproductive goals. Every day 830 women die from pregnancy, 33,000 girls are forced into child marriage and 11,000 girls undergo female genital mutilation. The Summit focused on several areas, including universal access to sexual and reproductive health and rights, and ending gender-based violence and harmful practices.

            They also recognized the importance of providing funding for these services. The money necessary to save the dignity and lives of so many people is estimated at $264 billion over 10 years. Although a huge sum, it equals the combined wealth of the 3 richest people in the USA, or what the US military spends in 3 months.

            After Cairo I realized that helping women in my medical practice was not enough. John Byrd, who also attended the ICPD, Fort Lewis College professor Don Gordon and I banded together to brainstorm ways to alert people to problems of overpopulation. We observed World Population Awareness Week with speakers, then taught an online class at the College, and ended up with a face-to-face class. Bio141, People and the Planet, was popular for several years.

            After writing “The Gynecologist’s Column” for Women’s World, I recognized that I could reach more people as an author than in the exam room or classroom. I approached Morley Ballantine, then Herald editor. who suggested writing a column. In addition, she gave me an unusual gift by allowing me to own the copyrights. Various of these Herald essays have also been republished in other media, and they are emailed to over 300 people in several countries.

            The ICPD has improved the lives of many people throughout the world. In addition, it motivated me to become more of an activist, including writing the Population Matters! column you are now reading.

©Richard Grossman MD, 2019