Population Matters-USA – working for a sustainable world

“The words ‘birth control’ and ‘population’ shouldn’t be in the same sentence. Indeed, they shouldn’t even be in the same room!”

I was interviewing the president of a company that markets contraceptives. She belongs to an ethnic group that has suffered from genocide and involuntary sterilization in the past. She was quite adamant that family planning should not be advocated as a means to help the environment.

Some words have adverse connotations to some people in certain situations. For instance, I used the word “vagina” in my work as an OB-GYN, but in many groups it would be rude to speak it. “Population” is one of the words that has become sullied in the recent past. My demographer friends talk about population all the time, but they don’t seem aware that there are many people who are antithetic to the word.

What is the meaning of “population”? One definition is: “the number of people in a country or region”, however that seems too simple. It has come to have the implication of “overpopulation”, as in the title of the Ehrlichs’ book, “The Population Bomb”.

Why does this simple word carry so much baggage? I think that there are several reasons. One is that some religions promote large families or prohibit the use of birth control; they follow the biblical admonition to “be fruitful and multiply”. In addition, focusing on human population forces us to take responsibility for environmental degradation.

Perhaps the main reason that “population” has negative connotations for many people is its past history of abuse. There have been two huge regrettable examples of population policies that ignored people’s civil and reproductive rights. China forced women to use contraception or to have abortions during its one child policy. In India, both men and women were forcibly sterilized during The Emergency, in the mid 1950s.

Unfortunately, there have been many smaller abuses of people’s reproductive rights. Sterilizations of poor Indigenous women in Peru is an example. That was part of Peru’s National Population Program during Fujimori’s reign. There have also been cases closer to home. Many “Mississippi appendectomies”—forced tubal ligations of Black women—have been documented. Native women also have been targeted, continuing the genocide of the 19^th century. The majority of states had eugenic laws in the early 20^th century, with forced sterilizations of “undesirable” people. Colorado was one of the exceptions without such a law.

Sterilization without consent is real. I assisted with an infertility operation many years ago. The patient had moved from Texas after getting divorced and remarrying. She had had 3 children by cesarean with her first husband, but hadn’t conceived with her new mate. At surgery we found that her tubes had been tied. The patient later told us that her doctor in Texas had not liked her first husband and had apparently done the tubal ligation without her consent or knowledge.

Both the Sierra Club and the National Audubon Society had population programs in the past. Then, they recognized the relationship between population growth and environmental problems, and had educational programs on that subject—but no longer. Apparently slowing population growth is too controversial for them, and for most other environmental groups.

It seems that the word “population” has bad connotations for many people now, including environmentalists. It brings up the specter of involuntary reproductive procedures done in order to limit world population growth or to get rid of certain populations of people.

“Population” is an important word, since the planet is already overpopulated. Therefore, need to pay attention to the word and remove barriers to access family planning. However, we also need to be aware of its bad baggage when we use it.

©Richard Grossman MD, 2025

Although she is often given credit for being the earliest to broadcast family planning in the USA, Margaret Sanger was not the first. However, perhaps she was the bravest since she was arrested eight times while trying to help women.

You may remember Sanger as the woman who started family planning clinics in New York; she spent time in jail for this audacious act. She persisted despite adversity, with the end result of a series of clinics that were the start of Planned Parenthood. Currently there are over 600 Planned Parenthood clinics in the USA. Her family planning work was greeted internationally as well as in the USA, with the International Planned Parenthood Federation providing reproductive health service in more than 145 countries.

Trained as a nurse, Sanger worked in a clinic for poor women in New York City early in the 20^th century. She realized that having children too close together was bad for the mothers’ health—and also for the children. Growing up with 10 siblings probably interested her in family planning!

Unfortunately, Sanger got on the eugenics bandwagon, which was common in that era. Her name is somewhat besmirched because of that. It is very concerning that we seem to be experiencing a rebirth of eugenics in the USA, with discontinuation of programs to help poorer people and those among us with disabilities.

There were at least two male physicians who helped pave the way for Sanger. Dr. Robert Dale Owen wrote “Moral Physiology; or, A Brief and Plain Treatise on the Population Question”, (1831). He wrote: “Is it in itself desirable, that man should obtain control over the instinct of reproduction, so as to determine when its gratification shall produce offspring, and when it shall not?” He suggested using withdrawal to limit family size and suggested that a tubal ligation could be done at the time of a (then, very rare) Cesarean section.

Owen also espoused an electrical devise to control fertility: “…considerable opportunity has been afforded by the sale of the Electro-Galvania alluded to in this work, for testing its efficacy as a preventive of conception.” The primary message of his book is furthering the message of Malthus—that overpopulation would bring on famine. He also advocated celibacy until “a late age”.

Dr. Charles Knowlton’s “Fruits of Philosophy: The private companion of young married people” (pictured above) appeared a year later, in 1832. Again, his primary message is a concern about overpopulation, but he gave more information about family planning. Knowlton recommended the rhythm method, or douching shortly after intercourse to prevent pregnancy.

The book described another means of birth control. The woman should insert a small, moistened piece of sponge in her vagina before intercourse. A thin ribbon attached to the sponge would aid its removal. This method is similar to what Francis Place, a British activist advocated in a pamphlet published 10 years earlier, and was commonly used by the upper classes.

Both of these books argue that family planning was not immoral. Unfortunately, Knowlton, a citizen of Massachusetts, spent 3 months in prison on obscenity charges. Apparently, the officials didn’t agree with his views on morality.

Forty years later, strict laws were enacted to prevent the mailing of obscene or abortion-related matter—the Comstock Act. Most of those laws have been overthrown, except for the part about mailing abortion information. Although it is now possible to mail information about family planning or get birth control pills by mail, now anti-choice forces in the USA are considering using this archaic Act to prevent prescription of medication abortion by telemedicine.