Categories
Contraception Family Planning Population Reproductive Health

Reject these Old Memes—2-2014

Recently a friend introduced me to the word “meme”. Now I run across this concept frequently.
The word “meme” is analogous to “gene”, but it is information in our culture rather than in our DNA. A meme is a building block upon which our way of life is built. One definition is: “an idea, belief or belief system, or pattern of behavior that spreads throughout a culture”.
An old example is the Pythagorean theorem—the square of the hypotenuse of a right triangle is equal to the sum of the squares of the other two sides. This meme is ancient.
One accidental meme is changing lives in Brazil. The average family size has dropped rapidly. In 1954, when I visited as a child, women had an average of over 6 children. Now the average is 1.8—less than replacement. This big change is largely because of TV telenovelas, where middle class families are all small.
Some memes are harmful. An example is a tradition in Nigeria that leads to the death of many children. For eons Traditional Birth Attendants used mud or other unclean substances to dress newborn babies’ umbilical cord stumps. If tetanus spores are present, the baby can die a horrible death from tetanus. This improved when TBAs were taught the advantages of cleanliness and sterile instruments. Now pregnant women getting prenatal care are immunized against tetanus and there are many fewer deaths.
Galileo, who was born 450 years ago this month, suffered because of a religious meme. This meme slowed the development of knowledge for centuries.
Ancient Egyptians thought that the sun rotated around them—the geocentric model of the solar system. A Greek may have first proposed that Earth revolved around the sun 2500 years ago—the heliocentric model. For centuries people believed that the earth was the center of the universe, supported by theology that interpreted the Bible thusly. One verse that supports this meme is found in Psalms 104:5: “(God) built the earth on its foundations, so it can never be moved”. There are still people who hold that the sun goes around the earth—including 26% of US citizens, according to a recent National Science Foundation survey!
In the early 17th century Galileo defended the heliocentric theory, for which he was accused of heresy and placed under house arrest for the rest of his life. The Inquisition’s ban on reprinting his works was only lifted a century later. It was not until the 19th century that the Roman Catholic Church removed books advocating heliocentrism from its Index of Prohibited Books. Pius XII was the first Pope to acknowledge the many important contributions of Galileo—in 1939. Yet there are people who believe that heliocentrism is a conspiracy (http://www.johnthebaptist.us/jbw_english/default.htm). It is amazing how long this meme has persisted!
Years ago I sold “green umbrellas” at a public health meeting. From a campaign in Bangladesh (where it rains a lot), these umbrellas carry slogans such as “stay well” and “take health services” in Bengali. A doctor from Bangladesh bought one, then a few minutes later returned and wanted his money back. I asked him what was wrong. He replied that one of the sayings is “small families”, and we should have as many children as Allah gives us. This is another case of a religious meme that has outlived its usefulness, since Bangladesh is very crowded.
I find it amazing that some religions have not yet recognized the benefits of contraception to individuals, to families and to the world. The official doctrine of the Roman Catholic Church is that only periodic abstinence (the “rhythm” method) is acceptable. This policy is ignored by many of the 1.2 billion Roman Catholics worldwide—and many women I have talked with have left the Church because of this policy.
In many Catholic countries, such as Brazil and in Western Europe, couples use modern contraception resulting in average family size less than two. There are places, including some of the poorest countries in the world where this prohibition against effective contraception is followed. They will continue to be stuck in poverty so long as people are prohibited from using modern family planning. Rwanda is an example; its rapid population growth was one factor leading to its genocide 20 years ago.
Memes can outlive their usefulness to society. It is time for women to have the same status and rights as men, and for all people to have the access to the means to manage their fertility.

© Richard Grossman MD, 2014

Categories
Action Contraception Medical

Vasectomy

“Can vasectomies really make a difference? Mine made a big difference in my life, and to this day, I consider it the single most important contribution I have personally made to the wellbeing of future generations….“ Paul Ehrlich.

 

It was time: I walked across the hall, lowered my pants and lay down on the exam table. Dr. Sam Callaway took good care of me.

We had two great sons and our family was complete. Although my wife volunteered to get her tubes tied, I decided to practice what I preached and went for the vasectomy. That was thirty years ago, and I’ve never regretted that decision.

My largest fear was that Sam’s office nurse would be around still, but Judy had already left. Sam talked to me as he worked and I barely felt any discomfort. He explained that he used a very thin needle for the local anesthesia, made tiny incisions and he was gentle. In a few minutes it was all over and I was on my way.

I’ll admit to some soreness that evening when I spoke at the prepared childbirth class my wife was teaching. And I moved carefully the next day when I needed to perform a cesarean. All in all, I took just a few aspirins (that was before ibuprofen!) and never had any ill effects.

Men have an anatomical advantage when it comes to sterilization. Whereas a woman’s tubes are deep inside her body, a man’s tubes, the vasa deferentia (singular: vas deferens) are much more accessible. When they are interrupted, sperm cannot get released, and the man is unable to cause pregnancy. Fortunately, sperm are only a tiny fraction of the male ejaculate, so sex is unchanged—or better, for lack of fear of pregnancy.

A vasectomy takes only a few minutes, is done with local anesthesia and is amazingly safe and effective.  The main hitch is that it takes several months to wash out all the sperm, and the man should be tested to be sure that he really is shooting blanks before trusting the surgery. Fortunately, the failure rate is less than one in a hundred.

Tubal ligation is more common in the USA than is vasectomy. Among married couples, one in 7 men is sterilized while one in 5 women has had the surgery. Since many sexually active people are not married, the overall statistics show a larger preponderance of women taking control of their fertility—more than a half million women are operated on every year while only half that number of men get snipped.

The popularity of vasectomy varies by country. It is rare in many parts of the world such as in Africa, but a quarter of men in New Zealand have had the surgery.

In Durango perhaps only one physician is left performing this important procedure after Centura took over the family practice group at Mercy. Dr. Mark Forrest has performed hundreds of vasectomies, including on some of my friends—and they have all done well. He says that it usually takes two visits: a consultation, then the actual surgery. He will check semen samples two and three months later, and if both are negative for sperm, the surgery can be considered a success. If this protocol is followed, the failure rate is lower than the rate of pregnancy after tubal ligation.

Furthermore, vasectomy is much less expensive. Nationwide, the price of male sterilization is $350 to 1000. Female sterilizations can now be done without an incision. Essure™ is an office procedure performed through the woman’s cervix, with mild sedation and local anesthesia. Unfortunately, its overall cost is about the same as tubal ligation—$1500 to 6000.

The first World Vasectomy Day will be observed October 18th of this year. This event was decreed by Jonathan Stack, an award-winning documentary filmmaker. The event will be celebrated by Dr. Doug Stein performing his favorite operations—you guessed it!—live from Australia. Dr. Stein has performed over 30,000 vasectomies, perhaps a world record.

Mr. Stack went to Dr. Stein for his own procedure, and thus got the idea for the film. His reasons for favoring vasectomy include: “…it’s time for men to share the burden of family planning” and “…we have to do a fairer job of sharing the planet’s finite resources.”

You can find out more at: www.worldvasectomyday.org, including links to the film’s trailer. They need money to finish this important film. I donated already, and hope that you will also consider supporting this film—because it is time for men to share the burden of family planning!

© Richard Grossman MD, 2013