Category: Family Planning

Categories
Family Planning Population Public Health

Puerto Rico

This story started 30 years ago when we lived in Puerto Rico. Actually, the real beginning was 15 years before that, in Nicaragua.

We returned to Puerto Rico this spring after a three-decade absence. The island seemed even better than when we lived there. There was less trash, people were friendlier and now toll roads bypass overcrowded arteries.

Of course, Puerto Rico is not a separate country, but a commonwealth of the USA. Fortunately Puerto Rico keeps independent statistics, and one of them was a real surprise.

Flash back to 1968. My best experience in medical school was in the little Nicaraguan town of Puerto Cabezas, on the Caribbean coast. I learned a huge amount from the one physician, Ned Wallace, at the Moravian hospital there.

Gail (then my wife of only two years) and I lived in a tiny cabin with another medical student couple, a short walk to the hospital—and to the Caribbean Ocean. We adopted Noxa (“hello” in Miskito), a sociable green parrot.

We traveled by dugout canoe to provide the first medical care some villagers had ever received. Our wives passed out worm medicine and gave immunization shots, while we medical students saw patients in the four languages of the area—Miskito, Spanish, Creole and English. It was not the best medical care, but our patients were appreciative.

Ned was an excellent role model—he could do just about anything! I realized that living and practicing medicine in the tropics had personal advantages, in addition to helping people. At that time I resolved that, if we ever had kids, they should grow up knowing that the entire world was not like the USA, and that everyone didn’t speak English. Fortunately, Gail agreed.

In 1983 we moved our family from Durango to the little hill town of Castañer in central Puerto Rico. I practiced medicine and our two sons, in 3rd and 6th grades, learned Spanish by immersion. It was an enlightening experience in a different culture.

I was frustrated in Castañer by the number of women who wanted to limit their fertility, but lacked the money. Typically women married young and had 3, 4 or more closely spaced children. When I asked older women what birth control they used, the answer was often “my husband takes care of me” (withdrawal) or “I’ve been operated” (tubal ligation). Birth control pills and IUDs, effective temporary means of contraception, were just too expensive in this impoverished area.

Before returning to Puerto Rico this year I consulted the World Population Data Sheet (www.prb.org) for some demographic information. To my surprise the TFR (Total Fertility Rate—the number of children a woman has during her lifetime) was low. For a society to neither grow nor shrink, the TFR has to be about 2.1–one child to replace teach parent, plus a fraction for children who die before adulthood. Puerto Rico’s TFR is 1.6 now, far below replacement! However, it will take several decades for the population to stabilize.

What brought about this change In Puerto Rico? Did people recognize that the island is limited in size, that it has approached its carrying capacity? Is it that there is less adherence to religious doctrine?

Nobody seems to know exactly what happened. As far as I can make out, however, marriage is later and more couples choose to be childless. More women are employed, a common reason people choose smaller families.  The main change seems to be that contraception and tubal ligation (still very popular) are available with governmental aid, helping people achieve their reproductive and economic goals. Legal abortion is less common now that contraception is easier to obtain.

Puerto Ricans live in a beautiful green place of sun and ocean, but they have low incomes by our standards—only a third of the average income on the mainland. Thanks to government support, now people are able to receive the family planning services they desire. Puerto Rico has joined half of the world’s countries where women have sufficient access to family planning so that their populations will eventually stop growing. Where does the USA fit in? our TFR, at 1.9, is slightly below replacement.

Our return to Puerto Rico was lots of fun. We visited with friends and enjoyed the sun and ocean. Teaching our granddaughters to body surf was special for me. I also learned that even a poor area, if it has the will to help women control their fertility, can achieve zero population growth along with an improved economy.

© Richard Grossman MD, 2013

Categories
Family Planning Population

Broadcast this Message

We were leaving one of Durango’s fine restaurants when the maître d’ engaged me in conversation.
“Aren’t you the person who writes for the newspaper?”
“Yes” I replied.
Then he said something such as “Thank you for writing what you do. It is an important message that most people are afraid to talk about.”
People greet me this way once or twice a month. It is encouraging to get positive feedback from people I don’t know, but who recognize me from the picture in the Herald.
This sort of encounter is heartening for several reasons. It means that people still do read newspapers, historically a vital means of communication and education. It means that I am not the only one in Durango who worries about overpopulation. Most of all, this sort of unsolicited contact shows that we belong to a friendly community.
In one form or another “Population Matters!” has appearing in the Durango Herald for 17 years. Sometimes I have strayed from the topic. I remember a message from my very tolerant editor, Bill Roberts: “stick to the subject.” Yet he has put up with articles that have nothing to do with population, but are about some of my local heroes—Linda Mack, Joe Fowler, Sister Sharon Ekler. In the past I have thanked the Herald for their support in publishing these articles—probably the only regular column on population issues in the world—and I would like to thank them again.
Not only has the Herald printed these columns, but also they have allowed me to own the articles’ copyrights. They have encouraged me to distribute the articles wherever I want. So far, this effort hasn’t been too successful, however.
You can go to the website, www.population-matters.org and find many of the older pieces. I have been lazy at keeping the blog up to date, however. You will find occasional announcements there, too. One notice is a request for subscriptions to the listserv. That way people outside of Durango who don’t subscribe to the Herald can read the columns after they are published.
If you know of anyone who shares a concern about our increasing numbers, and if they would like to get monthly emails with these essays, have them contact me. The best email is: subscribe@population-matters.org. Over a hundred people are now on that listserv from several different countries. Indeed, this growing list makes my regular email account balk at sending messages to so many people.
The preeminent British organization concerned about human population recently changed their name to “Population Matters”. They were kind enough to warn me, and we have agreed to cooperate. Their web address is the same as mine, but without the hyphen. Therefore be careful of that little symbol or you may end up on the wrong side of the Atlantic!
My efforts at reaching large numbers of people about this most important subject are, I admit, amateurish. As many people as possible need to understand that we are using more of the Earth’s resources than is sustainable. Education is the only way we can find a solution to this immense problem.
One friend has an idea of reaching more people in the USA with a mass advertising campaign. It would take a huge amount of money just to design, let alone execute, such a program. Do you know any billionaires who would like to help?
Another friend has brought subtle health education to multiple countries. Bill Ryerson’s Population Media Center promotes radio and TV programs with a message. The Center promote health and family planning through serial dramas (soap operas). They have been shown by scientific studies to be effective in educating and changing attitudes, including about safe sex where HIV is prevalent.
The message about small families has hit Brazil in a big way—but it is unintentional. The average Brazilian woman will have less than two children; the total fertility rate is just 1.9. How did this happen? Everyone watches TV in Brazil, and family shows are very popular. It is difficult to manage lots of kids on a TV set, so show writers have unwittingly set the standard of family size!
Human population growth is the cause of many of the world’s problems—climate change, pollution, extinction of species and probably even our current drought. I believe that people will change their lifestyles and decrease their desired family size if they understand the connection between population and global problems. Please help broadcast this important message!
© Richard Grossman MD, 2012