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Durango Herald Family Planning Population

Celebrate 20 Years of Population Matters!

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Twenty years ago this spring Morley Ballantine (then the Herald’s editor) gave me the responsibility of writing a column on human population issues. I want to take this opportunity to give an update on population and to thank some of the people who have been involved.

I believe that this is the only regularly appearing newspaper column about issues of human population. Indeed, it is probably the only regularly appearing treatment of this most important subject in any medium. It started as an idea for a book with short chapters, each with a verb in the title, and with a positive message about what individuals can do about population. Gail, my wife, and I were able to think of just 17 chapters initially and we worried that there might not be enough content for a whole book. About 240 essays later I have a long list of possible future topics!

Bill Roberts has been my editor and friend throughout these two decades. We seldom see each other, but have mutual respect. Bill has been great in keeping me in line: “stick to the subject” read one of his emails. Richard Ballantine has taken over his mother’s concern for population. He has provided support not only for these columns but also financial support through the Ballantine Family Fund for relevant events in our community.

For several years a group observed World Population Awareness Week in Durango. We brought in speakers and had events—but too often they competed with the wonderful Lifelong Learning series at Fort Lewis College. Fortunately Rich Hoehlein, organizer of this series, has agreed to have occasional talks on topics related to population rather than splitting the audience.

Gail is my first sounding board. I trust her reaction to an idea or draft article more than my own. She finds mistakes in drafts that I’ve been over many times, and comes up with solutions to writing problems. I am lucky to have such a talented writing partner.

When Population Matters! first hit the press, world population was about 5.7 billion; it has increased by a billion and a half to 7.2 billion in the past 20 years. This rapid increase is partially due to the International Conference on Population and Development, which shifted the focus away from population. The word “population” was tinged by a past history of coercion; instead the Conference focused on “reproductive health”.

Now we can measure the consequences of population and consumption using the “Ecological Footprint” concept, and have discovered that we are using resources much faster that the planet can provide. We also know that climate change is a repercussion of population growth, as are the decreasing numbers of wildlife and loss of species.

We have made many improvements in family planning since 1995. Emergency Contraception has helped prevent unplanned pregnancies. EC was rarely prescribed 20 years ago, but now EC pills are available in over 50 countries, in many without prescription. We have recognized Long Acting Reversible Contraception (LARC) as being much better than methods that require daily or weekly usage. Another LARC, a new IUD, will soon be available.

The Affordable Care Act (“Obamacare”) has taken a positive step to lower our high unintended pregnancy rate. It provides contraception without co-pay for any enrollee. (Unfortunately it does not pay for vasectomies!) An experiment in Colorado showed that it is possible to lower the teen pregnancy rate (and to decrease the number of abortions) by providing LARCs without charge to uninsured women. Unfortunately, a Colorado legislature killed funding to continue this program.

Even before EC pills were available without prescription it was possible to get them over the Internet. This same model is being used to provide birth control pills. But isn’t “the pill” dangerous? There are some risks with hormonal contraception, but a study in England has shown that women who used oral contraceptives, on average, lived longer than women who did not. Planned Parenthood has been providing pills safely for years to women without an exam—just a blood pressure reading. This miracle medicine is now available at: https://www.prjktruby.com for just $20 per month. This fee also helps to pay for birth control for women in the developing world, thanks to PRJKT RUBY.

My sense is that people are becoming more aware of population issues. FP2020, the program to provide quality family planning services for many of the world’s poorest countries, is a barometer of this change. My hope is that the USA will continue to see programs that will lower our high unintended pregnancy rate.

© Richard Grossman MD, 2015

PS: I have been distributing these monthly columns by email to people all over the country–and a few outside the USA. I promise only one email a month. If you would like to be added to the listserv, please contact me at: subscribe@population-matters.org
Thanks!
Richard

Categories
Contraception Family Planning Public Health

Provide Family Planning in the Democratic Republic of the Congo

DR Congo woman & child small 

The London Summit on Family Planning was the start of something big. If kept, an array of promises made at the groundbreaking July 11 [2012] event could have a major impact on the lives of women and girls for years to come.

                                               Susan A. Cohen, Guttmacher Institute

 

In a prior article I wrote about how it was possible for one doctor to perform hundreds of tubal ligations in one day—but probably not honor the rights of the patients. The next column was about putting human and reproductive rights first and foremost. Today’s column focuses on one country where FP2020 is making amazing improvements in the lives of women and children.

FP2020 is the nickname of the ambitious program started in 2012 at the London Summit on Family Planning. Its goal is to reach 120 million women of the 225 million who are unable to access modern contraception, but wish to regulate their fertility. These are women in developing countries who currently have little or no access to reproductive health care. Typically they have high fertility rates and high rates of child deaths, illegal abortion and maternal mortality. Often these women are the poorest of the poor, have little schooling and are subservient to men. Many of these women live grim lives.

A very high percentage of people in wealthy countries already use family planning (FP); indeed, that is part of how we became wealthy. It is time to share that knowledge and technology with our less fortunate brothers and sisters. Unfortunately where access to FP is limited, infrastructure is also challenging—transportation, sanitation and communication are often poor. Reaching these people will be difficult.

Providing full reproductive health care for every woman in the world who does not currently have access to those services would cost a whopping 40 billion dollars annually—about the same amount as the US military spends in a month. The lives saved by such an investment would make that money very well spent, however. Reaching all people in developing countries with FP and with maternal and newborn care would prevent 79,000 maternal deaths, 26 million abortions and 21 million unplanned births each year.

The cost of providing just FP services for these people would be about nine billion dollars a year. Because moms will be healthier, improved birth spacing alone would prevent over a million infant deaths globally each year!

Funding is a major challenge for FP2020. The programs are jointly supported by developing countries and by donor (wealthy) countries. In addition, generous funding has come from foundations; the Bill and Melinda Gates Foundation is a major source of financial support as well as being a prime mover. Assistance also comes from the UN and the US Agency for International Development, among many other organizations.

One of the FP2020 programs is in the Democratic Republic of the Congo. This beleaguered country has had a miserable history of colonialism, dictators and civil war. Average income there is less than two dollars per day. Only 53 % women are literate, and only one in twenty married women uses a modern method of contraception. Indeed, a 1933 law makes contraception illegal! The average woman bears over 6 children in her lifetime and the country will double in population every 23 years—exacerbating many of its economic and political problems.

Despite these challenges, FP2020 is seeing successes in DRCongo. One project was to map existing FP resources, using a sophisticated system of data collection with cell phones. They now know where there are trained FP personnel and which pharmacies have pills or injectable birth control. Fortunately, all sites offer condoms.

Women in DRCongo have been relying on traditional methods of FP for years, with too many unintended pregnancies—more than a million in 2013. Contraceptive implants (such as Nexplanon®) were introduced in 2014 with great success. So far, the program has recruited almost 200,000 new users of modern contraception.

What FP2020 has meant to women in DRCongo is telling. More than 300,000 unintended pregnancies were averted in 2013. Calculations suggest that 1481 women’s lives were saved, and 76,000 unsafe abortions were prevented by the use of modern contraception.

FP2020 offers hope for the future, especially for people in countries such as DRCongo. I am optimistic that FP2020 can help women and families lead healthier and happier lives and will be a model for the future of family planning. And I expect it and future programs will be built on respect for the people that they serve.

© Richard Grossman MD, 2015

Please feel free to pass this essay on to friends who might be interested. Let me know about people (including yourself!) who would like to be added to the email distribution listserv. People who subscribe will receive only one email a month.

Thank you! Richard Grossman MD, MPH  richard@population-matters.org