Categories
Medical Public Health Women's Issues

Goodbye Obstetrics

I helped with the birth of my last baby here in Durango in November. He is a healthy boy who weighed just under seven pounds.

More than 35 years ago we chose Durango as the best place to raise our two sons. They are now both married and left town long ago. My wife, Gail, and I still enjoy living in La Plata County—it is our home.

Durango was not the most lucrative place to practice back then, and it still isn’t. My starting salary was just $2,000 a month, and often I worked eighty hours or more a week. The work is strenuous, but helping women and families achieve their reproductive goals has been very satisfying.

At age 68 most people are already looking forward to full retirement. I still have goals to achieve, and am happy to be healthy enough to continue working. But I do enjoy sleeping a lot!

Perhaps I should hold my former neighbor, Dick Edwards, responsible for some of my reluctance to retire. Shortly after moving in to our first home on Rio Vista Circle I met Dick on the sidewalk. He said that retirement is dangerous—that a lot of people get sick or die shortly after they quit working. Of course there may be an error in this thinking, since some people retire due to bad health.

About 15 years ago I decided to work less and to be more active in the community and with global issues, and was able to do so. Although my income decreased, our sons had finished college and expenditures also had decreased. Working less allowed me to be active in volunteer organizations. Now I am involved in one local—Durango Nature Studies; one national—a committee of Planned Parenthood; and one international—Quaker Earthcare Witness.

I will continue practicing office gynecology. One of my goals is to take part in a Food and Drug Administration study of Quinacrine Sterilization. This is a means of permanent female sterilization that can be done without anesthesia. It is so simple that midwives have performed thousands of these procedures. QS uses a drug, quinicrine, that was developed in the 1930s as a replacement for quinine to prevent or treat malaria. It was prescribed to millions of GIs during the Second World War. The FDA has approved quinacrine for several uses, but not yet for sterilization. I hope to participate in a study of QS that will start in 2012. Quinacrine sterilization holds the promise of providing inexpensive, safe control of fertility for the millions of the world’s women who want to prevent pregnancy permanently.

Through the years I have been amazed by this community’s support. For instance, the Ballantine family has published this column for over 16 years. They allow me to own the articles’ copyrights so some of the articles have been reprinted, and I distribute them to 75 people in several countries by email. I plan to continue writing Population Matters! which may be the only regularly published newspaper column in the world that focuses on human population issues.

Providing safe, legal and caring abortion services has been controversial, but one of my priorities. I know that many people oppose abortion; I honor their feelings. But I also appreciate that there are many, many who support access to abortion. Twice in the past week strangers have come up to me to thank me for being a doctor who performs abortions.

It has been just 35 years since I started working here—more than a third of a century. The time has come for new people to take the reins. I would like to introduce Dr. Brie Todd, who has just joined Four Corners OB-GYN. She is a perfect fit with the rest of the staff of the organization—compassionate, up-to-date and technically excellent. I will continue working a few days a month in the office. For pregnant women or those who need frequent visits, I am happy to turn their care over to Dr. Todd and the other physicians, nurse practitioners and physician assistant at Four Corners.

            On this day, Christmas, I would like to recall a very important birth that is celebrated by two billion people worldwide. Two thousand years ago childbirth was dangerous, especially in a stable. In many parts of the world it still is perilous. We can be thankful that we live here and now, and that the little boy who was born on this day, and his mother, both did well.

© Richard Grossman MD, 2011

Categories
conservation biology Population Public Health

Birds and Bees for Biologists

Below is an editorial that was published in the journal Conservation Biology. I had had a dream of publishing something about human population’s effect on the natural world in Conservation Biology for years. Two articles were rejected and I was dejected. Then the journal’s new editor, Erica Fleishman, gave me the opportunity I was hoping for. She was wonderful to work with, helping to shape the piece and adding her own spin. I had to hold it in quarantine for a year after it was published.

If you get a chance to read the 25th anniversary issue of Conservation Biology (Volume 26, Number 6,December 2011), I strongly recommend the articles in the two Special Sections. They are available without charge at: http://onlinelibrary.wiley.com/doi/10.1111/cobi.2011.25.issue-6/issuetoc

 

Editorial

Birds and Bees for Biologists

My background is different from most readers of Conservation Biology. I chose a career in medicine and specialized in obstetrics and gynecology because of my concern about the human population. Initially I was worried about how the increase of human population would adversely affect my own species. In the last two decades, I have realized how profoundly we have affected the natural world and how we have caused the extinction of so many other species. To me it is unthinkable not to take action to preserve Creation and to prevent the loss of biological diversity.

It is frustrating for conservation professionals to be aware of the root causes of loss of biological diversity but not know what actions to take as individuals to lessen the effects humans have on biological diversity (Meffe et al. 1993; Meffe 1994). We know the human ecological footprint on the planet is now about 40% greater that what Earth can support sustainably (Wackernagel 2009). Our community can, however, slow the loss of biological diversity if we make it a priority to discuss family planning, consumption, and consumerism. Minimizing loss of biological diversity will require the efforts of many thousands of people in scores of disciplines and that people change their behavior. The approach to take to change human behavior will need to be multidisciplinary (Ehrlich 2010).

Almost 40 years ago Ehrlich and Holdren (1971) proposed a formula to estimate the effect of humans on the natural world: I=P×A×T,where I is impact, P is population, A is affluence, and T is technology. Of the three contributing factors, human population and affluence (or consumption) affect impact most strongly.

Ironically, these same two factors also endanger human society. Our extravagant use of fossil fuels is changing the climate of our planet. We know some of the effects climate change will have on species that are less mobile and flexible than humans, but we can only speculate on how our own species will be affected. For example, inundation of coastal land, crop failures, spread of disease, and increased armed conflict will likely accompany our new climate. It is predicted that people living in low-income countries and low-income people in high-income countries will suffer more from climate change than high-income people.

Many economic and political systems, with their stress on economic growth and affluence, are partly responsible for the current situation. Capitalism does not reward simple living. Many countries have pronatalist benefits or have social and economic systems that favor large families. For instance, in the United States the federal income tax code allows a deduction for every child in a family. Many societies value male children more than females; thus, women continue to bear children until a son is born.

In many societies it is taboo to talk about personal wealth or reproductive choices. Can you imagine meeting someone and asking how much money she has in the bank, or asking an acquaintance if his wife is taking birth control pills? It is possible, however, to avoid the taboo and still address the important issues of consumption and reproduction by being sensitive and choosing the proper setting. For instance, it is acceptable to discuss money in a financial institution and reproduction in a physician’s office.

In certain situations it is also acceptable for conservation professionals to discuss affluence and the choice of family size. Many of us are teachers or have contact with young people in other capacities. Conservation professionals can help young people make informed decisions about lifestyle and family size. Conservation professionals are qualified to teach about the effects of human population growth and high levels of consumption on the natural world and thus to discuss the advantages of a small family size and a simple lifestyle.

Despite strong social pressure, some people choose to consume relatively few resources. In many cases they trade higher incomes (and thus increased consumption) for simpler lifestyles. There is a long history of people voluntarily choosing a life of simplicity. The concept of a simple life has been overshadowed by the rise of com- mercialism, and the concept has only recently been redis- covered. Studies that compare the happiness of people in different countries suggest that income does not predict happiness. Although people in the United States have the highest income, the largest ecological footprint, and consume the most resources, they are not the happiest. A worldwide Gallup survey found that people in several countries with lower incomes than the United States are happier than people in the United States (English 2010). People in Costa Rica, for instance, are happier and consume much less than people in the United States.

People who have chosen a simpler lifestyle say they have more time to enjoy the pleasures of life. This is a benefit in addition to reducing one’s impact on the envi- ronment. More information on simple lifestyle is available on the Internet (search terms simple living and voluntary simplicity).

Already people are choosing to have smaller families than just 60 years ago. In 1950 the average number of children that women worldwide bore in their lifetime was 6; now the average is just 2.5. Many factors influence the number of children a woman bears during her lifetime. They include societal and religious norms, access to modern contraception, educational level, and whether she can expect her children to live to adulthood.

In many parts of the world people do not have access to modern family planning. Sometimes access is limited by lack of healthcare or barriers erected by medical systems, and in other cases poverty is an obstacle. Often people do not know enough about the advantages of contraception or there are social barriers to its use. Worldwide it is estimated that over 200 million couples want modern contraception but do not have access to it (Singh et al. 2009).

Social marketing can be an important means of inform- ing people about family size and contraception. Many people make erroneous assumptions about the effects of family planning methods on their health or are otherwise misinformed. Some have little knowledge of contraception and how to access it. Others believe they do not have a choice in the size of their families—that family size is determined by society or God.

Radio and television programs, such as serials (soap operas), have been very effective in empowering women, informing people about the advantages (and trade-offs) of small families, and teaching strategies to avoid HIV. The Population Media Center of Shelburne, Vermont (U.S.A.), has successfully educated people on these topics through such programming in over 18 countries. The Center for Biological Diversity of Tucson, Arizona (U.S.A.), has taken a novel approach to informing the public about the relation between human population growth and loss of biological diversity. They have distributed over one-third of a million Endangered Species Condoms. On each package is printed information about the interaction of human population growth and extinction of species.

All family planning must be voluntary for ethical reasons and because coercion may be counterproductive. For instance, in India during the mid-1970s people were coerced by the government through monetary payments into being surgically sterilized. People rebelled against these programs with the result that acceptance of family planning was set back.

For the social scientists among us there are many opportunities. In addition to designing programs to help minimize our footprints, social scientists can study the effectiveness of these efforts. Some conservation organizations working in and near locations with relatively high species richness have already incorporated family planning into the human services they offer as part of their conservation work (Cincotta & Engelman 2000). Although it seems intuitive that decreasing human population growth rates should decrease the loss of biological diversity, so far the results of few stud- ies support this expected interaction (e.g., Jha & Bawa 2006).

Conservation professionals have sought to save biological diversity by preserving species’ habitats, controlling non-native species, preventing unsustainable harvest, and cleaning up pollution. I suggest another powerful means to protect our progeny’s legacy. We can inform future generations about the effects of simple living and small families—for their own benefit, but especially for the benefit of the natural world.

Richard Grossman

P.O. Box 3100, Durango, CO 81301, U.S.A, email richard@population-matters.org

Literature Cited

Cincotta, R. P., and R. Engelman. 2000. Nature’s place: human popula- tion and the future of biological diversity. Population Action Inter- national, Washington, D.C. Available from http://www.population action.org/Publications/Reports/Natures_Place/NP_text_version. pdf (accessed July 2010).

Ehrlich, P. R. 2010. The MAHB, the culture gap, and some really inconve- nient truths. Public Library of Science Biology 8 DOI: 10.1371/jour- nal.pbio.1000330.

Ehrlich, P. R., and J. P. Holdren. 1971. Impact of population growth. Science 171:1212–1217.

English, C. 2010. Global well-being surveys find nations worlds apart. Gallup, Washington, D.C. Available from http://www.gallup. com/poll/126977/Global-WellBeing-Surveys-Find-Nations-Worlds- Apart.aspx (accessed July 2010).

Jha, S., and K. S. Bawa. 2006. Population growth, human development, and deforestation in biodiversity hotspots. Conservation Biology 20:906–912.

Meffe, G. K., A. H. Ehrlich, and D. Ehrenfeld. 1993. Human population control: the missing agenda. Conservation Biology 7:1–3.

Meffe, G. K. 1994. Human population control: the missing awareness. Conservation Biology 8:310–313.

Singh, S., J. E. Darroch, L. S. Ashford, and M. Viassoff. 2009. Adding it up: the costs and benefits of investing in family planning and maternal and newborn health. United Nations Population Fund, New York. Available from http://www.unfpa.org/webdav/site/ global/shared/documents/publications/2009/adding_it_up_report. pdf (accessed July 2010).

Wackernagel, M. 2009. World footprint: do we fit on the planet? Foot- print Network, Oakland, California. Available from http://www. footprintnetwork.org/en/index.php/GFN/page/world_footprint/ (accessed August 2010).

Conservation Biology, Volume 24, No. 6, 1435–1436

© 2010 Society for Conservation Biology

DOI: 10.1111/j.1523-1739.2010.01593.x