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Look where we need family planning the most

“As we crawled through the city, we encountered a crowded slum area. The temperature was well over 100, and the air was a haze of dust and smoke. The streets seemed alive with people. People eating, people washing, people sleeping. People visiting, arguing and screaming. People thrusting their hands through the taxi window, begging. People defecating and urinating. People clinging to buses. People herding animals. People, people, people, people.”

– Ann and Paul Ehrlich, Population Bomb, 1968

Impact = Population x Affluence (consumption) x Technology

– Ehrlich and Holdren, 1971

Close your eyes for a moment and conjure up an image of overpopulation. Did you picture hundreds of people hanging off a train in India, or dark-skinned crowds in a street in a poor country?

Yes, family planning is important in those scenarios. Voluntary access to modern contraception is important for humanitarian reasons in the global south.

You probably know the litany of its benefits: decreased maternal mortality, healthier children, economic savings, progress in standard of living and education, local environmental protection.

However, the need for effective, universal access to family planning and to safe, legal abortion is much more important in rich countries in the global north. This is because of the issue of consumption.

What? you might be asking. The average woman in many African countries has five or more children. Niger tops the list; the total fertility rate there is over seven!

Surely the population explosion there must be causing problems. Yes, Niger is one of the lowest ranked countries in the U.N.’s Human Development Index. Repeated drought has caused famine and population pressure and overgrazing causes environmental degradation.

Let’s compare two countries in the Western Hemisphere – the U.S. and Haiti. They are, respectively, one of the richest and one of the poorest in the world. The carbon footprint of an average person in the U.S. is about 20 tons of CO2 per year, while that of a Haitian is 0.2 tons – one hundredth of ours!

Thus, it would take 100 Haitians to equal the climate damage done by one of us.

Another way to compare the impact of a single person in the two countries is with ecological footprint. The ratio between the two countries is 16:1. Thus, 16 kids of a really large Haitian family would have the same impact of a single-child family in the U.S.

I have to admit that there are several problems with this comparison: It doesn’t include the two parents, the average Haitian family size is just a little over three, so I doubt that there are many as large as 16. The legacy of a large family grows over generations.

In Niger, if each generation has seven children, the number of grandchildren would be 49!

The two measures of impact are different. The carbon footprint is global because carbon emissions into the atmosphere spread over the whole planet. The ecological footprint includes carbon emissions, but it also includes effects that are localized, such as damage to the local environment.

In any case, the impact of a person in the U.S. is much greater than one in Haiti or Niger, and it is spread over the planet.

There is good news. The unintended pregnancy rate (this includes mis-timed and unwanted pregnancies) has dropped significantly in the U.S. Whereas this rate has hovered at about 50 percent for years, the latest information is that it has dropped to 45 percent.

The news is especially good for young women for whom an unintended pregnancy can be devastating. This decrease is due to increasing use of effective contraception.

It is very concerning that the new administration threatens women’s reproductive health and may make contraception and abortion services either unaffordable or totally unavailable.

Richard Grossman practiced obstetrics and gynecology in Durango. Reach him at richard@population-matters.org. © Richard Grossman MD, 2017



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