by Alan Weisman
“Nearly all are intentionally induced,” an anesthetist told him.
“How do you know?”
Curious himself, the anesthetist had been asking women patients during the dreamy moments before they fell unconscious. Potts was impressed that this colleague refused to publish his findings on the grounds that he had obtained compromising information from defenseless subjects—and because it would implicate several colleagues in illegal moonlighting. But he was even more impressed by the apparent scope of the need.
In 1966, Malcolm Potts visited Eastern Europe, where abortion had been legal and safe for over a decade, and where fertility rates were quite low, even though the most available contraceptive was coitus interruptus. Eventually he advised Parliament on what became the 1967 Abortion Act that legalized the procedure in the UK. He became the first male physician at London’s Marie Stopes Clinic. In 1968, he was named medical director of the International Planned Parenthood Federation.
It was in that capacity that he went to meet Harvey Karman. Immediately, he saw how important Karman’s invention would be in undeveloped countries, where death from mud-hut abortions was a principal cause of female mortality. To assure that it could be available in the poorest places on Earth, Karman agreed to coauthor a paper on the device so no one would be able to patent it. Even before their article was published in the British medical journal The Lancet, Potts took Karman and three other specialists at the invitation of Bangladesh’s government to aid girls and women raped during the 1971 war of liberation from Pakistan. Many of their fifteen hundred patients had been banished by their husbands and families; many more victims had committed suicide. To circumvent Bangladesh’s ban on abortion, they called the Karman cannula procedure “menstrual extraction”—a method of regulating a woman’s cycle, which, technically, it was. In every village they visited, they taught doctors, nurses, and midwives the simple, painless technique, which is still used there today.
“Like so much else we do as physicians, abortion is a healing process,” says Malcolm Potts, who today holds a chair at the University of California, Berkeley, where he directs the Bixby Center for Population, Health and Sustainability, and is married to international reproductive rights advocate Martha Campbell. “A five-minute operation on an unintentionally pregnant seventeen-year-old woman can change the trajectory of the next half-century of her life. Few other procedures in medicine have that power.”
As late as 1869, Potts says, the Vatican refused to comment on the subject of when life begins. Pope John Paul II’s 1983 assertion that it begins at conception has no medical basis, he adds, as many fertilized eggs never survive to advance from zygote to embryo to fetus to child.
“Religious assertions about when life begins are analogous to religious beliefs about life after death. They are both strongly held, but beyond the realm of science to prove or disprove. As an embryologist, I can no more tell you when life begins by looking down my microscope than an astronomer can tell you if heaven exists by scanning the constellations for the Pearly Gates.”
What he does know is that by 2025, 3 billion people will be short of water, and that countries with dwindling rivers such as Pakistan that have failed to control human fertility are more dangerous each year. In 1958, when there were fewer than 3 billion people, President Dwight Eisenhower identified population growth as a strategic security matter. The investigator he appointed, Major General William Draper, spent the rest of his life trying to convince world leaders to fund family planning. Half a century and more than double that number later, as Malcolm Potts reminds people, the 9/11 Commission Report warned that “a large, steadily increasing population of young men [is] a sure prescription for social turbulence.”
Over half the world’s 7 billion are under twenty-seven years old; over half of those are males; and over half of them are now jostling each other in cities, unmoored from the land-based traditions that defined most of human culture until only recently. Except for volcanic eruptions, every emergency on Earth is now either related to or aggravated by the presence of more people than conditions can bear. Malcolm Potts, who has worked worldwide—he gave Mechai Viravaidya his initial family-planning grant in Thailand—believes that contraception is the indispensible tool for bringing the planet and its people back to health.
He also understands that abortion, fraught as it is with ideology, is the safety net when contraception fails. “No country reaches replacement rate fertility without access to safe abortion,” says Potts. “They may be like Ireland, where you have to go to England, or Malta, where you go to Italy. But those two Catholic countries now have replacement fertility.”
He recently worked in Addis Ababa, capital of Muslim Ethiopia, the world’s most populous landlocked country, which legalized abortion in 2006. “Seventy percent of the hospital beds—orthopedics, neurology, everything—were occupied by botched abortions. In less than a year, we emptied them. The fertility rate there is now 1.8, because they’re offering responsible access to contraception and safe abortion. In fact,” he adds, “the most consistent users of contraception are women who’ve had an abortion.”
But outside Ethiopia’s capital, there are few trained abortion providers, and only 14 percent of women have any chance to get contraceptives, similar to Niger and other destitute countries. Estimates by the United Nations Population Fund and by the Guttmacher Institute, a premier source for reproductive health and population policy analysis,5 suggest that nearly a quarter of a billion women who would like to delay or stop having babies have no access to modern birth control.
What would it take to get it to them?
CHAPTER 17
The World With Fewer of Us
i. The Bottom Line
The good news, if the Guttmacher Institute and UNFPA are correct, is that we’re three-quarters of the way there. According to their figures, as of mid-2012, 75 percent of the sexually active women in the developing world who aren’t trying to get pregnant over the next two years (meaning they’re either spacing pregnancies or avoiding them altogether) are already using contraceptives. They calculate that 218 million unintended pregnancies are thus prevented annually, averting 138 million abortions, 25 million miscarriages, and 118,000 mothers dead of complications from childbirth or backroom abortions.
Subtracting the avoided abortions and miscarriages, family planning in developing countries prevents 55 million unintended births. Since we currently add 80 million people annually—a million more of us every 4½ days—without contraception reaching those women, our ranks would expand by a million more hungry humans every 2½ days. That’s seven more Beijings a year, instead of the four we’re currently adding.
Such big numbers are awfully hard to grasp. “That’s because we evolved in small groups,” says Malcolm Potts. “Until modern times, none of us ever saw more than maybe a thousand people. So most people’s minds go blank after a hundred thousand. Darwin said that we can understand some parts of nature and the universe, but we can’t comprehend them. A billion seconds equal 31.7 years. In the next twelve years, we’re going to add another billion people. So at the rate they’re arriving, we couldn’t even count them.”
Suppose, in the interest of avoiding another billion in the next dozen years, that the quarter-billion1 women who currently don’t or can’t plan their childbearing were able to, and did so. According to Guttmacher and UNFPA estimates, such women annually have 80 million unintended pregnancies. Half—40 million—get abortions, and more than half of those are the unsafe, frightening kind. Another 10 million miscarry. Thirty million have babies, 6 million of whom die before their first birthday.
If all the contraceptive needs in the developing world were met, not all those 30 million unplanned births would be avoided: contraceptives are sometimes forgotten, and sometimes fail. Some women stop using them, fearing side effects, and get pregnant before finding an alternative. Some mistakenly believe that breast-feeding provides total protection. But at minimum there would be 21 million fewe
r births. Subtract one Beijing per year.
The number of abortions would also drop, from 40 million to around 14 million. For anyone who opposes abortion, that is a powerful pair of numbers. They mean that right now, half the poor women of the world who get pregnant when they can’t afford to do something dangerous, and emotionally and physically painful—and often, by their own or someone else’s reckoning, sinful. They do this whether or not it’s legal, and regardless of what their (invariably male) religious authority permits. Access to contraception for them would prevent an additional 26 million abortions per year worldwide, on top of the 138 million abortions already averted by available birth control—numbers far exceeding any total achieved by pro-life movements. As an added humanitarian bonus, since more than half the abortions that poor women get—22 million—are unsafe, that number would drop to 7 million or less, and some 50,000 women’s lives would be saved.
There are barriers to this happening, such as getting birth control to unmarried women where premarital sex is stigmatized, or to married women who traditionally don’t get to decide when they’re ready to give birth. Some of them will contrive to get an IUD or long-lasting injections without a husband’s knowledge, and some single women will find ways to meet their needs—if those ways are locally available.
Whether they are depends on a surprisingly small amount of money to cover the contraceptive needs of every woman on Earth.
Currently, $4 billion each year is spent on contraceptive care in the developing world. UNFPA and Guttmacher estimate that about double that amount, $8.1 billion per year, could fully meet the needs for modern contraception in the developing world.
Between 2001 and 2011, the United States frequently spent more than that per month in Iraq and Afghanistan.
Nearly a billion of the current amount comes from countries such as the UK, the Netherlands, and Germany. The United States is the biggest donor, but since 1984 the amount depends on who happens to be president. Although the United States helped to create the United Nations Population Fund, UNFPA, in 1969 under Richard Nixon, by 1973 the Helms Amendment prohibited using foreign aid to pay for abortion as a method of family planning. In 1984, the Reagan administration proclaimed by executive order what is still known as the Mexico City Policy (or the “Global Gag Rule”) requiring foreign NGOs to pledge not to “perform or promote [emphasis added] abortion as a method of family planning”—meaning that the option of abortion couldn’t even be mentioned—as a condition for receiving U.S. funding, no matter whose money actually funded the abortion counseling or services.
This policy was rescinded by President Clinton, reinstated by President George W. Bush, and rescinded again by President Obama. Bush II also pulled all U.S. funding from UNFPA, claiming that UNFPA’s activities in China violated the Kemp-Kasten Amendment, which prohibits funding any program that supports coercive abortion or involuntary sterilization. In 2009, Obama reinstated it with a $50 million contribution, a number chopped steadily by Congress in succeeding years.
Most U.S. donations for population programs, however, are not sluiced through the United Nations but go directly through USAID, the world’s biggest supporter of family planning and reproductive health. The rest of the funding comes from private foundations, local governments, and from consumers buying pills and condoms over the counter.
In 2009, 98 percent of UNFPA’s foundation funding came from four American foundations—and 81 percent of that was from just one: the Bill and Melinda Gates Foundation.2 That the fate of the world’s women depends so much on American largesse underscores the fragility of global family planning—especially in the polarized new millennium, as a brutal partisan divide over not just abortion but even contraception has ignited what one side touts as a return to moral values, and the other calls a war on women.
By any name, it would have shocked Republican presidents Eisenhower, Nixon, and even George Bush Senior, who all supported population control.
During the years of Bush the younger, money that would have otherwise gone to international family planning was directed into HIV-AIDS programs. Worldwide, those programs today receive ten times more funding than family planning, a fact that greatly worries Malcolm Potts.
“HIV accounts for 5 percent of the global burden of disease, and it’s taking 20 percent of the money going from rich to poor countries for international health,” says Potts, who was one of the first doctors to bring attention to the threat of AIDS. As frightening as it is, the population crisis scares him more. “In the first five months of this year,” Potts and Martha Campbell wrote in 2011, “world population grew by enough to equal all the AIDS deaths since the epidemic began 30 years ago.”
Most conversations about population growth, Potts says, use the UN’s medium estimate of 9.2 billion people, which was where population was supposed to level off by 2050.
“Now, in a dramatic shift, they say it will exceed 10 billion by 2100. But the UN’s high and low estimates for 2100 are equally possible, depending on how serious the world gets about family planning. The difference between them is just half a child per woman. Half a child less, you get a far more sustainable figure of 6.2 billion. Half a child more, you get 15.8 billion. That last possibility would be utter disaster. So what we do in the next ten to fifteen years will make all the difference in the world.”
ii. Jasper Ridge
Paul Ehrlich, in an old blue sweater and a floppy canvas hat, armed with a pair of trekking poles, punches his way across the Jasper Ridge meadow that he has studied for more than half a century. It is a brilliant, sunny March afternoon, with a breeze masking the growl of Silicon Valley below. At eighty, Ehrlich still has a stride that makes friends quicken their pace to keep up. “Coming up here makes life worthwhile,” he says, gazing happily around the golden grassland, even though the Bay checkerspot butterfly populations he first came to observe in 1959 disappeared here by 1998.
Jasper Ridge, which rises alongside the San Andreas Fault, was part of the original farm that became the Stanford University campus. Ehrlich often says that his one substantial contribution as an ecologist was saving this uplift from the development that devoured surrounding farms and woodlands. For a decade, the maneuvers to create this two-square-mile experimental biological reserve occupied nearly a quarter of his time, as Stanford’s finance division considered it ideal for a large, profitable subdivision.
The ridge today looks much as it did then—even better, because the invention of catalytic converters cleared away much of the smog. The lichen-draped valley oaks that Ehrlich sees are just starting to leaf out. The ridge’s dry western slope is covered with spiny chaparral; growing on its wetter, north side are smooth-barked red madrones and Douglas firs; and following the streambeds are redwoods—this is the southern extreme of their range. The golden grasses are mainly invasives like wild oats that came on ships and in imported mission bricks: smog-borne, human-generated nitrogen has favored the growth of these invasive annuals. Part of the current research is to determine what it would it take to restore the perennial grasses that covered California before Europeans arrived—one of some fifty research projects under way here at any given time.
Paul Ehrlich on Jasper Ridge
A downy woodpecker roller coasters between two evergreen oak glades as Ehrlich passes through. During the 1970s, a student project discovered that Jasper Ridge, situated on the Pacific flyway, had the highest density of breeding land birds anywhere in the United States. More than a hundred fifty migratory and resident bird species are found here, as well as bobcat, red and gray fox, weasels, raccoons, mule deer, and mountain lions. A research center here archives fifty years of student projects; a habitat map of two tarantula species by one of Ehrlich’s undergrads, Stewart Brand, who would later publish The Whole Earth Catalog, is still used.
Years before The Population Bomb appeared, Paul Ehrlich had already gained renown among ecologists for the paper he coauthored with Peter Raven, the future director of Missouri Botanical Gardens. It w
as the first to describe coevolution: how two interacting species, such as butterflies and the plants their larvae eat, each influence the other’s development. Although coevolution is often understood as an ever-escalating biological arms race—in which plants evolve chemicals to repel insects, which in turn evolve immunities—their career-making collaboration came from observing that two distinct species of checkerspots, the Bay and the Chalcedon, were feeding on two different related species of flowers.
Across the meadow, Ehrlich can see an undergraduate biology class examining the saffron-colored sticky monkey-flower, the food that coevolved with the Chalcedon checkerspot. Because it typically grows along edges of trails and roads, it’s a good species for classes to study without stumbling into one of Jasper Ridge’s most abundant botanical species, poison oak, whose little red emerging leaves are everywhere.
It’s too early by a couple of weeks for the Chalcedon checkerspot, a mostly black and white butterfly that resembles the now departed Bay, except with far fewer red spots. What extirpated the latter, Ehrlich now knows, were weather extremes characteristic of a changing climate. The Bay checkerspot’s cycle depends on its caterpillar entering hibernation before the spring rains end and its host plant dries out. Beginning in the 1990s, years of unusually heavy spring rains that slowed the caterpillars’ feeding began alternating with unusually dry years that deprived them of food—either way resulting in mass caterpillar starvation.
Mass starvation was what Ehrlich began to fear back in 1966, after he, Anne, and their daughter, Lisa, found themselves on a mobbed Delhi street, their taxi marooned in an ocean of humanity. This was before the Green Revolution; as a population biologist, Ehrlich knew the mathematics of doubling times, and when he and Anne compared the human race’s spiraling numbers with crop data, they concluded that by the 1970s, famines would kill hundreds of millions of people—unless, as they wrote in the prologue to The Population Bomb, dramatic programs to increase food production stretched the Earth’s carrying capacity.