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Bending the population curve

BEYOND 7 BILLION

December 02, 2012|Malcolm Potts; Gopi Gopalakrishnan; J. Joseph Speidel; Kirsten Thompson; Leona D'Agnes; and Joan Castro; Martha Campbell; Djavad Salehi-Isfahani; William N. Ryerson; Carl Pope; John F. May; and Rajiv Shah
  • Rapid population growth is at the center of many of the world's pressing environmental, economic and security problems.
Rapid population growth is at the center of many of the world's pressing… (Anthony Russo / For The Times )

Hunger. Environmental degradation. Political instability. These were among the consequences of rapid global population growth documented in a five-part series in The Times in July. Now, Opinion has invited leading scholars to consider what, if anything, people and governments can do to address the issue. In the brief essays that follow, Malcolm Potts from UC Berkeley sets up the situation we are facing, and population experts from around the globe explain some of the approaches they've seen work -- and the reasons others have not. The series, by Times staff writer Kenneth R. Weiss and staff photographer Rick Loomis, can be found at latimes.com/populationrising.

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No one-size solution

By Malcolm Potts

Rapid population growth is at the center of many of the world's pressing environmental, economic and security problems. Look at the images coming out of Gaza, Goma or Kabul, and you'll see jostling crowds of men, most of them poor and without jobs. As the 9/11 Commission report concluded: "A large, steadily increasing population of young men without any reasonable expectation of suitable or steady employment [is] a sure prescription for social turbulence."

In the Sahel, that dry strip of land bordering the Sahara's southern edge, the crisis is already acute. In 1950, this region had 30 million people. Today there are 103 million. By 2050, climatologists predict that global warming will have greatly exacerbated the region's problems. And if family planning continues to be neglected, the population of the Sahel by 2050 will have exploded to a totally unsustainable 340 million. Tens of millions of people will be forced to migrate in a humanitarian catastrophe that in the next 30 years could bring as much misery to the world as HIV/AIDS has in the last 30 years.

The antidote is family planning, which is not only a universal need but also a basic human right. It is not about telling people what to do; it is about listening to what women want. Having worked internationally for almost 50 years, I have learned that whenever women are offered a range of family planning methods, backed up by honest information about side effects, family size always falls. Smaller families mean that parents are able to keep their children in school and put enough food on the table. When family planning is made available on a wide scale, as in South Korea and Brazil, not only do birthrates fall but entire countries grow more prosperous.

But to be effective, family planning programs need to take cultural and religious norms into account. They can't be coercive or insensitive, and must be tailored to specific needs. One size will never fit all. The ideas that follow remind us that, although contraception is as essential to modern living as the internal combustion engine or the microchip, there are still patriarchal individuals and institutions waiting to deny women their reproductive rights.

Malcolm Potts is a professor in the School of Public Health at UC Berkeley.

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The Kulanjan lesson

By Gopi Gopalakrishnan

Two years ago, in Kulanjan village in the Indian state of Uttar Pradesh, we learned an important lesson. A local entrepreneur, working with the World Health Partners network, had organized an IUD service day, in which village women could obtain the birth control devices and have them inserted for just $3. It seemed an ideal opportunity for Kulanjan. Women could get inexpensive intrauterine devices, and the entrepreneur who organized the event would get about a dollar for each device sold. Some 80 women registered to come.

The day arrived, and a public-sector nurse from some distance away came to do the procedures. But the women had questions. The biggest one was this: "Where do we go for medical attention if we experience excessive bleeding or backache?"

That was when we realized our mistake. Our focus had been on providing and inserting the IUDs, and we had no plan in place for what would happen subsequently. As a result, only one of the dozens of women who turned out that day left with an IUD. The others were too concerned about how they would get follow-up care if it became necessary.

We reworked our project, arranging for a nurse to visit the village every two weeks. If a problem developed, clients could also consult with a doctor by cellphone or over the Internet. With these safeguards in place, the results were remarkable. Our program ended up providing eight times the IUDs and 31/2 times the number of sterilizations as comparable initiatives.

The lesson of Kulanjan was this: Of course low prices for family planning services are important, since fertility is highest among the poor. But women require predictable follow-up care and sensitive communication that explains side effects, especially for methods such as IUDs and injectable contraceptives.

Gopi Gopalakrishnan is program director for World Health Partners.

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Better birth control

By J. Joseph Speidel and Kirsten Thompson

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