tag:theconversation.com,2011:/au/topics/family-planning-1026/articlesFamily planning – The Conversation2024-03-11T12:24:14Ztag:theconversation.com,2011:article/2251262024-03-11T12:24:14Z2024-03-11T12:24:14ZI’m a political scientist, and the Alabama Supreme Court’s IVF ruling turned me into a reproductive-rights refugee<figure><img src="https://images.theconversation.com/files/580509/original/file-20240307-26-mc43ro.jpg?ixlib=rb-1.1.0&rect=1095%2C1199%2C1403%2C1892&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Spencer and Gabby Goidel hadn't planned to become activists.</span> <span class="attribution"><span class="source">Spencer and Gabby Goidel</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The day before the Alabama Supreme Court ruled that <a href="https://apnews.com/article/alabama-supreme-court-from-embryos-161390f0758b04a7638e2ddea20df7ca">frozen embryos created and used for in vitro fertilization</a> are children, my wife, Gabby, and I were greenlighted by our doctors to begin the IVF process. We live in Alabama.</p>
<p>That Friday evening, Feb. 16, 2024, unaware of the ruling, Gabby started taking her stimulation medications, worth roughly US$4,000 in total. We didn’t hear about the decision until Sunday morning, Feb. 18. By then, she had taken four injections – or two doses – of each of the stimulation medications.</p>
<p>For those who don’t know, the <a href="https://theconversation.com/what-is-ivf-a-nurse-explains-the-evolving-science-and-legality-of-in-vitro-fertilization-224476">IVF process is a winding journey</a> full of tests, bloodwork and bills. An IVF patient takes hormones for eight to 14 days to stimulate their ovaries to produce many mature eggs. The mature eggs are then retrieved via a minor surgical procedure and fertilized with sperm in a lab. The newly created embryos are monitored, sometimes biopsied and frozen for genetic testing, and then implanted, usually one at a time, in the uterus. From injection to implantation, one round of IVF takes four to eight weeks. </p>
<p>IVF can be as stressful as it is exciting. However, the potential of having a successful pregnancy and our own child at the end of the process, we hoped, would make it all worth it. The decision by the Alabama Supreme Court threw our dreams up in the air.</p>
<p>I <a href="https://scholar.google.com/citations?user=ow6DhIQAAAAJ&hl=en&oi=ao">study politics</a> – I don’t practice it. I’m not involved in state or local government. I’m a scholar, not an activist or an advocate. But now one of the most intimate, personal events of our lives had been turned into a political event by the state’s highest court. As a result, I became something else, too, which I had not been before: an activist.</p>
<h2>Making sense of the ruling</h2>
<p>Throughout the process of creating, growing and testing embryos in a lab, as many as <a href="https://www.illumefertility.com/fertility-blog/ivf-attrition-rate">50% to 70%</a> of embryos <a href="https://theconversation.com/most-human-embryos-naturally-die-after-conception-restrictive-abortion-laws-fail-to-take-this-embryo-loss-into-account-187904">can be lost</a>. Similarly, in the preimplantation stage of natural pregnancies, <a href="https://doi.org/10.12688%2Ff1000research.22655.1">many embryos don’t survive</a>.</p>
<p>If embryos are children, as the court ruled, then fertility clinics and patients would be exposed to an immense amount of potential legal liability. Under this new framework, patients would be able to bring wrongful death suits against doctors for the normal failures of embryos in the testing or implantation phase. Doctors would either have to charge more for an already expensive procedure to cover massive legal-insurance costs or avoid IVF altogether.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A screen shows a microscope's view of a needle and cells." src="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lab staff at an in vitro fertilization lab extract cells from embryos that are then checked for viability.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/FrozenEmbryos/ebbb52ebd68b4ab691798f90b3319f05/photo">AP Photo/Michael Wyke</a></span>
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<p>The decision and its implication – that IVF could not continue in the state of Alabama – felt like a personal affront to us. We were infuriated to have this uncertainty injected into the process three days into injecting IVF medication. </p>
<p>While the decision clearly imperiled the future of IVF in Alabama, it was not clear to us whether we would be allowed to continue the process we had begun. We were left completely in the dark for the next four days. Gabby and I had no choice but to continue daily life and IVF as though nothing was happening. </p>
<p>For me, that meant teaching my <a href="https://bulletin.auburn.edu/coursesofinstruction/poli/">political participation course at Auburn University</a>.</p>
<h2>Teaching politics when it gets personal</h2>
<p>I’ll never forget walking into class on Monday, Feb. 19, and telling the students about the court’s ruling and how it – maybe? – was going to jeopardize Gabby’s and my IVF process. </p>
<p>Before starting IVF, Gabby and I had gone through three miscarriages together.</p>
<p>IVF doesn’t always work. Approximately <a href="https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&rdRequestForward=True&ClinicId=9999&ShowNational=1">55% of IVF patients</a> under the age of 35 – Gabby is 26 – have a successful pregnancy after one egg retrieval. We couldn’t imagine the pain of telling friends and family that our attempt at having a child had once again failed. So we had agreed we were going to tell as few people as possible about starting IVF. </p>
<p>Yet, here I was now, telling my entire class what we were going through and how the Alabama Supreme Court ruling could affect us. </p>
<p>I wasn’t alone in sharing our story. The night before my Monday morning class, Gabby published an <a href="https://www.al.com/opinion/2024/02/guest-opinion-alabama-supreme-court-embryo-ruling-may-make-it-difficult-for-us-to-have-children.html">opinion column</a> on our local news site about the ruling and our resulting fears and anxieties, which really resonated with people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clear batches of containers of eggs and embryos in a large, frozen circular container" src="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cryopreservation gives prospective parents more time to pursue pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/frozen-embryos-and-eggs-in-nitrogen-cooled-royalty-free-image/520157312">Ted Horowitz Photography/The Image Bank via Getty Images</a></span>
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<p>I was, that day and throughout the next few weeks, fixated on the conceptual gulf between the court’s ruling and public opinion. I wondered aloud, “Who’s against IVF? Surely, only 5% to 10% of the public agrees with this ruling.”</p>
<p>The actual numbers aren’t far off my in-class guess. <a href="https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabReport_XLG2Z6p.pdf">Only 8% of Americans</a> say that IVF is immoral or should be illegal. But the story is more nuanced than that. Approximately <a href="https://www.ipsos.com/sites/default/files/ct/news/documents/2024-02/Axios%20Ipsos%20Alabama%20IVF%20Topline%20PDF%202.28.24.pdf">31% of Americans and 49% of Republicans</a> support “considering frozen embryos as people and holding those who destroy them legally responsible.” </p>
<p>In an attempt to tie our personal political experience into the class topic, I remarked that this court decision was a surefire way to get people involved in politics. I had no clue at the time how prophetic my comment would be.</p>
<h2>Fleeing to Texas for reproductive rights?</h2>
<p>On Wednesday, Feb. 21, the <a href="https://www.al.com/news/2024/02/uab-pauses-in-vitro-fertilization-due-to-fear-of-prosecution-officials-say.html">University of Alabama Birmingham’s fertility clinic</a> paused IVF treatments. That wasn’t our clinic, but the move sent us into a total panic. Our clinic’s closure seemed inevitable – and within 24 hours <a href="https://www.nbcnews.com/health/health-news/university-alabama-pauses-ivf-services-court-rules-embryos-are-childre-rcna139846">it had paused IVF treatments as well</a>. </p>
<p>We didn’t know what we were going to do, but we knew we were likely leaving the state to continue IVF. I needed to tell my department chair what was going on.</p>
<p>I was walking out of my department chair’s office when my phone rang. Gabby told me, “We got in, we’re going to Temple.” I ran back into my department chair’s office, told her we were going to Temple, Texas, and then rushed home. </p>
<p><a href="https://www.cnn.com/2024/02/22/us/alabama-embryos-ruling-ivf-treatment-leaving-state/index.html">A reporter from CNN</a> beat me there. It was one of <a href="https://www.washingtonpost.com/nation/2024/02/24/alabama-ivf-treatment-ruling-abortion/">several</a> <a href="https://www.nbcnews.com/health/health-news/ivf-doctors-patients-fearful-alabama-court-rules-embryos-are-children-rcna139636">interviews</a> with <a href="https://apnews.com/video/alabama-assisted-reproductive-technology-courts-legislation-gabby-goidel-8990ee5efaab450b940da1e6a39bf8d1">major</a> <a href="https://www.msnbc.com/katy-tur/watch/-thoughtless-ivf-patients-speak-out-on-alabama-embryo-decision-204655173631">media</a> <a href="https://www.theguardian.com/us-news/2024/feb/22/alabama-fertility-pause-ivf-embryo-ruling">outlets</a> Gabby did in the wake of her opinion column. After the interview, we threw clothes in a suitcase, dropped our dogs off at the vet and drove to the Atlanta airport. We flew to Texas that night.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/9MCbgW7i2I0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">One of the Goidels’ many media interviews in the wake of the Alabama ruling.</span></figcaption>
</figure>
<p>The thought of not completing the egg retrieval never seriously entered our minds. We were confident that we could get in with another IVF clinic somewhere, anywhere. But we’re affluent. We’re privileged. What if we weren’t so well off? We wouldn’t have wanted to give up, but we wouldn’t have been able to afford the fight.</p>
<p>We spent exactly one week at my parents’ house in Texas. Thankfully, my parents live an hour and a half away from the Temple clinic. We met our new doctor, <a href="https://www.bswhealth.com/physician/gordon-bates">Dr. Gordon Wright Bates</a>, and were immediately reassured. His cool expertise and confidence were calming to a stressed-out couple. The Alabama Supreme Court may have upended our lives, but we felt weirdly lucky to be in such a comfortable place.</p>
<p>The egg retrieval was Wednesday morning, Feb. 28. By all indications, it went well. IVF, however, is full of uncertainties. Now we are waiting on the results from preimplantation genetic testing. After that, there’s implantation and hoping the embryo continues to grow. We’re not in the clear: IVF is a stressful process even without a state court getting in the way. But today we are in a situation more like an average couple going through IVF than we have been in the past few weeks.</p>
<p>Late Wednesday night, March 6, <a href="https://www.nytimes.com/2024/03/06/us/politics/alabama-ivf-law.html">Alabama Gov. Kay Ivey signed into law a bill</a> providing legal protection to IVF clinics in the state. Gabby and I rejoiced at the news. Hopefully, we’re the last Alabamian couple to flee the state for IVF.</p>
<h2>A mobilizing moment</h2>
<p>When state politics directly interferes with your life, it feels like a gut punch, as if the community that you love is saying you’re not loved back. It’s easy to see how such an experience could either discourage or motivate you. Research shows that traumatic events, for the most part, <a href="https://doi.org/10.1017/S0003055422001010">depress voter turnout</a> in the following presidential election. By contrast, families and friends of 9/11 victims <a href="https://doi.org/10.1073/pnas.1315043110">became and remained more politically engaged</a> than their peers. </p>
<p>In this case, the Alabama Supreme Court ruling mobilized Gabby and <a href="https://www.democracynow.org/2024/3/4/alabama_ivf_patients_warning_to_others">other</a> <a href="https://www.today.com/health/news/alabama-ivf-ruling-embryo-transfer-canceled-rcna140029">women</a> going through the IVF process. For better or worse, the women, couples and families mobilized by this decision will likely always be more engaged because of it.</p>
<p>“Oh, God,” I remarked to my dad, “we’re going to be activists now, aren’t we?”</p>
<p>“So?” he asked.</p>
<p>“No one likes activists,” I responded in jest. But if we’re going to have and raise the family we want, this is just the first of many decisions we’re going to make that someone’s not going to like.</p><img src="https://counter.theconversation.com/content/225126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Spencer Goidel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>I’m a scholar, not an activist or an advocate. But now one of the most intimate, personal events of our lives had been turned into a political event by the state’s highest court.Spencer Goidel, Assistant Professor of Political Science, Auburn UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1766622024-02-15T13:53:50Z2024-02-15T13:53:50ZChildren are expensive – not just for parents, but the environment – so how many is too many?<figure><img src="https://images.theconversation.com/files/573356/original/file-20240205-19-6s8ovc.jpg?ixlib=rb-1.1.0&rect=16%2C6%2C2120%2C1390&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protecting the planet for future children might mean having fewer children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/people-with-placards-and-posters-on-global-strike-royalty-free-image/1181043800?phrase=climate+protest+kid&adppopup=true">Halfpoint/iStock via Getty Images Plus</a></span></figcaption></figure><p>People born in the future stand to inherit a planet in the midst of a global ecological crisis. <a href="https://www.sciencedaily.com/releases/2020/11/201106093027.htm">Natural habitats are being decimated</a>, the world <a href="https://theconversation.com/arctic-report-card-2023-from-wildfires-to-melting-sea-ice-the-warmest-summer-on-record-had-cascading-impacts-across-the-arctic-218872">is growing hotter</a>, and scientists fear we are experiencing <a href="https://doi.org/10.1038/nature09678">the sixth mass extinction event in Earth’s history</a>. </p>
<p>Under such circumstances, is it reasonable to bring a child into the world?</p>
<p><a href="https://philosophy.arizona.edu/person/trevor-hedberg">My philosophical research</a> deals with environmental and procreative ethics – the ethics of choosing how many children to have or whether to have them at all. Recently, my work has explored <a href="https://www.routledge.com/The-Environmental-Impact-of-Overpopulation-The-Ethics-of-Procreation/Hedberg/p/book/9781032236766">questions where these two fields intersect</a>, such as how climate change should affect <a href="https://www.pdcnet.org/eip/content/eip_2019_0020_0001_0042_0065">decision-making about having a family</a>.</p>
<p>Procreation is often viewed as a personal or private choice that should not be scrutinized. However, it is a choice that affects others: the parents, the children themselves and the people who will inhabit the world alongside those children in the future. Thus, it is an appropriate topic for moral reflection.</p>
<h2>A lifelong footprint</h2>
<p>Let’s start by thinking about why it might be wrong to have a large family.</p>
<p>Many people who care about the environment believe they are obligated to try to reduce their impact: driving fuel-efficient vehicles, recycling and purchasing food locally, for example.</p>
<p>But the decision to have a child – to create another person who will most likely adopt a similar lifestyle to your own – vastly outweighs the impact of these activities. Based on the average distance a car travels each year, people in developed countries can save the equivalent of 2.4 metric tons of CO2 emissions each year by living without a vehicle, according to <a href="https://doi.org/10.1088/1748-9326/aa7541">one literature review</a>. For comparison, having one fewer child saves 58.6 metric tons each year.</p>
<p>So, if you think you are obligated to do other activities to reduce your impact on the environment, you should limit your family size, too.</p>
<p>In response, however, some people may argue that adding a single person to a planet of 8 billion <a href="https://doi.org/10.5840/enviroethics201133326">cannot make a meaningful difference</a>. According to this argument, one new person would constitute such a tiny percentage of the overall contribution to climate change and other environmental problems that the impact would be morally negligible.</p>
<h2>Crunching the numbers</h2>
<p>Environmental ethicists debate how to quantify an individual’s impact on the environment, especially their lifetime carbon emissions.</p>
<p>For example, <a href="https://stat.oregonstate.edu/directory/paul-murtaugh">statistician Paul Murtaugh</a> and scientist <a href="https://www.researchgate.net/scientific-contributions/Michael-G-Schlax-5771424">Michael Schlax</a> attempted to <a href="https://www.biologicaldiversity.org/programs/population_and_sustainability/pdfs/OSUCarbonStudy.pdf">estimate the “carbon legacy</a>” tied to a couple’s choice to procreate. They estimated the total lifetime emissions of individuals living in the world’s most populous 11 countries. They also assumed a parent was responsible for all emissions tied to their genetic lineage: all of their own emissions, half their children’s emissions, one-quarter of their grandchildren’s emissions, and so on. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A camera in the back of a minivan captures two adults riding in the front seat and two brunette children sitting in the back row." src="https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575665/original/file-20240214-18-llni5m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Calculating how many emissions an average person is responsible for is tricky – but for the average American lifestyle, it’s high.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/family-riding-together-in-car-royalty-free-image/103058683?phrase=minivan+kids&adppopup=true">PhotoAlto/Ale Ventura/PhotoAlto Agency RF Collections via Getty Images</a></span>
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<p>If emissions stayed similar to 2005 levels for several generations, an American couple having one fewer child <a href="https://www.biologicaldiversity.org/programs/population_and_sustainability/pdfs/OSUCarbonStudy.pdf">would save 9,441 metric tons of CO2-equivalent</a>, according to their calculations. Driving a more fuel-efficient car, on the other hand – getting 10 more miles to the gallon – would save only 148 metric tons of CO2-equivalent.</p>
<p>Philosopher <a href="https://web.utk.edu/%7Enolt/">John Nolt</a> has attempted to estimate <a href="https://doi.org/10.1080/21550085.2011.561584">how much harm</a> the average American causes over their lifetime in terms of greenhouse gas emissions. He found that the average American contributes roughly one two-billionth of the total greenhouse gases that cause climate change. But since climate change may harm billions of people over the next millennium, this person may be responsible for the severe suffering, or even death, of one or two future people.</p>
<h2>Collective toll</h2>
<p>Such estimates are, at best, imprecise. Nevertheless, even if one assumes that each individual child’s impact on the environment is relatively insignificant on the global scale, that does not necessarily mean that procreators are off the moral hook.</p>
<p>One common thought in ethics is that people should avoid participating in enterprises that involve collective wrongdoing. In other words, we should avoid contributing to institutions and practices that cause bad outcomes, even if our own individual contribution to that outcome is tiny. </p>
<p>Suppose someone considers making a small donation to an organization that they learn is engaged in immoral activities, such as polluting a local river. Even if the potential donation is only a few dollars – too small to make any difference to the organization’s operations – that money would express a degree of complicity in that behavior, or perhaps even an endorsement. The morally right thing to do is avoid supporting the organization when possible.</p>
<p>We could reason the same way about procreation: Overpopulation is a collective problem that is <a href="http://www.mlcfoundation.org.in/#assets/ijpd/2023-1/V_3_1_7.pdf">degrading the environment and causing harm</a>, so individuals should <a href="https://www.routledge.com/The-Environmental-Impact-of-Overpopulation-The-Ethics-of-Procreation/Hedberg/p/book/9781032236766">reduce their contribution to it</a> when they can.</p>
<h2>Moral gray zone</h2>
<p>But perhaps having children warrants an exception. Parenthood is often a crucial part of people’s life plans and makes their lives far more meaningful, even if it does come at a cost to the planet. Some people believe <a href="https://press.princeton.edu/books/paperback/9780691036656/children-of-choice">reproductive freedom is so important</a> that no one should feel moral pressure to restrict the size of their family.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three women, one of whom has white hair, stand smiling around a baby in a blue outfit and a pacifier." src="https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575662/original/file-20240214-28-63i1r3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Having children feels like an essential part of many people’s life plans.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/grandmother-looking-at-her-newborn-grandson-in-the-royalty-free-image/1444230309?phrase=newborn&adppopup=true">Abraham Gonzalez Fernandez/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>One point of general consensus among ethicists, <a href="https://doi.org/10.1111/j.1467-9930.1993.tb00093.x">following the lead</a> of <a href="https://www.merton.ox.ac.uk/people/professor-henry-shue">philosopher Henry Shue</a>, is that there is a moral difference between emissions tied to crucial interests and those that are tied to convenience and luxury. Emissions connected to basic human needs are usually regarded as permissible. It isn’t wrong for me to emit carbon to drive to the grocery store, for example, if I have no other safe or reliable transportation available. Getting to the store is important to my survival and well-being. Driving purely for recreation, in contrast, is harder to justify.</p>
<p>Reproduction occupies the messy conceptual space between these two activities. For most people today, having their own biological children is not essential to health or survival. Yet it is also far more important to most people and their broader life plans than a frivolous joyride. Is there a way to balance the varied and competing moral considerations in play here?</p>
<p><a href="https://www.pdcnet.org/eip/content/eip_2019_0020_0001_0042_0065">In prior work</a>, I have argued the proper way to balance these competing moral considerations is for each couple to have no more than two biological children. I believe this allows a couple an appropriate amount of reproductive freedom while also recognizing the moral significance of the environmental problems linked to population growth. </p>
<p>Some authors reason about this issue differently, though. Philosopher <a href="https://www.bowdoin.edu/profiles/faculty/sconly/">Sarah Conly</a> argues that it is permissible for couples <a href="https://academic.oup.com/book/7760">to have only one biological child</a>. In large part, her position rests on her argument that all the fundamental interests tied to child-rearing can be satisfied with just one child. Bioethicist <a href="https://bioethics.jhu.edu/people/profile/travis-rieder/">Travis Reider</a> <a href="https://link.springer.com/book/10.1007/978-3-319-33871-2">argues in favor of having a small family</a>, but without a specific numerical limit. It is also possible, as ethicist <a href="https://www.umu.se/en/staff/kalle-grill/">Kalle Grill</a> <a href="https://doi.org/10.5840/enviroethics20238860">has argued</a>, that none of these positions gets the moral calculus exactly right.</p>
<p>Regardless, it is clear that prospective parents should reflect on the moral dimensions of procreation and its importance to their life plans.</p>
<p>For some, adoption may be the best way of experiencing parenthood without creating a new person. And there are many other ways for prospective parents to do their part in mitigating environmental problems. Carbon offsets or donations to environmental organizations, for example, are <a href="https://doi.org/10.1080/21550085.2023.2223805">hardly perfect substitutes</a> for limiting procreation – but they certainly may be more appealing to many prospective parents.</p><img src="https://counter.theconversation.com/content/176662/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trevor Hedberg does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You can donate to environmental charities and even purchase carbon offsets, but not having an additional child typically has a much greater impact.Trevor Hedberg, Assistant Professor of Practice, W.A. Franke Honors College / Philosophy Department, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225672024-02-15T13:16:03Z2024-02-15T13:16:03ZMost people would be equally satisfied with having one child as with two or three – new research<figure><img src="https://images.theconversation.com/files/575046/original/file-20240212-18-cr3m9v.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2650%2C1918&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diverse-culture-families-playing-children-on-644803663">Tint Media/Shutterstock</a></span></figcaption></figure><p>Picture your ideal family. Do you have children? How many?</p>
<p>It’s fairly well established that when asked about their ideal family, people <a href="https://uk.style.yahoo.com/parents-happiest-with-this-number-of-children-130657574.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALSMoZY_favqh1RLJg3osUVkZY4Rcc-gZ73Db3kMC4q4wHFgjNXJeTMPDGEwWCJfcYMawoqwwsnmEprKNbIpz1qN6Dh3gSvg3SLmTlvez2ll1oiAXxQics4EvK5c5M4Kw73OjCf2ADaZ_uO3NxJkkhniFfs20KNzuUuLll_4-5Mi">tend to say</a> that <a href="https://www.businessinsider.com/american-families-ideal-number-of-kids-cost-raising-child-expensive-2023-11?r=US&IR=T">two children</a> is the best number to have. But this regularity has come about from asking the simple question: “Ideally, how many children would you like to have?”. </p>
<p>But if two children really was the best number to have, surely most people would have two – but they don’t. In South Korea, the average number of children is less than one per woman. In the US it’s 1.64. </p>
<p>A huge number of studies have tried to figure out why this is – why there’s a gap between the number of children people say they want, and how many they have. But it turns out we may have been asking the wrong questions. </p>
<p>When you take a different approach and ask people to rate different options of family life, you get a far more accurate idea of what people are happy with. <a href="https://www.pnas.org/doi/10.1073/pnas.2311847121">My research</a> with colleagues has done just this. I found that people still valued parenthood. But they valued having one child just as highly as having two or three. </p>
<h2>Family values</h2>
<p>A family isn’t just about the number of children. There are a whole range of other things to consider when thinking about what your ideal family might look like. Are you married, cohabiting, or a single parent? Who does the washing up and changes the nappies? What does the work-life balance in your family look like? </p>
<figure class="align-center ">
<img alt="Family of three in kitchen" src="https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We found that number of children mattered less than you might expect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-young-family-three-home-kitchen-45888763">michaeljung/Shutterstock</a></span>
</figcaption>
</figure>
<p>When you bring in factors like this, the ideal number of children starts to change. </p>
<p>We carried out research with around 10,000 people in a range of countries: the US, Norway, Italy, Spain, Japan, China, South Korea and Singapore. We showed each person in the study six scenarios with descriptions of different families. Half of the respondents were shown scenarios that included families with no children as well as with children, and the other half saw scenarios that included families with one, two or three children. </p>
<p>These scenarios had further varying factors, such as traditional or egalitarian gender roles and the amount of contact with extended family. In some, family members communicated well, and not in others. We asked the people in our study to rate these different scenarios on a scale from one to ten.</p>
<p>The findings are clear. Looking at all the responses, overall people do feel that a family with no children is not ideal. Parenthood still matters. But there is no discernable difference in how people rated the families with one, two or three children. </p>
<p>The only outlier is China, where people viewed having three children somewhat negatively: understandable after decades of policies curbing fertility. Nowhere in our study was having just one child viewed more negatively. </p>
<h2>Importance of communicating</h2>
<p>What does come out very strongly is the role of communication, both within the nuclear family but also with grandparents. This characteristic is the most important feature of the ideal family of today.</p>
<p>If you think about it, this finding is not all too unexpected. Good communication means strong emotional support – and that is what most people would like to receive from a family. If communication breaks down, then why bother with having a family if you can get the necessary support elsewhere through friends and other social networks?</p>
<p>Other features matter too – obviously. Respondents viewed low income negatively (apart from in Norway). More egalitarian gender roles and good work-life balance are important. But our findings, which are remarkably similar across different countries, show that good communication matters the most in people’s vision for good family life – more than the number of children they might have.</p><img src="https://counter.theconversation.com/content/222567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arnstein Aassve receives funding from Horizon Europe. </span></em></p>We found no discernable difference in how people rated family scenarios with one, two or three children.Arnstein Aassve, Professor in Demography, Bocconi UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2096072023-07-16T09:56:52Z2023-07-16T09:56:52ZAfrica’s groundbreaking women’s rights treaty turns 20 - the hits and misses of the Maputo protocol<figure><img src="https://images.theconversation.com/files/537007/original/file-20230712-25-tmsax3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's been improvements in sexual and reproductive health outcomes.</span> <span class="attribution"><span class="source">Lucian Coman/Shutterstock</span></span></figcaption></figure><p><em>2023 marks two decades since the adoption of the Maputo Protocol. The <a href="https://au.int/en/treaties/protocol-african-charter-human-and-peoples-rights-rights-women-africa">Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa</a> (the Maputo Protocol) is <a href="https://au.int/en/newsevents/20230217/african-union-gender-pre-summit-20-years-maputo-protocol">arguably</a> the most progressive legally binding instrument on women’s and human rights instruments globally. A total of 44 African countries have signed and <a href="https://www.sfcg.org/wp-content/uploads/2015/03/Maputo-Protocol-Baseline-Report.pdf">ratified</a> it. The <a href="https://au.int/sites/default/files/treaties/37077-treaty-charter_on_rights_of_women_in_africa.pdf">Maputo Protocol</a> provides for extensive and progressive women’s rights. These include the right to health and reproduction, inheritance, economic and social welfare, education and training, access to justice and equal protection before the law, and elimination of harmful practices. Reproductive health researcher Anthony Ajayi unpacks the significance of the document in women’s lives over the years.</em></p>
<hr>
<h2>What does it mean for sexual and reproductive rights?</h2>
<p>Articles 2 and 14 made specific provisions to protect the sexual and reproductive rights of women and girls.</p>
<p>Article 2 mandates member countries to enact and implement laws and other measures to curb all forms of discrimination, especially harmful practices that endanger health and general well-being. </p>
<p>Advocacy efforts to end child marriage and female genital cutting are anchored on this specific provision. Such efforts have resulted in 43 African countries now having laws that put the minimum age of marriage at 18 years old or above for both girls and boys. While some of these countries have parental consent exceptions and parallel customary marriage laws, the past ten years have seen more countries remove these exceptions. Also, <a href="https://au.int/sites/default/files/documents/42276-doc-GettingtozeroFGM-FinalWebPages-small.pdf">22 out of 29 African countries</a> practising female genital cutting now have national laws in place banning the practice.</p>
<p>Article 14 mandates member countries to ensure the right to health of women, including sexual and reproductive health. This includes the right to control fertility, decide whether to have children, the number of children and the spacing of children, and choose any method of contraception. </p>
<h2>Has it been effective?</h2>
<p>Since the inception of the Maputo Protocol, most African countries have removed <a href="https://academic.oup.com/heapol/article/30/4/432/558465">user fees</a> for maternal health services in government-owned health facilities. This has increased access to quality maternal healthcare services for marginalised women and girls. As a result, <a href="https://www.who.int/publications/i/item/9789240068759">maternal deaths</a> have declined markedly. </p>
<p>More countries have <a href="https://reproductiverights.org/sites/default/files/documents/World-Abortion-Map.pdf">broadened</a> their laws to allow access to safe abortion in cases of sexual assault, rape, incest, life-threatening fetal anomalies, and when a pregnancy endangers the woman’s mental and physical health or her life. Between 2000 and 2021, 22 African countries expanded their legal grounds for abortion. Six – Cape Verde, South Africa, Tunisia, Mozambique, São Tomé and Príncipe (up to 10 weeks of gestation in Angola) – permit abortion at the woman’s request during the first trimester of pregnancy. More countries have developed and launched post-abortion care guidelines to expand access for women and girls.</p>
<p>The success of the Maputo Protocol in protecting and guaranteeing the rights of women and eliminating discrimination is quite remarkable. Where the rights of women and girls are violated, the Maputo Protocol has become an instrument for seeking legal redress and a tool for seeking accountability. It was referenced in these examples:</p>
<ul>
<li><p>A court ruling in December 2020 found that the Kenya government <a href="https://www.equalitynow.org/news_and_insights/9_ways_maputo_protocol/">violated</a> several human rights instruments, including the Maputo Protocol, for failing to investigate and prosecute cases of sexual and gender-based violence that happened during the post-election violence of 2007. The government was ordered to pay compensation to four of the survivors, amounting to KSh 4 million (about US$40,000) each.</p></li>
<li><p>In December 2019, the ECOWAS Court of Justice found that the ban on pregnant schoolgirls going to school in Sierra Leone was discriminatory and in violation of girls’ right to education, in breach of Articles 2 and 12 of the Maputo Protocol. Since the ruling, the government of Sierra Leone has lifted the ban.</p></li>
<li><p>Article 13 and 17 of Tanzania’s Marriage Act, which set the minimum age of marriage for girls at 15 years and 18 years for boys, was challenged at the appeal court in 2019. Citing the Maputo Protocol, the court upheld the earlier ruling that marriage under the age of 18 was illegal.</p></li>
</ul>
<h2>What have its shortcomings been?</h2>
<p>Progress in realising women’s and girls’ rights remains uneven within and between countries. Eleven countries haven’t ratified the protocol. Twenty-four haven’t fulfilled their reporting obligation to the African Commission on Human and Peoples’ Rights. Consequently, <a href="https://www.oecd.org/gender/data/ensuring-strong-equitable-legal-frameworks-as-an-accelerator-for-gender-equality-in-africa.htm">discriminatory laws</a> persist. And customary, common and civil laws remain in parallel with constitutional provisions. This creates loopholes for the violation of women’s and girls’ rights. </p>
<p>For example, 11 countries (Cameroon, Seychelles, Sudan, South Africa, Burkina Faso, Gabon, Guinea-Bissau, Mali, Niger, Senegal, and Tanzania) permit girls below 18 years to marry. One member state has no minimum age for marriage. But legal reforms are happening in five of these countries.</p>
<p>There’s been improvement in sexual and reproductive health outcomes. But sexual and gender-based violence, child marriage and female genital cutting remain high in <a href="https://gh.bmj.com/content/bmjgh/5/1/e002231.full.pdf">most African</a> countries. <a href="https://www.who.int/publications/i/item/9789240068759">Maternal deaths</a> and <a href="https://unaids.org/sites/default/files/media_asset/data-book-2022_en.pdf">new HIV transmission</a> have declined. But incidences remain relatively high in several countries. </p>
<p>Young people, particularly girls, bear a <a href="https://gh.bmj.com/content/bmjgh/6/2/e004129.full.pdf">disproportionate</a> burden of poor sexual and reproductive health outcomes. This hinders their smooth transition into adulthood and affects their immediate and lifelong health (physical and mental) and socioeconomic wellbeing and empowerment.</p>
<h2>What more needs to be done?</h2>
<p>More advocacy is needed to ensure: </p>
<ul>
<li><p>the remaining 11 countries ratify the protocol</p></li>
<li><p>countries with reservations about some of the articles in the protocol need to address them </p></li>
<li><p>those who have ratified it fully domesticate and implement its provisions. </p></li>
</ul>
<p>Such advocacy should be informed by contextually relevant evidence on sexual and reproductive health, including what works in addressing harmful practices, increasing young people’s access to information and services, and reducing new HIV infections and maternal deaths. </p>
<p>The partnership between all actors working to ensure women’s health and reproductive rights are realised should be reinvigorated and sustained to make certain that gains are consolidated and not reversed. </p>
<p>Entrenching a culture of equity around sexual and reproductive rights will also require tailored engagement with community and religious leaders to build their capacity on matters of sexual and reproductive health. Sustained funding of civil society organisations working to ensure women’s rights is also key, and so is the need to bolster the women’s movement on the continent.</p>
<p><em>Juliet Kimotho, senior advocacy officer at the African Population and Health Research Center, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/209607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Idowu Ajayi is affiliated with the African Population and Health Research Center. </span></em></p>The success of the Maputo Protocol in protecting the rights of women and eliminating discrimination is remarkable.Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2070342023-06-28T07:50:53Z2023-06-28T07:50:53ZEvery 2 seconds in the world a baby is born prematurely – report identifies biggest challenges for their survival<figure><img src="https://images.theconversation.com/files/531103/original/file-20230609-25-ucxday.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A premature infant receives care at Koidu Government Hospital in Kono, Sierra Leone. </span> <span class="attribution"><span class="source">Melina Mara/The Washington Post via Getty Images</span></span></figcaption></figure><p>Globally, about <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30451-0/fulltext">one baby in 10</a> is born too soon – that’s around one baby
every two seconds. A full term pregnancy is around nine months or 37 weeks. Babies born before this mark are considered premature. Preterm birth is a significant global health issue. It can cause serious short term consequences, such as respiratory and cardiac problems. In the long term, babies born prematurely may face motor, neurosensory, cognitive and behavioural deficits. </p>
<p>A decade ago in 2012, a global coalition of stakeholders launched <a href="https://www.who.int/publications/i/item/9789241503433">Born Too Soon: The Global Action Report on Preterm Birth</a>. The report made a case for global action to mitigate the problems of preterm birth. </p>
<p>Since then, many countries have adopted plans and resolutions on newborn health. Global guidelines now include life-saving interventions, such as the use of antenatal corticosteroids and kangaroo mother care (skin-to-skin contact). There’s also been growth in community activism on preterm birth and stillbirth prevention, driven by networks of parents, health professionals, academia and civil society. </p>
<p>Despite these interventions, the last decade has seen no measurable change in global preterm birth rates in any region of the world. For example, in southern Asia 13.3% of babies in 2010 were born premature; this figure was 13.2% in 2020. In sub-Saharan Africa 10.1% of babies in both 2010 and 2020 were premature. A group of over 140 individuals from more than 70 organisations contributed to a new report, <a href="https://www.who.int/publications/i/item/9789240073890">Born Too Soon: decade of action on preterm birth</a>, to coincide with the 10th anniversary of the first report.</p>
<p>The latest report shows that the overall progress in improving the wellbeing of babies born prematurely, and that of their families, has not gone fast enough or far enough. Where babies are born often dictates whether they will survive. Inequalities related to race, ethnicity, socioeconomic and educational status, and access to quality healthcare services determine the likelihood of death and disability. For example, one in 10 extremely preterm babies (born before 28 weeks or seven months) survive in low-income countries. In high-income countries more than nine in 10 of these babies survive. </p>
<p>Strategies to reduce preterm birth include: pre-conception care such as access to family planning; sexual health programmes aimed at prevention and treatment of infections prior to and during pregnancy; and assessment and treatment of low nutritional status before conception. </p>
<p>The report is a wake-up call. The problem of preterm birth needs concerted efforts from governments and donors. Families, communities, healthcare providers and the civil society must also be actively involved in the solutions. </p>
<h2>Key findings</h2>
<p>In addition to established global issues, the report highlights new and intensified challenges which have affected efforts to improve preterm birth outcomes. We call these the “four Cs”:</p>
<p><strong>Conflict:</strong> By the end of 2022, over 100 million people were driven from their homes by war, violence or human rights abuses, particularly in countries such as Ukraine, Afghanistan, Sudan and Mozambique. Worldwide, 61% of maternal deaths, 51% of stillbirths and 50% of newborn deaths occurred in countries that required UN humanitarian aid in 2023. Surviving newborns from conflict zones are particularly vulnerable to lifelong risks as a result of poor healthcare services.</p>
<p><strong>COVID-19:</strong> The pandemic destabilised health services for women and newborns. Separation of newborns from caregivers threatened high-impact practices like kangaroo mother care and exclusive breastfeeding (giving no other food or drink – not even water – except breast milk). A recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955179/">study</a> found that if universal coverage of kangaroo mother care were achieved, more than 125,000 newborn lives around the world could have been saved. The number of newborn deaths from COVID-19 could have been lower than 2,000. </p>
<p><strong>Climate change:</strong> Climate change (including extreme heat) and natural disasters are displacing millions of people. The health impacts are wide-ranging. In 2020, <a href="https://www.stateofglobalair.org/health/newborns#fragile-stage">20%</a> of newborn deaths were attributed to air pollution, mostly because of preterm birth. Toxic chemicals in maternal blood <a href="https://www.stateofglobalair.org/health/newborns#risk-home">results</a> in immune system stress and placental dysfunction.</p>
<p><strong>Cost of living crisis:</strong> Disruptions to supply chains caused by the COVID-19 pandemic and the climate crisis have dramatically increased the cost of living. Global <a href="https://www.imf.org/en/Publications/WEO#:%7E:text=Global%20inflation%20is%20forecast%20to,to%204.1%20percent%20by%202024.">inflation</a> rose from 4.7% in 2021 to 8.8% in 2022, creating a global cost of living health crisis. There are <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00120-7/fulltext#:%7E:text=Good%20nutrition%2C%20shelter%2C%20and%20the,health%20timebomb%20for%20the%20future.">reports</a> of babies dying in low- and middle-income countries following discharge to families who cannot afford heating and oxygen at home, further compromising maternal and newborn health outcomes.</p>
<h2>Recommendations</h2>
<p>The <a href="https://www.who.int/publications/i/item/9789240073890">new report</a> sets an ambitious agenda to reduce the burden of preterm birth by addressing contributory factors both within and outside the health system. Its recommendations have crucial contextual relevance to Africa, where preterm birth is the <a href="https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortality-report-2021#:%7E:text=Sub%2DSaharan%20Africa%20has%20the,36%25%20of%20global%20newborn%20deaths.">leading cause of deaths</a> in babies under a month old. </p>
<p>In summary, the report recommends:</p>
<p><strong>1. Counting and accounting for preterm births</strong></p>
<p>Data availability and quality must improve. This can be done by counting every baby everywhere, including those stillborn, and accurately recording gestational age and birth weight. </p>
<p><strong>2. Rights and respect</strong> </p>
<p>Women and their families should be empowered and cared for with respect. This will take more healthcare providers and stronger accountability.</p>
<p><strong>3. Women’s and maternal health services</strong></p>
<p>Women’s access to high-quality, respectful sexual, reproductive and maternal health services is fundamental. All women and adolescent girls should be able to determine the number and spacing of their children. </p>
<p><strong>4. Care for small and sick newborns</strong></p>
<p>Most of the major causes of neonatal death can be prevented by caring for the small or sick newborn. This requires commitment, resources and joined-up systems. </p>
<p><strong>5. Intersectoral action</strong> </p>
<p>There is a need to invest in policies that prioritise equitable and inclusive education, including sexuality education, and innovative financing schemes that support families with preterm babies. Countries also need emergency response plans to avoid service interruptions in times of crisis.</p><img src="https://counter.theconversation.com/content/207034/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The last decade has seen no measurable change in global preterm birth rates in any region of the world.Priya Soma-Pillay, Chair: School of Medicine and Head of Department: Obstetrics and Gynaecology, University of PretoriaDilly OC Anumba, Professor of Obstetrics and Gynaecology, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2065032023-06-01T05:57:19Z2023-06-01T05:57:19ZWant long-term contraception? There are more effective options than the pill. But they can be hard to find<figure><img src="https://images.theconversation.com/files/529283/original/file-20230531-17-pe8br4.jpg?ixlib=rb-1.1.0&rect=15%2C286%2C3521%2C2068&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-contraceptive-spiral-hands-nurse-device-2206348007">Shutterstock</a></span></figcaption></figure><p>Australians’ access to a range of contraceptive options depends on where they live and how wealthy they are. A recent <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report">parliamentary inquiry</a> recommends ways to end this “postcode lottery” for people who want to use long-acting reversible contraception.</p>
<p>There are several types of long-acting reversible contraception: the hormonal contraceptive implant, the hormonal intrauterine devices (IUD) and copper IUDs. </p>
<p>With fewer than <a href="https://www.nejm.org/doi/pdf/10.1056/nejmoa1110855">one in 100 users</a> becoming pregnant in a year while using them (compared to up to <a href="https://theconversation.com/how-effective-is-the-pill-122189">seven</a> in 100 contraceptive pill users) these are the <a href="https://www.nejm.org/doi/pdf/10.1056/nejmoa1110855">most effective</a> contraceptives available. Once they’re inserted into the body, you don’t need to remember to carry a condom, take a daily pill or fill a new script. </p>
<p>So why are they so hard to access in Australia? And what needs to change?</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/australian-womens-access-to-abortion-is-a-postcode-lottery-heres-what-needs-to-change-206504">Australian women's access to abortion is a postcode lottery. Here's what needs to change</a>
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<h2>How do they work?</h2>
<p>The <a href="https://www.tandfonline.com/doi/abs/10.1080/13625187.2000.12067162">contraceptive implant</a> (known as Implanon NXT in Australia) is a small flexible rod, inserted just under the skin of the upper inner arm. It releases a progestogen hormone which prevents monthly egg release from the ovary for up to three years. </p>
<p>IUDs are small T-shaped devices which are inserted into the uterus. Hormonal IUDs contain a progestogen hormone and <a href="https://pubmed.ncbi.nlm.nih.gov/21074010/">mainly work</a> by thickening the cervical mucus and preventing sperm from swimming up into the uterus. There are two types of hormonal IUDs: Mirena and Kyleena. Both last up to five years. Kyleena is slightly smaller and contains a lower dose of hormone than Mirena. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/17531610/">Copper IUDs</a> are hormone-free and last up to ten years. They work through their toxic effect on sperm and the egg to prevent fertilisation. </p>
<h2>They have additional benefits for some users</h2>
<p>As well as better protection from pregnancy, some long-acting reversible contraception methods have other benefits. </p>
<p>The hormonal IUD, Mirena, for example, <a href="https://pubmed.ncbi.nlm.nih.gov/35611632/">reduces heavy menstrual bleeding</a>. This can improve people’s quality of life and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28513/">reduce the need for a hysterectomy</a>.</p>
<figure class="align-center ">
<img alt="Clinician talks to patient" src="https://images.theconversation.com/files/529488/original/file-20230601-21858-ivgtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529488/original/file-20230601-21858-ivgtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529488/original/file-20230601-21858-ivgtnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529488/original/file-20230601-21858-ivgtnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529488/original/file-20230601-21858-ivgtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529488/original/file-20230601-21858-ivgtnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529488/original/file-20230601-21858-ivgtnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">IUDs can have other benefits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abortion-provider-talking-care-patient-2063751323">Shutterstock</a></span>
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<p>Hormonal pills (containing estrogen) and the vaginal ring can’t be used by people with certain conditions, such as migraine with aura, or by people aged 35 years or older who smoke. This isn’t the case for long-acting reversible contraception methods, which most people can safely use. </p>
<p>Copper IUDs are an <a href="https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016/fsrh-ukmec-full-book-2019.pdf">essential option</a> for people who cannot or prefer not to use hormones. This includes people with hormone-driven cancers such as breast cancer, for whom any hormonal contraceptive would be considered unsafe. </p>
<h2>Why aren’t they more available?</h2>
<p>Access to long-acting reversible contraception is not universal in Australia. </p>
<p>Cost can be a <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-015-0227-9">considerable barrier</a> to uptake for some people. While the implant and hormonal IUDs are subsidised by the Pharmaceutical Benefits Schedule (PBS), this is not the case for copper IUDs, which can cost up to A$120 for the device. </p>
<p>Out-of-pocket IUD insertion-related costs can also vary from zero to hundreds of dollars if people don’t have access to publicly funded services. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-an-iud-but-worried-about-pain-during-insertion-heres-what-to-expect-179831">Considering an IUD but worried about pain during insertion? Here’s what to expect</a>
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<p>On the supply side, too few health professionals provide these essential services. </p>
<p>Inadequate remuneration for insertion procedures <a href="https://pubmed.ncbi.nlm.nih.gov/35557481/">act as a deterrent</a>. An IUD takes 30 minutes of inserter and assistant time, and the equipment costs around A$25 per insertion. Yet the <a href="http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=35503&qt=item">Medicare rebate</a> is just A$72.05. Costs may be higher in rural areas, due to higher set-up costs and reduced access to things like sterilising services for procedural equipment.</p>
<p>Insertion and removal of long-acting reversible contraception also requires practical training. This can be costly for GPs and nurses, especially for IUD training, which also means taking around three days off work to achieve the necessary number of supervised IUD insertions. This can be even longer and more costly for rural practitioners, with additional travel time and accommodation costs.</p>
<p>This lack of trained inserters contributes to inequities for people who have chosen a long-acting reversible contraception but can’t find a local practitioner to insert their IUD or implant. </p>
<figure class="align-center ">
<img alt="Doctor types on laptop" src="https://images.theconversation.com/files/529487/original/file-20230601-25431-g1chk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529487/original/file-20230601-25431-g1chk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529487/original/file-20230601-25431-g1chk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529487/original/file-20230601-25431-g1chk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529487/original/file-20230601-25431-g1chk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529487/original/file-20230601-25431-g1chk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529487/original/file-20230601-25431-g1chk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Doctors are deterred by inadequate remuneration for IUD and implant insertion.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/NFvdKIhxYlU">Unsplash/National Cancer Institute</a></span>
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<p>Nurses and midwives could <a href="https://pubmed.ncbi.nlm.nih.gov/26662068/">ably fill this gap</a>. There are multiple <a href="https://pubmed.ncbi.nlm.nih.gov/34836756/">successful models</a> of nurse-led long-acting reversible contraception services and postpartum insertion of implants by midwifes nationally and internationally. </p>
<p>However, most nurses aren’t able to access Medicare remuneration, which creates <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-015-0227-9">additional barriers</a> for this highly skilled workforce to provide these services. </p>
<h2>What are the recommendations for reform?</h2>
<p>The Senate inquiry has recognised these barriers and recommends making contraception universally affordable, and specifically, subsidising copper IUDs. </p>
<p>It also recommends adequate remuneration through Medicare for GPs, nurses and midwives to provide long-acting reversible contraception insertion and removal, and collaborative efforts between the government and medical colleges to improve access to workforce training. </p>
<p>While the recommendations are welcome, they now need to be turned into actions through adequate funding. </p>
<p>The government also needs to fund every Primary Health Network (which plan services) across Australia to identify local gaps and ensure the contraceptive needs of the communities they serve are met equitably, affordably and transparently. </p>
<p>While one size does not fit all, and people must be provided with sufficient and accessible information to make an informed choice, no one who wants an IUD or implant should be denied this choice based on where they live and how much they can pay. </p>
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<strong>
Read more:
<a href="https://theconversation.com/how-effective-is-the-pill-122189">How effective is the pill?</a>
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<img src="https://counter.theconversation.com/content/206503/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Bateson has received honoraria for attending advisory committees and providing education to health professionals sponsored by Organon and Bayer, and has received untied research support from Organon. </span></em></p><p class="fine-print"><em><span>Kathleen McNamee's employer, Sexual Health Victoria, receives funding from Organon, Mayne Pharma, and Bayer Australia and New Zealand to train and support doctors and nurses in the provision of contraception. She has not received any personal remuneration for these activities.</span></em></p>Fewer than one in 100 people who use IUDs and contraceptive implants become pregnant each year, making them the most effective contraceptives. But they can be difficult to access. Here’s why.Deborah Bateson, Professor of Practice, University of SydneyKathleen McNamee, Adjunct Senior Lecturer, Obstetrics & Gynaecology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1993252023-03-12T07:41:45Z2023-03-12T07:41:45ZNigeria’s cities are growing fast: family planning must be part of urban development plans<figure><img src="https://images.theconversation.com/files/514165/original/file-20230308-387-khb6j1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Government investments in infrastructure in Nigeria will remain insufficient as urban populations grow. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-jankara-market-in-lagos-island-on-march-10-2016-in-news-photo/646132122?phrase=markets%20in%20nigeria&adppopup=true">Frederic Soltan/Getty Images</a></span></figcaption></figure><p>Nigeria is rapidly urbanising, with more people living in urban areas than in rural communities. A recent World Bank <a href="https://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS?locations=NG">estimate</a> shows that 53% of the <a href="https://data.worldbank.org/indicator/SP.POP.TOTL?locations=NG">213 million Nigerians</a> live in urban areas. That’s projected to rise above <a href="https://www.un.org/fr/desa/around-25-billion-more-people-will-be-living-cities-2050-projects-new-un-report">70%</a> by 2050. </p>
<p>Lagos, Nigeria’s biggest city, already has <a href="https://worldpopulationreview.com/continents/africa/cities">over 15.9 million people</a>. The country’s urban growth rate is <a href="https://dhsprogram.com/publications/publication-fr359-dhs-final-reports.cfm">6%</a> and the general population growth rate is about <a href="https://data.worldbank.org/indicator/SP.POP.GROW?locations=NG">2.4%</a>.</p>
<p>Although urban areas are hubs for socioeconomic development, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676403/">many large cities are unsafe and unhealthy</a>. </p>
<p>Unfortunately, infrastructure development and service delivery <a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00924-0">aren’t keeping pace</a> with urban population growth in Nigeria. <a href="https://www.whp-journals.co.uk/JPS/article/view/768">Millions of urban residents face enormous challenges</a> like housing deficits, overcrowding and limited economic opportunities. Poverty, air and noise pollution, insecurity, heightened criminality and environmental degradation are others. Climate change is also causing rising sea levels, flooding, heatwaves, more intense droughts, crop failures and famines that <a href="https://www.unhcr.org/news/briefing/2022/10/635b913a4/millions-face-harm-flooding-across-west-central-africa-unhcr-warns.html">affect residents of urban areas across Nigeria</a>. </p>
<p>All these pressures, combined with poor planning, make life difficult in the country’s cities. One of the tools to deal with unsustainable urbanisation is family planning.</p>
<p>In <a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00924-0">my study</a> I explored how family planning policy and urban development programmes in Nigeria were linked between 2000 and 2020. The study suggests the need to integrate family planning and health more effectively into urban and territorial planning. This will contribute to preventing unsustainable urbanisation and urban poverty. </p>
<h2>Migration, fertility and urban growth</h2>
<p>High population growth in cities across Africa is mainly driven by a natural increase: <a href="https://blogs.afdb.org/fr/inclusive-growth/urbanization-africa-191">more births than deaths</a>. When a country is 30% or more urban, the contribution of natural increase to urban growth <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/padr.12407">becomes larger than that of migration</a>. </p>
<p>The <a href="https://dhsprogram.com/publications/publication-fr359-dhs-final-reports.cfm">total fertility rate for Lagos is 3.4 children per woman</a> – higher than the replacement fertility level of 2.1. </p>
<p><a href="https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf">Nigeria’s total fertility rate is 5.3</a> (4.5 in urban and 5.9 in rural areas), which is far higher than the rate of countries <a href="https://www.statssa.gov.za/publications/Report-03-01-63/Report-03-01-632011.pdf">like South Africa (2.7)</a> and <a href="https://www.statistics.gov.rw/publication/Rwanda_population_2022">Rwanda (3.6)</a>. </p>
<p><a href="https://www.downtoearth.org.in/news/africa/just-12-women-in-nigeria-used-modern-contraceptive-methods-report-78730">Only 12% of married women in Nigeria use modern contraceptives</a> (18.2% in urban and 7.8% in rural areas). Again, this is far lower compared to <a href="https://dhsprogram.com/publications/publication-fr337-dhs-final-reports.cfm">South Africa (48%)</a> and <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-022-01517-4">Rwanda (58%)</a>. </p>
<p>The unmet need for family planning among currently married women is <a href="https://www.dhsprogram.com/pubs/pdf/FR359/FR359.pdf">high in urban Nigeria, at 20%</a>.</p>
<h2>Evidence from research</h2>
<p>Meeting the family planning needs of the urban population can help to achieve population growth rates that make cities to be good places to live. But family planning remains a neglected subject in urban development programmes in Nigeria. My study set out to explore how population and city planning could be integrated better.</p>
<p>Part of the study consisted of interviews with 37 key informants in the family planning and urban development sectors in Ibadan, south-west Nigeria and Kaduna, north-west Nigeria. </p>
<p>More than two thirds of the informants recognised the importance of making family planning part of urban development initiatives. It can help address complex urban governance challenges such as pressure on infrastructure and social services.</p>
<p>But I found that family planning and urban development actors mostly worked in silos. This was a result of systemic barriers like the lack of a policy framework and support for sectors to work together.</p>
<p>The respondents said there were no policy documents or programmes that clearly linked family planning to urban development. Existing guidelines in each sector weren’t always carried out or monitored properly. For example, housing standards to prevent overcrowding weren’t enforced. And some people working in these fields didn’t have enough knowledge about each other’s work, or were frequently transferred to other government jobs. Buy-in was also identified as an issue: family planning can be a sensitive area for religious reasons. And informants noted a lack of will among professionals in different sectors to work as a team.</p>
<p>Urban development stakeholders, city planners and municipal authorities didn’t see family planning as a critical element in their initiatives. </p>
<p>But actors in both sectors suggested possible ways to achieve more effective working relationships. These included more research and sharing of knowledge, involving civil society organisations and the media, and sensitisation talks with government officials and political leaders.</p>
<p>They said a policy and regulatory framework would need to be in place to guide collaboration. </p>
<h2>Family planning for healthy cities</h2>
<p>Effective family planning services can give women more control over their health, time and activities. They can then play a greater part in meeting national development goals. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-nigerias-weak-health-system-affects-women-and-girls-the-most-163904">Why Nigeria's weak health system affects women and girls the most</a>
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<p>With a high rate of natural population increase across urban Nigeria, government investments in infrastructure won’t be sufficient. Housing deficits – already at <a href="https://housingfinanceafrica.org/countries/nigeria/">28 million units</a> – and overcrowding will remain big challenges. Slums – already home to <a href="https://data.worldbank.org/indicator/EN.POP.SLUM.UR.ZS?locations=NG">49% of Nigeria’s urban population</a> – will grow. Urban poverty – already afflicting <a href="https://nigerianstat.gov.ng/news/78">42% of urban residents in Nigeria</a> – will rise. <a href="https://theconversation.com/nigerias-spiralling-insecurity-five-essential-reads-186696">Insecurity</a> will remain a big problem. Climate change crises will worsen. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nigeria-floods-expert-insights-into-why-theyre-so-devastating-and-what-to-do-about-them-192409">Nigeria floods: expert insights into why they're so devastating and what to do about them</a>
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<p>There is no single solution to unsustainable urbanisation in Nigeria. But adequate investments in family planning programmes will help. </p>
<p>Effective and consistent use of family planning will reduce unintended pregnancies and unwanted fertility. A slower population growth rate consistent with national development goals can be achieved. </p>
<p>National and sub-national governments ought to consider the critical role of family planning in their urban development initiatives. This will make rapidly growing Nigerian cities more suitable for healthy living.</p><img src="https://counter.theconversation.com/content/199325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sunday Adedini receives funding from Bill and Melinda Gates Foundation through the International Union for the Scientific Study of Population (IUSSP). </span></em></p>Cities are increasingly unsafe and unhealthy. Family planning can help curb unsustainable urbanisation.Sunday Adedini, Associate Professor, Federal University, Oye EkitiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1963882023-03-02T19:09:06Z2023-03-02T19:09:06ZThinking of having a baby as the planet collapses? First, ask yourself 5 big ethical questions<figure><img src="https://images.theconversation.com/files/513061/original/file-20230302-14-deh1mm.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3734%2C2500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Do you want to have a baby? But, on a planet rocked by the climate crisis, ecosystem collapse, famine and poverty, is having one just adding to the problem – and therefore unethical?</p>
<p>I am a PhD Candidate at Monash Bioethics Centre, and I research the ethics of procreation in a time of climate change. I’ve found there’s no simple “yes” or “no” answer to whether we should produce more children when Earth is in such dire straits. </p>
<p>People who want to have children are faced with a dilemma. Creating a child who will be responsible for high emissions over their lifetime requires others to stay in poverty (if the planet is to operate within its physical limits). This, it can easily be argued, furthers injustice and inequality. </p>
<p>But many of us want to have children – doing so can be one of the most meaningful things we do with our life. </p>
<p>What should we do? Ethics can provide an answer. It shows there is a moral obligation to consider the effects of child-bearing without obliging people to not have children as a result.</p>
<figure class="align-center ">
<img alt="man and women lie on bed with baby" src="https://images.theconversation.com/files/513065/original/file-20230302-17-plcira.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513065/original/file-20230302-17-plcira.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513065/original/file-20230302-17-plcira.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513065/original/file-20230302-17-plcira.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513065/original/file-20230302-17-plcira.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513065/original/file-20230302-17-plcira.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513065/original/file-20230302-17-plcira.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Having a child can be one of the most meaningful things we do with our life. But is it ethical in these challenging times?</span>
<span class="attribution"><span class="source">Natacha Pisarenko/AP</span></span>
</figcaption>
</figure>
<h2>What is overpopulation?</h2>
<p>Many people argue the world has an overpopulation problem. Overpopulation <a href="https://pubmed.ncbi.nlm.nih.gov/12281798/">has been defined</a> as the state where there are more people than can live on Earth in comfort, happiness, and health and still leave the world a fit place for future generations.</p>
<p>But this definition is open to interpretation. Overpopulation is not just about numbers, but also values. If people in affluent countries value their lifestyles – and the opportunity for others to have the same lifestyle – then the world is overpopulated.</p>
<p>I live in inner-city Melbourne. When I calculate my <a href="https://www.footprintcalculator.org/home/en">ecological footprint</a>, it’s confronting to discover we would need about four Earths for everyone to live like me. If everyone lived like the average American, we would need more than five Earths.</p>
<p>Indeed, estimates by <a href="https://www.academia.edu/10991141/Will_Limited_Land_Water_and_Energy_Control_Human_Population_Numbers_in_the_Future">ecologists</a> and <a href="https://www.researchgate.net/publication/356572845_Climate_ethics_and_population_policy_A_review_of_recent_philosophical_work">philosophers</a> show a person born in the developed world can enjoy their lifestyle only if there are no more than two or three billion people on the planet. There are now more than <a href="https://www.worldometers.info/world-population/">eight billion</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-should-be-wary-of-blaming-overpopulation-for-the-climate-crisis-130709">Why we should be wary of blaming 'overpopulation' for the climate crisis</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="people walking on a crowded street" src="https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people argue the world has an overpopulation problem.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So what do we do?</h2>
<p>We could address the dilemma by decreasing per capita emissions of greenhouse gases. However, this on its own won’t be sufficient. </p>
<p>Why? First, it’s difficult to reduce emissions at the speed required to mitigate catastrophic climate change. The goal of the <a href="https://unfccc.int/process-and-meetings/the-paris-agreement/the-paris-agreement">Paris Agreement</a> is to prevent the world from warming by 2°C from pre-industrial levels. To achieve this goal, <a href="https://www.science.org/doi/10.1126/science.aah3443">we must</a> halve emissions by 2030, halve them again by 2040, and again by 2050. </p>
<p>Unfortunately, we are <a href="https://climateactiontracker.org/publications/glasgows-2030-credibility-gap-net-zeros-lip-service-to-climate-action/">not on track</a> to achieve the Paris goals. This failure will cause significant suffering and <a href="https://www.ipcc.ch/report/ar6/wg2/">millions of deaths</a>. And the most disadvantaged people will be affected first and most severely. This is unjust.</p>
<p>Second, developing countries must be allowed to increase their emissions to <a href="https://www.ecologicalcitizen.net/pdfs/epub-048.pdf">escape poverty</a>. People in poverty consume very few resources. To stay at this low-level of consumption is dehumanising. We should be advocating for many people to consume more.</p>
<p>Third, having fewer children helps solve the injustices caused by climate damage. If global fertility rates dropped by only 0.5 births per woman, about 5.1 billion tonnes of carbon <a href="https://philpapers.org/archive/HICPEA.pdf">would be saved</a> each year by the end of the century. This would contribute to between <a href="https://www.pnas.org/doi/full/10.1073/pnas.1004581107">16% and 29%</a> of the emissions savings needed to avoid catastrophic climate change.</p>
<figure class="align-center ">
<img alt="people wade through floodwaters" src="https://images.theconversation.com/files/513070/original/file-20230302-19-plcira.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513070/original/file-20230302-19-plcira.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513070/original/file-20230302-19-plcira.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513070/original/file-20230302-19-plcira.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513070/original/file-20230302-19-plcira.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513070/original/file-20230302-19-plcira.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513070/original/file-20230302-19-plcira.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Having fewer children helps solve injustices caused by climate damage, such as displacement due to floods.</span>
<span class="attribution"><span class="source">Zahid Hussain/AP</span></span>
</figcaption>
</figure>
<p>Fourth, even if the world’s average per capita emissions decrease, a growing population multiplies emissions. </p>
<p>Emissions tend to grow on a one-to-one ratio with rising populations. Between 1975 and 2009, for example, both population and emissions <a href="https://overpopulation-project.com/wp-content/uploads/2018/12/2010_Ryerson_TheMultiplierofEverythingElse_PostCarbonReaderSeries5221.pdf">rose by 43%</a> in the United States. Not addressing population growth means we may undo good work achieved by reducing per capita emissions.</p>
<p>And finally, we cannot address per capita emissions without addressing reproduction. The decision to not bring someone into the world is about <a href="https://www.biologicaldiversity.org/programs/population_and_sustainability/pdfs/OSUCarbonStudy.pdf">20 times more effective</a> at reducing individual emissions than the sum total of many other “green” acts we can do, such as recycling and driving less.</p>
<p>For instance, in a developed nation, having one fewer children <a href="https://iopscience.iop.org/article/10.1088/1748-9326/aa7541">saves about 58 tonnes</a> of emissions per year. The next best decision someone can make to limit their emissions is to live car-free. But, this will only save about <a href="https://iopscience.iop.org/article/10.1088/1748-9326/aa7541">2.4 tonnes of emissions per year</a>.</p>
<p>As ethicists have recently <a href="https://commons.pacificu.edu/work/sc/f69d70ba-8600-4198-b467-266a3435e91e">pointed out</a>, if there is any duty to reduce our per capita emissions, there is a duty to limit the amount of children we have.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bob-brown-is-right-its-time-environmentalists-talked-about-the-population-problem-148347">Bob Brown is right – it's time environmentalists talked about the population problem</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="man opens lid to recycling bin" src="https://images.theconversation.com/files/513074/original/file-20230302-22-hr8cj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513074/original/file-20230302-22-hr8cj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513074/original/file-20230302-22-hr8cj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513074/original/file-20230302-22-hr8cj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513074/original/file-20230302-22-hr8cj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513074/original/file-20230302-22-hr8cj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513074/original/file-20230302-22-hr8cj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not having a baby is far better for the planet than many other ‘green’ acts combined.</span>
<span class="attribution"><span class="source">James Ross/AAP</span></span>
</figcaption>
</figure>
<h2>Resolving the dilemma</h2>
<p>I should acknowledge here that I don’t have the lived experience of being a woman or person who can carry a child, nor do I have children yet.</p>
<p>However, I do believe the world must address overpopulation. I say this knowing it is <a href="https://teachersinstitute.yale.edu/curriculum/units/1998/7/98.07.03.x.html">not an easy or comfortable</a> topic to broach. It involves sexuality and contraception, personal rights and religion.</p>
<p>And I realise there is no way forward that can solve all injustices. </p>
<p>If people in affluent nations keep bringing children into the world, there will not be enough resources for many current and future people to live and flourish. </p>
<p>But it would also be <a href="https://www.academia.edu/27846638/Whose_Job_Is_It_to_Fight_Climate_Change_A_Response_to_Hickey_Rieder_and_Earl">unjust</a> to demand an individual give up reproducing. The freedom to decide whether to bring someone into the world is central to many people’s <a href="https://link.springer.com/article/10.1007/s10790-021-09797-y">dignity and life’s meaning</a>.</p>
<p>And the United Nations Declaration of Human Rights <a href="https://humanrights.gov.au/our-work/commission-general/universal-declaration-human-rights-human-rights-your-fingertips-human#:%7E:text=Article%2016&text=Men%20and%20women%20of%20full,marriage%20and%20at%20its%20dissolution">recognises</a> that every man and woman has the right to found a family. </p>
<p>So the most appropriate answer is not one that seeks to eliminate injustices altogether. Rather, it should minimise injustice as much as possible.</p>
<p>Telling people not to have children, or to have fewer children, is too strong. The solution must <a href="https://onlinelibrary.wiley.com/doi/10.1111/japp.12099">tread a finer line</a>. But how? By placing a moral obligation on people to consider the environmental and justice issues of bringing someone into the world.</p>
<figure class="align-center ">
<img alt="man and women look lovingly at baby" src="https://images.theconversation.com/files/513062/original/file-20230302-23-jdw7rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513062/original/file-20230302-23-jdw7rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513062/original/file-20230302-23-jdw7rk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513062/original/file-20230302-23-jdw7rk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513062/original/file-20230302-23-jdw7rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513062/original/file-20230302-23-jdw7rk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513062/original/file-20230302-23-jdw7rk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We must consider the environmental and justice issues of bringing someone into the world.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Five big questions</h2>
<p>For a person wanting children, this means it’s <a href="https://www.theglobaljusticenetwork.org/index.php/gjn/article/view/96/71">no longer enough</a> to only ask questions such as: can I be a good parent? Do I have the means to support a child?</p>
<p>Anyone with the means to control their fertility now has an obligation to also ask themselves the following five questions:</p>
<ol>
<li><p>Will my child have a high-emissions lifestyle and will this mean others must live in poverty? If so, is this justifiable?</p></li>
<li><p>Do I have biological parenting desires - that is, the desire to parent someone who has my genes? Or do I simply have parenting desires - that is, the desire to raise someone in a loving environment according to my values, regardless of their genes? </p></li>
<li><p>Even if I might discover a strong biological connection once I have a child, could I be fulfilled in my life if I raised someone who is not biologically connected to me?</p></li>
<li><p>If I have only parenting desires, can this be <a href="https://philpapers.org/archive/RULPAG-3.pdf">satisfied in other ways</a> such as through fostering, teaching, mentoring or, if possible, adopting?</p></li>
<li><p>Does satisfying my parenting desires in other ways particularly apply to me if I already have one biological child?</p></li>
</ol>
<p>Often people who choose not to have children feel the need to explain the decision to others. The above approach would mean the reverse: requiring that people who wish to ethically bring someone into the world must themselves address difficult questions.</p>
<p>A just society values everyone being able to pursue having a child if they wish to. Yet, it also demands that everyone consider the ramifications of doing so.</p><img src="https://counter.theconversation.com/content/196388/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Craig Stanbury does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s no simple “yes” or “no” answer to whether we should produce more children when Earth is in such dire straits.Craig Stanbury, PhD Candidate, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1980172023-01-19T15:02:35Z2023-01-19T15:02:35ZChina’s population decline is a result of decades of botched family planning measures and will have global implications<p>China’s population has <a href="https://www.theguardian.com/world/2023/jan/17/chinas-population-falls-for-first-time-in-more-than-60-years">fallen for the first time in 60 years</a> and is set to be reduced by half by the end of the century. After declining for some years, China is now in what a government official called an “<a href="https://www.bbc.co.uk/news/world-asia-china-64300190">era of negative population growth</a>”, with the national birth rate hitting a record low of 6.77 births per 1,000 people.</p>
<p>China has long been the most populous country in the world. Apart from the famine years (1959-61) caused by the <a href="https://www.britannica.com/event/Great-Leap-Forward">Great Leap Forward</a> political campaign, China’s population has rapidly increased over the past decades.</p>
<p>China’s rapid population growth started to slow in the 1970s when the Chinese government introduced family planning measures because of fears of “overpopulation”. The most far-reaching measure was the <a href="https://www.brookings.edu/articles/the-end-of-chinas-one-child-policy/">one-child policy</a> adopted in 1980 that restricted each household to only one child (with certain exceptions, such as members of ethnic minorities, rural households and later children of two single children). </p>
<p>According to the government’s logic at the time, reducing population growth would free up scarce resources needed to increase the standard of living and boost economic growth. The rate of growth in China’s population accordingly <a href="https://www.npr.org/2023/01/17/1149453055/china-records-1st-population-fall-in-decades-as-births-drop">slowed for several decades</a>. Now, for the first time in decades, the population is beginning to shrink. </p>
<p>But whether China’s population really has peaked, and when and how fast this shrinkage will be, is not clear cut and is <a href="https://www.nature.com/articles/d41586-022-02304-8">subject of some debate</a>. The <a href="https://population.un.org/wpp/Graphs/DemographicProfiles/Line/156">UN World Population Prospects from 2022</a>, at first estimated that China’s population will only start declining in around 2030. </p>
<p>Data on China’s population is notoriously unreliable and varies depending on who is doing the counting. According to <a href="https://www.theguardian.com/world/2023/jan/17/chinas-population-falls-for-first-time-in-more-than-60-years">China’s National Bureau of Statistics</a>, the country had 1.4117 billion people at the end of 2022, compared with 1.4126 billion a year earlier. But the <a href="https://www.unfpa.org/data/world-population/CN">United Nations Population Fund</a> has estimated the number of people in China at 1.4485 billion and the World Population Review estimates it at <a href="https://worldpopulationreview.com/countries/china-population">1.426 billion people</a>.</p>
<p>The <a href="https://www.pewresearch.org/fact-tank/2022/12/05/key-facts-about-chinas-declining-population/#:%7E:text=The%20UN%20forecasts%20that%20China%27s,of-the-road%20projection.">variation in projections of population trends</a> are based on different assumptions and data sources, leading to different expectations as to how China’s society will develop over time. </p>
<p>The further forward in time these projections are made, the more difficult they become. Many factors affect how fertility rates develop over a decade – let alone half a century. So predictions that China’s population will be cut in half by 2100 need to be read with some caution. They depend on assumptions of how societies develop over time.</p>
<h2>Government failure</h2>
<p>For decades the Chinese government has attempted to actively manage population development by influencing its fertility rate. After the one-child policy led to a rapid decrease in <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=CN">China’s fertility rate</a> (1.3 in 2020), the end of this policy in 2016 allowed families to have two, then <a href="https://www.csis.org/blogs/new-perspectives-asia/no-three-child-policy-alone-will-not-save-china-impending-demographic">three children</a>. </p>
<p>The Chinese government has also begun to support families in other ways, for instance, by promoting <a href="https://thechinaproject.com/2021/11/29/in-china-longer-maternity-leave-is-a-tough-sell/">longer maternity leave</a> and <a href="http://www.chinatax.gov.cn/eng/c101269/c5167582/content.html">tax incentives</a> for having children.</p>
<p>But these policy changes appear to be too little, too late. Many experts – in China and elsewhere – have argued that the scrapping of the one-child policy came <a href="https://www.nature.com/articles/d41586-022-02304-8">a decade too late</a> to influence the rapid slowdown of its population growth. </p>
<p>Uptake of the new family planning policies has also been scarce. After decades of promoting a nuclear family of three, this image has become deeply ingrained in Chinese society. Not only that, but costs for education, housing and marriage have increased. Having more children is simply considered to be <a href="https://www.reuters.com/world/china/chinas-child-rearing-costs-far-outstrip-us-japan-research-2022-02-23/">too expensive</a> for many families. </p>
<p>Yet, for some forecasters, this population decline has come at a faster pace than expected. One reason may be the <a href="https://www.weforum.org/agenda/2022/07/china-population-shrink-60-years-world/">COVID pandemic</a> which has discouraged families from having more children. But COVID’s effects are hard to judge. For instance, data on China’s <a href="https://www.ft.com/content/9bac3627-1f80-4423-bad7-a0c331740b06">COVID-related deaths is unreliable</a>. </p>
<h2>What does it mean for the world?</h2>
<p>When more people live longer – and fewer people are born – it has two consequences: a shrinking workforce and increased costs for people in old age. China’s rapid economic growth has been a result of its large and cheap workforce. With fewer workers available and global moves to de-couple from China, companies are <a href="https://foreignpolicy.com/2022/08/02/companies-fleeing-china-friendshoring-supply-chains/">moving their production elsewhere</a>. This threatens China’s economic growth model at a time when it is transitioning from a labour-intensive to a knowledge-intensive economy.</p>
<p>Another growing concern has been how to care for a rapidly growing ageing population. <a href="https://www.weforum.org/agenda/2022/07/china-population-shrink-60-years-world/">Projections estimate</a> that by 2079 there will be more Chinese people outside than inside the workforce. Even if population ageing proceeds slower than expected, pension, health and social care costs will become a heavy strain on economic development unless productivity increases. </p>
<p>China is not alone in facing such issues. Other <a href="https://www.unescap.org/sites/default/files/SDD%20Ageing%20Fact%20Sheet%20Overview.pdf">East Asian countries</a>, such as in Japan and South Korea, are also facing rapid population ageing. Similarly, <a href="https://www.weforum.org/agenda/2021/01/declining-working-age-populations-japan-korea-germany-italy-employment/">many European nations</a>, including Germany and Italy, have faced population decline for decades. </p>
<p>But China’s situation is different. First, it is facing population ageing and decline <a href="https://www.weforum.org/agenda/2017/10/china-will-grow-old-before-it-gets-rich/">while it is still a middle-income country</a>, making it harder to finance socio-economic change. </p>
<p>Second, from an international standpoint, China has assumed a central position in global supply chains – so anything that affects China will have knock-on effects for the world economy. So this story of China’s population decline has immense implications for China’s position in the world and the global economy at large.</p><img src="https://counter.theconversation.com/content/198017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christina Maags does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>China’s birth rate hit a record low in 2022.Christina Maags, Lecturer in Chinese Studies , University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1972702023-01-12T13:22:17Z2023-01-12T13:22:17ZUS birth rates are at record lows – even though the number of kids most Americans say they want has held steady<figure><img src="https://images.theconversation.com/files/504125/original/file-20230111-17-rb1th.jpg?ixlib=rb-1.1.0&rect=605%2C401%2C4607%2C3396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More one-and-done families influence the overall birth rate.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-multi-ethnic-parents-kissing-son-royalty-free-image/764783339">Maskot via Getty Images</a></span></figcaption></figure><p>Birth rates are falling in the U.S. After the highs of the Baby Boom in the mid-20th century and the lows of the Baby Bust in the 1970s, birth rates were relatively stable for nearly 50 years. But during the Great Recession, from 2007-2009, <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-17.pdf">birth rates declined sharply</a> – and they’ve kept falling. In 2007, average birth rates were right around 2 children per woman. By 2021, levels had dropped more than 20%, close to the <a href="https://apnews.com/article/birth-rates-science-coronavirus-pandemic-health-d51571bda4aa02eafdd42265912f1202">lowest level in a century</a>. Why? </p>
<p>Is this decline because, as some suggest, young people <a href="https://www.nbcnews.com/news/world/adoption-highest-forms-love-pope-francis-says-rcna11065">aren’t interested in having children</a>? Or are people facing increasing barriers to becoming parents?</p>
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<p><a href="https://scholar.google.com/citations?user=yEWD08QAAAAJ&hl=en&oi=ao">We are demographers</a> <a href="https://scholar.google.com/citations?user=2c_rF_IAAAAJ&hl=en&oi=ao">who study</a> how people make plans for having kids and whether they are able to carry out those intentions.</p>
<p><a href="https://doi.org/10.1111/padr.12535">In a recent study</a>, we analyzed how changes in childbearing goals may have contributed to recent declines in birth rates in the United States. Our analysis found that most young people still plan to become parents but are delaying childbearing.</p>
<h2>Digging into the demographic data</h2>
<p>We were interested in whether people have changed their plans for childbearing over the past few decades. And we knew from other research that the way people think about having children changes as they get older and their circumstances change. Some people initially think they’ll have children, then gradually <a href="https://doi.org/10.1007/s13524-018-0739-7">change their views over time</a>, perhaps because they don’t meet the right partner or because they work in demanding fields. Others don’t expect to have children at one point but <a href="https://doi.org/10.1111/jomf.12402">later find themselves desiring to have children</a> or, sometimes, unexpectedly pregnant. </p>
<p>So we needed to analyze both changes over time – comparing young people now to those in the past – and changes across the life course – comparing a group of people at different ages. No single data set contains enough information to make both of those comparisons, so we combined information from multiple surveys. </p>
<p>Since the 1970s, the <a href="https://www.cdc.gov/nchs/nsfg/index.htm">National Surveys of Family Growth</a>, a federal survey run by the National Centers for Health Statistics, have been asking people about their childbearing goals and behaviors. The survey doesn’t collect data from the same people over time, but it provides a snapshot of the U.S. population about every five years.</p>
<p>Using multiple rounds of the survey, we are able to track what’s happening, on average, among people born around the same time – what demographers call a “cohort” – as they pass through their childbearing years.</p>
<p>For this study, we looked at 13 cohorts of women and 10 cohorts of men born between the 1960s and the 2000s. We followed these cohorts to track whether members intended to have any children and the average number of children they intended, starting at age 15 and going up to the most recent data collected through 2019.</p>
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<p>We found remarkable consistency in childbearing goals across cohorts. For example, if we look at teenage girls in the 1980s – the cohort born in 1965-69 – they planned to have 2.2 children on average. Among the same age group in the early 21st century – the cohort born in 1995-1999 – girls intended to have 2.1 children on average. Slightly more young people plan to have no children now than 30 years ago, but still, the vast majority of U.S. young adults plan to have kids: about 88% of teenage girls and 89% of teenage boys.</p>
<p>We also found that as they themselves get older, people plan to have fewer children – but not by much. This pattern was also pretty consistent across cohorts. Among those born in 1975-79, for instance, men and women when they were age 20-24 planned to have an average of 2.3 and 2.5 children, respectively. These averages fell slightly, to 2.1 children for men and 2.2 children for women, by the time respondents were 35-39. Still, overwhelmingly, most Americans plan to have children, and the average intended number of children is right around 2. </p>
<p>So, if childbearing goals haven’t changed much, why are birth rates declining?</p>
<h2>What keeps people from their target family size?</h2>
<p>Our study can’t directly address why birth rates are going down, but we can propose some explanations based on other research. </p>
<p>In part, <a href="https://doi.org/10.1016/j.jadohealth.2016.06.024">this decline is good news</a>. There are fewer unintended births than there were 30 years ago, a decrease linked to increasing use of effective contraceptive methods like IUDs and implants and improved insurance coverage from the Affordable Care Act.</p>
<p>Compared with earlier eras, people today start having their children later. These delays also contribute to declining birth rates: Because people start later, they have less time to meet their childbearing goals before they reach biological or social age limits for having kids. As people wait longer to start having children, they are also <a href="https://doi.org/10.1353/dem.0.0073">more likely to change their minds about parenting</a>.</p>
<p>But why are people getting a later start on having kids? We hypothesize that Americans see parenthood as harder to manage than they might have in the past. </p>
<p>Although the U.S. economy overall <a href="https://www.bls.gov/opub/mlr/2018/article/great-recession-great-recovery.htm">recovered after the Great Recession</a>, many young people, in particular, feel <a href="https://doi.org/10.1007/s10834-017-9548-1">uncertain about their ability to achieve</a> some of the things they see as necessary for having children – including a good job, a stable relationship and safe, affordable housing. </p>
<p>At the same time, the <a href="https://doi.org/10.1007/s13524-012-0146-4">costs of raising children</a> – from child care and housing to <a href="https://nces.ed.gov/programs/digest/d21/tables/dt21_330.10.asp">college education</a> – are rising. And parents may feel more pressure to live up to <a href="https://doi.org/10.1093/sf/soy107">high-intensive parenting standards</a> and prepare their children for an <a href="https://www.ucpress.edu/book/9780520278103/motherload">uncertain world</a>. </p>
<p>And while our data doesn’t cover the last three years, the COVID-19 pandemic may have increased feelings of instability by exposing the lack of support for American parents.</p>
<p>For many parents and would-be parents, the “right time” to have a child, or have another child, may feel increasingly out of reach – no matter their ideal family size.</p><img src="https://counter.theconversation.com/content/197270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Hayford receives funding from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development and the National Institute on Aging. She is affiliated with the American Sociological Association and the Population Association of America. </span></em></p><p class="fine-print"><em><span>Karen Benjamin Guzzo receives funding from the Eunice Kennedy Shriver Institute of Child Health and Human Development. She is affiliated with the Population Association of America, the American Sociological Association, the National Council on Family Relations, and the Council on Contemporary Families. </span></em></p>Childbearing goals have remained remarkably consistent over the decades. What has changed is when people start their families and how many kids they end up having.Sarah Hayford, Professor of Sociology; Director, Institute for Population Research, The Ohio State UniversityKaren Benjamin Guzzo, Professor of Sociology and Director of the Carolina Population Center, University of North Carolina at Chapel HillLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1865372022-10-12T12:18:11Z2022-10-12T12:18:11ZMale birth control options are in development, but a number of barriers still stand in the way<figure><img src="https://images.theconversation.com/files/488588/original/file-20221006-22-mkhlv3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1999%2C1499&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lack of pharmaceutical industry interest has stymied the development of new male contraception options.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/lowering-sperm-count-royalty-free-illustration/825328902">filo/DigitalVision Vectors via Getty Images</a></span></figcaption></figure><p>In the wake of the reversal of Roe v. Wade, developing more contraception options for everyone becomes even more important.</p>
<p>Women and people who can become pregnant have a <a href="https://fphandbook.org">number of effective birth control methods</a> available, including oral pills, patches, injections, implants, vaginal rings, IUDs and sterilization. But for men and people who produce sperm, options have been limited. Two options, withdrawal and condoms, both have <a href="https://doi.org/10.1363/psrh.12017">high failure rates</a>. Withdrawal has a failure rate of about 20%. Condoms have a failure rate of only 2% when used correctly, but that rate rises to 13% based on how people typically use them. Vasectomies have a failure rate of less than 1%, but they require minimally invasive surgery and are seen as a permanent method of contraception. Neither vasectomies nor withdrawal protect against sexually transmitted infections.</p>
<p>There has not been a new form of male birth control since the introduction of the “<a href="https://www.healthline.com/health/mens-health/no-scalpel-vasectomy">no-scalpel vasectomy</a>” in the 1980s. <a href="https://lundquist.org/christina-chung-lun-wang-md">I, along with my team</a>, have been developing male contraception methods since the 1970s. I believe that new safe, reversible and affordable contraception options can help men participate and share contraceptive responsibilities with their partners, and <a href="https://doi.org/10.1016/j.contraception.2017.08.015">reduce the rate of unintended pregnancies</a>.</p>
<h2>Taking responsibility for family planning</h2>
<p>A <a href="https://www.malecontraceptive.org/uploads/1/3/1/9/131958006/mci_consumerresearchstudy.pdf">2017 survey</a> of 1,500 men ages 18 to 44 found that over 80% wanted to prevent their partner from getting pregnant and felt that they had shared or sole responsibility for birth control. </p>
<p>Men who are dissatisfied with condoms are more likely to either use withdrawal as a form of birth control or never use contraception. Of those dissatisfied with condoms, however, 87% percent are interested in new methods for male contraception. This translates to an estimated <a href="https://www.malecontraceptive.org/uploads/1/3/1/9/131958006/mci_consumerresearchstudy.pdf">17 million men in the U.S.</a> who are looking for new methods of contraception to prevent unintended pregnancies.</p>
<p>Similarly, a 2002 survey of over 9,000 men in nine countries over four continents found that <a href="https://doi.org/10.1093/humrep/deh574">over 55%</a> would be willing to use a new method of male birth control. Importantly, a 2000 survey across three continents found that <a href="https://doi.org/10.1093/humrep/15.3.646">98% of women</a> would trust their partner to use a male birth control method.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person displaying a variety of birth control methods." src="https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488600/original/file-20221006-24-7c71p6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The onus of birth control has largely fallen on women and people who can become pregnant.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-explaining-contraception-royalty-free-image/602936017">Peter Dazeley/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<h2>Barriers to male contraception</h2>
<p>Strong interest in a new male contraceptive raises the question of why there haven’t been any new male birth control methods since the ‘80s.</p>
<p>Male contraception development has primarily been supported by governmental and nongovernmental organizations, including the <a href="https://www.who.int/publications/m/item/global-study-men-and-women-male-contraceptive-knowledge-using-mixed-methods">World Health Organization</a> working with academic medical centers. However, these agencies frequently do not have a <a href="https://doi.org/10.3389/fendo.2022.891589">drug development infrastructure</a> comparable to pharmaceutical companies, with programs typically run by only a handful of personnel assisted by clinical research organizations. Limited financial resources further slow down development.</p>
<p><a href="https://www.bloomberg.com/news/features/2017-08-03/why-we-can-t-have-the-male-pill">Lack of interest from pharmaceutical companies</a> may also play a role in deterring male contraception development, and there are a number of possible reasons the drug industry shies away from male birth control. One reason includes weighing the cost of development with uncertainties about the potential market. Other reasons include uncertainties about who would dispense these drugs and unclear <a href="https://pharmaceutical-journal.com/article/feature/overcoming-the-challenges-in-developing-male-contraceptives">regulatory requirements</a> for male contraceptive methods to receive FDA approval. Companies may also be concerned about liability if pregnancy occurs.</p>
<h2>New methods currently in development</h2>
<p>Researchers are currently looking into several different methods of male contraception.</p>
<p><a href="https://doi.org/10.1210/clinem/dgab034">Hormonal methods</a> are usually taken as a gel applied to the skin, injection to the muscle or oral pill. These methods typically contain testosterone and a progestin. The progestin suppresses two pituitary hormones that control the testes, the organs that produce sperm. While the testes require high concentrations of testosterone to make sperm, testosterone is typically included in hormonal methods to ensure that there is an adequate level of the hormone for other bodily functions. Counterintuitively, taking testosterone may also help <a href="https://doi.org/10.5534%2Fwjmh.180036">suppress sperm production</a>, because increasing circulating testosterone levels above a certain level suppresses the same two pituitary hormones. The addition of a progestin further enhances the suppression of sperm production.</p>
<p>The hormonal contraceptive candidate furthest along in development is currently in an ongoing <a href="https://clinicaltrials.gov/ct2/show/NCT03452111">second stage clinical study</a> that has recruited over 400 couples across four continents. I served as the principal investigator of this trial at the Lundquist Institute. The results of the study, sponsored by the <a href="https://www.nichd.nih.gov/about/org/dir/dph/officebranch/cdp">Eunice Kennedy Shriver National Institute of Child Health and Human Development</a> and the <a href="https://www.popcouncil.org/research/contraceptive-development">Population Council</a>, have so far been promising with minimal side effects, and the couples have found the gel acceptable to use.</p>
<p>My team and I are also developing drugs that function like <a href="https://doi.org/10.1210/clinem/dgab034">both testosterone and progestin</a>, but in a single compound. These drugs are currently undergoing early testing in people as a daily oral pill or a long-acting injection.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wYXI0Vt9oPU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Scientists have been trying to develop male birth control pills for decades.</span></figcaption>
</figure>
<p><a href="https://doi.org/10.3389/fcell.2020.00061">Nonhormonal methods</a> typically involve drugs that specifically target sperm-producing organs to decrease sperm concentration or function. Nonhormonal drugs show efficacy in animal models, but preclinical toxicology results are needed before clinical studies to demonstrate safety, tolerability and efficacy in people can begin. <a href="https://doi.org/10.1210/clinem/dgab034">A few</a> of these methods are working toward first-stage clinical trials.</p>
<p>Another nonhormonal method involves reversibly blocking the vas deferens, an organ that transports sperm for ejaculation. Studies sponsored by the <a href="https://www.malecontraceptive.org">Male Contraceptive Initiative</a> and <a href="https://www.parsemus.org/humanhealth/male-contraceptive-research/">Parsemus Foundation</a> are testing <a href="https://doi.org/10.1210/clinem/dgab034">hydrogels</a>, a type of polymer that retains water, that block sperm from traveling through the vas deferens.</p>
<p>People are ready for new contraceptive methods. I believe that collaboration across academic, government, nonprofit and pharmaceutical sectors can help deliver new birth control methods that are safe, reversible, acceptable and accessible to all.</p><img src="https://counter.theconversation.com/content/186537/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christina Chung-Lun Wang receives funding from the Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health, USA. She is a member of the International Committee for Contraceptive Development of the Population Council. She was a temporary consultant for the Research Group for the Study of Male Reproduction and previously named the Task Force for the Regulation of Male Infertility of the World Health Organization. She is currently an investigator at The Lundquist Institute and a Professor of Medicine in the Division of Endocrinology, Department of Medicine at the Harbor-UCLA Medical Center. </span></em></p>There hasn’t been a new form of male birth control since the 1980s. More contraception options for all partners could help reduce the rate of unintended pregnancies.Christina Chung-Lun Wang, Physician/Investigator at Lundquist Institute at Harbor-UCLA Medical Center and Professor of Medicine at David Geffen School of Medicine, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869542022-07-19T13:48:08Z2022-07-19T13:48:08ZWhy sexual and reproductive law for east African countries is being resisted<figure><img src="https://images.theconversation.com/files/474625/original/file-20220718-76655-yr3tdw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Six of the countries of the East African Community – Burundi, Kenya, Rwanda, South Sudan, Uganda and Tanzania – recently concluded public hearings on a new sexual and reproductive health bill. Proponents of the bill argue that it will improve access to sexual and reproductive health which, in turn, will improve other public health and development indicators such as maternal mortality and HIV infection rates. But the bill has faced fierce opposition since it was first tabled in 2017. The Conversation Africa’s Ina Skosana spoke to researchers Anthony Ajayi and Nicholas Etyang to unpack what the bill covers and where the sticking points are.</em></p>
<hr>
<h2>Is a regional response practical? Has it worked anywhere else?</h2>
<p>Article 118 of the <a href="https://www.eacj.org/?page_id=33">Treaty for the Establishment of East African Community</a> mandates partner states to cooperate around health issues, and to develop policies for the region. </p>
<p>Regional responses can help fast-track progress, harmonise laws and create a uniform front for addressing sexual and reproductive health issues. The development of regional frameworks is not new on the continent. Other examples include the South Africa Development Community sexual and reproductive health strategy 2019-2030, South Africa Development Community model law on gender-based violence, and the regional body’s model law on eradicating child marriage and protecting children already in marriage. </p>
<p>Regional frameworks help citizens hold their governments to account. The East Africa region is pushing for integration on many fronts. These include immigration policies, trade, and security. Remarkable progress has been made in the areas of <a href="https://www.eac.int/trade">trade</a> and <a href="https://www.eac.int/immigration">immigration</a>. This could be repeated with health cooperation.</p>
<p>But getting regional laws through is hard. In the case of East Africa, seven countries are part of the East Africa Community. Getting everyone on board is a tough ask especially when it comes to contentious issues like sexual and reproductive healthcare.</p>
<p>The first attempt to pass an East African sexual and reproductive health bill was in 2017, with the 3rd Legislative Assembly. But <a href="https://www.eac.int/press-releases/1933-eala-withdraws-bill-on-sexual-and-reproductive-health-rights">numerous concerns were raised by stakeholders</a>. And limited time for consultation before the end of their term meant the bill could not move forward. </p>
<p>The 4th Legislative Assembly began working on a revised bill in January 2020 and has conducted a series of stakeholder consultations. But resistance continues.</p>
<h2>Why does the bill matter?</h2>
<p>The 2021 version of the bill is a progressive legislation. It has huge potential to address the sexual and reproductive health challenges of East Africans. Adolescent girls are disproportionately affected by sexual and reproductive health issues. The bill addresses these disparities substantively. </p>
<p>In East Africa, complications arising from early pregnancy and child birth are among the leading causes of death among girls aged <a href="https://apps.who.int/adolescent/second-decade/section3/page2/mortality.html">15 to 19 years</a>. Young girls are also disproportionately exposed to new HIV infections and sexual violence. If passed, the bill will address adolescent pregnancy and protect the right of young mothers to return to school. </p>
<p>Unsafe abortions are also among the leading causes of maternal death. These account for <a href="https://www.sciencedirect.com/science/article/pii/S2214109X1470227X">about 10%</a> of maternal mortality. By expanding access to safe abortion, more lives would be saved. If passed, the bill will be a huge win for women’s and girls’ reproductive rights in the region.</p>
<h2>What’s in the Bill?</h2>
<p>The sexual and reproductive health Bill lays out five ambitious objectives. These are: </p>
<ul>
<li><p>to protect and facilitate the fulfilment of all persons’ sexual and reproductive health and rights across the life course;</p></li>
<li><p>to promote and provide age-appropriate sexual and reproductive health information and services for all persons, including adolescents and young people</p></li>
<li><p>to facilitate and promote the prevention of newborn, child mortality, maternal mortality, and morbidity from preventable causes;</p></li>
<li><p>to facilitate and promote the reduction and elimination of unsafe abortions, HIV and other sexually transmitted infections, early and unintended pregnancies; and</p></li>
<li><p>to prohibit and facilitate the elimination of harmful practices. </p></li>
</ul>
<p>The Bill has 29 clauses covering a range of issues. These include integration of sexual and reproductive health services into universal health coverage, sexuality education, continuation of education after pregnancy, menstrual health as well as family planning. </p>
<p>In addition, the Bill makes provisions to safeguard the sexual and reproductive health and rights of people with disabilities. </p>
<p>Section 16 provides limited access to abortion on the grounds that, in the opinion of a health worker, the pregnancy can endanger the mental or physical health or life of the woman. Additionally, in case of sexual assault, rape, and incest. </p>
<p>Section 17 protects the right of women and girls to post-abortion care irrespective of the legality of the abortion. It also shields health workers from prosecution for providing post-abortion care.</p>
<p>Section 21 recommends restricting the use of assisted reproductive technology such as surrogacy for only those medically diagnosed as unable to bear children. In addition, it recommends that partner states give special licenses to designated providers and protect surrogate mothers from exploitation. </p>
<p>Section 22 prohibits harmful cultural practices such as child marriage, forced sterilisation, and female genital mutilation. </p>
<p>Lastly, the Bill mandates partner states to develop and implement common strategies for detecting, preventing and reporting sexual and gender-based violence.</p>
<h2>What’s the hold-up in passing it?</h2>
<p>The Bill faced opposition at the public hearings held on June 27-30. Some oppose the Bill entirely, while others want specific provisions removed. </p>
<p>Resistance is primarily from religious and conservative groups, who maintain that some provisions of the Bill are part of the Western agenda, and against East African cultural values. </p>
<p>Three sections of the Bill remain contentious despite the revisions made after the first reading and stakeholder consultations.</p>
<p>First is the provision for comprehensive sexuality education for young people, which they oppose because they believe it will expose children to early sex. Some question why the government should be responsible for providing sex education to children instead of parents. They also oppose contraceptive access for young people and argue that abstinence-only messages should be provided to young people. This is despite <a href="https://www.jahonline.org/article/S1054-139X(07)00426-0/fulltext">scientific evidence</a> to the contrary.</p>
<p>A representative of the ministry of education in Uganda wants the word “comprehensive” removed because it is inconsistent with the language approved nationally. </p>
<p>Advocates for the Bill maintain that sexuality education is not all about sex but encompasses information on menstrual health, decision making, body awareness, social skills (family, respect, and kindness), sexual consent, healthy relationship, gender-based violence, HIV testing, and pregnancy.</p>
<p>The provision on abortion faces the most opposition. Opponents take issue with the definition of abortion in the Bill and argue that it does not reflect African values. They claim that, if passed, the Bill would make abortion services available on-demand. </p>
<p>Partner states have ratified the <a href="https://au.int/en/treaties/protocol-african-charter-human-and-peoples-rights-rights-women-africa">Maputo protocol</a>, which allows for the termination of pregnancy on the grounds provided for in the proposed Bill. But opponents reject the provision that allows for pregnancy termination in cases of rape, incest and sexual assault. Stakeholders from the Burundi government claim the bill promotes immorality and voluntary termination of pregnancy, contrary to divine principles, the national constitution, and culture.</p>
<p>Lastly, critics oppose the section on surrogacy, claiming it deviates from the order of creation and allows for LGBT individuals to have children. A few Muslim leaders in Kenya and Tanzania reject the ban on child marriage and argue that once menstruation starts, regardless of age, a girl can be married.</p><img src="https://counter.theconversation.com/content/186954/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Idowu Ajayi is affiliated with the African Population and Health Research Center. </span></em></p><p class="fine-print"><em><span>Nicholas Okapu Etyang is affiliated with the African Population and Health Research Center. </span></em></p>Adolescent girls are disproportionately affected by sexual and reproductive health issues. These proposed law substantively addresses these disparities.Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterNicholas Okapu Etyang, Policy officer, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1864392022-07-08T12:17:24Z2022-07-08T12:17:24ZRoe v. rap: Hip-hop artists have long wrestled with reproductive rights<figure><img src="https://images.theconversation.com/files/472888/original/file-20220706-25-xszarp.jpg?ixlib=rb-1.1.0&rect=22%2C56%2C7439%2C4398&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rap songs about abortion are rife with raw emotion.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/condenser-microphone-on-boom-stand-with-headphones-royalty-free-image/1304350107?adppopup=true">Tashi-Delek / Getty Images</a></span></figcaption></figure><p>Hip-hop culture is often recognized as being <a href="https://www.congress.gov/bill/117th-congress/senate-resolution/331/text">born on Aug. 11, 1973</a>. That was about seven months after <a href="https://www.oyez.org/cases/1971/70-18">Roe v. Wade</a>, the landmark decision that protected the right to choose to have an abortion. </p>
<p>Accordingly, reproductive rights have long been part of the discourse in rap music, which has always sought to hold a mirror to society to reflect its realities, values, ambitions, fantasies and taboos. With the U.S. Supreme Court having <a href="https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf">ruled that there is no constitutional right to an abortion</a>, rap lyrics will undoubtedly reflect this new reality. </p>
<p>What follows is a sampling of rap songs from the past several decades that have dealt with the subject of abortion and reproductive rights in the era of Roe v. Wade. The list is by no means exhaustive. </p>
<p>Collectively, the songs represent a diversity of viewpoints and are written from a variety of perspectives – from guilt-ridden, would-be mothers and apprehensive fathers to the imagined vantage point of the unborn themselves.</p>
<h2>‘La Femme Fétal,’ by Digable Planets (1993)</h2>
<p>This song actually presages a time when Roe v. Wade would no longer be the law of the land and even mentions Justice Clarence Thomas, who wrote in favor of the decision that overturned the case. It features a narrator who recounts a story of a friend who attempts to get an abortion but is harassed at the clinic.</p>
<p><em>If Roe v. Wade was overturned, would not the desire remain intact / Leaving young girls to risk their healths / And doctors to botch, and watch as they kill themselves / I don’t want to sound macabre / But hey, isn’t it my job / To lay it on the masses and get them off their asses / To fight against these fascists</em></p>
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<figcaption><span class="caption">‘La Femme Fétal,’ by the Digable Planets, (1993)</span></figcaption>
</figure>
<h2>‘My Story (Please Forgive Me)’ by Jean Grae (2008)</h2>
<p>This song takes listeners into the mind of a young woman who experiences guilt and remorse after having had an abortion. The song even unmasks the grim realities of undergoing the procedure.</p>
<p><em>They put you in a room, where you can change into / Your gown and shower cap, shaking as a fiend would do / And that’s when you think of leaving, fleeing the building / and then they call you and you hear the call of your children</em></p>
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<figcaption><span class="caption">‘My Story (Please Forgive Me),’ by Jean Grae, 2008.</span></figcaption>
</figure>
<h2>‘80’s Baby,’ by CyHi The Prynce featuring BJ The Chicago Kid (2017)</h2>
<p>CyHi raps from the perspective of an unborn baby who asks his mom – based on the things she does while pregnant – whether she’s prepared to be a mother. </p>
<p><em>You don’t know it kills me when you taking them pills / But see how it scars me and all the pain that I feel / I’m just here starving, you haven’t gave me a meal / Ma, you think you ready to have this baby for real? / ‘Cause I’m on the way</em></p>
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<figcaption><span class="caption">‘80’s Baby,’ by CyHi The Prynce featuring BJ The Chicago Kid (2017)</span></figcaption>
</figure>
<h2>‘Keep Ya Head Up’ by 2Pac (1993)</h2>
<p>Tupac has dealt with the plight of single mothers since his 1991 debut album, which featured “<a href="https://www.youtube.com/watch?v=NRWUs0KtB-I">Brenda’s Got a Baby</a>,” the story of a 12-year-old girl who is molested by a relative who gets her pregnant and then abandons her. In “Keep Ya Head Up,” from his sophomore album, Tupac defends a woman’s right to choose the circumstances under which she wants to give birth.</p>
<p><em>And since a man can’t make one / He has no right to tell a woman when and where to create one / So will the real men get up / I know you’re fed up ladies, but keep your head up</em></p>
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<figcaption><span class="caption">“Keep Ya Head Up,” by Tupac (1993)</span></figcaption>
</figure>
<h2>‘You Vs. Them’ by Jhene Aiko (2011)</h2>
<p>Aiko, mother to a daughter named Namiko, <a href="https://www.vibe.com/news/entertainment/next-jhene-aiko-127309/">told VIBE magazine</a> how her song “You Vs. Them” was about her conclusion that it was a false choice to have to choose between having a child and her career. “I was like ‘should I be a mom or should I be a singer?’ But found that I could be both.”</p>
<p><em>‘Cause if I never had you / Then I could never lose you / Do you know what might happen / If I decide to choose you? / Then the world may just stop spinnin’ / It may just well be the endin’ / Talkin’ all about existence / Who knows? / But I cannot see tomorrow / If you’re not in my tomorrow</em></p>
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<figcaption><span class="caption">“You Vs. Them” by Jhene Aiko, (2011)</span></figcaption>
</figure>
<h2>‘Retrospect for Life’ by Common featuring Lauryn Hill (1997)</h2>
<p>This song speaks to the misgivings and strife that couples can experience when their union results in an unplanned pregnancy.</p>
<p><em>I wouldn’t choose any other to mother my understanding / But I want our Parenthood to come from Planning / It’s so much in my life that’s undone / We gotta see eye to eye, about family, before we can become one</em></p>
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<figcaption><span class="caption">‘Retrospect for Life,’ by Common featuring Lauryn Hill, 1997.</span></figcaption>
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<h2>‘To Zion,’ by Lauryn Hill (1998)</h2>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1431999303267069955"}"></div></p>
<p>In this song, Lauryn Hill sings in a soul-stirring voice about how she resisted suggestions to terminate the pregnancy that brought her son Zion.</p>
<p><em>Woe this crazy circumstance / I knew his life deserved a chance / But everybody told me to be smart / “Look at your career,” they said / “Lauryn, baby, use your head” / But instead I chose to use my heart / Now the joy of my world is in Zion</em></p>
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<figcaption><span class="caption">‘To Zion,’ by Lauryn Hill, 1998.</span></figcaption>
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<h2>‘Abortion’ by Doug E. Fresh & The Get Fresh Crew (1986)</h2>
<p>In this song, Doug E. Fresh – a beat boxer who regarded himself as “the world’s greatest entertainer” – depicts abortion as “mind distortion” and casts women who seek an abortion in a negative light.</p>
<p><em>Girl, you must be crazy to kill a newborn baby / Sitting on your ass all day so lazy.</em></p>
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<figcaption><span class="caption">‘Abortion,’ by Doug E. Fresh & The Get Fresh Crew (1986)</span></figcaption>
</figure>
<h2>‘What’s Going On’ by Remy Ma featuring Keyshia Cole (2006)</h2>
<p>In this song, Remy Ma tells the story of a young and poor mother who wrestles with whether to abort the life growing inside of her. </p>
<p><em>It’s a life living in my body / But it don’t gotta to live / It’s up to me, but if I keep what the f— I got to give / I mean, I’m still young and I don’t really have s— / And if this n— decide to leave then my child a be a bastard / It’s drastic / Nobody really understands me / My mom don’t give a f— and neither does the rest of the family / They like “Remy, you can’t afford it you expect us to support it” / I feel my seeds apart of me and I don’t want to abort it, so</em></p>
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<figcaption><span class="caption">‘What’s Gong On,’ by Remy Ma featuring Keyshia Cole, (2006)</span></figcaption>
</figure>
<h2>‘If These Walls Could Talk,’ by Gat Turner and Viva Fidel, (2014)</h2>
<p>In this <a href="https://gatturner.bandcamp.com/track/if-these-walls-could-talk">song</a>, Milwaukee rap artists Gat Turner and Viva Fidel give listeners a glimpse at the struggle of a mother who doesn’t want to be pregnant from the vantage point of her unborn child.</p>
<p><em>Shook like an unborn, man, my life in danger / cause first sign of trouble mama looking for the hanger / shook like an unborn, mama trying to murder me / first degree abortion, devil call it surgery</em></p>
<figure class="align-center ">
<img alt="Two Black men look directly at the camera against the backdrop of a world map." src="https://images.theconversation.com/files/473224/original/file-20220708-7399-6a89q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473224/original/file-20220708-7399-6a89q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473224/original/file-20220708-7399-6a89q9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473224/original/file-20220708-7399-6a89q9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473224/original/file-20220708-7399-6a89q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473224/original/file-20220708-7399-6a89q9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473224/original/file-20220708-7399-6a89q9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Milwaukee rap artists Viva Fidel (left) and Gat Turner.</span>
<span class="attribution"><a class="source" href="https://gatturner.bandcamp.com/track/in-killwaukee">Gat Turner and Viva Fidel</a></span>
</figcaption>
</figure>
<h2>‘S—, Man!’ by Skylar Grey featuring Angel Haze (2018)</h2>
<p>In the sole rap verse on this track, rapper Angel Haze speaks as a mother deciding to keep a child despite the child’s being conceived in a rocky relationship.</p>
<p><em>This ain’t what I expected / It ain’t happenin’ like I thought it / And if they say, ‘Love is free’ / Then tell me why the f— it’s costin’ / And yes, it happens often / And I should cope with my losses / And you say you’re not ready / I don’t believe in abortions</em></p>
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<figcaption><span class="caption">‘Shit, Man!’ by Skylar Grey featuring Angel Haze (2018)</span></figcaption>
</figure>
<h2>‘Lost Ones’ by J. Cole (2011)</h2>
<p>J. Cole raps from the perspective of parents having a discussion about something that could become increasingly rare in the post-Roe v. Wade era: their options.</p>
<p><em>I’ve been giving it some thought lately and, frankly / I’m feelin’ like we ain’t ready and it’s – hold up now, let me finish / Think about it baby me and you we still kids, ourself / How we gon raise a kid by ourself? / Handle biz by ourself</em></p>
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<figcaption><span class="caption">‘Lost Ones,’ J. Cole (2011)</span></figcaption>
</figure>
<h2>‘Autobiography’ by Nicki Minaj (2009)</h2>
<p>In this song, Minaj speaks from the standpoint of a remorseful mother who hopes to be reunited in the afterlife with the child she aborted.</p>
<p><em>Please baby, forgive me, mommy was young / Mommy was too busy tryna have fun / Now, I don’t pat myself on the back for sending you back / ‘Cause God knows I was better than that / To conceive you, then leave you, the concept alone seems evil / I’m trapped in my conscience / I adhered to the nonsense, listened to people who told me / I wasn’t ready for you / But how the – would they know what I was ready to do?</em></p>
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<figcaption><span class="caption">‘Autobiography,’ by Nicki Minaj (2009)</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/186439/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>A.D. Carson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Several rap songs speak on the subject of abortion from the perspective of the unborn child.A.D. Carson, Assistant Professor of Hip-Hop, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1828622022-05-24T14:19:25Z2022-05-24T14:19:25ZWe tested plants used for contraception in South Africa. Here’s what we found<figure><img src="https://images.theconversation.com/files/463584/original/file-20220517-16-zqkwzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>In <a href="https://theconversation.com/unintended-pregnancy-rates-are-highest-in-africa-a-look-at-the-complex-reasons-180454">sub-Saharan Africa</a>, 91 per 1,000 pregnancies are unwanted. This is around three times the rates of unintended pregnancies recorded in Europe and North America. </p>
<p>There are many reasons for this, from the individual to the household and community and policy levels. For instance, a young woman may want to terminate a pregnancy so she can finish her <a href="https://theconversation.com/unintended-pregnancy-rates-are-highest-in-africa-a-look-at-the-complex-reasons-180454">education</a> or get the skills to improve her socio-economic prospects. These pregnancies may end in unsafe abortions. Breaking the cycle of unwanted pregnancy is therefore critical to realising <a href="https://theconversation.com/unintended-pregnancy-rates-are-highest-in-africa-a-look-at-the-complex-reasons-180454">socio-economic development</a> in Africa. </p>
<p><a href="https://www.ajrh.info/index.php/ajrh/article/view/2515">Indigenous contraception</a> methods, including medicinal plants, have long been used in various African societies to prevent unwanted pregnancy. Medicinal plants used for contraception vary widely in composition and can be used as single species or herbal mixtures (concoctions). In most cases they are used as a tea. In the past, our research group has identified <a href="https://www.sciencedirect.com/science/article/pii/S0378874118323857">23 medicinal plants</a> reported to be used for contraception in South Africa. </p>
<p>But concerns have been raised about the safety, efficacy and quality of indigenous contraception methods.</p>
<p>In a recently published <a href="https://www.mdpi.com/2223-7747/11/2/193">study</a>, we tested a plant-based concoction used for contraception by health practitioners in the Batswana tradition, in South Africa’s North West province. We collaborated with practitioners to investigate the phytochemical composition and likely mechanism of the plants. Using rats as test subjects, we tested whether the plants were safe to use and whether they prevented pregnancy in the rodents. </p>
<p>Studies like ours that evaluate the safety and efficacy of medicinal plants using rodents as models are necessary before such studies can be performed on humans. </p>
<p>Our study supports the idea that herbal contraceptives can assist in the development of safe and effective hormonal contraceptives. </p>
<h2>Key findings</h2>
<p>Our <a href="https://natural-sciences.nwu.ac.za/indigenous-knowledge-systems-centre/home">research and teaching centre</a> in South Africa aims to create bridges between indigenous and modern scientific knowledge. Part of our work is to explore concerns relating to the use of plants in traditional medicine. </p>
<p>We found a herbal mixture that was commonly used for contraception by traditional practitioners. <a href="https://www.mdpi.com/2223-7747/11/2/193">The mixture</a> consisted of three medicinal plants and was taken orally by women for contraception. A traditional health practitioner with knowledge and experience of medicinal plants used for contraception in the study area assisted with the collection of the three plant species (<em>Bulbine frutescens</em>, <em>Helichrysum caespititium</em> and <em>Teucrium trifidum</em>). The preparation of the herbal mixture for scientific evaluation was based on the recipe provided by the traditional health practitioners.</p>
<p>First, we profiled the phytochemicals in the herbal mixture using modern analytical techniques. This told us the types and quantity of compounds that were in the herbal mixture.</p>
<p>Then we evaluated the safety and efficacy of the herbal mixture with rodents as animal models. This work was done at the preclinical drug development facility of our <a href="https://health-sciences.nwu.ac.za/pcddp">research partners</a>. The safety of the herbal mixture was evaluated using the <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/acute-toxic-class-method">acute toxic class method</a>. This procedure follows certain steps to establish whether further testing is needed or not. </p>
<p>During the efficacy study, female rats were randomly divided into four groups, each consisting of seven rats. We gave female rats the herbal mixture for three days, then put them with male rats for three days. Three groups received different doses of the mixture. A control group did not receive the mixture. </p>
<p>Overall, the herbal mixture extract was found to be safe. It had no toxic effects on cells and <a href="https://www.mdpi.com/2223-7747/11/2/193">no rat got sick or died</a>. </p>
<p>Our investigations showed that the herbal mixture contained <a href="https://www.mdpi.com/2223-7747/11/2/193">bioactive compounds</a> with contraceptive activity. Two of the doses showed no contraceptive efficacy. A dose of 50 mg/kg showed a low rate of contraceptive efficacy (14%) – only one rat out of seven did not fall pregnant.</p>
<p>The results suggest that there is potential for developing safe and efficacious herbal contraceptives from natural extracts of local plants. Medicinal plants and the associated indigenous knowledge could offer alternatives for women who have health problems with or lack access to modern contraceptives. </p>
<h2>Moving forward</h2>
<p>In future we would like to know more about medicinal plants used for male contraception, female emergency contraception and termination of pregnancy (abortifacients). </p>
<p>We want to determine the effects these plants have on reproductive hormones and reproductive organs as guided by laboratory and animal experiments. We also want to determine the effect of storage and packaging on the quality of these plant-based concoctions and extracts. </p>
<p>Since some traditional practitioners cultivate wild medicinal plants in their home gardens, we would also like investigate whether that affects their safety, efficacy and quality.</p><img src="https://counter.theconversation.com/content/182862/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Molelekwa Moroole receives funding from National Research Foundation.</span></em></p><p class="fine-print"><em><span>Adeyemi Oladapo Aremu receives funding from the National Research Foundation, Pretoria, South Africa. He is a member of the Global Young Academy (GYA), Young Affiliate of the African Academy of Sciences (AAS) and South African Young Academy of Science (SAYAS). </span></em></p><p class="fine-print"><em><span>Professor Simeon Materechera is a researcher at the Indigenous Knowledge Systems Centre of the North-West University. </span></em></p>Medicinal plants and the associated indigenous knowledge could offer alternatives for women who lack access to modern contraceptives.Molelekwa Moroole, DSI/NRF Postdoc Research Fellow, North-West UniversityAdeyemi Oladapo Aremu, Associate professor, North-West UniversityMaterechera Simeon, Professor of Soil Science, North-West UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1795362022-05-24T12:45:52Z2022-05-24T12:45:52ZProtestants and the pill: How US Christians helped make birth control mainstream<figure><img src="https://images.theconversation.com/files/464873/original/file-20220523-42302-xv0uq2.jpg?ixlib=rb-1.1.0&rect=22%2C7%2C999%2C723&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protestant Christians have been debating -- and more often than not, supporting -- modern contraceptives since they first appeared.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-government-and-doctors-have-decided-the-10-million-news-photo/514867588?adppopup=true">Bettmann/Bettman via Getty Images</a></span></figcaption></figure><p>Since the Supreme Court overturned Roe v. Wade, many Christians have celebrated the prospect of an America where abortion is someday <a href="https://religionnews.com/2022/05/19/as-roes-potential-fall-nears-abortion-abolitionists-turn-on-pro-life-elites-sbc-tom-ascol-women-murder-criminal/">banned entirely</a>.</p>
<p>Meanwhile, other conservative Christians have been working on a related target: <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/05/19/some-states-already-are-targeting-birth-control">limiting access to some contraceptives</a>.</p>
<p>In July 2020, when <a href="https://www.supremecourt.gov/opinions/19pdf/19-431_5i36.pdf">the Supreme Court</a> ruled that organizations with “sincerely held religious or moral objection” are not obligated to provide contraceptive coverage to their employees, many conservative Christians <a href="https://ministrywatch.com/supreme-court-rules-in-favor-of-little-sisters-of-the-poor/">applauded</a>. Six years before, the evangelical owners of crafting chain Hobby Lobby took their objections to covering the IUD in their health insurance plans all the way to the Supreme Court. Hobby Lobby argued – incorrectly, according to most <a href="https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices#:%7E:text=Copper%20Intrauterine%20Device&text=The%20available%20evidence%20supports%20that,which%20it%20remains%20highly%20effective.">medical authorities</a> – that it was <a href="https://www.theatlantic.com/health/archive/2014/03/heres-why-hobby-lobby-thinks-iuds-are-like-abortions/284382/">a form of abortion</a>, and therefore they should not have to cover employees’ health insurance for it. The justices sided with the chain’s owners.</p>
<p>Yet as access to both abortion and contraception <a href="https://www.today.com/health/womens-health/overturning-roe-v-wade-threaten-birth-control-access-rcna27092">comes under threat</a>, the vast majority of Protestants <a href="https://www.cdc.gov/nchs/data/nhsr/nhsr062.pdf">use or have used</a> some form of contraception. Their actions are supported by almost 100 years of pastoral advocacy on the issue. In my work as <a href="https://www.colorado.edu/wgst/samira-mehta">a scholar of religous studies, gender and sexuality</a>, I have researched the Protestant leaders who campaigned to make contraception respectable, and therefore widely acceptable, in the mid-20th century. </p>
<p>History, I have found, provides a different story about the relationship between Protestants and birth control.</p>
<h2>‘Responsible parenthood’</h2>
<p>As new contraceptive options emerged in the first two-thirds of the 20th century, from the <a href="https://www.popsci.com/story/science/contraception-diaphragm-history/">diaphragm</a> to the birth control pill, Christian leaders <a href="https://doi.org/10.2979/amerreli.1.2.02">wrestled with what to think</a>. Many came to see birth control as a moral good that would allow married couples to have satisfying sex lives, while protecting women from the health risks of frequent pregnancies. They hoped it could ensure that couples would not have more children than they could care for, emotionally and economically.</p>
<figure class="align-center ">
<img alt="A black and white photograph shows women with baby carriages lined up on a street." src="https://images.theconversation.com/files/464874/original/file-20220523-31005-tpf96t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464874/original/file-20220523-31005-tpf96t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464874/original/file-20220523-31005-tpf96t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464874/original/file-20220523-31005-tpf96t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464874/original/file-20220523-31005-tpf96t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=522&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464874/original/file-20220523-31005-tpf96t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=522&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464874/original/file-20220523-31005-tpf96t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=522&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Women with children stand outside Sanger Clinic, the first birth control clinic in United States, in Brooklyn, New York in 1916.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/women-with-children-outside-sanger-clinic-first-birth-news-photo/1347202932?adppopup=true">Circa Images/GHI/Universal History Archive/Universal Images Group via Getty Images</a></span>
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<p>They looked inward, considering the consequences of birth control for their own communities, and hoped that “planned” or “responsible” sex would create healthy families and decrease divorce. They also looked outward, thinking about birth control’s wider implications, at a time of widespread concern that the global population <a href="https://www.smithsonianmag.com/innovation/book-incited-worldwide-fear-overpopulation-180967499/">was rising too quickly to handle</a>.</p>
<p>By the time <a href="https://theconversation.com/freer-sex-and-family-planning-a-short-history-of-the-contraceptive-pill-92282">the pill</a> came on the market in the 1960s, liberal and even some conservative Protestants were advocating for birth control <a href="https://www.universitypressscholarship.com/view/10.5149/northcarolina/9781469636269.001.0001/upso-9781469636269-chapter-009">using new theological ideas about “responsible parenthood</a>.”</p>
<p>“Responsible parenthood” reframed debates about family size around “Christian duty.” To be responsible in parenting was not only to avoid having more children than you could afford, nurture and educate. It also meant considering responsibilities outside the home toward churches, society and humanity.</p>
<p>Protestant leaders supporting contraception argued that the best kind of family was a father with a steady job and a homemaker mother, and that birth control could <a href="https://www.universitypressscholarship.com/view/10.5149/northcarolina/9781469636269.001.0001/upso-9781469636269-chapter-009">encourage this model</a>, because smaller families could maintain a comfortable lifestyle on one income. They also hoped that contraception would help couples stay together by allowing them to have satisfying sex lives.</p>
<p>Multiple denominations <a href="https://doi.org/10.2307/1190751">endorsed birth control</a>. <a href="https://www.nytimes.com/1958/08/26/archives/lambeth-bishops-for-birth-control-family-planning-described-by.html">In 1958</a>, for example, the Anglican Communion stated that family planning was a “primary obligation of Christian marriage,” and chastised parents “who carelessly and improvidently bring children into the world, trusting in an unknown future or a generous society to care for them.” </p>
<h2>The big picture</h2>
<p>Religious leaders’ support for “responsible parenthood” was not just about deliberately creating the kind of Christian families they approved of. It was also about heading off the horrors of <a href="https://www.nytimes.com/2015/06/01/us/the-unrealized-horrors-of-population-explosion.html">population explosion</a> – a fear very much front of mind in mid-century America.</p>
<p>In the middle of the 20th century, with increased access to vaccines and antibiotics, more children were living to adulthood and life expectancies were rising. Protestant leaders feared this so-called <a href="https://www.smithsonianmag.com/innovation/book-incited-worldwide-fear-overpopulation-180967499/">population bomb</a> would outstrip the Earth’s food supply, leading to famine and war. </p>
<p>In 1954, when the global population stood at <a href="https://www.eea.europa.eu/data-and-maps/daviz/data-visualization-40#tab-chart_1">about 2.5 billion</a>, Rev. Harry Emerson Fosdick, <a href="https://www.christianitytoday.com/history/people/pastorsandpreachers/harry-emerson-fosdick.html">one of the most prominent Protestant voices of the age</a>, framed overpopulation as one of the world’s “basic problems,” and the birth control pill, which was then being developed, as the best potential solution.</p>
<p>Richard Fagley, a minister who served on the World Council of Church’s Commission of the Churches on International Affairs, <a href="https://books.google.com/books/about/The_Population_Explosion_and_Christian_R.html?id=jhbaAAAAMAAJ">argued that</a> in family planning, science had provided Christians with a new venue <a href="https://www.universitypressscholarship.com/view/10.5149/northcarolina/9781469636269.001.0001/upso-9781469636269-chapter-009">for moral responsibility</a>. Medical knowledge, Fagley wrote, is “a liberating gift from God, to be used to the glory of God, in accordance with his will for men.”</p>
<p>These “responsible parenthood” ideas held that religious couples had a responsibility to be good stewards of the earth by not having more children than the planet could support. In the context of marriage, contraception was viewed as moral, shoring up a particular form of Christian values.</p>
<h2>Yesterday’s arguments</h2>
<p>These ideas about “good” and “bad” families often rested on assumptions about race and gender that reproductive rights advocates find troubling today. </p>
<p>Early in the 20th century, predominantly white, Protestant clergy were very interested in increasing access to contraception for the poor, who were often Catholic or Jewish immigrants <a href="https://www.ucpress.edu/book/9780520303218/birth-control-battles">or people of color</a>. Some scholars have argued that early support for contraception was predominantly about eugenics, particularly before World War II. Among some white leaders, there was concern about so-called <a href="https://doi.org/10.2307/204082">race suicide</a>: the racist fear that “they” would be overwhelmed.</p>
<p>Apart from <a href="https://doi.org/10.1017/jme.2021.54">some eugenicists, however</a>, most of these clergy wanted to give people access to contraception in order to create “healthy” families, regardless of income level. Yet many were unable or unwilling to see how they were promoting a narrow view of the ideal family, and how that marginalized poor communities and people of color – themes I am studying in my current book project.</p>
<p>Moreover, many proponents were advocating for women’s health, but not reproductive freedom. Their priority was setting women up for <a href="https://uncpress.org/book/9781469636269/devotions-and-desires/">success to attain their ideal</a> of the middle-class, Christian motherhood. With fewer children, some hoped, families would be able to get by on just a husband’s salary, meaning more women at home raising children.</p>
<h2>A battle won – and lost?</h2>
<p>Over the decades, Protestant leaders have, in large part, disappeared from pro-birth control arguments.</p>
<p>There are many reasons. Mid-century agricultural technologies reduced fears of overpopulation – which have only recently been <a href="https://theconversation.com/curb-population-growth-to-tackle-climate-change-now-thats-a-tough-ask-153382">reawoken by the climate crisis</a>. Meanwhile, mainline Protestant churches, and their public influence, <a href="https://www.pewresearch.org/fact-tank/2015/05/18/mainline-protestants-make-up-shrinking-number-of-u-s-adults/#:%7E:text=Pew%20Research%20Center's%202014%20Religious,Study%20was%20conducted%20in%202007.">are shrinking</a>. Conservative leaders eventually grew concerned that birth control would lead to more working women, not fewer. And since the 1970s, evangelicals <a href="https://www.npr.org/2019/06/20/734303135/throughline-traces-evangelicals-history-on-the-abortion-issue">have grown increasingly opposed</a> to abortion, which was increasingly linked to birth control through the broad term “family planning.”</p>
<p>In other words, since the “population bomb” was no longer ticking, contraception no longer seemed like such an urgent necessity – and some of its other implications troubled conservatives, breaking an almost pan-Protestant alliance.</p>
<p>Meanwhile, liberal Protestants had so embraced contraception that they no longer viewed it as turf that needed defending. Today, 99% of American girls and women between the ages of 15 and 44 who have ever had sex <a href="https://www.cdc.gov/nchs/nsfg/key_statistics/c.htm#contraception">use or have used a contraceptive method</a>. Reproductive rights advocates turned their attention to abortion rights – largely leaving religious views on birth control to their opponents.</p><img src="https://counter.theconversation.com/content/179536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samira Mehta does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Conservative Christians have cheered restrictions on some birth control. But many decades ago, Christian leaders’ support helped contraceptives become acceptable in the first place.Samira Mehta, Associate Professor of Women and Gender Studies & Jewish Studies, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1825632022-05-06T15:11:12Z2022-05-06T15:11:12ZRoe v Wade to be overturned? What this would mean for reproductive rights around the world<p>Reproductive rights have been an urgent topic of discussion around the world in recent days, following the leak of a draft opinion of the US supreme court, written by Justice Samuel Alito, in the case of Dobbs v Jackson Women’s Health Organization. If enacted by the court, this opinion would overturn the landmark 1973 case of Roe v Wade. Roe instated the constitutional right to abortion in the US under the <a href="https://www.pbs.org/tpt/constitution-usa-peter-sagal/equality/due-process-equal-protection-and-disenfranchisement/#:%7E:text=The%20Due%20Process%20Clause%20of,process%E2%80%9D%20refers%20to%20fair%20procedures.">Due Process Clause of the 14th Amendment</a>, which references a woman’s right to privacy.</p>
<p>Overturning Roe would mean that abortion, no longer deemed a constitutional right, would return to the individual US states to legislate. So far, <a href="https://www.nbcnews.com/data-graphics/map-23-states-ban-abortion-post-roe-america-rcna27081">12 states have so-called “trigger laws”</a>, which would immediately criminalise or ban abortion in the case of Roe falling. This would clearly be disastrous for the rights of women and pregnant people in the US, many of whom would lose all access to abortion healthcare services. </p>
<p>The potential loss of Roe’s constitutional protection for abortion highlights the need for a framework of not just reproductive rights, but reproductive justice. <a href="https://www.law.berkeley.edu/php-programs/courses/fileDL.php?fID=4051">Reproductive justice</a> is about creating a society where principles of equity and inclusion mean that every woman has the right to exercise control over their own body. It is a concept developed by Black American feminists in the 1990s. Reproductive justice goes beyond merely the “right to choose” upheld in a case such as Roe, and asks broader intersectional questions of society.</p>
<h2>The global picture</h2>
<p>Reproductive justice frameworks have become a hallmark of <a href="https://www.bbc.co.uk/news/uk-northern-ireland-politics-56041849">recent movements to legalise abortion in Ireland</a>, <a href="https://ohrh.law.ox.ac.uk/new-abortion-legislation-in-northern-ireland/">the UK</a> and Latin American countries such as Argentina and <a href="https://www.civicus.org/index.php/media-resources/news/interviews/5308-mexico-alliances-public-debate-and-the-diversification-of-voices-are-indispensable-in-the-struggle-to-expand-rights">Mexico</a>. In Ireland, the “<a href="https://theconversation.com/ireland-votes-to-repeal-the-8th-amendment-in-historic-abortion-referendum-and-marks-a-huge-cultural-shift-97297">Repeal the 8th</a>” campaign also included calls for the provision of free contraception and comprehensive sex education in state schools. Ireland voted to remove a ban on abortion from its constitution in 2018. </p>
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Read more:
<a href="https://theconversation.com/ireland-votes-to-repeal-the-8th-amendment-in-historic-abortion-referendum-and-marks-a-huge-cultural-shift-97297">Ireland votes to repeal the 8th amendment in historic abortion referendum – and marks a huge cultural shift</a>
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<p>In the UK, Northern Irish activists, including those from <a href="https://www.alliance4choice.com/">Alliance for Choice</a>, have emphasised the need for “free, safe, legal, and local” abortion provision including telemedicine for community members who cannot otherwise access abortion, in particular during the COVID-19 pandemic.</p>
<p>In Argentina, the “<em>¡Aborto legal ya!</em>” (Legal Abortion Now) campaign took the form of a <a href="https://www.nytimes.com/2021/01/01/world/americas/argentina-abortion.html"><em>“marea verde</em>” or “green wave”</a> of feminist campaigners who took to the streets to protest in favour of legalising abortion. One of the hallmarks of the campaign was an awareness of the socioeconomic divide in the country. </p>
<p>Although people from all backgrounds were accessing illegal abortion before the new law, people living in poverty were far more likely to die from it. </p>
<h2>Standing strong and united</h2>
<p>Reproductive justice therefore requires an intersectional approach, viewing society as a community in which demographic factors require that particular care and attention is given to certain parts of the whole. In the US, it is clear that people of colour, LBTQ+ people, undocumented immigrants, disabled people, and people living in poverty will be the first and worst hit by the fall of the Roe doctrine. Women and pregnant people from poorer socioeconomic backgrounds, including many of the aforementioned marginalised communities, will find themselves unable to find the means to travel to a state where abortion remains legal.</p>
<p>Roe was decided based on the right to individual privacy. But what the Alito/Dobbs leak has shown is that rights are fragile things, easily removed. A reproductive rights framework is only as strong as the law it is written in. The constitutional foundations of Roe were criticised by many – including former Supreme Court Justice, the late <a href="https://www.law.nyu.edu/sites/default/files/ECM_PRO_059254.pdf">Ruth Bader Ginsburg</a> – as not being rooted firmly enough in principles of liberty and equality. </p>
<p>This constitutional weakness is what enabled Justice Alito to write his opinion overturning it, using an originalist view of the Constitutional text that sees abortion rights – as Alito reportedly wrote in his leaked opinion – as not “<a href="https://www.politico.com/news/2022/05/02/read-justice-alito-initial-abortion-opinion-overturn-roe-v-wade-pdf-00029504">deeply rooted in this Nation’s history and tradition</a>”. </p>
<p>What the US will see now, and where a justice framework proves strongest, is a culture of mutual aid springing up to circumvent or defy abortion bans in states where the legislature chooses to render the procedures illegal. Already, these informal support networks have been seen in countries such as Poland, Malta, and Gibraltar, where <a href="https://www.asn.org.uk/">Abortion Support Network</a> aims to fund procedures and travel for women and pregnant people who cannot afford to leave their jurisdiction to access abortion care. </p>
<p>Other campaigns such as Women on Waves have taken part in direct action, performing abortions in international waters near countries where it is illegal. The <a href="https://abortionfunds.org/">National Network of Abortion Funds</a> in the US will no doubt attract significant support. </p>
<p>The potential overturn of Roe signals dark days ahead for women and pregnant people in the US. But the international abortion and reproductive justice movements show that people stand strongest when they are united.</p><img src="https://counter.theconversation.com/content/182563/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Duffy is affiliated with Lawyers for Choice, an independent advocacy group of legal academics and lawyers who work to promote reproductive rights and justice in Ireland.</span></em></p>Overturning this landmark US Supreme Court ruling would set back reproductive justice for women around the world.Sandra Duffy, Lecturer in Law University of Bristol Law School, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1826022022-05-06T14:15:34Z2022-05-06T14:15:34ZUS abortion law decision brings attention to rights of women in Africa<figure><img src="https://images.theconversation.com/files/461746/original/file-20220506-26-ccjgjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Access to safe abortion is recognised as a human right. </span> <span class="attribution"><span class="source">Bryan Dozier/Anadolu Agency via Getty Images</span></span></figcaption></figure><p><em>A <a href="https://www.theguardian.com/us-news/2022/may/02/roe-v-wade-abortion-supreme-court-draft-opinion">leaked draft</a> of a majority opinion of the US Supreme Court has revealed the court’s leaning towards undoing its 1973 landmark ruling (Roe v Wade) which gave women in the US a constitutional right to abortion. The leaked document is not the court’s final decision – this is expected in a couple of months. But reproductive health experts are warning that it could threaten women’s rights around the world. The Conversation Africa’s Ina Skosana spoke to reproductive health researcher Sara Casey about how women in Africa could be affected by US policy decisions.</em> </p>
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<h2>1. What is Roe v Wade? What’s its significance in relation to abortion rights?</h2>
<p><a href="https://www.oyez.org/cases/1971/70-18">Roe v Wade</a> is the landmark United States Supreme Court decision that gave women a constitutional right to abortion. That decision means that pregnant people living in the US can obtain an abortion on request, subject to some restrictions. Individual states can introduce restrictions on that access, but cannot ban abortion. </p>
<p>The leaked US Supreme Court opinion that could overturn Roe means that each US <a href="https://www.washingtonpost.com/nation/interactive/2022/abortion-rights-protections-restrictions-tracker/">state</a> can make its own laws regarding whether or not abortion should be permitted, and under what circumstances. </p>
<p>If the ruling striking down Roe is eventually issued, <a href="https://www.guttmacher.org/article/2021/10/26-states-are-certain-or-likely-ban-abortion-without-roe-heres-which-ones-and-why">26 US states</a>, where 58 million women live, will certainly or probably ban abortion. Only 16 states have laws protecting the right to abortion. Millions of people living in the US will lose access to safe abortion care. Those who are poor, young, black, undocumented or have experienced intimate partner violence will be most affected. They are most likely to have an <a href="https://www.guttmacher.org/sites/default/files/factsheet/fb-unintended-pregnancy-us.pdf">unintended pregnancy</a>, are more likely to die due to <a href="https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief/">pregnancy or its complications</a>, and have least access to <a href="https://www.guttmacher.org/report/sexual-reproductive-health-services-in-us-sources-care-2006-2019">sexual and reproductive health services</a>. </p>
<p>The World Health Organisation (WHO) and other international bodies recognise that <a href="https://www.who.int/publications/i/item/9789240039483">abortion access is linked to human rights</a>. Banning abortion <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30315-6/fulltext">does not reduce</a> the number of abortions. It makes them <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31794-4/fulltext">less safe</a>. In countries where abortion is <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31794-4/fulltext">highly restricted</a>, 75% of abortions are unsafe compared to 13% in countries where abortion is available on request. Around <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30315-6/fulltext">half</a> of unintended pregnancies end in abortion – regardless of abortion’s legal status.</p>
<p>This decision would make the US an outlier in the world. </p>
<p>Over the past 25 years, countries around the world have moved towards <a href="https://reproductiverights.org/maps/worlds-abortion-laws/">liberalisation</a> of their abortion laws. In 2003, the African Union adopted the <a href="https://www.prb.org/wp-content/uploads/2019/12/maputo-protocol-fact-sheet-safe-engage.pdf">Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa</a> (commonly known as the Maputo protocol). It explicitly recognises abortion as a human right in cases of rape, incest and foetal impairment and to preserve the mental or physical health or life of the woman. Many of the 39 countries that have signed and ratified the Maputo protocol have not yet fully aligned their national law to comply with the protocol. But <a href="https://www.guttmacher.org/report/from-unsafe-to-safe-abortion-in-subsaharan-africa">21 African countries have liberalised their abortion laws since 2000</a>, including seven that moved to comply with the Maputo protocol.</p>
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Read more:
<a href="https://theconversation.com/benins-groundbreaking-new-abortion-law-will-save-the-lives-of-many-women-170901">Benin's groundbreaking new abortion law will save the lives of many women</a>
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<h2>2. What, if any, is the implication for women in African countries?</h2>
<p>Anti-abortion ideology in the US has already affected <a href="https://www.guttmacher.org/gpr/2017/06/when-antiabortion-ideology-turns-foreign-policy-how-global-gag-rule-erodes-health-ethics">US foreign policy</a>, and disrupted access to sexual and reproductive health services in Africa and globally. </p>
<p>The US in the largest bilateral <a href="https://sgp.fas.org/crs/row/IF11013.pdf">funder</a> for sexual and reproductive health. Countries that rely heavily on foreign aid to fund their health system look to donor countries for guidance. It is likely that countries may use the US abortion ban to further restrict abortion access out of fear that the US global health assistance on which they depend may be reduced. </p>
<p>This happened under the <a href="https://globalgagrule.org/understanding-the-policy/">Global Gag Rule</a>, which was in place under the Trump administration (and every Republican administration since 1984). The rule required non-governmental organisations based outside the US that received US government global health assistance to certify that they would not use any funding to provide legal abortion services, referrals, or information to clients, or to advocate for the liberalisation of a country’s abortion law. </p>
<p>Despite its intention, <a href="https://doi.org/10.1016/S2214-109X(19)30267-0">research</a> has shown that this policy has resulted in increased abortions and decreased contraceptive use in sub-Saharan Africa and Latin America and the Caribbean. </p>
<p><a href="https://theconversation.com/us-anti-abortion-gag-rule-hits-women-hard-what-we-found-in-kenya-and-madagascar-154434">Research</a> we conducted provided evidence of the devastating impact of the Global Gag Rule in <a href="https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1794412?src=recsys">Kenya</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1838053?src=recsys">Madagascar</a> on integration of health services, health facility closures, disrupted referral networks and weakened advocacy efforts. In our studies, we found evidence of a chilling effect of the rule where organisations tended to over-interpret it out of fear of losing US funding.</p>
<p>Stakeholders in <a href="https://srhrforall.org/download/a-powerful-force-u-s-global-health-assistance-and-sexual-and-reproductive-health-and-rights-in-malawi/?wpdmdl=2254&refresh=62729fd3b06131651679187">Malawi</a>, <a href="https://res.cloudinary.com/dhu2eru5b/images/v1630079250/websites/pai2020/Access-Denied-Senegal_134768aa59/Access-Denied-Senegal_134768aa59.pdf">Senegal</a> and several <a href="https://31u5ac2nrwj6247cya153vw9-wpengine.netdna-ssl.com/wp-content/uploads/2019/06/IWHC_GGR_Report_2019-WEB_single_pg-2.pdf">other countries</a> reported that national policymakers look to US abortion politics as rationale for restricting abortion access. </p>
<p>In addition, the religious right in the US has emboldened local and regional anti-choice movements, particularly in <a href="https://doi.org/10.1080/26410397.2020.1795449;">Kenya</a>. The US anti-choice movement’s success with the Supreme Court will likely encourage and strengthen their efforts elsewhere, and threaten local progress in advancing sexual and reproductive health and rights. </p>
<p>Women and adolescents who find themselves with an unintended pregnancy, particularly those who already face structural inequalities, will be most affected.</p>
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Read more:
<a href="https://theconversation.com/unintended-pregnancy-rates-are-highest-in-africa-a-look-at-the-complex-reasons-180454">Unintended pregnancy rates are highest in Africa: a look at the complex reasons</a>
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<h2>3. Why does a decision in a US court have a bearing on women in Africa?</h2>
<p>This decision should not affect women in Africa. For the reasons described above, though, it may in fact do so. </p>
<p>It is, however, important to note that abortion is still legal in the US and clinics are still open. This is a draft opinion, not yet a ruling. The Global Gag Rule is not currently in effect, so NGO funding is not subject to those restrictions on their funds. </p>
<p>As the reproductive rights and justice movements come together in the US to fight for the right to abortion, this provides an opportunity for coalition-building with reproductive rights groups in Africa that have fought to expand abortion access. Together they could continue to fight for greater abortion access and prevent a US decision from slowing progress on reproductive rights in African countries.</p><img src="https://counter.theconversation.com/content/182602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara E Casey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It is likely that countries may use the US abortion ban to further restrict abortion access for fear of losing health funding.Sara E Casey, Assistant Professor, Heilbrunn Department of Population and Family Health, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1825252022-05-06T11:52:24Z2022-05-06T11:52:24ZHow US policy on abortion affects women in Africa<figure><img src="https://images.theconversation.com/files/461539/original/file-20220505-27-rcxm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A demonstrator holds a sign during a rally in support of abortion rights on May 3, 2022 in Seattle, Washington. </span> <span class="attribution"><span class="source"> David Ryder/Getty Images</span></span></figcaption></figure><p>Policies and decisions made in the United States echo around the world and often have widespread implications. Take sexual and reproductive health, for example. Decisions made in the US have caused, and could cause, severe damage to progress in access to these services in developing countries.</p>
<p>The first US policy with implications for healthcare in other countries is the <a href="https://www.guttmacher.org/gpr/2020/04/unprecedented-expansion-global-gag-rule-trampling-rights-health-and-free-speech">global gag rule</a>, first enacted by Ronald Reagan in 1984. Under this policy, non-US organisations that receive US government funding cannot provide, refer for, or promote abortion as a method of family planning. Successive US presidents have decided whether to enact or revoke the policy. President Joe Biden set it aside when he took office in 2021.</p>
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Read more:
<a href="https://theconversation.com/us-anti-abortion-gag-rule-hits-women-hard-what-we-found-in-kenya-and-madagascar-154434">US anti-abortion "gag rule" hits women hard: what we found in Kenya and Madagascar</a>
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<p>The second was a decision made by the US Supreme Court <a href="https://www.bbc.co.uk/news/world-us-canada-61939185">overruling</a> the constitutional right to an abortion. The court <a href="https://www.bbc.co.uk/news/world-us-canada-61939185">overturned</a> the landmark 1973 decision, <a href="https://supreme.justia.com/cases/federal/us/410/113/">Roe v Wade</a>, that gave American women this choice. </p>
<p>For countries that look to the US for guidance and for funding, the consequences will go beyond abortion. The striking down of Roe v Wade, coupled with the global gag rule (if and when it is reinstated by a Republican administration), empowers national and international opposition to sexual and reproductive health services such as family planning, abortion, and comprehensive sexuality education. </p>
<p>In African countries, where incremental gains are beginning to manifest in improved legislation and policies due to decades of advocacy and lobbying, this will be a devastating blow. For example, in 2020 we <a href="https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1794412">studied</a> the impact of the global gag rule in Kenya. Our findings pointed to government officials using the US government position to restrict conversations around abortion in official meetings. </p>
<p>What happens in the US may effectively deny women their rights and set back the <a href="https://www.unwomen.org/en/news/in-focus/women-and-the-sdgs/sdg-3-good-health-well-being">sustainable development agenda</a> target of reducing maternal, neonatal, and child morbidity and mortality.</p>
<h2>Global gag rule</h2>
<p>In 2017, under President Donald Trump’s administration, the US government reinstated and expanded the <a href="https://www.guttmacher.org/gpr/2020/04/unprecedented-expansion-global-gag-rule-trampling-rights-health-and-free-speech">global gag rule</a>. Republican administrations have typically reenacted the policy focusing on family planning assistance. But the <a href="https://theconversation.com/abortions-rise-worldwide-when-us-cuts-funding-to-womens-health-clinics-study-finds-112491">Trump global gag rule</a> expanded the scope to cover most categories of US government global health assistance instead of only family planning assistance. </p>
<p>Biden’s administration has <a href="https://theconversation.com/what-african-countries-can-expect-from-biden-and-what-they-should-ask-for-154870">rescinded</a> the policy. But the reverberations of its application between 2017 and 2021 are still being felt across the globe.</p>
<p>The US is one of the <a href="https://donortracker.org/united-states/globalhealth">largest</a> public health donors. <a href="https://theconversation.com/us-anti-abortion-gag-rule-hits-women-hard-what-we-found-in-kenya-and-madagascar-154434">Many African countries</a> depend on external assistance for funding aspects of healthcare, including family planning and quality post-abortion care.</p>
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Read more:
<a href="https://theconversation.com/insights-into-how-the-us-abortion-gag-rule-affects-health-services-in-kenya-145777">Insights into how the US abortion gag rule affects health services in Kenya</a>
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<h2>Roe v Wade</h2>
<p><a href="https://supreme.justia.com/cases/federal/us/410/113/">Roe v Wade</a> stipulated that the US constitution protected a pregnant woman’s right and freedom to choose to have an abortion without excessive government restriction. </p>
<p>The decision by the US Supreme Court to overturn this will set back gains made in sexual and reproductive rights and freedoms and improvements in maternal, neonatal, and child health indicators across the globe. </p>
<p>Increasingly, countries in Africa are moving towards <a href="https://theconversation.com/benins-groundbreaking-new-abortion-law-will-save-the-lives-of-many-women-170901">liberalisation of abortion laws</a> and, to some extent, decriminalisation of abortion. For example, the Democratic Republic of Congo is <a href="https://www.prb.org/resources/the-democratic-republic-of-the-congo-leads-the-way-on-abortion-access-a-pathway-for-reproductive-rights-advocates-in-francophone-africa/">improving access to safe abortion</a>. Many consider this as progress. </p>
<p>Even before the issue came before the Supreme Court, several US states had made laws that limit access to safe and legal abortion, allowing abortion for only up to six weeks of gestation. The US has strong institutions and systems to contest and possibly overcome such decisions. It could even codify legal abortion in the constitution.</p>
<p>But women in countries that look to the US for guidance and for funding may not have those options. </p>
<h2>The right to choose</h2>
<p><a href="https://www.cairn-int.info/article-E_POPU_1802_0225--abortion-around-the-world-an-overview.htm">Evidence</a> is clear that restricting abortion does not reduce the incidence of abortion. Instead, it makes abortion less safe. Women and girls who are denied access to safe procedures are forced to use unsafe methods and providers. Unsafe abortion can cause complications that range from moderate to life-threatening. More than <a href="https://www.guttmacher.org/fact-sheet/abortion-subsaharan-africa#:%7E:text=In%20Sub%2DSaharan%20Africa%2C%20more,in%20the%20region%20per%20year">77%</a> of abortions in Africa annually are unsafe.</p>
<p>Poorer and marginalised women and girls bear the <a href="https://www.ippf.org/sites/default/files/death_and_denial_unsafe_abortion_and_poverty.pdf">heaviest burden</a> when their right to choose is denied. Rich and powerful people can find a way to meet their needs. But poor people are forced to have more children than they can afford. The lack of family planning methods and safe and legal abortion is a danger to women’s health. It also puts women and girls at risk of <a href="https://www.sciencedirect.com/science/article/pii/S0022347618312976">greater poverty</a>.</p>
<h2>US influence in African countries</h2>
<p>US policies, particularly the Roe v Wade Supreme Court decision, will permeate the international community. African governments that subscribe to conservative sexual and reproductive health norms may draw inspiration from such decisions. </p>
<p>The US ruling could lend support to African decision-makers who are against providing women with options. They might use it to deny women access to critical healthcare in contradiction of their rights. </p>
<p>Anti-choice civil society movements, too, will draw impetus and validation from such a ruling to oppose progressive actions and policies at the <a href="https://foundation.mozilla.org/en/campaigns/exporting-disinformation-how-foreign-groups-peddle-influence-in-kenya-through-twitter/">national and sub-regional levels</a>. </p>
<p>Several sub-regional economic blocs in Africa are in the process of enacting sexual and reproductive health laws. For example, a sexual and reproductive health bill is currently at the East African Legislative Assembly. Reversal of Roe v Wade might stall or terminate such processes.</p><img src="https://counter.theconversation.com/content/182525/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Boniface Ushie works for the APHRC, which receives funding from Sida. </span></em></p><p class="fine-print"><em><span>Kenneth Juma works at the African Population and Health Research Center (APHRC), which receives funding from Sida. </span></em></p>For countries that look to the US for guidance and for funding, the consequences will go beyond abortion.Boniface Ushie, Research Scientist, African Population and Health Research CenterKenneth Juma, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1641892021-07-12T14:15:29Z2021-07-12T14:15:29ZCOVID-19 lockdowns and contraception: unexpected findings in four African countries<figure><img src="https://images.theconversation.com/files/410577/original/file-20210709-15-5qyh93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women's need for contraception and contraceptive use must be an ongoing priority.</span> <span class="attribution"><span class="source">Jonathan Torgovnik for The Hewlett Foundation/Reportage by Getty Images</span></span></figcaption></figure><p>The <a href="https://theconversation.com/africa/covid-19">COVID-19 pandemic</a> has affected the <a href="https://pubmed.ncbi.nlm.nih.gov/32191167/">sexual and reproductive health needs</a> of women across contexts. To curb the spread of disease across sub-Saharan Africa, many governments imposed early lockdown measures, including closures of borders, enforcement of curfews, and restrictions on movement. </p>
<p>During these initial lockdown periods (around March to June 2020), <a href="https://pubmed.ncbi.nlm.nih.gov/32343244/">modelling projections </a> and data <a href="https://journals.co.za/doi/pdf/10.18772/26180197.2020.v2n2a7">collected</a> from <a href="https://ejrh.org/index.php/ejrh/article/view/418">health providers</a> warned that women would have difficulty accessing sexual and reproductive healthcare, including contraceptive services.</p>
<p>Health services were threatened in a <a href="https://www.ippf.org/blogs/contraception-and-covid-19-disrupted-supply-and-access">number of ways</a>. Clinical staff in charge of COVID-19 interventions had limited access to personal protective equipment. The closure of workplaces and transport services affected supply lines, and stock outs of many contraceptive methods were seen within the next three to six months. The fear of an increased risk of COVID-19 infection from health facilities discouraged women from seeking services. </p>
<p>In some settings, clinical activities deemed “non-urgent”, such as prenatal care, were often delayed. At the same time, the lockdown itself may have increased women’s exposure to gender-based violence as a result of longer periods in the presence of perpetrators, usually intimate partners, and more limited opportunities for seeking help. </p>
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Read more:
<a href="https://theconversation.com/sexual-and-gender-based-violence-during-covid-19-lessons-from-ebola-137541">Sexual and gender-based violence during COVID-19: lessons from Ebola</a>
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<p>Early reports were helpful in advocating for women’s sexual and reproductive health needs. But few studies were able to quantify the actual impact of the COVID-19 pandemic and of its mitigation measures on the women’s lives and well-being. Specifically, population-level data were needed to help us understand how the pandemic affected women’s need for and use of contraception – and pinpoint who might be most at risk of experiencing unintended pregnancy.</p>
<p>In our <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00105-4/fulltext#%20">recent research</a> we aimed to answer these questions by surveying women in four African countries. We looked at how COVID-19 impacted their sexual and reproductive health needs and access. What we found was surprising and contrary to the fears of experts and activists. Overall, the women we spoke to were able to avoid unintended pregnancies. But women’s need for contraception and contraceptive use must be an ongoing priority. The findings showed certain groups to be particularly vulnerable. </p>
<h2>Need for and use of contraceptives</h2>
<p>The <a href="https://www.pmadata.org/">Performance Monitoring for Action study</a> conducts annual surveys on women’s reproductive health needs across sub-Saharan Africa. These surveys are generally done face-to-face by trained interviewers. But due to COVID-19 mitigation measures, normal procedures were not possible. </p>
<p>We therefore conducted a phone-based survey from May to June 2020. The survey included questions specific to COVID-19 knowledge and reproductive health behaviours since COVID-19 restrictions. </p>
<p>Our analyses included 7,245 women who were married or living with a partner in Burkina Faso, Kinshasa (Democratic Republic of the Congo), Kenya, and Lagos (Nigeria). We included these geographies because we had already collected data between November 2019 to February 2020 – just before the COVID-19 pandemic – and could compare key reproductive health indicators between time points.</p>
<p>Both need for contraception and actual use of contraception differed substantially across the four geographies. </p>
<p>Lagos was the only setting where women’s need for contraception rose. It increased by 5% between pre-COVID-19 and the survey following the onset of the pandemic. Increases in contraceptive need were not observed in other settings.</p>
<p>Contrary to our expectations, we found that overall contraceptive use among women in need of contraception increased in most settings. This increase was significant in rural Burkina Faso and in Kenya.</p>
<p>Across all four geographies, we saw that the economic fallout of the pandemic impacted women’s lives. </p>
<p>Most women reported a partial loss in household income since COVID-19 restrictions. In Kinshasa, however, the impact was more severe. Nearly 70% of women reported complete loss of household income. Accordingly, increases in contraceptive use were seen for women who had experienced partial economic losses in Kenya and rural Burkina Faso, perhaps corresponding to changing fertility intentions in times of economic uncertainty.</p>
<p>Fortunately, our overall findings are not aligned with predictions and media reports that there would be large numbers of unintended pregnancies as a result of decreased access to reproductive health services. In fact, our findings on overall increases in contraceptive use in Kenya and rural areas of Burkina Faso point to women acting on their reproductive preferences and seeking to prevent pregnancy.</p>
<p>Importantly, however, some women may not have been able to use contraception to prevent unintended pregnancy in the early stages of the pandemic. We also looked at these trends by sociodemographic characteristics. We found that some women may be at increased risk of unintended pregnancy – specifically, young women in Lagos and women without children in Kinshasa. Understanding the reasons for increased contraceptive need and decreased contraceptive use for these groups is critical. </p>
<p>Young women already face stigma in accessing contraceptive services and this is likely heightened during the pandemic due to closure of youth-friendly services. Women who have never had children may similarly face familial and societal pressure to conceive soon after marriage, regardless of their competing financial or educational aspirations. Ensuring that all women and girls are able to achieve their childbearing goals must remain central throughout the pandemic, and beyond.</p>
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Read more:
<a href="https://theconversation.com/why-nigerias-weak-health-system-affects-women-and-girls-the-most-163904">Why Nigeria's weak health system affects women and girls the most</a>
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<h2>Looking ahead</h2>
<p>Overall, these results are encouraging. </p>
<p>But the sexual and reproductive health needs of women and girls must remain a priority for governments, international donors, and service providers. This is especially important as many countries experience new waves of COVID-19 cases and enter continued periods of restrictions. </p>
<p>Contraception should be considered a basic need in sub-Saharan Africa and other places where health systems are weak and fragile. Access should not be affected by pandemics or other situations that necessitate restrictions on movement.</p>
<p>Family planning policies and programmes in these settings should prioritise the reproductive and sexual health needs of women at all times. And more so during health emergencies, where women also face disproportionate economic and societal setbacks.</p><img src="https://counter.theconversation.com/content/164189/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shannon N. Wood works for The Johns Hopkins Bloomberg School of Public Health and received funding from The Bill and Melinda Gates Foundation for this work.</span></em></p><p class="fine-print"><em><span>Celia Karp works for the Johns Hopkins Bloomberg School of Public Health and received funding from the Bill and Melinda Gates Foundation for this work.</span></em></p><p class="fine-print"><em><span>Funmilola OlaOlorun is affiliated with the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins University and received an honorarium for overseeing the data collection for this work in Lagos, Nigeria. </span></em></p><p class="fine-print"><em><span>Pierre Akilimali is affiliated with the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins University and received an honorarium for overseeing the data collection for this work in DRC ( Kinshasa and Kongo Central).</span></em></p>Contrary to expectations, researchers found that overall contraceptive use increased in most settings.Shannon N. Wood, Assistant Scientist in the Department of Population, Family and Reproductive Health, Johns Hopkins UniversityCelia Karp, Assistant Scientist in the Department of Population, Family, and Reproductive Health, Johns Hopkins UniversityFunmilola OlaOlorun, Lecturer/ Honorary Consultant at College of Medicine, University of IbadanPierre Akilimali, Associate Professor of Medicine and Public Health, University of Kinshasa Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1639042021-07-09T10:13:31Z2021-07-09T10:13:31ZWhy Nigeria’s weak health system affects women and girls the most<figure><img src="https://images.theconversation.com/files/410383/original/file-20210708-13-1ep073o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mothers wait with their babies to receive treatment at a dispensary .</span> <span class="attribution"><span class="source">ISSOUF SANOGO/AFP via Getty Images</span></span></figcaption></figure><p>Nigeria’s healthcare service delivery is very poor. It ranks among the worst globally in terms of access and quality. In 2018 it was ranked 142 out of 195 countries by the general medical journal, the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30994-2/fulltext">Lancet</a>. The World Bank <a href="https://data.worldbank.org/indicator/SH.UHC.SRVS.CV.XD">ranks</a> it 42 on a scale of 100 in its universal coverage index, which indicates the availability of essential healthcare services in the participating countries.</p>
<p>Some of the reasons for the sub-optimal healthcare delivery are linked to the country’s <a href="https://worldpopulationreview.com/countries/nigeria-population">rapid population growth</a> from 122.2 million in 2000 to 211.4 million.</p>
<p>Other factors include poor funding – <a href="https://www.devex.com/news/sponsored/2-decades-on-nigeria-falls-short-of-landmark-health-pledge-99555">the government spends less than 5%</a> of its annual budget on health – and high attrition and <a href="https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-017-0205-4">migration of health workers</a>. </p>
<p>There is also inefficiency within the health system and systemic neglect of rural areas. A poor reward system and a trade union crisis – including prolonged industrial actions by health workers – and corruption complete the list. </p>
<p>Women, young girls and children are the <a href="https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf">worst affected</a> by the poor health services. This is particularly true for those living in rural areas where the burden of disease is disproportionately high. </p>
<p>Some of the health indicators are very frightening. Nigeria <a href="https://www.who.int/reproductivehealth/maternal-health-nigeria/en/">accounts</a> for nearly 20% of global maternal deaths. It is also among the <a href="https://apps.who.int/iris/bitstream/handle/10665/327596/WHO-RHR-19.23-eng.pdf?sequence=13&isAllowed=y">five countries</a> with the highest maternal deaths. </p>
<p>The reasons for this state of affairs are threefold. The first is that there are major hurdles to accessing care, which has a knock-on effect on women accessing decent family planning services. The other major contributor is that the opportunities for girls to attend school are massively curtailed, particularly in northern Nigeria. Extended years in school have been shown to make a marked difference to the choices girls make in later life.</p>
<h2>Hurdles to accessing healthcare</h2>
<p>The average Nigerian woman or child faces a host of hindrances in accessing health services. </p>
<p>The first is cost. Although the country’s national healthcare policy provides a framework for access to basic healthcare, most Nigerians are still faced with out-of-pocket payment for health services. This is a major hindrance for most women from poor households. </p>
<p>The second is the patriarchal system that operates in Nigeria. This restricts women’s ability to make decisions about what money should be spent on, and also about their healthcare and that of their children. </p>
<p>Thirdly, women are also plagued with issues like <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05700-w">transport, distance to health facilities</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29669538/">poor health literacy and poverty</a>.</p>
<p>Fourth are bureaucracy delays within the health facilities and referral systems for those at high risk to access essential healthcare. </p>
<p>Fifth, there is the <a href="https://pubmed.ncbi.nlm.nih.gov/29669538/">poor attitude of health workers, and frequent industrial action</a>.</p>
<p>Sixth, there is a lack of essential drugs and equipment. </p>
<p>Seventh, corruption and poor infrastructure. </p>
<p>And lastly, inadequate capacity. <a href="https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-017-0205-4">There aren’t enough human resources to deliver essential health services</a>. There are only about two health workers available for every 1,000 people. </p>
<p>This inability to access healthcare has resulted in women not being able to access adequate family planning services. </p>
<h2>Having babies</h2>
<p>There is <a href="https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception">overwhelming evidence</a> that if women access family planning services there are improvements in maternal and child health. It also <a href="https://www.prb.org/resources/family-planning-improves-the-economic-well-being-of-families-and-communities/">increases</a> the wellbeing of individuals, families and communities. </p>
<p>For example, family planning promotion has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642363/">identified</a> as a very important factor in addressing high-risk births.</p>
<p>But only about <a href="https://www.pmadata.org/sites/default/files/data_product_results/PMA2020-Nigeria-National-R3-FP-Brief.pdf">one-fifth</a> of Nigerian women are currently using a modern method of contraceptive and <a href="https://www.pmadata.org/sites/default/files/data_product_results/PMA2020-Nigeria-National-R3-FP-Brief.pdf">about 23%</a> said they had unmet needs for family planning while <a href="https://www.pmadata.org/sites/default/files/data_product_results/PMA2020-Nigeria-National-R3-FP-Brief.pdf">only 38%</a> were satisfied with the family planning method they used.</p>
<p>Over a quarter of childbearing mothers in Nigeria <a href="https://www.pmadata.org/sites/default/files/data_product_results/PMA2020-Nigeria-National-R3-FP-Brief.pdf">considered</a> their last birth as a product of unwanted pregnancy. </p>
<p>Nigeria also has a very large number of births among adolescent girls. It’s estimated that about one-fifth of adolescent girls have begun to have children. The adolescent fertility rate is <a href="https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf">estimated</a> at 123 births per 1,000 for girls aged 15-19. <a href="https://dhsprogram.com/pubs/pdf/FR308/FR308.pdf">Kenya</a>’s comparative number is below 85.</p>
<p>The consequences are reflected in high-risk birth, intergenerational poverty and poor life skills. It is also <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1859-1">reflected</a> in limited opportunities for the mothers and children.</p>
<h2>Education for girls</h2>
<p>Education is one of the major <a href="https://www.oecd.org/dac/gender-development/44843817.pdf">indicators</a> of women’s empowerment, particularly secondary school education. It enhances women’s health literacy skills and has been <a href="https://onlinelibrary.wiley.com/doi/10.1111/sifp.12156">identified</a> as a major factor in the uptake of family planning and child health care.</p>
<p>Only about 65% of girls compared with 71% of boys have a primary education. And only 39% of girls <a href="https://education.gov.ng/nigeria-digest-of-education-statistics/">completed junior secondary school</a> while 29% completed senior secondary school.</p>
<p>These indicators vary widely across the country and disproportionately affect those in the rural areas, particularly in northern Nigeria. </p>
<p>Some reasons for this gender disparity in educational attainment are poverty, gender apathy and discrimination against women. Others are religion, cultural factors and lack of government’s commitment to girl-child education.</p>
<p>Girl-child education is a fundamental human right, entrenched in the <a href="https://sdgs.un.org/goals/goal5">Sustainable Development Goals</a>. It enhances the socioeconomic status of the individual girls, family, and society at large. <a href="https://onlinelibrary.wiley.com/doi/10.1111/sifp.12156">Studies</a> have shown <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320680/">that education improves</a> health literacy, decision making and childcare practices among women. </p>
<h2>Next steps</h2>
<p>The Nigerian government has made a <a href="https://www.familyplanning2020.org/nigeria">policy commitment</a> to achieve a modern contraceptive prevalence rate of 27% among all women by 2024. But this will only be achievable with more political commitment at the federal and sub-national levels. </p>
<p>A reduction in fertility of one child per woman in Nigeria <a href="https://pubmed.ncbi.nlm.nih.gov/22784535/">would lead</a> to a 13% increase in GDP per capita in 20 years, and 25% in 50 years. Current estimates by the Guttmacher Institute and Nigeria Family Planning Blueprint (2020-2024) say if <a href="https://www.guttmacher.org/fact-sheet/adding-it-up-contraception-mnh-nigeria">all unmet needs for modern contraception were met</a>, it would prevent 1.9 million unintended pregnancies, 685,000 unplanned births, 1.01 million unsafe abortions in Nigeria, 42,000 maternal deaths and 217,000 infant deaths per annum.</p>
<p>The government has made a commitment to strengthen collaboration with states, donors and other stakeholders on implementing an effective health insurance scheme to make household family planning expenditures reimbursable. </p>
<p>But there is a need for more financial commitment to increase the annual allocation for contraceptives by government at all levels. And there is the need to target adolescents with vulnerable socio-demographic profiles, particularly those in the rural areas in the northeastern and northwestern part of the country. </p>
<p>The government also needs to do a great deal more when it comes to educating Nigerian girls. Efforts to improve school attendance have been made, including the implementation of <a href="http://www.fao.org/faolex/results/details/en/c/LEX-FAOC169078/">Home-Grown School Feeding</a>. But there are limited – or no – government interventions at the national level to improve gender parity in education. </p>
<p>At sub-national level, there are some intervention programmes towards improving girl-child education, particularly in <a href="https://centreforgirlseducation.org/programs">Kaduna</a>, <a href="https://www.girlchildconcerns.org/education-sensitization/">Borno</a> and <a href="https://www.vanguardngr.com/2019/08/girl-child-education-a-cheery-intervention-by-maritime-academy/">Edo</a> States. However, their impact is minimal and further impaired by insecurity, political instability and corruption.</p>
<p>Investing in girls’ education will substantially contribute to increasing women’s contraceptive use, prevent unwanted pregnancies and improve maternal and child health.</p><img src="https://counter.theconversation.com/content/163904/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Akanni Ibukun Akinyemi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The average Nigerian woman or child faces a host of hindrances in accessing health services.Akanni Ibukun Akinyemi, Professor of Demography and Social Statistics., Obafemi Awolowo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1624142021-06-30T12:12:00Z2021-06-30T12:12:00ZChina’s ‘one-child policy’ left at least 1 million bereaved parents childless and alone in old age, with no one to take care of them<figure><img src="https://images.theconversation.com/files/407757/original/file-20210622-23-1iohzjj.jpg?ixlib=rb-1.1.0&rect=0%2C89%2C5000%2C3263&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For four decades, the Chinese government has restricted family size.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/pedestrians-and-a-man-carrying-baskets-pass-by-a-huge-news-photo/158661292?adppopup=true">Peter Charlesworth/LightRocket via Getty Images </a></span></figcaption></figure><p>A child’s death is devastating to all parents. But for Chinese parents, losing an only child can add financial ruin to emotional devastation. </p>
<p>That’s one conclusion of a <a href="https://www.sixthtone.com/news/1006719/their-only-child-gone%2C-shidu-parents-shun-chinas-kid-centric-society">research project on parental grief I’ve conducted in China since 2016</a>.</p>
<p>From 1980 to 2015, the Chinese government limited couples to one child only. I have interviewed over 100 Chinese parents who started their families during this period and have since lost their only child – whether to illness, accident, suicide or murder. Having passed reproductive age at the time of their child’s death, these couples were unable to have another child. </p>
<p>In 2015, the Chinese government raised the birth limit to two, an effort to <a href="https://www.nytimes.com/2021/05/31/world/asia/china-three-child-policy.html">reverse declining birthrates and to rejuvenate an aging population</a>. In May 2021, it announced that Chinese families could have up to three children. </p>
<p>The new “three-child policy” received generally <a href="https://theconversation.com/chinas-three-child-policy-is-unlikely-to-be-welcomed-by-working-women-162047">lukewarm responses in China</a>. Many Chinese couples say they prefer <a href="https://www.sup.org/books/title/?id=26948">not to have multiple children</a> due to the rising cost of child rearing, how it would complicate women’s professional aspirations and declining preference for a son. </p>
<p>The childless parents I interviewed told me they felt forgotten as their government moves further away from the birth-planning policy that left them bereaved, alone and precarious in their old age – in a country where <a href="https://www.cambridge.org/core/journals/china-quarterly/article/abs/little-quilted-vests-to-warm-parents-hearts-redefining-the-gendered-practice-of-filial-piety-in-rural-northeastern-china/F6B2FD8F587F18AB4C30AE8C409AEF45">children are the main safety net for the elderly</a>.</p>
<h2>Having and losing an only child</h2>
<p>China’s one-child policy was a massive social engineering project launched to slow down rapid population growth and aid economic development efforts.</p>
<p>Until the early 1970s, most Chinese women <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=CN">had at least five children</a>. By 1979, China’s population had nearly reached <a href="https://data.worldbank.org/indicator/SP.POP.TOTL?locations=CN">1 billion</a> – <a href="http://www.gov.cn/gzdt/2009-09/11/content_1415054.htm#:%7E:text=1949%E5%B9%B4%EF%BC%8C%E5%85%A8%E5%9B%BD%E4%BA%BA%E5%8F%A3%E5%87%BA%E7%94%9F%E7%8E%87,%E6%80%BB%E4%BA%BA%E5%8F%A3%E4%B8%BA5.42%E4%BA%BF%E3%80%82">up from 542 million in 1949</a>. The Chinese government claimed that the one-child limit prevented 400 million births in China, although <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1728-4457.2013.00555.x">this calculation has been disputed</a> as an exaggeration. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A mother wearing a straw hat pushes a buggy with a child sitting it. There are two other children walking near the buggy." src="https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407759/original/file-20210622-13-xwv2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A family strolls in Beijing, 1972.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BeijingStreetScene/597761b4540c4080a71b9074a26e850c">AP Photo/Horst Faas</a></span>
</figcaption>
</figure>
<p>The birth limit was unpopular at first. </p>
<p>“Back then, we wanted to have more children,” said a bereaved mother who was in her 60s when I interviewed her in 2017. “My parents had an even harder time accepting that we were allowed to have only one child.”</p>
<p>To enforce the unpopular one-child policy, the Chinese authorities designed <a href="https://link.springer.com/article/10.1007/s11013-013-9351-x">strict measures</a>, including mandatory contraception and, if all else failed, forced abortion. </p>
<p>Those who violated the policy paid a financial penalty, and children from <a href="https://anthrosource.onlinelibrary.wiley.com/doi/abs/10.1111/maq.12352">unauthorized births often could not be registered for citizenship status and benefits</a>. Parents who worked for the government – and under China’s economic system, many urban workers did – risked losing their job if they had more than one child. </p>
<p>Several bereaved mothers told me that they had gotten pregnant with a second or third child in the 1980s or 1990s but had an abortion for fear of job loss. </p>
<p>The one-child policy, while painful, contributed to an age structure that benefited the economy: The large working-age population born before and after it grew rapidly compared to the country’s younger and older dependent population. </p>
<p>This “demographic dividend” accounted for <a href="https://catalog.ihsn.org/index.php/citations/63586">15% of China’s economic growth between 1982 and 2000</a>, according to a 2007 United Nations working paper. </p>
<h2>An uncertain old age</h2>
<p>Yet China’s one-child policy also created a risk for couples: the possibility of becoming childless in old age. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A baby is fed by its mother" src="https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407764/original/file-20210622-21-qcxowc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The original caption of this 1994 photo accompanying an article on China’s one-child policy was: ‘A baby is fed by its mother. The child is probably never to have a sister or brother.’</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/baby-is-fed-by-its-mother-the-child-is-probably-never-to-news-photo/158661290?adppopup=true">Peter Charlesworth/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<p>“Families with an only child are walking on a tightrope. Every family can fall off the tightrope at any moment” if they lose their only child, one bereaved mother explained to me. </p>
<p>“We are the unlucky ones,” she said. </p>
<p>In China, where the <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/spol.12368">pension</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/10670564.2014.882617">health care</a> systems are patchy and highly stratified, adult children are the main safety net for many aging parents. Their financial support is often necessary after retirement. </p>
<p>It is estimated that 1 million Chinese families had <a href="http://www.chinadaily.com.cn/html/feature/lifeafterloss/index.html">lost their only child by 2010</a>. These childless, bereaved parents, now in their 50s and 60s, face an uncertain future. </p>
<p>Due to the country’s longstanding tradition of filial piety, <a href="https://www.cambridge.org/core/journals/china-quarterly/article/abs/little-quilted-vests-to-warm-parents-hearts-redefining-the-gendered-practice-of-filial-piety-in-rural-northeastern-china/F6B2FD8F587F18AB4C30AE8C409AEF45">children also have a moral obligation to support their aging parents</a>. Parental care is actually the legal responsibility of children in China; it is written into the <a href="http://www.gov.cn/guoqing/2018-03/22/content_5276318.htm">Chinese Constitution</a>. </p>
<p>This safety net does not exist for parents who lost the only child the government would let them have. </p>
<h2>Help, but not enough</h2>
<p>Over the past decade, <a href="https://www.reuters.com/article/us-china-protests/hundreds-of-bereaved-chinese-protest-over-one-child-compensation-idUSKCN0XF1KW">groups of bereaved parents have negotiated with the Chinese authorities</a> to demand financial support and access to affordable elder care facilities. Those I interviewed said they had fulfilled their obligation as citizens by abiding by the one-child rule and felt the government now had the responsibility to take care of them in their old age.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman shows a picture to the camera." src="https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407763/original/file-20210622-25-b7rod7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A bereaved parent of the one-child era shows a picture of her late son.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/one-woman-who-lost-her-son-in-recent-years-traveled-from-news-photo/175849032?adppopup=true">William Wan/The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>Eventually, the authorities responded to their grievances. </p>
<p>Starting in 2013, the government has initiated multiple programs for bereaved parents, most notably a monthly allowance, hospital care insurance and in some regions subsidized nursing home care. </p>
<p>However, bereaved parents told me that these programs were insufficient to meet their elder care needs. </p>
<p>For example, adult children often take care of their parents during hospitalization, bathing them and buying meals. Private care aides can charge up to US$46 a day, or 300 yuan, to do these tasks. In regions that now provide <a href="http://www.xinhuanet.com/2020-01/14/c_1125462230.htm">government-paid hospital care insurance for childless parents</a>, most plans cover between $15.50 to $31 – about 100 to 200 yuan – daily for a care aide, based on my research. </p>
<p>Other people I interviewed worried about the high cost and <a href="https://www.sixthtone.com/news/1006061/chinas-hidden-crisis-a-growing-elder-care-gap">limited availability</a> of quality nursing homes in many regions. China’s elder care facilities cannot meet the demand of its aging population, and living in these facilities is not covered by insurance.</p>
<p>China’s controversial one-child policy is history, but its legacy may depend on how the Chinese authorities treat the grieving parents left in its wake.</p>
<p>[<em>The Conversation’s Politics + Society editors pick need-to-know stories.</em> <a href="https://theconversation.com/us/newsletters/politics-weekly-74/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=politics-need-to-know">Sign up for Politics Weekly</a>.]</p><img src="https://counter.theconversation.com/content/162414/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lihong Shi receives funding from the Wenner-Gren Foundation for Anthropological Research. </span></em></p>China limited families to one child from 1980 to 2015 to curb population growth. The policy paid off economically for the country, but it left couples whose only child died grieving and impoverished.Lihong Shi, Associate Professor of Anthropology , Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1558082021-03-04T15:31:01Z2021-03-04T15:31:01ZHow men can support maternal health: lessons from Rwanda<figure><img src="https://images.theconversation.com/files/387182/original/file-20210302-19-1itlhr6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The stigma on men's involvement in maternal health is a significant barrier to their participation.</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Rwanda has seen an improvement in <a href="https://theconversation.com/lessons-from-rwanda-on-how-trust-can-help-repair-a-broken-health-system-124183">public health</a> over the past 20 years. The maternal health field has benefited greatly from such improvements. In particular, the country has seen a remarkable reduction in <a href="https://apps.who.int/iris/handle/10665/327595">deaths</a> related to pregnancy. But more must still be done to meet key national and international maternal health targets. Achieving continued improvement will require identifying and acting on new opportunities, including deepening men’s involvement in maternal health. </p>
<p>In Rwanda, as with most African countries, there are <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-9-32">few programmes</a> that promote men’s involvement in maternal health. Maternal health is widely thought of as primarily a woman’s issue, and so opportunities for men’s involvement as partners are often unclear. The social stigma placed on men’s involvement in maternal health is a significant barrier to their participation. </p>
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Read more:
<a href="https://theconversation.com/how-to-get-malawian-men-more-involved-in-antenatal-care-and-why-it-matters-148124">How to get Malawian men more involved in antenatal care - and why it matters</a>
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<p>What are the opportunities for men to become more involved in supporting maternal health? We explored this in a <a href="https://link.springer.com/article/10.1186/s41256-020-00185-w">recent study</a> through speaking with pregnant and recently pregnant Rwandan women. We learned that men have particularly important roles to play in increasing access to maternal health services. Interventions involving men are encouraged to increase their understanding of the implications of their involvement in maternal health. But this must be done without compromising women’s autonomy in decision-making. </p>
<h2>Our research</h2>
<p>We conducted in-depth interviews with pregnant and recently-pregnant women to gain an understanding of their views on men’s role during pregnancy. We spoke to women across five districts in rural and urban parts of the country.</p>
<p>We identified three key ways men can play a more active role in maternal health. </p>
<p>First, men can practically help their partners access care by assisting with the costs of attending clinical appointments such as transport, health insurance, and meals while on route to the clinic. Men can also facilitate women’s involvement in maternal care by taking care of household chores while women attend maternal health appointments. Overall, men’s involvement in facilitating access to maternal care could have spillover benefits for using other services, such as family planning.</p>
<p>Second, men can support the maternal health decisions made by women. This can ultimately facilitate care access. And doing so still enables women’s autonomy in decision making – an important and often ignored ingredient in improving maternal health. </p>
<p>Third, women told us that men can meaningfully participate in gathering and reviewing information on maternal health. This positions them to play a role in supporting informed decisions when it comes to maternal health and women’s health more broadly. </p>
<p>Community volunteers who contribute to promoting maternal health in collaboration with the Ministry of Health, known as <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1065-4">community health workers</a>, are well positioned to support men’s increased roles in maternal health. </p>
<p>As one woman we spoke with explained: </p>
<blockquote>
<p>It is helpful when a community health worker gives information in the presence of my spouse…because that makes him help me. </p>
</blockquote>
<p>Given their important roles in the process of involving men in maternal health, community health workers should be supported in actively facilitating men’s involvement.</p>
<p>But there are societal <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-9-32">barriers</a> to deepening men’s involvement in maternal care. Perhaps the most significant one is the generally low social expectation that is held regarding men’s involvement in such care.
These expectations are often limited to the very basics, whether financially or attending specific appointments. This low social expectation is influenced by <a href="https://www.hindawi.com/journals/ijrmed/2017/2929013/">factors</a> such as education, income and cultural beliefs. Shifting such fundamental social barriers to <a href="https://www.tandfonline.com/doi/full/10.3402/gha.v9.31482">assist men</a> to understand the opportunities for their deeper involvement in maternal care requires dedicated effort.</p>
<p>Some women deliberately <a href="https://www.sciencedirect.com/science/article/abs/pii/S027795361630466X?casa_token=ELYtjImsQrUAAAAA:gM-vqmo1IdswK06u6vsJFHGgqkwe2v1GoYp0JQOGzxu5p8e7ceFUow-tDOq5m_R5j-z8C7on">refuse</a> to be accompanied by their partners to clinical appointments. This is because it may be perceived as a form of public display of affection, which is considered inappropriate. Shifting such beliefs requires an understanding of how they pose a barrier to men’s involvement in maternal health and requires deep community investment. </p>
<h2>Making the change</h2>
<p>Discussions at the community level that engage men in thinking and talking about maternal health are still rare. But these discussions are vital to increasing men’s understanding of why they should become involved in maternal care and facilitate women’s access to such care. This includes developing a shared understanding of how involvement can happen without compromising women’s autonomy in decision making on maternal health. </p>
<p>Increasing Rwandan men’s involvement in maternal health will enhance health equity and health outcomes within families, communities, and the country at large. The risks of encouraging and achieving this involvement are minimal and the potential benefits are great. </p>
<p>Involving men more in such care will be essential if Rwanda is to meet many of its maternal health goals. As our research has shown, this includes meeting targets related to women’s access to such care.</p><img src="https://counter.theconversation.com/content/155808/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Germaine Tuyisenge receives funding from the Centre for Gender and Sexual Health Equity (Vancouver, Canada), Mitacs (Canada) and was formerly funded by the Training, Support and Access Model for Maternal, Newborn and Child Health in Rwanda and Burundi, a project funded by Global Affairs Canada (2016-2020).</span></em></p><p class="fine-print"><em><span>Valorie A. Crooks receives funding from the Michael Smith Foundation for Health Research, Canadian Institutes of Health Research, and Canada Research Chair Secretariat. </span></em></p>Men can practically help their partners access care by assisting with the costs of attending clinical appointments such as transportation, health insurance, and meals while on route to the clinic.Germaine Tuyisenge, Postdoctoral Fellow, Simon Fraser UniversityValorie A. Crooks, Professor, Department of Geography and Canada Research Chair in Health Service Geographies, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1530912021-01-13T05:00:06Z2021-01-13T05:00:06ZWorried about Earth’s future? Well, the outlook is worse than even scientists can grasp<figure><img src="https://images.theconversation.com/files/378461/original/file-20210113-21-rwemte.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5568%2C3692&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Daniel Mariuz/AAP</span></span></figcaption></figure><p>Anyone with even a passing interest in the global environment knows all is not well. But just how bad is the situation? Our new paper shows the outlook for life on Earth is more dire than is generally understood. </p>
<p>The research <a href="https://www.frontiersin.org/articles/10.3389/fcosc.2020.615419/full">published today</a> reviews more than 150 studies to produce a stark summary of the state of the natural world. We outline the likely future trends in biodiversity decline, mass extinction, climate disruption and planetary toxification. We clarify the gravity of the human predicament and provide a timely snapshot of the crises that must be addressed now. </p>
<p>The problems, all tied to human consumption and population growth, will almost certainly worsen over coming decades. The damage will be felt for centuries and threatens the survival of all species, including our own.</p>
<p>Our paper was authored by 17 leading scientists, including those from Flinders University, Stanford University and the University of California, Los Angeles. Our message might not be popular, and indeed is frightening. But scientists must be candid and accurate if humanity is to understand the enormity of the challenges we face.</p>
<figure class="align-center ">
<img alt="Girl in breathing mask attached ot plant in container" src="https://images.theconversation.com/files/378462/original/file-20210113-21-1vk2ung.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378462/original/file-20210113-21-1vk2ung.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378462/original/file-20210113-21-1vk2ung.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378462/original/file-20210113-21-1vk2ung.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378462/original/file-20210113-21-1vk2ung.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378462/original/file-20210113-21-1vk2ung.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378462/original/file-20210113-21-1vk2ung.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Humanity must come to terms with the future we and future generations face.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Getting to grips with the problem</h2>
<p>First, we reviewed the extent to which experts grasp the scale of the threats to the biosphere and its lifeforms, including humanity. Alarmingly, the research shows future environmental conditions will be far more dangerous than experts currently believe.</p>
<p>This is largely because academics tend to specialise in <a href="https://www.tandfonline.com/doi/abs/10.1080/15487733.2007.11907989">one discipline</a>, which means they’re in many cases unfamiliar with the <a href="https://www.dymocks.com.au/book/fragile-dominion-by-simon-levin-and-simon-a-levin-9780738203195">complex system</a> in which planetary-scale problems — and their potential solutions — exist. </p>
<p>What’s more, positive change can be impeded by governments <a href="https://www.embopress.org/doi/full/10.15252/embr.201643381">rejecting</a> or ignoring scientific advice, and <a href="https://www.nature.com/articles/s41562-020-0884-z">ignorance of human behaviour</a> by both technical experts and policymakers.</p>
<p>More broadly, the human <a href="https://www.nature.com/articles/s41562-020-0884-z">optimism bias</a> – thinking bad things are more likely to befall others than yourself – means many people underestimate the environmental crisis. </p>
<h2>Numbers don’t lie</h2>
<p>Our research also reviewed the current state of the global environment. While the problems are too numerous to cover in full here, they include:</p>
<ul>
<li><p>a <a href="https://www.nature.com/articles/nature25138">halving</a> of vegetation biomass since the agricultural revolution around 11,000 years ago. Overall, humans have altered almost <a href="https://ipbes.net/global-assessment">two-thirds</a> of Earth’s land surface</p></li>
<li><p>about <a href="https://science.sciencemag.org/content/366/6471/eaax3100">1,300 documented</a> <a href="https://www.nature.com/articles/s41559-019-0906-2">species extinctions</a> over the past 500 years, with many more unrecorded. More broadly, population sizes of animal species have declined by more than <a href="https://www.worldwildlife.org/publications/living-planet-report-2020">two-thirds</a> over the last 50 years, suggesting more extinctions are imminent</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-a-mass-extinction-and-are-we-in-one-now-122535">What is a 'mass extinction' and are we in one now?</a>
</strong>
</em>
</p>
<hr>
<ul>
<li><p>about <a href="https://www.un.org/sustainabledevelopment/blog/2019/05/nature-decline-unprecedented-report/">one million</a> plant and animal species globally threatened with extinction. The combined mass of wild mammals today is less than <a href="https://www.pnas.org/content/115/25/6506">one-quarter</a> the mass before humans started colonising the planet. Insects are also <a href="https://www.annualreviews.org/doi/abs/10.1146/annurev-ento-011019-025151">disappearing rapidly</a> in many regions</p></li>
<li><p>85% of the global wetland area <a href="https://www.publish.csiro.au/mf/mf14173">lost</a> in 300 years, and more than 65% of the oceans <a href="https://www.nature.com/articles/ncomms8615">compromised</a> to some extent by humans</p></li>
<li><p>a halving of live coral cover on reefs in less than <a href="https://www.nature.com/articles/nclimate1674">200 years</a> and a decrease in seagrass extent by <a href="https://science.sciencemag.org/content/366/6471/eaax3100">10% per decade</a> over the last century. <a href="https://www.pnas.org/content/113/48/13785">About 40%</a> of kelp forests have declined in abundance, and the number of large predatory fishes is <a href="https://onlinelibrary.wiley.com/doi/full/10.1046/j.1467-2979.2003.00103.x">fewer than 30%</a> of that a century ago.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="State of the Earth's environment" src="https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=521&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=521&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=521&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=654&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=654&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378178/original/file-20210112-15-1ornvrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=654&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Major environmental-change categories expressed as a percentage relative to intact baseline. Red indicates percentage of category damaged, lost or otherwise affected; blue indicates percentage intact, remaining or unaffected.</span>
<span class="attribution"><span class="source">Frontiers in Conservation Science</span></span>
</figcaption>
</figure>
<h2>A bad situation only getting worse</h2>
<p>The human population has reached <a href="https://www.prb.org/2020-world-population-data-sheet/">7.8 billion</a> – double what it was in 1970 – and is set to reach about 10 billion by 2050. More people equals more food insecurity, soil degradation, plastic pollution and biodiversity loss. </p>
<p>High population densities make pandemics more likely. They also drive overcrowding, unemployment, housing shortages and deteriorating infrastructure, and can spark conflicts leading to <a href="https://theconversation.com/by-inciting-capitol-mob-trump-pushes-u-s-closer-to-a-banana-republic-152850">insurrections</a>, terrorism, and war.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-explained-why-we-need-to-focus-on-increased-consumption-as-much-as-population-growth-138602">Climate explained: why we need to focus on increased consumption as much as population growth</a>
</strong>
</em>
</p>
<hr>
<p>Essentially, humans have created an ecological <a href="https://www.investopedia.com/terms/p/ponzischeme.asp">Ponzi scheme</a>. Consumption, as a percentage of Earth’s <a href="https://www.footprintnetwork.org">capacity to regenerate itself</a>, has grown from 73% in 1960 to <a href="https://www.mdpi.com/2079-9276/7/3/58">more than 170% today</a>. </p>
<p>High-consuming countries like Australia, Canada and the US use multiple units of fossil-fuel energy to produce one energy unit of food. Energy consumption will therefore increase in the near future, especially as the global middle class grows.</p>
<p>Then there’s climate change. Humanity has already exceeded global warming of 1°C this century, and will almost assuredly <a href="https://www.ipcc.ch/sr15/chapter/spm/">exceed 1.5 °C</a> between 2030 and 2052. Even if all nations party to the <a href="https://unfccc.int/process-and-meetings/the-paris-agreement/the-paris-agreement">Paris Agreement</a> ratify their commitments, warming would still reach between 2.6°C and 3.1°C by 2100.</p>
<figure class="align-center ">
<img alt="people walking on a crowded street" src="https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/364900/original/file-20201022-18-iwc4eu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The human population is set to reach 10 billion by 2050.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>The danger of political impotence</h2>
<p>Our paper found global policymaking falls far short of addressing these existential threats. Securing Earth’s future requires prudent, long-term decisions. However this is impeded by short-term interests, and an economic system that <a href="https://theconversation.com/piketty-challenges-us-to-consider-if-we-need-to-rein-in-wealth-inequality-67552">concentrates wealth among a few individuals</a>.</p>
<p>Right-wing populist leaders with <a href="https://www.nature.com/articles/d41586-018-07236-w">anti-environment agendas</a> are on the rise, and in many countries, environmental protest groups have been labelled “<a href="https://theconversation.com/extinction-rebellion-terror-threat-is-a-wake-up-call-for-how-the-state-treats-environmental-activism-129804">terrorists</a>”. Environmentalism has become weaponised as a political ideology, rather than properly viewed as a universal mode of self-preservation.</p>
<p>Financed <a href="https://theconversation.com/a-brief-history-of-fossil-fuelled-climate-denial-61273">disinformation campaigns</a>, such as those against climate action and <a href="http://alert-conservation.org/issues-research-highlights/2014/11/27/progress-in-the-battle-against-illegal-logging">forest protection</a>, protect short-term profits and claim meaningful environmental action is too costly – while ignoring the broader cost of not acting. By and large, it appears unlikely business investments <a href="https://www.un.org/press/en/2019/ecosoc6972.doc.htm">will shift at sufficient scale</a> to avoid environmental catastrophe.</p>
<h2>Changing course</h2>
<p>Fundamental change is required to avoid this ghastly future. Specifically, we and many others suggest: </p>
<ul>
<li><p><a href="https://theconversation.com/life-in-a-degrowth-economy-and-why-you-might-actually-enjoy-it-32224">abolishing</a> the goal of perpetual economic growth</p></li>
<li><p>revealing the true cost of products and activities by forcing those who damage the environment to pay for its restoration, such as through <a href="https://theconversation.com/carbon-pricing-works-the-largest-ever-study-puts-it-beyond-doubt-142034">carbon pricing</a></p></li>
<li><p>rapidly eliminating fossil fuels</p></li>
<li><p>regulating markets by curtailing monopolisation and limiting undue corporate influence on policy</p></li>
<li><p>reigning in corporate lobbying of political representatives</p></li>
<li><p>educating and <a href="https://www.ted.com/talks/katharine_wilkinson_how_empowering_women_and_girls_can_help_stop_global_warming">empowering women</a> across the globe, including giving them control over family planning.</p></li>
</ul>
<figure class="align-center ">
<img alt="A coal plant" src="https://images.theconversation.com/files/378465/original/file-20210113-15-6b1vqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378465/original/file-20210113-15-6b1vqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378465/original/file-20210113-15-6b1vqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378465/original/file-20210113-15-6b1vqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378465/original/file-20210113-15-6b1vqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378465/original/file-20210113-15-6b1vqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378465/original/file-20210113-15-6b1vqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The true cost of environmental damage should be borne by those responsible.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Don’t look away</h2>
<p>Many organisations and individuals are devoted to achieving these aims. However their messages have not sufficiently penetrated the policy, economic, political and academic realms to make much difference.</p>
<p>Failing to acknowledge the magnitude of problems facing humanity is not just naïve, it’s dangerous. And science has a big role to play here. </p>
<p>Scientists must not sugarcoat the overwhelming challenges ahead. Instead, they should <em>tell it like it is</em>. Anything else is at best misleading, and at worst potentially lethal for the human enterprise.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mass-extinctions-and-climate-change-why-the-speed-of-rising-greenhouse-gases-matters-56675">Mass extinctions and climate change: why the speed of rising greenhouse gases matters</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/153091/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Corey J. A. Bradshaw receives funding from the Australian Research Council. The Rockefeller Foundation provided funding for elements of this research via a Bellagio Writer's Fellowship to CJAB and PRE.</span></em></p><p class="fine-print"><em><span>Daniel T. Blumstein receives funding from the US National Science Foundation and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Paul Ehrlich does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Humanity is destroying Earth’s ability to support complex life. But coming to grips with the magnitude of the problem is hard, even for experts.Corey J. A. Bradshaw, Matthew Flinders Professor of Global Ecology and Models Theme Leader for the ARC Centre of Excellence for Australian Biodiversity and Heritage, Flinders UniversityDaniel T. Blumstein, Professor in the Department of Ecology and Evolutionary Biology and the Institute of the Environment and Sustainability, University of California, Los AngelesPaul Ehrlich, President, Center for Conservation Biology, Bing Professor of Population Studies, Stanford UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1345302020-04-28T12:11:21Z2020-04-28T12:11:21ZMeasuring maternal grief in Africa<figure><img src="https://images.theconversation.com/files/330839/original/file-20200427-145499-upbyfd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2295%2C1995&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In places where children die with tragic frequency, the collective grief of parents affects all society.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/sad-lonely-woman-depression-flying-hair-1471114553?irgwc=1&utm_medium=Affiliate&utm_campaign=Pixabay+GmbH&utm_source=44814&utm_term=https%3A%2F%2Fpixabay.com%2Fvectors%2Fsearch%2Fgrief%2520woman%2F">Mary Long/Shutterstock</a></span></figcaption></figure><p><em>The Research Brief is a short take on interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Most parents living in industrialized countries today reasonably presume that <a href="https://www.who.int/data/gho/publications/mdgs-sdgs">all their children will survive childhood</a>. </p>
<p>But child death remains woefully common in some parts of the world. A baby born in certain sub-Saharan African countries is roughly 20 times more likely to die in early childhood than a <a href="https://data.unicef.org/topic/child-survival/under-five-mortality/">baby born in North America or Western Europe</a>. </p>
<p>Our recent <a href="https://doi.org/10.1073/pnas.1907343117">study</a> measures the proportion of parents who’ve lost a child. Academic research on child death typically focuses on an individual child’s risk of death, so examining this tragedy from the perspective of parents is a new approach. </p>
<p>To determine how many parents have lost children, we used <a href="https://dhsprogram.com/">Demographic and Health Survey Program</a> <a href="https://www.statcompiler.com/en/">data</a> to track 30-year trends in 20 sub-Saharan African countries with the highest child mortality rates. These surveys have collected detailed reproductive histories from women for decades, allowing us to evaluate the experiences of mothers over time.</p>
<p>We found that <a href="https://www.pnas.org/content/pnas/suppl/2020/02/04/1907343117.DCSupplemental/pnas.1907343117.sapp.pdf">more than 20% of all young mothers</a> across West, Central, East and Southern Africa have lost a child under the age of 5, primarily due to infectious and waterborne diseases. Among older mothers aged 45 or higher, 25% to 50% have lost a young child. </p>
<p>Data from the West African countries of Mali, Liberia, and Nigeria, as well as from three southern and eastern African countries – Malawi, Rwanda and Uganda – is even more staggering. In those places, up to one in five mothers has suffered the death of two children. Some have lost more than two children. </p>
<h2>Why it matters</h2>
<p>The death of a child is an excruciating and enduring event that affects parents in lasting ways. </p>
<p>Bereaved parents have an <a href="https://doi.org/10.1177/0192513X07302728">elevated risk of depression, anxiety</a> and an <a href="https://jech.bmj.com/content/66/10/927.short">array of physical health problems</a>, from cardiovascular disease to early death. The stress of losing a child also <a href="https://link.springer.com/article/10.1007/s13524-019-00846-7">strains marriages</a>, leading to more conflict, intimate partner violence, divorce and abandonment. </p>
<p>Quantifying how many mothers have lost a child gives us a sense of these individual and collective strains in a given place. In our paper, which published in the <a href="https://www.jstor.org/journal/procnatiacadscie">Proceedings of the National Academy of Sciences</a> journal in February, we call this collective grief the parental “bereavement burden.” </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330443/original/file-20200424-163098-9tm4jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">High child mortality rates affect both women who’ve lost children and those expecting.</span>
<span class="attribution"><a class="source" href="http://shutterstock.7eer.net/c/44814/42119/1305?u=https%3A%2F%2Fwww.shutterstock.com%2Fen%2Fimage-photo%2Fid-730996924&subId1=image&subId2=list&subId3=nohits&sharedid=https%3A//pixabay.com/vectors/search/pregnant%2520woman%2520afro/">Vivid Vector/Shutterstock</a></span>
</figcaption>
</figure>
<p>That measure, in turn, tells us something important about the broader social context for all women. In places where infant and child death rates are high, the fear of losing a child is acute. Even women who have not lost a child worry that they will. </p>
<p>Maternal grief, in other words, is a shared phenomenon that affects how all women in a society navigate major life decisions.</p>
<p>For example, fertility researchers know that if mothers anticipate the loss of their own children – both current and future – they <a href="https://doi.org/10.1177/000312240607100206">will have more children</a>. <a href="https://theconversation.com/tanzanian-president-bluntly-attacks-contraception-saying-high-birth-rates-are-good-for-economy-103513">Using contraception</a> to plan for small families – <a href="https://theconversation.com/kenya-needs-a-new-plan-to-make-contraceptives-accessible-again-48470">assuming it is available</a> – is a luxury reserved for those who can reasonably think all the children they give birth to will survive.</p>
<h2>What still isn’t known</h2>
<p>In the shadows of the high child mortality rates are millions of grieving mothers who bear the personal, social and marital costs of a child’s death. </p>
<p>Yet this population receives very little scholarly or political attention. In some sub-Saharan African countries, that’s more than half of all women who are invisibly suffering the bereavement burden.</p>
<p>Our study illustrates the pressing need to understand the mother’s experience of child death and incorporate grief into a country’s public health considerations. </p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/134530/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In many sub-Saharan African countries, 20% of mothers have suffered the death of a child, a new study finds. In Mali, Liberia and Malawi, it’s common for mothers to lose two children.Emily Smith-Greenaway, Associate Professor of Sociology, USC Dornsife College of Letters, Arts and SciencesJenny Trinitapoli, Associate Professor of Sociology, University of ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1360882020-04-16T17:47:24Z2020-04-16T17:47:24ZCountries’ Covid-19 responses could debunk some myths around the ‘abortion pill’<figure><img src="https://images.theconversation.com/files/328047/original/file-20200415-153330-hbt7a6.jpg?ixlib=rb-1.1.0&rect=0%2C83%2C1550%2C946&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The "abortion pill" mifepristone. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/92599314@N00/46193282711">Robin Marty/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>With health-care facilities around the world overburdened by the Covid-19 pandemic, a number of countries have revised their abortion regulations. On March 27, <a href="https://www.imt.ie/uncategorised/telemedicine-abortion-consultations-permitted-health-minister-27-03-2020/">Ireland</a> authorised remote consultations for medical abortion through telemedicine. Self-administration of medical abortion pills has also been approved in <a href="https://www.bbc.com/news/newsbeat-52092131">England</a> and now women are allowed to take medical abortion pills at their homes. Most recently, in <a href="http://www.rfi.fr/en/france/20200411-france-extends-access-to-abortions-during-covid-19-pandemic">France</a>, the maximum delay for medical abortion at home has been extended from seven to nine weeks.</p>
<p>While coronavirus emergency has further hindered access to safe abortion in countries such as <a href="https://www.opendemocracy.net/en/5050/italy-access-abortion-during-covid/">Italy</a> and <a href="https://www.publico.es/sociedad/aborto-coronavirus-crisis-coronavirus-abortar-sea-dificil-e-inseguro.html?fbclid=IwAR1EsUGLHJkYxVF2QaI1sX-ZeyKF-uj2tjsT42Os6qztXCgWe5Mu0OamSW4">Spain</a>, elsewhere it also debunked some myths around abortion. Behind the recent regulations relaxing access to medical abortion and paving way to telemedicine, there has been, in fact, a significant work and pressure for so long.</p>
<p>According to the <a href="https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf">World Health Organization</a> (WHO), a medical abortion within first trimester can be controlled by women themselves and may take place at home. Studies have also shown that self-administration of medical abortion pills at home is <a href="https://scielosp.org/article/bwho/2011.v89n5/360-370/en/">well accepted and effective</a>, with 86-98% of women reporting satisfaction with the method and complete abortion achieved in 87-98% cases. Similarly, telemedicine abortion has also shown to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/30869829">highly acceptable to both women and providers</a>, revealing similar success rates and safety outcomes to in-person abortion care. Nonetheless, many countries do not allow remote consultations for abortion and not permit home-use of medical abortion pills.</p>
<h2>Reducing overregulation</h2>
<p>Medical abortion entails a non-surgical termination of a pregnancy that uses a combination of mifepristone and misoprostol tablets. Misoprostol was developed in the 1970s and has long been prescribed for the treatment of ulcers and other conditions; mifepristone (also known as RU-486) was developed in France in late 1980s. The pills have been proven to be highly effective in terminating undesired preganancies and have been registered as <a href="https://gynuity.org/resources/list-of-mifepristone-approvals">abortfacient drugs</a>.</p>
<p>Despite its effectiveness, medical abortion is still not allowed in many countries. Even in countries where medical abortion is practised, the pills remain <a href="https://www.nejm.org/doi/full/10.1056/NEJMsb1612526">overregulated</a>, as self-administration is not allowed and women are required to visit a medical facility to take the pill. For example, the US Food and Drug Administration maintains the label “REMS” (risk evaluation and mitigation strategy) for mifepristone, requiring the pill to be given by a certified prescriber at a <a href="https://www.self.com/story/fda-abortion-pill-restrictions">clinic or another healthcare facility</a>. In France, it is only sold to medical staff and women are required to swallow it in the <a href="http://base-donnees-publique.medicaments.gouv.fr/affichageDoc.php?specid=66422290&typedoc=N">presence of a doctor or another certified medical staff</a>. As a result, women cannot purchase the abortion pills at a drugstore or order it online.</p>
<p>In contrast, in an article presented at the 2016 National Abortion Federation Annual Meeting and published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMsb1612526"><em>New England Journal of Medecine</em></a> in 2017, a group of medical experts argued that abortion pills have low safety concerns and should become available in pharmacies on doctor’s prescription. Groups supporting womens’ rights have compared the abortion pill to others without the REMS label, <a href="https://www.womenonweb.org/en/page/561/is-an-abortion-with-pills-dangerous">such as Viagra</a>, and assert that “the abortion pill” is much safer, and thus should be easily accessible to women.</p>
<h2>Unburdening health-care systems and easing access</h2>
<p>Given that the Covid-19 emergency is pushing governments to strengthen their health-care systems and reconsider how care is delivered, telemedicine abortion, entailing remote consultations over the internet or phone, has considerable potential. It would not only ease the burden on medical staff and health-care facilities, but also to help women avoid the odds of contracting Covid-19. It has been shown that telemedicine abortion can help <a href="https://theconversation.com/is-the-future-of-abortion-online-110339">ensure access to safe abortion</a>, especially in places where women still have to negotiate through institutional obstacles and abortion stigma.</p>
<p>Although the new abortion regulations relaxing access to abortion pills are said to be a temporary response to the Covid-19 pandemic, they have the potential to change the terms and conditions of abortion access long-term.</p><img src="https://counter.theconversation.com/content/136088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazal Atay est membre de Women on Web International Foundation. </span></em></p>With healthcare facilities burned by the Covid-19 pandemic, some countries have eased access to the “abortion pills” mifepristone and misoprostol (RU-486), a change that could signal a long-term shift.Hazal Atay, Ph.D candidate, INSPIRE Marie Skłodowska-Curie Fellow, Sciences Po Licensed as Creative Commons – attribution, no derivatives.