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Posted on August 2, 2019 at 12:51 AM

This week’s New England Journal of Medicine (NEJM) carries
an
opinion piece
(subscription required) pressing the concern that
human-caused climate change should prompt a concerted effort to develop new
methods of contraception and increase the ready availability of all forms of
contraception worldwide.  About 222
million women in the lowest-income countries need family planning services, the
author says.  About 40% of pregnancies (80
million out of a worldwide annual total of 210 million) are unintended, with
similar rates in higher- and lower-income nations, it is said.  Past Malthusian fears about overpopulation
had subsided with improved agriculture and a leveling, or even declining,
fertility rate in many countries, but that appears now to have created a false
sense of security, because the world’s population continues to grow, global
warming and resource depletion are threatening sustainability of the ecosystem,
and “naturalists” warn that half of all species living today may be
extinct by 2100 because of human activity. 
While the number of people the earth can support has been estimated at
between 2 and 100 billion, the author prefers a more conservative “modern
estimate” of 1.5 to 5 billion, as opposed to the current 7.7 billion.

Leaving aside the question of why the earth’s carrying
capacity is a proper topic within the purview of the NEJM, the author says that
currently available contraception is inadequate.  Sterilization “is not suitable” for
people who want to have children, hormonal methods have side effects, and
barrier methods are not reliably used. 
(In case the reader wonders, abortion is not listed.)  Moreover, side effects notwithstanding,
needing a prescription for much contraception limits availability and increases
costs.  Development of newer methods,
including some that would also protect against sexually transmitted diseases,
could meet a large need, limit population “growth,” and have the
further advantage of giving people more choices.

Unless one is fundamentally opposed to contraception on moral grounds, these suggestions may seem attractive on the surface.  Better, effective, preferably reversible, affordable, widely available, low-risk contraception would be welcomed by most people.  But the primary aim of this particular piece does not seem to be the well-being of individuals, but limiting the number of them overall.  One might object that pursuing limits on population is an invitation to tyranny, just in more sophisticated forms than one-child policies or forced sterilization.  One could not trust full reproductive freedom to “limit the excess population,” as Ebenezer Scrooge famously advocated.  Rather, controls would have to be instituted on who could have children, how many, and under what circumstances, not to mention trying to control what sort of people are brought into the world.  I do not think this is a farfetched concern.  After all, the NEJM writer thinks there are too many people already.  Might not someone (someone else, not the writer of the piece in question) think that some culling would be for the good of the ecosphere overall?  Getting back down to 5 billion from 7.7 billion would be a reduction of about 35%–an apocalyptic figure, to be sure.  I must confess that it would not entirely surprise me to see a future NEJM piece addressing population reduction.

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