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Editorial MAY 2008

The Environment, Global Warming, and the Obstetrician-Gynecologist

Ronald T. Burkman, MD

During the past few months, there has been an increasing focus on various environmental issues, especially those related to global warming. Even the presidential candidates have expressed their views on the topic. Yet there seems to be little recognition that we need to be in a crisis mode if we are going to avoid an ecological disaster. Here are only a few of the sobering statistics from the United Nations and other sources to consider.

Let us first look at the world’s water supply. Five major rivers including the Nile, Yellow, and Colorado no longer reach the ocean; 70 more rivers are likely to achieve the same status soon. The reason? The water is used up for consumption and irrigation before it reaches the ocean. Yet, 1.1 billion of the world’s population (about 17%) consumes unclean water. Further, 90% to 95% of all sewage and 70% of industrial wastes are dumped untreated into surface waters. It is estimated that by 2030, the polar ice cap will be present only in winter and polar bears are likely to exist only in zoos.

What about carbon emissions? During the past 50 years, the planet’s forest cover has declined by 50% and carbon dioxide emissions have increased by more than 30%. Across the world, 1.5 billion people are cutting firewood faster than the trees can grow back. A March 2008 series on China on National Public Radio indicated that China has replaced the United States as the world’s largest contributor to carbon emissions. In Beijing, several thousand additional cars are introduced each month onto the highways, further adding to the city’s carbon emissions.

In 2007, half of the world’s population was urban (about 3.2 billion people) and the statistic is likely to increase with time, a situation that will further contribute to global warming.

So what does all this have to do with obstetrics and gynecology?

As elegantly stated recently in an editorial by Speidel and Grossman; “—little attention is paid to the connection between these tragedies and their most fundamental cause: overuse of the planet’s resources due to the large and still rapidly increasing numbers of humans and our excessive consumption.” Accounting for life expectancy, for the decade ending 2015, an estimated 750 million people will be added to the world’s population, or more than 200 000 humans per day. The vast majority of this population growth is in developing countries. Some of the projected growth seems staggering. For example, between 2007 and 2050, India’s population may grow from about 1.1 billion to 1.7 billion people; Bangladesh’s from 149 million to 231 million people; and Pakistan’s from 169 million to 295 million people.

Much of this growth will be difficult to sustain economically and will likely lead to additional unrest in the world. Not all of these children are wanted, a problem that is not confined to the developing world. For example, in the United States, roughly half of pregnancies are unplanned or unwanted; yet, about half of these result in birth, a statistic that has not substantially changed during the past 2 decades. It is also estimated that more than 200 million women in developing countries would like to delay further childbearing.

One obvious strategy to deal with this crisis is to not only increase the accessibility of family planning services worldwide, but also to reduce the discontinuation rates of the available methods and the side effects that also contribute to discontinuation. To be successful in this endeavor, substantial sums of money will need to be invested to improve availability of contraceptive methods through more robust family planning services, both here and abroad. In addition, improved contraception methods need to be developed through comprehensive research.

In short, the field of obstetrics and gynecology will need to play a key role in contraceptive development and program development in order to deal with this growing crisis. Obviously an additional strategy is to motivate people and companies to voluntarily consume less and be more environmentally conscious—eg to think “Green”—a strategy that unfortunately has had only modest success so far in the United States. Similarly, we hope we can rely on individuals to make appropriate decisions regarding family size. However, if such voluntary efforts fail and the environmental effects become more severe, we run the risk that more draconian measures will need to be undertaken to deal with this crisis.

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Ronald T. Burkman, MD, Associate Editor

Sources

1. The INFO Project. Population reports. Series L. www.infoforhealth.org/pr.
2. Sierra Club. Published 2007. www.sierraclub.org.
3. Speidel JJ, Grossman RA. Family planning and access to safe and legal abortion are vital to safeguard the environment. Contraception. 2007;76(6):415-417.
4. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2006 Revision. www.un.org/esa/population/publications/wpp2006/wpp2006.htm.
5. National Snow and Ice Center. http://nsidc.org.