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Editorial DECEMBER 2009

The Environment, Global Warming, and the ObGyn: Revisited

Ronald T. Burkman, MD

In the May 2008 edition of The Female Patient I discussed some of the issues related to global warming and the environment.1 I pointed out that many of our major rivers have their water consumed to the extent that the rivers never reach the ocean, and that in the next few decades, the polar ice cap may exist only in winter, endangering species such as the polar bear. I also noted that the world’s urban population is growing rapidly, pressuring less-developed countries to increase their housing, food supply, and education resources to support this growth.

These issues were highlighted in recent articles published in the Lancet.2,3 The authors point out that this year is the 15th anniversary of the 1994 International Conference on Population and Development (ICPD) in Cairo, Egypt. The ICPD was perhaps the first large international conference to focus attention not only on population growth but also reproductive rights. The authors note that despite some progress, there has been a substantial lack of both political and financial investment in the goals of the conference.

For example, individuals between the ages of 10 and 25 account for 1.5 billion of the world’s population and are the group most in need of adequate reproductive services. Yet more than 200 million women lack access to contraception, and the demand for contraception is likely to increase markedly in the near future. In addition, more than 500,000 women die annually in pregnancy or childbirth, and approximately 76 million unintended pregnancies occur each year. The vast majority of individuals most at risk and in need reside in developing countries, which often lack the resources to effectively deal with these problems.

Of further interest is that climate change and the role of population growth are now being more formally addressed. In a report by the London School of Economics briefly discussed in the September Lancet editorial, it was pointed out that addressing the global unmet need in family planning would have a substantial impact on carbon emissions. According to their statistical model, for each $7 spent on family planning over the next 40 years, global carbon dioxide emissions would be reduced by more than 1 ton.4

To tackle these issues, the world will need to again address the goals of the ICPD. Unfortunately, as noted in a 2008 presentation to the United Nations, there is still substantial bias in many countries relative to the rights of women and children.5 For example, there can be political bias that is counter to the rights of women, because resources are often controlled by men. Similarly, there often is age bias, with more resources being devoted to adults than children. Finally, there is almost always bias in favor of persons as opposed to the unborn fetus, an issue that is clearly challenging in selected circumstances.

Ultimately, resources should be allocated on the basis of justice, not only within countries but ideally across the world as well. Clearly, we are a long way from fully realizing this principle of justice and from meeting the 15-year old goals of the 1994 ICPD in Cairo. It would be a great step forward if the leaders of the world, particularly in the “have” countries, would step up to meet these challenges.

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Ronald T. Burkman, MD, Editor-in-Chief

References

1. Burkman R. The environment, global warming, and the obstetrician-gynecologist. Female Patient. 2008;33(5):17-18.
2. Greer G, Chau K, Hinz C, Thanenthiran S. Sex, rights, and politics—from Cairo to Berlin. Lancet. 2009;374(9691):674-675.
3. Sexual and reproductive health and climate change [editorial]. Lancet. 2009; 374 (9694):949.
4. Wire T. Fewer emitters, lower emissions, less cost: reducing future carbon emissions by investing in family planning. Optimum Population Trust; August 2009. Available at: www.optimumpopulation.org/reducing emissions.pdf. Accessed October 15, 2009.
5. Chervenak FA, McCullough LB; International Academy of Perinatal Medicine. Women and children first—or last? The New York Declaration. Am J Obstet Gynecol. 2009;201(4):335.