It should be an occasion for celebration, this birth, a great excuse for a
gigantic party. Instead we can expect a round of hand-wringing and glumness more
suited to a funeral. Indeed, one US organisation engaged in the fight against
population growth, Zero Population Growth, has already dubbed this birthday the
“Y6B day”. The strangest thing of all about this joyless reaction is how few of
us will even bother to think it strange. What’s going on?

What’s going on is that for the past few decades we have had it drummed into
our heads that we are on the brink of a devastating population explosion. Women
in poor countries are having far too many babies, and unless they change their
ways, we are headed for a global shortage of food, water and jobs. Population
growth must be controlled at all costs.

It’s about time we saw the situation as it really is. Women worldwide are
having fewer babies, and have been doing so for some time.

So what is all the fuss about? Well, until a decade ago, forecasters believed
that the world’s population would hit 12 billion during the next century. Now
world population is expected to stabilise at under 9 billion, and most experts
think that fertility rates are unlikely to rise again
(New ĐÓ°ÉÔ­´´, 2 October, p 20).
Rather than picking up pace, the population explosion is
starting to fizzle out.

How should we adjust to the new reality and acknowledge that the population
bomb is not primed to go off? A good start would be to wind up the UN Population
Fund (UNFPA), the organisation behind next week’s special day, because as long
as it exists we will continue to see people—and their babies—as a
problem.

Winding down

Some of the credit for the slowdown in population growth rates should go to
the UNFPA. But to that effect, officials should recognise that its job is done.
Population controllers have become a victim of their own success. They should
either bow out, or, alternatively, slim down the UNFPA, redefine its goals and
stop seeing the doling out of condoms to control birth rates as an end in
itself.

To a certain extent, this has already happened. The agency’s budget is
falling, and it has begun to take more interest in promoting education, the
empowerment of women and access to reproductive healthcare as well as poverty
and environmental issues. It even sends emergency obstetric teams to war zones,
such as Kosovo, and to disaster areas, such as earthquake-stricken areas in
Turkey.

But the UN already has a specialist health agency. It is called the World
Health Organization. Similarly, it has other agencies that look after children,
promote education, fund development and help countries protect their
environment. Should the global taxpayer fund the UNFPA for activities that are
better covered by other UN agencies. The answer must surely be, no.

Last month, the UNFPA launched its latest world population report, 6
Billion: A Time for Choices (see www.unfpa.org). One of these
choices should be the winding up of the UNFPA itself.

What happens, of course, is that we all lose out. The victim group phenomenon
began in the US but is now spreading—and hard-headed evidence counts for
little in the face of the emotions it unleashes.

Take the case of Norplant. Almost from the moment the Pill popped out of
labs, family planning experts were dreaming of the next revolution. Women could
easily forget to take the Pill. What was needed was a “fit and forget”
contraceptive. Enter Norplant, with its six matchstick-sized capsules that sit
under the skin of the inside arm. It’s benefited millions of women worldwide and
is now available in nearly 60 other countries. But if you want to get this
implant in Britain, be quick, for in October it will vanish from clinics.

When Norplant was launched in Britain six years ago, it had been under
clinical assessment since the 1960s, its pros and cons detailed in some 400
papers. In the first year, some 34 000 British women switched to it. The only
complaints came from women who couldn’t get the implant because their health
authorities were too stingy to provide it.

But the honeymoon was shortlived. Across the Atlantic, a lengthy damages case
against the makers of silicone breast implants had just netted the litigants a
small fortune, and lawyers were on the lookout for similar lucrative causes.
Norplant was an obvious target. “Will the lawyers kill off Norplant?” wondered
the headline writers of the New York Times in May 1995, after reports
that hundreds of American women had joined a lawsuit against Wyeth-Ayerst,
Norplant’s manufacturer. Their chief claim was that the procedure for removing
Norplant capsules was painful and could cause scarring, even nerve damage. Some
women also claimed to have experienced irregular bleeding.

A week later, a legal firm in Nottingham began the hunt for British “victims”
after one dissatisfied user took her story to the press. Like those of some of
the American women, Caroline Forster’s story was pretty awful. She spoke about
side effects such as heavy, continuous bleeding and shambolic attempts to remove
Norplant from her arm. Soon Forster, her lawyers and other women who claimed to
have suffered from the implant launched a Norplant Action Group.

The legal action had no chance of success and never reached the courts. Yes,
some of the women had suffered, and badly. But fact is that the Pill can also
cause problems. Since the implant works by releasing a progestogen hormone found
in many oral contraceptives, it was never going to be free from the risk of side
effects—as the distributors explained in the literature that a ccompanied
their product. And yes, not all doctors were competent at explaining those
risks, or at inserting and removing the capsules. But these were failings of the
healthcare system, not the technology.

In the US, adverse publicity scared women off using Norplant, but the implant
survived—just. In Britain, it was doomed because of the literally hundreds
of damning articles published in the media. Some had headlines that were just
about plausible (“High-tech birth control has ruined our sex lives”), others
were beyond parody (“New birth control made me a monster”). And throughout, key
scientific reports backing the implant were consistently ignored or pushed to
the background.

Lurid headlines

In 1998, for instance, the WHO, the American College of Obstetricians and
Gynaecologists, and Britain’s Family Planning Association issued a statement
recommending the implant as “safe and effective”.

The contraceptive faced other problems. Doctors were as bothered by a dispute
with health officials over the fees they would be paid to provide it as they
were about the fear of a litigious patient. But without the lurid headlines,
demand for the implant would have remained high.

So what’s to be learnt? From top professionals to the layest of lay people,
we all need better ways of getting independent information about technologies we
have to live with. But in a climate where governments and their watchdog
agencies are no more trusted than industry, it’s not obvious where that
information is going to come from.

As for the drugs companies and healthcare system, both sides could benefit
from making doubly sure that the medics know how everything works properly. In
the present climate of fear over new technologies, nobody can leave anything to
chance.

The victim-is-always-right mentality of the media is unlikely to change. But
maybe it will come to recognise that trashing a technology can also create
victims.

In this case, those victims are vulnerable teenagers in need of “fit and
forget ” contraception who have been scared off implants for good.