David Payne: It’s the economy, mum and dad

David Payne Should doctors advise people to limit the number of children they have for the sake of the environment, asks the latest bmj.com poll. Our decision to ask this question was triggered by a huge amount of weekend coverage of the editorial by John Guillebaud and Pip Hayes: Population growth and climate change.  Scotsman columnist Gerald Warner accuses doctors of being conscripted into the bogus “man-made” global warming hysteria who should stick to the day job instead of being missionaries for “progressive dogma.”

Lewis Page takes a similar line on www.theregister.co.uk. “Are babies really the same as patio heaters?” he asks, adding: “How would the doctors like it if barristers started handing out prescriptions, or accountants took to offering minor surgical operations? Maybe the docs should leave the eco advice to climate scientists or someone like that.”

But professions can and do wade into each other’s territory, of course. Just yesterday, Chief Rabbi Jonathan Sacks told Anglican bishops attending the Lambeth conference that religions should face the challenge of environmental disaster. I don’t read anybody urging him to stick to the day job and leave global warming to scientists and politicians.

I gleaned a sense of the reaction to the BMJ editorial before I left work on Friday evening when a colleague spotted Nicholas Lezard’s “No kidding, BMJ” blog in the Guardian.  Nicholas cited Homer Simpson’s lament: “I have three children and no money.  Why can’t I have no children and three money?”

But the editorialists weren’t advocating that people limit the number of children they have for economic reasons. Their argument is that there’s a clear link between world consumption of fossil fuels, fresh water, crops, fish and forests, and world population, (now standing at more than 6700 million).

Is it not worth looking at the economic argument for a moment? A survey last month found that the UK’s credit-crunched  parents could spend £186,032 on raising a child from birth to the age of 21, up by 33% in five years. And by 2012, it could increase by 42%, to more than £265,500. That’s presumably before you’ve even forked out family tickets for that year’s London Olympics.

The cost of raising children, or the environmental impact of having them, (perhaps both, in fact), may not be lost on modern UK Catholics. Forty years after the publication of Pope Paul VI’s Humanae Vitae  encyclical, it seems that lots of them are ignoring its ban on artificial birth control.

A survey of 1500 Mass-going Catholics in England and Wales for Catholic weekly The Tablet  finds that more than 60% of those aged between 18 and 45 have used condoms, and more than 42% have used the pill.

Instead of families now taking up a whole pew (not uncommon in the 60s and 70s), Tablet editor Catherine Pepinster writes that she now sees smaller, more affluent family units.

I personally find that rather sad. As the youngest of five, I know first hand the real-time soap opera that comes with having a batallion of brothers, sisters, in-laws past and present, nephews, nieces, and their offspring. I’ve never envied children with a paucity of siblings (although a bedroom of one’s own would have been nice), particularly when you have ageing parents to watch out for. When there’s more of you, you can share the load.

But back to the bmj.com poll, which is about the environmental, rather than economic cost, of having children. As I write it’s a close-run thing, with 53% saying that no, doctors should not be advising people to limit the number of children they have for the sake of the environment. Last night a similar figure thought the opposite. So don’t forgot to vote, after reading the editorial, of course.

David Payne is editor, bmj.com

  • Dorothy Crowther

    I don’t think there is any choice. We must try to do something about limiting the world population. If there is continued population growth we will all be doomed.
    This is not a new idea. When I was having my children in the late sixties I was told by several people that it was wrong to have more than two children because the world was overpopulated. We limited our family. Now I feel sad about the lack of grandchildren but I still think it was right.
    However I do feel that education for women is of supreme importance as well as access to contraceptives for all.

  • Francois Hugo

    The planet’s problem is human overpopulation.
    Population has tripled in the last 50 years.
    The effect on all resources; water, food and land is obvious.
    People generate greenhouse gases, global warming is exacerbating the effects.
    The answer is:
    Education about contraception methods,
    and when all else fails,
    available on request, free, worldwide.
    The alternative is:
    Chaos, leading to Death by Famine, Pestilence, and War.
    Francois Hugo

  • Dr.N.P.Viswanathan

    If we have a world war 3 it will bring more destruction,disaster
    Famine and disease will not bring down the population.
    Natural calamity will bring additional responsibility and
    rebuilding and we will have more orphan children As we have
    seen after earthquakes ,floods And psunami.
    I endorse the views of Dorothy Crowther.

  • Dear Francois, Dorothy and NP Viswanathan

    Just to let you know that we took the poll down today after a week, and it had 1122 votes, with 609 (54%) believing that doctors shouldn’t be advising people to limit the number of children they have, and 513 (46%), saying yes, they should. A colleague also alerted me to Frank Furedi’s Spiked online blog (Ignore this missive from our downbeat doctors).

  • At last this the population challenge out in the open. Regardless of old scenarios we have now changed the world in so many respects that we have to meet the serious unintended consequences as best we can.
    1) Citing the editorial:”Population control need not be coercive, — Half of pregnancies worldwide are unplanned. Simply by meeting women’s unmet contraceptive needs, several developing countries have halved their fertility rates. Clear evidence points to the demand for contraception increasing when it is available, accessible, and properly marketed.”
    2) The second major argument – not mentioned in your editorial – is the negative correlation between wealth and what number of children families want – anyway in many developing countries. So the fight against poverty may be of outmost importance in restricting the worlds population size. The rules of economic dealings must be adjusted so that securing food and service for individuals getting older no longer need to be based on plenty of children.
    3) Doctors can easily do a major job on issue 1) without being coercive. They may contribute like other citizens on issue 2). Well – – somewhat more because they see other results of poverty more often. So direct advices to individual should not be needed more than earlier?

  • Does anyone else find it ironic that the article in question appeared in the same print issue as an article about witnessing in court in which it was stressed how important it is for doctors not to give professional advice that goes beyond their area of competence?

    My area of competence is medicine. Not the environment. All I know about carbon footprints is what I’ve read in passing in a few popular articles. Surely there has to be more than that to what sounds like a big and complex subject? I certainly do not feel that I have any sort of detailed or in-depth knowledge or understanding of the problem, or that I would know enough to be aware of potential disadvantages to any advice I might give on the subject. I certainly would not want to take medical advice from an environmentalist whose understanding of medicine was as pop-culture and superficial as my understanding of environmental issues, and I would consider it out of line of such a person to try giving it.

    If I gave a patient advice on any medical subspecialties that went beyond my knowledge level, then it would be considered an inappropriate abuse of my authority as a doctor. Yet, for some reason, when it comes to giving advice on a completely different topic on which I have no formal training whatsoever, I’m being advised that I should go right ahead.

  • Anna

    Whilst I agree with the last comment re whether or not this is within our professional duty to advise, I feel strongly that as advocates for public health, it is clear that it is our duty as a profession as a whole (not as individuals) as climate change is undoubtably the greatest global public health threat.
    I was also brought up to believe in the 70s that having more than 2 children was essentially irresponsible. I am amazed by friends and colleagues who are evangelical about recyling yoghurt pots but have chosen to have 3 or more children.

    I have also contacted the BMJ to suggest that as per the Lancet’s policy, there could be a reduced rate “online only” subscription as, whilst it’s a good read, I do not feel that the amount of paper that the BMJ contributes to is acceptable. I have not yet received a response to this.