Burden of Billions

Burden of Billions

Cal global health experts break the silence on population growth.

On July 11—World Population Day—the United Nations will mark the date that, 22 years ago, the earth’s population first exceeded 5 billion. Today, the number has increased to 6.8 billion, with no signs that growth will ever slow. Yet for the past 40 years, an uncomfortable silence seems to have replaced a once-lively discussion of population growth and its relationship to the long-term future of humankind.

Now, though, the tide may be turning—with prominent U.C. Berkeley policy leaders Malcolm Potts and Martha Campbell, who have a lifetime of global health work (not to mention a marriage certificate) between them, at the forefront of a resurgent international effort to place slowing population growth back on the mainstream agenda.

“We are very hopeful and optimistic people—we want to change the world,” says Potts, an energetic and eloquent speaker described by Campbell as “74 going on 47.”

Since 1992, Potts, the former medical director of the International Planned Parenthood Federation, has headed the Bixby Center for Population, Health, and Sustainability, a research institute at the U.C. Berkeley School of Public Health. Campbell, the former director of the population program at the David and Lucile Packard Foundation and a lecturer at the U.C. Berkeley School of Public Health, founded and serves as president of an eight-year-old Berkeley-based nonprofit, Venture Strategies for Health and Development. Working closely with the Bixby Center, Venture Strategies funds and implements family planning and health programs around the world.

So it was good news for the couple when, last January, Cal’s School of Public Health received a $15 million gift from the Fred H. Bixby Foundation, allowing a significant expansion of the existing Bixby program. (The schools of public health at UCLA and UCSF are also affiliated with Bixby programs, but the U.C. Berkeley center most consistently targets population growth as a crucial element in global public health.)

Guests at a reception celebrating the endowment included United Nations population experts, representatives from the Bill & Melinda Gates Foundation, and public health policy advocates from Africa and China. Over the next several days, the prestigious invitees would participate in a cutting-edge international forum on “The World in 2050,” co-sponsored by the three Bixby programs. In a voice filled with conviction, the British-born Potts described the mission of the Bixby Center to explore and draw attention to links between global population growth and the environment, economic stability, public health, education, and violent conflicts. To many around the world, the topic of population growth remains contentious, but among those who heard Potts speak that winter night, the excitement was palpable.

Love’s labor: Husband-and-wife team Malcolm Potts and Martha Campbell promote non-coercive family planning around the globe. Photo by Peg Skorpinski.

For some, it may have been reminiscent of an era when population growth was topic one on college campuses like U.C. Berkeley, and among circles of concerned citizens. In 1968, Stanford professor Paul Ehrlich’s The Population Bomb sparked fierce controversy, predicting that uncontrolled population growth would result in worldwide famine and starvation in the 1970s and ’80s. In short order, “Zero Population Growth” became a rallying cry. However, thanks to advances in food production most notably attributed to the “Green Revolution” (a term coined by former United States Agency for International Development director William Gaud to describe agricultural advances that increased crop yields), Ehrlich’s apocalyptic vision did not become a reality, at least not within the time frame he described. And over the years, voices once raised on the question of population growth and its link to global well-being grew quiet.


Campbell, 68, has dedicated much of her research and writing over the years to exploring “the perfect storm” of circumstances contributing to the silence. One, she says, families in developed countries are, in fact, having fewer children, so the effects of population growth are not as readily visible in places like the United States. Two, research about increasingly scarce resources tends to focus on how much we consume, but often overlooks the issue of population growth. Three, governments and international health agencies have prioritized the HIV/AIDS epidemic as a primary concern. Four, conservative religious and political groups have been influential in reducing funding for international family planning. And five, people mistakenly associate efforts to reduce unintended pregnancies with coercive family planning approaches, such as China’s one-child policy.

Of these factors, the latter concerns Potts and Campbell the most. “Women want smaller families,” Potts maintains. “If they are given the choice they will have fewer children. They will benefit, their countries will benefit. And in the end, this planet will benefit.”

“You don’t need to tell anyone to have fewer children, you just need to make it easier for them,” Campbell adds. Even in the United States, where women have more control over family size than in many other parts of the world, there is room for improvement. Citing barriers to family planning services such as high cost and lack of health insurance, Kate Bedford, the Bixby Center’s communication manager, points out that 50 percent of all pregnancies in the United States are unintended. That is a significant number, considering that, worldwide, only 40 percent of pregnancies are unplanned. In developed countries other than the United States, the number is considerably lower.


Potts’s decades of experience in the global family planning field provide numerous examples of a non-coercive approach. “I used to work in Iran under the old Shah, and they had a top-down family planning system”—in other words, a government-directed system—”which had no effect on population growth,” he says. But “under new leadership, family planning became a voluntary bottom-up effort, and religious leaders and people at the village level bought into it.” The result, according to Potts, was a dramatically declining birth rate that rivaled China’s.

Access to voluntary family planning doesn’t just improve lives, he asserts—it saves them. “One woman dies every minute either from childbirth or abortion around the world,” he says, “and 90 percent of those deaths are in the least developed countries.” Currently, the Bixby Center and Venture Strategies are collaborating to provide women in those countries with options for choosing family size—and improving their health. One major effort is to decrease the incidence of massive hemorrhage, one of the leading causes of deaths related to childbirth. The Bixby Center’s role is to research causes of maternal deaths and medical solutions; Venture Strategies follows up by working with pharmaceutical manufacturers, governments, and health experts throughout the world to make low-cost, high-quality, off-patent (or generic) medicines available to communities in need.

Interestingly, such health interventions don’t necessarily involve medical personnel. “One of the primary focuses at both the Bixby Center and Venture Strategies is shifting family planning and maternal health tasks normally associated with doctors and nurses, to people in villages in developing countries around the world,” says Potts. Citing the example of a powerful new anti-hemorrhagic drug, Potts says, “we can teach women to dose themselves and teach traditional birth attendants how to administer the drug to their patients.”

Campbell and Potts have reason for optimism these days. Shortly after his inauguration, President Obama lifted the Global Gag Rule, imposed by President Bush in 2001, which restricted U.S. family planning funding for international nongovernmental agencies. This move opens the door to increased financial support for voluntary family planning services and education worldwide.

Closer to home, both are heartened by the reaction of students who volunteered their time to the “World in 2050” forum. With backing from the Center, as well as the Sierra Club and Americans for Informed Democracy, the students founded Bixby Youth In Action to address the impact of rapid population growth. They plan to lobby Congress, work to improve access to family planning services worldwide, and offer classes on the U.C. Berkeley campus on the topic. In April, the youth group co-sponsored, with the Sierra Club, “Sex and Sustainability,” an art exhibit that examined the connection between population, poverty, and women’s lives via artwork by U.C. Berkeley students. A possible national tour is pending.


To understand why Potts and Campbell see jump-starting the population discussion as an urgent need, it is important to look at our current world population. Is 6.8 billion people too many? In 1968, when Ehrlich published his frightening book, there were only 3.5 billion of us. Current projections place the total number of humans on the planet by 2050 between 9 and 10 billion. Many experts believe that the earth’s environment could be sustained with a world population of about two billion people, notes Campbell. In any case, she continues, “There is no such thing as sustainable population growth—that is, growth that goes on forever.” Yet every day our planet experiences a net gain of about 200,000 people, which means thousands of babies are being born as you read this story.

Some might ask why it really matters how many people live on the planet. According to religious groups that, for moral or spiritual reasons, oppose artificially limiting family size, it doesn’t. Conservative think tanks such as the Cato Institute claim that population growth (a sign, they suggest, of decreasing global death rates) has been accommodated by improvements in food and energy production, or that money should be spent on health care for women and babies—rather than directed toward family planning programs.

Campbell and Potts disagree, saying that poverty is the one-word answer to that question. “When people have a lot of unintended pregnancies,” Potts explains, “then whole societies suffer—they are poorer, less healthy, and sometimes more violent.”

Rapid population growth, and high rates of unplanned pregnancies, the Berkeley couple asserts, can be linked with harm to the natural environment, lack of education, and poverty, but the links may not always be straightforward.

Take impact on the environment. “Population and global warming need to be separated because population growth is not the key cause of global warming,” says Campbell. Energy consumption levels, not human existence per se, raise carbon dioxide emissions, and the highest consumption rates are in America and Europe. Smaller populations in developed countries, therefore, have a larger carbon footprint than larger populations in developing countries. Nevertheless, says Campbell, it’s poor people who will suffer the most from global warming, partly because there will not be enough water to go around. Higher temperatures worldwide are drying up our fresh water supplies, but so are soaring numbers of thirsty people, she adds.

Violence is also exacerbated by population growth and unintended pregnancies, says Potts. In his 2008 book, Sex and War: How Biology Explains Warfare and Terrorism and Offers a Path to a Safer World, Potts provides a complex, compelling argument about the connection between population growth and the threat of terrorism and warfare. The current situation in Pakistan, embroiled in conflict with the Taliban, offers a case study, he says. “When a population grows so rapidly, as it is in Pakistan, that it outstrips the ability of the government to provide for basic needs such as food, health services, and education, religious groups step in to fill the void.” He points to the proliferation of Islamic madrassa schools, known for encouraging militant views toward the West. “For half a century, military analysts have pointed to a rapid population growth in certain countries as threatening global security,” Potts notes in Sex and War.

In Berkeley as elsewhere, World Population Day offers an excellent opportunity to ponder the future of our increasingly crowded planet. Potts and Campbell encourage individuals and groups to engage in discussion on this important topic, and are eager to speak to gatherings of 50 or more people. These two lifelong activists, whose blended family includes six children and four grandchildren, have no plans to ride into the golden sunset of retirement anytime soon. They believe their effort is too important—for the future of the planet, for the future of their family—to slow down now.

“The most important thing is to continue to work to remove terrible and unnecessary barriers to family planning, in the U.S. and around the world,” says Potts. “We want people to realize we live in a finite world, and that rapid population growth is harmful, but that it can be slowed in a way that respects human rights.”

Noelle Robbins is The Monthly’s health columnist.

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