Josh Ruxin on Family Planning

Below, Josh Ruxin responds to the question:

The boundaries of science are continually expanding as scientists become increasingly integral to finding solutions for larger social issues, such as poverty, conflict, financial crises, etc. On what specific issue/problem do you feel we need to bring the scientific lens to bear?

There's no question that scientific progress can have a major social impact. However, the history of science suggests that the adoption of major breakthroughs, particularly to benefit the poor, can actually be an overwrought and lengthy process. Further, science tends to identify very specific solutions to individual problems--a vaccine, a water purification device, a surgical procedure--and these taken on their own may not provide the social impact desired. However, as projects and approaches emerge that make use of integrating multiple solutions, opportunities for real progress are bound to emerge. The key question is: What issue that can be solved with a scientific "fix" is the biggest constraint on human progress?

As a seasoned development worker I could point to a raft of issues, but there's certainly a standout: family planning. When you run your hand over the planet, it's evident that the poorest people continue to have the largest numbers of children, virtually ensuring perpetual poverty. Having too many kids places strain on the environment, weak public systems of education and health, and constrains women from realizing their potential in nearly every respect. Nearly two decades ago I worked on this issue in Bolivia where women constantly complained about the difficulties of being on the pill (their husbands threw it out when they discovered it), and in getting husbands to use condoms. As a result, it was nearly a weekly occurrence for a pregnant woman to have an "accident" falling off a horse or a roof onto her abdomen in a thinly veiled attempt to have an abortion. In Rwanda where I live, the average woman has about six children during her lifetime. Thanks to superb science-based solutions in health, chances are rapidly declining that any of those children will perish before reaching the age of five. That's the good news. The bad news is that simply producing an adequate amount of food on some of the smallest farms in Africa is becoming tougher and tougher. Furthermore, in Rwanda and other poor countries where women reproduce at these levels, birth itself often comes with a horrific death penalty: More than 500,000 women in the poorest countries die every year in childbirth.â¨â¨

The astonishing population growth rates, which seem to have no end in sight, are plaguing the infrastructure of the world's poorest countries. While interventions such as condoms, the pill, Jadelle (hormonal implants), Depo-Provera, and the IUD work well in industrialized settings, in developing countries due particularly to deeply-seated misogyny combined with low levels of access to health care (imagine resorting to visiting a clinic 10 miles away once every three months for a Depo-Provera shot to keep your husband from knowing you're avoiding pregnancy!), it's vital to expand available options. Scientists should be exploring other options, particularly contraceptive vaccines to prevent men from producing sperm and advancing the more challenging science that would offer women a similar effect for ovulation.