Women, Men and Population Worries

By Alexander Sanger

The recent simultaneous release of the census data from the United States and China has led commentators around the world to ponder causes and effects of declining rates of childbirth in these and other countries. This is not a new phenomenon – birth rates have been declining in the West for 200 years, long before the pill. More recent declines have occurred in many countries in the East and West, North and South, for decades as women have become more educated and modern contraception has become more available. In many countries of varying incomes, fertility rates are stubbornly below the replacement rate, presaging declining populations.

Commentators have focused on the economic effects of reduced work forces, leading to reduced economic growth, innovation and standards of living, and on the budgetary effects of aging populations (in Japan diapers for adults outsell those for babies) leading to pressures on pension schemes. 

Discussions about what is causing this phenomenon have looked at the emancipation and education of women and the rising costs of childbearing and the never-yet-lessened demands childbearing and child raising place on parents. Parenting, or non-parenting rather, can be seen as a rational economic and lifestyle choice – an either-or between career and personal fulfillment and happiness on one side and the cost (financial and otherwise) of children on the other. Childcare and housing and outstanding student loans are cited as the major deterrents. Women especially still, despite decades of advancement, bear the brunt of this unpalatable choice – old gender patterns and expectations lead to women performing most childcare and housework and sacrificing more career opportunities. Add in the economic insecurity brought on by COVID 19, and the decision to parent becomes even more fraught. As a result, infertility issues are increasing, in women and men, as couples delay childbearing. Couples are having fewer children than they say they want.

Looking at the other side of the fertility coin, teen pregnancies and childbearing have fallen drastically in the US. Teen childbearing rates have fallen since 1991, when there were 61.8 births per 1000 teens. In 2020, the rate was 15.3. Cross that item off the culture war list. 

China had a long-term decline in adolescent childbearing (and marriage) in the late 20th Century but has seen a recent rebound in both in some rural provinces. The reasons for this rebound include the gender imbalance (more males in each age cohort than females due to the One-Child Policy), resulting in an imbalance in the marriage market and in males resorting to various strategies to land a bride as early as possible, including paying a bride price and finding younger brides. Rural girls are at greater risk for early marriage due to lower education levels, lack of opportunity and persistent traditional culture and gender norms.

Foregoing early childbearing leads to reduced overall childbearing – many women simply don’t catch up and have the number of children they want. The percent of women in the US age 30-34 who are childless rose from 26% in 2006 to 33% in 2018. Looking at US women age 40-44, in 1980, 90% were mothers; in 2006, 80% were mothers and in 2018, 86% were mothers. 

The New York Times on June 18, 2021 published a front-page story by Sabrina Tavernise and three others about women in the US delaying motherhood. Some of the above factors were discussed. Delaying childbearing was found more pronounced in areas with good economic prospects for women. Women there have more incentive to wait.

But the Times left out a few things. 

There was no mention of men. Are men delaying fatherhood like women are? Is taking two to tango a 20thCentury phenomenon not worthy of discussion in today’s climate? I remember an unmarried woman with no children in her 30s in a rural community saying to me a few years ago when I asked her about her romantic prospects, “there are no eligible men.” There were men in this community, it seemed as many men as women, but none measured up to her standards. She moved afield to find a mate. 

If we look at delayed motherhood, we must perforce look at the entire mating system including fatherhood – couples meeting, mating, sex, contraception, abortion, childbirth and child rearing. 

Are men and women in the US partnering or marrying at less rates? Yes. For all US men and women ages 18-34, in 2004, 33% had no steady romantic partner, whereas in 2016, it was 45%.

There are similar figures for adults under age 35 who are not living with a spouse or partner: in 2007 it was 56% and in 2017 it rose to 61%. In many instances, women are not, and cannot, rely on a male for support, hence they make their own career. In China, one report states that 15 million more adults lived alone in 2021 than in 2018. They are termed ‘empty nest youth’.

How about sexual activity? Quite a male/female difference. For men age 18-24 in 2000-2, 19% reported no sexual activity for the preceding year. In 2016-8, it rose to 31% of males. 

For women of the same ages in the same time periods, the rate rose from 15% to 19%. Quite a difference in reported sexual activity with far more males than females reporting none. 

Accurate figures in China are harder to come by. One survey in China found that during Covid, 53% of men and 30% of women had fewer sexual partners during Covid, and 40% of males and 32% of females reported less sexual activity. A similar gender gap as the US. 

What is going on with men and women and the mating system? 

Sex is down, pregnancies (intended and unintended) are down, abortions are down, and childbearing is down. Declining pregnancies can be attributed to less sex and better contraception.  Surveys indicate that couples are contracepting more and using better methods, including LARCS, Long-Acting Reversible Contraception. In China, contraception is harder to come by for adolescents but freely available to adults, including the long-acting methods. 

Are some sex differences at play here? The figure of men having less sex than women begs for an explanation. Are men fearful of approaching women, of dating, of initiating sex? Are women choosing more rigorously? Are more men not making the cut? Hence women having more sex with a smaller pool of eligible males?

Here we see individual choices ending up collectively driving governments batty. We have individual choices in two totally disparate countries, US and China, leading to the same end result. What is the commonality, if any? As women advance economically and are more educated, are males perceived to be (or are) in decline? Are women pickier? 

What are governments to make of this? Is it their business when and how many offspring its citizens have (or how much sex they have)? And what, if anything, can they do about it?

It is a valid function of governments to enable its citizens to have the offspring they want, i.e., to be able to reproduce, and to have those offspring survive and in turn reproduce. To be able to reproduce means maintaining the essential reproductive biology, i.e., fertility, including preventing environmental damage to reproductive organs for starters. Other damage to fertility comes from age, lifestyle, i.e., drinking and obesity, and STIs. Is infertility on the rise? Declining sperm counts have been in the news, though a recent report counters this. No matter the cause, shouldn’t governments be subsidizing fertility treatments for the married and unmarried if they want its citizens to have more children? China prohibits single women from using infertility services.

Then there are social, economic and cultural factors that relate to mating, sexual activity, pregnancy, abortion, childbearing, childrearing decisions. Each would take a separate volume to discuss and are of vital importance. These factors are what are now called intersectionality but have been reproductive factors since time immemorial and determine individual reproductive strategies, each of which takes place in a certain environment. In the days before modern medicine (and still in too many countries), childbirth was a major killer of women. The rates and risk were (and are) determined by such factors as race, geography, poverty, education, family unit, in addition to childbirth services and medical care. 

To the extent lower childbearing is a decision subject to outside influence, what are governments’ responses? Last month in China, the government adopted a three-child policy, now permitting married couples to have three. The likely effect? Near zero, just like the adoption of the two-child policy was five years ago. No mention of a right of unmarried women to have three children, not that many would, because non-marital childbearing is a rarity in China, unlike the US and much of the rest of the Western world – it is about 40% in the US and 42% in the EU and 55% in Scandinavia. It is well over 50% in much of Latin America. Many or most are in non-marital consensual unions/partnerships. The rate is under 1% in India. The only constant is that birthrates are declining in all these countries whether the parents are married or unmarried. So, put aside subsidizing marriage as a “solution” to the declining birthrate issue. 

Likewise subsidizing childbirth. Various EU countries have tried a variety of approaches including subsidizing childcare, tax credits, parental leave etc. and the effect is marginal, though not nil. Germany had an uptick after expanding access to affordable childcare and providing parental leave but not a major one. The uptick may be one of timing to take advantage of the benefits not an uptick in total number of children. China has a two-week paid parental leave for fathers though few take it. A government purchasing its future citizens is, generally speaking, money wasted.

How about free education? The expense of educating children is often cited as a deterrent (as well as unpaid student loans). About 24 countries around the world provide free (or nearly free) university education – many are in the EU, which has stubbornly declining birth rates. Others include Malaysia (at 2.0 births per woman and falling), Brazil (1.7 and falling) and Kenya (3.5 and falling). 

To solve the government’s fiscal issues, some are raising the age of retirement (easier for office workers than laborers) and increasing taxes on a reduced workforce (few or none dare reduce pension benefits). 

Then we get to the nub. What has all this to do with women’s and men’s individual choices about childbearing? And really, do, or should rather, governments have say?

Look what happens when governments intrude. In China, the One Child Policy led to a gender imbalance. Its policy against Muslim childbearing is akin to genocide. In Romania in the 1980s, the ban on birth control and abortion resulted in a generation of women rendered infertile by botched abortions. Government fines on the childless is the next frontier. If a government can prohibit childbearing, then can’t it require it? China and used to prohibit pre-marital sex, as did most US states. Can states require procreative sex? What is the difference in terms of asserted government powers? Is the Handmaid’s Tale coming?

In the US, states are adopting the Romania strategy and are falling over each other to prohibit abortion, — see Mississippi and Texas – itching to overturn Roe v. Wade. And then overturning Griswold v. Connecticut, which legalized birth control. We see this push at the time the census shows a declining white population. We saw this in the mid-19th Century with white Protestants fighting back against immigrant Irish Catholics with the Know-Nothing Party to criminalize birth control and abortion so as to prevent the white Protestant women from using them. The Party also pushed to deny Irish the right to vote – the laws aiming to limit minority voting turnout and against immigration are nothing new. Tribal tensions and animosity are alive and well. 

What are women and men seeing when they think (consciously or subconsciously) about having children? In biology, there is the concept of reproductive strategy where each individual chooses, consciously or subconsciously, the timing and number of offspring to give them the best chance of survival and having offspring of their own. This includes choosing a mate. In many parts of the world, that means marriage. In much of the West, it doesn’t. The number of singles is on the rise in China. The sex ratio imbalance in China, that there are more men than women, is also a factor. Males have to compete more to attract a mate. Women can be choosier. What are they looking for: good genes, an equal partner, a provider, an equal helpmate in parenting – and … an apartment – the latest form of dowry. One commentator in China said, “housing prices are still the best sterilization tool.” Long work hours are a deterrent to men taking on more housework and childcare (the Times recently had an article on unmarried men in China choosing vasectomies). Long work hours for women and lack of affordable child care are also a deterrent to motherhood, as the Times also pointed out. The gender imbalance is alive and well—look at women being penalized more in COVID than men.  What in the US we call “intersectionality” is profoundly important to “solving” the problem – gender, discrimination, economic and social factors, all weigh in on individual lives and choices.

What we see are individual reproductive strategies at odds with national childbearing goals. 

Pennsylvania Ballet a Disgrace

The Pennsylvania Ballet announced their upcoming digital season a few days ago. The season is dedicated to their founder, Barbara Weisberger, who died in December. One might have thought that the company would feature ballets choreographed by women in her honor.

Nope. Not one.

Eleven choreographers. All male.

Men 11 – Women 0.

What were they thinking? Clearly they weren’t thinking.

What a lost opportunity to salute their female founder. What a kick in the face to women creators in ballet.

What are the women (and the good men) on the company’s board thinking? Are they going to let the male director get away with this?

Time for a reckoning.

See: https://paballet.org/spring-2021/

Reinventing the American Orchestra

Anthony Tommasini wrote an article in The New York Times this week (https://www.nytimes.com/2021/02/12/arts/music/american-orchestra-classical-music.html) on how orchestras need to reinvent themselves in our nation’s new environment. Scant mention was made of female composers, living and dead, being part of the solution – with only one mention of the New York Philharmonic’s Project 19, which commissioned works from 19 female composers, many of color.

It is no secret that under 3% (or 2% I’ve also heard) of music played by symphony orchestras in this country are written by women. The same is true worldwide. A huge percentage is by Beethoven, Mozart and Bach. A modern composer can mean Rachmaninoff who died in 1943. Commendable efforts are sputtering along to find African-American composers to play. The go-to African-American female composer last season has been Florence Price, who died in 1953.

As always, smaller ensembles, and venues like National Sawdust, are way ahead in this regard and didn’t need our national reckoning with race to spur their efforts at diversifying whose music gets played and who plays it. Why doesn’t every orchestra (and opera company) have a smaller ensemble that plays new music in different venues? The New York Phil Bandwagon was a great start, giving concerts in New York neighborhoods, including new commissioned works. Co-commissioning new works by living composers, male and female, of all ethnicities, can be a bridge to building community and understanding and new audiences. And it can spread the costs of a commission among several orchestras, while giving greater exposure to a new work that too often get a premier and die.

Orchestras need, like baseball teams, to build the farm system. They need to sponsor younger composers right out of conservatory, provide composer-in-residencies that would pair a young untried composer with a more experienced one and do repeated readings of their works so that the composer can get feedback and refine their compositions. And make recordings so that the new works can get greater exposure.

All it takes is vision, and will, and, yes, money. But the payoff can be multiples of the investment.

Glimmers of Hope

The newspapers reported last week that some Republicans are resigning from their party out of disgust with Trump and Trumpism. This is a mistake. It leaves the party in the hands of the fanatics. The sensible Republicans should stay and fight for their party.

Reproductive rights are in the ascendancy in the Western Hemisphere. The momentum in Argentina, where abortion up to 14 weeks was decriminalized at the end of December, is spreading to Chile, where advocates are working to get sexual and reproductive rights in the new constitution and to Colombia, where efforts are underway to take abortion out of the criminal code. These coupled with the repeal of the Global Gag Rule signals that progress is not impossible if the will and activism are there.

At some point, Republicans who believe that the government should not be in the business of regulating, controlling and subjugating women will take back control of their party. Polls show that about half of Republicans support Roe v. Wade. It will take these sensible Republican women and men showing the fortitude that women and men in Argentina showed. Politicians will cave once they realize they won’t be re-elected. These women should not be resigning from the Republican Party in disgust; rather than should recruit others to take it back from Trump and his misogny.


Excerpted from The Guardian

Argentina has become the largest Latin American country to legalise abortion after its senate approved the historic law change by 38 votes in favour to 29 against, with one abstention.

The bill, which legalises terminations in the first 14 weeks of pregnancy, was approved by Argentina’s lower house earlier this month after being put to congress by the country’s leftwing president, Alberto Fernández.

“Safe, legal and free abortion is now law … Today we are a better society,” Fernández celebrated on Twitter after the result was confirmed.

Fernández has previously said that more than 3,000 women had died as a result of unsafe, underground abortions in Argentina since the return of democracy in 1983.

The landmark decision means Argentina becomes only the third South American country to permit elective abortions, alongside Uruguay, which decriminalised the practice in 2012, and Guyana, where it has been legal since 1995.

Cuba legalised the practice in 1965 while Mexico City and the Mexican state of Oaxaca also allow terminations.

Giselle Carino, an Argentinian feminist activist, said she believed the achievement in the home country of Pope Francis would reverberate across a region that is home to powerful Catholic and evangelical churches and some of the harshest abortion laws in the world.

In most countries, such as Brazil, abortions are only permitted in extremely limited circumstances such as rape or risk to the mother’s life, while in some, such as the Dominican Republic and El Salvador, they are banned altogether.

“I feel incredibly proud of what we’ve been able to achieve. This is a historic moment for the country, without a doubt,” said Carino, head of the International Planned Parenthood Federation, Western Hemisphere Region.

“It shows how, in spite of all the obstacles, change and progress are possible. Argentinian women and what’s happening right now will have an enormous impact on the region and the world,” Carino added, pointing to parallel struggles in Brazil, Chile and Colombia.

Colombian activists recently petitioned the constitutional court to remove abortion from the country’s criminal code while campaigners in Chile hope a new constitution might lead to expanded women’s rights.

In the region’s most populous nation, Brazil, activists are waiting for the supreme court to rule on a 2018 legal challenge that would decriminalise abortion in the first weeks of pregnancy.

Mariela Belski, Amnesty International’s executive director in Argentina, called the result “an inspiration to the Americas”.

“Argentina has sent a strong message of hope to our entire continent: that we can change course against the criminalisation of abortion and against clandestine abortions, which pose serious risks to the health and lives of millions of people.”

Carino said the leftward political shift that brought Fernández to power had undoubtedly boosted the pro-choice campaign after the previous year’s setback. Among those who helped Fernández win office were many young women who took part in the #NiUnaMenos protests and were voting for the first time.

Carino said the real credit lay with Argentina’s indefatigable women “who never stopped occupying the streets and the social networks – not even against the backdrop of the pandemic – and kept up their struggle, without haste but without rest”.

“If anything made the difference, it was this.”


A Tribute to Mary Lindsay

By Alexander Sanger

Mary Lindsay, former board chair of Planned Parenthood of New York City and hence my one-time boss, died on October 4, 2020 at age 100.

Not just indominable, she was unfailingly kind, thoughtful and gracious. As a leader at PPNYC, she was universally respected by her colleagues on the board and the staff. Being a nurse, she cared deeply about how we treated our clients and would walk through the clinics with an eagle eye open and her mouth shut, saving her comments for when we were alone. She knew the role of the board and that of the staff and would behave and lead accordingly. But for term limits, she would have been PPNYC’s board chair for decades.

Generous to PPNYC, she inspired her fellow board members and friends to be as generous as they could, again leading led by example. She chaired at least two capital campaigns, made the lead gifts and then solicited her friends to join her. She was inspiring for our common vision, and friends could not resist Mary’s call to be a part of building something larger than themselves. “I have learned it is a wonderful thing to have people give their money to something they believe in,” she once said. “I have also learned that if you do not ask for it, someone else is going to, and so you had better get there first.”

And coming from Republican stock, though she had become a Democrat, she was invaluable in lobbying and cajoling politicians and donors from the Republican side of the aisle and insured that the staff be nonpartisan in our communications, when it was so tempting to be otherwise. She joined with P.L. Harrison, Barbara Mosbacher and Barbara Gimbel, of the New York State Republican Family Committee, to lobby in Albany for family planning and abortion rights.

She came to PPNYC from the board of the Margaret Sanger Research Bureau, where she had first volunteered as a nurse and then became board chair after my father stepped down, and where she helped that organization merge into PPNYC. She and my father worked closely together and had immense respect for each other. She worked with PPNYC to incorporate the training of doctors and nurses from around the world in family planning into our clinical practice. This program, called the Margaret Sanger Center, brought the best in family planning training to practitioners serving the most needy women and men in the Third World. Mary loved to travel with PPNYC’s education staff, Peter Purdy, Shirley Oliver and Errol Alexis, to view and evaluate our far flung programs around the world.

Below is the list of the board and advisors of the Margaret Sanger Research Bureau before Mary became chair. 

The MSRB board was a distinguished and powerful group: women like Charlton Phelps, Helen Edey, Emily Workum and Jane Canfield worked alongside the equally powerful men: Alan Guttmacher, M.D., Henry Clay Frick, M.D., Christopher Tietze, M.D. and George Zeidenstein. Mary led them all as board chair, a tribute to her leadership and diplomatic skills, as physicians were not especially known at that time for their high opinion of nurses.
Mary and I travelled to Cairo in 1994 for the UN International Conference on Population and Development where, among other things, we appeared on a panel together on how to advocate for reproductive rights in different cultures. With us on the panel were the Health Minister of the Philippines, Juan Flavier, and from Egypt, Aziza Hussein, a leading women’s rights advocate. I spoke about PPNYC’s subway advertising campaign and Mary spoke about how she lobbied Republicans and Democrats in Albany and Washington. We stunned our fellow panelists with our forthrightness about sex – Juan Flavier had been condemned from the pulpit by Cardinal Sin of the Philippines for his advocacy of condom use to prevent HIV transmission, and Aziza Hussein spoke of how she had to avoid mentioning sex when advocating for family planning in Egypt, instead advocating for child spacing. 

Juan Flavier, Mary, Aziza Hussein, Alex Sanger
Mary speaking in Cairo

On the day after our panel, at Mary’s instigation, she and I, accompanied by Peter Purdy, the PPNYC Vice President for International Affairs and his wife, Susan, along with Peggy Kerry, a PPNYC advisor and sister of Senator John Kerry who was at the Conference, took a dawn horseback ride to the Sphinx and Pyramids. We had the desert to ourselves. No one of the other 20,000 delegates had the imagination or gumption to organize this mad venture. We rode across the desert in a gallop and saw the sun rise over the Pyramids as the day warmed. It was an experience we never forgot. 

Mary is second from left

Mary was most interested in, as she said, “the rights of women and men to make the decision of when and whether to have a child.” She dedicated so much to make that a reality.

She said: “I cannot separate freedom of choice from family planning and abortion. It seems to me that you have got to be able to make your own decision about having a child, or not having a child.  And, if for whatever reason, you become pregnant and you do not want to be, the option to have an abortion should be available.  The same is true of contraception. From the time someone is fertile, that someone should be able to manage their fertility. I think it is as simple as that. That is not only an issue about women, but about the children that are brought into the world that is so important to me.” 


IPPF/WHR Statement on Separation from the Global IPPF – August 5, 2020

For more than 60 years, IPPF/WHR has worked as an independent organization alongside the International Planned Parenthood Federation to secure sexual and reproductive health and rights for women and girls in the Americas and the Caribbean.

We are proud of what we have accomplished together over the decades, but we believe that our movement has reached a crossroads – and that separating from the global Federation is the best way to fulfill our organization’s mission.

More than a year ago, we initiated a process of reflection, rejecting the patriarchal and colonial legacies of the past, and reimagining the WHR through the lens of intersectional feminism. We reinvented our business and funding models to address shortfalls from IPPF’s funding structure, and we reformed our organizational structure to ensure that women and girls are at the center of our new horizontal partner model of cooperation. These reforms positioned us to meet the serious challenges of the COVID-19 global pandemic.

This is a unique historical moment in Latin America and the Caribbean, one in which civil society is openly rejecting patriarchal systems of oppression. IPPF/WHR is excited to embrace and work alongside a new generation of community leaders fighting for equity and social justice.

We are confident that our decision to separate from the global Federation will enable us to better deliver on the kind of change that is needed to support women, girls, and the underserved communities across our region. And we will do so with good governance, transparency and accountability to our donors and to the women and girls we serve.

Today, as an independent organization, we are more committed than ever to securing sexual and reproductive health and rights for all women and girls in Latin America and the Caribbean. We are excited to embark on this new chapter and look forward to working with you as a partner in this journey.