Garth Rattray | Inhibitions to being fruitful and multiply – Part 1

Recently, there has been a lot of talk and concern about Jamaica’s falling fertility rate. Things have certainly changed. Several decades ago, we were experiencing a population boom. Our people were so productive that, sometime between 1973 and 1974, our National Family Planning Board vigorously coined the slogan, “Two is better than too many”. At that time, our birth rate was 4.5 children per woman.

Fast forward to 2023 to 2024, in just 50 years, our total fertility rate (TFR) has plummeted from 4.5 to between 1.3 and 1.9 births per woman. This translates to approximately 11.6 births per 1,000 people. We went from a baby boom to a baby recession. The number of Jamaican births per 1,000 population is way below the necessary replacement birth rate of 2.1 births per woman needed to retain a stable population. For the very first time, the number of babies being born is not enough to sustain our population from one generation to the next. Our numbers are dwindling.

The details are very revealing. Aside from the declining TFR over the decades, the rate was 21.7 per 1,000 at the turn of the century, and then, over the past 8 years, it has fallen by a whopping 24 percent. This, combined with our ageing population, is causing genuine concerns for the viability of our future workforce and, of course, for the impending negative impact on our economy.

Jamaica is certainly not unique, and we are not the worst. Several Caribbean nations, and countries and territories like Singapore, San Marino, China, Malta, Hong Kong (a Special Administrative Region – SAR), Taiwan, Macau (another SAR) have a TFR that is lower than Jamaica’s. South Korea has the world’s lowest TFR.

Experts are blaming our low TFR on several factors. The high cost of living, unaffordable childcare, high immigration rates, and infertility. Most people tend to assume that in infertile relationships, the woman is the problem. However, it may surprise many to learn that men are just as infertile as women.

When a couple is infertile, the female factor contributes about 30 per cent. The male factor contributes about the same 30 per cent. A combination of male and female factors contributes about 20 to 30 per cent, and in 10 to 30 per cent, unknown causes are to blame. Sometimes the female body perceives the male sperm as it would invading bacteria, hunts them down and destroys them.

I would like to suggest that, although contraception has been available for a long time and has become more varied and commonplace, the easy access to the termination of pregnancies (TOPs) is a contributor to our falling TFR. The highest users of TOPs are those women who find a particular pregnancy inconvenient. Sometimes they are not financially or emotionally prepared for the massive changes that a child brings into their lives. Sometimes they are not in a welcoming environment. Sometimes they are trying to achieve financial stability or to improve their education. Since they can’t hibernate the foetus until a more appropriate time, they terminate it.

TABOO TOPIC

This taboo topic is more at work in contributing to our low TFR than most people believe. Although TOP is illegal, it is estimated that many women are accessing them easily. During history taking, several women have told me that they have had multiple TOPs; one even told me that (up to that juncture) she had nine TOPs.

Society is mealy-mouthed and two-faced on this very vexing and controversial topic. I vividly recall that, one of our beauty queens [unintentionally] became pregnant during her reign. She bravely kept the pregnancy and relinquished her crown prematurely. Her decision to retain her pregnancy drew sharp criticisms. I was very happy and proud of her decision. Most women in her position would have decided differently to keep face, the crown, and all that goes with it. They would have quietly had a TOP, and none would be the wiser. Most women could not bear the pressure of the decision that she made.

There was a time when TOPs could only be performed surgically. The procedure was expensive and somewhat risky … sometimes resulting in emergency hospitalisation for severe haemorrhage, damage to the uterus (that sometimes resulted in a loss of the womb), infection (that can end up causing infertility, and even death), or emboli (that can end in severe illness or death).

Nowadays, TOPs are often simple to achieve with the use of a drug. In the late 1980s, a drug was developed that helped to prevent and treat ‘stomach’ ulcers from certain medications. Like several other drugs, it was found to have an ‘off label’ effect. This drug also affects the womb in such a way that it facilitates and initiates labour. Obstetricians sometimes use that drug to ‘ripen’ (soften and thin) the cervix and to initiate uterine contractions. However, that drug has come to be used frequently in TOPs. Some estimates are that its use for TOPs exceeds half of its overall use. Although it is not without risk, it is a popular and quiet way that many women choose to end their [unwanted] pregnancies.

Feminism (female equality and female power) is no longer a fad, it’s a necessity. More and more every day, women are realising that they are on their own. Generally, many men have abdicated their responsibility to take care of the home (spouse and children). Consequently, some women have become not biologically, but socially ‘androgenised’. They behave like traditional men, and ‘men’ don’t bear children.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com