reamer raven holt is a pioneering epidemiologist going face to face with infectious diseases and tackling big tobacco in this interview dr raymond holt highlights the biggest challenge of all global population my main in controlling population growth in europe and in the americas and much in asia but the middle east and africa and taking care of everybody around the world wants the smartest people such as yourself to be working on the toughest problems why pick population control well i'm an epidemiologist and population is always a question when you're dealing in  many deaths in the population we were always concerned with population and thus it was never far from interest and understanding my professional life is driven divided in three sections the first  really the ultimate job dealing with the world population explosion because the population really was exploding around the world after more world war two so i was invited to take the role of director of population unit the u s agency for in there's a development when you went into usa id that they have a policy that already existed in not exactly the they had numbers policy statements but they did not have a clearly stated that being there being the case did you help them there was ever a good time and it but it was there were a lot of casualties and one thousand nine hundred sixty eight there were many other things happening i can't imagine that it was easy to do anything you could i remember back then president johnson had a full understanding of the importance of the population determinant in human affairs and it was very important and he said so on thirty five speeches he spoke of the importance of  then somehow the vietnam war came along and i remember clearly july one thousand nine hundred sixty five and on television and watched president johnson stand up and say we will stand in vietnam we will stand in vietnam bush told the buttons to put a half million americans into vietnam to try and win that war well of course what happened then america and considerably in south america and it's also worked very well in much of the asian most notably of course china japan and south  korea and in the you all made great progress that particularly china really got the job done largely in the decade of the one nine hundred seventy s they pushed really all the buttons that needed to be pushed to go from a great excess of fertility rate to where they wanted it which would be ten or twelve births per thousand population per year china is known as an oppressive government how did it did they do their population control as a result of oppression under the communist regime they had starvation and fifty nine and testified before congress about world population issues as soon as he even mentioned population and the list of countries you  stir statement from the catholics the promotion of artificial birth control is a morally humanly psychologically and politically disastrous approach to the population problem they will not support any public assistance other at home or abroad to promote artificial birth prevention abortion or sterilization whether through direct aid or by means of international organizations so for the united states to promote birth control overseas and president eisenhower he said quote i cannot imagine anything more emphatically a subject that is not a proper political or governmental activity or function or responsibility and the explosive question they will go on question they do private groups not to governments you can see it was caught it from the binet beginning it was a very controversial prop when you were there yet and later today what is it with regard to population that you wanted wanted then and want now i simply want to provide it possible for women and couples everywhere to control their trips to many of the developing countries was family planning was contraceptives was the ability of families to determine their own time effort tell tale was that something that that was the reason why you went right  many countries there was very little active family planning going on until nine hundred sixty two things happened the oral contraceptive as we knew it was licensed in the u s and shortly thereafter in europe and most countries of the were also new libby's loop into uterine device became popular dr raven hold insisted upon why distribution of condoms as part of the usa id program i was going on the trip to asia the colored condoms were now fully available from a u s company  alabama and i took a substantial supply long to asia and bring them with to the various countries if i showed the colored condoms to the to the ambassador or the head of oral contraceptives to any country that and then we did a number of things to improve this initially oral contraceptives were usually package did with twenty one hormone tablets so woman would take a tablet each day for twenty one days and then stop for a week we put in seven pairs few marie tablets iron time that's because in the much of asia where the people do not eat and so this was a program of the united states federal government that you write in your administrating administering and i actually you were the one who was the architect and we were adapting the technology of oral contraceptives to what we need to do over all the developing countries we want packaging like three monthly cycles in the another package and then we bought these by the millions and billions and we had some good people materials for the next year from headquarters they look to see how much they used last year and so they look at past orders and past usage as a guide to how much order for next year will or course sent over the thirty or forty million and they distributed those then they had to the bun supply see if the workers out there truly have an abundant supply and have hoarders in a sense they give it out sparingly because they want to keep the local worker needs to keep adequate ammunition in their own hands so it was always a problem to cause them to start really giving way adequate quantities of contraceptives was there any motional opposition or you know and some of the less developed countries that you talked about any other type of opposition that wasn't of a science basis cultural opposition is a very big country of course it depends upon leadership in an easy we were fortunate the we had very good people in the mission there and the indonesians had but some very good people in key positions they get really caught up with the movement from the president on down they were all gung ho to go in the whole country of course with a kind of leadership they all turned on to the so oral contraceptives went over big and in an easy and time and many countries adversaries senator nelson from my home state of wisconsin and hearing and invited anybody that had anything bad to say about oral contraceptives said to his committee committees holt the oral contraceptives and all the work that you did with them and spreading them around the world did it work well yes it worked very well and indeed our program then became the main source of oral contraceptives for the divel were i was in my office in virginia and a doctor from johns hopkins came to my office to show me his equipment for doing to and he said that this this could be done this is an outpatient procedure and simplify to me and we simplified the equipment dish and the so that it became very well designed to do this all decisive solution to the problem of excess fertility for the woman now more than half the population of women in the us with a tubal ligation after the finish the bearing they want and that became very important part of or well there's this great picture that we have to talk about though the woman in the in the middle and in the sorry contraceptives abortion of course was practiced where they didn't do abortion of course in china when in periods of starvation they killed the infant this was a common practice and in china and many other countries it was infanticide when they ran out of food and they had to somehow adept surgical  abortion to the developing fetus that became an important fertility control room method and almost all countries in japan for example like arthur and company agreed with the legalization of abortion in one hundred forty seven and soon abortion became practiced maidenly in japan it was condoms and abortion were the two main ways of controlling fertility japan was able to adapt to the straitened circumstances and really become very effective economically and everything from the from the u program was a borscht and one of the alternatives that you dealt with in family it was particularly when you know with our supreme court decision  have equipment that the people in the in these kinds of districts without electricity could could use and so coming back from their we developed a but things things change that's very successful program that used all these different methods of family planning and including the last one as we talked about late one nine hundred seventy s you made a decision to leave and why was that in december hundred seventy three certain congressmen went ahead and passed the law that the u s could not provide assistance for abortion and so that cut us off at the pass that was  serious constraint upon the effectiveness of the program jimmy carter became a candidate for the u s presidency in the thirty first of august one thousand nine hundred seventy six as he was campaigning he and and either that or immediately after the meeting and agreement was struck between jimmy carter and the catholic bishops that if he were elected he would turn over the direction of the agencies in the u s government who are an interest in birth control they would put them under catholic direction elections and political trade offs brought big changes in the united states policies toward world population starting with the usa id sander levin who had twice run for the governorship of michigan trouble they always were very supportive here suddenly becomes a person who is determined to just move me away and grab ahold of this even though he had no particular discombobulate in this purse my staff held on hoping that somehow the tide would change but when i finally realized it would not change then he said i want to go back with the centers for the c d c in their washington office and my interest is continued and in this book you find some chapters from subsequent years population and the world continues to go to go up   because the european birth rates are down to around ten per cent that is just about as low as that i mean if you keep that the population would shrink rather than  in other areas let america has come a long ways forward china has really done the work india is been the problem all the time it never really solve its problems not the what it is in india all of your work and world population as you look back now what what's your greatest hope in terms of what is going to take to get world population under control so a lot of work to be done particularly naff or poor africa has suffered because they're just taking numbers of actions to improve the water to the immunize they can drop that death rate in african country in half in just several years then of course the population grows but they haven't done anything to improve the country otherwise the hand of the additional people these countries really mounted a remarkable movement with a conference in cairo at which time somehow they managed to get a modification of the congressional function where these monies from the u s congress would not just go for birth control but it would go for general health in africa very sudden the it changed so that most of this money was being spent to help the increased populations of are coming in much less to prevent desired births and that's where it's been ever since what has been happening since one nine hundred ninety four is that the just go ahead the same way that china did get your fertility under control as soon as you can and then you can begin to do many other things to improve yourself dr robert all it's been an absolute pleasure thank you very