What is the biggest contribution UK couples can make to combating climate change? Ditch the Chelsea tractor? Curtail air travel? Think again: have fewer children. That's the argument made in the British Medical Journal (July 25).

Each new UK birth will be responsible for 160 times more greenhouse gas emissions than a new birth in Ethiopia, according to the Optimum Population Trust. But “population” and “family planning” seem taboo words, say John Guillebaud, emeritus professor of family planning and reproductive health at University College, London, and Dr Pip Hayes, a GP in Exeter. “Should UK doctors break a deafening silence here? Isn't contraception the medical profession's prime contribution for all countries? Something needs to be done to separate sex from conception - namely, contraception.”

Half of all pregnancies worldwide are unplanned and evidence suggests that, consistent with normal consumer behaviour, the demand for contraception increases when it is available and accessible. But many women face barriers to contraception, including lack of empowerment and abuse of their rights by husbands, partners or mothers-in-law, or from religious authorities, or even contraceptive providers.

And what of planned pregnancies? The authors say: “Should we now explain to UK couples who plan a family that stopping at two children, or at least [that] having one child less than first intended, is the simplest and biggest contribution anyone can make to leaving a habitable planet for our grandchildren?”

What else can the health service do? Continuing to decontaminate surgical instruments in-house would be a good start. Nursing Times (July 22) reports that plans to transport the instruments to decontamination supercentres would clock up 100 miles each trip.

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