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Interesting to see that old colonial opinions still flourish at the BMJ. Having decided that African women are intelligent enough to hold down jobs but not to bottle feed safely, thereby putting countless babies at risk, they are now to be told to limit their families.1
Africans like having large families. No doubt that will change in time, but that should be determined by the people themselves, not by Europeans, who like having long haul holidays and driving large cars and are not prepared to give them up. The options suggested for limiting population growth include contraception, which presents problems with choice of method and access and “safe abortion.” If that takes off in Africa with the enthusiasm that it has in this country the annual health budget will be mopped up.
How about doing what the Africans want? In my experience, although the death of a child is mourned, it is, in time, accepted. Funds should be diverted from keeping children alive to ensuring optimum health for their parents by establishing some form of health facility in every area, supplying medical assistants with bicycles, ensuring a safe supply of front line drugs, and discussing, intelligently, the problem of safe childbirth—and maybe improve the roads so that women can get to hospital or teach village practitioners to do caesarean sections.
How about tackling the problem of the tsetse fly that devastates large areas of Africa, which not only causes trypanosomiasis (said to be increasing), but also means no draught animals and no dairy products? If all conferences and advocacy groups were dismantled there might be enough money to free Africa of this scourge and liberate much productive land. But then there wouldn't be much in it for the drug firms, conference centres, caterers, and all those agencies that keep academics in business.
Competing interests: None declared.