Global Conflict Nutrition Population

Worry over Hunger in Africa

from World Watch magazine

            I have had the good fortune to have visited 5 of the 54 countries in Africa. Each has left me with a strong image.

            When I think of Cairo, Egypt, I think of a man leading a donkey cart with his wife seated inside. After he moved beside the cart to help his wife down, I realized from her contour she had come for a prenatal checkup to the women’s health clinic we were visiting. According to our informant, an English-speaking female gynecologist, over 90% of the women she attended had survived female genital mutilation. I considered the difficulty of this woman, brought by cart, would have when giving birth.

            At dusk Gail and I wandered around Cape Town, South Africa, then walked leisurely to our hotel. A man came from the shadows while passing a park and grabbed my arm with a viselike grip. He asked for money to get home to his “settlement”. When I asked for more information, he produced a neatly typed letter explaining where he lived and how much it would cost to get a ride home. Although usually generous, this smelled of a racket and we walked away after I peeled off his fingers. Many times, especially while reading Trevor Noah’s “Born a Crime”, I have wondered if this poor man really was honest in his need.

            Eswatini (formerly “Swaziland”) was my introduction to Sub-Saharan Africa. I accepted an invitation to go there with trepidation, because of the way SSA is portrayed in the media. However, I felt very comfortable while there. I have many competing images from Eswatini: the healthy twins I helped birth while the mother was lying on a gurney outside; the football-sized tumor I removed from a woman’s pelvis after getting permission from her landlord to do the surgery since women couldn’t give their own consent. Perhaps the strongest image, however, is the skinny cattle on the red, barren land. Because only the royal family, the government and a few elites can own land, cattle are the Swazi people’s wealth.

            I became curious while walking past a small building at the Baptist Medical Centre in Nalerigu, northern Ghana. It turned out to be a clinic where malnourished infants and small children were fed. A parent (usually the mother) stayed with each child; sometime older children would accompany them. Fans turned overhead and mosquito nets hung on empty cribs. Breastfeeding was encouraged, and the older kids were fed nutritious food. In addition to their meals, parents received instruction on food preparation and nutrition.

            A friend convinced me to overcome my revulsion of the Rwandan genocide and go to Kigali for an international conference on family planning. Gail and I discovered a peaceful, clean city where people cooperate despite different ethnicities. The image that sticks in my mind is not what we saw there, but a picture from the article “Remember Rwanda?” published in World Watch magazine. “Cutting the last tree on the lot” shows a barren background with 3 people watching, and is emblematic of over-usage of natural resources. One theory of the root cause of the genocide is poverty combined with more people than the land could bear.

            These 5 countries are arranged above in order by current average per capita annual income. They go from $3569 in Egypt down to an incredibly low $798 in Rwanda, according to the World Bank.

            Some individuals worry that White people’s concern over rapid population growth in Africa is motivated by racism. Some point out that the footprint of a person in Africa is much smaller than our own, so Africans should be able to have larger families. However, the average number of children an African woman births is over 4, which means the population will double in just 28 years if growth continues at the present rate. Already there are food shortages in many places in Africa. In order to prevent famine and even possible future genocide, I feel that some African countries need to slow population growth. We can help with education and making contraception available to all. Next month I’ll write about an African success!

© Richard Grossman MD, 2022


Give Thanks for Good News

An unintended pregnancy can change a young woman’s life. Worldwide, there are 120 million unintended pregnancies each year.

            The world our three granddaughters will inherit will be different from the world that we have known. I hope that their world in half a century is not too ghastly—and there is reason to support that hope.

            The risk of extreme overpopulation seems to be waning. The global TFR (the number of children a woman will bear) is close to replacement. Also, the number of global unplanned births approximates the net number of people added to the planet each year.

            In 2020 the global TFR was 2.3. In 1990, just 30 years ago, the TFR was almost one child larger, at 3.2. 

            The global TFR was over 5 when I was born in 1943 and has been dropping ever since. For a country with a low child mortality rate, replacement TFR is about 2.1. That is one child to replace the mother, another to replace the father and one tenth to account for children who don’t live to reproductive age. That number is higher where the child mortality rate is high—2.2 or 2.3. Fortunately, child mortality has dropped considerably in the past 3 decades, which is why we use 2.1 for the goal of ZPG (Zero Population Growth). We have made amazing progress!

            Well, if the TFR is so close to ZPG, we don’t need to worry about overpopulation, right? WRONG! There are three problems with that contention. Most important is that the planet is already overpopulated. We have almost 8 billion people on Earth, whereas 3 billion would be sustainable. To get our population down to a sustainable number without massive mortality will require a TFR close to 1. Second, it has taken many years to lower the TFR to 2.3, and most of the “low-hanging fruit” has been picked. It will be difficult to get it to 2.1 or below. Third, population momentum will keep growth going for decades after we reach ZPG since there will be many young people who will be starting their families. We will need a TFR significantly less than 2 in order to reach a sustainable population. Today’s children, including our granddaughters, will be happier and safer if the world becomes less crowded rather than more so. 

            The number of unintended (or unplanned) pregnancies globally is about 120 million each year. What is an “unintended pregnancy”? Social scientists recognize that there is a spectrum of desire. At one end of the spectrum are our two sons who were definitely planned—and also very much loved. At the other end of the continuum might be a pregnancy that results from rape during war.

            The global rate of unintended pregnancy has dropped from 79 to 64 per thousand reproductive-aged women from the early 1990s to the late 2010s. The global abortion rate also dropped slightly in the same 25-year period. Safe, effective contraception has helped lower both of these rates. Of those 120 million unintended pregnancies, many will be miscarried and others will be aborted, so perhaps 80 million are carried to term.

            It is coincidental that the number of unintended births is close to the net growth of our population. If we can make family planning services available to all people, there is a good chance that global population will stabilize or start to decrease. Because we consume the most, we in richer countries must have the fewest unintended pregnancies. Remember, consumption multiplied by the number of people determines environmental impact. Therefore, unintended pregnancies cause the most impact in rich countries, such as the USA. In this same 25-year period, the unintended pregnancy rate has dropped by almost half in Europe and northern America, some of the world’s richest countries.

            Unfortunately, there is also bad news. Politicians are not very interested in investing in family planning, although it has been shown that every dollar spent would save many dollars for maternal and newborn care—and save many lives of women and children.

© Richard Grossman MD, 2021