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


Make Men Responsible for their Children

Annual number of Costa Rican births 1986-2008. The vertical line is at 2001, when Law 8101 was enacted.

            A chance encounter in a parking lot gave me the idea for this month’s essay. “Why not make a man responsible for the cost of raising any child he fathers?”

            “That’s a great idea!” I said, then mentioned that Costa Rica has a law that helps achieve that goal. Like many Latin American countries, Costa Rica has a history of many unintended and teen pregnancies. The law has helped improve that.

            Law 8101 “Ley de Paternidad Responsible”, to prevent “deadbeat dads”, was passed in 2001. The law allows an unmarried new mother to state the name of the baby’s father. If the man protests that he is not the father, he can elect to have a DNA test. If the test shows he is the father, he is financially responsible for child support until age 18, or older when his offspring is studying. The law labels a man who refuses to have the test done as having “malicious behavior”. In that case, the man is assumed to be the child’s father and he is responsible to pay to raise the child. If the test shows that he is not the father, he is off the hook and he can sue the woman for false accusation.

            In order to make this law work, Costa Rican officials set up a state-of-the-art DNA laboratory. Apparently, their laws have always favored the woman in paternity cases, however 1801 goes several steps further. In the past the onus of proof of paternity was on the woman, and many women were unable to afford the DNA testing or legal fees. Now, fortunately, women do not have to pay to prove paternity.

            The law includes some interesting provisions. Although Costa Rican Social Security pays for the DNA testing initially, if the tests prove that the man is the father, then that cost is subtracted from his bank account. However, if a mother makes a false claim of paternity, she is stuck with the bill. Finally, a man who does not formally acknowledge his responsibility for a child still has to pay child support—but he loses visitation rights.

            Costa Rica is aggressive in pursuing child support. Moreover, the amount of money is significant—it can be a quarter of a man’s income, or even half if he has fathered multiple children. There are even special courts to enforce child support laws.

            The legislature strongly supported this law, as did the president in 2001, Miguel Rodriguez Echeverría. Their main motivation was to ensure the intergenerational wealth transfer from fathers to their children. Costa Rica still has a paternalistic society where most of a family’s wealth belongs to the man.  Decreasing unintended pregnancies and sexually transmitted diseases were welcome unintended consequences of Law 8101.

            The US system for DNA testing and getting fathers to pay child support doesn’t seem to be as effective as in Costa Rica. A friendly person at the Colorado Department of Human Services wrote that almost $18 million is collected every month of what is owed to families,  in our state alone. Unfortunately, only 6 out of every 10 support dollars gets paid that are owed, meaning that parents monthly evade paying about $12 million of what they owe their children. To my surprise, I also learned that not all parents owing child support are men: 13% are women.

            Has the Costa Rican law struck terror into the hearts of philanderers? It turns out that only a small percentage of men accused of fathering a baby are required to get a DNA test; most new fathers are happy to be responsible for their children. However, there was a significant decrease in the total number of births—a significant step down in the slow decline of birth rates Costa Rica has been experiencing. This peaceful nation, where people are among the happiest and healthiest in the world, has a law that has helped to reduce unplanned pregnancies and encourage parental responsibility.

© Richard Grossman MD, 2021