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Africa and the pill

I recently gave a talk to a distinguished group at the Fellowship Forum in Palo Alto, where I was asked about contraception use in Africa. My subject was AIDS in Africa, and among other things, I had described grannies in their 90s who were taking care of 16 grandchildren because no one else was left to look after them. In this context, one questioner wondered whether we might prevent fewer orphans by encouraging Africans to grow smaller families.

During my travels in Africa, I talked to some women about contraception, which I found was not that widely accepted. A few women were on Norplant, a device that was discontinued in this country in 2002 after a flood of lawsuits by women who claimed they hadn’t been adequately warned about side-effects. But the pill was not readily available.

With that background in mind, I read with great interest a commentary in today’s New York Times by Nicholas Kristof on the issue of contraceptive use in Africa, particularly the Congo. In recent years, U.S. Republican administrations haven’t been very supportive of family planning programs, though that is starting to change under the Obama administration, he notes. But there are other cultural and social issues that play into the issue as well:

Condoms are somewhat easier to obtain, but many men resist them. More broadly, many men seem to feel that more children are a proud sign of more virility. So the pill, 50 years old this month in the United States, has yet to reach parts of Africa.

Women also feel pressured to have more children for a number of reasons, he notes. For one, children fall prey to a wide range of ailments - from malaria to diarrheal diseases - so having more children is a hedge against this problem. And women feel pressure to have children for societal reasons as well, as it enhances their status in the community.

"In short, what is needed is a comprehensive approach to assisting men and women alike with family planning - and not just a contraceptive dispensary," Kristof concludes.

Of course, taking a comprehensive approach is key to this and many other issues in Africa, including the fight against AIDS. Education, social and culture norms and economics are all factors that affect people’s behaviors - and ultimately, their health.

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