More babies in a starving world
Thursday, 07 August 2008

Anjana Ahuja

If you had a few million pounds to splurge on the problems of Africa, where would you start? Well, in sub-Saharan Africa you could throw it at malaria, tuberculosis or HIV/Aids. You could use it to alleviate starvation and malnutrition, or, as a longer-term measure, on birth control.

You probably wouldn't think of spending it on treatments for infertility. Yet, over the past few years, medical bodies - including the World Health Organisation - have called for the misery of involuntary childlessness to be accorded the same importance in poor countries as it is in rich ones. Later this month the European Society of Human Reproduction and Embryology (ESHRE) will announce plans for fertility treatment programmes for developing countries. The society claims that IVF cycles can be offered for as little as £100; the equivalent cost in the UK is nearer £3,000.

It is a controversial call, given that many African countries are struggling to cut birth rates and to feed the children that they already have. Fertility treatment is relatively expensive, with rather low success rates (around 20 to 30 percent). African women are especially vulnerable to infertility arising from untreated sexually transmitted diseases, which suggests that targeting STDs might be a more economical way to combat childlessness.

And yet, and yet. The infertile suffer disproportionately in poor countries, where children are an insurance policy in old age as well as a joy in themselves. Women receive particularly harsh treatment; one WHO analysis revealed that in countries such as Egypt and the Gambia, infertile women are excluded from social events, so that they cannot cast an “evil eye” over their pregnant peers. Childlessness regularly leads to divorce or polygamy, even to enslavement by in-laws. Barren women are often thrown out of the marital home.

I shall never forget visiting a poor village in India and meeting an elderly childless couple; unusually, the husband refused to countenance leaving his beloved wife. Despite their poverty, you would have dearly wished them a child, too.

— Could that judicial hellhole - Guantanamo Bay, on the island of Cuba - be transformed into a symbol of hope? One academic suggests that it be converted into a biomedical research facility for studying diseases in the Americas. Child mortality rates in Bolivia and Haiti, for example, are comparable to those found in Botswana and the Congo.

Dr Peter Hotez, Editor-in-Chief of the Public Library of Science Neglected Tropical Diseases, writes: “It is a moral outrage that ... the United States allows its closest neighbours to suffer from some of the world's worst levels of disease, poverty, and malnutrition. Reinventing [Guantanamo Bay] ... could help change America's reputation and legacy.” Surely a finer legacy than dodgy justice and orange boiler suits.
Anjana Ahuja joined The Times in 1994, and writes for times2 and the comment pages.

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