Anjana Ahuja
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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. In her Science Notebook she writes about science, medicine and technology, and their impact on society. She holds a PhD in space physics from Imperial College, London. She is currently on maternity leave.
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I feel I must respond to the response made of my original comment. first of all, we must address the true cause of Africa's misery, Africa's misery is caused by and continues to be caused by European imperialism Its continuing influence is to maintain good prices of products for Europe to sell. They prevent Africa from competing because they know if Africa reaches their full capacity of production. No one could compete with them. second i must tell you why I care. I care because I have grown up my whole life with muscular dystrophy, a very debilitating disease that requires my use of a wheelchair. Even right now I am using voice activation software to write this. Also, the best caregiver I've ever had was from Africa and it took a lot of work for him to get his wife and child to America. It is interesting the countries mentioned. are known for their treatment of women. This does not truly describe Africa.Egypt is a wealthy country, not one that needs any assistance
Peter Nutley, Moorpark, USA California
Mike Poulson
Wow! Your comments on infertility being natures' way of blocking a person's genetic line took my breath away. Clearly you have never known the misery of infertility and wouldn't know an empathetic feeling if it jumped up and bit you on your unmentionables. You'd better pray those words don't come back to bite you in the same area...
I can see the reasoning behind offering infertility treatment to people in the 3rd world but would say that the money would be better spent on, as others have said, fighting disease, poverty and malnutrition. Also if we could educate people not to stigmatise those with no children perhaps we could convince them to adopt those kids left orphaned by the aforementioned disease poverty and malnutrition?
Nix, London, UK
personally I am against the use of fertility treatments. Because they are unnatural, the likelihood of birth defects, and autism and other
terrible diseases is increased adding this to the problem that are already out there. Also, there is almost a guarantee of the destruction of life.
The right thing to do is to adopt a needy child not give birth to one of privilege.birth control is one of the worst things that could be done in
Africa at will create the conditions in which there will be no young people to take care of the old. This would leave Africa, fully dependent
upon the rest of the world and further depopulate a great race and culture from the face of the earth, a dream, many eugenics, believers have
had for many years. Only way for Africa to solve its problems is to just stop telling it what to do. We should assist them, but not impose upon
them. What we think they need. I would spend money on infrastructure, roads, sewers, electricity and recovery of natur
Peter Nutley, Moorpark, USA California
Reading the accounts in The Times today (8th March) and the two previous days, of the financial threats to Radio Astronomy pioneered by Sir Bernard Lovell made me recall the situation in the 1930s when Sir Ernest Rutherford at Cambridge came under attack for wasting money on nuclear research instead of more practical subjects. Rutherford was able to withstand these attacks. In addition to his contributions to nuclear research, his work made a much greater contribution to immediate problems than had been realised. When the War broke out, our development of Radar played a vital part. Leading this development were many of the scientists trained by Rutherford. They were able to do this because their studies in nuclear research had been responsible for the development of the electronic technology at the heart of our Radar.
Today we are faced by major World Problems crying out for Science to solve. Obviously, they won't be directly solved by the "blue skies" (or should we say "dark skies"
Ernest Putley, Malvern, UK
small low interest loans to set up african owned manufacturing companies
Chris, lisbon, portugal
Why would I bother with Africa?
Why splurge?
Why not use our money wisely on education, science, housing, health services, defence of our territory, and other snsible things?
C Blackmore, Melksham, Englandistan
I respect Ms. Ahuja's right to opinion, but this strikes me as arguing to solve macro-economic problems with micro-economic principles. The problems faced in Africa do not solely stem from the colonial era, nor to the lack of effort or funds from Western countries. There are cultural institutions in place that always have and will lead to failure.
A conundrum has developed from two "well intentioned" philosophies guiding the West: Help the poor in these countries, but do it in a manner that does not change the underlying culture. As a result most humanitarian efforts lead to naught.
Finally, her final diatribe against the US destroys whatever credibility she worked to build within the article. It's the typical, Euro-chic, argument that the US spends so little on foreign aid. In reality, the US provides more foreign aid - both government and private - than the next 25 donor countries combined.
Rob , Oakton, Virginia, USA
I would not spend a dime on Africa.
Having lived in South Africa for the past 2 years it is now evident from my perspective that the problems of Africa ARE not educational, they are purely cultural.
Of course no doubt this continent DOES need our help, but billions have been spent and all gone down the drain due to one thing and one thing only: cultural values and modus operandi on this perplexing continent.
Therefore what i would say is, keep your millions if you have them to spare and let the likes of Warren Buffet and Bill Gates do their bit...
Those millions would be spent better in the UK.
John Skooman, Pretoria, South Africa
These are really interesting posts - thank you. Stewart: the point is that many infertile women actually do want kids, and perhaps that is why we should consider the ESHRE proposal. My point is also that barren women suffer differently in poor countries, and therefore imposing the beliefs of the developed world (eg Africans shouldn't be having more children) is probably not helpful. It's interesting that the idea of 'entitlement' to children crops up here, which is exactly the same argument used to justify (or not) IVF treatment on the NHS. Are children a right or a luxury? Is infertility an illness? If so, why is it less of an illness in Africa than in the UK?
If, Mike, you believe in Nature's way of culling the gene pool, does that also mean we should deny African children vaccines or other medicines? Such denial would achieve the desirable side-effect of cutting population but would be, I think, ethically unjustifiable.
anjana ahuja, london,
I agree entirely with the author of the article. It may sound strange to people used to hearing that what the world needs is fewer people, and therefore more spending on contraception. But look at the problem from the point of view of individuals: the couples who have too many children and those couples who cannot have children are different individuals. Family planning programmes should be directed at those people who aldready have children, so that they do not have more than 2 children, while those couples who cannot have children at all should be allowed the benefit of IVF programmes.
Rajan Munshi , Bombay, India
I agree with James, Brighton, uk.
We should be paying people not to have kids. Well not paying them, but making sure they get their fair too and are looked after. Only a strong state would give people that confidence.
I don't understand how poor families can have 5-10 kids when they know they wont have enough money to educate or feed them.
In Western countries, we hold off having babies because of the costs of bringing them up.
I suppose its all about Education.
chetas patel, croydon, surrey
Is Anjana Ahuja suggesting that we should tackle prejudice and intolerance of infertile women in poor, backward countries by trying to reduce infertility? It's rather like trying to tackle racism by reducing ethnic minorities.
Stewart Ware, London, UK
James seems to show that concern for overpopulation really means "just enough of us, way too many of you"
Steve, Bedford,
Poverty and famine are mostly caused by war, which are often fed by charity and loans. Poverty is not caused by lack of birthcrontrol, nor by the already poor having children.
Strictly speaking poverty is a lack of an essential requirement: ie. food/water, clothing and shelter. The poor couple mentioned may well have been poor compared to their neighbours, but in absolute terms may have been more than wealthy enough to have children.
Greg Lorriman, Leatherhead, UK
I think the painful truth is the point about STDs producing infertility. And who transmit most of these diseases but men who don't want to wear a condom as it restricts their "feeling". What needs to be done is penalties on feckless males and education. Once education has a clear worth and the cost of it becomes a burden on parents , then there will more of a neded for fertility treatment. All in all though, there are just too many people on this planet.
John, Knutsford, UK
What utter madness.
What the world really needs is an injectable contraceptive which can be given to girls at the age of ten to ensure that they do not have any children for 15 years.
This would give two major benefits
(a) A major reduction in the already over populated world.
(b) The poorer women of the world would get the chance of an education and improve their own lives and everybody around them.
LJS, EDINBURGH,
I would recommend that the Americans make it clear that this is an ALTERNATIVE use for Guantanamo Bay, not an ADDITIONAL use.
Rosemary , Germany,
James of Brighton is spot-on. There are way too many people in the world, and any form of fertility treatment is ill-advised.
Who on earth suggested that having children was a God-given right? You certainly have a right to try to conceive, but if you fail,. it is natures way of blocking your genetic line. If rats are anything to go by, as the planet becomes more over-crowded fertility rates automatically drop. It's a self-controlling system that is best left to its own devices.
Mike Poulsen, Reading, Berkshire
The problems of the 3rd WOrld won't be solved by fertility clinics, or by farming subsidy, or by irrigation programmes, or by food aid, or by education.
It will take a big approach doing all these things and more; taking pot shots at a single issue misses the point quite spectacularly.
This isn't a single-issue problem, and a single-issue critique is wholly inappropriate.
Ed, ABerdeen, Scotland
what rubbish.
There are to many people full stop in the World.
We sould be finding ways so stopping people having children, give money to people not to have them.
This would help with, disease, poverty and malnutrition much more than bringing into the world some poor child we is going to starve to death.
James, Brighton, uk