World Development Report 1984

Box 8.5 Infertility: a challenge to programs in sub-Saharan Africa
5,ur.e%- in the l.'s and 1ialX ti,urid c.ntual lertilit, dechnE rnEr- bting irerr,le in the rentiring 'i"
rhit an t-eragee Ar 12 per.:ent cit i,orren Ur . hat c3ue, h,gh le.ei, ot interrilit% ' Ferccnt .,r cdcE 1%hen the interrilir!
.h,, had pa;Ed their childbeaidng sear Sccu ill, tranmin,tted dcl.a4c- partICu aued u... b:, m' uall trncniirthed di;e3- i,
ir e,ghteen ;ubt -aharan ciuntrie- ..ere lark gcnrrl-rrhea and ;. phdili 3rc malcr , e;-;ential that both partner; e med,
hildle;,: c.mpar,cld 1 ih . rate et 2 t. :ius;e- nIt b-ih pr,m.ir and eo. mdar, All. rtarekd kther cau e, ol Inenr,
r%:rEnr onher. rr de'elvpinc countri-; intert,lr: C,.nnhea it elit untreiled can be pre%enicd b, imprc.'. ing rhe qu3a
Childl -ne - primar inlerrilir - can kLad t! ireteribek bk c a -- thc r t, i cb.:tctr:iclcare a 1`h 1b. 1rain,ng .
a3 grc.ati.t 1' the Cenlral Airic3n lai-pia3n 'jabc in ir rmen and *t the a- rradre.nal rmid, ._ nd * n.:reacric
Reputblic 1 percenti C rmer-. inr l-per. deicren, in men Bcau;,.- the * mptirr.; rhc a.1l-ibnLr, t in trct.,n 'c that
crnt Zaire 21 pttcrrnt I C:.:neŽ: 2'1 per ..Tc nof rcdt, nti,eabl1 in i, cnmen i .1 ,-upl,c can pr-.em un an,cd pr.gn;n
centi ,nd Cabnin ' percrnIi ir par; -1 ma3. g ti:r tral sear; ..,ithciut irrat- :,e h.ht rm,ghi rculi, n airrticn
Za.ire ; ma;nn 3; no per cnt CI o-mnn nicnt -;,tphili; c.au-e- rmi,carr.age 3nd Er_,r arv l*e. ;pcciali-r;r itenirc I -r
a:ed Itt. -ni I c tc -r. -nine . erc child. ,tillb,rth i *bt--erical i
c:,re and unh' . dlair. -- ind rr,atrt-in m. nrrilrn ,n |r
1 hi; ldldkrne'm in ,ciunZer 3ce ieni. alb-rtion arc additinal ca3ue;-t 4Lib,a3haran Mnru.. ,ince riei
.ri.up; 4 I:.' .g-r,m ,n Hpre;unm,abl dJui ncc.ndJr ,nit. NI lnruiitiriir con- lin,c' hi E been ,et up irncniii..n
ni- in-pro. cdmnedical carei but cull higb cittldetcct; gental tuberctulo;i; ind K;en% ,a 1an-3n,ai and Uanda P'r-c.ram
In Lnr,er-.,-n lit prienl .:. % Kie n.i a.d aric-u' uter.ntin a nal rid u;re-r 1 cnt. rihc ;pnicad - ' ir;*
rthi. r.. thiri% I ur 3rc childle;- in the in-ctic-.n- a;! c.ntribure nm,tred d ;ea,c h., e bten niaunched ir lt.h
% .:.ngc- the rigurec ar- 12 t... 13 perceri in TrcaITi,cnt kir intierlii. *. ,- i and cntrral : republi,c rtcan Erhicip,a and
aditrin larg-e number- .t pe-ple ;uttir dtl,cult e .e ri then the mutecn-me - Zannm, Th, Aec.tarn r. r \ilurtar-
Ir.,m ,ec.ndar. niertilir., -the nabil. uncerta,n Dependring irn ithe *3u" ...nl teriiar-i.-n h.a- pro rided a rant; t,.,r
t1, .Krree batncei-. r'h again th-u.lv nte Huarter tU cinehiltr .I c- upie; re -3rch trearnierrt irainin.a publ c
,n, an carlter hirth 5uudiem in Ken a treated m,i ;ubceq.uenis ha e a I,.e ,du-:icn n in . n \,icera 5K-tn
h.a,e .h.-- .n rbir prim3ri 3nd ;econdar. t[,rrh Three malnir cau,.-;-e ual. d Lear-c anld budanr,
rnerirliti, Occur i rh appro\.n,iaielt irin;rmired dr-ca'., pi)-r c-betrical Re-ource; arc necded i.r revearch u,.
cjulji trcquenc: . h,le rn imuch ! L\esr -arc and ilegtl abortion-can be pre rhe cau;' anid treatment c-I nilert,itl. a;
itrica 4eciindar. intertilt acccunts; Tor \ented ar le-; cc;i Public carnmpain; an .ell a; i-r better d3ta .in ,r- pre\i aenc;
up 1k. -trdlr0ol di3gno;ved a;e;. inlcrm couple;o hecauce; c-iutintwrilit Al-kui 94 r,llion oIi a total 41 in m,ltwin
i)ridri inittrr,lt, arrlici, 14 iT... 3,- ptrcc nI ihc ;,rnpt-mr ii ;e-.uall. Iran 'mnwted ;perir bi th public qector Kr. .- ,r,ert,lt
c.i .-.K.men i gzd tateer. c la.rs in ditrtrent d-ctae tic prc .enti,:n thrKouigh linliting re-earch i- .rld . -ide in Ps1i tnt cri
reon; ci I a3metnr-in .e\ual parrner; and ue :Il bNrrier meth r;e t 3rch inr . urinapla,ned cau-; t -.
The cc.n;e-rquence; it unrlenrilrti are3 p3r . d; .- ,I cc-nira:epiin lenpecuall c:n- inerlilir thc bulL 1rh,-. -irk a c.-.cn.
:iularls ;e. re lor %ornicn V. hicr mas be dim 4i and rbe a. abilt i.t tra3rmt nt uctedL- b, the rinter iKr Ponpulai ii r
-cra c ized 3binj.ned ir. n d iir cd Fear The;- irli.rmari,,nal ettori; r-ned to be Re>i. arch in the Unit- l i tre Tlitjal
.-. t ,nernilt, mace' o-cuple; rtluctant I., drrtcid tr mer in partiular ;ince th, endin. t c:n intetlri.h re;atch b- 'he
pract ,e modern c-nirt racepticin Thu arc rr.i.rc rcluciani ti:. utbmit t. inierTliht i.'rldl h Uran,ii ,1.a. ,iealr in
although hi.,h ntertillr\ kecp; Iertdio. ie;i' anrd 'rearneni Thougth in-men arE .Ph, rl:fi I i!iil The i. nir-i rati-%n; De-
tI.er th3n ,r then .,ie o ,uld be-e% tr. u-uall, htd rn^pon;,Lile Idr childles- . c-pmnten Pr.uFrjarnrrn,e ha; pru.p:irc
-rctni rin-.rcrmnent r, hildle ;;ne-;
rducte -total lertilil bn atout 1-ut 3kS
nc-n iln t;.c Ihc i ccount tiir abour 4iJ
percent c: interrilitt c:3e; 't lnr account
increac,ng thi; 3mn:iunr r.:. 1-4 rnli-in 3
%ar ~.rer 'he nce\t le t r -ci en -. tar;
,nhibir; cicntracepn. e u c and 'Ic-u i.- r an..rh,r 4i1 pe r:ernr .ith t-oth prt-
are quite diverse, ranging from one of the world's percent a year; the total fertility rate in 1982 was
poorest (Afghanistan) to five of the wealthiest 5.4. Migration is common, both into and out of the'
(Kuwait, Libya, Oman, Saudi Arabia, and the region and among countries within it.
United Arab Emirates). But 90 percent of its 260 In most countries fertility is higher than would
million people live in thirteen middle-income be expected given per capita income (see Figure
countries. All share a common cultural heritage 8.2). Five high-income oil exporters, with per capand
are predominantly Islamic. Countries in the ita incomes of $14,820, had a fertility rate of 6.9 in
Middle East and North Africa have the second 1982. In the past decade incomes in Jordan, Syria,
highest rates of population growth and fertility in and Algeria have risen strongly but total fertility
the world, after sub-Saharan Africa. Between 1970 has remained at more than 7. Income growth in
and 1982 their population grew at an average 2.9 these countries is recent and social development
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