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  • Title: The demographic evidence for the incidence and cause of abnormally low fertility in tropical Africa.
    Author: Caldwell JC, Caldwell P.
    Journal: World Health Stat Q; 1983; 36(1):2-34. PubMed ID: 6689236.
    Abstract:
    This paper documents and seeks the causes of the abnormally low fertility observed in much of Central Africa. Demographic, ethnographic, historical, and other evidence suggests that some form of venereal disease, probably gonorrhea, is the main cause of both primary and secondary sterility, with cultural factors playing an important role. Oral tradition and evidence from demographic models indicate that sterility in Central Africa probably dates back no further than 100 years. Sterility is not related to the general level of health, frequency of infection, lack of medical care, or other indices of morbidity or mortality. Primary sterility is ethnic-specific and appears to be related to different attitudes toward adolescent sexual permissiveness. Secondary infertility is much more common. Most of Central Africa has a social tradition of prolonged female postpartum sexual abstinence during breastfeeding. This encourages men to go to prostitutes. The fact that secondary sterility is much more common than primary sterility suggests that sterility resulting from congenital venereal diseases is of little importance. The decline of sterility in the Belgian Congo after 1945 following a public health campaign based on penicillin indicated that sterility could be prevented but not reversed. The same pathogen may be responsible for high rates of primary sterility in some ethnic groups and substantial rates of secondary sterility in others, depending on the age at which females are 1st exposed.
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