To the Editor.
—In their excellent Commentary, Elmore-Meegan and O'Riorden1 urge that international aid be focused away from the elite of cities in Africa and concentrated on the village poor. We comment on these aspects, by referring to the experience in South Africa, the black population of which is undergoing major transition.In urban areas (where 40% of the population live), the birth rate has fallen. In the big cities, it is about 20 per 1000 population, half of the former rate. In rural areas, the rate is still high, although research shows that it would certainly be lower were the choice left wholly to women. In urban areas there is increasing appreciation that smaller families equals higher education for children, better houses, television, and holidays. Unfortunately, however, there are disadvantages, namely, increased smoking and alcohol consumption, diminished physical activity, and less secure family life and values. On this
Walker A, Walker B, Glatthaar I. Africa on the Precipice: Perspective From South Africa. JAMA. 1994;271(10):744. doi:10.1001/jama.1994.03510340034017