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Maurice King and Elizabeth Yi Wang (Department of Paediatrics Obstetrics and Gynaecology, University of Leeds, Worsley Building, Clarendon Way, Leeds LS2 9JT, UK) John Cleland and Steven Sinding (Nov 26, p 1899)1 are to be congratulated on becoming neo-Malthusian, but they don't go far enough. The conventional wisdom assumes that, as development takes place, birth rates will fall to match death rates, so that populations will eventually stabilise. Unfortunately, the conventional wisdom takes no account of time, and forgets that, while this is supposed to be happening, rapidly growing populations may be exceeding the carrying capacity of their ecosystems, they may have no new land to go to, and they may be failing to develop adequate economic links with the rest of the world. The end result of all this is the direst poverty, starvation, and violence. Malthus did not have a name for this predicament, but Liebenstein did: demographic entrapment.2 This has a definitive stage when starvation, violence, or both have actually broken out, and a warning stage when, because populations are increasing rapidly, these can be confidently predicted. Cleland and Sinding give some indication of the huge scale of this predicament, particularly in its warning stage, and Alexandratos confirms it.3 Examples of the definitive stage include Rwanda and Ethiopia. Hitherto the “solution” to demographic entrapment has been to keep it taboo and to assume that Malthus was wrong, even in Africa. Now, the only compassionate response is to lift the taboo and to consider what demalthusianisation or “disentrapment” might involve. In addition to all the conventional methods for promoting development, fertility must now fall with great urgency. It is seldom realised that, as the result of the demographic momentum of communities that are as young as those in Africa, populations would at least double, even if all families had two children only from now on. Rwanda, for example, and some other parts of the Great Lakes Region are therefore in the Chinese predicament of needing one-child families, without the Chinese discipline that was so useful in promoting them, or the Chinese potential for economic development. One-child families might seem ridiculous in Africa. However, many times in the Congo recently I have delivered this “crunch” message in French: “Should I, or should I not, say to you my friends in Africa, that, if you don't reduce your fertility, if necessary to one child only, you must expect the direst poverty, starvation, and violence, if indeed you are not experiencing it already? I argue that I have to, and that not to do so is the gravest dereliction of duty in public health. If you want to lynch me, you are welcome. I trust that I will proceed to my martyrdom with a good courage!” The last time I said this I was presented with a bunch of flowers! Amazingly, about a third of the teenage girls whom I addressed in Kinshasa said that they only intended to have one child. So it seems that this health message is now both practical and crucial. As a contribution to the huge task that confronts the UN agencies, a website devoted to disentrapment is now available,4 as also is a manual for the health workers of Africa who will need to implement it.5 We declare that we have no conflict of interest. 1. Cleland J, Sinding S. What would Malthus say about AIDS in Africa?. Lancet 2005; 366: 1899-1901. 2. Liebenstein H. A theory of economic development. Princeton: Princeton University Press, 1954:. 3. Alexandratos N. Countries with rapid population growth and resource constraints. Pop Dev Rev 2005; 31: 237-258. 4. King MH. Demographic disentrapment (accessed Nov 11, 2005). 5. King M, Mola G. Primary mother care and population. Peterborough:
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