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United States of America (New York) 17

POPULATION AND DEVELOPMENT REVIEW

MARCH 1993 - VOLUME 19, NUMBER 1

93.17.25 - English - Paul R. EHRLICH, Anne H. EHRLICH, Department of Biological Sciences, Stanford University (U.S.A.), and Gretchen C. DAILY, Energy and Resources Group, University of California, Berkeley (U.S.A.)

Food Security, Population, and Environment (p. 1-32)

Keeping global food production abreast of human population growth involves balancing the costs of inadequate diets against those associated with exceeding the limits of sustainable agriculture. Those limits are set by: losses of farmland to other uses; diminishing opportunities for irrigation; erosion and degradation of soils; biological limits to yield increases; diminishing returns from fertilizer use; chemical pest-control problems; declining genetic diversity of crops and their wild relatives; depressed yields from increased ultraviolet-B radiation and pollutants; possible rapid climate change and sea-level rise; and a general deterioration of the free services supplied to agriculture by natural ecosystems. Dramatic declines in human fertility, ecologically sustainable agriculture, preservation of biodiversity, and revised socioeconomic policies are essential to preventing further reductions of Earth's long-term carrying capacity. (WORLD POPULATION, FOOD PRODUCTION, ENVIRONMENT)

93.17.26 - English - Alejandro PORTES and Richard SCHAUFFLER, Department of Sociology, Johns Hopkins University (U.S.A.)

Competing Perspectives on the Latin American Informal Sector (p. 33-60)

The informal sector has gained increasing attention among social scientists and policymakers concerned with third world development. The authors trace the demographic and economic processes that set the framework for the emergence of this phenomenon in Latin America and examine competing perspectives on its character and consequences. Two such perspectives offer polar views of the informal economy as either a manifestation of the problem of poverty or as a potential solution to it. Conceptual and empirical anomalies associated with each view have given rise to a third, intermediate position. Measurement strategies and empirical estimates of informal activity associated with each theoretical perspective are presented. The significance of these differences for policies targeted on urban labor absorption and economic development is highlighted. (LATIN AMERICA, INFORMAL SECTOR, POVERTY, ECONOMIC THEORY)

93.17.27 - English - Griffith FEENEY, Program of Population, East-West Center, Honolulu, Hawaii (U.S.A.), and WANG Feng, Department of Sociology, University of Hawaii at Manoa (U.S.A.)

Parity Progression and Birth Intervals in China: The influence of Policy in Hastening Fertility Decline (p. 61-101)

The Chinese government has launched two major fertility control policies over the past two decades, the wan-xi-shao - later-longer-fewer - policy of the 1970s and the one-child family policy introduced in 1979. This article examines the demographic impact of these policies by analysing annual series of mean ages at first marriage, period parity progression ratios, and mean birth intervals for city, town, and rural residents for China as a whole, and for four provinces. The magnitude, direction, and timing of the changes give strong evidence of the impact of the policies. Although the program aimed at achieving the one-child family has received greater attention by most observers, the later-longer-fewer policy had the greater impact on fertility decline. (CHINA, ANTINATALIST POLICY, COMPARATIVE ANALYSIS)

93.17.28 - English - B. Gopalakrishna KUMAR

Low Mortality and High Morbidity in Kerala Reconsidered (p. 103-121)

The achievements of Kerala as measured by conventional quality-of-life indicators (such as literacy and the expectation of life) have attracted considerable interest. A number of surveys indicate, however, that Kerala has the highest morbidity rate in India. This article examines the available secondary data on this question and analyzes primary data collected during fieldwork in two villages of Kerala. Three types of explanations for the apparent paradox of the Kerala figures are offered: (1) morbidity as a statistical illusion; (2) morbidity as a matter of perception; and (3) morbidity as real illness burden. While the first two explanations cannot be entirely discarded, the evidence suggests that the third factor is also significant. (INDIA, MORTALITY DECLINE, MORBIDITY)

93.17.29 - English - Amartya SEN, Department of Economics and Philosophy, Harvard University (U.S.A.)

On the Darwinian View of Progress (p. 123-137)

There are three distinct components in the Darwinian analysis of evolutionary progress: (1) an explanation of how evolution works; (2) an idea of what constitutes progress; and (3) a substantiation of the way evolution brings about progress. Of the three, the first is thoroughly profound. But the other two features are limited by Darwin's attempt to see progress entirely in terms of the quality of the species. This approach, which concentrates on the characteristics of living beings rather than on the actual lives they can lead, yields a very limited view of progress and diverts attention from the need to adjust the world in which we live. This, in turn, has encouraged either activism in genetic manipulation (as in the eugenics movements), or a passive reliance on spontaneous progress (more in line with Darwin's own pronouncements). These limitations are particularly telling in the contemporary world, given the prevalence of remediable deprivations. We do need Darwin, but only in moderation. (EVOLUTION, THEORY)

93.17.30 - English - Barry M. POPKIN, Carolina Population Center, University of North Carolina, Chappel Hill, NC (U.S.A.)

Nutritional Patterns and Transitions (p. 138-158)

Throughout human existence, diet and nutritional status have undergone a sequence of major shifts among broad patterns of food use. Large shifts in the composition of diet, reflected in changes in stature and body composition and in disease patterns, have occurred. The nature and pace of these nutritional changes vary considerably over time and space, with a noticeable acceleration of change now occurring in many countries. A marked worldwide shift is evident toward a diet high in fat and processed foods and low in fiber, with corresponding increases in degenerative diseases. Such a shift is not inexorable; however, knowledge and appropriate policies will be needed if currently developing societies are to bypass the more detrimental aspects of the nutrition patterns that characterize many industrialized societies. (DIET, NUTRITION)

93.17.31 - English - Dennis A. AHLBURG, Center for Population Analysis and Policy, University of Minnesota, Minnesota (U.S.A.)

The Census Bureau's New Projections of the US Population (p. 159-174)

The US Bureau of the Census has released a radically revised set of projections of the population of the United States. The population is no longer projected to decline a few decades hence but rather to grow to 383 million by the year 2050. The projections reflect higher fertility, longer life expectancy, and higher rates of net immigration than were assumed in the earlier report issued in 1989. These assumptions imply that the population will continue to age and that the number of americans over the age of 85 years will grow especially rapidly. The ethnic and racial make up of the population is projected to shift appreciably, with the Hispanic population providing much of the growth into the 21st century. Significant uncertainty clouds the future path of the US population, especially in the longer run. (UNITED STATES, POPULATION PROJECTIONS)

JUNE 1993 - VOLUME 19, NUMBER 2

93.17.32 - English - John C. CALDWELL and Pat CALDWELL, Health Transition Centre, Australian National University, Canberra (Australia)

The South African Fertility Decline (p. 225-262)

Until recently, less has been known about demographic change in South Africa than in many other sub-Saharan African countries. This situation is now changing with the publication of analyses based on household fertility surveys. Each of the country's four-racial' groups is seen to have participated in demographic transitions albeit at distinctly different times. The fertility of black South Africans (numerically by far the largest of the four groups) began to decline in the early 1960s, and, with a current total fertility rate of 4.6, this decline represents the earliest and most advanced African fertility transition south of the Sahara. The decline has been assisted by a vigorous national family planning program, which helps to answer the question as to how African fertility might be affected if Asian-type family planning programs were implemented elsewhere in sub-Saharan Africa. (SOUTH AFRICA, FERTILITY TRENDS, DEMOGRAPHIC TRANSITION)

93.17.33 - English - Christopher LANGFORD, Pamela STOREY, London School of Economics and Political Science, London (U.K.)

Sex Differentials in Mortality Early in the 20th Century: Sri Lanka and India Compared (p. 263-282)

A number of researchers have noted more marked excess female mortality in north India than in south India. This has been attributed to sociocultural differences between these areas, leading to women being less valued in the north. Since Sri Lanka shares cultural similarities with south India, including a relatively benign attitude toward women, it should on this basis also resemble south India with respect to sex differentials in mortality. However, evidence for the early 20th century points to much higher excess female mortality in Sri Lanka than in south India, indeed more like the situation in north India. As their main explanation the authors suggest that book worm disease and malaria were far more severe in Sri Lanka than in south India and that these diseases affected women more than men. (SRI LANKA, INDIA, EXCESS MORTALITY, FEMALE MORTALITY)

93.17.34 - English - ZENG Yi, Institute of Population Research, Peking University (China) et al.

Causes and Implications of the Recent Increase in the Reported Sex Ratio at Birth in China (p. 283-302)

This article shows that the reported sex ratio at birth increased substantially in China during the 1980s. An application of the reverse survival method to data front the 1990 census, the 1987 One Percent Population Survey, and the 1988 Two-per-Thousand Fertility and Contraception Survey shows that sex-differential underreporting of births is the most important cause of the high reported sex ratio at birth in China, accounting for about onehalf to three-quarters of the difference between reported sex ratios and the value expected under normal circumstances. The increasingly high observed sex ratio of live births delivered at hospitals indicates that prenatal sex determination by ultrasound and other diagnostic techniques (widely available in China) is the second most important cause of the high reported sex ratios at birth. Sex differential underreporting of births and sex selective induced abortion after prenatal sex determination can explain almost all of the increase in the reported sex ratio at birth in China during the late 1980s, ruling out the possibility of widespread female infanticide. (CHINA, SEX RATIO, UNDERREGISTRATION, SEX DIFFERENTIALS)

93.17.35 - English - Marshall GREEN, Population Action International, Washington, DC (U.S.A.)

The Evolution of US International Population Policy, 1965-92: A Chronological Account (p. 303-322)

This factual review of the evolution of US international population policy and assistance focuses on the statements and actions of the Executives Branch of the United States Government. Quoted statements of Presidents, officials in the Department of State, AID Administrators, and other American officials are supplemented by documentation of actions of the Executive and Legislative branches of the government relating to population policy decisions. The emphasis is on policy, not implementation. The overall record of the United States in international population/family planning assistance's supportive of developing country efforts to reduce rates of population growth in the interest of human welfare and overall economic development. (UNITED STATES, POPULATION POLICY, INTERNATIONAL COOPERATION)

93.17.36 - English - Johannes P. PRONK, Minister for Development Cooperation (Netherlands)

Migration: The Nomad in Each of Us (p. 323-327)

Foreign migrants enriched Europe in many ways over the course of centuries. At present, many in Europe are frightened by the slicer numbers of immigrants and understand ably so. But fear is a bad adviser. The author argues for the need to pool insights, knowledge, and experience to arrive at fair and sensible solutions to the challenging problems that lie ahead, keeping in mind that migration is a natural human activity, a phenomenon as old as mankind. (EUROPE, INTERNATIONAL MIGRATION)

93.17.37 - English - Deanna L. PAGNINI, Center for Demographic Studies, Duke University, Durham (U.S.A.), and Ronald R. RINDFUSS, Department of Sociology, University of North Carolina, Chapel Hill, NC (U.S.A.)

The Divorce of Marriage and Childbearing: Changing Attitudes and Behavior in the United States (p. 331-348)

The past 25 years have witnessed large-scale changes in the structure of American families. One of the most dramatic transformations has been the increasing separation of marriage and childhearing. One-quarter of all births now occur outside of marriage. Given that nonmarital fertility has historically been considered a social problem, how have Americans reacted to its increasing prevalence? Using data from four cross-sectional surveys undertaken between 1974 and 1989, the authors document that attitudes toward births outside of a marital relationship became increasingly permissive. They examine the social and demographic correlates of these attitudes and find that the structure of the determinants has not changed over time. The shift in attitudes was pervasive across social groups. They also present evidence on a concomitant change in attitudes toward a new gender-role orientation within two-parent families. (UNITED STATES, ILLEGITIMATE FERTILITY, OPINION SURVEYS)

SEPTEMBER 1993 - VOLUME 19, NUMBER 3

93.17.38 - English - Douglas S. MASSEY, Center for Latin American Studies, University of Chicago, Chicago (U.S.A.) et al.

Theories of International Migration: A Review and Appraisal (p. 431-466)

This article surveys contemporary theories of international migration in order to illuminate their leading propositions, assumptions, and hypotheses. In doing so, it hopes to pave the way for a systematic empirical evaluation of their guiding tenets. The authors divide the theories conceptually into those advanced to explain the initiation of international migration and those put forth to account for the persistence of migration across space and time. The review suggests that, because they are specified at such different levels of analysis, the theories are not inherently logically inconsistent. The task of selecting between theories and propositions thus becomes an empirical exercise, one that must occur before a truly integrated theoretical framework can be fully realized. (THEORY, INTERNATIONAL MIGRATION, COMPARATIVE ANALYSIS)

93.17.39 - English - Robert A. POLLAK, Department of Economics, University of Washington, Seattle (U.S.A.), and Susan COTTS WATKINS, Department of Sociology, University of Pennsylvania, Philadelphia (U.S.A.)

Cultural and Economic Approaches to Fertility: Proper Marriage or Mésalliance? (p. 467-496)

Economic models have organized much fertility research, particularly over the last two decades. As usually formulated, these models assume that preferences are fixed and thus "explain" fertility differences by differences in opportunities (constraints). Yet some interpretations of the evidence on fertility transition appear inconsistent with explanations based solely on differences in opportunities and have led to explicit challenges to them. Challenges to fixed-preference explanations take three forms: explanations that allow variable preferences, explanations that emphasize diffusion, and explanations that emphasize "culture". The article first addresses the consistency of the empirical findings and the interpretations drawn from them with various fixed-preference economic models. It then discusses variable-preference economic models, the roles that diffusion may play in these models, and the relationship between cultural and economic explanations of fertility. (ECONOMIC MODELS, DIFFERENTIAL FERTILITY, CULTURE)

93.17.40 - English - Richard A. EASTERLIN, Christine M. SCHAEFFER, Department of Economics, University of Southern California (U.S.A.), and Diane J. MACUNOVICH, Department of Economics, Williams College (U.S.A.)

Will the Baby Boomers Be Less Well Off Than Their Parents? Income, Wealth, and Family Circumstances Over the Life Cycle in the United States (p. 497-522)

This article assesses the retirement outlook of American baby boomers - those born between 1946 and 1964 - compared with their parents with regard to income, wealth, and family situation (having a spouse present or grown children available, and the likelihood of living alone). Differences between trailing and leading edge boomers and between those better and worse off are considered. The analysis finds that, on average, the boomers' living levels in retirement are likely to be considerably better than their parents', except possibly for the poorest segment of the trailing edge. However, a noticeably smaller proportion of retired boomers will have a spouse or adult children, and a considerably larger proportion will live alone. This contrast reflects the fact that the boomers raised their economic status over that of their parents largely by remaining single or childless, or by having fewer children and combining mother's work with childbearing. (UNITED STATES, SOCIO-ECONOMIC DIFFERENTIALS, INTERGENERATIONAL SOCIAL MOBILITY, LIFE CYCLE)

93.17.41 - English - David A. COLEMAN, Department of Applied Social Studies, Oxford University, Wellington Square, Oxford 0X1 2ER (U.K.)

Contrasting Age Structures of Western Europe and of Eastern Europe and the Former Soviet Union: Demographic Curiosity or Labor Resource? (p. 523-556)

Since World War II divergent fertility trends in the European former USSR and Eastern Europe, and those of Western Europe, have created contrasts in the age distributions of their respective populations. The Eastern coutries have experienced neither the baby boom of persons now in their 30s nor a shortage of teenagers and younger children. Eastern Europe and the former Soviet Union are facing serious economic and political difficulties at a time when their populations are now relatively free to migrate westward. At the same time, population decline and labor shortages are forecast for Western Europe. Could migration of this "complementary" Eastern European population help to resolve the projected demographic and labor force problems of Western Europe? This seems unlikely. Eastern Europeans lack the skills and qualifications likely to be needed in Western Europe in the future. Eastern European populations also lack the family connections that facilitate immigration, while Western countries are a]ready strengthening border and other controls to minimize immigration from all sources. (WESTERN EUROPE, EASTERN EUROPE, USSR, AGE DISTRIBUTION)

93.17.42 - English - Michael A. STOTO and Jane S. DURCH, Division of Health Promotion and Disease Prevention, Institute of Medicine, Washington, DC (U.S.A.)

Forecasting Survival, Health, and Disability: Report on a Workshop (p. 557-582)

Uncertainty about the pace of continuing mortality decline over the next few decades is a concern for planning and policymaking. Various approaches give similar short-term forecasts, but results differ in the medium term (i.e., through 2065). Workshop discussions supported use of medium term forecasts produced by a statistical model by Lee and Carter; qualitative adjustments should be made on the basis of medical and biological knowledge about forces likely to affect mortality. To use such forecasts for policy purposes, improved statistical methods may be needed to reflect the degree of uncertainty. A better understanding of future mortality trends will require further research and modeling in medical demography. Specific risk factors, diseases, and causes of death must be examined, and the relationships between individual elements must be explored. In addition, the nature of aging and any intrinsic relationship between aging and disease require further study. (PROJECTIONS, MORTALITY, MORBIDITY, MORTALITY DETERMINANTS)

93.17.43 - English - Laurence J.C. MA, Department of Geography, University of Akron (U.S.A.), and Chusheng LIN, Department of Geography, University of British Columbia, Vancouver (Canada)

Development of Towns in China: A Case Study of Guangdong Province (p. 583-606)

The patterns of China's urban growth and urbanization have been shaped primarily by the growth of the large and medium-sized cities. In the post-Mao era, however, increasing diversification and commercialization of the rural economy, reduced government controls, and relaxed restrictions on rural-urban migration have greatly stimulated the growth of towns in China. This case study of the towns of Guangdong Province reveals that both the number of towns and their population have increased rapidly since the reforms. The development of town enterprises has attracted numerous rural migrants, particularly as permanent migration to the cities is still restricted. To seek employment in industry and trade was cited by most migrants as the chief reason for migration to towns. The state has not played an active role in the growth of towns in China. For the first time in the history of the People's Republic, the towns are experiencing genuine growth with development. If current trends continue, the growth of towns may well lead to the formation of a second track of urbanization, namely "urbanization from below". (CHINA, URBANIZATION, RURAL-URBAN MIGRATION, MIDDLE-SIZE TOWNS)

DECEMBER 1993 - VOLUME 19, NUMBER 4

93.17.44 - English - Simon SZRETER, Faculty of History, University of Cambridge, Cambridge (U.K.)

The Idea of Demographic Transition and the Study of Fertility Change: A Critical Intellectual History (p. 659-702)

The idea of demographic transition was the product of a particular conception of demographic social science as simultaneously investigative science and policymaking guide. This proposition is demonstrated principally through an analysis of the writings of Frank Notestein, set in the context of relevant aspects of the intellectual, institutional, and political history of the period c. 1930-60. This provenance helps to explain the persistence of the idea of demographic transition in the study of fertility change, since policy relevance has continued to exert strong influence in this field. As a result insufficient consideration has been given to the full range of alternative social scientific methodologies that are available for the study of fertility change. It is therefore argued that emancipation from the transition idea and from its associated, rather dated methodology is a condition for further intellectual progress in the study of fertility change. (POPULATION THEORY, DEMOGRAPHIC TRANSITION, FERTILITY TRENDS, METHODOLOGY)

93.17.45 - English - Naohiro OGAWA, College of Economics, Population Research Institute, 1-3-2 Misaka-cho, Chiyoda-ku, Tokyo 101 (Japan), and Robert D. RETHERFORD, Program on Population, East-West Center, Honolulu, Hawaii (U.S.A.)

The Resumption of Fertility Decline in Japan: 1973-92 (p. 703-742)

After a period of some 15 years during which fertility was at replacement level, Japan experienced a resumption of fertility decline, starting in 1973, that has continued to the present. This article analyzes the fertility decline in postwar Japan, especially since 1973, and the demographic and socioeconomic factors contributing to it. The analysis, based primarily on period parity progression ratios, suggests that Japan's fertility decline since 1973 has occurred mainly because of postponement of marriage and first birth and declines in ratios of progression to marriage and first birth. It is shown that women's rising educational attainment plays an important role in inducing the new marriage and fertility pattern. The effect of women's education is associated with a number of related socioeconomic changes, including rising wages of women and higher opportunity costs of marriage and childbearing, as well as changes in values. (JAPAN, FERTILITY DECLINE, FERTILITY DETERMINANTS)

93.17.46 - English - Massimo LIVI-BACCI, Faculty of Polical Science and Department of Statistics, University of Florence, Viale Morgagni 59, 50134 Florence (Italy)

On the Human Costs of Collectivization in the Soviet Union (p. 743-766)

Population statistics suppressed or hidden during the 1930s are now emerging from the archives of the former Soviet Union. Of foremost importance is the 1937 census, the results of which are now available. In light of the new data it is possible to reappraise the human losses generated by the liquidation of the kulaks, forced collectivization, and the famine of 1932-33. Using appropriate hypotheses concerning the normal level of mortality and the number of births between the 1926 and the 1937 censuses, the article presents a plausible range of estimates of excess mortality during the decade, from a minimum of about 6 million to a maximum of about 13 million. Many estimates arrived at in earlier studies fall within this range, but some of them are too conservative or are clearly exaggerated. Parallels are drawn between this man-made catastrophe and the 1959-61 famine that occurred in China as a consequence of the Great Leap Forward. In both cases economic, political, and social circumstances - forced acceleration of industrialization, forced collectivization, increased compulsory grain procurement - not only caused decline in agricultural output and starvation, but weakened traditional networks of mutual support and crippled the traditional defenses that could mitigate economic and social stress. (USSR, COLLECTIVISM, DEMOGRAPHIC STATISTICS, EXCESS MORTALITY)

93.17.47 - English - Gigi SANTOW, Health Transition Centre, Australian National University, Canberra (Australia)

Coitus Interruptus in the 20th Century (p. 767-792)

Coitus interruptus, commonly called withdrawal, is a contraceptive method that currently receives little attention in population studies. Nevertheless, withdrawal can be used with considerable efficiency and, despite a general decline of its use in Northern and Western Europe, North America, and Australia, remains important in some countries of Southern and Eastern Europe. Evidence from Australia shows that it also survives among some Southern European immigrant populations. Among different peoples the properties of withdrawal variously disqualify it from consideration or recommend its rise. The decline and persistence of the use of withdrawal therefore carry important lessons about the special nature both of the method and of the societies in which it continues to be used despite the availability of a variety of modern methods.. In particular, the method's survival in Southern European populations is a useful reminder that there is no "best" contraceptive, that families can be planned without recourse to outside assistance, and that efficient contraception need not be modern contraception. (COITUS INTERRUPTUS, CONTRACEPTIVE PREVALENCE)

93.17.48 - English - Bruce A. CARNES, Center for Mechanistic Biology and Biotechnology, Argonne National laboratory, Argonne, Illinois (U.S.A.), and S. Jay OLSHANSKY, Department of Medicine, and Population Research Center, University of Chicago, Chicago (U.S.A.)

Evolutionary Perspectives on Human Senescence (p. 793-806)

Species have evolved adaptive strategies for ensuring reproductive success. Reproduction concentrated early in life suggests that extreme mortality at young ages has been a common demographic characteristic among all forms of life. Because it operates through the differential reproductive success of individuals, natural selection, the arbiter of evolution, is not effective after the reproductive period ends. Requiring survival beyond the reproductive period for senescence to be expressed suggests that senescence is not genetically programmed, but neither is there an active program for immortality. What we call senescence may simply be the inadvertent consequence of surviving beyond the reproductive period. As survival is further extended, inevitable declines in physiological function and a proliferation of fatal and nonfatal degenerative diseases that become progressively less amenable to modification would be predicted. This model of senescence can provide a theoretical framework for demographers in their development or evaluation of models of human mortality. (SENESCENCE, EVOLUTION, LIFE SPAN, THEORETICAL MODELS)

93.17.49 - English - John C. CALDWELL and Pat CALDWELL, Health Transition Centre, Australian National University, Canberra (Australia)

The Nature and Limits of the Sub-Saharan African AIDS Epidemic: Evidence from Geographic and Other Patterns (p. 817-848)

The majority of victims of the HIV/AIDS epidemic are found in sub-Saharan Africa. The fact that the African epidemic is almost entirely heterosexual in transmission and that pronounced regional differentials exist in its incidence allows a unique opportunity for studying the mechanisms whereby the epidemic has spread. The ecological and clinical evidence renders it virtually certain that the location of the major AIDS belt extending from Uganda to Zimbabwe has been determined by the lack of male circumcision in this area. This probably enhances the direct transmission of HIV and makes more likely the transmission of genital ulcer diseases, especially chancroid, which act as cofactors for HIV transmission. The epidemic will likely intensify in the areas where males are not circumcised, but elsewhere will largely remain restricted to high-risk groups, such as prostitutes and their regular clients. Beyond Africa, there may be a considerable epidemic risk in the non-Muslim (and hence non-circumcising) areas of Asia. Here much depends on the extent of nonmarital and commercial sexual activity, the level of intravenous drug use, and the extent to which genital ulcerating disease is contained. (AFRICA SOUTH OF SAHARA, AIDS, CIRCUMCISION)


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