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Madonna and a Little Mercy - Robert J. Walker

Malawi's rejection of Madonna's attempt to adopt a little 3-year-old girl named Mercy makes for alliteration and good headlines, but it's the underlying story that really deserves the attention.

Mercy is just the unfortunate poster-child for a much larger tragedy.

In Malawi, as in many other sub-Saharan countries, the AIDS epidemic has orphaned vast numbers of children, including many children born with HIV. And while there have been major advances in the treatment of AIDS in Africa, too little is still being done to halt its spread.

Unless more is done to promote the use of condoms by sexually active couples and more HIV-positive women are given the knowledge and means to control their fertility, the number of orphans in Africa will continue to rise.

In sub-Saharan Africa, about 60 percent of adults living with HIV or AIDS are women. Many of them, quite understandably, do not want to have additional children, but lack knowledge of, or access to, modern methods of birth control. Given a choice, few people bring a child into this world knowing that the child will likely be orphaned at an early age.

While birth control is more prevalent in Malawi than in many neighboring countries, an estimated 27 percent of Malawian women of childbearing age want to space or limit their number of children, but lack the knowledge and means. Giving those women information and access to contraceptives can help to reduce the growing numbers of orphans and improve the chances that those who are already living in orphanages eventually find homes.

During the eight years of the Bush administration, U.S. support for the treatment of HIV/AIDS in Africa has soared, but prevention efforts have lagged. In seeking to prevent the spread of AIDS in Africa, the Administration's "ABC" approach stressed the A and the B ("abstinence" and "being faithful") while downplaying the C (use of condoms).

As a result, the administration was slow to integrate family planning services into HIV/AIDS service, and prevention efforts have largely faltered, particularly in the prevention of mother-to-child transmission of the HIV virus.

Few things are as tragic as an orphaned HIV-positive child, but our failure to support family planning in Africa is part of an even larger tragedy. Over the past half-century, fertility rates have dropped sharply in many developing countries, but fertility rates remain quite high in the poorer areas of sub-Saharan Africa. Overall, sub-Saharan Africa has a fertility rate -- 5.4 births per woman -- that is the highest of any region in the world.

Unless fertility rates drop more rapidly, some countries, like Niger, will triple their population by mid-century.

When African women are not able to decide when and how many children to have, everyone suffers. Unregulated fertility contributes to high maternal and infant death rates. It also means that children, particularly girls, are less likely to go to school. As a result, many African families -- and the communities they live in -- are not able to break the cycle of poverty.

The world will soon forget about Mercy and maybe even Madonna, but let us not forget Malawi and some of the other African nations that are struggling against great odds to improve the health and well-being of their people. They need our help. That is why supporters of international family planning assistance are hoping that the new administration will more than double the existing level of support in next year's budget.

Mr. President, have a little mercy on the all the Mercys of sub-Saharan Africa.

Mr. Walker is executive vice president of The Population Institute, a nonprofit organization working to achieve a world population that can live in harmony with the planet. He can be contacted at rwalker@populationinstitute.org.