Disease control and public health have been key aspects of social and political life in sub-Saharan Africa since time immemorial. With variations across space and time, many societies viewed disease as the result of imbalances in persons and societies and combined the use of materia medica from the natural world, spiritual divination, and community healing to redress these imbalances. While early encounters between African and European healing systems were still marked by mutual exchanges and adaptations, the emergence of European germ theory-based biomedicine and the establishment of racialized colonial states in the 19th century increasingly challenged the value of African therapeutic practices for disease control on the continent. Initially, colonial states focused on preserving the health of European soldiers, administrators, and settlers, who were deemed particularly vulnerable to tropical climate and its diseases. Around 1900, however, they started paying more attention to diseases among Africans, whose health and population growth were now deemed crucial for economic development and the legitimacy of colonial rule. Fueled by new insights and techniques provided by tropical medicine, antisleeping sickness campaigns would be among the first major interventions. After World War I, colonial health services expanded their campaigns against epidemic diseases, but also engaged with broader public health approaches that addressed reproductive problems and the social determinants of both disease and health. Colonial states were not the only providers of biomedical healthcare in colonial Africa. Missionary societies and private companies had their own health services, with particular logics, methods, and focuses. And after 1945, international organizations such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) increasingly invested in health campaigns in Africa as well. Moreover, Africans actively participated in colonial disease control, most notably as nurses, midwives, and doctors. Nevertheless, Western biomedicine never gained hegemony in colonial Africa. Many Africans tried to avoid or minimize participation in certain campaigns or continued to utilize the services of local healers and diviners, often in combination with particular biomedical approaches. To what extent colonial disease control impacted on disease incidence and demography is still controversially debated.
Susanne M. Klausen
Fertility has long been highly prized in Africa, especially in societies where economic production depended mainly on human labor power. In addition to their role as future workers, children were crucial for, inter alia, securing lineages, providing social security, and ensuring spiritual safekeeping. Women were therefore expected to produce offspring. For them, bearing children was elemental to their social identity, security, and status; failing to reproduce could be calamitous. For both women and their husbands, infertility was often stigmatizing, but women usually bore the brunt of blame for involuntary childlessness and therefore could suffer especially devastating social consequences, such as divorce and ostracism. Managing fertility involved a wide range of reproductive practices. Africans believed infertility was caused by supernatural forces; consequently they sought assistance from spirit mediums and traditional healers to help women achieve or maintain fecundity. Postpartum women practiced birth spacing to ensure infants’ health, achieved through sexual abstinence and prolonged breastfeeding. Because premarital pregnancy was often a serious violation of social norms, youth were typically taught ways to avoid conception while engaging in premarital sex play. Women procured abortions using a variety of methods, including ingestion of plant-based concoctions and extreme manual pressure to kill the fetus. Childbirth, though feared for the risk involved, was typically a welcomed event although the social context for birth varied according to culture and social organization. In some societies, midwives attended women, whereas in others, solitary birth was the ideal. The reproductive politics and practices of precolonial societies informed those of the colonial era, which in turn helped shape postcolonial Africa. Western incursions into African societies had uneven effects on indigenous practices related to reproductive health, fertility control, and childbirth. While some indigenous ideas and practices persist, others, such as post-partum sexual abstinence, have been severely undermined.