"As a physician committed to a full-time career in fertility control I am often asked the question: When did you first become interested in family planning. I can quote the year, the month, the day.

"I was visiting an aid post in a rural, remote jungle area of New Guinea. Towards the end of a long day, a woman of about 30, in a grass skirt, shyly laid a small crying baby on the crude bamboo table which served as an examination couch. The baby, a three-month-old boy with a distended abdomen, had a small hernia. He was dehydrated and like many babies in that region, underfed, for mothers are often unable to obtain the adequate protein diet so necessary for a good flow of breast milk. Besides, she was still suckling another child of about two-and-a-half years.

"I reduced the size of the hernia, but it was obvious that if it was not operated on it would recur and evenutally strangulate. In that case, unless the mother was able to walk the 10 miles or so to the river and then bring the baby by canoe to the hospital, or unless a doctor or nurse was traveling in the area, the baby would die.

"As I handed back the baby and the little bundle of rags which passed for nappies, I gently explained to the mother the need to perform a small operation at our little district hospital; otherwise the swelling would return and the child might die. in Pidgin English, lingua franca of New Guinea, the phrase for death has a brutal finality about it: 'Pininin belon' you'e die pinish' - die finish.

"Without emotion the mother began to tell me of her troubles. She had four young children and her husband had recently died. She was unable to spend enough time finishing or preparing sago - the staple diet of the area - and the sale of copra from her few coconut trees did not raise enough cash to meet the meagre needs of her family. She ended her sad monologue of tragedies by saying that she could not leave the family to take this baby to a distant hospital.

"I pleaded, cajoled, even threatened; but she was adamant. She would not leave her other children, nor would she let me take the baby down the river with me to the hospital. Eventually we compromised. I would perform the operation right there in the crude village dispensary.

"The operation went well despite my inexperience in this field and the primitive conditions. We anaesthetised the infant with ether and gauze. The wound was neat, bleeding had not been a problem, and we finished before the evening swarm of mosquitoes had become unbearable.

"I was deeply satisfied and success had released the tension of the operation. Proudly I carried the limp and still sedated baby out to the mother, who was squatting in the shade of a tree with her children. As I handed her the baby and she saw he was still alive her face fell in obvious disappointment.

"My shock was absolute. My immediate reaction was one of utter indignation. The gulf separating my life experience and that of this pitifully poor native woman was complete. She had wanted the baby to die - not live - during the operation.

"I suddenly realised that I had presented her not only her baby, but with another mouth to feed - another dependent human being to whom she could offer nothing: no father, no education, no future - merely the cruel ritual of her bare survival.

"It was at that moment that I began to realise that preventing a birth could be as important as saving a life"