The sugar plantation complex in West India was based on forced labour, mostly slaves from Africa. The problem was that this population had to be sustained by a constant stream of new slaves just to maintain their numbers. This demographic imbalance has during generations puzzled scholars and doctors. Modern research, however, shows that the fertility rates were normal. The problem was the infant mortality. The slaves' cultural tradition concerning childbirth had fatal consequences by being transferred to West India, where many newborn slave children died of neonatal tetanus.

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