Data were collected from 368 Rwanda women, 50 non-lactating and 318 lactating, to determine the effect of lactation on conception rate and the return of menstruation. During lactation the majority of conceptions were found to be delayed by some 15 months, but the family spacing effect was maximal during the first 9 months. By 27 months after delivery the contraceptive effect of lactation can be assumed to have largely disappeared.

Summary The effectiveness of disease control by mobile teams decreased when countries became independent. Early case‐finding and continuity of care require permanently accessible health care facilities where rationalization by professionals and participation of the users are well balanced. The Primary Health Care concept, a plea for this equilibrium, has been discredited by different types of misapplication. Correctly functioning and accessible first line health services, completed by a referral level, are a precondition for effective participation of the users. Where ‘ideal health districts’ cannot be realized, a form of steady exchanges between generalists and the specialists of the referral level has lead to diverse ‘functional districts’.

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