The authors explain that Prunus africana (CITES App. II listed in 1995) is at the confluence of the “northern perspective” on bans as a conservation tool and the “southern perspective” on sustainable use as a conservation incentive. After 42 years of international trade in wild harvested medicinal bark from Africa and Madagascar, the experience with Prunus africana holds several lessons for both policy and practice in forestry, conservation and rural development.