With the world’s highest birth rate in a country where first-time mothers are often barely past puberty, having a baby in impoverished Niger can be tantamount to a death sentence.
The West African state and humanitarian groups have worked to slash both birth and maternal mortality rates, but despite strides results are not good enough, the UN warned this week.
“Every two hours, a Niger woman dies from complications linked to pregnancy or childbirth,” said Monique Clesca, the UN Population Fund (UNFPA) representative in the country.
About 3,000 people, mainly women, gathered in the western city of Tahoua as part of a new push to rein in the birth rate and reduce maternal mortality.
“Dying while giving life is a social injustice,” said Malika Issoufou, wife of Nigerien President Mahamadou Issoufou, while visiting women suffering from gynaecological complications in the Tahoua hospital.
The trend has not been easy to buck in a culture that encourages early marriage, big families and pregnancies in quick succession, and where some clerics in mainly Muslim Niger have blasted contraception as against Islam and “dictated by white people from the West.”
“The more kids you have, the more you’re worth,” Clesca said, describing traditional views. “When girls marry, they’re under pressure to prove they’re fertile within the first year.”
This has left landlocked Niger, where more than 60 percent live below the poverty line, with the highest birth rate in the world, an average of 7.6 children per woman, official figures show.
In 2006, Niger made all pre-natal care free of charge, as well as birth by Caesarian, which up to then was prohibitively expensive. Contraceptive products are also distributed at no charge.
“Ten years ago, no one dared broach demographic questions. Now, everyone is talking about them, starting with the government, the president,” said Isselmou Boukhary, Niger’s deputy representative for the UN children’s fund, UNICEF.
Even if the situation remains “quite worrisome,” it is slowly improving, Boukhary said.
With 535 mothers dying for every 100,000 live births — meaning one woman for every 186 viable births, Niger is among the world’s top 15 countries with the worst maternal mortality.
Yet the situation has improved since 2006, when 648 women died for every 100,000 births, according to Niger’s health ministry.
During the same period, contraceptive use has gone from 5 to 12 percent, the ministry said.
A tradition of early marriage has not helped. Nearly 80 percent of Niger women are wed by the time they reach 18 and 40 percent before the age of 15, making complications frequent.
“At this age, the body is still fragile and not ready for maternity,” said Yahaya Mani, a doctor working in the Niger countryside.
Official records bear this out, according to the UN which said a third of maternal deaths are among girls 15 to 19.
“The parents know the risks. But they prefer to marry their girls off early rather than risking a pregnancy outside marriage, which would damage the family’s honor,” Clesca said.
After the first baby others follow quickly, giving Niger one of the world’s top population growth rates at 3.9 percent per year, according to official figures.
Young mothers often have “one baby on the breast, one on their back and another at their feet,” which can leave them weak, a humanitarian source said.