Show caption Niger has the highest birthrate in the world. Women have an average of more than seven children each. Photograph: Jill Filipovic Development 2030 Why have four children when you could have seven? Family planning in Niger With the world’s highest birthrate, Niger’s population is set to double in 17 years. NGOs are providing contraception, but what if women want more babies? Jill Filipovic @JillFilipovic Wed 15 Mar 2017 15.21 GMT Share on Facebook

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Roukaya Hamani has an in-law problem. Her husband’s parents want more grandbabies, but she doesn’t want any more children right now. She’s already given birth four times; one of the babies died, and so now she has three, ages seven, five, and 16 months. She’s 18 years old.

“I just pray to God to bless those three babies I have,” she says. The local health centre in her village of Darey Maliki offered her free contraception, which they get partly from the NGO Pathfinder, but Hamani declined. “Maybe [my in-laws] would tell my husband to marry another woman to have more babies,” she says. “If they want me to have another pregnancy, I can do it just for them to feel happy.”

Hamani, a smiley, gap-toothed girl in a long orangey-brown headscarf worn in the popular style here – tight around her face and then flowing down to the knee, over a bright printed dress – never went to school, and got married when she was 10 and her husband was 20. He works in the fields and she keeps the home, waking up at dawn every day. “Why don’t I want to have another?” she says. “Because being a mother is not easy work.”

Hamani’s life is in many ways illustrative for women in rural Niger, where she lives in a small village of mud-brick houses lining sand-dust roads. Girls here get married young, usually as teenagers, and have their first child at 18. Polygamy is legal and commonplace, especially in the rural areas where about 80% of the population resides. More than half of girls don’t complete primary school, and fewer than one in 10 attend secondary school – as a result, less than a quarter of women here are literate. Women have an average of more than seven children apiece, the highest in the world. And they face a one-in-23 chance of dying from pregnancy or childbirth.

But Hamani is unusual in that three babies are enough for her. Despite having the highest fertility rate in the world, women and men alike in Niger say they want more children than they actually have – women want an average of nine, while men say they want 11.

When you have a huge number of young people who are jobless, they have no choice but to emigrate

Birth rates as high as Niger’s contribute to rapid population growth. The country’s population exploded from 3.5 million people in 1960 to nearly 20 million today, with half of the current population under the age of 15. The overwhelming majority – 80% of Nigeriens – live in poverty. The landlocked nation is largely desert, less than 20% of the land is arable, and that number is shrinking due to climate change. At current growth rates, the population is set to double in 17 years. This, experts say, drives poverty, famine, political instability, and violence.

“When you have a huge number of young people who are jobless, they have no choice but to emigrate,” says Hassane Atamo, the division chief for family planning at the Niger ministry of health, noting that large numbers of young men go to nearby Ghana, Nigeria or Ivory Coast seeking work. “They may also fall into crime, or integrate into terrorism. The country is facing this problem as well, with the Boko Haram issue – they are recruiting jobless young people.”

To combat the health issues that come with high birth rates as well as the burden many young and out-of-work people place on a fragile economy and vulnerable security situation, the Nigerien government has turned to the solution: modern contraception. What they haven’t figured out, though, is how to get women to use it.

“This is a time bomb, because all the Sahel is in this situation, and especially with climate change, the food supply will be less abundant than before,” says John May, a visiting scholar at the Population Reference Bureau. “It’s a huge crisis.”

In a jam-packed room at a health clinic in Magama, a town in Niger’s Tillaberi region, 60-odd women cram side by side, each with a baby or two in tow, to hear Aboubacar Gousmane talk about family planning. Gousmane, an expressive, charismatic employee of Marie Stopes International, a global reproductive health organisation that does family planning work at this clinic, stands in front of a desk with a “choice kit” packed full of sample contraceptives.

“Family planning is about making space between your children,” Gousmane tells the group as babies cry. “We know our communities are poor. If we have many babies, we make it harder for ourselves. That’s why we say you should space pregnancies.” Contraceptives at this clinic, he tells the women, are free.

Currently, Marie Stopes International’s family planning work at this clinic is funded by USAid. Last year, they served nearly 30,000 clients. But since it is an international organisation that supports liberalising abortion laws and provides elective abortions in other countries where the procedure is legally allowed (in Niger, abortion is largely outlawed) it is going to lose its US funding thanks the “global gag rule” put into place by President Trump. Leaders from the organisation say they are hopeful that private donors and more sympathetic governments will fill the gap, but that it will be a substantial blow.

Marie Stopes International healthcare workers counsel women about contraceptive options. Photograph: Jill Filipovic

In front of an attentive all-female audience, Gousmane goes through each contraceptive method, holding up samples – a T-shaped IUD, a needle with a little bottle of Depo-Provera, two white matchstick-sized implants, a slinky female condom – and explains how they’re used and how long they last. “It’s not for you to stop pregnancies or stop delivering babies,” he says. “It’s so you can deliver healthy babies and your body can make another baby.”

Many working in development say that to prevent a series of catastrophes – environmental, economic, security – women in Niger need to have smaller families. But unless women want their families to be smaller, there’s no reason to think the fertility rate will decrease anytime soon.

In Niamey, Niger’s capital city, the global health organisation PSI sends outreach workers to meet with women and talk about family planning. This is how 30-year-old Hadiza Idrissa ended up in the front yard of Mohammadou Rabi, a 39-year-old mother of four, her hair tucked under a gold scarf, a month-old infant in her lap.

Idrissa is helping Rabi figure out what kind of contraceptive to use, showing her samples and explaining the benefits of each one. Rabi asks if the IUD might fall out, or if the implant might break in her arm. Idrissa answers patiently (no and no); when Rabi says she isn’t sure what to pick and just asks Idrissa to choose for her, Idrissa says: “It’s up to you to choose a method. We just explain how the methods work.” She asks Rabi if she wants to come back in a few days, “so you can have a little time to reflect on what you want”. What Rabi wants is a break before having more children, ideally two or three more. “I like to make the Muslim community grow,” she says.

Niger’s population challenges are compounded by the prevalence of a conservative strain of Islam, which encourages followers to have as many children as possible. Any organisation working to put contraceptives into the hands of women has the dilemma of doing so in a way that doesn’t provoke religious backlash. Political leaders, too, have elections to worry about, and don’t want to cross influential clerics by pushing the population issue.

Women gather below a neem tree in a village outside of Dongondoutchi to hear Moundadou Magagi, a health agent with PSI, explain family planning options. Photograph: Jill Filipovic

Some women feel that having more babies gives them a break in their difficult lives. In the villages the days are an endless cycle of hard physical labour from the time you’re an adolescent (or younger) until you become too old to work.

The thing I like in motherhood ... is giving my baby his bath and playing with him

“I really don’t have time for amusement,” says Hamsatou Issaka, a pretty 15-year-old who lives in a village several hours from the nearest city of Dosso. “I just work all day. Then you sleep.” She nurses her one-year-old son, Habibou. “The thing I like in motherhood,” she says, a big smile breaking across her face, “is giving my baby his bath and playing with him.” A new baby also means a 40-day break from the usual demanding physical labour – and another few years of baby baths and giggles breaking up the monotony of tilling the earth and pounding the millet.

Issaka met her husband, a lanky young man with a wide smile and easy laugh, when she was 12 and he was 15; they got married soon thereafter. All of her friends are married with children and she can’t imagine going into her 20s without a husband and children. Having lots of children is the norm because they bring wealth (“they come with two hands to work but only one mouth to feed”). So why have four when you could have seven? Seven, one of Issaka’s neighbours says pointedly, is a bigger number than four.

“A large family size is a cultural ideal in Niger in a similar way that in the US or UK, a romantic relationship is a cultural ideal,” says Hope Neighbor, a partner at consulting firm the Camber Collective, which has researched increasing contraceptive use in the country. “We need to be more thoughtful in how we communicate family size and desires,” she says. “This doesn’t mean you tell people they need to have smaller families. It means reframing how they think about families, because it creates tremendous risk to the mother, and tremendous risk to the fragile environment in Niger.”

This is why, many experts say, Niger needs a strong campaign for girls education. “If we want to bring change, we must bring young girls to school,” says Laouali Assiatou, the deputy secretary general of the ministry of population, promotion of women, and protection of children.

Most of the time the girl is in school but the parents pull her out. She can’t speak for herself

Child marriage, Assiatou notes, “happens to vulnerable families. Most of the time the girl is in school but the parents pull her out. She is going to be violated. She can’t speak for herself. She will be pregnant early. She’s in her husband’s house, she has no money. She’s not mature enough to deliver and health services are not very developed in our country. She’s going to have a difficult pregnancy. She can die, or she can deliver a stillborn, or she can end up with a fistula and be rejected by society.” The end result, she said, is that keeping girls out of school “keeps the community in a cycle of poverty”.

Despite assumptions, studies haven’t demonstrated a correlation between polygamy and family size. Nigerien women in polygamous marriages have about the same number of children as women in monogamous ones. But some women’s health advocates argue that polygamy contributes to the norm-setting of large families and consolidation of male power in the household, with a potential second wife wielded as a threat to a married woman who doesn’t want more babies.

Mariama Hassan, who has lived in Darey Maliki village her whole life, got married at 18, late by village standards. As she breastfeeds her daughter, Ramatou, she says she wants to see her baby girl finish school, and eventually get married as well – but not until she’s 25. “I want her to be a doctor,” Hassan says. “I say 25 because I want her to be mature before getting married, and I want her to finish her studies.”

Her hopes for her own life are different. “In my lifetime, I want to have what God decides for me,” she says. What does that mean in terms of children? She smiles and laughs. “I hope God gives me 12.”