HAOWA was already struggling to feed five children before she gave birth to triplets in the Gabi region of southern Niger 19 months ago. Now, when her babies scream for food she often finds herself helpless. “If they cry and I have nothing to give them, then I must let them cry,” she says, cradling two infants who bear the hallmarks of malnutrition. Their hair is yellowing, their bellies are distended and their expressions glazed. They lack the energy to shake the flies from their faces. It is a dismal but depressingly common picture in west Africa’s largest country.

Niger is, by the reckoning of the UN’s Human Development Index, the poorest place on earth. Most of its inhabitants eke out a living growing subsistence crops on small plots of dusty, infertile land. Despite this agricultural bias, the drought-stricken country cannot feed itself, even in good years. An estimated 2.5m people out of a total of 17m have no secure source of food. When harvests fail, which they do almost annually, that number shoots up. In 2012, when the worst of the recent food crises ravaged the Sahel region, almost a quarter of Niger’s population was said to be going hungry, prompting desperate relief campaigns by international donors.

This perpetual food crisis is compounded by doggedly high fertility rates. With an average of 7.6 children per woman, Niger has the world’s highest rates. Poverty, ignorance and poor access to contraception are contributing factors, as are cultural issues like competition between wives. Men in Niger tend to be polygamous, and local doctors note that their spouses often try to prove their value by outdoing each other in child births. This contributes to Niger having the highest population growth rate on earth. At current projections, the number of inhabitants will more than triple between now and 2050 to 55m.

In such circumstances, demographers mostly agree, family planning is key. Two years ago, only 12% of women in Niger professed to use modern contraceptive methods. That is a reasonable increase on rates of 5% in 2005 but dismally low by global standards. About 50% of women of child-bearing age use modern contraceptives in Rwanda and Zimbabwe.

The improvements that have been registered are, in large part, the work of donors. Across the country, foreign-funded health centres are promoting long-term options like contraceptive implants; local health workers are being trained to distribute other prophylactics. At present the United Nations Population Fund (UNFPA) is the only importer of contraceptives, flying in millions of dollars’ worth this year. It runs a “school for husbands” which teaches men, who traditionally tended to obstruct women seeking birth control, about family planning. The schools hope to dispel wild rumours about contraception. One woman living outside of Zinder, the country’s second-biggest city, used to believe the pill would cause haemorrhages or make her unborn child anaemic. “I was scared for the first two months,” she says.

The political will to improve things is weak: the government professes support but allocates only a tiny proportion of its budget to family planning. And the appetite for change among the population is limited. Only about a quarter of women express any desire to space out their births, let alone reduce their number. More than 20 years ago Niger identified population control as a priority in the fight against poverty. But birth rates are still rising.