Niger’s fertility rate is the highest in the world* (7.2 children/woman). The country’s high population growth is explained by this very high fertility rate, the youthfulness of the population (with an average age of 15 years), a low level of education, and a patriarchal society where men work in the fields (79% of the population in rural areas) while women stay at home or do market gardening.
Asmaou Hamadou, 30, mother to Faiza, 4, and Antarou, 3, is no exception. She lives in the village of Zabori Zadey in Dosso region with her husband, a farmer who can barely make ends meet.
Asmaou is pregnant with her third child.
Can you imagine that at seven months of pregnancy Asmaou sleeps on an empty stomach because she has no food? At this stage of her pregnancy, she hasn't yet made any purchases for her baby because she lacks money.
“My husband is a farmer, and I stay at home to take care of my children,” says Asmaou. “We only live on what my husband grows per year and often after a few months the products are finished and we lack food. When this time comes, the children cry, and I have to wait every afternoon to see if my sister, with whom I live in the same village, decides to bring food for me and my children. In case she doesn't, we sleep hungry.''
According to tradition in Niger, the woman's first pregnancy must be at her parents' home, so she can receive the necessary care during and after her delivery. For 40 days, she does nothing until she recovers, after which she goes home.
“I gave birth to my eldest daughter, Faiza, at my parents' home,” says Asmaou. “After the delivery I had food and they took care of me. However, the circumstances of my second delivery were difficult. I gave birth at home, and I had to go and pound millet all day long in people's houses so that in the evening they would give me food out of compassion. Just some days after my delivery I was doing my housework myself and it makes me feel tired.’’
In Zabori Zadey, the main meal is millet porridge and maize couscous accompanied by moringa leaves because the majority of villagers do not have sufficient means to pay for other cereals. Only those who are well-off can afford to vary their diet with rice, says Asmaou.
''Most of the year we only eat millet porridge or maize couscous with oil because we don't even have enough money to buy moringa leaves,” she says. “For example, yesterday we didn't eat because we don't have money to pay for oil to put in the maize couscous. As for the rice, we often eat it only once a year.”
Because of the poor living conditions of this family, the nutritional situation of Asmaou’s children is alarming. Asmaou was malnourished just after the birth of her second child and did not have enough milk to feed him. She had to wean him at the age of one. Having nothing else to offer, she gave him the meal they usually ate at home. As a result, Antarou was malnourished right after weaning.
''I weaned my son when he was a year old because I didn't have milk,” she says. “I gave him our food and medicine. The other women in my village advised me to give it to my child. It will make him sleep, and he will forget to ask for the breast. That's what I did, and my child was vomiting and had diarrhoea, day by day; he was losing weight. So I took him to the village health community worker, he consulted him and told me that my child was malnourished. He referred us to the health center in Kargui Bangou where we were taken care of until my son was cured.''
Fortunately, two Community Health Workers offer their services to support more than 1,200 people in this village. When they are limited they refer the inhabitants to the health centre of Kargui Bangou, the only health centre closest to the village which is 6 kilometres away. In this health centre, there is no water point and the women have to come with their containers.
Asmaou is grateful for the community health workers. ''There are community health workers in our village and whenever my children are sick, I take them home, and they give me medicine,” she says. “They also give me advice on my pregnancy and always push me to go to the health centre for my prenatal consultations even if it is far from the village. I will follow their advice and give birth in the health centre of Kargui Bangou even if it is far from my home.
And yet—the health centre at Kargui Bangou doesn’t have everything a mother-to-be needs for a successful delivery. “During my previous deliveries, my husband and mother-in-law had to rent a cart to bring me to the health centre,” she says. “There was no water there. We carried two 25-litre jerry cans from our village to the health centre. After the delivery this water was insufficient to wash all my dirty clothes. My husband had to go to the village of Kargui Bangou to pay for more water.”
The water that Asmaou brings to the clinic is not clean. “In my village, we draw water from an open well. Debris and dust get in, so my children often have diarrhoea and stomach aches,” she says. “But every time I bring them to the community health workers they are healed. Last month my 3-year-old son had diarrhoea and was vomiting. I was worried and agitated, so I took him to the community health worker who gave him some medicine and he was better.''
The community health workers who serve Asmaou’s village save lives.
“I am completely grateful to God for the two community health workers that we have in our village because they saved our lives,” she says. “As soon as we leave they welcome us and give us free medicine even if they only have limited stocks.”
The intervention of a community health worker may have saved her daughter’s life.
''I will never forget what they did for me when my daughter Faiza was 3 months old,” she says. “She had a fever at night. I ran desperately to the community health worker. He calmed me down and told me that she had malaria. The same day he gave us treatment and after a few days, she was cured. I wish there were more community health workers in my village because what they do for us is priceless. Thanks to them we don't have to travel a long distance to go to the health centre. I would also like them to have more medicines so that they can continue to treat us. With our situation, if the Community Health Workers don't have medicines, my husband has to borrow money to pay for the drugs. Every time he borrows money, he has to work for months in other people's fields to earn money and repay the debtors.”
Asmaou is praying for two things: clothes for her newborn and opportunity that would allow her to care for all of her children.
“At the moment, I am praying for two things, first, that I can have some money to pay for clothing to dress my unborn baby when he arrives, and secondly, that after I give birth I get training to learn sewing or knitting. This will allow me to have an income-generating activity to take care of myself and my children.''
Ensuring more equitable access to resources and services like land, water, technology, innovation, credit, banking, and financial services for women like Asmaou will enhance their rights, increase agricultural productivity, reduce hunger and improve economic growth. If they had the same access to productive resources as men, they could significantly increase the yields of farms, thereby reducing the number of hungry people in the world.
*Statista - Niger Fertility rate from 2008 to 2018: https://bit.ly/30OV5rH