Kristen P. Patterson
Former Program Director
This article was originally posted on the Ms. Magazine blog.
In the mid-1990s, I served as a Peace Corps volunteer in a village in Niger, a West African country consistently ranked as one of the poorest in the world. I lived in a mud hut, learned a local language, made lasting friendships and did interesting work. Nearly 20 years later, two memories stand out from those years: It was incessantly hot, and I went to a lot of baptisms.
Things haven’t changed much in Niger since then, except that women are having even more children and it’s getting even hotter and drier. Niger’s fertility rate, historically very high, is now the world’s highest at an average of 7.6 children per woman (compared to 1.9 in the United States). Niger had about 9 million people in 1996 and now there are almost 19 million.
By 2050, Niger’s population is projected to more than triple to 68 million unless the birth rate slows substantially. But currently only 12 percent of married women in Niger use a modern form of contraception, compared to an average of 29 percent across Africa and 56 percent globally. There is an urgent need to make voluntary contraception available so that women and their families are able to live healthy, productive lives.
Early marriages also play a key role in birth rates by extending the length of childbearing years, and they pose high health risks for women. In Niger, half of girls are married before their 16th birthday. I saw this up close when I lived there. Salama, a young bride who was pregnant for the first time, lived on the edge of the village in an impeccably clean house. I used to go and talk with her when I needed a quiet escape from the bustle of village life. Like many Nigerien women wed too young, she died during childbirth from laboring too long to deliver a baby too large for her still developing adolescent body. In fact, Save the Children rated Niger the worst place in the world to be a mother.
Meanwhile, Niger is acutely vulnerable to climate change. It’s a large country, about twice the size of Texas, but only about 13 percent of the country is suitable for agriculture, and even that land is dry for much of the year. Much of the country is part of the Sahara Desert. Families are having a harder time each year eking out enough food from this parched land, and it’s difficult to provide enough pasture and water for their livestock, too.
These twin challenges for Niger (and many other nations) will come into focus later this month when countries from around the world gather in Paris for a major conference on climate change. It’s an occasion for the world’s leaders to commit to real action to slow global carbon emissions that heat the planet and exacerbate the kinds of challenges Nigeriens face.
How does family planning fit into the climate change picture? Research supports the linkage by showing that fewer people in the world could lead to substantial long-term climate-related benefits by lowering carbon emissions. Approximately 222 million women in the world would like to plan the number and spacing of their children, but currently are not able to because they don’t have access to modern contraception. Meeting their needs through providing voluntary, rights-based family planning could be a global hat trick–for women, their children and the climate. And for women and their households, the additional health, education and economic benefits that accompany family planning would reduce their vulnerability to the impacts of climate change and build their resilience.
Recently, more scientists and governments have made the connection between population growth and global carbon emissions and have recognized the multiple benefits that family planning provides. Some environmentalists believe there is a strong chance for real progress at the Paris climate talks. My hope is that additional headway will be realized through climate negotiations that acknowledge the compound benefits of rights-based voluntary family planning for women and children at the individual level and for the planet. And in the end, people in Niger and elsewhere will benefit.
Comfort Olorunsaiye recently earned a Ph.D. from the University of North Carolina-Charlotte. She was a participant in PRB’s 2014-2015 Policy Communication Fellows Program, funded by USAID through the IDEA Project. This article, written as part of the program, is based on the author’s research and does not necessarily reflect the views of PRB.
(August 2015) Summary: Maternal deaths can be prevented when women give birth in health facilities attended by skilled personnel. A study in seven West and Central African countries shows that poor women and women who live in impoverished rural or urban communities are less likely to deliver in a health facility than wealthy women and those who live in wealthy communities. Providing vouchers to cover health care costs for low-income pregnant women and expanding the number of trained midwives in poor communities could remove the obstacles to delivery with a skilled birth attendant and help to prevent maternal deaths.
Each year, more than 100,000 women in West and Central Africa die from pregnancy-related causes—mostly during labor and delivery, or soon after—more than in any other region of the world.1 Maternal deaths are tragedies; these deaths also put the health and survival of children at risk and threaten economic development, yet the vast majority of maternal deaths are preventable.
A large body of research finds that one of the best ways to prevent maternal deaths is to ensure that women give birth under the supervision of skilled personnel.2 When women give birth in a health facility, they are likely to have trained personnel in attendance. But many women who stand to benefit from this critical intervention still give birth at home without the skilled care needed to avert or address unexpected complications and assure safe delivery.
One well known reason women often do not deliver in a health facility is lack of money, either for transport, health services, or other related costs.3 A recent study in seven West and Central African countries—Central African Republic, Chad, Democratic Republic of Congo, Ghana, Nigeria, Sierra Leone and Togo—took a deeper look at this issue.4
The researchers found that along with individual wealth, location makes a difference. In the seven countries, only about one-half of all births are in a health facility. For women who live in poor communities, whether urban or rural, this share drops to slightly fewer than one in four (see Figure 1).
In poor communities, more than 80 percent of the wealthiest women (those whose household income was in the top 20 percent) in those communities deliver at a health facility compared to less than 20 percent of the poorest (see Figure 2). These findings suggest that being very poor in a poor community poses special barriers to facility-based delivery.5
There are several possible explanations for why the poorest women are least likely to deliver in health facilities. Poor communities typically have weak or nonexistent health facilities.6 Very poor women do not have the resources needed for transportation or other costs to seek care at facilities elsewhere. They may be forced to contend with long wait times and other challenges at understaffed and under-resourced facilities in their communities, and these conditions may deter them from seeking care. Even in countries that offer free health care for women and children, out-of-pocket costs for supplies such as disinfectants and other cleaning agents can still keep facility-based delivery out of reach.7
To reduce the exceptionally high rate of pregnancy-related deaths in West and Central Africa, policymakers need to address potentially hidden inequities by improving physical access to maternal health care on the one hand, and removing financial barriers to skilled delivery care on the other.
Governments can start by adopting strategies that have shown considerable promise in similar settings, such as cash transfers (payments directly to mothers). In Kenya, facility-based delivery and the use of postnatal care among the poorest women doubled following the introduction of a reproductive health voucher program in three districts.8
Training and deploying midwives to provide skilled birth attendance to women in their communities can also reduce maternal deaths. In Nigeria, the Midwives Service Scheme trained newly graduated, unemployed, or retired midwives, and employed them in underserved areas. In target areas, this initiative resulted in a 60 percent increase in the use of prenatal care, and a nearly 50 percent increase in childbirths attended by a health professional.9
With these few critical steps, the region can take action toward saving the invaluable lives of hundreds of thousands of mothers. By reducing preventable maternal deaths, West and Central Africa can also reduce child deaths and improve overall economic development.