As part of the Family Planning Voices initiative, Kristen P. Patterson, director of the People, Health, Planet program at Population Reference Bureau, recently shared the story of her Peace Corps experience in Niger from 1996 to 1998 and what family planning looks like in a country with one of the highest fertility rates.

I majored in biology and environmental studies in college and then joined the Peace Corps right after college. I was sent to Niger in West Africa, which, as you know, had the highest fertility rate in the world and still does…. I lived in a rural village with a population of about 800 people for two years. It was two different ethnic groups, and I learned Hausa, the local language. As I got to know the community’s needs during my time there, family planning came up, and in Hausa—in Niger at least—they call family planning maganin hutu, which means “rest medicine.” I never really appreciated that until I had children. [Laughs] Then I thought, “Wow! This ‘rest medicine’ is a really good idea.”

It was a very typical rural village in Niger, about three kilometers from the nearest road. There was no school. There was no health clinic. There were two wells for water, and there were women and men who were interested in planning their families, but the nearest health clinic was a one-and-a-half-hour walk. So for a woman in Niger to go to the health clinic, she would have to ask another woman to make food for her family for that day and then walk an hour and a half, usually with her youngest baby on her back, and then wait at the clinic, where they may or may not have supplies, and the doctor or nurse may or may not be there, and then not eat any food all day, and then walk all the way home. To the best of my knowledge, there was no method mix in Niger at that time. I don’t know if there is now, but this was in the late 1990s. Pretty much the pill was the only contraceptive that was available. Condoms were available, but back then married people wouldn’t have used condoms in Niger.

Just thinking about the journey that you had to make—the commitment to get the pills and then not knowing if when you got to the clinic you would or wouldn’t be served—was really challenging.

I became close friends with people in the village, and talking with really close friends, they would say, “Oh, we would never marry our girls before they get their periods.” But even when a girl gets her period, she could still not be fully developed yet. And so often, girls would get married for economic reasons, especially the poorer households if the families didn’t have enough resources to go around. Then they would often arrange marriages for their daughters, where the daughters could be taken care of by another family.

I saw child marriage not so much as a cultural driver but an economic driver, although I will say there’s a strong cultural component, because premarital sex is absolutely prohibited in Niger. So if you’re not going to have a wide range of contraceptives available to girls, the risk of a girl having premarital sex and getting pregnant is so great. And you have the economic challenges. Those two factors combine to push girls—to push the families—to marry perhaps earlier than you would like in an ideal world.

A girl typically gets married at 16 and has her first child at 18 in Niger and then has one every two years. One of my closest friends had nine children, and she was remarkable and well-known in the village because all of them were alive. Because in the late ‘90s in Niger, the child mortality rate was still about 25 percent. That has actually decreased dramatically in the past 20 years, but I went to a lot of births every week, and I went to a lot of funerals, also every week. It wasn’t just for old people—it was for women who had died in childbirth or children. I felt when I came back from Peace Corps that I had matured beyond my years….

The everyday life in my village was amazing and wonderful and warm, but then people would say a lot, “It’s the will of God.” And I think that’s the only way people could deal with their reality is to have faith and to assume that things will get better.

View the photo slide show and story on the FP Voices blog.

Interviewer: Liz Futrell.
Reproduced with permission from FP Voices.

About Family Planning Voices

Family Planning Voices (#FPVoices) is a digital initiative led by the Knowledge for Health (K4Health) Project and Family Planning 2020 that uses storytelling to forge connections among global health workers and share the incredible positive impact family planning has on individuals and communities. We pair vivid photography and conversational interviews to document personal experiences to improve access to contraception information and services worldwide. Family Planning Voices is supported by USAID’s Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-13-00068 with the Johns Hopkins University. To learn more, visit