Shifting Norms on Family Size: Niger Focuses on Youth

Sara Stratton, MPH

Palladium | Senior Technical Advisor, Family Planning, Health, and Health Policy Plus
A woman with her 11th child in Niger, the country with the highest total fertility rate in the world.

A woman with her 11th child in Niger, the country with the highest total fertility rate in the world. © 2013 Alison Heller/Washington University in Saint Louis, Courtesy of Photoshare

This piece was originally published on the Health Policy Plus blog, Viewpoints.

Earlier this year I traveled to Niger to support the Ministry of Health in refining the country's Costed Implementation Plan (CIP) for family planning. While there, I worked with a dedicated group—ministry staff, implementing partners, representatives from the religious community, and youth advocates—to agree on priorities that could accelerate progress on Niger's ambitious goal to increase its modern contraceptive prevalence rate (mCPR) from 13 percent (or 14.4% for married women) to 50 percent by 2020. We spent 3.5 days combing through the results of their mid-term review of Niger's CIP to set priorities and identify which population groups, in addition to women, we should focus on reaching: youth (what age range?), men (which men: community leaders? partners?), religious leaders? At the end of the workshop, we felt a sense of accomplishment in our priorities going forward, which included establishing how the government can extend services throughout the large Sahelian country using community health workers, mobile clinics, and strategies to improve data collection. Another important priority we agreed on was a focus on educating youth on the socioeconomic benefits of family planning.

For many decades, family planning has been considered a human right, one that has been validated in numerous international agreements. Following the London Summit on Family Planning in 2012, more emphasis was placed on ensuring the concepts of choice and rights-based services. The importance of choice for couples on when to have children, and how many to have, cannot be overstated. We know that over 225 million women around the world still lack access to modern contraceptive methods. This means that many women have an unmet need for family planning services and would like the choice to access such services and methods.

Despite efforts to bring voluntary choice for family planning services and methods to all areas of Niger, I often heard during my visit that the desire by women for large families persists. Colleagues recounted visits to local maternity wards where more than 700 babies were born per month, or field visits to nutrition/food security projects where women indicated a desire for at least 10 children, if not more. My colleagues noted that, as one moves further from the capital, Niamey, the more there is a lack of appetite for contraception—even when child spacing was presented as an important way to increase the likelihood of delivering a healthy baby.

These observations added to the workshop's strong consensus about the importance of government and implementing partners engaging in activities to educate Niger's youth about reproductive health and the responsibilities of parenthood.

With over one-third of its population under 24 years of age, Niger has a young and growing population. There is a role for development partners to help young girls in Niger—and in other West African countries—reach maturity before they begin having children. Young people need the opportunity to grow and learn and to understand that children by choice, not chance is part of creating healthier communities. While fewer, intentionally spaced children may present a day-to-day burden for some families, it also means more household resources for food, education, and healthcare and wider health and social benefits for the community.

In spite of the desire by many Nigeriens for large families and high fertility, there are key opportunities to change these underlying social norms. In Niger—as in the other eight Ouagadougou Partnership countries—there is a dynamic group of youth ambassadors who are changing the dialogue about family planning within their own sociocultural context. These youth ambassadors recognize the challenges facing their country, including low nutritional status, poor educational attainment, high unemployment, and increasing insecurity due to radical movements in the Sahel. They understand how to position these messages in the context of a demographic dividend, which the African Union has prioritized this year. The youth leaders understand the links between family planning, population growth, and economic development—and they embrace these types of messages.

Niger has set ambitious goals for itself, and HP+ is working to help the country achieve these goals by focusing on executing its CIP. In the best of circumstances, increasing mCPR from 13 to 50 percent is a courageous undertaking, but the goal becomes even more so given the underlying social norms and desire for large families. To increase mCPR, it will be critical to work to change these norms through youth ambassadors and a focus on reaching youth. And these challenges aren't just present in Niger, but throughout the region. As the youth movement in Ouagadougou Partnership countries gains momentum and youth enter their lives as couples and parents, perhaps we will eventually see a shift in norms that will ease the desire for large families and facilitate efforts to expand modern contraceptive use. As this shift occurs, more women and couples can feel comfortable using contraceptives to space their pregnancies. This will lead Niger and its people toward a common goal: healthier families, a thriving economy, and greater opportunities for future generations.