Niger: gender interests must be at the heart of all our health planning
Saadi is 22 and has just given birth to her third baby.
She is recovering from a Caesarean performed in the Aguie district hospital in the Maradi region of Niger.
Seeing how young she was, Dr Mohamed Moctar encouraged her to get sterilised during her Caesarean. Saadi turned down the offer. Both procedures are free in Niger although a woman must pay CFA 1100 (£1.35) for a normal delivery.
Young, malnourished, pregnant
Saadi is one of more than 40 women who were in the Aguie hospital to deliver babies. Their average age was 25. Almost all were giving birth for the second, third or even fourth time.
Almost all, mothers and children, were severely malnourished.
About 10km away, in Gangara rural commune, is a maternity centre Save the Children has helped build. The facility, which is managed by the Aguie hospital, looks impressive, with large rooms for consultations and pre- and post-natal care.
It’s easy to understand the community’s delight when you compare these with the old maternity rooms, which look too small even for their new purpose of storing drugs.
Niger’s highest fertility rate
The Maradi region has the highest fertility rate in the country: 8 children per woman.
As soon as a girl gets her first period she is ready for marriage, whether she is 7 or 15. Poor, malnourished girls marry early and get pregnant: the risks of complicated deliveries, fistulas, bleeding to death during the birth or simply giving birth to weak, severely malnourished babies are all extremely high.
There is currently no legal age of consent for girls in Niger. A bill for the education of girls had Presidential support but it also tried to make marriage for girls under 16 illegal, so MPs, traditional chiefs and religious leaders rejected it.
The furore led to it being hastily amended. The bill, now minus the mention of marriage but making it mandatory for girls to stay in school until age 16, is awaiting Parliamentary approval.
Building robust health systems
By building maternity centres we have ensured better facilities for women to deliver babies, thus reducing maternal, newborn and infant mortality. But an additional priority is to work to prevent girls who are still children getting pregnant.
We need to help strengthen social systems by advocating for legislation and policies that promote gender equality and protect girls from child marriage. We need to work with traditional male and female leaders to ensure that these improvements in girls’ situation are enforced.
Save the Children supports the development of universal health coverage, health financing and resources policies, and free maternal and newborn services, and helps build civil society capacity among local organisations, to advocate for all these things.
These are all crucial activities that will contribute to stronger, transparent, inclusive and robust health systems. Gender equity should be the norm and not the exception: that is the way for us to make sure that the health rights of women and girls are always protected.
In this way, we can work towards a time when women like Saadi are presented with their first baby at 22 – not their third, along with a well-meant offer that most of us would find only too easy to refuse.