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Snakes, bandits and Boko Haram

All in a day's work for Marie Stopes Niger

"I want a good future for my children. It is truly my plan to allow them to grow up strong and be educated."

Poisonous snakes, bandits, angry husbands and Boko Haram: it’s all in a day’s work for Marie Stopes Niger.

But despite the many dangers, the team demonstrates a total commitment to the mission and improving the lives of their compatriots.

According to the UN's Human Development Index Niger is the poorest place in the world, a situation compounded by the highest fertility rate on earth: an average 7.1 children per woman.

In rural, conservative Maradi, where most inhabitants eke out a living as subsistence farmers, that number rises to nearly eight, and when harvests fail as they did last year, the situation for families is perilous.

"My big motivation is the life of our community. Today our biggest problem is the high birth rate and at 7.8 children per woman, Maradi has the highest rate in Niger."

Insa Manou Koura, a community based mobiliser for Marie Stopes Niger in Maradi, said:

"My big motivation is the life of our community. Today our biggest problem is the high birth rate and at 7.8 children per woman, Maradi has the highest rate in Niger. We will never end malnutrition and all the evils it brings unless we manage to bring that number down. If we can succeed, however, it will save the lives of women and guarantee the future of their families."

Religion and culture both contribute to the continuing desire for large families – ideally nine children for women and 11 for men. But as the regional manager for Maradi, Aladji Boni Sylla Abdul Rachid Dia (otherwise known as Boni) points out: "Family planning is not a decision made just by the couple." Religious leaders wield a strong influence, with men and women describing babies as a gift from God, and pressure exerted by the wider family for a brood of grandchildren.

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More practical reasons also influence decision-making. Men in Niger tend to be polygamous and with inheritance divided between the wives according to the number of children, women have a powerful economic reason for wanting to produce more offspring.

Yet despite these pervasive influences, women in Niger demonstrate a fierce desire for family planning to space their births and improve the health of their families. And many will do what it takes to access it, regardless of the risks.

Boni says: "Our teams often spend the night at health centres so women who have obstacles can come back under cover of darkness to take a method. We also have women who come to us and leave by the window because there are people outside who might see her."

A consummate problem solver, Boni is ready for each challenge as it arises, but in spite of his nimble and cautious approach, the situation can be risky for both the women and the team, who regularly have to defend themselves from angry husbands as well as a host of other dangers.

Our teams often spend the night at health centres so women who have obstacles can come back under cover of darkness

In any one week, Boni is faced with issues ranging from bandits ambushing a team member and stealing their motorbike to poisonous snakes crossing the site where the mobile team is providing services. He has even been alerted to a Boko Haram presence in a nearby village.

But keenly aware of women's desire to be able to space their births to better care for their children, he and the team are resolved to put their own well-being second.

Insa adds: "We arrive at 8am and work all day. We have no time to rest. If we have a moment we snack or we pray, then it's back to work. It will be the same tomorrow or it could be even busier."

Each time the mobile team arrive, blasting music from loudspeakers to announce their presence, crowds of women queue up to wait their turn, sheltering in whatever shade they can find or dancing happily to the songs.

One woman, Hinda Elhj Abdou, 35, a mother-of-four, describes why she is such a passionate advocate for family planning. Raising her arm to show off the matchstick-sized implant embedded just beneath the skin of her upper arm, she says:

"Last year when the rains failed, men fled the village for Nigeria to try to find work. How do you manage on your own with 10 children?

"I want to leave time between my births in order for my children to be healthy and blossom. I want a good future for my children. It is truly my plan to allow them to grow up strong and be educated."

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