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How do women in Hausa-speaking Niger think about pregnancy and childbirth differently from women in the United States or Europe? Barbara M. Cooper sets out to answer this question to understand how childbirth has been experienced in the history of the African Sahel, a place that has the world's highest fertility rates, but also one of the highest rates of maternal and infant mortality. Cooper presents a history of what it is like for many rural women to bear children in Niger. She sketches out the influence of geography, ethnicity, social status, and religion to come to a deeper understanding of reproduction and the practices of fertility and maternal well-being from colonialism to today. Cooper unveils a complex landscape of religious and family life where women who have no children may be shunned, where competition between wives for fertility may be intense, and where access to medicine may be improvised. In this patriarchal society where women are poorly educated a culture of sorrow and shame develops among them. Cooper suggests that in this volatile environment it is little wonder that pregnancy and birth are tremendously dangerous practices.

The Millennium Development Goal 4 (MDG 4) is to reduce by two-thirds the mortality rate of children younger than 5 years, between 1990 and 2015. The 2012 Countdown profile shows that Niger has achieved far greater reductions in child mortality and gains in coverage for interventions in child survival than neighbouring countries in west Africa. Countdown therefore invited Niger to do an in-depth analysis of their child survival programme between 1998 and 2009. We developed new estimates of child and neonatal mortality for 1998–2009 using a 2010 household survey. We recalculated coverage indicators using eight nationally-representative surveys for that period, and documented maternal, newborn, and child health programmes and policies since 1995. We used the Lives Saved Tool (LiST) to estimate the child lives saved in 2009. The mortality rate in children younger than 5 years declined significantly from 226 deaths per 1000 livebirths (95% CI 207–246) in 1998 to 128 deaths (117–140) in 2009, an annual rate of decline of 5·1%. Stunting prevalence decreased slightly in children aged 24–35 months, and wasting declined by about 50% with the largest decreases in children younger than 2 years. Coverage increased greatly for most child survival interventions in this period. Results from LiST show that about 59 000 lives were saved in children younger than 5 years in 2009, attributable to the introduction of insecticide-treated bednets (25%); improvements in nutritional status (19%); vitamin A supplementation (9%); treatment of diarrhoea with oral rehydration salts and zinc, and careseeking for fever, malaria, or childhood pneumonia (22%); and vaccinations (11%). Government policies supporting universal access, provision of free health care for pregnant women and children, and decentralised nutrition programmes permitted Niger to decrease child mortality at a pace that exceeds that needed to meet the MDG 4. Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Canada, Norway, Sweden, and the UK; and UNICEF.

Niger is afflicted with high rates of poverty, high fertility rates, frequent environmental crises, and climate change. Recurrent droughts and floods have led to chronic food insecurity linked to poor maternal and neonatal nutrition outcomes in vulnerable regions. We analyzed maternal and neonatal nutrition trends and subnational variability between 2000 and 2021 with a focus on the implementation of policies and programs surrounding two acute climate shocks in 2005 and 2010. We used four sources of data: (a) national household surveys for maternal and newborn nutritional indicators allowing computation of trends and differences at national and regional levels; (b) document review of food security reports; (c) 30 key informant interviews and; (d) one focus group discussion. Many food security policies and nutrition programs were enacted from 2000 to 2020. Gains in maternal and neonatal nutrition indicators were more significant in targeted vulnerable regions of Maradi, Zinder, Tahoua and Tillabéri, from 2006 to 2021. However, poor access to financial resources for policy execution and suboptimal implementation of plans have hindered progress. In response to the chronic climate crisis over the last 20 years, the Nigerien government and program implementers have demonstrated their commitment to reducing food insecurity and enhancing resilience to climate shocks by adopting a deliberate multisectoral effort. However, there is more that can be achieved with a continued focus on vulnerable regions to build resilience, targeting high risk populations, and investing in infrastructure to improve health systems, food systems, agriculture systems, education systems, and social protection. Multisectoral nutrition and food security policy and program investments in response to climate shocks in vulnerable regions have played a meaningful role in improving food security and maternal and fetal growth in Niger over the last 20 years. Key messages Niger is ranked as the most vulnerable country in the world for exposure and sensitivity to the negative effects of disasters and climate change. Acute environmental shocks in 2005 and 2010 elevated government and development partner responses to the ‘food security crises’. Multisectoral policy and program investments in vulnerable regions played a meaningful role in improving food security and subsequently maternal and neonatal nutrition but progress is slow or stagnant. The Nigerien government, program implementers, and donors should prioritize investments in infrastructure and shock resilience to improve health systems, food systems, agriculture systems, education systems, and social protection, particularly in high risk populations.

Globally climate risks are rising, and agriculture remains one of the most affected sectors. Niger is one of the most affected countries, where, there is little knowledge of farmers’ perceptions of climate risks and adaptation strategies. This research aimed to address these knowledge gaps. In total 160 farm households were randomly selected from two villages and respondents were interviewed using a semi-structured questionnaire. Descriptive statistics and a regression model were used for data analysis. Based on the survey results, the perceived risks include temperature increases, short rain season, recurrent droughts, stronger winds, increased pests, and diseases and reduced crop yields. Agronomic practices including crop association and diversification, changing planting dates, use of improved seed varieties, use of mineral fertilizers were implemented as adaptation strategies. Strategy adoption was significantly influenced by farming experience, education, farm and household size, soil fertility, livestock ratio. 80% of farmers adjusted their farming system, and the level of adaptation was significantly determined by soil fertility, climate change information, food production, and number of strategies adopted. This study highlights that policymakers should incorporate communities’ knowledge of environmental change and locally adapted solutions to streamline their transition to sustainability.

Intimate partner violence (IPV) and reproductive coercion (RC) significantly impact women's and girls' health. Among other determinants, wives' discordance from their husbands' fertility-related attitudes may increase husbands' use of IPV and RC. This study aims to assess if such discordance in attitudes towards the timing of the first pregnancy is associated with IPV and RC among adolescent wives (AWs) in rural Niger. Data from 918 AWs, their husbands, and peers from a baseline assessment for a community-based family planning program in Niger were analyzed. Multilevel logistic regression models tested the association between AWs' attitudinal discordance and their experience of IPV and RC. AWs with discordant attitudes who preferred a shorter wait for childbirth than what their husbands preferred had 0.35 times lower odds of experiencing physical IPV, while those who preferred a longer wait had higher odds of experiencing sexual IPV (AOR = 2.56) and RC (AOR = 2.56). Similarly, relative to the collective attitudes of husbands in the village, the AWs with discordant attitudes supporting no delay in first childbirth had 0.23 times lower odds of experiencing physical IPV, while those who supported delayed childbirth had 6.11 times greater odds of experiencing sexual IPV. Violence prevention interventions need to address social norms that tie women's values to reproductive choices. Empowering women, engaging men, and involving the community in supporting women's autonomy in fertility decisions are crucial. Additionally, integrating IPV and RC mitigation into family planning programs is essential, especially in places like Niger, where fertility decisions are tied to cultural norms.

Niger faces a myriad of health challenges and development efforts are complicated by persistent poverty, high population growth rates, and climate change. Integrated social and behavior change (SBC) addresses health outcomes through collective action and approaches at the limited points of entry individuals have with the health system. We conducted a mixed-methods study to evaluate the effectiveness of an integrated SBC program in the Maradi, and Zinder regions of Niger. We applied contribution analysis, a theory-based plausibility analysis, to assess contributions of the intervention. We found the program contributed to improved behavioral determinants. Male engagement and income generating activities provided further support for women to practice health behaviors. However, increases in male partner out-migration was negatively associated with health outcomes. While the program did not generate statistically significant improvements in health outcomes in the intervention area, exposure to health messages and participation in women's groups were positively associated with health outcomes suggesting sustained implementation of the integrated SBC approach at scale may achieve improved health outcomes. Programs should continue to invest in health promotion efforts that include gender sensitive interventions. Further research is needed to understand how women's agency and autonomy evolves as household composition changes through male out-migration.

A systematic method, incorporating the revised universal soil loss equation model (RUSLE), remote sensing, and the geographic information system (GIS), was used to estimate soil erosion potential and potential area in the Maradi region of south-central Niger. The spatial trend of seasonal soil erosion was obtained by integrating remote sensing environmental variables into a grid-based GIS method. RUSLE is the most commonly used method for estimating soil erosion, and its input variables, such as rainfall erosivity, soil erodibility, slope length and steepness, cover management, and conservation practices, vary greatly over space. These factors were calculated to determine their influence on average soil erosion in the region. An estimated potential mean annual soil loss of 472.4 t/ac/year, based on RUSLE, was determined for the study area. The potential erosion rates varied from 14.8 to 944.9 t/ac/year. The most eroded areas were identified in central and west-southern areas, with erosion rates ranging from 237.1 to 944.9 t/ac/year. The spatial erosion maps can serve as a useful reference for deriving land planning and management strategies and provide the opportunity to develop a decision plan for soil erosion prevention and control in south-central Niger.

This study aims to examine associations between spousal communication about contraception and ever use of modern contraception, overt modern contraceptive use (with husband's knowledge), and covert modern contraceptive use (without husband's knowledge) among adolescent wives and their husbands in Niger. Cross-sectional data, from the Reaching Married Adolescents Study, were collected from randomly selected adolescent wives (ages 13-19 years) and their husbands from 48 randomly selected villages in rural Niger (N = 1,020 couples). Logistic regression models assessed associations of couples' reports of spousal communication about contraception with wives' reports of contraception (overall, overt, and covert). About one-fourth of adolescent wives and one-fifth of husbands reported spousal communication about contraception. Results showed couples' reports of spousal communication about contraception were positively associated with ever use of modern contraception. Couples' reports of spousal communication about contraception were negatively associated with covert modern contraceptive use compared to overt use. Wives' reports of spousal communication were marginally associated with covert use compared to no use but husbands' reports were not. Among a sample of couples in Niger, spousal communication about contraception was positively associated with modern contraceptive use (compared to no use) and negatively with covert use (compared to overt use) but wives' and husbands' reports showed differential associations with covert use compared to no use. Since there is little understanding of couple communication surrounding covert contraceptive use decisions, research should focus on characterizing content and context of couple communication particularly in cases of disagreement over fertility decisions.

Background Efficiency in the use of financial and other resources for providing adolescent sexual and reproductive health (ASRH) policies and programs is an important factor that can affect provision of and access to services in resource-constrained contexts of developing countries with limited capacity. However, very few studies have been conducted to understand this situation. Our study, therefore, estimated technical efficiency scores for health facilities that offer primary ASRH care services in Niger and the relationship between the capacity of these health facilities and their level of technical efficiency. Methods The data used for this study were collected from a survey of 71 primary healthcare facilities providing ASRH in Niger from January 28 to March 15, 2022. A stochastic frontier analysis technique based on the Cobb-Douglas production function specification was used for analysis. A Tobit model estimation was used to examine the relationship between health facility capacity and the level of technical efficiency. Results The average technical efficiency in production of primary care ASRH services of the health facilities in the sample was 58% implying high levels of technical inefficiency. Disaggregated analysis revealed that the average score was greater in health facilities where the primary caretaker or head of the institution was female (60%) rather than male (53%). Primary healthcare facility capacity was assessed in four dimensions of operational capacity, managerial capacity, adaptive capacity and leadership capacity. There was a positive association between health facility capacity and the technical efficiency score. However, the levels of association differed from one dimension of health facility capacity to another. Conclusions There is much room for improving the efficient use of financial and other resources in primary healthcare facilities that provide ASRH in Niger. Potential interventions include giving women more responsibility for these facilities and strengthening the ASRH production capacity of these facilities.

Background Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger. Methods We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13–19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV. Results Baseline and 24-month follow-up data were collected April–June 2016 and April–June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41–8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68–5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18–0.88 for Arm 2; aIRR 0.46, 95% CI 0.21–1.01 for Arm 3). No Arm 1 effects were observed. Conclusions The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730 Plain language summary Although Niger has both the highest levels of fertility and of child marriage in the world, as well as substantial gender inequity, there have been no high-quality evaluations of public health programs aiming to increase contraceptive use or decrease intimate partner violence. In this study, we conducted a high quality, randomized controlled trial to evaluate whether the Reaching Married Adolescents public health program could increase modern contraceptive use and decrease intimate partner violence among married adolescent girls (13–19 years old) and their husbands in the Dosso region of Niger. The results of this evaluation provide evidence of the value of individual home visits for wives and their husbands in increasing modern contraceptive use, the value of small group discussions in reducing intimate partner violence, and the combined value of receiving both approaches at the same time for both increasing modern contraceptive use and decreasing intimate partner violence. The current study advances the state of evidence regarding contraceptive use and IPV among married adolescents and their husbands in Niger, highlighting the importance of engaging male partners in such public health programs, as well as of using multiple modes of delivery of programs. The success of this intervention in the high-risk context of Niger suggests that other countries in the region may benefit from testing this approach to improve the health and well-being of young wives.